70 SPRING-TIME SURGEBY 



with but one or two fingers inserted into the peri- 

 toneal cavity, one can see that the opening up of 

 the second inguinal canal would be far less in- 

 jurious than inserting the whole hand through 

 the belly wall in the attempt to bring across the 

 second testicle. It is best to make a double opera- 

 tion, but remove both testicles at one casting. 



The operation where entrance to the peritoneal 

 cavity is made by an incision directly through, the 

 belly wall in the neighborhood of the internal ring 

 is used by several operators and with success. I 

 have not found it as satisfactory, from a number 

 of standpoints, as the inguinal-canal route. 



An operation that one will very infrequently 

 have occasion to use is that in which the peri- 

 toneal cavity is reached through its triangle of 

 the upper flank. This operation is the one of 

 election when a large testicle is to be removed. 

 The opening is made at a point where it can be 

 completely controlled from a surgical standpoint, 

 it can be closed and protected and it is where 

 danger of intestinal prolapse is absent. Opening 

 the belly cavity in this region is a safe procedure 

 under even moderate aseptic conditions. I have 



