PRACTICAL CRYPTORCHID CASTRATION 63 



importance. From a practical standpoint the en- 

 larged testicles may be divided into two classes, 

 viz., cystic and solid, the former admitting of a 

 reduction in size by tapping. Upon the discovery 

 of an enlarged testicle during the progress of the 

 operation the operator settles two questions in his 

 mind. First, is the testicle small enough to pass 

 out through the ring safely? This, however, 

 varies greatly in different cases and the operator 

 is the judge of the possibilities in a given case. 

 Second, is the testicle cystic? If so, it is tapped 

 through the inguinal canal with a long trocar. 

 The technic is as follows: An assistant, not 

 necessarily but best a skilled assistant, empties 

 the rectum of the patient and inserts the hand into 

 the same as far forward as possible. By the direc- 

 tions and assistance of the operator, the assistant, 

 by rectal manipulation, pushes the testicle up 

 against the internal ring and holds it there firmly 

 by pressure from behind. The operator then in- 

 serts a trocar up the canal, and it is usually an 

 easy matter to draw off the cystic fluid. The 

 rectal manipulation of an assistant is of great 

 value also in the withdrawal of a large testicle 



