18 SPRING-TIME SURGERY 



view, the entire epididymis being abnormally 

 elongated and attenuated. The testicle itself re- 

 mains firmly lodged above the internal ring, or 

 incarcerated in it, and, however much traction 

 may be exerted on the epididymis, the gland 

 usually remains immovably fixed. 



The first case of this kind with which we met 

 led us into error, and we removed the epididymis 

 and a portion of the vas deferens, while we left 

 the testicle in the abdomen. Later in our clinic 

 we operated upon a case, the history of which 

 could not be traced, but which had evidently been 

 operated upon by some one who had fallen into 

 the same error, removing the epididymis and 

 leaving the testicle. The condition offers some 

 difficulty to overcome. The most direct method is 

 to freely incise the peritoneal sheath down to the 

 internal ring and either dilate this by forcing the 

 finger through the ring along side of the vas de- 

 ferens and epididymis, or by cautiously incising 

 the ring with a scalpel or bistoury. The testicle 

 may then be withdrawn and removed. 



If the testicle itself is encountered in this re- 

 gion (inguinal cryptorchidism) the gland is to be 



