METHODS OF OPEEATIXG. 645 



fastened by pulling its handles together and fastening them with 

 the slide. The testicle being now firmly secured, the operator 

 is to divide the non-vascular posterior part of the cord, close 

 to the surface of the clam and above the epididymus, by 

 running a sharp knife flatwise upon the clam, taking care, 

 however, not to cut beyond what is seen to be white and 

 bloodless, and leaving the testicle and vascular cord untouched 

 Avith the knife. The vascular portion of the cord is now to be 

 firmly embraced with the torsion forceps as close as possible to 



Fig. 115. — Torsion forceps. 



the surface of the clam, and the testicle cut off within about an 

 inch from the forceps. The forceps — the grasp of which having 

 been fixed by the screw — is now to be turned slowly round 

 with the right hand of the operator, the left being engaged in 

 keeping the clam steady, when it will be seen that the tissues 

 of the cord quickly give way, until the spermatic artery alone 

 remains ; this gives way more slowly, and very frequently will 

 remain unbroken till it is drawn out as small as a piece of 

 thread. In some instances it will be found necessary to re- 

 apply the torsion forceps after a few turns have been made, 

 owing to the cord commencing to give way at a distance from 

 the clam, which — if not prevented by the reapplication of the 

 forceps — would leave a quantity of ^bruised tissue attached to 

 its extremity. 



It is important that but as little as possible of the cord, 

 bruised by the forceps, should be left attached, and that the 

 cord should be made to break across as near to the clam as pos- 

 sible. It is also important to bear in mind that the forceps 

 should be turned slowly and steadily, rapid jerking twists being 

 calculated to rupture the artery before its coats are sufficiently 

 bruised. When the division of the artery is complete, the clam 

 is to be slowly removed, the cord allowed to escape into the 

 scrotum, and the other testicle operated upon. I have operated 



