REPORTS OF CASES. 
93 
ibout eight inches long, extended from the upper part of the 
scrotum to a point perhaps two inches external and anterior 
:o the internal abdominal ring. 
2. The external ring and aponeurosis of the external oblique 
nuscle being fully exposed, the aponeurosis of the external 
oblique muscle and the internal oblique apd transversalis 
nuscles were divided to a point about one inch external and 
interior to the internal abdominal ring. 
3. The sac was isolated and incised. The hernia was of 
he congenital variety. The testicle was atrophied and the 
globus major of the epididymis occupied the external abdom- 
nal ring. It was therefore impossible to perform a 
horoughly radical hernia operation without sacrificing the 
esticle either by amputation or by constriction of its epi- 
iidymis. 
4. The testicle was amputated and the peritoneal cavity 
dosed off by a few quilt sutures applied along a line consid¬ 
erably higher than the so-called neck of the sac. The sac was 
excised close to this line of sutures. 
5. Six quilt sutures, passed very deep, were taken through 
he pillars of the external ring and through the divided exter* 
lal oblique aponeurosis and the internal oblique and trans- 
rersalis muscles. 
6. The skin wound was closed bv buried skin sutures. 
The transplantation of the vas deferens, one of the princi- 
)al features of Halsted’s operation, was, under the circum¬ 
stances not indicated. 
He was kept well under morphia and lay very quietly 
intil late in the evening, when, as he became uneasy the hob- 
>les were removed and he was allowed to rise, four men being 
)resent to assist him should he have any difficulty in getting 
ip. The floor, which was of clay, was built up by bedding 
o that he stood with his rump at least six inches higher than 
)is withers, and his head was tied up so that he should not 
-ttempt to lie down. The next morning a bar was put across 
he box three feet from the wall so that he could not move 
)ut of position. 
The day following the operation the mucous membranes 
