TREATMENT OF UMBILICAL HERNIA BY HERNIOTOMY. 
279 
on account of their one-sided fastening, pressure cannot be so evenly 
applied. 
In using wooden clams one is sometimes applied over the other to 
prevent the first falling off. Degive recommends this, especially in large 
hernise, when the upper clam should he about 12 inches long, the under 
one some 4 inches less. The upper is applied as close as possible to 
the belly, so that after the animal rises, the sac appears to have vanished. 
Hernhe as large even as a man’s head may be completely cured by this 
method. Demesse states having thus cured a case where two hands 
could be passed through the umbilical ring together. Should the sheath 
in male animals reach so far forward that it would be touched by the clam, 
the latter may be applied at right angles to the long axis of the body. 
(c) Herniotomy. When, as in very large hernise, the above methods 
fail, a cure may possibly be effected by suturing the hernial ring. 
Cordelier gives the following indications for this operation:—1. Strangu¬ 
lation. 2. Large size of the hernia. 8. Long existence of the hernia. 
4. Impossibility of reducing the condition. 5. Adherence of the con¬ 
tents to the hernial sac. 6. Inflammation of the hernia, or the existence 
of colic. The operation is carried out as previously described, and under 
antiseptic precautions. The animal is chloroformed, laid on its back, 
the entire surface shaved, rinsed free of soap, and disinfected. The skin 
is then divided in the long axis of the hernia or of the hernial ring. 
From this point the operation may be completed either with or without 
opening the peritoneal cavity. Siedamgrotzky prefers the latter way, 
and next separates the skin from the hernial sac, which he thrusts into 
the hernial opening. The edges of the umbilical ring are then freshened, 
brought together with strong silk threads, and the flaps of skin, after 
being shortened to the necessary extent, united above them. An anti¬ 
septic dressing is secured over all by means of bandages or a few threads, 
and healing takes place completely in from twenty to thirty days. 
Catgut is here unsuitable, as it is too quickly absorbed. Guttmann 
had five relapses among twenty cases from this cause. 
Storry proceeded in a similar way. After dividing the sac from the 
skin, he sutured it with a strip of white leather, then cat it off and sewed 
the skin together. 
This method is to be preferred to lierniotomia interna (which necessitates 
opening the peritoneal sac), if for no other reason than that the chances 
of peritonitis are slighter, and success is not endangeied by piolapse of 
portions of intestine or omentum. It must, hovevei, not be foigotten 
that in many cases the peritoneum cannot be separated fiom the sui- 
rounding tissues, especially at the base of the hernial sac, and that the 
peritoneal cavity is apt to be opened in making the attempt. Neveithe- 
less bad results seldom occur. 
