CASTRATION OF CRYPTORCHIDS. 
357 
•se either hand at his discretion. The hand and arm being well 
died, the former is formed into a cone by bringing the fingers 
ogether, and is carried towards the external ring, the internal or 
>repubic commissure and posterior edge of which are distinctly 
elt. It should be introduced into this ring by a slight pressure, 
aid a rotary motion. Then turning it outwards, upwards and 
lightly backwards, it is pushed carefully, methodically and with 
ill the tact at his command, into the inguinal interstice, by a 
,emi or quarter rotation from left to right and again from right 
o left, close outwards to the external angle of the interstice. 
In this way, the hand slowly penetrates, and as it were, slides 
mward, as it makes its way through a single separation of the 
wo organs (the small oblique muscle and the crural arch) which 
n resting against each other form the inguinal tract, and by the 
aceration of the cellular tissue which fills it up. 
To avoid lacerating the small oblique muscle of the abdomen 
the ends of the fingers, the operator must, during all the 
of the introduction of the hand, keep it well applied upon 
he crural aponeurosis, and upon the internal commissure, the 
lorsal face being turned forwards against the fleshy fibres of the 
nuscles, and the fingers being slightly flexed backwards. 
Deliberation in the work is indispensable. The surgeon 
hould move slowly, and pause in his work if in any doubt as to 
he parts which are touched; and he should stop at the slightest 
loubtful sensation, to proceed again only when certain that every¬ 
thing is right. 
Thus guided, the hand reaches the bottom of the interstice, 
md the pulp of the fingers will then readily distinguish the peri¬ 
toneum, and through this, the intestinal circumvolutions. It 
remains only to perforate this, which is done by pushing two or 
:hree fingers through, and opening them, thus penetrating the 
ibdominal cavity as the peritoneum is torn. The testicle or the 
epididymis is usually felt at once, and they are then brought out¬ 
wards; but cases sometimes occur in which it becomes necessary 
to enlarge the opening in order to introduce the entire hand into 
the abdominal cavity. 
This peritoneal laceration, through which access is had to the 
