508 
R. MIDDLETON. 
of the operation have often been described. I will, then, only 
consider the points which, in my opinion, have not previously 
been accorded the place which their importance merited. 
In Denmark, as in Belgium, the inguinal canal has been 
selected by those having most to do with cryptorchids ; the 
old method by Caesarian section is seldom applied. From my 
view the former merits the preference, inasmuch as the tes¬ 
ticles are more easily, and at once more directly, reached. 
When these organs remain in the abdomen they are regularly 
situated in the vicinity of the superior inguinal opening, and 
exceedingly seldom in other than this region. 
The operation per the inguinal canal also deserves the pref¬ 
erence when, before the operation, the location of the testes 
in the abdomen cannot with certainty be recorded; as when 
they are diminutive in size, and flabby, or when they are sit¬ 
uated directly in the canal itself. In this last situation, re¬ 
moval by section of the flank would be seriously difficult, and 
in case of a narrow inguinal ring could not be carried out with¬ 
out resorting to the other operation and enlarging the ring. 
I will present the method recommended by Stockfleth and 
Nelson (Denmark) and lately modified by Bang. 
The important problem is the proof of the presence of the 
testes in the abdominal cavity ; this in itself is not without 
difficulty to the novice. Degive for this purpose introduces the 
hand into the rectum and therewith glides upon the lateral wall 
of the abdomen from the superior to the inferior regions. With 
this, I recommend also the following : Seek the anterior border 
of the pubis, and about four inches from the linea alba extend 
the fingers laterally as wide as possible upon the wall of the 
cavity. As a rule one feels the hemispherical, soft bodies, and 
can by manipulating with the fingers distinguish the size and 
outlines. Sometimes when in doubt, the proof is repeated 
after the administration of a purge; in other cases the vas 
deferens is followed from the vesicula seminalis to its junction 
with the organs of generation ; which are either disposed in 
the inguinal passage and can be here detected through palpa¬ 
tion by abducting the limb and simultaneously manipulating 
externally ; or they may be felt at the internal inguinal ring, 
