The methods of performing the operation of castration may be variously classified, though in each class a varying number of modes will come under our notice.

The first class will include the operations by which, the envelopes having been cut through, the vaginal sac opened and the testicle exposed, the organ is separated by an immediate section of the cord. A number of different processes are included under this head, among which are those of scraping, of tearing, of torsion, of linear crushing, or by the ecraseur, and of firing, or the actual cautery.

The second class has also for its first or preliminary step, that of the first, viz., the incision of the bags, the opening of the vaginal sac, and the exposure of the testicle. But instead of removing the organ by the division of the cord, we proceed as a second step, to the application of an apparatus designed to operate by producing compression along the length of the cord, and in this are included but two modes of operating, that by the ligature and that by the clamps.

The third class, according to our category, presents to our view two further operations, both of which are essentially bloodless and dispense with the incision of the bags, consisting of certain peculiar manipulations which insure the destruction of the testicular structure, and consequently of its secreting power. They comprehend the process of the crushing of the spermatic cord, and that of subcutaneous double twisting—the bistournage of the French.

We now enter upon the consideration of each of the separate modes we have thus enumerated.

SIMPLE EXCISION.

This is claimed to be one of the oldest modes of operating, and though to a great extent discarded by practitioners of the present day, still finds its application in the treatment of the smaller animals. With larger patients, however, though still strongly recommended by some practitioners, it is not generally employed on account of the profuse hemorrhage which necessarily follows the amputation of the cord. Still it is conceded that this hemorrhage, as in many cases of the clean, transverse section of arterial blood vessels, will cease spontaneously by the contraction of the vessels on themselves, and the formation of a clot at the divided end, as well as in the surrounding cellular tissue. However, there is a possibility of the continuance of the hemorrhage for some length of time, and the bad effects of excessive depletion are not to be overlooked, especially in an animal whose general constitution has from any cause suffered impairment. If there is any one of the various modes of operating in which the standing position is allowable, this, in our opinion, is the one, the steps of the process being so few and so short, and admitting such simplicity and rapidity. These consist in making a free opening in the bag, reaching with a single stroke of the knife into the vaginal cavity; grasping the testicle and pulling it gently downwards; and cutting the cord right across, from the front backwards, above the epididymis, the cord returning of itself into the vaginal sac—the division being made, of course, on both sides. The animal is then kept quiet in his stall and left alone until the hemorrhage subsides.

SCRAPING.

This operation, which is said to have originated in India, is but a modification of the preceding. Instead, however, of using a sharp edged instrument to divide the cord, the surgeon, on the contrary, employs a dull knife, with which the coats of the artery and portions of the cord are scraped until the separation takes place. They are thus placed in good condition for their temporary closure. This method is probably attended with a diminished amount of hemorrhage, and if carefully performed, it may be entirely absent, the clot closing the artery, and the condition of the lacerated threads of the vessel acting favorably, as well, in preventing it. The manipulations are similar to those accompanying the simple excision, though it is better and more safely effected when the animal is on his back. The testicles being exposed by the incision through the envelopes, the posterior septum of the cord is cut through by a transverse section, and the scraping of the anterior fasciculus of the cord then performed, by a slow movement from above downwards, along a certain extent, in order to effect a solution of continuity by a sort of wearing through the tissues. This operation is slow and requires a careful hand for its execution. But as it may in some cases be followed by severe hemorrhage, it cannot, for that reason, be recommended for large animals, for solipeds especially.

TEARING AND TORSION.

These two modes of operation may, to a great extent, be considered as identical. Indeed, the mode of torsion may be said to have arisen principally as a modification of that of tearing, which is the older. In tearing, the cord was subjected to a certain amount of torsion by the hand, and then torn apart at a given point in its length; while in the process of simple torsion, as properly performed, we obtain a division of the cord by twisting it with instruments, which enables the operator to effect the separation at a definitely determined spot. Tearing differs, then, from torsion only in the fact that after giving several twists to the cord in order to gather its fibres into a more compact mass, and to diminish the resistance of the more superficial layers, it is divided in its continuity by a violent traction upon its fibres in the direction of its length.

In this process, especially applied to ruminants, the testicle being exposed, the operator secures the cord firmly with the thumb and index finger of one hand, to prevent the traction from taking effect too far upwards when being made by the other hand, after the cord has been twisted a few times on itself.

TORSION.

In this method of castration the cord is twisted with sufficient force to cause it to break of itself at the point of the greatest violence. Its design is to accomplish the removal of the testicle without dragging or excessive traction upon the cord, and thus to avoid the hemorrhage following the torsion of the spermatic artery, as a mode of hemostasis sufficient to prevent the flow of blood attendant upon the rupture of the cord. The operation may be performed either above or below the epididymis, or may consist simply in the torsion of the artery alone. At first the hands only were called upon to act in the manipulations, and the operation was from this cause known as free torsion, until about fifty years ago, when instruments were introduced into general practice, and gave rise to the plan of limited torsion.

FREE TORSION.

Free torsion, or that in which the hands alone are employed in the operation, may be performed, as before stated, either above or below the epididymis.

Above the Epididymis.—The first is one of the oldest modes of castration known; one which must have been practiced contemporaneously with the use of clamps, or in the first age of surgery. The first steps of the operation required for the exposure of the testicles are the same as have already been detailed. When this is accomplished the steps of torsion and rupture are then performed in the following manner: The operator, grasping the testicle, carefully draws out the spermatic cord, and with a pointed bistoury makes a transverse incision, above the tail of the epididymis, through the posterior septum of the cord, involving what we know as the white muscle of Bouley, the efferent canal, and the small testicular artery. He then seizes the anterior fasciculus of the cord between the thumb and index finger of the left hand, squeezing it as tightly as possible, and having with the other hand secured the cord at a short distance below the point where the left hand has already been placed, performs the torsion by a rotatory movement given to the testicle itself, the motion having for its result the twisting and tearing of the cord when long enough continued to overcome the tenacity of its fibres. Fifteen or twenty turns of the organ will usually be found sufficient to effect the rupture. A considerable degree of strength in the fingers is required in this movement, and for this reason the torsion may take effect further up than may be desired, and beyond the point designed, which may result in an unnecessary amount of irritation and injury. When the torsion has gone so far that the rupture of the cord has been effected, the stump is released, and retracts in the inguinal canal to a certain height limited by the presence of the posterior septum, which holds it in place, and to a great extent prevents its return through the superior orifice of the inguinal canal.

Below the Epididymis.—This, the fourth step of the operation, consists in the separation of the testicle from the epididymis and the torsion of one upon the other. The testicle being exposed, the operator, taking hold of its appendix, the epididymis, with the left hand, and of the gland with the right, their cellular serous attachment is divided by the thumbs from the posterior to the anterior extremity, from the tail to the head of the twisted efferent canal. If this cannot be done with the hand, the convex bistoury must be called into action. This accomplished, the head of the epididymis is firmly secured with the fingers of the left hand, and the right hand, left free, gives to the testicle the number of rotatory motions necessary to separate it from its excretory canal—that is, from eight to ten. When the testicle is thus severed, the stump of the end, with the epididymis, is pushed back into the vaginal sac, where it is confined by the application of a suture upon the middle of the edge of the scrotal wound.

LIMITED TORSION.

Limited Torsion Above the Epididymis.—As we have seen, this is the operation by which the division of the spermatic cord is effected by torsion made upon a given point in its length, and limited by the use of special instruments.

We have already called attention to the difficulty of the operation of free torsion, which requires a great deal of strength, and which, besides, may be accompanied by a serious inflammatory condition of the parts, through rough manipulations of the cord. It is for this reason that this mode of procedure must have been reserved for small animals, as, if performed upon the larger kinds, it can only be by men whose muscular force is sufficient to enable them to overcome and bring into subjection the struggling subjects of their operations.

It was in 1883 that two French veterinarians, Renault and Delafond, of the Alfort school, introduced the use of instruments in the operation, as an improvement upon the manual methods and their effects on the sequelÆ, though it is said to have been already practiced in Germany as far back as the last century. The instruments employed are two forceps of peculiar construction, and which were more or less modified, one of which (fixing forceps, Fig. 3,) is to be applied upon a fixed point of the cord, where it is suffered to remain, and the other (moving forceps, Fig. 4,) is employed to accomplish the rotation of the testicle and the lower end of the cord. Those of Renault and Delafond or of Reynal are now in general use. Those of Beaufils (Fig. 5) are, we believe, too complicated for general use.

Modus Operandi.—In the first step of the operation, the ordinary manipulations of the division of the envelopes, the opening of the sac and exposure of the testicle being accomplished, and the envelopes being carefully pushed upwards, the torsion and excision of the cord are effected in the following manner: The entire cord is embraced by the fixing forceps (see Fig. 6), or only its anterior fasciculus if the posterior septum has been cut, as in the process by free torsion above the epididymis. An assistant, seizing it from before backwards between its open branches and strongly closing them, holds it firmly, without pulling upon the cord. The operator then grasps the cord with the moving forceps above the testicle, and a little below the point held by the assistant, leaving a small space between the instruments, and closing his own tightly, begins the movement of torsion, which he directs from left to right. For this he sometimes requires both hands, one of them keeping the instrument in place, while the other continues the rotation as described. Ten or fifteen turns of the forceps are usually sufficient to complete the rupture of the cord, the artery, owing to its facility of elongation, being the last part to give way. The testicle then separates, being held in the branches of the moving forceps; the fixing forceps are removed, and the cord is drawn upwards into the vaginal sac. It is important in this operation to caution the assistant against drawing on the cord during the struggles of the animal, consequent upon the pain caused by the first application of the instruments, and the pressure upon the parts when held between their inflexible iron jaws; but on the contrary, to maintain it as closely as possible against the inguinal region.

This process of castration is one of the most rapid of all the forms of operating. The only hemorrhage likely to occur is merely that of the small testicular artery, if it should happen to be divided when the torsion is confined to the front portion of the cord.

Below the Epididymis.—This process differs from the preceding only in the fact that instead of holding the cord between the fingers, it is held by the fixed forceps, the use of the moving instrument being rendered unnecessary by the slightness of the adhesion of the seminal gland to its appendix.

LINEAR CRUSHING.

The originator of the use of that peculiar instrument, the ecraseur (Fig. 7), so valuable an adjunct in the operation of castration, is Mr. H. Bouley, who brought it into use at a date as early as the year 1857. It is not, therefore, an American invention, as has sometimes been claimed. The function of this instrument is to effect the division of living parts without hemorrhage. The original ecraseur of Chassaignac has received many modifications, all of which, however, operate upon the same principle The essential design of all is to produce a general constriction of the blood vessels, by which their internal and middle coats being first divided, may contract within the cavity of the vessel in such a manner as to close their cavity and form a sort of stopper to the artery, while the external cellular covering, the last to undergo division, is so stretched, under the action of the instrument, and so closely adapts itself by its ends, that insufflation through the free ends of the vessels fails to remove the closing arrangement of the two coats first divided.

Modus Operandi.—The operation is comparatively a very simple one. The testicle being exposed, as in all the other methods, the chain of the instrument is so placed around the cord that the pressure takes place upon the greater mass of tissue, in order that it may continue the longer; which being done, the lever of the instrument is brought into action, and the constriction caused by the chain slowly kept up until the definite division of the tissue is accomplished. The essential condition of success in the operation, having in view the desired hemostatic effect, is to act slowly. According to Prof. Bouley, an interval of several seconds should be suffered to elapse after each rotation of the wheel which moves the chain. If the tissues are divided too rapidly, the section of the artery is apt to be too clean, and a hemorrhage is likely to be the result. This objection, however, though made by one of the highest authorities in veterinary surgery, does not seem to be justified by the results obtained by American operators, most of whom both recommend and practice its execution as rapidly as possible; and according to their own statements, a serious hemorrhage is seldom encountered. The fact that it has been observed in any case, however, confirms the wisdom of the recommendation of Prof. Bouley, and as most of our American confrÈres prefer the operation with the animal in the standing posture, the reason of their neglect of the prudent and more truly surgical process can be readily appreciated. To avoid the hemorrhage Dr. House invented a clamp which he applied upon the cord previous to the amputation with the ecraseur (Fig. 8). This mode of castration is not very extensively practiced by European practitioners. The reason of this is probably to be looked for in the essential necessity of safety which so protracts its performance.

FIRING.

This mode of castration consists in the application to the cut end of the testicular cord—previously divided with the bistoury, or by the cautery—as a means of hemostasis, of an iron heated to a white heat—the actual cautery. This is claimed to be one of the oldest modes of operating, Vegetius and Absyrtus describing it as a common process of castration. It is much in favor in England, and in some parts of Germany, though less practiced in some other parts of Europe. The instruments essentially needed for the operation of castration by firing are two; the first, a peculiar forceps for holding the cord and securing it while the application of the cautery is being made; and the second, the iron or cautery itself.

Fig. 9.

SINGLE FORCEPS FOR CASTRATION BY FIRING.

DOUBLE FORCEPS FOR CASTRATION BY FIRING.