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278                                               MEDICAL JURISPRUDENCE

largely occupied by a blood clot; on the outer surface towards the lower end of the
organ, was a small rupture of the substance which had caused haemorrhage beneath the
capsule with the formation of a cyst-like cavity containing serous fluid ; this had burst
into the peritoneum setting up peritonitis. A portion of the omentum was adherent
to the ruptured cyst-like cavity. There was no free blood in the abdominal cavity.
The other organs were normal, there being nothing to suggest that an impact had
occurred in the spleen.—Owen Thurston, Ind. Med. Gaz., Oct. 1904, p. 379.

3.   A Hindu male, aged about 45 years, and residing in Hardoi, who was addicted to
drinking alcohol to excess and smoking charas, fell down unconscious in a lane while
walking on the afternoon of the 13th August 1906, and died immediately.   At the post-
mortem examination I did not notice any external mark of injury over the abdomen
on the part corresponding to the region of the spleen, but the abdominal cavity was
full of blood, and the spleen was ruptured.   The spleen was so soft, friable and pulta-
ceous that not an inch of the solid substance could be taken out entire.   It was lying
in a thickened capsule which showed as if it was a bag containing the pultaceous mass.
The  rupture was  spontaneous  probably  due to  contraction  of  extraordinary  muscles
brought to head in a fall, for there was no history of the deceased having received a
blow, or having been hit against a hard substance in the splenic region during the fall.
—Ind. Med. Gaz., Oct. 1906, p. 423.

4.    The following is a case of spontaneous rupture of the spleen during an attack
of malaria: —

A male patient, 22 years old, was admitted into hospital for fever. Two days after-
wards at about midday he felt nauseated and began to have a mild rigor. At about
2 pjn. 10 grains of quinine were administered orally as his blood smear was examined
with positive result. At about 2-30 p.m. he became pale and uneasy and his pulse rate
was 120 per minute. By 3 p.m. the patient appeared to be entering a state of profound
shock and the intravenous administration of serum was commenced, and a small intra-
venous dose of quinine was given. Blood transfusion was, substituted as soon as pos-
sible for the administration of serum. By 4 p.m. the patient was completely collapsed
and was pulseless and comatose. He died at 8-30 p.m. Post-mortem examination
revealed the presence of pints of serum with blood clots. The spleen measured
12" X 6" X 4" and weighed about 4 pounds. In its posterior inferior surface was a
rupture covering an area of about 6 square inches.—K. R. Torode, Med. Jour., Australia,
Vol. H, Sep. 21, 1946, p. 414; Ind. Med. Gaz., Bee. 1946, p. 555.

5.   A Mahomedan male, aged 30 years, felt suddenly sick and severe pain in the
iliac region, while he was reading his holy Quran in a sitting posture on the 9th June
1944.   Laparotomy revealed a ragged tear, 2\" long, on the renal surface of the spleen
at the level with the lower part of the hilum.    The spleen was 5£" long and weighed
over nine ounces.   The patient recovered.   There was no history of trauma.—S. C. Gupta,
2nd. Med. Gaz., June 1945, p. 296; see also N. W. Billiangady, Ind. Med. Gaz., Sep. 1947,
p. 539.

6.   The  following  is   a   case   of   spontaneous   rupture   of   an   enlarged   leuksemic
spleen: —

A Sinhalese man, aged 56 years, was admitted into hospital with the history of
pain in the upper part of the abdomen of two months' duration. The pain was conti-
nuous and related to meals. As the pain became more severe and was not relieved
by any medication laparotomy was performed to explore the abdominal cavity. The
spleen measured 22 by 18 cm. and weighed 1,800 g. There was an extensive rupture
exposing a large area of splenic pulp on the visceral surface and adjacent part of the
diaphragmatic surface. Two irregular linear ruptures extended from this area towards
its upper border, and a triangular-shaped rupture was seen towards its lower pole.
Two linear ruptures extended from the splenic notch towards the diaphragmatic surface.
There was no history of trauma,—G. H. Cooray, Brit. Med. Jour., March 29, 1952, p. 693.

Kidneys.—Owing to their deep situation in the abdomen rupture of the
kidneys is rare by direct violence from blows, unless considerable force is
applied to the lumbar region over the twelfth rib.

During the Hindu-Mahomedan riot at Agra in 1913, a young Hindu of about 20
years of age was hit by one of the rioters with a lathi in the left lumbar region and died
immediately. On post-mortem examination the left kidney, which was quite healthy,
was found ruptured.

The kidneys may be ruptured by the slightest indirect violence, when
they axe already weakened by diseases, such as hydronephrosis, pyelone-
phritis, pyonephrosis, tuberculosis, abscess, nephritis, tumour, etc.

The kidneys may be accidentally ruptured when an individual is run over
by a heavy vehicle, such as a motor car or a country cart or when he is