THIRD METHOD OF CASTRATION -- CRUSHING OF THE TESTICULAR CORD --
DOUBLE SUBCUTANEOUS TORSION -- BISTOURNAGE -- FOUR STEPS OF THE
OPERATION -- SYMPTOMS FOLLOWING -- CASTRATION OF CRYPTORCHIDS --
INGUINAL CRYPTORCHIDY -- ABDOMINAL CRYPTORCHIDY -- MODUS OPERANDI --
FIVE STEPS IN THE OPERATION -- EFFECTS FOLLOWING THE OPERATION OF
CASTRATION -- MODE OF CICATRIZATION -- HYGIENIC AND SUBSEQUENT
ATTENTIONS OR AFTER CARES.
As I have before stated, the third method of castration embraces the
processes in which the testicular envelopes are left intact, while it is
the gland or cord which is submitted to the peculiar manipulations by
which their structure, and therefore the secreting powers of the
testicle, are so essentially modified. In treating of this method, two
special operations present themselves for our consideration, to wit: the
_crushing of the testicular support_, and the _double subcutaneous
twisting_, or _bistournage_ of the French. These are employed
principally in the castration of ruminants, though efforts have been
made to apply the latter in the case of solipeds. The modes of operating
which we have already described are, however, also applicable to the
ruminants.
CRUSHING OF THE TESTICULAR CORD.
This consists in crushing the spermatic cord with a hammer, the vessel
continuing, meanwhile, to be covered with its envelopes. It was first
described in the year 1826, and is most commonly practised in some
French districts. The instruments used are two cylindrical pieces of
wood, each about one yard in length and two inches in diameter; and a
hammer or mallet formed of hard and heavy wood. The animal being
properly secured in the standing position, the testicles being drawn
well down into the bottom of the envelopes, the sticks are placed, one
behind and one in front of the cord, close to the upper extremity of the
gland. When in that position they are moved in such a manner that
instead of remaining, one in front of the other, one becomes so
superimposed upon the other that the spermatic cord becomes twisted in
the form of the letter S (Fig. 15). While held together in this position
by an assistant, the operator, placing himself in front of one side of
the hind quarter, with repeated blows of the hammer or mallet, crushes
the cord at the point where it rests upon the wood which occupies the
inferior position, of course guaging the force and frequency of the
blows by the effect observed, until the crushing of the organ is
satisfactorily accomplished. As a measure of caution, it will be well,
upon the completion of the process of crushing, to surround the cord
with a ligature moderately tightened, in order to guard against the
drawing up of the cord into the inguinal canal, an accident not likely
to occur, however, if the operation has been well performed.
[Illustration: FIG. 15.
CASTRATION BY CRUSHING OF THE CORD.]
DOUBLE SUBCUTANEOUS TORSION; BISTOURNAGE.
In this mode of operating, principally in vogue in the southern parts of
France, the position of the testicle is so changed that its lower
extremity is made to take the place of the upper, the cord is subjected
to a certain degree of torsion, and then the testicle is restored to its
normal position, to undergo a process of atrophy which destroys its
power of secretion by a physiological action. The great length of the
cord and the greater laxity of the cellular tissue situated between the
dartos and the fibrous coat, render this operation much easier in the
ruminants than in the solipeds. Simple in its manipulations, although
still involving a certain degree of dexterity, and followed by
comparatively no symptoms of reactive fever, the only instrument
necessary for its performance is a piece of cord, twine, or rubber,
sufficiently strong to secure the testicular envelopes when the gland
has been subjected to the double displacement, and the cord to the
torsion it has undergone. In this operation, no special preparation
being demanded, the animal is usually treated on his feet.
The late Mr. Serres, of the veterinary school of Toulouse, divides the
operation into four steps, viz., _first_, the softening of the bags and
separation of the dartos from the fibrous tissue; _second_, the
displacement (dislocation) of the testicle; _third_, the torsion of the
cord; and _fourth_, the pushing up of the testicles into the inguinal
region, with the application of the ligature to keep them in place.
[Illustration: FIG. 16 (A).
DOUBLE SUBCUTANEOUS TORSION IN CATTLE.
Softening the bags--first position of the hands.]
[Illustration: FIG. 16 (B).
DOUBLE SUBCUTANEOUS TORSION IN CATTLE.
Softening of the bags--second position of the hands.]
The first step is the most difficult for the surgeon as well as the most
painful to the horse, though the contrary is the fact where the subject
is an ox. The operator, stationing himself behind the animal, grasps
the testicles with both hands (Fig. 16) and quickly draws them down into
the scrotum. Holding them there with the right hand, with the left he
raises the scrotum by the lower part, firmly pulling upon it downwards
and slightly from before backwards. The testicles are then moved upward
and downward in the sac, carrying with them the fibrous covering. During
this time a peculiar crackling sound is heard, which is caused by the
tearing apart of the fibres of the cellular tissue lying between the
dartos and the fibrous coat. This laceration is sometimes difficult to
effect, especially in aged animals, in which case the up and down motion
of the testicles will require a greater number of repetitions before the
adhesions are torn.
[Illustration: FIG. 17.
DOUBLE SUBCUTANEOUS TORSION IN CATTLE.
Position of the left hand at the beginning of the second step.]
[Illustration: FIG. 18.
DOUBLE SUBCUTANEOUS TORSION IN CATTLE.
Second step.]
The second step consists in the displacement or dislocation of the
testicle, which is accomplished in the manner following: The testicles
being pushed well upwards in the vaginal sac, one of them, the left, for
example, is drawn well downwards with the left hand, which grasps the
cord above the epididymis (Fig. 17), the thumb resting on the back of
the cord, and the remaining fingers in front of it, while the right
hand, placed in pronation, pinches the inferior part of the scrotum.
Maintaining these dispositions, the testicles are displaced by the
simultaneous action of both hands, the left pushing the cord from above
downwards and from before backwards, in such a manner as to depress as
much as possible the superior extremity of the gland, while with the
fingers of the right hand, resting by their dorsal face against the
posterior part of the testicle (Fig. 18), the inferior extremity of that
organ is pushed upwards. Without losing hold of the envelope, the
movement of this hand gives way to these opposite and simultaneous
pressures, that of the left hand tending to lower the head of the
testicle, and that of the right elevating its tail, and the gland is
being flexed upon the cord from which it is suspended, backwards and
upwards. At the moment when the testicle forms an acute angle with the
cord, the thumb of the left hand, resting upon the cord, comes into
action to aid in the displacement by making a _point d’appui_ upon the
inferior extremity of the organ, which now occupies the superior
position, in such a manner that the spermatic gland is placed parallel
with the cord. The manipulations are completed by pushing the testicles
upwards towards the inguinal ring, to break up whatever adhesions of
cellular tissue may remain. This second step of the operation being
completed, the two organs are found to be so placed that they are
parallel one with the other, the testicle being posterior to the cord.
[Illustration: FIG. 19.
DOUBLE SUBCUTANEOUS TORSION IN CATTLE.
Third step. Position of the hands when the torsion is about being made.]
[Illustration: FIG. 20.
DOUBLE SUBCUTANEOUS TORSION IN CATTLE.
Third step. Position of the hands during the torsion.]
The third step, or that of the torsion of the cord, now presents itself
to our notice. To effect this, the testicle must be firmly held at the
bottom of the envelopes (Fig. 19), the left hand placed forward upon the
cord, and the right behind and upon the testicle. The operator then
gives to the organ a twist with the right hand by a motion of rotation
from left to right and from without inwards, while with the other he
draws upon the cord in the opposite direction. The result of this
manipulation is to give to the gland half a turn around the cord (Fig.
20), which thus becomes displaced and takes a posterior position. By a
change in the action of the hands, but a repetition of the same
movement, the right hand now acting on the cord, while the left is
applied to the testicle, the remaining portion of the motion of rotation
is performed, and a complete torsion of the spermatic support
accomplished. By repeating this action, of course as many turns of the
cord as may be thought necessary, can be secured, two, however, being
generally found sufficient, although, in a few instances as many as four
or five may be required--never more than that. The length of the cord is
the principal controlling circumstance. When these several steps have
been completed with one testicle, their repetition is, of course, in
order with the other. And when both have been treated, the consummation
of the operation is called for by entering upon the fourth step, or that
of the application of the ligature.
[Illustration: FIG. 21.
DOUBLE SUBCUTANEOUS TORSION IN CATTLE.
Position of the testicles and ligature en masse of the bags when the
operation is finished.]
To accomplish this both testicles are firmly seized with both hands,
and pressed upwards as far as possible against the inguinal ring (Fig.
21). It is necessary to be very careful to ascertain that they rest on
the same level, in order to be secure against the possibility of
untwisting. The ligature is then applied by passing three or four turns
of it around the scrotal envelopes, immediately below the testicles,
with not more than a sufficient degree of tightness to assure it against
slipping off.
The symptoms which succeed the operation are not commonly of a very
serious nature, and subside within a period of time varying from two to
six hours. Following the operation an inflammatory swelling takes place
in the bags, and after one or two days assumes large dimensions. The
ligature can now be removed, and the animal left to himself, without
further treatment, the testicles undergoing a slow process of atrophy
readily recognized by their appearance and the position they always
thereafter occupy in the vaginal sac.
CASTRATION OF CRIPTORCHIDS.
The abnormal development of animals in which the testicles have failed
to make their appearance by descending through the inguinal canal into
the bags, is quite commonly met with in solipeds, the animal being then
known by the designation of ridglings or originals. The position assumed
by the organ in relation to its normal situation being so altered that
it may be found either partly engaged in the inguinal canal (Fig. 22),
or only remaining close to its superior opening (Fig. 23), is one of
these inequalities, constituting what is called inguinal criptorchidy;
another being when it remains floating in or adherent to some parts of
the abdominal cavity--a condition known as abdominal criptorchidy (Fig.
24). As this condition has usually a peculiar effect on the temper of
the animal so affected, often rendering him unfit for general use, it
necessitates, on that account, the act of castration, with some changes
in the manipulations described for the operation upon animals exempt
from such an infirmity. In these cases the operation presents more
difficulties, and is of a more serious character than the former,
demanding on the part of the operator all the skill and knowledge which
can be acquired from its frequent performance and extensive study. That
the operation is one which is largely performed on the Continent there
is no doubt, and many European operators have made for themselves an
extensive reputation in connection with it. Among these the name of
Professor Degives, of the Brussels school, merits mention.
[Illustration: FIG. 22.
TESTICLE ENGAGED IN THE INGUINAL RING.
B--Testicle. C--Gubernaculum testis. D--Inguinal ring.]
But there is probably, on this Continent at least, no better accredited
authority, in this branch of surgery, than a gentleman, a layman, of
Illinois, known very widely as FARMER MILES, who has for many years not
only sustained an eminent repute in his specialty as a gelder, but I
believe, has devoted a large share of study specially to the castration
of ridglings. He has not only traversed large portions of the
United States in the practice of this interesting branch of veterinary
surgery, but has likewise achieved much renown and appreciative
criticism from foreign sources, having travelled extensively in various
European countries, and earned much honor from those who have watched
his methods, and received ocular proof of his dexterity and success
within the sphere of his special field of usefulness.
[Illustration: FIG. 23.
TESTICLE CLOSE TO THE RING.
C′--Internal portion of the gubernaculum testis.
C--Its external portion.
B--Testicle.
D--Inguinal ring.]
[Illustration: FIG. 24.
TESTICLE FLOATING IN THE ABDOMEN.
A--Peritoneal ligament attached to the lumbar region.
B--Testicle.
C--Gubernaculum testis.
D--Inguinal ring.]
The method of procedure, which has in his hands proved so exceptionally
successful, though no doubt essentially original with him, is still, we
believe, based upon the same principles which govern the operation as we
find it described and illustrated in the works of the classical writers
who have given their attention to the subject.
We now turn to the consideration of the _modus operandi_, as observed in
the two forms of cryptorchidy, the inguinal and the abdominal.
INGUINAL CRYPTORCHIDY.
The preliminary steps in this case are the same as those which are
necessary in the castration of animals under normal conditions. The
instruments required are a convex bistoury, one or two clamps, or a
ligature, and an actual cautery, or the ecraseur most commonly in use.
To these is sometimes added a pair of long forceps of peculiar
construction, with jaws terminating in two spoon-shaped extremities,
designed to grasp the testicle when placed high in the inguinal canal,
or if only partly engaged in the ring. Prof. Degives divides the
operation into five steps.
_First; the incision of the scrotum and the dartos._--The operator, with
or without the aid of an assistant, makes a straight longitudinal
incision upon the scrotum at the place where the testicle is nominally
situated, carefully dividing, also, the yellow fibrous layer which
represents the dartos, being especially careful at this point to avoid
the large venous branches which abound in the region involved. A sort of
hooked bistoury is, we understand, preferred by some veterinarians for
this incision, on the score of the additional safety secured by the use
of an instrument of that form.
_Second step; exposure of the external inguinal ring._--To accomplish
this the loose cellular tissue which lies under the dartos is torn and
divided by the fingers until the ring is felt. The
_Third step is the dissection of the vaginal sheath._--The sheath being
situated at varying depths, the dissection is effected by carefully
introducing the hand into the inguinal canal, and separating it as much
as possible by passing the fingers around its external surface.
_Fourth step; opening the sheath._--The opening is made lengthwise, and
of sufficient width to allow of the passage of the testicle. When this
organ is situated high up in the ring, it is frequently difficult to
grasp it and keep it sufficiently steady in position to permit the free
use of the bistoury. The sheath being opened and all the testicular
envelopes divided, we complete the operation by perfecting the
_Fifth stage, or the removal of the testicle._--There are two ways of
accomplishing this, viz.: the direct and the indirect division of the
cord. In the former case the amputation is effected either by the
process of cauterization, by limited torsion, or with the ecraseur. In
the latter the testicle is removed either by a ligature or by the
process of the clamps. The process by the ecraseur is at once that which
is most generally preferred and the easiest of application.
ABDOMINAL CRYPTORCHIDY.
In this severe form of the trouble under consideration, the various
steps of the operation demand careful study. Indeed, so common, so
serious, and so frequently fatal are the complications which the surgeon
may expect to encounter, that many operators habitually discourage the
interference with this peculiar violation of normal conditions.
The first two steps of the operation are similar to those which belong
to castration in inguinal cryptorchidy. Following on we have for the
_Third step, the perforation of the inguinal canal_, or the
establishment, by the operator, of an artificial communication from
without, with the abdominal cavity within. To effect this the surgeon
introduces his hand, with the fingers united in the form of a cone, into
the external inguinal ring, and carefully forces them upward towards the
external angle of the ilium, resting them upon the crural arch. He soon
reaches the closed superior inguinal ring, feeling only the peritoneal
membrane, where it is readily torn. Then tearing it sufficiently to
permit the passage of the entire hand, or as large a portion of it as is
necessary, he has reached the
_Fourth step, or the seizure and removal of the testicle._--The hand, or
three fingers, are then passed into the abdominal cavity, in order to
feel for the organ or its appendages, until the location is determined,
whether of testicle, epididymis, vas deferens, or blood vessels. These
are usually found floating not far from the torn opening of the
peritoneum. But if not so readily discovered, the hand must be carried
above the neck of the bladder, towards the end of the deferent canal,
which must be followed until the epididymis or testicle is found. It is
then carefully brought outwards by a slow and steady traction upon the
testicle itself, or upon a portion of the epididymis, or even upon the
extremity of some of the testicular blood vessels.
_Fifth step._--The removal of the organ is always much more safely
effected with the ecraseur than by other means. The operation is
completed by the application of a suture upon the external wound, in
order to guard effectually against the possibility of ventral hernia
occurring subsequently.
Abdominal cryptorchids are sometimes treated by removal through the
flank--an operation intrinsically more dangerous, as well as less
promising of success than that in the inguinal region.
EFFECTS FOLLOWING THE OPERATION OF CASTRATION.
These will vary more or less in extent and severity, according to the
method employed in its performance, and in any case they may be
considered in two divisions; as primary or immediate, and secondary or
consecutive.
Amongst the first phenomena most commonly observed is, of course, a
manifestation of pain, characterized by symptoms of colic, exhibited by
the animal in a more or less marked degree, being the result of the
unavoidable irritation arising from the manipulations practised upon the
organs of generation, whose nerves rise from the sympathetic as well as
from the cerebro-spinal nervous system; and from the pain excited in the
spermatic cord by the pressure of the clamps, for example. These colicky
pains, which are more severe under the bloodless method than in those of
the other mode, usually subside after the first hour following the
operation, and as a rule require but little treatment more than that of
the walking exercise. This sort of pain having subsided, the only
further trouble likely to be noticed is the local trouble resulting from
the lesion to which the testicular region has been subjected. Resulting
from this local lesion, as well as from the rough manipulations
attending the various steps of the different procedures, a peculiar
stiffness will be observed in the motion of the animal. This may be
referred either to the local pain proper, to the dragging to which the
cord has been subjected, or to the presence of the clamps, which,
resting closely in the groin, necessarily more or less impede the action
of locomotion.
Hemorrhage may also occur immediately after the operation, either while
the patient is still on the ground or as soon as he regains his feet.
This may be due either to the solution of continuity at the edges of the
wound of the envelopes, or may proceed from the small testicular or the
spermatic artery. The first two causes of hemorrhage need not engage our
attention, usually ceasing spontaneously, and never being attended with
serious inconvenience. It is not so, however, in the case of hemorrhage
proceeding from the spermatic blood vessel proper, occurring after those
methods of operating which dispense with the closing of the artery by
artificial appliances, as is done with the clamp or the ligature, or
which may be observed in castration by torsion, cauterization, the use
of the ecraseur, or especially by the process of simple excision. Though
not necessarily fatal, the hemorrhage in these instances may require
prompt and effectual interference by the surgeon for its suppression.
It is not rare for castrated animals to become more or less tympanitic,
a condition which may be due, more or less, to the introduction of
atmospheric air into the abdominal cavity during the performance of the
operation. This condition of things is usually remedied by the unaided
action of natural causes.
The secondary effects also vary according to the manipulations of the
method which they follow. The development of reactive fever is an event
which in many cases requires close watching, and while it is true that
many castrated horses will manifest no subsequent illness, even to the
extent of a slight elevation of temperature, others, on the contrary,
show unmistakable signs of a general inflammatory condition and this is
the more marked and definite as the condition of the wound has been left
in a more or less complicated state. The presence of the ligature or of
a portion of the cord which has yet to complete the sloughing action,
following the method by cauterization and by the clamps, are sufficient
to encourage the inflammatory tendency.
MODES OF CICATRIZATION.
The cicatrization of the wound of castration takes place in two ways.
While the upper part heals by adhesive inflammation at and above the
point where the amputation has been performed, it is below that point in
a process of cicatrization by the second intention, the parts filling up
by the development of granulations, and being accused by an abundant
suppurative process. The first fact observed is that the parts become
more or less swollen. The swelling is at first limited to the edges of
the wound, but increases and spreads to the scrotum, then to the sheath,
or even extends forwards and backwards to the perineal region. A flow of
serosity will be observed almost immediately following the operation, at
first thin and yellowish, but will, before the second or third day,
become thicker and more purulent in character, so progressing that after
that period it will become a laudable, creamy pus, in evidence of the
process going forward towards the establishment of sound and healthy
cicatrization. This cicatrization will proceed until the healing is
complete--that is, for a period varying between thirty and forty
days--the swelling slowly subsiding from the moment when the suppuration
becomes established.
THE HYGIENE AND THE SUBSEQUENT ATTENTION.
The moment the patient has risen from his bed and has been thoroughly
cleansed from the blood that has soiled his legs, it becomes necessary,
if the clamps have been used, to apply the necessary means to prevent
their removal by the action of the tail. This is done by braiding the
hairs shortly, and sometimes tying it up on the side. Even when this is
not necessary, from the clamps not having been used, it is better to
have the tail tightened up short, in order, when the suppurative process
is established, the more easily to preserve the cleanliness of that part
of the body. It is recommended by some veterinarians, also, as soon as
the animal is on his feet, to have him thoroughly rubbed and dried,
lest, as is not uncommon, he should have perspired excessively during
the operation. He may be warmly blanketed if he has been accustomed to a
covering, or in any case, placed in a quiet stall and tied up. If quiet
and unexcited, and exhibiting no immediate ill consequences of the
operation, he may, after an interval, be allowed to go loose in a box
stall. If there are any manifestations of pain, or colicky symptoms,
walking exercise may be given. Quietness, protection from changes of the
weather, moderate diet, varying according to his condition, are
included in the only general instructions that can be given.
The wound simply requires to be kept clean. Washing with cool water and
soap when the discharge is well established, will fulfil this
indication. The closing of the edges of the wound is to be carefully
prevented by the introduction of the finger between them, care being
taken to avoid the laceration of any points where union has already
taken place in the upper part of the wound.
It is not an unusual thing to find even these simple measures of caution
overlooked by gelders, some of them even recommending that the animal
should, immediately after the operation, be violently exercised--even
put in harness and made to draw a wagon. It is true that a little and
gentle exercise may be beneficial, with a view to the removal of the
soreness and pain of the newly castrated animal; it must be admitted
even that Professor Bouley recommends slow exercise to be carried to the
extent of fatiguing the animal. But when we take into consideration how
seriously some animals, at least, are affected by the operation, and the
serious complications which may follow it--even laying aside the
humanitarian view of the question--we must necessarily conclude that
such directions and such a practice is in violation of all the laws of
true surgery, and even if justified by the strongest statistics, is
condemned if confronted by a single fatal case.