CRYPTORCHIDECTOMY 269 



skin toward the internal abdominal ring. While this step 

 of the operation is being executed the canal is palpated for 

 the testicle which might be found in the canal covered with 

 the tunica vaginalis. 



The opening of the vaginal canal is facilitated somewhat 

 by oiling the hand. But when oiling is practiced care should 

 be taken to use only a perfectly sterilized lubricant. Re- 

 cently boiled linseed oil with three to five per cent phenol, 

 kept in a well stoppered sterilized bottle answers the pur- 

 pose. 



Third Step. — Perforating the Peritoneum.— When the 

 hand has been thus placed palpation with the index finger 

 here and there soon discloses a thin spot, where the finger 

 can be • pushed through by pressing about half a pound. 

 First the index finger alone is pushed through ; then, if the 

 cord cannot be found at once by "wiping" around in diff- 

 erent directions, the second finger is also passed through 

 the perforation. Failure to find the cord or the testicle 

 with the two fingers may necessitate passing the entire hand 

 into the abdominal cavity, but as this is an exceptionally 

 hazardous procedure, and is only required in anomalies of 

 great rarity, the failure to find the testicle with the two 

 fingers must be complete before it is attempted. 



Fourth Step. — Searching for the Testicle. — The search 

 begins as soon as the hand enters the external abdominal 

 ring and continues while the canal is being opened, in the 

 hope of finding the testicle in the canal (extra-abdominal), 

 and when the hand has penetrated the required distance (six 

 to nine inches) the index finger palpates for a possible fluc- 

 tuant sac that announces the existence of the intra-inguinal 

 variety (Farmer Miles' No. 4). If these extra-abdominal 

 manipulations show that the canal is free from any evidence 

 of a testicle the diagnosis of intra-abdominal cryptorchidism 

 is then certain, and the perforation of the abdomen as de- 

 scribed in step three becomes necessary. The perforation be- 

 ing made first with the index finger, attempt is made to hook 

 up the cord or some' part of the testicle without any further 

 enlargement of the opening, and indeed very frequently the 

 intra-abdominal pressure will press the testicle toward the 

 opening when the least bit of traction is applied to any of 

 its appendages. But when these efforts fail after a few min- 

 utes' trial, the second finger is passed through the perfor- 

 ation and the search extended over wider limits. The 

 fingers execute wiping movements, first against the parietal 

 peritoneum and then in different directions amongst the vis- 



