50 SPRING-TIME SURGERY 



mistakes. One is in keeping too far forward and 

 the other is in being afraid to insert the hand far 

 enough up the canal. I therefore try to empha- 

 size the importance of going high up into the 

 groin and keeping back against the thigh when 

 forcing the hand up the canal. 



Locating the Internal Inguinal Ring. — 

 After the canal has been traversed by the hand 

 the selection of a spot for the opening into the 

 belly is the next thing of importance. There are 

 four places that may be used and are used by 

 various operators. 



1. Through the internal ring. 



2. Below the internal ring. 



3. In front of the internal ring. 



4. Above the internal ring. 



No matter what position is selected for the 

 opening, the wise operator will first locate the in- 

 ternal inguinal ring as a starting point. This 

 ring represents the upper end of the inguinal 

 canal. After the hand has been forced up the 

 canal to a point beyond the upper border of the 

 internal oblique muscle the operator finds that 

 only a relatively thin structure separates his 



