week. There was also occasional
hiccough, and stitch on drawing a long breath. The respiration
was shallow and rapid. The bowels acted twice shortly after the
injury.

The pulse was rapid and small, and a week after the injury was
still above 100. The abdomen was then normal and moving
symmetrically, and the respiration fairly easy. There were no
signs of chest trouble, but some mucous expectoration. A slight
icteric tinge existed. The patient made a good recovery.

_Wounds of the spleen._--Uncomplicated wounds of the spleen were
necessarily rare, and beyond this the strict localisation of a track to
the spleen is not a matter of great ease. None the less the spleen must
have been implicated in a considerable number of the wounds crossing the
chest and abdomen. I know of only one case in which a wound which
crossed the splenic area caused death from haemorrhage, and of this I can
give no details, as I never saw the patient. In this instance, however,
a wound of the spleen was diagnosed after death from the position of the
wounds. The patient continued to perform his duty as an officer in the
fighting line for at least an hour after being struck, and then died
rapidly apparently from an internal haemorrhage.

In case No. 201, included amongst the renal injuries, a wound of the
spleen existed, but had given rise to no symptoms, and at the time of
death, some three weeks later, was cicatrised. The only other assertion
of importance that I can make is, that, as far as I could judge, wounds
of the spleen from bullets of small calibre were not, as a rule,
accompanied by haemorrhage, since I never saw a case in which dulness in
the left flank suggested the presence of extravasated blood, and in no
case that I saw was there any history of general symptoms pointing to
the loss of blood.

This is only to be explained by our similar experience with regard to
wounds of the liver unaccompanied by puncture of main vessels, and
perhaps haemorrhage is still less to be expected in the case of the
spleen, in consequence of the contractile muscular tunic with which the
organ is provided.

I can quote no case of certain injury to the spleen, except that already
referred to discovered at a _post-mortem_ examination, but many wounds
were observed in positions of which the following may be taken as a
type. _Entry_, through the seventh left costal cartilage, 3/4 of an inch
from the sternal margin;