'510 
R. MIDDLETON. 
2 . The exposure of the inguinal canal; for this purpose the 
two index fingers, with or without the thumb, are used; the 
loose connective tissue is pushed forwards and backwards in 
the direction of the internal ring. When the fingers are in¬ 
serted up to the knuckles, the hand upon the intero-posterior 
commissure is removed, while the index and middle fingers of 
the other hand are again inserted for the purpose of finding, 
if possible, the tunica vaginalis, or any portion of the vas. Oc¬ 
casionally a portion of the epididymis is felt in the canal, as a 
characteristically yielding body. The testicle is easily 
diagnosed by its form ; and when felt the tunica vaginalis 
is incised sufficient for the removal of the organ. When the 
globus minor only is discernable, the question arises, if the in¬ 
ternal ring be of sufficient size to permit the passage of the 
generally stunted testicle ; to ascertain this, one or two fingers 
are introduced. When Avidening of the natural openings is 
indicated 1 would advise the tenotome or herniotome. When 
the testes lie upon the abdominal wall the inguinal canal will 
of course be found empty, that is, only occupied by connec¬ 
tive tissue; on the side of the canal toward the median line 
soft muscular substances of the oblique interims abdominis 
is felt, which, if followed, leads to the internal ring, pro¬ 
viding one be extant. When the tunica vaginalis fails to 
appear in the canal, so also generally fails the internal 
inguinal ring; and the anatomical disposition is precisely as 
in the female. 
3. Perforation of the occluded abdominal Avail; there are 
three possible Avays of removing the testicles from the ab¬ 
domen, through the inguinal canal. 
a. Ety perforating the peritoneum and thick connective 
tissue which covers the situation of the absent or incompletely 
developed internal ring. 
b. By thrusting the fingers through the connective tissue 
behind this ring. 
c. By lacerating the fibers of the internal oblique towards 
the white line and close by the side of the internal opening. 
I have tried all three methods and prefer, as do the Danish, 
the last one. The first presupposes the existence of an in 
