808 
DIAPHRAGMATIC HERNIA. 
abdomen. For this purpose an incision, about 4 to 5 inches in length, is 
made in the skin of the right Hank, following the direction of the outer oblique 
abdominal muscle. After dividing the other muscles to the same extent, 
the peritoneum is broken through; the hand introduced into the peritoneal 
cavity, the omentum perforated, and a search made for the incarcerating 
spermatic cord, which is divided either with a bistouri cache or with a 
specially constructed knife in the form of a hook. 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 not to be 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. 
XII—DIAPHRAGMATIC HERNIA (HERNIA DIAPHRAG- 
MATICA). 
Rupture of the diaphragm is commonest in horses, but also occurs in 
dogs and other animals, and is caused by sudden falls, by rearing and 
falling over, and by severe tympanites ; in exceptional cases, it occurs as 
a complication of fractures of the ribs. Abdominal organs may then pass 
into the thorax, a condition termed diaphragmatic hernia. Lehnhardt 
saw the disease 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 or, more rarely, the colon. Provided the bowel does 
not become strangulated in this opening, respiration is little affected. 
Symptoms and progress. Large masses of abdominal viscera entering 
the thorax may cause sudden asphyxia by compressing the lungs, whilst 
strangulation produces the usual symptoms, and, taxis being impossible, 
soon leads to death. In the absence of such fatal complications, difficulty 
in breathing is marked, the animals behaving 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 in the lungs, and in short 
no absolute diagnosis can be founded on clinical examination. The 
character and course of the symptoms and the absence of fever, though 
never pathognomonic, are perhaps the most reliable guides, though an 
