DIAPHRAGMATIC HERNIA. 47 



upper extremity was situated about two inches from the cesophageal 

 opening. The left margin was concave in shape, very thick above, but 

 thin throughout the rest of its extent, and was everywhere fibrous 

 except towards its centre, where it appeared injected and hasmorrhagic. 

 At the centre of the tear was a strong fibrous band as thick as a lead 

 pencil. 



Through this large opening, which had certainly existed for several 

 months, the stomach and spleen had been thrust into the chest cavity, 

 describing a rotary movement forwards, and from left to right, around 

 the cardiac end of the stomach as an axis, causing the right cul-de-sac 

 of the stomach (pxlorus) to advance a considerable distance into the 

 thorax. 



The right lung, congested and emph}sematous like the left, was 

 adherent at its posterior part to the sides of the chest. Here again we 

 found food material, which had traversed the posterior mediastinum. 

 Of this mediastinum only traces remained. The pericardium contained 

 about a quart of greyish liquid. 



The diaphragmatic rupture had existed for a long time ; the fibrous 

 state of its borders showed this clearl}-. The hernia, at first formed of 

 a few loops of small intestine and epiploon, had scarcely inconvenienced 

 the animal, for the first symptoms of colic were only noted six days' 

 before death. Gastric indigestion probabl}- formed the first step 

 towards producing the grave symptoms which preceded the end. The 

 gastric hernia was probably produced by the animal's violent struggles 

 on the night between the i6th and 17th October. In the position the 

 stomach had assumed food could no longer enter it, the cesophageal 

 opening being hermeticall}- closed. 



To sum up, this horse died from rupture of the stomach, a compli- 

 cation of the hernia from which it had already long suffered, as shown 

 by the state of the walls of the diaphragmatic rent. The stomach 

 was probably ruptured soon after it became herniated. 



How may such a hernia occur ? What is the primary cause of the 

 diaphragm becoming ruptured ? 



Cases published during the course of the last half-century afford a 

 reply to these questions. In these the accident has happened in 

 consequence of violent struggles and energetic contraction of the 

 abdominal muscles — either during work, or when animals had been 

 cast. In some the horse was heavily laden, and after a specially great 

 effort suddenl}' stopped, showed pain, fell, and died from asphyxia ; or 

 again survi^'ed for a few hours, showing s\-mptom3 cl colic and severe 

 dyspnoea. Sometimes an animal cast for operation, after struggling 

 violently, presented the same alarming symptoms and died rapidly, or 



