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.
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