244 OPERATIVE TECHNIQUE. 



operator, who has carefully disinfected his hands and arms and thrust 

 his sleeves back above the elbow. The position is the same as in 

 castration. The operation is divided into the following stages : 



1. Incision. — An incision is made through the skin, about two to 

 three inches long, over the outer inguinal ring (perhaps slightly nearer 

 the middle line) and parallel with it, and the subcutaneous tissue and 

 fascia 13'ing at this point are divided to the same extent. Any bleeding 

 vessels are at once ligatured, and blood removed with sterilised 

 pledgets of tow. 



2. Opening the inguinal canal. — The loose connective tissue in the 

 inguinal canal must now be thrust on one side, both index fingers and 

 possibl}' the thumbs being emplo}'ed, and an entrance effected in the 

 direction of the inner abdominal ring. The index and middle fingers 

 of the hand corresponding to that particular side of the animal are 

 then passed into the inguinal canal to make sure whether the processus 

 vaginalis and remainder of the spermatic cord lie there. Should the 

 testicle be met with at this stage (retentio inguinalis), the operation 

 becomes very simple, being, in fact, just like ordinary castration. 

 Sometimes a more or less degenerated process of the- tunica vaginalis, 

 perhaps as large as the finger of a glove, together with the end of the 

 epididymis, may be felt in the inguinal canal. In that case the inner 

 abdominal ring must be examined by introducing the index finger, and 

 its width discovered. Generally it is very narrow, and would not even 

 permit the passage of the rudimentar}- testicle. As it is difficult to 

 dilate, I prefer in such cases to ignore the process of the tunica 

 vaginalis, and seek an entrance to the abdominal cavity alongside of 

 it. When the inner abdominal ring appears wider, the processus 

 vaginalis is to be divided and the operation continued as after 

 perforation of the abdominal walls. 



3. Perforation of the abdominal icalls. — By passing the fingers, 

 nearly to the last knuckle, into the inguinal canal, the abdominal wall 

 can be felt in the depths. The posterior border of the obliquus 

 abdominis and the fibres of the obliquus internus can be clearly 

 distinguished. Close behind the latter is a mass of loose connective 

 tissue. Degive makes his perforation at this point. Like Bang, I 

 prefer entering through the inner oblique abdominal muscle at the 

 inner wall of the inguinal canal, somewhat nearer the median line than 

 the inner abdominal ring. This produces a "button-hole woun'd," 

 which does not gape, but, on the contrar}-, soon comes together again 

 and prevents prolapse of the bowel. A vigorous thrust with the index 

 and middle fingers during inspiration carries them through the 

 abdominal wall into the peritoneal cavity. Different animals, however, 



