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ABDOMEN                                                            273

of a pitchfork stuck in the ground. About 12 inches of the handle after perforating
his trousers entered his rectum, producing intraperitoneal rupture of the rectum. About
15 inches of the ileum had a mottled purpuric appearance suggesting minute sub-
peritoneal haemorrhages and two hay seeds were found lying on the anterior surface
of the stomach. The patient was cured after an operation.

It must be remembered that a column of air under pressure rushing
from the nozzle of a compressed air hose which does not touch the body may
enter the bowel through the anus and cause fatal injury. In such cases the
sigmoid is usually injured, the anus and rectum escaping.

Block and Weissman41 cite a case where a man, aged 45, received the following
injuries when one of his fellow-workers, as a practical joke, placed the nozzle of the
air hose about an inch from his rectum: —

An irregular perforation with a diameter of about 25 mm. of the intestine slightly
above the junction of the sigrnoid with the rectum on the left side together with a lace-
ration of the mesosigmoid, about 50 mm. long. Faecal matter escaped into the peri-
toneal cavity through this opening. The patient recovered after the necessary operation.

An apprentice rivetter after unscrewing his hammer from his compressed air pipe
blew air at a boy, aged 15, as a joke. Another apprentice had his arm on his shoulder,
but could not say whether he was bending or not. The boy said "oh" and collapsed.
The jury was satisfied that the boy died by a blast of compressed air entering the anus
from a distance of 6". The air pressure in the nozzle of the pipe used was one hundred
pounds to the square inch.42

Pancreas.—Wounds of the pancreas are extremely rare. They may
occur from direct violence applied to the epigastrium or from penetrating
wounds of the abdomen. They are usually accompanied by injuries of the
other abdominal organs. But when "the stomach is empty, the pancreas
alone may be ruptured by being pressed against the spinal column by the
object struck, and may produce severe shock owing probably to damage to
the sympathetic and semilunar ganglia. Mocquot and Constantini43 des-
cribe a case of complete rupture of the pancreas in a bicycle accident. The
shock was intense, and the youth died on the twenty-fourth day. In a case
in which a young man was run over by a tonga and died on the eighth day,
I found a contusion of the pancreas towards its tail. There were also
contusions of the bases of the lungs and of the front of the transverse colon.
The left kidney was ruptured in about its middle, lacerating its substance
with the capsule intact on its posterior surface. There were three small
abrasions externally on the chest, but no injury on the abdominal wall.

Gray and Hodgson44 report the case of a man, aged 20, who, while
playing football was charged by another player and fell to the ground with
his opponent on top of him. The latter's knee hit him on the abdomen.
Within fifteen minutes of the accident he suffered from shock and died in
forty hours. Post-mortem examination revealed the presence of a tear of
the pancreas anterior to the vertebral column. There was no tear of any
other organ or no bruise of the abdominal wall. On the other hand, Brown
and Barlow 45 describe a case of complete division of the pancreas, followed
by recovery through an operation from an automobile accident without
serious injury.

Liver.—Owing to its size, its fixed position and its friable consistence,
the liver is frequently wounded by a stab in the abdomen, or is often
ruptured by a blow, kick, crush, or fall, or even by a sudden contraction of
the abdominal muscles. It may also be lacerated by the fractured ends of
a rib perforating the diaphragm. There may or may not be signs of external
injury. Fifteen cases of rupture of the liver came to my notice during a

41.    Jour. Amer. Med. Assoc., March 22, 1926, p. 1,597.

42.    Jour. Amer. Med. Assoc., Dec. 8, 1928, p. 1,816.

43.   Revue de C/iirurgie, Paris, 61, 1923, p. 21; Jour. Amer. Med. Assoc., Aug.
p. 510.

44.    Brit. Med. Jour., Feb. 14, 1931, p. 264.

45.   Jour. Amer. Med. Assoc,, May 28, 1932, p. 1,882.