566 DIAPHRAGMATIC HERNIA. 



abdominal muscle. After dividing the other muscles to the same 

 extent, the peritoneum is broken through ; the hand introduced 

 into the peritoneal cavity, and a search made for the incarcerating 

 spermatic cord, which is divided either with a bistouri cache or with 

 a hooked knife. When the operator has convinced himself of the 

 absence of a similar condition on the other side, the wound is sutured 

 and treated according to general principles. If performed early, the 

 operation is stated to be not dangerous. Strauss lost only 11 animals 

 out of 110 subjected to operation ; Kuhmann cured 112 cases in ten 

 years ; von Weil claims only to have lost 4 cases out of a total of 

 200 ; Anker records 44 recoveries. Caudwell operated successfully, 

 on two steers, by opening the right flank and dividing the cord, which 

 he found incarcerating the bowel in each case (V. Record, March 18th, 

 1911). 



XII.— DIAPHRAGMATIC HERNIA (HERNIA DIAPHRAGMATICA). 



Rupture of the diaphragm is commonest in horses, but also occurs 

 in dogs and other animals, and is caused by sudden falls, collisions, 

 street accidents, by rearing and falling over, and by severe tympanites ; 

 in exceptional cases, it occurs as a complication of fracture of the 

 ribs. Abdominal organs may then pass into the thorax, a condition 

 termed diaphragmatic hernia. The rupture may be in the muscular 

 periphery or in the tendinous centre of the diaphragm. Lehnhardt 

 saw this hernia in a cow ; the recticulum had entered the thorax. 

 In dogs the stomach, liver, or spleen may be found in the thorax ; 

 in horses the small intestine, stomach, or more rarely, the caecum or 

 colon. In horses, hernia through the muscle produces more distur- 

 bance than hernia through the tendinous centre. In the former 

 haemorrhage or strangulation may soon lead to death, whilst in the 

 latter adhesions quickly form between the displaced viscus and the 

 tendon and the patient may continue to improve ; but irrespective 

 of the position of rupture, when large masses of abdominal viscera 

 enter the thorax, sudden asphyxia may be caused. 



Symptoms and progress. In the absence of such fatal com- 

 plications, difficulty in breathing is marked, the animals heaving as 

 though broken-winded, owing to interference with the diaphragm, 

 and ruminants show digestive disturbance. 



It has been stated that the condition may be diagnosed with 

 certainty by auscultation, but such is seldom the case. It is always 

 difficult to say whether the peristaltic sound originates in the abdomen 

 or the thorax, and, therefore, beginners may easily form an erroneous 

 diagnosis. Nor can a tympanitic percussion sound be regarded as 

 evidence of the disease, because this accompanies a series of changes 



