HEENIA. 435 



Twisted ^Sutures. — This consists in applying upon the hernial 

 sac several stitches of strong cord in order to keep the reduced 

 hernia in statu quo. It is sometimes used in dogs, but is uncer- 

 tain and dangerous. 



Suture of Delavigne. — This is another dangerous mode of 

 operation, no longer in practice because of the hazard of injury to 

 the intestines. It consists in ai^plying a strong double suture at 

 the base of the sac in the following manner : With a small needle, 

 like that used by harness makers in sewing leather, a thread is 

 I^assed through and through on both sides of the flat, cutaneous 

 surface from right to left, or vice versa, then carried back the re- 

 verse way at a small distance from the first puncture, and the 

 sutures firmly tied. This is repeated until the entire sac is in- 

 cluded and the sutures have gone beyond the umbilicus. From 

 fifteen to twenty days are said to be sufficient to effect a radical 

 cure. 



Method of Mangot. — To make a closing suture on the hernial 

 sac, without danger to the intestine, Mangot has recommended 

 the use of a perforated plate of lead, by which to aid in the reten- 

 tion of the intestines in place and accurately define the line ujJon 

 which the sutures are to be applied. The plate is made to cor- 

 respond in dimensions with the opening of the umbilical ring, but 

 somewhat longer and wider. Besides the longitudinal slit in its 

 center, it also has an eye at each corner for the attachment of 

 strings to secure it in place by tying them over the back. The 

 hernia being reduced, and the plate put in place by pushing the 

 skin of the sac through its longitudinal opening, the operator ap- 

 phes a continued suture over and on the outside of the plate to 

 keep it in position, with the flap of sewed skin hanging below it, 

 the entire apparatus being securely attached to the abdominal 

 walls by two pins running through the sac at the extremities of 

 the suture. 



During the first days there is much inflammation. About the 

 third or fifth day the pins are removed and the skin below the su- 

 ture excised, leaving the plate to be retained only by the strings 

 which pass over the back. These are sufficient, however, to keep 

 it in place, and its removal will not be necessary until inflamma- 

 tion is well estabUshed all around them. A simple dressing, held 

 in place by a bandage, will help the cicatrization, which is said to 

 take place in from seven to eight days. 



