PHRENIC HERNIA

Abstract

yeeoUition of intenal hmmorrhage does not say much for she 4&gn8tiC acumen of the medical attendant. I must ve confess that a satisfactory relation can be esablished 'between the symptoms during life and the appearances ifter death 'There is, however, a peculiarity about the case that will faorly excuse the apparent wat of true induction; and the point was so marked, and is so important, that it has chiefly influenced me in bringing the case before the notice of the society. I allude to the 801 reference at the commencement, and during the early part of the attack, of all the patient's intense sufferings, to the scat of the large end of the stomach. Coupled with this guide was the frequent vomiting of suspected blood, which suspicion was subsequently strengthened by the circumstance undoubtedly occurring. If hamorrhage had taken place in the first instance near the ostensible seat of complaint, its presence in ann portion of the alimentary canal would soon have mamifested itself, and any effusion into the general cavity would have afforded signs that could not have been overlooked; but here it took place into a circumscribed cavity, the existence of which could not be suspected. In this manner not only was the presence ofthe htemorrhage masked from examination, but its usual symptoms were probably disguised by the pressure of the walls of the cyst checking the flow of blood before it induced the syncope characteristic of its loss. Frequent and various as the instances are of sympathy between different organs of the body arising from the morbid condition of any one of them, the present case stands alone in my own experience in the suddenness and completeness of the development of the reflex sensations. It is inexplicable by any known relation of nervous communication. I can scarcely suggest a cause in the probable immediate influence of the lesion upon the peritoneum, and of the transference of the sympathetic effects by this structure, but in what mysterious manner, it is impossible to surmise. I am fortunately able to complete the statement of the case, by narrating the early history of the cyst. When 18 years of age, this poor lady was attended by my father for ovarian dropsy; she was also taken by her friends for advice to London, and returned with the recommendation that tapping should be performed. Mr. Boden did not think the symptoms sufficiently urgent to justify the operation, and advised its postponement. Soon afterwards, the cyst relieved itself by bursting through the bladder; and from that time to the present attack, Mrs. A. never felt any sensation to remind her of the existence of her former complaint. She married soon after her recovery, resided some years in a tropical climate, and had several children. The cyst appears to have contractod to.a certain point, then to have remained unclosed but dormant for thirty years, and finally, to have occasioned death by the sudden effusion of blood into its cavity.