HEENIA. 433 



practitioners recommend the introduction of two small wooden 

 pias just under it, either parallel or crossing each other, through 

 the base of the sac. 



If the hernia is very large, instead of employing this mode of 

 simple ligature, en masse, the operator may use two hgatures. 

 By pushing through the middle of the sac, close to the abdomen, 

 a dog seton-needle, carrying a doubled cord, and converting it 

 into two parts ia cutting it from the needle, each length will serve 

 to embrace half of the tumor, ia the manner practiced in the pro- 

 cess of removing large, hard tumors by Hgature. Legoff has rec- 

 ommended the use of several ligatures dipped iato ammonia, placed 

 one above the other upon the whole length of the sac, from its 

 bottom to its base, tightening them more and more as they ap- 

 proach the abdomen. By this process he combined constriction 

 with cauterization. 



This mode of treating umbilical hernia is a simple and easy 

 one, but yet it is not very frequently practiced. The uncertainty 

 of its results, the possibility of the sloughing of the skin at too 

 early a period, with the danger of eventration, as well as that of 

 injuring the intestines with the wooden pins or the needle, have all 

 combined to impair its credit and discourage its use among care- 

 ful operators. 



(b) Clamp. — ^In this process, which dispenses with the caustic, 

 after the reduction of the hernia, the sMn is stretched and pressed 

 between the branches of a wooden clamp or of a specially adapted 

 forceps. The clamp is a simple implement, and may be made with 

 a curve, in which case its convexity is made to adapt itself to that 

 of the abdomen. When applied, it is pressed close to the abdom- 

 inal walls, and its branches brought together with nippers adhoe, 

 and secured with a strong cord, as in the process of castration. 

 The clamp is left on from nine to fifteen days. In many cases, 

 the displacement of the instrument is prevented by using the 

 wooden or metallic pins passed through the skin below it, the 

 ends of the latter being bent over to keep them in place. This 

 operation possesses some great advantages, but offers also some 

 special dangers, among which is the instinctive tendency of the 

 patient to get rid of the irritating appliance by tearing it off. 



Another objection to the clamp is found in the danger of caus- 

 ing troublesome excoriations of the sheath by the friction which 

 it necessarily occasions. Benkert and Brogniez have advocated 



