Four cases of aneurism of the arch of the aorta, and a case of diaphragmatic hernia / by John Reid.
- John Reid
- Date:
- [1840]
Licence: Public Domain Mark
Credit: Four cases of aneurism of the arch of the aorta, and a case of diaphragmatic hernia / by John Reid. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![one the protrusion is said to have occurred tlirougli tlie opening for the svmpatlictic nerve, (Platner's Dispnt. De Hydrocel, as quot- ed by Morgagni) ; in three the protrusion occurred through the a?sophageal opening (Resigius de Vcntriculi in Cavo Thoracis Situ Congenito, Berlin, 1823) ; a case by Fantoni, as quoted by Monro, and a case by Clauder; in one it was placed an inch to the left of the oesophageal opening, (one of Dr Macauly's cases); in one, it was placed thi'ec inches to the left of the oesopha- gus, (case of Sir A. Cooper) ; in one, in the middle of the left por- tion of the diaphragm, (one of Monro's cases) ; and in one (sup- posing it to be a case of congenital hernia) it must have occu- pied nearly the same situation as in the case we have described, since it is stated to have been situated about three inches from the ribs, and placed more anteriorly than the oesophagus. 4. In at least two of the recorded cases, the protruding parts were firmly adherent to the edges of the opening, (cases of Sir A. Cooper and Chauvet).* We would certainly expect that in cases of wound of the diaplaragm, that if the person survived, inflamma- tion of the edges of the divided muscle would occur, and proba- bly cause adhesions between the edges of the wound and the parts which may have protruded into it, as in the case we have describ- ed. That lymph may be effused and unite the protruded parts to the edges of the opening in some cases of congenital deficiency of a part of the diaphragm, is a 'priori certainly quite possible, and in two cases which we have cited above it had actually occurred. 5. Some of the cases of congenital deficiency of the dia- phragm terminated fatally, as in ours, by strangulation of the ])rotruding portion of the intestines, (cases of Dr Clark, Sir A. Cooper, and Monro.) Approaching the consideration of this case with all the caution which an examination of the recorded cases of conge- nital malformation of the diaphragm must naturally induce, wc still feel strongly convinced that the protrusion of the colon was the consequence of a wound of the diaphragm. If we reflect upon the circumstance, that a sharp instrument could scarcely be thrust into the chest through the ninth and tenth intercostal space, Avhere the cicatrix was found, without wounding the diaphragm, and thus necessarily at the part where the opening in it was found, if the muscle be in a relaxed state, or during expiration, as we have frequently satisfied ourselves upon the dead body ; upon the great rarity of such small congenital deficiencies in the diaphragm; upon the uneasiness felt by the patient in the lefthypochondrium, and the severe attacks of ileus after the infliction of the wound ; con- joined with the improbability that a person could have arrived at In Sir A. Cooper's ease, tlie omentum was the adherent part.](https://iiif.wellcomecollection.org/image/b22274741_0016.jp2/full/800%2C/0/default.jpg)
