METHODS OF CURE IN HERNIA. 
269 
and even of the hernial aperture. The cautery, lately recommended in 
man, has the same effect. Eadical treatment consists in removal of the 
sac and closure of the hernial aperture by causing the hernial ring 
or the neck of the hernial sac to unite, or by other methods. This 
procedure presents much greater difficulties in animals than in men, 
because it is neither so easy to attain asepsis, nor to keep the animal 
in the necessary dorsal position after operation, and when the many other 
dangers incidental to such operations are considered, few cases justify 
interference. 
The following methods of radical cure are employed:— 
(1) Ligation of the hernial sac. This can only be resorted to where 
the sac possesses a narrow neck. To prevent displacement of the 
ligature, it has been recommended to pass needles transversely through 
the neck of the sac, and to apply the ligature over them. It need scarcely 
be said that the hernia must first be reduced. 
(2) In hernisewith broad bases interrupted ligatures may be employed. 
After returning the hernia, strong threads of sterilised silk are passed 
through the neck of the sac in the neighbourhood of the hernial opening. 
The procedure consists thereafter in multiple ligation ; the skin of the 
hernial sac can then be cut through and separated from underlying 
tissues, the other coats of the hernia similarly treated, and the skin 
brought together over them. This method is frequently employed, and 
usually allows of healing by first intention, which greatly tends to ensure 
success. Sometimes, after dissecting away the skin, it is possible to 
close the hernial sac by ligatures applied round its neck. 
The hernial sac may also be opened, and after multiple ligation of its 
neck be removed, following which the skin should be closed with sutures. 
Healing is often completed without pus formation. But in large animals, 
and especially in herbivora, suturing the hernial ring often presents 
insurmountable obstacles, because the abdominal walls are too firm and 
resistant to allow of approximation and union. Where the aperture is 
slit-like, further trouble is often caused by the hernial contents having- 
become adherent to the abdominal walls, and dissection is both difficult 
and very dangerous. After freeing the bowel, or cutting off* the 
omentum, or, if necessary, ligaturing it, the hernial contents are returned 
to the abdomen and the ring sutured. To assist union of the cicatrised 
edges of the hernial ring, they can be pared with the knife or scissors, 
or numerous superficial incisions made. In inserting sutures, the left 
hand holds back the viscera to protect them from the needle. The edges 
are brought together with strong, carefully sterilised silk, the hernial 
ring being as far as possible closed. Where tension is great, quilled 
sutures are useful. The skin is afterwards brought together with strong- 
material, a deep hold being taken. 
