. The principles and practice of surgery. ceration caused by a greatmuscular effort, or by a crushing force. Its most frequent cause is con-genital malformation or defect in the diaphragm, and this condition isfound much more often in females than males. The aperture of escape is usually upon the left side, sometimesmedian, and rarely on the rightside. In three cases it has oc-curred on both sides simulta-neously. The stomach and trans-verse colon, omentum, small in-testines, spleen and liver are theviscera most often are seldom covered com-pletely by peritonaeum or sy
. The principles and practice of surgery. ceration caused by a greatmuscular effort, or by a crushing force. Its most frequent cause is con-genital malformation or defect in the diaphragm, and this condition isfound much more often in females than males. The aperture of escape is usually upon the left side, sometimesmedian, and rarely on the rightside. In three cases it has oc-curred on both sides simulta-neously. The stomach and trans-verse colon, omentum, small in-testines, spleen and liver are theviscera most often are seldom covered com-pletely by peritonaeum or symptoms are displacement ?of the heart, and other thoracicviscera, as determined by auscul-tation and percussion, embar-rassed respiration, constipation,vomiting, etc. Prognosis.—Dr. Bowditch, ofBoston, in a most exhaustivetreatise upon this subject, has collated 88 cases. Of the congenital cases11 died within two hours after birth, more than half survived one year,and 8 lived to adult age. In the accidental cases death generally took. Diaphragmatic Hernia. 746 OBTUKATOK HEENIA. place within from one to seven days; in one case life was prolongedthirty-eight years, but not more than one in ten survived beyond Treatment.—The patient should be placed in the erect position, orin such an attitude that the viscera will have a tendency to drag down-wards toward the pelvis; and the bowels should be moved by stimu-lating enemata. In every case upon record, in which a diaphragmatic hernia wasstrangulated, the patient has died. No operation has hitherto beenmade for its relief, but Dr. Bowditch has suggested that in certain casesit would seem possible that the knife might afford relief. Epigastric Hernia. Syn., Hernia Epigastric a, R. C. Richter denied the possibility of an epigastric hernia; but it is certainthat it sometimes occurs, especially in the vicinity of the xiphoidcartilage, where the aponeurotic covering is thin. Lapeyronie was ableto verify a case of this kind by
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