754 



GENITO-URINARY ORGANS. 



fingers (Fig. 311). Simultaneously the operator presses on the hase 

 of the testicle with the thumb of the left hand, thus causing a rotary 

 movement in a vertical plane ; the tail of the epididymis becomes 

 uppermost. A certain empty space separates the testicle from the 

 base of the scrotum. 



Third stage. Torsion of the cord. The testicle having been 

 rotated, the cord must be twisted so that the vessels may be oblite- 

 rated. The left hand continues grasping the cord, which is then 

 brought in front of the testicle, whilst with the right hand the testicle 

 is pushed backwards and is made to describe a semi-circle. The cord 

 was previously on the left side ; it is now on the right, and simul- 

 taneously the testicle passes from right to left. 



In completing the turn the 

 hands must not be changed, and, 

 above all, must not let go their 

 hold ; and the cord is pushed for- 

 wards and towards the right with 

 the right hand, whilst the testicle 

 is pushed backwards and to the 

 left with the left hand. The cord 

 and the testicle resume their ori- 

 ginal position ; one complete turn 

 has been effected. These manipu- 

 lations are repeated several times, 

 and the cord soon assumes the 

 appearance of a large, hard, tense 

 string. To ensure obliteration seven 

 or eight turns should be made in 

 the case of the bull and four or 

 five in that of the ram. 



Torsion of the right testicle 

 being complete, the gland is thrust towards the upper part of the 

 scrotum and the left testicle is submitted to the same manipulation, 

 the position of the hands, however, being reversed. 



Fourth stage. Fixation of the testicles in the inguinal region. 

 Both testicles having been thrust upwards as far as possible into 

 the inguinal region, the scrotum is ligatured below them. Tape or 

 thick cord should be used, to guard against gangrene of the lower 

 portions of the scrotum. A considerable oedematous swelling soon 

 occurs, and when at the end of twenty-four or forty-eight hours 

 infiltration is well developed, the ligature should be removed. 



Dubourdieu has described a different method, in which the testicle 

 is rotated in a horizontal plane. The position of the hands is 



Fig. 312. — Bistournage. Third phase. 



