CASE OF STRANGULATED PHRENIC IIERNIA. 
437 
The cause of the perforation in the diaphragm was the next 
object of inquiry, and an irregular callus on the inner surface of 
the rib immediately opposite to it shewed that a fracture at some 
earlier period had taken place, and I have no doubt a puncture of 
the diaphragm from the fractured portion of the rib simultaneously 
occurred ; and thus, as clear a history of the case is given as could 
be desired. The only questions remaining are, How long since did 
the fracture occur ] and did the hernia immediately follow or take 
place after] Now the mare had been in the establishment in which 
she died for a year and a half, and, if any accident had happened 
during that period, it was entirely without the knowledge of those 
about her. But this I do not believe to have been the case ; and 
the polished semi-tendinous edge of the perforation, with the folded 
and contracted state of the portions of the intestine lying in it, 
satisfy me that a considerable length of time had elapsed since the 
proximate cause of the inj ury took effect ; and this contracted ap- 
pearance of the intestine, be it borne in mind, was permanent; for, 
on straightening two or three feet of it, and laying it on the ground, 
the strictures remained, and you had no difficulty in exactly re- 
placing it in the position it occupied prior to death. I am disposed 
to believe, therefore, that the hernia took place immediately subse- 
quent to the accident. 
About eight months ago this mare was laid up for nearly a month 
with a bad tread on the coronet of the near hind leg, which ran on 
to sloughing and the formation of deep-seated sinuses. During her 
treatment for this she had a dose of physic, which, with the usual 
remedies, put her to rights ; but the case was a bad one, and she 
suffered severely from it. Not a single indication, however, was 
given of any abnormal arrangement of any viscus even of second- 
ary importance, much less of one so vital as the intestinal canal. 
The only apparent bad effect of this malposition was, that from 
the decreased diameter of the intestine the food could not pass so 
freely as before, and, as a consequence, the stomach had become 
considerably enlarged — at least, I should say, to double the size 
of its normal state, and this without the slightest appearance of 
disease ; indeed, it was perfectly healthy throughout, — another 
proof of the length of time the hernia had existed, and of the faci- 
lity with which nature adapts herself to circumstances ; for 1 cer- 
tainly never saw a stomach so enlarged, except in cases of death 
from rupture of that organ, or from coma depending on over-dis- 
tention of it. The cavity of the thorax was perfectly free from 
disease, as were also its contents ; but the right lung was consider- 
ably lessened in bulk, from the pressure produced by the presence 
of so unusual a neighbour. 
The entire absence of all severe symptoms is a remarkable fea- 
VOL. XVIII. 3 o 
