1 68 Anatomy Applied to Medicine and Surgery. 



to cough, hence, if bronchitis be present, as it frequently 

 is, the gravity of the case is increased. These symptoms 

 are simulated very closely in hysterical paralysis, but, in 

 the latter condition, there is not the same degree of inter- 

 ference with the expansion of the lower ribs that there is 

 in true paralysis of the diaphragm. Hiccough is an in- 

 termittent spasm of the diaphragm the result of some 

 disturbance of the phrenic nerve, while, at the same time, 

 there is more or less involvement of the laryngeal branches 

 of the pneumogastric which causes a spasm of the larynx 

 as the air is inspired. In electro- therapeutics, one pole 

 may be placed along the posterior border of the sterno- 

 mastoid, opposite the level of the upper border of the thy- 

 roid cartilage, and the other in the region of the dia- 

 phragm, for the purpose of applying electricity to the 

 phrenic nerve. 



Subphrenic Abscess. A subphrenic abscess 

 is the result of inflammatory action localized under the 

 diaphragm, and on either side of the suspensory ligament 

 above the liver. In it the diaphragm may be pushed as 

 high as the third rib, or the liver may be displaced down- 

 wards. When there is air in the abscess cavity, the char- 

 acteristics of pyo-pneumothorax are closely simulated. 



Operation. The tenth rib at the side should be re- 

 sected, the diaphragm divided and the abscess reached 

 without injuring the pleura, since the latter does not ex- 

 tend down as far as the tenth rib. 



