horax; there are many modern cases on record. Internal hernia
through the diaphragm is mentioned by Cooper, Bowles, Fothergill,
Monro, Ballonius, Derrecagiax, and Schmidt. Sir Astley Cooper mentioned
a case of hernia ventriculi from external violence, wherein the
diaphragm was lacerated without any fracture of the ribs. The man was
aged twenty-seven, and being an outside passenger on a coach (and also
intoxicated), when it broke down he was projected some distance,
striking the ground with considerable force. He died on the next day,
and the diagnosis was verified at the necropsy, the opening in the
diaphragm causing stricture of the bowel.

Postempski successfully treated a wound of the diaphragm complicated
with a wound of the omentum, which protruded between the external
opening between the 10th and 11th ribs; he enlarged the wound, forced
the ribs apart, ligated and cut off part of the omentum, returned its
stump to the abdomen, and finally closed both the wound in the
diaphragm and the external wound with sutures. Quoted by Ashhurst,
Hunter recorded a case of gunshot wound, in which, after penetrating
the stomach, bowels, and diaphragm the ball lodged in the thoracic
cavity, causing no difficulty in breathing until shortly before death,
and even then the dyspnea was mechanical--from gaseous distention of
the intestines.

Peritonitis in the thoracic cavity is a curious condition which may be
brought about by a penetrating wound of the diaphragm. In 1872 Sargent
communicated to the Boston Society for Medical Improvement an account
of a postmortem examination of a woman of thirty-seven, in whom he had
observed major injuries twenty years before. At that time, while
sliding down some hay from a loft, she was impaled on the handle of a
pitchfork which entered the vagina, penetrated 22 inches, and was
arrested by an upper left rib, which it fractured; further penetration
was possibly prevented by the woman's feet striking the floor. Happily
there was no injury to the bladder, uterus, or intestines. The
principal symptoms were hemorrhage from the vagina and intense pain
near the fractured rib, followed by emphysema. The pitchfork-handle was
withdrawn, and was afterward placed in the museum of the Society, the
abrupt bloody stain, 22 inches from the rounded end, being plainly
shown. During twenty years the woman could never lie on her right side
or on her back, and for half of this time she spent most of the night
in the