762 
DEPARTMENT OF SURGERY. 
been taken, the patient should be placed in the most convenient 
position, and an incision made through the skin and subcutan¬ 
eous tissue, along the transverse axis of the external inguinal 
ring (Fig. 38.) The incision should be about 10 cm. long, 
avoiding the external pudic artery and the subcutaneous abdom¬ 
inal artery and vein. 
The external ring is opened by breaking through the con¬ 
nective tissue ; if the testicle is on the right side use the right 
hand (on the left side use the left hand), and insert it 
into the external ring with the first two fingers extended (Fig. 
39), and with gentle pressure rotate it, occasionally spread them 
(the fingers) apart like a glove stretcher, keeping close to 
Poupart’s ligament and in the subcutaneous tissue, until you 
reach the commissure formed by Poupart’s ligament and the 
internal oblique muscle (“internal inguinal ring ”), then break 
through the peritoneum with a sudden thrust. If possible only 
two fingers should be inserted into the abdominal cavity and an 
attempt made to secure the vas deferens and draw the testicle 
to the opening made in the peritoneum ; if the vas deferens can¬ 
not be found, the entire hand must be inserted into the abdom¬ 
inal cavity and a search made for the vas deferens and the tes¬ 
ticle ; if it cannot be found, the other hand should be placed 
into the rectum to press the viscera in the direction of the hand 
that is in the abdominal cavity. When the vas deferens or tes¬ 
ticle is found, the operator must improvise the best and most 
simple way to get the testicle into the inguinal canal. When 
the testicle is in the inguinal canal, it should be brought to the 
surface, or as near to it as possible, and removed with an emas- 
culator or ecraseur. 
