278 
TREATMENT OF UMBILICAL HERNIA. 
centre through which the empty sac is drawn and then ligatured. Two 
wooden pegs are then thrust through the skin below the thread, the sac 
is cut off, and the plate of lead fastened over the animal’s back by four 
straps, which pass through suitable holes at the corners of the plate. 
Imminger has lately introduced this method in foals, but he employs 
silver wire for ligation. If the wire is not too thin, and not too strongly 
pulled, prolapse of bowel does not occur. 
(b) Bemoval of the sac by clams. The"clams act like multiple ligatures 
Fig. 124.—Bordonnat’s clam. 
and are most useful in hernise with broad bases; but, 
although this method is simpler than ligation, it usually 
prevents healing by first intention. A further difficulty 
in using clams is the fact that they easily fall off. To 
prevent this, pegs are thrust through the sac below the 
clam, or the clam itself penetrates the sac. Bordonnat 
constructed for this purpose the iron clam shown in 
fig. 124, and Combe invented a perforated clam (fig. 125) 
allowing the passage of ligatures or strong needles. After 
reducing the hernia, the clam is applied to the neck of 
the sac, as near as possible to the under surface of the 
belly, and in the direction of the linea alba, and fastened 
by screws, or, as in castration, by a cord. Whatever the 
method employed, the following symptoms almost always 
appear:—During the first few hours after operation there is 
slight colic. Next day signs of inflammation become 
apparent: the umbilical region is swollen and painful; 
the hernial sac is cold, purple in colour, and insensitive; appetite is in 
abeyance and fever is present. Towards the fourth day the skin becomes 
necrotic; the clams separate and fall about the twelfth to the fifteenth 
day, leaving a considerable wound and much local swelling, which dis¬ 
appears slowly. In three weeks to a month the umbilical opening should 
be obliterated. Incases of very wide umbilical ring, however, recurrence 
of the hernia was noted even after the above treatment. 
The chief points in using clams are to grasp sufficient skin, and to 
fix the clam firmly and evenly; and therefore wooden clams fastened 
with cords are less satisfactory than iron ones with screws, because, 
Fig. 125.— 
Combe’s clam. 
