TREATMENT OF UMBILICAL HERNIA. 
277 
where the abdominal opening is not of greater diameter than the thumb. 
Where the base is broad the cord easily slips off; removal by multiple 
ligature, i.e., ligation in sections, is then preferable, and in foals, and 
even in older horses, gives good results. Procedure is as follows :—The 
animal is cast, placed on its back, the hind legs bent and drawn out¬ 
wards, the hair shaved from over the hernial sac, and the latter washed 
and rinsed with a disinfecting fluid. After complete reduction, the folds 
of the sac are gathered together in the direction of its long axis, and, 
beginning at one end, transfixed close to the abdominal wall with a 
slightly bent needle, provided with a strong sterilised double silk thread. 
The threads, when drawn through, are divided close to the needle, and 
the ends of the one half tied tightly together, whilst an assistant draws 
the sac gently upwards. The needle carrying the second half of the 
thread is again passed through the sac about f of an inch from the first 
point of incision, and this section ligatured in a similar way. The same 
process is continued until the entire sac is ligatured. Should the animal 
struggle whilst the needle is being passed, the fingers of the left hand are 
Fig. 123.—Kiilm’s needle for ligation of the sac in umbilical hernia. 
placed on the umbilical ring to prevent the intestine protruding and 
being transfixed, or one waits until the animal is again quiet. The 
entire sac is then once more rinsed with sublimate or carbolic solution, 
and the ligatures on both sides of the sac powdered with a mixture of 
iodoform and tannin (1 to 8), or the entire sac may be painted with 
wound gelatine and covered with wadding. 
The animal is now allowed to rise and placed in a stall provided with 
good clean straw. Should the above described precautions be taken, the 
wound generally heals aseptically. In from ten to fourteen days the 
ligatured portion of the sac sloughs away, and the wound appears healed. 
The operation is performed in a similar way at Brussels, but, instead of 
silk, strong waxed cords or hemp threads are employed, lo facilitate 
the work of ligation French veterinarians use an iron clam, which is 
applied over the empty hernial sac close to the abdominal walls. It 
prevents the portions of bowel which enter the sac when the animal 
struggles being penetrated by the needle. This may just as easily be 
avoided by chloroforming the animal, or by carrying out the above 
described method. 
To prevent prolapse of the viscera during multiple ligation, Mangot 
employs a long rectangular plate of lead, which has an opening in the 
