TREATMENT OF UMBILICAL HERNIA BY HERNIOTOMY. 537 



one should be about 12 inches long, the under one 4 inches less. The 

 upper clam is applied as close as possible to the belly, so that after 

 the animal rises, the sac appears to have vanished. Hernise as large 

 even as a man's head may be completely cured by this method. 

 Demesse states having thus cured a case where two hands together 

 could be passed through the umbilical ring. Should the sheath 

 in male animals reach so far forward that it would be touched by 

 the clam, the latter may be applied at right angles to the long axis 

 of the body. 



(c) Herniotomy. When, as in very large hernise, the above 

 methods fail, a cure may possibly be effected by suturing the hernial 

 ring. Cordelier gives the following indications for this operation : — 

 1. Strangulation. 2. Large size of the hernia. 3. Long existence 

 of the hernia. 4. Impossibility of reducing the condition. 5. Ad- 

 hesion of the contents to the hernial sac. 6. Inflammation of the 

 hernia, or the existence of colic. The operation is carried out as 

 previously described, and under antiseptic precautions. The animal 

 is chloroformed, laid on its back, the entire surface shaved, rinsed 

 free of soap, and disinfected. The skin is then divided in the long 

 axis of the hernia or of the hernial ring. From this point the operation 

 may be completed either with or without opening the peritoneal 

 cavity. Siedamgrotzky prefers the latter way, and next separates 

 the skin from the hernial sac, which he thrusts into the hernial opening. 

 The edges of the umbilical ring are then freshened, brought together 

 with strong silk threads, and the flaps of skin, after being shortened 

 to the necessary extent, united above them. An antiseptic dressing 

 is secured over all by means of bandages or a few threads, and healing 

 takes place completely in from twenty to thirty days. Catgut is 

 here unsuitable, as it is too quickly absorbed. Guttmann had five 

 relapses among twenty cases from this cause. 



Storry proceeded in a similar way. After dividing the sac from 

 the skin, he sutured it with a strip of white leather, then cut it off 

 and sewed the skin together. 



This method is to be preferred to internal herniotomy (which 

 necessitates opening the peritoneal sac), if for no other reason than 

 that the risk of peritonitis is less, and success is not endangered by 

 prolapse of portions of intestine or omentum. It must, however, 

 not be forgotten that in many cases the peritoneum cannot be 

 separated from the surrounding tissues, especially at the base of 

 the hernial sac, and that the peritoneal cavity is apt to be opened 

 in making the attempt. Nevertheless bad results seldom occur. 



The peritoneum may be incised without grave risk as shown 



