Symptoms. 419 



on the nephro-splenic ligament; the iipper left loop of the colon usually rests 

 directly upon the ligament and appears strangulated, while the lower left loop 

 which is now directed upward and to the left is not compressed or very little. The 

 posterior half of the bloated left portion of the colon runs backward and down- 

 ward in a curve, and the upper loop is more or less situated in front of the lower 

 loop. If at the same time the pelvic flexure is directed forward and somewhat 

 laterally, the bands of the lower portions present a spiral course. Strangulation of 

 loops of small intestines, which the authors have seen occasionally in other forms 

 of colic, was never found in this affection. 



According to Larsen the presence of some tense loops of small intestines in 

 the region of the right flank, directly at the abdominal wall, points to displacement 

 of the small intestine through the foramen of Winslow; this was also found in a 

 case of Forssell. The authors have had similar findings in displacement of the small 

 intestines, due to dilatation of the stomach. 



In diaphragmatic hernia respiration is difficult from the 

 start on walking downhill, and in certain positions on the side. 

 Over the posterior and lower portions of the thorax one finds 

 tympanitic and often metallic sounds, which frequently change in 

 pitch. Soon there appear symptoms pointing to acute pleuritis 

 (tenderness on pressure upon the intercostal spaces, friction 

 sounds), or to accumulation of blood in the pleural cavity. In 

 diaphragmatic hernia of the left side the heart may become dis- 

 placed by prolapsed loops of intestines and the apex beat may 

 disappear. 



A peculiar type of dyspnea was seen in a horse where a recent extensive rupture 

 of the diaphragm gave rise to a prolapse of the small intestines and the stomach. 

 In spite of marked and rapid excursions of the ribs a passive drawing in of the 

 intercostal spaces did not occur, but, on the contrary, a strong inspiratory drawing 

 in of the espigastrium, the flanks and the region of the loins. The cause of this 

 form of dyspnea was found in the large extent of the rupture of the diaphragm; 

 during each inspiration a part of the small intestine was drawn through the open- 

 ing of the diaphragm into the thorax and the intraabdominal pressure was diminished 

 in consequence. 



In strangulation of the small intestine acute dilatation of 

 the stomach (see page 298) is frequently seen later on. 



The behavior of the pulse, sensorium, temperature and 

 respiration are similar to what is seen in grave forms of em- 

 bolism and thrombosis (see page 406) ; the pulse rises after a 

 few quarters of an hour, or at least after a few hours, to above 

 sixty per minute, and as it grows faster it grows weaker, the 

 sensorium becomes clouded, respiration difficult and the temper- 

 ature rises. 



In strangulation of a very short piece of intestine, it may 

 occur, however, that acceleration of the pulse and elevation of 

 temperature takes place very slowly and does not reach a high 

 degree. In a. horse where a piece of small intestine 30 cm. long 

 became strangulated by a pediculated lipoma, the pulse was 

 only 56 after 13 hours and the temperature 38.6%, yet, when a 

 laparotomy was made 2 hours later, fetid fluid was found in the 

 free abdominal cavity and necrosis of the intestinal wall. 



The clinical picture in cattle is also characterized by 

 marked symptoms of colic. The animals kick with their hind 

 legs and push against the abdomen with their horns ; they shake 

 their heads, look around towards the abdomen, lie down, soon 



