I'mbilic Hernia 1053 



oil of mustard, concentrated solutions of salt, and spirits of tur- 

 pentine. Great care should be taken not to inject the irritants 

 into the peritoneal cavity, as such an error would be exceedingly 

 dangerous. 



c. Ligation. In umbilic hernia, where the ring is very 

 large, there is little if any hope of succeeding by either of the 

 previous methods. Consequently some method must be applied 

 for bringing the margins of the hernial ring into close apposition, 

 and retaining them in contact until they become adherent. This 

 usually involves the destruction of the hernial sac. Numerous 

 methods have been introduced for bringing this about, one of the 

 oldest and crudest of which is the ligation of the entire hernial sac 

 at its base, so tightly as to cause its death and sloughing away. 

 Such, a ligature, if w^ell applied, decreases greatly or closes the 

 hernial ring, by the tension exerted upon the walls of the hernial 

 sac and the surrounding tissues. For the application of such a 

 ligature, the patient is secured upon its back, and the hernial sac 

 is firmly grasped. After the contents have been safely returned 

 into the abdominal cavity, the sac is drawn up tightly, and the 

 neighboring skin and skin muscle are brought together in such 

 a manner as to tend to draw the margins of the umbilic ring 

 nearer to each other. Then, around the base of the hernial sac, 

 a stout ligature is tighty applied. The ligature may consist of a 

 strong silk or linen cord, in harmony with the size of the hernia, 

 or of an elastic ligature which ma}' act more promptly than the 

 others. The latter does not need tightening, because its elasticity 

 causes a continuous compression until the tissues become des- 

 troyed and the sac sloughs away. If there should appear to be 

 any doubt about the security of the ligature, a suture or a 

 skewer may be passed through the hernial sac below it, and any 

 danger from its slipping thus obviated. 



The results from ligatures have not generally been satisfac- 

 tory, and the method has largely fallen into disuse. They are 

 uncertain in their action ; they may cause a very tardy slough ; 

 the hernia may reform before the sac is completely destroyed ; or 

 a very rapid necrosis may occur, resulting in prolapse. 



d. Clamps have been recommended verj' highly, by some 

 practitioners, in the treatment of umbilic hernia. They do not 

 differ materially, in their general character, from the clamps 

 used in castration, and their application is upon a similar princi- 



