Anomalies and Curiosities of MedicineGould, George M. (George Milbrey)
Science
Anomalies and Curiosities of Medicine
Gould, George M. (George Milbrey)
Abnormalities, Human; Medicine -- Anecdotes
Anomalies of the Diaphragm.--Diemerbroeck is said to have dissected a
human subject in whom the diaphragm and mediastinum were apparently
missing, but such cases must be very rare, although we frequently find
marked deficiency of this organ. Bouchand reports an instance of
absence of the right half of the diaphragm in an infant born at term.
Lawrence mentions congenital deficiency of the muscular fibers of the
left half of the diaphragm with displacement of the stomach. The
patient died of double pneumonia. Carruthers, McClintock, Polaillon,
and van Geison also record instances of congenital deficiency of part
of the diaphragm. Recently Dittel reported unilateral defect in the
diaphragm of an infant that died soon after birth. The stomach, small
intestines, and part of the large omentum lay in the left pleural
cavity; both the phrenic nerves were normal. Many similar cases of
diaphragmatic hernia have been observed. In such cases the opening may
be large enough to allow a great part of the visceral constituents to
pass into the thorax, sometimes seriously interfering with respiration
and circulation by the pressure which ensues. Alderson reports a fatal
case of diaphragmatic hernia with symptoms of pneumothorax. The
stomach, spleen, omentum, and transverse colon were found lying in the
left pleura. Berchon mentions double perforation of the diaphragm with
hernia of the epiploon. The most extensive paper on this subject was
contributed by Bodwitch, who, besides reporting an instance in the
Massachusetts General Hospital, gives a numerical analysis of all the
cases of this affection found recorded in the writings of medical
authors between the years 1610 and 1846. Hillier speaks of an instance
of congenital diaphragmatic hernia in which nearly all the small
intestines and two-thirds of the large passed into the right side of
the thorax. Macnab reports an instance in which three years after the
cure of empyema the whole stomach constituted the hernia. Recently Joly
described congenital hernia of the stomach in a man of thirty-seven,
who died from collapse following lymphangitis, persistent vomiting, and
diarrhea. At the postmortem there was found a defect in the diaphragm
on the left side, permitting herniation of the stomach and first part
of the duodenum into the left pleural cavity. There was no history of
traumatism to account for strangulation. Longworth cites an instance
of inversion of the diaphragm in a human subject. Bartholinus mentions
coalition of the diaphragm and liver; and similar cases are spoken of
by Morgagni and the Ephemerides. Hoffman describes diaphragmatic
junction with the lung.
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