The Perineum. 299 



Hydrocele. Should tapping of the sac be employed, 

 it is advisable to bear in mind that, in the majority of 

 cases, the testicle is situated posteriorly, and hence the tro- 

 car and canula should be inserted from the front, and, 

 after penetrating the tunica vaginalis, as evidenced by the 

 cessation of resistance to its passage through the tissues, 

 the point of the trocar "should be directed upwards so as 

 to avoid the testicle. , 



Varicocele. In the open method of operating for var- 

 icocele a transverse incision through the scrotal tissues is 

 better than a longitudinal one, since, when sutured, the 

 edges of the resulting wound are better approximated 

 than in the longitudinal incision because of the direction of 

 the unstriped muscular tissue of the dartos of the scro- 

 tum. Before ligating the pampiniform plexus of veins, 

 the vas deferens should be identified by the cord-like feel 

 it imparts to the fingers, and should be carefully avoided, 

 not only for its own sake, but also because the artery of 

 the vas deferens runs along with it. Two or three veins 

 should be left out of the ligature, since otherwise, orchitis 

 or atrophy of the testicle might result, and, lastly, the 

 plexus should be excised between two ligatures, one above, 

 on the cord, and, the other below, near the globus minor 

 of the epididymus. 



In castration, an incision is made from a point one inch 

 beneath the external ring to the bottom of the scrotum, 

 and when the testicle and cord are exposed, the latter is 

 divided about three-quarters of an inch below a clamp 

 placed upon its upper part. It is better to ligate the blood- 

 vessels separately, rather than to include the whole of the 

 cord in one ligature, since this might slip and permit 

 secondary hemorrhage. 



