314 
F. MAURI. 
tract. To avoid this accident, which might bring on an even¬ 
tration, it is prudent to bring the testicle through the perito¬ 
neal opening before the hand is removed from the abdomen. 
To do this, the fingers are flexed from forward backward, the 
testicle is pushed downward, while the intestines are kept in 
place with the dorsal face of the hand. This is then with¬ 
drawn carefully, carrying the testicle downward more or less, 
according to the length of the cord. In this motion the pos¬ 
terior border of the small oblique, which was pushed away 
and encompassed the hand, falls back immediately into posi¬ 
tion on the crural arch and the opening is closed, its elevated 
position preventing the exit of the intestinal circumlocution. 
Thus it is seen that eventration is but barely possible if 
one follows strictly the rules of the modus operandi herein 
described. If, on the contrary, the operator, after passing it 
through the inguinal ring, immediately turns his hand toward 
the peritoneum or against the small oblique, not only will the 
intestines have a tendency to push through the opening thus 
left dilated, but the accidental laceration of the muscle will 
remain gaping, and eventration is rendered unavoidable, not¬ 
withstanding the best contentive dressing. 
A difficulty which must not be overlooked and against 
which one must guard, is the excessive fatigue of the arm 
and hand while in the inguinal tract or in the peritoneal cav¬ 
ity, resulting from the efforts of the operator and of the com¬ 
pression made by the muscles of the abdomen and of the 
thigh. Under its influence the fingers will lose much of their 
tactile sensitiveness, and will no longer act as intelligent 
assistants. At such times the inexperienced surgeon may lose 
his self control, becoming uneasy and uncertain through fear of 
having undertaken too difficult a task. To continue in such a 
condition is to expose himself to false manipulations and seri¬ 
ous accidents. The surgeon must then stop his work, with¬ 
draw his hand and rest himself. He cleanses his arm and 
hand, dips them several times in cool water and waits until 
the suppleness and sensibility have returned. Another im¬ 
portant precaution not to be neglected, is to avoid reintroduc¬ 
ing the hand until it has been thoroughly disinfected with 
