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.

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.

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.

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.

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.

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.

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.

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.

---