The pocked or "pitted" RBC count is being increasingly utilized as a test of splenic function. Since little is known about patterns of formation and removal of the characteristic organelles in the pocked RBC, we performed serial pocked RBC counts following splenectomy in six patients and in three animal species (dogs, rats, and rabbits). In the patients, pocked RBC counts began to rise within 1 week following splenectomy and reached a plateau (40-60%) by 60-100 days. Similar results were obtained following splenectomy of dogs, except that the plateau value was less. Pocked RBCs in splenectomized rats rose initially, but after the sixth week there was a progressive decline in their numbers; splenosis or accessory spleens were not visualized at autopsy. Rabbits had only a slight and inconsistent rise in pocked RBCs after splenectomy. When the rate of removal of pocked RBCs from the circulation was determined by transfusion of blood from splenectomized dogs in eusplenic animals, the pocked RBC count rapidly decreased within 3 to 6 hours. Pocked RBCs did not disappear when crosstransfused into a splenectomized recipient animal. Prior treatment of the recipient dog with either corticosteroids or vincristine did not affect the pattern of removal of pocked RBCs. We conclude that pocked RBCs rise slowly following splenectomy, disappear rapidly from the circulation in the presence of a normal spleen, and vary in pattern of rise and peak levels following splenectomy of different laboratory animals.

ROYAL VICTORIA INFIRMARY, NEWCASTLE UPON TYNESPONTANEOUS rupture of the stomach is a rare and usually fatal acute abdominal emergency. A recent review of the world literature (Albo, de Lorimier, and Silen, 1963) lists 43 recorded cases and adds I other.Further cases have been described (Olsen and Foley, 1961 ; Shaldon, 1961 ; Foex, 1962). Aetiological factors reported have included aerophagy, excessive intake of sodium bicarbonate, and external trauma.Pyloric stenosis has been present as a predisposing factor i n few of the recorded cases. CASE REPORTMrs. A., aged 45 years, was admitted to the Royal Victoria Infirmary as an emergency at 2.45 a.m. on 6 Nov., 1964, complaining of severe abdominal pain and distension. Her distress was such that she could not give an adequate history of her condition.HISTORY.-The history, obtained in retrospect, was that for 5 years she had suffered episodic epigastric pain, heartburn, and nausea. The pain had been relieved by alkalis. A barium-meal examination in 1961 was normal but a chest radiograph taken at the same time showed partial collapse of the lower lobe of the left lung. This was proved to be associated with bronchiectasis and treatment was given with good effect. She had suffered almost continuous epigastric discomfort and pain for 6 weeks before her admission to hospital and had been vomiting copiously. This pain had not been relieved by alkalis. The vomiting was of the type associated with pyloric stenosis. For 5 days she had eaten only small amounts of invalid and strained baby foods. In the 24 hours immediately preceding admission, she had vomited once, bringing up only a small volume of brown fluid. At 9.0 p.m. on 5 Nov., while sitting in a chair watching television, she developed a severe upper abdominal pain which persisted without relief for 5 hoyrs. At 2.0 a.m. on 6 Nov. it suddenly became 'agonizing .O N EXAMINATION.-The patient was obviously in great pain. She was thin, dehydrated, and appeared to have recently lost weight. Her respiration was rapid and grunting. The abdomen was distended and tympanitic with generalized tenderness and rigidity.Clinical findings were : temperature, 99" F. ; pulse, 130 per min.; blood-pressure, 1zo/80 mm. Hg. The blood picture was: Haemoglobin IOO per cent, P.C.V. 49 per cent, W.B.C. 8200 per c.mm. The blood chemistry gave: urea 54 mg. per IOO ml.; sodium 139 mEq./l.; potassium 3.8; chloride gg mEq./l.; carbon-dioxide content 28 mEq. per IOO ml. Radiographs of the'abdomen (supine and lateral decubitus) showed that: There is considerable gaseous distension of the bowel with hepato-diaphragmatic interposition of the colon. Some intraperitoneal fluid is present and there is the suggestion of free,intraperitoneal gas shown on the lateral decubitus film.A nasogastric tube was passed but no aspirate was obtained. Anintravenous infusionof normal saline was started.Her condition deteriorated at an alarming rate. The abdominal distension increased visibly and the respiratory capacity was correspondingly reduced. Breathing was rapid and ...

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