Spontaneous Rupture of the Normal Spleen

H. S., a youth, aged 14, felt as well as usual on the morning of Jan. 20, 1931. On arising he ate a large breakfast. Shortly after breakfast he became nauseated and vomited immediately. His retching was quite hard. He had no pain prior to vomiting but experienced a slight pain in the epigastrium shortly thereafter. Within an hour the pain was rather general over his abdomen. No history of trauma could be elicited from the patient or his friends at the military school where he lived. I saw him two hours after the onset and found him suffering with moderate pain and nausea. His pulse was 80; his temperature 98. Examination revealed nothing other than slight tenderness over the upper part of the abdomen. When I saw him again six hours later, the pain had become more severe and partially localized in the right iliac fossa. His temperature was