Traumatic rupture of the diaphragm is a condition which has assumed greatly increased clinical significance in the past quarter-century, when roentgen diagnosis and improved anesthetic and surgical techniques have made treatment successful with some degree of regularity. Despite advances, there are still diagnostic pitfalls, and the associated phenomena of mediastinal shift, intestinal obstruction or strangulation, and perforated viscus may tax the ingenuity and skill of the surgeon.
In this day of high-speed automobile accidents, with patients receiving multiple injuries, one is apt to become concerned with conditions obscuring the diaphragmatic injury. Careful attention to physical signs in such cases will often give the clues which lead to the proper diagnosis. Gibson,4 in a concise report in 1929, called attention to six signs which can establish the diagnosis of diaphragmatic hernia with strangulated bowel. These are (1) diminished excursion of the thorax on the affected side, due in part at