394 DISEASES OF THE INTESTINES. 



the surface of the belly. The clams ought to be of extra length, and not 

 to be squeezed so tight as to endanger sloughing of the included skin. In 

 regard to the suture, some prefer one sort, some another ; probably an 

 imitation of what is called the cobbler's or saddler's stitch would afford 

 most security. 



In an Operation with the Clams, the same as is recom- 

 mended in ventral hernia, hereafter, great precaution 

 should be taken not to include the intestine, or any part of 

 it, within the grasp of the clams. This was inadvertently 

 done on one occasion, by Mr. King, V.S., Stanmore, in a 

 case of umbilical hernia, and the result was artificial anus 

 at the umbilicus, out of which " the fseces came very co- 

 piously." With this the mare " lingered eight days," and 

 then sank. Examination showed that •' the intestine passed 

 over the original aperture in the parietes, adhering firmly to 

 its edges, and that a portion of it, of the size of a crown- 

 piece, had sloughed away." But this slough did not take 

 place '^ until at least a month after that of the sac." 



Ligature is the curing process very successfully adopted 

 by Professor Simonds. '^ Several cases of exomphalous," he 

 says, " have come under my notice. I have been successful in 

 all of them, as far as regards perfect reduction of the tumour. 

 I first cast the animal, and, placing him on his back, grasp the 

 hernial sac between my fingers, drawing it up from the belly, 

 and being careful not to include any portion of the protrud- 

 ing intestine, of which there is little fear, except (which is not 

 likely in so young an animal) adhesion has taken place be- 

 tween the peritoneum covering the intestine and that por- 

 tion of the membrane lining the sac. Being safe with 

 regard to these things, 1 take a strong waxed cord or strinig, 

 and place it round the sac, as near as possible to the abdo- 

 men, and, pulling it tightly, I pass it round the sac two or 

 three times, and securely fasten it. The patient may then 

 be permitted to rise, and in a majority of cases, no after- 

 treatment will become necessary. In the course of a few 

 days, the parts included in the ligature begin to slough, and, 

 the healing process taking place, the sac is entirely got rid 

 of, and the cure perfected." ^' Occasionally, about the third 



