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A Case of Diaphragmatic Hernia, with Strangulation of a Portion of the Small Colon
174
Tlte Veterinary Journal.
July 30th, free frem muscular spasm. Put on shoe. August 4th, on my return from the cavalry manreuvres in Surrey, I found the animal completely restored to health, and arrangements are being made for it to rejoin its regiment-the 14th Hussars- from which it was lent to the Australians. It is a noteworthy fact, that this was the only case of sickness that occurred amongst the 400 horses that took part in the various displays. A
CASE OF DIAPHRAGMATIC HERNI A, WiTH STRANGULATION OF A PORTION OF THE SMALL COLON. B Y CHA RLES sHEATHER, F.R . C. V.s.,
LONDOX .
A YOU NG, well-bred, high-couraged bay gelding, used as a leader, was driven a short time on the morning of Friday, August 7th, and subsequently was taken to Hampton Court and back in the evening. On arrivai at the stable he appeared to have a slight attack of Colic, the symptoms being of a common type, and not of a violent nature. The owner applied some remedies, and at intervals the animal seemed free from pain, alternated with somewhat acute suffering. This state of affairs continued until I p.m. on Saturday, August 8th, when my assistant, Mr. W. Pye, was summoned to attend him. He found him standing, frequently looking at his flanks, with a pulse of 60 and a temperature of 100;°, the visibl e mucous membranes slightly inj ected, and respiration rather accelerated. Urine had been passed in an ordinary mann er, but the bowels had not acted since the attack commenced ; the rectum was empty and distended. At 6 p.m. there was but little variation in his condition, but he had had in the interval one attack of violent pain, exhibited by rapid movement round his box, pawing and striking with his feet, turning with his nose to his flanks, and a hurried respiration. At midnight his pulse was 72, and small but regular; temperature, 102°; the mucous membranes were more injected, while he still gave evidence of pain by looking back at his near flank. On Sunday, August 9th, at 7 a.m., his pulse was 84, weak but regular; temperature, 104 0 ; the mucous membran es deep red, and his respiration very accelerated. He had remained standing in one position all night, and bore a very depressed yet anxious expression. At I p.m. he stood in the same spot, with his forelimbs advanced, the muscles of the shoulders in a state of vibra-
A Case of Diaphragmatic Henu·a.
175
tion, large patches of sweat about his body, an accelerated and apparently painful respiration, and the greatest possible disinclination to move; occasionally he would emit a short grunt, and reel slightly sideways. His nose would be held about a foot from the ground as a rule, but at intervals he would raise his head, arch his neck and bring his chin quickly towards his sternum, and once this movement was followed by a gush of sour-smelling fluid from his nostrils while I was observing him; the mucous membranes were a hremogeneous deep red, the mouth dry and the tongue brown on its dorsum surface. It was reported that the symptoms of vomition had been noticeable for about an hour, but only once previously had there been actual expulsion of matter, and then it was sour-smelling, brownish-green fluid . His pulse was 96, almost imperceptible; the temperature had reached IOS Q • An exploration of the rectum revealed nothing in the form of frecal matter, but that the viscus was dilated, dry, and at the extreme limit of reach, contracted suddenly in its lumen. On withdrawing the arm it was noticed to have distributed over it a quantity of dark-red gelatinous-looking matter, evidently bloodstained mucus, but there was no evidence of direct or free hremorrhage. The hopeless nature of the case was at once apparent, but it was not so easy to arrive at a correct diagnosis, for while vomition pointed to a lesion in connection with the more anterior portion of the digestive tube, the blood-stained mucus from the rectum testified to the existence of some serious condition of the posterior bowel. He died, after reeling about for some few minutes, about S p.m. The post-mortem examination revealed a rent in the tendinous portion of the diaphragm to the upper and left part of the tend inGUS centre, and a loop of the small colon, three feet long (with its meso-colon intact), but quite gangrenous through the opening. The stomach was dilated with semi-fluid contents, the condition of fluidity being somewhat remarkable. A previous case of Diaphragmatic Hernia which came under my observation was of a more ordinary nature. The situation of the rent was about the same, but almost the whole of the small intestines had gone into the thorax, and the abdomen was diminished to such a degree as to enable a diagnosis to be made; in this case, the respiration simulated that of a sheep at a show, while the attitude was constantly a standing one with trembling and partial sweats present from the onset. There was great anxiety, and in the early part of the case, which lasted 30 hours, rapid movement round the box, but no extension of forelimbs when at rest.
Tlte Veterinary Journal.
July 30th, free frem muscular spasm. Put on shoe. August 4th, on my return from the cavalry manreuvres in Surrey, I found the animal completely restored to health, and arrangements are being made for it to rejoin its regiment-the 14th Hussars- from which it was lent to the Australians. It is a noteworthy fact, that this was the only case of sickness that occurred amongst the 400 horses that took part in the various displays. A
CASE OF DIAPHRAGMATIC HERNI A, WiTH STRANGULATION OF A PORTION OF THE SMALL COLON. B Y CHA RLES sHEATHER, F.R . C. V.s.,
LONDOX .
A YOU NG, well-bred, high-couraged bay gelding, used as a leader, was driven a short time on the morning of Friday, August 7th, and subsequently was taken to Hampton Court and back in the evening. On arrivai at the stable he appeared to have a slight attack of Colic, the symptoms being of a common type, and not of a violent nature. The owner applied some remedies, and at intervals the animal seemed free from pain, alternated with somewhat acute suffering. This state of affairs continued until I p.m. on Saturday, August 8th, when my assistant, Mr. W. Pye, was summoned to attend him. He found him standing, frequently looking at his flanks, with a pulse of 60 and a temperature of 100;°, the visibl e mucous membranes slightly inj ected, and respiration rather accelerated. Urine had been passed in an ordinary mann er, but the bowels had not acted since the attack commenced ; the rectum was empty and distended. At 6 p.m. there was but little variation in his condition, but he had had in the interval one attack of violent pain, exhibited by rapid movement round his box, pawing and striking with his feet, turning with his nose to his flanks, and a hurried respiration. At midnight his pulse was 72, and small but regular; temperature, 102°; the mucous membranes were more injected, while he still gave evidence of pain by looking back at his near flank. On Sunday, August 9th, at 7 a.m., his pulse was 84, weak but regular; temperature, 104 0 ; the mucous membran es deep red, and his respiration very accelerated. He had remained standing in one position all night, and bore a very depressed yet anxious expression. At I p.m. he stood in the same spot, with his forelimbs advanced, the muscles of the shoulders in a state of vibra-
A Case of Diaphragmatic Henu·a.
175
tion, large patches of sweat about his body, an accelerated and apparently painful respiration, and the greatest possible disinclination to move; occasionally he would emit a short grunt, and reel slightly sideways. His nose would be held about a foot from the ground as a rule, but at intervals he would raise his head, arch his neck and bring his chin quickly towards his sternum, and once this movement was followed by a gush of sour-smelling fluid from his nostrils while I was observing him; the mucous membranes were a hremogeneous deep red, the mouth dry and the tongue brown on its dorsum surface. It was reported that the symptoms of vomition had been noticeable for about an hour, but only once previously had there been actual expulsion of matter, and then it was sour-smelling, brownish-green fluid . His pulse was 96, almost imperceptible; the temperature had reached IOS Q • An exploration of the rectum revealed nothing in the form of frecal matter, but that the viscus was dilated, dry, and at the extreme limit of reach, contracted suddenly in its lumen. On withdrawing the arm it was noticed to have distributed over it a quantity of dark-red gelatinous-looking matter, evidently bloodstained mucus, but there was no evidence of direct or free hremorrhage. The hopeless nature of the case was at once apparent, but it was not so easy to arrive at a correct diagnosis, for while vomition pointed to a lesion in connection with the more anterior portion of the digestive tube, the blood-stained mucus from the rectum testified to the existence of some serious condition of the posterior bowel. He died, after reeling about for some few minutes, about S p.m. The post-mortem examination revealed a rent in the tendinous portion of the diaphragm to the upper and left part of the tend inGUS centre, and a loop of the small colon, three feet long (with its meso-colon intact), but quite gangrenous through the opening. The stomach was dilated with semi-fluid contents, the condition of fluidity being somewhat remarkable. A previous case of Diaphragmatic Hernia which came under my observation was of a more ordinary nature. The situation of the rent was about the same, but almost the whole of the small intestines had gone into the thorax, and the abdomen was diminished to such a degree as to enable a diagnosis to be made; in this case, the respiration simulated that of a sheep at a show, while the attitude was constantly a standing one with trembling and partial sweats present from the onset. There was great anxiety, and in the early part of the case, which lasted 30 hours, rapid movement round the box, but no extension of forelimbs when at rest.