358 
M. JACOULET. 
abdominal cavity is, as we have already said, made some 12 or 1 
centimetres outward of the linea alba, and near the sub-lumbi 
region. This renders the occurrence of hernia difficult on a 
count of the elevated situation of the opening, as well as by tlj 
closing of the tract, which takes place as soon as the hand is r 
moved, in consequence of the exact co-operation of the sma 
oblique muscle, pushed backwards against the crural arch by tl 
intestinal mass. 
We do not hesitate to repeat that, if great caution has nc 
been observed, as soon as the external inguinal ring is passe 
through, to turn the hand outwards in the interstice in order t 
avoid the perforation of the small oblique, by the position give 
to it, and the careful movement, the peritoneal opening would b 
made at a point too low, and too close to the median line, whik 
moreover, the laceration of the muscle could not be closed u 
with precision at the moment of the withdrawal of the hant 
eventration would be the unavoidable consequence of the fals 
manipulation. 
In the perforation of the inguinal interstice the operator ma 
meet two principal difficulties: 
u 1st.— The natural resistance of the external inguinal ring 
and 
“ 2d.—The pressure resulting from the occasional ver 1 ; 
violent contraction of the muscles of the abdomen and posterio 
leg.” 
Mr. Degive gives clear instructions for overcoming these diffi 
culties. He says: “Very fortunately these obstacles are not in 
surmountable. The operator can always overcome them by pro 
ceeding slowly, quietly and watchfully. 
u It is not a rare thing in these circumstances for the arm anc 
hand to become quite exhausted and even paralyzed both by tin 
efforts made and the continued compression experienced. In these 
circumstances the operator may easily lose confidence and th< 
presence of mind so essential in the operation to insure a successfu 
conclusion. 
u It may even happen that he shall relinquish the undertaking 
just at the point of time when a little intermission for rest at th< 
