502 



VENTRAL HERNIOTOMY. 



the means advised for umbilical hernise may be employed. Trusses 

 can seldom be used, and treatment is then practically confined to 

 the following : — 



(1) Application of irritants or mineral acids. Rademacher recom- 

 mends sulphuric acid. 



(2) Simple or multiple ligation, or the application of a clam. 

 This method presupposes the absence of adhesion, which, as already 

 stated, is somewhat rare. Simple ligation is seldom successful, on 

 account of the large base of the hernia, and therefore recourse must 



Fig. I 



Fig.2. 



Fig. 400. — Schema illustrating Degive's operation for umbilical and ventral 

 hernise. A, Serous ; B, musculo-aponeurotic, and C, cutaneous coats 

 of the hernia ; D, the special needle in place ; E E, clam ; F F. nails. 

 The three figures show the successive stages of the operation. 



be had to either multiple ligation or the clam, after making sure of 

 the absence of adhesion. Either a wooden clam (castrating clam) 

 or the iron one shown in Figs. 392 and 393 may be used, and the 

 mode of application is the same as in umbilical hernia. 



Degive has used the following method extensively in cases of 

 ventral and umbilical hernia?. Under antiseptic precautions, he 

 first opens the hernial sac in order to break down any existing 

 adhesions, and then transfixes the skin and edges of the hernial ring 

 with pack needles about 8 inches long. Above these he adjusts a 

 clam, which is closed by means of a screw and firmly secured. The 

 pack needles are then replaced by horse-shoe nails, the points of which 

 are bent round. In about a week the necrotic tissue falls away, and 



