310 
M. JACOULET. 
must be carefully separated in order to expose this ring entirel 
or to expose the vaginal sheath, as in the rare cases of inguiD; 
cryptorchidy in which the testicles have come down to the low( 
part of the interstice. To do this, while an assistant separate 
the edges of the scrotal wound, the operator lacerates the layei 
underneath with his fingers, guiding himself by the internal con 
missure of the inguinal ring; that is to say, the point of inse 
tion of the prepubic tendon, to the anterior border of the pubii 
or by the testicle, when it is felt under the cellular tissue. 
Bands resisting to the fingers are divided with the scissors 
the use of the bistoury being contra-indicated on account of th 
blood vessels. 
SECOND PART. 
This differs in abdominal and inguinal cryptorchidy. 
1st.—Inguinal Cryptorchidy. 
Comprising two steps Prehension and ablation of the testicle 
A. Prehension .—Two conditions may here present them 
selves. Either the testicle may be down on a level with the ex 
ternal inguinal ring, or it may be concealed higher up in the in 
guinal canal, or it may have remained in the abdomen, while onh 
a portion of the epididymis is down in the groin. In the firs 
case, the laceration of the layers of sub-dartoic cellular tissue ha: 
exposed the organ; and then an easy isolation finishes tin 
operation. Or, in the second case, the external inguinal cana 
having been well dissected by the laceration of the cellular tissue 
meshes, two or three fingers are introduced in it, and soon the 
organ is felt. The testicle and epididymis are then drawn out bj 
careful pulling until they are out of the external ring of the canal 
Bearing in mind the anatomical peculiarities already referred 
to, it will be easily understood that if the testicle is engaged ir 
the interstice, the fingers will readily recognize it through the 
external ring. But it may happen that it is situated so high up 
that the fingers are too short to reach it; in this case the vaginal 
sheath bem^ carefully raised with the forceps or a sharp tenacu¬ 
lum and opened, the testicle will at once descend until it can be 
easily reached and secured. 
