ACQUIKED HERNIA. 



489 



with sterilised strong silk, the skin heing afterwards brought together 

 with silk sutures after removal of the sac itself. A surgical dressing 

 can then be applied to the umbilicus. The patients should be carefully 

 dieted. 



When the hernial ring is large and its lips widely dilated, the silk 

 sutures, even when supported by secondary sutures, sometimes cut 

 through the tissues and do not 

 achieve the desired result. 



Degive's method (see "Moller 

 and Dollar's Eegional Surgery," 

 p. 304) can then be employed. The 

 hernial sac is opened under anti- 

 septic precautions, in order to break 

 down any existing adhesions, and 

 the skin and edges of the hernial 

 ring are transfixed with packing 

 needles about 8 inches long. Above 

 these is adjusted a clam, which is 

 closed, by means of a screw and 

 firmly secured. The packing needles 

 are then replaced with horse-shoe 

 nails, the points of which are bent 

 round. In about a week the ne- 

 crotic tissue falls away, and recovery 

 occurs even in severe cases in which 

 previous treatment had failed. 



Fig. 2. 



Fig. 222. — Schema illustrating Degive's 

 operation for umbilical and ventral 

 herniae. A, Serous ; B, musculo- 

 aponeurotic, and C, cutaneous coats 

 of the hernia; D, the special needle 

 in place ; EE, clams ; FF, nails. The 

 three figures show bhe successive 

 stages of the operation. 



ACQUIRED HERNIA. 



Acquired or accidental hernise 

 are not serious, and only deserve 

 to be studied in so far as they 

 affect organs contained within the 



abdominal cavity. They may result from violence, or may occur 

 without the intervention of any external cause. 



Traumatic herniae may occur at any point in the abdominal wall. 

 Under the influence of a violent blow from a waggon pole, a horn 

 thrust, a kick, a fall, etc., the muscular tunic of the abdominal wall 

 is injured and becomes fissured in the direction of its fibres. The 

 peritoneum is rarely affected. Being pushed outwards by the digestive 

 viscera, however, the peritoneum projects into the muscular layer, 

 distends it, separates the layers of subcutaneous tissue, and finally 

 forms a distinct hernia. 



