CHAPTER VII. 



operations for hernia. 



Derr's Operation for Umbilical Hernia. 



DEFINITION.— A method of clamping umbilical hernia 

 by means of skewers and ligatures. 



INDICATIONS. — Exomphalocele is an abnormality of 

 young animals that tends towards spontaneous recovery as 

 the affected subject grows older. They generally appear 

 about the third week after birth when the navel has healed 

 and the fcetal structures (urachus, umbilical vein and artery) 

 have undergone the regular course of post-natal atrophy. 

 While the navel is still»an open wound and the umbilical ori- 

 fice is still plugged with these foetal vessels the intestines .are 

 prevented from protruding, but when the skin has healed and 

 the vessels have atrophied without simultaneous closure of 

 the orifice, the intestines whose weight increases from day to 

 day, bear down- upon the elastic skin and at once produce a 

 typical hernia. Later, as the animal grows older, the mesen- 

 tery grows relatively shorter and the orifice tends to become 

 smaller and smaller, with the effect that the hernia gradually 

 disappears spontaneously. The spontaneous disappearance 

 of umbilical hernias under these influences of growth and de- 

 velopment has an important bearing upon their management, 

 and has been the cause of extravagant claims for certain lines 

 of treatment which have been credited with results that na- 

 ture itself accomplished. 



Blisters, caustics, actual cautery, trusses, clamps and sup- 

 porting bandages are so many expedients used to effect cures, 

 and whilst they are helpful in assisting nature to correct the 

 abnormality, they should only be credited with the benefit 

 actually derived from them, since the umbilical hernias that 

 disappear without their use are indeed legion. Amongst 

 these various modes of treatment for recent exomphaloceles, 

 the truss is the most effectual as well as the least troublesome 

 to apply. The truss appropriate for this purpose consists of a 

 round piece of soft wood (pine) having a founded pro- 

 tuberance in the center that will fit loosely into the orifice, 

 and strong elastic bands that will encircle the body to hold 



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