^O CLINICAL VETERINARY MEDICINE AND SURGERY. 



assist diagnosis, provided a considerable portion of the intestine or 

 stomach has passed into the chest cavity. By applying the ear to the 

 lower portions of the chest borborygmus and liquid sounds may both 

 be very clearly heard ; sometimes they are so strong as to give the 

 impression of proceeding from portions of the intestine close to the 

 thoracic wall, or directly under the region auscultated. I should 

 remind you that similar but duller and more distant abdominal sounds 

 may be heard during acute affections of the chest, when pleuritic 

 effusion or pulmonary hepatisation exists. 



Over the remainder of the chest one usually notes an increased 

 vesicular murmur, and sometimes, towards the middle or lower third, 

 a slight tubal sound. 



Percussion of the lower part of the thorax reveals a zone of semi- 

 dulness, with or without a tympanitic sound. In the upper parts 

 resonance is normal. In recent or complicated hernia percussion may 

 produce pain, indicated by groaning, or by the animal flinching from 

 the operator. 



When the indications furnished by auscultation and percussion 

 are not sufficiently characteristic to assure the diagnosis, you have in 

 exploratory puncture a last means of settling the question — I should 

 say, which may settle the question, — for when the trocar or needle 

 fails to bring away fluid from the stomach or intestine, it is sometimes 

 because the instrument has not entered the viscus, despite the latter 

 being displaced ; while should the hernia consist of epiploon or spleen 

 the result is necessarily negative. 



Although diagnosis is possible, you see that in cases it is extremely 

 difficult, and should be announced with the greatest reserve. In our 

 patient the borborygmus and " glou-glou " sound extended far in 

 advance, and were unmistakable; the puncture, which I suggested 

 making, would have dissipated any final doubt. On passing the 

 trocar we should have seen issue a little greyish liquid, mixed with 

 fragments of semi-digested material, which had passed into the two 

 pleural cavities from the rupture in the stomach. 



The prognosis is in the highest degree grave. Large herniae kill 

 in some days, often even in a few hours ; sometimes even more rapidly. 

 Death may result almost instantaneously. When the accident occurs 

 during work the animal becomes greatly depressed, groans, reels about, 

 falls to the ground, and dies. The greater number of herniae compatible 

 with life sooner or later become complicated — with fatal results usually 

 through strangulation and gangrene of the herniated organs, some- 



