730 DISEASES AND ABNORMALITIES. 



umbilical opening, and through which the hernial sac is passed before 

 the ligature is made. 



Some authorities prefer a double ligature, made by passing a double 

 cord through the base of the sac by means of a sacking-needle, and tying 

 each separately or entirely round the sac. Sometimes the ligatures are 

 multiple ; and Legoff has recommended the employment of several liga- 

 tures passing through the sac from apex to base, each becoming tighter 

 as the abdomen is neared. 



Ligatures are very simple and easily applied, but they have their draw- 

 backs, and these have led to their disuse. Among their disadvantages 

 are uncertainty in their action — which is sometimes too intense, at other 

 times insufficient ; the sac often sloughs off before adhesion has taken 



Fig. 211. 

 Umbilical Clam. 



place to such a degree as to sustain the weight of the abdominal viscera : 

 and it has been pointed out that there is risk of including or wounding 

 the intestine. 



Very favorable results obtained by the elastic ligature in castration, are 

 recently reported by Guerin {Recueil de Med. Veterinaire, July 30, 1877) ; 

 this ligature might prove very effective in umbilical hernia. 



The procedure by clams is often resorted to, particularly when the hernia 

 is serious. The ordinary wooden clam (Fig. 211) may be employed, or one 

 of iron, either hinged at one end or tightened by screws. To render the 

 coaptation of the two branches of the clam more perfect, and to prevent the 



Fig. 212. 

 Armatage's Iron Umbilical Clam. 



instrument slipping when tumefaction sets in, as well as to produce more 

 prompt inflammation, adhesion, and gangrene, various contrivances are 

 in use. Borhauer has used a clam, in the branches of which are a num- 

 ber of holes placed opposite each other, and through which wooden or 

 metal pins can be passed when the instrument is fixed on the sac. Other 

 practitioners use a clam with toothed branches, the teeth perforating the 

 walls of the sac. Armatage recommends an iron screw clam, one branch 

 of which has a long deep groove, and into this fits a narrow projecting 

 ridge on the opposite branch (Fig, 212). 



To apply the clam, he gives the folio\ying directions : " The animal is 



