62 6 
TAIT BUTLER. 
thus made may then be enlarged by the introduction ol two 
.fingers. To lacerate the tunica vaginalis reflexa it is gener¬ 
ally necessary to introduce a scalpel and nick the membrane, 
when the opening may be enlarged with the fingers and the 
testicle secured without difficulty. The completion of the 
operation may be effected as in ordinary castration and, there¬ 
fore, no further description is necessary. If after passing the 
fingers up under the dartos as far as the internal ring and 
carefully manipulating the tract of the canal, the testicle is 
not discovered, the operator must continue the process of 
breaking down the loose cellular tissue in the direction of the 
external angle of the ilium until a point about an inch and a 
half superior to the internal inguinal ring has been reached. 
When this has been done sufficiently to allow the hand to 
pass freely into the artificial channel thus formed the next 
step is to enter the abdominal cavity. This should be done 
at a point superior to but in the vicinity of the internal ingu¬ 
inal ring. If the opening be made even through the muscular 
and other tissue directly superior to the inguinal ring the 
operation may be completed with ease and safety; but the 
preferable point at which to enter the abdominal cavity is 
about an inch, or an inch and a half, above and behind the 
internal inguinal ring. Or, in other words, behind Poupart’s 
ligament and between it and the ilium, but superior to the 
inguinal ring. If when the ligament is felt the index finger 
be passed over it and then turned downwards the cavity may 
be entered with ease. Moreover, if a point an inch superior 
to one on a level with the internal inguinal ring be selected 
the finger enters the abdominal cavity on the line of descent 
of the testicle and above the crural vessels, thereby combin¬ 
ing the greatest possible convenience and safety. 
After the index finger of the hand corresponding to the 
side on which the ectopim of the testicle exists has been forced 
into the abdominal cavity, the next finger may be pressed 
down alongside of it so as to slightly enlarge the opening. 
If the opening has been made where above directed, in no case 
will it be necessary to introduce the whole hand into the ab¬ 
dominal cavity unless the testicle has remained in its primary 
