DIAPHRAGMATIC HERNIA. 5 I 



times through rupture of the intestine or stomach, as in the case we 

 have seen. Prognosis is rendered still graver by the uselessness of 

 treatment. 



In few conditions is there such a poverty of treatment. The 

 methods suggested are either ineffective, dangerous, or impracticable. 

 Let us shortly consider them. 



The hernia is diagnosed, and is recent. It has existed for several 

 days, or a day, or for only a few hours. What are we to do ? Some 

 authors recommend the treatment usual in colic, particularly bleed- 

 ing. It is better to leave the animal quiet, to calm pain by morphine 

 or chloral, and to give liquid nourishment — gruel, mashes, or milk. 

 Provided the herniated mass is not too large, and the dimensions and 

 shape of the rupture do not favour strangulation by engorgement, the 

 animal may, after the subsidence of inflammatory symptoms, become 

 capable of light steady work. Many reported cases show this. 



When strangulation has occurred, death can only be prevented by 

 surgical intervention, consisting in returning the herniated organs to 

 the abdominal cavity. Bouley proposed this method. As, he says, 

 in such cases death is certain, why not try the only possible method 

 of avoiding it ? This consists in introducing the hand into the abdo- 

 men through the left flank, and by gently pulling on the displaced 

 viscera effecting reduction. Such interference, however, would be 

 only palliative. The rent in the diaphragm remaining open, the hernia 

 might at any moment recur with fatal consequences. As to radical 

 cure, /. e. reduction of the hernia and closure of the diaphragmatic 

 wound, it has hitherto been regarded as impracticable in large animals. 



