ABDOMEN 277 Another case 51 is also recorded in which a married woman, aged 34, had received a blow on the left side in the small of the back just below the ribs about a fortnight ago and the blow brought her to the knees and she spent a sleepless night with the pain which also persisted through the next day. After that, however, she felt quite all right, and indeed went on foot to the skating rink with a friend and had no further trouble until June 23, 1930, when on waking up in the morning she did not feel very well, was seized with very severe pain in the gastric region and died after a few hours. Post-mortem examination revealed a transverse tear, 2" long, on the convex surface of the normal spleen, which weighed 4J ounces and measured 4J" x 3i". Wounds of the spleen are rare, but may be caused by a stabbing or cutting instrument or by a foreign body piercing accidentally its pulp. In his reported cases Crawford52 found one case of wound to every fifty cases of rupture. In March 1924, a Hindu male, 30 years old, resident of Police-Station Mohanlalganj, District Lucknow, died from the effects of a stabbing wound in the left side of the chest caused with a spear. At the post-mortem examination I found an incised wound, If" X 1", obliquely along the left post-axillary line in the interspace between the eighth and ninth ribs piercing the diaphragm and penetrating the external surface of the spleen to an extent of \" X 1/6" three inches above its inferior border. The body of a Hindu male, aged 40, said to have died of wounds, was examined by me on the 29th May 1929, thirty-six hours after death. In addition to several wounds on the body there was an incised wound, 1J" x 5", obliquely along the back over the left eleventh rib 4" to the left of the spine and penetrating the abdominal cavity by cutting through the rib. There was an incised wound, 1" x J" X &', along the outer surface of the spleen in its lower part and near its anterior border. " Jacob 53 reports an accidental case in which an adult male was engaged in splitting firewood with the aid of a hammer and chisel, when a piece of iron breaking off from the chisel-head flew and pierced the left side of the back of another labourer, 35 years old, and wearing only a loin cloth and standing at a distance of 12 feet. This resulted in a punctured wound, |" X I" just below the lower border of the tenth left rib, about 5" away from the midline. The wound was directed downwards and inwards, and had lacerated margins. Death occurred within ten minutes of the accident. At the post- mortem examination the wound was found to enter the pleural cavity through the tenth intercostal space and passing through the diaphragm entered the spleen to the middle of its visceral surface, where a piece of the chisel, 1J" X J" X 1", was found embedded in its substance. Cases of Spontaneous Kupture of the Spleen.—!. On the evening of the 9th February 1904, a Nepalese employed as a Naik driver in a Government Yak Corps lay down to sleep in a tent after he had finished his work. At about 7-20 p.m. he called to his brother, who was a driver in the corps, and said that he had pain in his side. The Havaldar and the man's brother went to the tent when they found him in great distress and complaining of intense pain "near his heart". The Havaldar at once called a British Officer who came to the tent and looked at the man who still complained of the pain and weakness but made no accusation of anybody having struck him nor could in any way account for the pain. He grew rapidly weaker and died a few minutes before eight—about half an hour after the pain commenced. On post-mortem examina- tion the body was found to be well-developed and powerful and the age of the deceased appeared to be between twenty-five and thirty years. There was no external mark of injury. On opening the peritoneal cavity a large quantity of blood gushed out; the peritoneum was found perfectly healthy and no adhesions were found in any part of the abdomen. A large rupture was found in the spleen extending through the anterior angle of the hilum. The organ was enlarged to double its normal size and was very soft. The other abdominal organs were quite healthy.—Davys, Jnd. Med. Gaz., June 1904, p. 218. 2, A Hindu male, aged about 20, was admitted into the Calcutta Medical College Hospital on the 30th April 1903, with the history of abdominal pain of ten hours' dura- tion. There was constipation but no vomiting. The abdomen was generally tender, the tenderness being most marked in the left iliac region; it was slightly distended. On the 1st May, the abdomen was more distended, the distension being more marked in the epigastric region; the tenderness was greater and free fluid was present in the abdominal cavity. He comnlained of much thirst. Colotonay was performed but no obstruction was present. He died at 9 a.m. on the 3rd May. At the post-mortem examination the spleen was found slightly, if at all, enlarged and its substance was 51. Dawson-Walker, Lancet, March 7, 1931, p. 523 ; -vide also L. E. Jones, Brit Jour., Oct. 28, 1944, p. 561. 52. Jnd. Med. Gaz., June 1902, p. 220. 53. Antiseptic, Vol. 49, October 1952, p. 1.