THE ABDOMEN 915 



didymis, situated on the front of the spermatic cord immediately above the 

 globus major, beneath the visceral layer of the funicular portion of the tunica 

 vaginalis ; and (3) the vas aberrans of Haller, situated at the point where the 

 globus minor passes into the vas deferens. The tissue between the globus 

 major and the testis should be carefully unravelled, and an effort made to 

 show the coni vasculosi entering the globus major after leaving the testis. 

 The vas deferens should be shown as it passes off from the globus minor, and 

 the tortuosity wluch it here presents is to be noted. The tunica albuginea 

 is next to be opened by making a vertical, median, anterior incision. On 

 separating the t'.vo halves from the substance of the testis the dissector is 

 to observe the fibrous processes, thereby torn, which pass into the interior 

 of the organ between the lobuU testis. An attempt should now be made to 

 show the lobuli testis by teasing out the glandular tissue, which may bring 

 into view the tubuli seminiferi. A transverse incision should next be made 

 through the testis, in order to show the forward projection of the tunica 

 albuginea from the back part of the testis into the interior for a short dis- 

 tance, known as the corpus Highmorianum, or mediastinum testis. 



The abdominal wall above the umbilicus is to be removed by making a 

 vertical incision through it at either side of the middle Une, thus preser\-ing 

 meanwhile a median strip. The lateral parts of the waU are then to be 

 divided along each costal margin as far back as the position of the body will 

 allow. Reverting to the median vertical strip, the dissector should study 

 on its posterior surface a median fold of parietal peritoneum, representing a 

 part of the falciform Ugament of the liver, which contains the obUterated 

 umbilical vein. The umbilicus and this peritoneal fold are to be preserved. 



Without in any way disturbing the contents of the abdominal cavity, the 

 dissector should remove with a sponge any fluid which may have accumu- 

 lated. He should then make himself acquainted with the various regions 

 into which the cavity is divided, and the lines and planes by which these 

 divisions are effected. He should also study the boundaries of the cavity. 

 The succeeding stages of the dissection being very complicated, it is ad'/ isable 

 that the dissector should exercise considerable method in his mode of pro- 

 cedure. His first duty is to take a superficial view of the contents of the 

 abdomen in their undisturbed position, and this should be done in the 

 following order : the liver, the stomach, and the great omentum, depend- 

 ing from the great curvature of the stomach. It should be noted that 

 the great omentum descends lower on the left side than on the right, and 

 that a few coils of the ileum are visible beyond it on the right side. The 

 caecum will be partly seen in the right iliac fossa, and the iliac colon is partly 

 visible in the left iliac fossa. 



The great omentum is next to be raised and laid over the costal margin, 

 when the coils of the jejunum and ileum will come into view. The trans- 

 verse colon will also be seen crossing from the right to the left hj'po- 

 chondrium. If the urinary bladder should be distended, a part of it would 

 be seen in the h\-pogastrium. The foregoing represent the contents which 

 are seen on taking a superficial view. The coils of the jejunum and ileum 

 should now be carried over to the left side, and the ascending colon examined. 

 Superi )rly it will lead to the hepatic flexure, and, without disturbing the 

 parts, the right kidney should be felt. The caecum %\-ill now be fully exposed 

 at the lower end of the ascending colon, and the vermiform appendix, and 

 the mode of ending of the ileum in the large intestine, should be carefully 

 examined. The coils of the jejunum and ileum are then to be carried over 

 to the right side, and the descending colon, commencing above at the splenic 

 flexure and terminating below in the iliac colon, is to be examined. The left 

 kidney is to be felt for, and, if the jejunum is followed upwards, the duodeno 

 jejunal flexure will be exposed. 



The dissector should now study (i) the position and connections of the 

 stomach, and {2) the position and connections of the intestinal canal (except 

 the duodenum, pelvic colon, and rectu-n). In connection with the small 

 intestine the possible presence of Meckel's diverticulum, about 3 feet from 

 the ileo-OEcal valve, is to be borne in mind. In studying the laige intestine. 



