22 SPRING-TIME SURGERY 



secure the forceps in this position, with the de- 

 sired structure firmly caught, and the beginner 

 introduces his hand, palpates all the parts, rup- 

 tures the peritoneum, grasps the gubernaculum 

 and then the vas deferens, followed by the epi- 

 didymis, and completes the operation. 



Reaching and recognizing the internal ring, 

 operators divide themselves into two or more 

 groups in their further procedure. 



We recommend, in those cases we have just 

 mentioned, in which the operator can grasp the 

 vas deferens or epididymis outside the ring in the 

 processus vaginalis, still covered by the periton- 

 eum, that the peritoneal covering be ruptured by 

 dragging upon it, the tail of the epididymis 

 grasped and drawn out and the testicle itself 

 brought out by traction upon the epididymis, thus 

 completing the operation without the insertion of 

 the hand or even of a finger into the abdominal 

 cavity. In some cases, the testicle may not be 

 drawn through the narrow ring by traction alone, 

 in which instances we insert an index finger, 

 dilate the ring, and, exerting traction on the epi- 



