436 CASE OF STRANGULATED PHRENIC HERNIA. 
vened, and l was obliged to have the orifice closed. This first 
made me look at the case with suspicion, as I have repeatedly 
found that where the pulse is full, hard, and quick in bowel attacks, 
and blood-letting is not well borne, a fatal result is too frequently to 
be apprehended. The rectum was emptied, and the patient directed 
to be well littered down, and kept quiet and undisturbed, with the 
precaution that, should she appear to be at all worse during the 
night, I should be sent for. I heard nothing more of her, however, 
till I repeated my visit early in the morning, when I found her 
dying. The horse-keeper stated that she had been occasionallv 
restless during the night, but not to any violent degree, and that 
she had just then lounged forward with her head against the man- 
ger, and slipped down, in which position I saw her die. She had 
not broken out into any perspiration during the night — had not 
placed herself in any remarkable attitude, or presented any ap- 
pearance at all unusual. Her owner, who was present, and had 
seen her frequently, concurred in these remarks. 
Within half an hour of her death we proceeded to make a 
post-mortem examination on the spot. On opening the abdominal 
cavity, the stomach appeared unusually dilated, and a few patches 
of inflammation were scattered over the intestines. On dividing 
the mesenteric bands, and turning out the stomach, liver, and intes- 
tines, a portion of the ilium remained, with the appearance of hav- 
ing adhered to the diaphragm. This led to a more careful examina- 
tion, when a perforation was discovered in the diaphragm, midway 
between the centre of that organ and the ribs on the right side : 
it was not more than large enough to admit the thumb, and was 
filled by two portions of the ilium. An incision about two inches in 
length relieved the stricture sufficiently to enable me to withdraw 
from the cavity of the thorax about eighteen inches of intestine, 
perfectly strangulated, quite black, and that at one point would, to 
all appearance, have sphacelated in a few hours, had the mare lived. 
The perforation in the diaphragm was of long standing, as its 
polished silvery edges clearly indicated ; nor was the hernia of re- 
cent date ; for the two portions of intestine lying in the hole — that 
is, the portion entering the cavity of the thorax, and the portion 
returning again into the abdominal cavity, a space of eighteen 
inches extending between them — were drawn in, puckered, and 
contracted, and had evidently adapted themselves to the size of 
the orifice through which they had to pass : in short, the animal 
had not only been living, but working hard, and keeping herself in 
good condition, for at least a year and a half, with a diaphragmatic 
hernia, that, as sooner or later happens in so many hernial cases, 
had become strangulated, and death had ensued within four-and- 
twenty hours. 
