46 
DEPARTMENT OF SURGERY. 
gress. The herniotomy is performed under the strictest aseptic 
precautions. The incision into the sac is made carefully to pre¬ 
vent wounding the viscera, and in a direction to favor gravity 
drainage during healing. When the fissure is exposed its edges 
are scarified with a curette and then brought into juxtaposition 
with catgut sutures passed completely through the wall, includ¬ 
ing the peritoneum. There is no tenable objection to the pass¬ 
ing of such sutures through this membrane. In fact, the peri¬ 
toneum always assists materially in closing the orifice. The 
surgical wound is then made perfectly bloodless and closed up 
with ordinary sutures. There is always an inclination here to 
cut away some of the superfluous skin, and entirely obliterate 
the sac. This may be done to a limited extent only, as provision 
must be made for considerable swelling which may rupture the 
sutures. A drainage opening is provided at the dependent end 
of the incision. The after care consists in keeping the patient 
quiet and in the standing position. The wound is treated as 
such. The sequelae are death from septic peritonitis and chronic 
fistulae. 
Whenever the fissure is too wide to co-arctate with sutures, 
the above method is of course out of the question and the only 
recourse is the covered operation. To take advantage of all the 
possibilities of this method the patient is prepared as above 
mentioned, then in the recumbent position the hernia is reduced 
by gravity and manipulation and a steel skewer passed com¬ 
pletely through the base of the sac. A strong cord is then 
passed around the tumor beneath the protruding ends of the 
skewer and tied tight enough to cause strangulation. The cord 
is left undisturbed until it sloughs off, about twenty days. The 
inflammatory action may be perpetuated throughout by bi-weekly 
injections of salt water, subcutaneously. This method does not 
occlude the orifice but removes the tumor by supporting the 
viscera. Success depends upon the stability of the adhesions 
produced between the subcutem and underlying textures. A 
large share of the old ventral herniae cannot be satisfactorily 
treated by this method on account of their wide base and thick¬ 
ness of the sac wall. Only the hernia having a comparatively 
narrow base and thin wall is successfully reduced by strangula¬ 
tion of the sac. 
Recent Ventral Hernice offer a much more favorable field for 
operative interference. If treated promptly and intelligently 
the great majority are curable. When called immediately after * 
the infliction of such an injury the surgeon is frequently tempted 
