26 SPRING-TIME SURGERY 



by the insertion of one finger, the danger from 

 visceral prolapse is very remote. We have not 

 observed the accident under these conditions. 



If the entire hand is forced through the ring, 

 admittedly there is danger of prolapse. If the 

 entire hand is forced through the fascia of the 

 small oblique above and anterior to the internal 

 ring or elsewhere in the vicinity, the inevitable 

 rent will pass down, and involve, or pass along- 

 side the ring and produce a tear essentially iden- 

 tical with that caused by forcing the hand directly 

 through the ring. 



Pathologic Testicles. — Should the testicle fall 

 within the second or third class we have men- 

 tioned, and be greatly enlarged, so that it must 

 be removed entire, it matters little whether the 

 internal ring is enlarged to permit its escape or 

 the same sized opening is made in close prox- 

 imity to the ring. There results a great rent 

 through which visceral prolapse is highly proba- 

 ble. Should the operator know in advance that 

 he has a testicle of extraordinary size to deal 

 with, he should abandon the inguinal route and 

 choose the upper flank as the safer and better. 



