CASTRATION Castration has been practised upon domestic animals for various reasons from the earliest times. Male animals whose flesh is used for human consumption—cattle, sheep, and pigs— are universally castrated. This effects con siderable economy by doing away with the necessity for separating the male from the female members of the same species. Castrated animals develop better and fatten more easily and quickly, and their flesh is of better quality —less coarse and less likely to have an objectionable odour than that of uncastrated animals.
In the case of sheep the wool produced by the castrated male is considered to be of finer quality.
The male of those animals used for work— the horse, ass, mule, and ox—is castrated in order to render him a more useful servant of mankind, making him more tractable and enabling him to be placed in company with the female and other males of the same species, both at work and at rest. In this respect, however, one cannot fail to remark the tractableness and apparent inexcitability of the majority of the male animals in those countries where it is common to employ them uncastrated: custom and usage being great determining factors in this respect.
Occasionally castration is indicated in the surgical treatment of displacement, disease, or vice; as in the case of tumours or other diseased conditions of the testicles or their appendages, and accidental injuries to the scrotum and testicles, prostatitis, inguinal or scrotal hernia, cryptorchidism, masturbation, or viciousness.
Castration is dictated, too, by another reason of such wide and deep economic influence as in reality to outweigh in importance all others.
In the unnatural environment in which domestication has placed these servants of mankind, man's selective ability, gained by experience and observation, has been substituted for nature's selective method of the survival of the fittest in order that the standard of efficiency of these animals, both as regards their temperamental and their physical attributes, may be maintained, and, if possible, improved. Judicious mating of the male and female of domesticated species has replaced the pro miscuity of nature. And though great improve ment has resulted, there still is room for more. A stricter enforcement of registration of only those animals suitable for breeding would lead to results well worth attaining.
Methods of Castration.The methods by which the operation is performed are numerous, and vary somewhat in the different species. The destruction of the function of the testicle may be brought about by the complete removal of the gland, or by the obliteration of the vessels leading to it, Siebold's and Burdizzo's method, or of the duct leading from it, vasectomy.
When total excision of the gland is practised the ideal method to be aimed at is one whereby a quick and sure check upon the haemorrhage consequent upon severance of the blood-vessels going to the gland is obtained by the least damage to the tissues, accompanied by the least chance of infection of the cord and of the wounds of the scrotum.
Only those methods commonly employed in each species and regarded as being the best will be described. Space thereby saved will be employed to better advantage in giving more detailed descriptions of those methods recom mended. This is necessary if the description of the operative technique is to be of any real service. Many men possess a natural manipula tive dexterity. These have, or soon develop, a short and sure method of performing the operation of castration on the various domestic animals. Many, however, possess little or no such ability. To these, detail in description of both what to do and what not to do may lead to a certain amount of proficiency and success by a much shorter route than the route—often a very long one—of personal experience and observation.
In giving minute details of the digital manipulation of the testicle and its appendages, and of the various instruments used in the methods here described, the writer by no means wishes to infer that these only are correct, or that any others cannot be just as good. He wishes rather to convey the impression that whatever method is employed it should be followed with such attention to detail that no unnecessary handling of tissues or instruments occurs. That all movement should be definite of purpose and distinctly consecutive is as important in this operation as in any other, and if this principle is carried out from the first, such a degree of certainty of purpose and of execution will be developed in the mind and hands that much valuable time will be saved, and satisfactory results obtained.
Provided the rule that"efficiency must not be sacrificed to speed"is followed, anything in connection either with the method employed for restraint, or with the performance of the operation itself that tends to lessen the time occupied and to render the operation simpler and easier, is of the utmost importance, and has a direct bearing on the results obtained.
The writer fully recognizes in writing upon a subject about which there is such a diversity of opinion as to methods, or details in carrying these out, that there must of necessity be many who will not agree with what is stated here. Those that are satisfied with the success of their own methods have no need, and would be ill-advised, to change them for others.
Restraint. In connection with his various operations the veterinary surgeon is constantly called upon to restrain effectively his patients. And in no part of his work is more effectual restraint required than in castration.
It is essential that the method of restraint adopted shall be easy and quick of application, effective and secure when completed, and easily and quickly removed. Further, it must lie applied with every regard to humanitaria principles. Although this applies to all the domestic animals with which one has to deal, it is, however, more important in the case of the horse since he is the largest, strongest, and most valuable of them all: and especially is this the case when the operation is performed on the animal in the recumbent position.
The actual operation of castration is com paratively simple, and, provided that one pos sesses ordinary knowledge of surgical technique, proficiency in performing it can be acquired easily. Restraint, however, is an entirely different matter. An extensive knowledge and experience of the handling of horses is a great asset. It is necessary that this should be supplemented by the knowledge of the applica tion of the various methods of restraint, and by confidence in one's own ability to apply them effectively. This knowledge and confidence can be attained only by practice and experience, although some men acquire them more quickly and more thoroughly than others. The neces sary dexterity, nerve, and physical strength are not shared equally by all. Many men appear to possess an inborn ability to control and command animals.
This efficient handling and securing of animals is necessary if avoidable accidents to the operator, his assistants, and the animal are to be pre vented.
The surgeon should personally assist in apply ing the necessary restraint, and if he is thorough, he himself will do the principal work in securing the animal. There are some accidents that are unavoidable, and will occur even with the most careful and experienced operator in attendance, but considerably more will occur if the applica tion of restraint is left to others.
A description of all the methods of restraint that may be employed is not intended. Re straint is dealt with in another part of this book. A few details, however, of special methods of restraint that the writer has found successful in dealing with the various animals will be mentioned.
The general principles followed in castration are the same for all animals. Aseptic conditions should be observed where possible, but in the majority of cases environment and unalterable circumstances render their attainment an im possibility. Antiseptic methods, however, can, and should, be employed always, although, judging by the results obtained where they are not observed, some might be tempted to think that they are not essential. However, the extra care and trouble spent in taking strict antiseptic precautions are more than repaid by the better results obtained in all cases, and bad, or perhaps fatal results, though they cannot be wholly averted no matter what method is adopted, will be very much fewer, and when they do occur there will be nothing for which the operator can reproach himself.
No special preparation, other than keeping the animal short of food for some twelve to twenty four hours before operating, is necessary.
-After - treatment consists in keeping the animal under such conditions that infection of the operation wounds is least likely to occur, and where he can be observed and, if necessary, suitably fed and exercised.
Anatomy. — Though many thousands of animals are castrated annually by persons pos sessing no technical knowledge of the anatomy of the male reproductive glands and their sur roundings, a clear and definite understanding of the structural anatomy of these parts is, however, essential to the surgeon if he is to possess the knowledge and consequent confi dence to enable him to perform the operation of castration in a skilful manner, and be pre pared to encounter and successfully deal with any abnormality that may exist, or untoward circumstance that may arise in connection with the operation. And especially is this necessary to enable one to operate successfully upon cryptorchids.
The testicle is intra-abdominal during early development of the foetus. During its descent before reaching the internal abdominal ring it is suspended in a fold of the peritoneum; this fold becoming later the tunica vaginalis pro pria. On its further descent through the inguinal ring and canal to the scrotum the testicle carries with it another layer of the peritoneum, the tunica vaginalis reflexa, and portions of the tissues forming the abdominal wall. These con stitute the various layers of the testicular sac. Its descent into the scrotum is usually complete at or about the time of birth. Often one or both are retained in the inguinal canal, and the descent into the scrotum may be delayed for three or four years unless the animal is previously operated upon. Occasionally this retention is permanent, and may be abdominal also. This condition constitutes cryptorchidism.
In rare cases the testicle, though it has descended from the abdomen, has taken an abnormal subcutaneous position away from the scrotum. This condition is encountered with almost equal frequency in cattle, sheep, pigs, and dogs, but very rarely in the horse.
The term scrotum is somewhat loosely applied, and by it is understood generally the common covering and individual sacs which protect and partially support the testicles. In a more restricted and truer sense it is the name given to that modified, bag-like portion of the skin, situated at the extreme infero-posterior portion of the abdominal wall between the thighs, that forms the external covering of the testicular pouches. It is thin and elastic, smooth and covered with fine hairs, and on its whole sur face has numerous sebaceous and sweat glands. All of which qualities specially adapt it in all circumstances for acting as a covering and protection to such important organs.
It is divided mesially by a longitudinal furrow, more or less unevenly, since in the majority of cases one testicle, the left, is larger and hangs at a lower level than the other. Along this furrow is a distinct line or raphe continuous behind with that of the perineum and in front with that of the sheath.
Immediately under the skin and firmly adherent to it is a reddish yellow tissue—the dartos. This is composed of fibro-elastic tissue containing unstriped muscular elements, and is continuous with the subcutaneous fascia. In reality this layer consists of two separate pouches which blend inferiorly on their inner sides to form the septum scroti in line with and above the scrotal raphe. Superiorly these sides diverge again to allow for the passage between them of the penis, to which they act as a kind of sling. Superiorly the mouths of the pouches become thinner and adherent to the abdominal wall around the external abdominal ring. The dartos is loosely attached by areolar connective tissue to the underlying tunics except at one particular point—the postero-inferior extremity. Here it is firmly adherent to these tunics and indirectly to the tail of the epididymis. This connecting band con stitutes the scrotal ligament and is a remnant of the gubernaculum testis.
The scrotum normally, when the animal is in good health, assists in supporting the testicles. This depends upon the state of tone in the muscular elements in the dartos. Further, these muscular elements contract under the influence of cold; the scrotum becoming drawn up and markedly wrinkled. Under the in fluence of heat or loss of tone from fatigue or debility, they relax, allowing the testicles to become pendulous, the scrotum smooth and having a marked neck superiorly.
Anatomically it is customary to describe as separate structures the next three layers in ternal to the dartos. From outward to inward they are: the spermatic fascia, continuous with the tendon of the external oblique ab dominal muscle; the cremasteric fascia, con tinuous with the tendon of the internal oblique muscle; and the infundibuliform fascia con tinuous with the transversalis fascia. These form a complete covering to the next and innermost layer, the tunica vaginalis reflexa, which is closely adherent to, and considerably strengthened by them in its lower part.
In connection with the cremasteric fascia is the external cremasteric muscle, a wide flat muscle which arises from the iliac fascia and passes down through the inguinal canal covering the postero-external surface of the tunica vaginalis reflexa, into which it is inserted to ward the lower outer surface by numerous short tendons. Contraction of this muscle raises the tunica vaginalis reflexa and along with it the testicle.
The tunica vaginalis reflexa is the innermost layer of the scrotum. It is the parietal layer of the tunica vaginalis, and is a fibro-serous sac continuous with the abdominal peritoneum brought down by the descent of the testicle. It extends from the internal inguinal ring above downward through the inguinal canal inclined slightly inward and backward to the bottom of the scrotum below. It is somewhat pytiform, the lower dilated portion containing the testicle and its epididymis. The upper narrower portion which lies in the canal, gives passage to the spermatic cord. Its extreme upper limit opens directly into the abdominal cavity.
This opening should allow only of the passage of the blood and lymph vessels, the nerves of the cord and testicle, and the vas deferens. When, however, it is abnormally wide a loop of intestine or a portion of the omentum may pass through into the cavity of the tunica vaginalis, either remaining in the region of the inguinal canal alongside the spermatic cord, or descending to the bottom of the sac along side the testicle, thus constituting respectively inguinal or scrotal hernia.
The visceral layer of the tunica vaginalis or tunica vaginalis propria, completely covers the spermatic cord, testicle, and epididymis.
Posteriorly the two layers come together forming a frenum, which extends from the extreme upper limit of the sac down towards the tail of the epididymis round the scrotal ligament. The cavity of the tunica vaginalis between its two layers is a potential one only, similar to those of the peritoneum and pleura. Normally it contains a very small quantity of serous fluid. This fluid when in excess con stitutes hydrocele.
The testicles are suspended by the spermatic cords in a longitudinal position in their respec tive sacs. Besides varying in size in different members of the same species they usually vary to a less extent in the same subject: the left generally being larger and at a lower level than the right.
The testicle is ovoid in shape, but some what compressed laterally. The inferior border being markedly convex in both directions; the superior border which gives attachment to the spermatic cord is almost straight. The epi didymis is attached to this border also and overhangs it externally. The epididymis which is formed by the complex coils of the excretory canal of the gland is divided for descriptive purposes into three portions: head, body, and tail. The head, or glob= major, is closely adherent to the anterior portion of the testicle by the efferent ducts of the latter and by con nective tissue, and is bound down to it by the common serous covering. The body, which is enclosed in a loose fold of this serous covering —the tunica vaginalis propria—passes in a back ward direction along the junction of the sper matic cord and testicle slightly overlapping the outer surface of the latter. The tail, or globes minor, is firmly attached, but not so closely as the head, by a thick fold of the tunica vaginalis propria to the posterior extremity of the testicle. The efferent ducts come together to form the vas deferens, which as it leaves the tail of the epididymis is very convoluted. This, turning inwards and for wards, becomes straight and passes up the inner side of the cord towards the posterior border in a fold of the serous covering. At the entrance to the abdominal cavity it leaves the other elements of the spermatic cord, passes backward and inwards to the pelvis lying in the free edge of the urogenital fold, and crosses the ureter and the round ligament—the remnant of the umbilical artery—in the free edge of the lateral ligament of the bladder. Gaining the dorsal surface of the bladder it turns backwards, becoming dilated, and passes along the neck of the bladder under the prostate gland, accom panied by its fellow of the opposite side, where it joins the duct of its corresponding vesicula seminalis forming the ejaculatory duct—a short duct which passes through the wall of, and opens into, the urethra. The wall of the vas deferens is thick. Externally, with the exception of the last few inches of its course, it has a sero-fibrous tunic, and under this a thick muscular coat of longitudinal and circular layers. Internally it is lined by a mucous membrane with columnar epithelium. This structure gives the cord a firm cord-like char acter which simplifies its detection, a factor which may assist in locating the testicle in cryptorchid operations.
The spermatic cord is composed of the structures brought down by the testicle during its descent from the abdominal cavity to the scrotum. Its constituent parts come together at the internal inguinal ring, from whence it descends in the vaginal sac to become attached to the upper border of the testicle, covered for its entire length by the tunica vaginalis propria. Its anterior margin is rounded and free; its posterior is continuous with the tunica vaginalis reflexa. Under this serous covering it consists of the spermatic artery and veins, lymphatic vessels, nerves, vas deferens, internal cremaster muscle, and the cremasteric artery. The first four of these structures are bound together with loose connective tissue to form the anterior or vascular part of the cord. The vas deferens, as has already been said, is situated in a serous fold on the postero-internal aspect of the cord. The internal cremaster muscle consists of bundles of unstriped muscular tissue extending from the internal inguinal ring to the testicle and epididymis interspersed in the tissues of the cord. Its action is to draw the testicle upwards. The cremasteric artery supplies the tissues of the spermatic cord. It is usually the first branch given off from the external iliac artery but occasionally arises direct from the posterior aorta. The spermatic artery supplies the testicle and the epididymis. It arises direct from the posterior aorta and passes down the anterior portion of the spermatic cord, making many flexions and convolutions, especi ally in its lower part just before reaching the testicle. The satellite veins form a remarkable sinuous convoluted mass around the coils of the artery, forming what is known as the pam piniform plexus. The nerves are derived from the sympathetic system.
The Bull.The scrotum has a well-marked neck and is much longer, more pendulous and slightly more hairy than in the horse. It is invariably flesh-coloured except in the naturally black-coloured breeds. The testicles are oval, more elongated, and relatively larger than in the horse, and their long axis is vertical. The head of the cpididymis is flat and long, partly covering the anterior border of the testicle.
The spermatic cord is comparatively longer, but otherwise similarly constituted.
The Ram.The scrotum in some breeds is covered with hair similar, but less in amount, to that growing on the face. In others the scrotum, particularly on its lateral aspects, is covered with wool.
The shape and disposition of the scrotum and testicles are similar to those of the bull. The glands are very voluminous.
In some breeds of goats in Eastern countries, the menial groove of the scrotum is very marked, and in some animals to such an extent has this developed, that each testicle is suspended in an entirely separate pouch from the neck of the scrotum downwards.
The Boar.The scrotum in this species is not well defined. It is situated posteriorly towards the perineal region. The testicles are relatively large and ovoid, their long axis being downwards and forwards. The tail of the epididymis, which is large in comparison, is dorsally situated towards the anus. The sper matic cord is more friable than in other species, especially in the young animal.
The Dog.The scrotum is in the perineal region also, but well defined and sparsely covered with fine hairs. The testicles are firm and roundly oval in shape.
The Cat.The scrotum is situated slightly more posteriorly than in the dog and is thickly covered with fur. The testicles are firm and oval. The inner tunics of the scrotum are very tough and fibrous and closely applied over, though not adherent to, the testicle and epi didymis.
Castration of the Horse The male of this species may be castrated from a few months old up to any age.
Excepting the comparatively small per centage of animals that may be used for stud purposes the majority are operated upon at from one to two years old.
The best age, and consequently the commonest at which young animals are castrated, is about one year.
It has been said that when the operation is performed on animals a few months old, there is less danger of injury and less notice taken of the operation. It is not popular, however, owners holding, and probably rightly, the opinion that it is not advisable, during the first nine months of a colt's life, to run the risk of doing anything that might lower its vitality and hinder its development.
It is a debatable point, too, whether injury is less likely to take place at a period when, though there is less strength there is immature development, than when there is more strength but better development. Certain it is that quite a large number of foals suffer from inguinal or scrotal hernia, whereas the percentage so affected at one year old is very small.
In unthrifty and undeveloped colts the operation should be postponed until they are two years old.
The time of the year at which the operation may be performed is quite immaterial as far as an adult or an animal that is going to be housed is concerned. It has no effect practi cally upon the result. All that is necessary is that a clean stable be provided and the animal exercised daily. In the case of young animals, from the beginning of May to the end of August is the time usually preferred. The milder and warmer weather of this time of the year is not so much responsible for the better results as is the more thriving condition and better health of the animals. That they can be turned out to grass is perhaps the greatest factor of all. No colts do so well as those that are turned out directly after having been operated upon and no further notice taken of them.
It used to be advised that they should not be allowed out in the rain. Little or no harm will result, however. Far better let the colt run the risk of a soaking from the rain than that of infection from an unclean stable.
Experience teaches that cold weather with an easterly wind blowing is a time to be avoided for castrating colts. Certain it is that they do not do so well—in fact, many do badly— during such climatic conditions. The probable explanation is that there is a varying degree of infection in many cases, and though the biting cold of an east wind does not of itself cause the trouble in the wounded parts, it does, however, assist in lowering the animal's vitality and the body tissues' own natural defensive powers, thus allowing an aggravation and extension of an already existing infection.
Many advise that very hot weather also should be avoided, giving as a reason the more likely infection of the scrotal wounds by flies. To observe such precaution in the British Isles is unnecessary. The weather there cannot be too hot for the castration of horses. It is conceiv able, however, that in some countries the very hot season should be avoided.
While the foregoing may be taken as a general guide for all colts, it may be observed that colts that have been wintered well can be castrated a month or two earlier: their testicles are better developed and their winter coat is cast earlier. Conversely, those that have wintered badly do not start thriving till late in the season: their testicles are ill-formed and their winter coat unshed. The shedding of the winter coat may be taken as an indica tion as to the time the individual colt is fit to be operated upon. Many hold that a colt castrated while the old hair is unshed always has a dull unthrifty-looking coat.
Preparation. In order to lessen the risk of any injury occurring, the animal should be kept without food for twelve to twenty-four hours before the operation. This is more necessary when the animal is to be cast for operation than when the operation is to be performed in the standing position, especially so in the case of older animals and those of heavy breeds; although in the standing operation also it is very advisable, for there is certainly less tendency for haemorrhage to occur following the use of an ecraseur or emasculator if the animal has been well starved. And further, an animal inclined to show fight, will show less on an empty stomach than on a full one. Lastly, the necessity for casting an animal is always a possibility.
At one time it was considered necessary or advisable to give a dose of physic by way of preparing an animal, even a colt, for castration. This is quite unnecessary in young animals, and even in older animals living on hard food, all that need be done is to discontinue the corn for a few days. In the case of a gross con ditioned horse of one of the heavier breeds, a. dose of physic a week or so before the opera tion may be beneficial. An animal cannot be in too hard and good condition. The healthier the animal the better recovery he will make.
Care must be taken to ensure that an animal is in good health and not suffering from any disease that is likely to hinder his progress after the operation. In young animals, strangles is a disease to be particularly guarded against. No animal that has recently suffered from, or is possibly infected with, strangles should be subjected to the operation of castration. Serious trouble such as abscess formation in the in guinal region, and possibly peritonitis, may result. No matter what the actual cause of death following castration may be, it is always the operation that is blamed.
There is another point in the preparation of adult or old animals for castration, and that is the cleansing of the sheath. This is by no means necessary as far as cleansing for the operation itself is concerned, but is advisable in view of the possibility of excessive oedema of the sheath and penis following the operation. This may be aggravated and its treatment complicated by the accumulation of dirt and smegrna on these parts.
The common practice, however, of doing this after the animal is cast and tied up ready for operation cannot be too strongly condemned. In the case of"broken"animals this can, and should, be done a day or two beforehand. In the case of young animals it is not necessary, and it is better to leave it undone than to do it at the time of operating.
Before proceeding with the operation by any method a careful examination of the scrotal region should be made in order to ascertain whether or not both testicles are present in the scrotum; whether there is any displace ment or other abnormality of these organs, such as malformation, disease, or adhesion of the covering tunics; and whether a hernia— scrotal or inguinal—is present. In respect of this latter it is always advisable to ask the question whether there is any history of the animal having been ruptured as a foal. Al though many such animals are completely recovered at one year old, one would proceed with more care, if possible, with such an animal, and if any doubt at all should exist in the operator's mind it would be better to postpone the operation to the autumn, or the next year. The slight inconvenience thus caused the owner will reflect less on the operator than would the loss of the animal.
Hydrocele, which varies considerably in degree, is often met with in unthrifty animals, or those that have been wintered badly; and occasion ally in an animal in quite good condition. If excessive, it becomes necessary to distinguish it with certainty from hernia.
Careful digital palpation, keeping clearly before one's mind a mental picture of the anatomy of these parts—knowing what to feel for and feeling for it—will enable one to decide with a degree of certainty that one should have the confidence to act upon.
A sense of touch developed by the experience gained from digital examination of the scrotal region of every colt operated upon stands one in good stead when called upon to decide in such a case. The scrotal tunics, especially the tunica vaginalis reflexa, are often considerably thickened in these cases. If, however, nothing hut peritoneal fluid be present, the sides of the sac can be approximated between the thumb and index finger. The testicle, too, is often ill developed, soft, and flabby, making it necessary to distinguish between it and possible descended bowel or omentum. This can be done by making out its anatomical structure, and tracing back posteriorly along the frenum of tunica vaginalis propria to the junction with the tunica vaginalis reflexa. The external inguinal ring should be made out and the inguinal canal explored as far as possible. It is a good plan to make this examination without the applica tion of a twitch, if possible. Even when its use is essential this instrument should be lightly applied. The animal may also be"coughed" by an assistant in order to help the detection of a small inguinal hernia. The procedure roughly outlined is that which should be followed in all animals: a few seconds will suffice where no suspicion of abnormality exists.
Operation. The horse may be castrated in the standing or recumbent position. Each of these two methods has its staunch supporters.
Unfortunately there has been a tendency for a supporter of one method to endeavour to establish it by decrying the other, rather than by successfully demonstrating the superiority of his own method.
The writer does not aim at establishing the credit of one method at the expense of the other. His aim is to state fairly the advantages and disadvantages of both. If, in doing so, he should appear to be prejudiced in favour of the standing operation the reader should consider that this method is the one which he has con sistently followed and staunchly advocated for many years.
Standing Operation. Although a certain amount of physical strength and dexterity is required for carrying out this method of oper ating, a much more valuable asset for a surgeon, if he is to become expert, is an intimate know ledge of the handling of horses and the ability and experience to apply such knowledge. He can then undertake the operation with every confidence, and will soon make use of and appreciate the advantages it has to offer.
A previous experience of castrating in the recumbent position is very valuable - in fact, necessary. For, apart from the knowledge thereby gained of the handling of animals of all kinds, the knowledge of the anatomy of the scrotal region, and of the various methods applied and instruments used in performing the operation, there is also the fact that the surgeon has always to be prepared to perform the operation in the recumbent position, either on account of an existing abnormality, or some untoward circumstance arising. In the case of the latter a good sound knowledge gained by previous experience is essential.
Probably the greatest advantage of this method is that little assistance is required: one good man at the animal's head, and pos sibly, but by no means necessarily, some one to hand the instruments to the operator. It does not require much experience in country practice to find out how difficult it is in many instances to obtain the help necessary for casting animals, and when it is forthcoming, how often it consists of old men and very young boys.
It is a great advantage to have assisting one a man who has been trained to take charge of the head. He will not spend his time looking to see what the operator is doing, but will watch for and anticipate what the animal is going to do. It is advisable, however, to enquire as to the possibility of help in case of emergency; and in this respect a surgeon should always provide himself with some"tackle"with which he can cast an animal if necessary.
Other undoubted advantages of the method are: less physical exertion to the operator, especially if he takes part in securing the animal in the recumbent position; the operation is per formed where the animal is caught and a great amount of time is thus saved, and for this reason, too, rainy weather need not necessarily interfere with arrangements.
What is thought by many to be the chief disadvantage of the method is the supposed greater danger to the operator. This is more apparent than real, if he knows his job. It is really remarkable how few animals give any great trouble. It is exceptional for one to kick. The older animals sometimes do so, and then only when the incision through the scrotum is made; but if the operator is standing in the proper place he is not likely to be touched.
Occasionally a colt, especially a thoroughbred, will throw himself down, and may do this so suddenly as to constitute a danger to the operator. Here again, however, if he does not lose sight of the possibility of this occurring and always maintains a correct position, few accidents will occur. Occasionally a really vicious animal is encountered. Time should not be wasted and unnecessary risks run in a senseless endeavour to operate on such an animal standing.
One other disadvantage is always put for ward, namely, the descent of bowel resulting from an undetected hernia. If the examina tion of the scrotal region before operating has been as careful as it should have been, this is no more likely to occur than it would be had the animal been cast. For if it is so slight as to be missed during manual examination before casting, it is more than likely that it would not manifest itself while the animal is down but would descend when the animal rose.
The advantage of the recumbent position is that the actual operation can be proceeded with without interruption. Many assert that it is necessary if real surgery is to be accomplished.
That observance of strict surgical methods does not of itself ensure success in castration, no matter how much it may deserve it, is an indisputable fact, and one that will be impressed all too surely upon the novice. Surgical methods which are successful can be applied equally well in the standing or recumbent positions. The latter position has the advantage that the animal is already in a suitable position for remedial measures in case of severe hwmorrhage immediately following the operation. Such an eventuality, however, is exceedingly rare.
The adoption of the recumbent position is necessary if a general anwsthetic is given; in cases in which any abnormality is in existence, such as inguinal or scrotal hernia, and adhesion or disease of the testicle or its appendages; and when dealing with a very vicious animal.
Some of the disadvantages of the method have been mentioned when dealing with the standing method: the amount of assistance and the greater exertion required, the necessity of moving the animal to a suitable place for casting, and the longer duration of the opera tion. The risk of injury to the animal, especi ally in old heavy horses, during or consequent upon casting and securing does exist. Injury may be serious or slight, permanent or temporary.
The assumption that the castration of a young unbroken animal in the recumbent position is accompanied by less risk to those engaged in the task than when the operation is performed in the standing position is erroneous. These animals always show more fight in the open, and quite considerable risk is run before the animal is tied securely on the ground. In the standing position the risks are encountered during the operation. In the recumbent position equal risks are encountered before the operation.
Use of an Ancesthetic. The advisability of, and the necessity for, administering a general anwsthetic before castrating any member of the equine species, no matter of what age, are questions over which there have been, and for a certainty will be, many discussions. Some hold strong opinions for its adoption, while others hold equally strong opinions against. It is conceded that the supporters of either view are honest in their convictions, and the decision to employ an anwsthetic or not in the case of young unhandled animals is left to them, and no effort is made to influence their opinions.
Of course it is out of the question to employ a general anwsthetic when the animal is operated upon in the standing position, although there is no objection to administering some hypnotic, such as chloral hydrate, when operating by this method upon animals other than young unbroken ones.
A general anaesthetic should be given when the operation is performed in the recumbent position in all but the young unbroken animal. If the operator holds the view that the latter should not be castrated except under the influence of an anwsthetic, to be consistent in his humanitarian principles let him become proficient in administering an anaesthetic to the standing animal. This in the writer's opinion is the only justifiable method of admin istering chloroform for performing the operation of castration upon young animals. If the animal is cast before administering the anws thetic, then he will be conscious of much more than half of the total shock and fear that he undergoes, and the advantage of the anwsthetic as a means of restraint will be lost.
Since by far the greatest number of animals are operated upon at the age of one or two years the method of dealing with them will be described, and any difference in the case of older horses mentioned afterwards. As was stated earlier, particular attention will be paid to detail in handling, since this is essential to good operating.
Many veterinary surgeons are in the habit of having colts haltered in readiness for them; some refuse to do the operation unless this is done. Sometimes this haltering is done the day before; or it may be done only just before the surgeon's arrival, in which case the animals are almost sure to be in a"muck sweat."In any case they are usually in a more nervous condition than they would have been had they been left unhaltered, for the catching of them is left generally to a man unsuitable for the job, and has been accompanied by much shouting and hustling. Occasionally of course it has been done by the owner himself, or some one who is a horseman and knows what an advantage quietness is. The catching of young animals by the operator himself or under his direction may entail a little extra time, but is generally worth while by rendering the handling of the animals easier; and especially is this so if the standing operation is going to be performed. Further, there is more tendency to haemorrhage —though not necessarily serious—and less favourable results in animals that are in an overheated condition.
The haltering of animals as foals and teaching them to lead should be encouraged, for this enables them to be handled and dealt with not only for castration but for other purposes.
In any case, one should always be provided with a useful halter such as that shown in Fig. 297. It consists of a head-piece and nose band made of strong webbing. Both are bound by stout leather to a brass ring at either side and are maintained at right angles to one another by a strong corner stay of leather. This keeps them in proper relationship to one another and aids materially in putting on the halter. A twelve-foot shank is spliced on to the off-ring and passes through the near one. By having rings the shank will draw tight easily, and the halter be adjusted into its proper place instead of pulling off, as happens generally with an ordinary hemp halter without rings, if the animal should move before it is correctly placed. The correct method of holding the halter is also shown in Fig. 297. A fairly roomy loose-box or building is the best place for catching the animals. They should be quietly driven into one corner, and if possible kept there. By exercising a little patience they can be approached and the halter placed across the back just behind the withers; the right or left hand being over the back according as to whether one is standing on the near or off side of the colt. The halter is gradually pushed up the neck until the nose-band, with the shank crossing it as shown in Fig. 297, is over the ears, when it is released—in many cases the colt throws up his head when the nose-band touches his ears and so aids the putting on of the halter if it be released quickly—and the shank will swing round under the lower jaw. Occasionally one comes across a particularly nervous animal that will not allow himself to be approached near enough to do this by hand. In this case a long stick may be used with which to put on the halter. The shank between the two rings is wound round the stick once or twice and the halter laid carefully on the animal's back and gradually drawn up the neck until the nose band is over the ears—not so easily done as said perhaps, but possible by exercising patience. Do not twist the head-strap round the stick and so have to bring the halter towards the colt's head from the front. Much time and almost all patience will be used up by so doing. No severe pulling on the halter should be allowed, except from directly in front of the animal, otherwise he is likely to rear and be brought over backwards, when injury to the head may possibly result.
A word of warning might be given here. Never have animals in a stable where there is a long, low, wide manger across one end, as is commonly used for cattle. It is very easy for an animal either to stumble sideways into it or to get knocked into it if several animals are in the stable. It is almost impossible to get an animal out of such a manger without serious injury of some sort. The writer has anything but pleasant recollections of having to cut through a nine-inch oak post with a hand saw with the colt's legs flying about overhead, on an occasion when he had been tempted to take chances in such a building, none other being convenient at the time.
After catching the animal the procedure differs somewhat according to whether the standing or recumbent position is going to be followed. The standing method will be de scribed first.
Instruments and Appliances. All employed in this method are equally applicable to the recumbent position. A few used in the latter, however, are not serviceable in the standing position and will be described later.
Those required are: a knife for exposing the testicles; an emasculator or ecraseur for removing them, or caustic clamps for applying to the spermatic cords; if these are used, a pair of steel forceps for closing them securely will be required, and also a pair of scissors for excising the testicles below the clamps. Further requirements are: a tray for the instruments; a spray containing tincture of iodine or iodized chloroform for disinfecting the scrotum; a strong twitch; a pair of blinds; a smock-coat; and a clean basin or bucket with water, soap, and a towel.
Besides these instruments actually required for the operation the surgeon should be pro vided with those that might be required in case of emergency: dressing-scissors, forceps, suture-needles and material, hernia-needle, strong wooden clamp, cotton-wool and anti septic, and some casting appliances.
Knife. The object aimed at is to obtain at one attempt a good opening through the tunics as well as the scrotum. This can be accomplished with any pattern of knife in the adult animal or one in which the testicles are well developed, but is . more difficult in a young animal with ill-developed testicles. A knife having a fairly straight edge is preferable. It should have a slightly curved cutting edge, a fixed handle, and be comparatively short. The all-important point in any pattern of knife that may be preferred is its sharpness.
Emasculator. Various patterns are now com monly made. Only those of proved efficiency and reliable make should be employed, and even then there is perhaps a slight element of luck in obtaining an instrument of first-rate efficiency. Severance of the cord by these instruments is effected by a combina tion of crushing and cutting, and at the same time compression is exerted upon its proximal end. The"Safety" (Fig. 298) is probably one of the most reliable. Others are the"Reliance" (Fig. 299) and the"Huish - Blake" (Fig. 300).
Ecraseur. This instrument acts by crushing through the cord by means of a tightening flexible chain. The ordinary Miles's pattern (Fig. 301), or Robertson's, may be employed.
Dewar's pattern (Fig. 302) is the best.
This instrument, besides being made stronger and longer, possesses the ad vantage over other patterns of having a sliding lock on the screw thread which en ables the chain-slack to be taken up quickly before applying the steady crushing action of the screw. The chain is strong and has a bevelled edge on one side, by which one is said to get a greater crushing effect.
its separate joints backwards and forwards by hand. This renders it very much less liable to jam and break. After use the chain should be freed of small particles of tissue, washed clean, rinsed in boiling water, dried, and kept in a jar of absolute alcohol—methylated spirit will not do. This not only preserves it in the best condition but sterilizes it ready for use, thus rendering boiling it unnecessary: a process which tarnishes it and lessens its pliability.
Many hold to the opinion that in using the emasculator or ecraseur for castration the amount of haemorrhage immediately following the removal of the testicle is directly propor tional to the speed at which the instrument is used; that in the case of the emasculator it should be slowly closed and held so for some time and very slowly opened, and in the case It is advisable to take off the very sharp edges of a new chain and also of the slot through the end of the shaft by very slight application of fine emery-paper. The chain should be made quite pliable by freely moving of the eeraseur that the chain should be tightened very slowly indeed. Greater factors in lessening the amount of haemorrhage are: well starving the animal, and placing either instrument well up the cord above the extremely convolutive portion of the spermatic artery, closing the instrument on the cord while this is stretched taut, and cutting through the cord at a steady, moderate pace.
Caustic Clamp. The most serviceable is a light round wooden one having the approxi mating surfaces of each half flat, upon which the caustic—coarsely ground perchloride of mercury is the best—is applied by means of some adhesive material, the two halves being tied at one end with cord and closed at the other by a leather ferrule. A pair of steel forceps should be used for closing the clamp, as then there is no fear whatever of the leather ferrule coming off or the clamp slipping. An ordinary pair of curved trimming-scissors—not serrated—with the points well rounded, are the most useful for removing the testicle below the clamp. Some operators remove the testicle by means of the same knife that they use for opening the scrotum: a bad practice, for not only is the edge of the knife destroyed, but by using a knife for such a purpose the animal is subjected to an unnecessary risk of injury.
Tray. An enamel one containing some antiseptic solution of reliable strength. Any antiseptic that has no chemical action on metal instruments will do. For an emasculator or ocraseur a wide-mouthed, deep enamel vessel, containing a 2 per cent solution of lysol or similar antiseptic, is better than a tray.
Spray. Any spray having a more or less vertical jet answers the purpose quite well.
Twitch. A good twitch with reliable cord of 20 to 30 loosely woven strands, and a strong handle about four feet long for young unbroken animals. For use on adult or broken animals a handle not more than two and a half feet long is equally efficient and easier to manipulate.
Blinds. Should be small and tight-fitting. An ordinary stable rubber answers admirably, or a cloth about two feet square folded triangu larly and placed across the eyes, the ends being twisted round the head - piece of the halter or bridle.
A blind is perhaps more effective in pre venting an awkward animal from kicking than a twitch. Al though by no means necessary in the great majority of yearlings of the heavier breeds, a blind is well worth the small trouble of putting on in all others and in adult animals.
If the operator adopts the method of using caustic clamps he will find great assistance in wearing a smock-coat having a left-hand breast pocket which has been stitched vertically into three divisions, in each of which he can put a clamp, its leather ferrule having been removed and put into the left-hand side pocket. The steel forceps for closing the clamp are put into the right-hand side pocket. The third clamp saves releasing the testicle in case a clamp has been knocked out of the hand on to the ground.
All instruments should be sterilized by boiling daily before being used, and then wrapped in sterilized lint. It is not practi cable, neither is it necessary, to boil them between each operation if the surgeon is operating on many animals on the same day. If care is taken in looking after the instruments the disinfection by an antiseptic of reliable strength is sufficient.
Operation. The technique of the standing operation is the same for old and young animals. Before commencing the operation the surgeon should take care that everything for the completion of it is in absolute readiness.
If the stable or building in which the animal has been caught is suitable as regards light and space, it is much better for the operation to be performed there; as the majority of animals will stand much more quietly indoors than out in the open.
A twitch is applied and the scrotal region carefully examined in order to ascertain that no abnormality. exists. It is necessary to remember that the less time that is allowed to elapse between the application of the twitch and the commencement of the operation itself the better the animal will stand. If the animal is inclined to be very awkward the next step may be dispensed with. Tincture of iodine is applied to the scrotum. This is done much . more effectively and easily by spraying than by any other method. The operator quickly washes his hands and rinses them in some antiseptic. The animal should be stood along side a wall, with his off side to it but not too close. It should not be pushed back into a corner or on to a manger, as this only cramps the space between the thighs and belly. If possible the animal should be so placed that the light falls on the scrotal region; this is not really necessary, however. The man holding the twitch, which is now tightened, also holds the shank of the halter and endeavours to keep the head a little inclined towards the near side, or this may be done by another man holding the shank short in his left hand and placing his right hand on the side of the neck. The instruments should have been placed where they can be got at readily, or may be handed to the operator by an assistant.
The operator then stands on the animal's near side as near the elbow as possible, taking care to see that no one is standing just behind him so that he cannot step back quickly if necessary. With the thumb and index-finger of the left hand, the palm of the hand away from the scrotum, he seizes the off testicle covered by the scrotum. Occasionally it may be necessary when the testicle is small to grasp it with the right hand first and draw it down gently so as to enable a suitable hold to be obtained with the left. It should be so held that the scrotum is stretched tightly over the testicle, and by exerting a fair degree of traction and well flexing the wrist the testicle and scrotum are brought into such a position as to enable a bold incision to be made, with the knife in the right hand in front of the near hind leg, in a downward and backward direction, freely exposing the testicle at one stroke. If the incision is as bold as it should be, and is made backwards and upwards, there is a risk of injury to the colt's thighs, and should he snatch up the near hind leg, as he sometimes does, the right arm clasping the knife in the hand is in such a position that injury to the operator's left arm or hand may result.
Some operators say that they never look at the scrotum, not even when making the incision. If this is so they either possess an invaluable sense of touch and direction, or show an entire disregard of injury to themselves and the animal. Certainly, with the exception of making the scrotal incision, it is best not to bend down and look up into the scrotal region. There is no necessity for it; the operation can be per fectly performed by digital manipulation only. The operator can maintain a much safer posi tion by not so doing; and he will have less pain in his back at the end of a big day's work.
When the testicle is liberated it is grasped at its junction with the cord by closing the third and fourth fingers of the left hand over it in the form of a clamp without withdrawing this hand from the scrotum. By holding it in this way the thumb and index-finger are left free to direct the placing of whatever instrument is used, and keep the scrotal integument and tunics clear of it.
Care should be taken not to handle in any way the cord above where it is going to be severed. Slight traction is put upon the cord: the animal will draw against this at first, but will soon give way if it is slight and maintained. It is at this time that the animal is inclined to throw himself down or lie over on to the operator. The operator should keep himself well clear of the animal, not only for safety, but because the animal is very much less likely to lean over. If the animal is inclined to walk on, let him, or make him do so if he will not give down the testicle.
If the emasculator is used, it is grasped in the right hand by the handles and its jaws put round the cord, care being taken that they are above the epididymis and well up the cord and at right angles to it. Traction is exerted on the anterior or vascular portion of the cord so that the instrument can be placed on the cord above the convoluted portion of the artery when it is on the stretch. The instrument is then firmly and definitely closed, and gently opened. Similar procedure is carried out in connection with the near testicle.
The ecraseur is used in like manner; the testicle being passed through the chain loop and the latter directed well up the cord. The chain-slack is taken up tightly by manipulation with the right hand, while the left maintains the vascular portion of the cord on the stretch. The shaft of the instrument is then grasped by the left hand and the handle turned by the right until the cord is cut through.
If a wooden caustic clamp is used the testicle is maintained in the same manner, the clamp being placed high up on the cord by the right hand from behind forwards, being directed by the thumb and index-finger of the left hand. The cord is placed well into the back part of the clamp, the front ends of which are then grasped by the thumb and index-finger of the right hand and brought together; the left hand, liberated from the testicle, quickly places the leather ferrule on the clamp. The clamp is seized by the steel forceps behind the ferrule and in front of the cord and closed tightly, and the ferrule pushed well home. The testicle is removed by scissors about one inch below the clamp, and thus prevents the clamp being pulled off.
In young animals the sooner the clamps are removed after six hours the better. In no animal is it necessary to leave them on longer than the next day. Before being removed the remainder of the cord below the clamp is cut away with the curved scissors. The cord which fixes the clamp at its posterior end is cut by passing a knife into the notch between the two halves, the knife being given a slight twist so as to open the clamp, which is then gently removed from the cord, the end of which is returned into the scrotum by grasping the lips of the wound and pulling them down wards. Occasionally considerable swelling of the scrotum and prepuce has taken place be fore the clamp is removed. This is due not to infection, but to the formation of a blood clot between the scrotum and tunics caused by bleeding from a severed vessel — more com monly a vein—either on the inner side of the scrotum or in the tunic wall. The lips of the scrotal wound close round the cord along the clamp and imprison this blood, which should be carefully removed. Otherwise it will form a very suitable medium for bacterial growth and may lead to trouble.
After-treatment will be dealt with later.
In the case of broken and adult animals the procedure is almost identical.
The administration of some hypnotic such as chloral hydrate previous to operating may be adopted. A bridle should be used in place of a halter, and blinds invariably put on. There is practically no difference in the technique of the operation itself. If the cord is very big it may be necessary when using the emasculator or ecraseur to sever the vas deferens and non vascular posterior portion of the cord above the tail of the epididymis with a knife or with scissors, thus lessening the pain to the animal and relieving unnecessary strain upon the instrument.
The caustic clamp is the most reliable for old animals, and should be left on from eighteen to twenty-four hours.
The Recumbent Position.In addition to the instruments and appliances mentioned in con nection with the standing operation, excluding the caustic clamp, it is necessary to mention instruments for removing the testicle by actual cautery, and appliances for casting and securing the animal.
The use of the actual cautery for dividing the spermatic cord and arresting the haemorrhage is one of the oldest, and until comparatively recent times one of the commonest methods employed. Although it earned its reputation before aseptic or antiseptic surgery was under stood or even dreamt of, it can be used along with the application of present-day principles with such satisfactory results that it is still employed, and preferred by many.
Some employ it for making the incision through the scrotal tunics to expose the testicle in order that the scrotal wound shall not heal too quickly and prevent the escape of any discharge.
A steel clamp (Fig. 303), hinged at the end of the blades, which should be wide so as to prevent the heat of the iron, used for searing the cord, coming in contact with the skin, and usually having at the end of the handle a by no means necessary spring ratchet or hook with which to keep it securely closed when applied to the cord.
The pattern of iron used for burning through the cord and searing the blood-vessels is similar to that of the ordinary firing-iron. It is not necessary that the edge of it should be particu larly sharp: if made thin and sharp it only becomes burnt and rough. Both the edge and the flat surface of the iron should be smooth. Care should be taken that they are not"burnt"when heated. If very scaly, this should be removed by a file or by rubbing on a piece of stone or brick. No irons work so cleanly and well as those heated in a wood fire. The iron should be at a dull red heat and free from all scales and ashes.
Restraint. Many different methods of re straint employed for casting and securing animals for castration have been described at various times. Most surgeons have their own particular fads on the subject, taking exception to certain parts in some of the methods while adopting other parts, and maybe introducing some variation of their own. Any one who has adopted a certain method which in his hands has proved satisfactory and safe, and with which he is thoroughly acquainted, will natur ally continue to employ it. Any one parti cular method with which one is thoroughly acquainted always appears to be simpler and easier than any other.
Those methods recognized as the best and most commonly employed have already been described earlier in this work. By some of the methods adopted the patient is secured in the dorsi-cumbent position, by others in the lateri-cumbent position. With the exception of those cases where some abnormality exists, such as hernia, scrotal or inguinal, or some displacement or disease of the testicle, the lateri-cumbent position is the better all-round method. In this the animal is cast on his near side and the off hind leg tied up.
The advantages claimed for it are: the methods of restraint usually employed can be more quickly and easily applied; less space and assistance are required, since the animal is better controlled and falls more or less where he stands; while being just as securely held, the animal is less liable to injury; the scrotal region is better exposed; and there is less liability of infection of the inguinal canals.
The double side-line, made of a single cord, or having a simple leather collar with two cords, is about the worst method. It may be the simplest and safest to those who apply it, but this does not justify its use. A considerable amount of room and assistance are required; the animal is more likely to fall badly; securing and releasing cannot be done quickly; the animal when secured can, and does, thrust his hind legs straight forward, in which position he is able to exert such muscular force that injury to the muscles or bones of the back and hind limbs may result; and, above all, the testicles are most inaccessible.
Bad as the method is for castration, its use in cryptorchid or hernia operation is most inadvisable.
At the risk of occupying a little space a method that the writer has found serviceable will be described. Fig. 304 shows the method applied before casting, and Fig. 305 when the animal is secured. Four men only are necessary. No. 1 holds the twitch; No. 2 the halter until the ropes are adjusted, when he hands over the halter to No. 1 and goes to the off side; No. 3 stands on the off side and No. 4 on the near side of the animal. The operator himself usually being either No. 3 or No. 4, preferably No. 3.
A strong rope is used, on one end of which is spliced about a foot of plain chain, and at two and a half feet from the same end is fixed a quick release hook. The chain end is placed over the animal's neck by No. 3 standing on the off side, brought round under the neck and enclosed in the hook, the length of chain enabling the rope to be accommodated to the size of the neck. A half hitch is then made with the rope round the body just behind the elbows; the direction of the rope being over the back, down the near side, under the chest, up the off side, and passed double under that part of the rope coming from the neck, and laid across the back ready to be grasped from the near side. It is not necessary, in fact it is inadvisable, to draw the free end right through, as the rope will then be in the right position for releasing. No. 4 on the near side puts on the near hind fetlock a rope fifteen feet long and having a spliced noose at one end. This rope can be passed round the thigh, threaded through the noose, and allowed to descend into the heel, or the noosed end may be gently thrown between the hind feet on the ground and picked up with a stick and then threaded as before. Two webbing hobbles with metal D's (Fig. 306) are put on the fore pasterns, one by the man on the near side and one by the man on the off side. The end of the rope from the near hind pastern is then passed through the hobble D's from the near to the off side. No. 3 and No. 2, who has come from the head, grasp this rope, both standing in front of it, and so clear of the free off hind leg when the animal is on the ground. No. 4 seizes the doubled end of the neck-rope, and on a given word both sides pull steadily and firmly, pulling in a somewhat backward direction rather than at right angles to the animal's sides. When the animal is on the ground No. 1 pulls the head back and, kneeling on the neck, maintains it in this position. The animal may kick once or twice with the free hind leg. When quiet a double hitch round the near hind fetlock is made with the shackle rope, or if the animal should struggle very much and there is any danger of getting struck by the free leg the looped end of the neck-rope may be put round the pastern of the off hind limb, and this pulled slightly out of the way by exerting traction on the free end of the rope. Before securing the off hind leg the half hitch round the body should be pulled taut so that the bend in the rope is about half way up the chest wall. When the doubled end of the neck-rope has been put round the pastern of the off hind leg the free end is pulled until the foot is brought up to the chest wall just behind and above the elbow, and secured there by a double hitch being made round the pastern. The free end should be held by No. 4 with his knees pressing against the top of the animal's quarters, thus exerting a backward pull on the leg.
Operation.After the animal has been caught he must be taken to some place where he can be cast. Nowhere equals a piece of clean level turf. A manure yard must be avoided, and no matter how dry the bottom of a straw-yard and clean the straw, it never equals the grass; the straw getting in the way of the casting ropes and dust and dirt off the straw flying round and soiling the operation wounds and the cords.
If possible the animal should have been confined in a building adjacent to the place where he is going to be cast, and certainly not where he will have to go through, or have the chance of taking his attendants through, varying depths of liquid manure.
Before casting, a twitch is applied and the scrotal region carefully examined for any abnormalities, if this has not been possible before the animal was brought out.
When the animal has been secured the scrotal area is well sprayed with tincture of iodine. The surgeon now carefully washes and disinfects his hands, having any instruments he may require in a tray containing some antiseptic. The operator stands behind the lower thigh of the animal, about equidistant from the root of the tail and the hock; in such a position the scrotum is freely accessible. He should not stand directly behind the horse's buttocks, and certainly not behind his croup, leaning over the upper quarter. The left foot is placed on the hair of the tail close to the end of the dock in order to prevent this flicking on to the scrotum if the animal struggles.
It is very necessary to remember that it is during this particular part of the operation that the animal invariably struggles. The traction that is placed on the cord by the right hand, so as to enable the instrument to be put above the tail of the epididymis, and as high up as possible on the anterior vascular part, should be steady and maintained and not forced in any way while the animal is struggling. The contraction of the muscular fibres in the cord will soon be relaxed, enabling the testicle to be drawn down and the cord seized high up. Another point to observe always is that when once the instrument is round the cord the hand holding the instrument should be tightly pressed against the perineum whenever the animal is struggling, especially so when the cord has been finally seized. Whatever movement the animal makes the hand will follow it, and no traction on the cord by the instrument can take place and perhaps tearing result. If the posterior non vascular portion of the cord is previously severed there is no difficulty in placing the instrument high up on the vascular portion. In the case of an old animal, however, the cremasteric artery may be of sufficient development as to cause considerable haemorrhage if this part is divided by a knife or pair of scissors. If the actual cautery is being used the clamps can be closed on the cord above the epididymis, and the posterior part of the cord severed and seared; then by opening the clamps the vascular part can be easily drawn down to be severed at the proper level.
To continue the description of the operation. If an emasculator is used, the instrument is lifted from the tray by the left hand and the jaws put round the cord from behind forward, but not closed. Traction is put on the testicle and cord by the right hand, while the left, maintaining the jaws of the instrument free from, but close to, the cord, passes them up the cord, pushing back the scrotum and tunics until the cord can be seized, the posterior part about an inch or two above the tail of the epididymis, and the anterior part about three or four inches above its junction with the gland. The jaws are then firmly closed upon the cord by exerting pressure upon the handles. The right hand can release its hold of the gland and assist in the complete closure of the instrument if necessary. The testicle is lifted away and the instrument gently opened and replaced in the tray. The same procedure is then carried out in connection with the right testicle.
If the ecraseur is employed the testicle is passed through the chain loop by the right hand, and again firmly grasped. The instrument is held in the left hand by putting the third and fourth fingers through the steel loop on the lower side of the shaft, and the thumb stretched out over the screw-head that maintains the chain-ends in position. The procedure is the same as with the emasculator: the testicle and cord are pulled down by the right hand, and the chain passed up the cord to the proper level, but first take up the slack by drawing back the thumb until only sufficient is left to allow the chain to move freely up the cord. The chain is then tightened by drawing on it with the left thumb, a good grip of the cord being made. The right hand, having released the testicle, and having pulled the sliding lock into position—if the instrument be a Dewar—proceeds to turn the handle gently and firmly until the cord is severed. The testicle is removed, and the right one treated in the same manner.
If the actual cautery is used the steel clamp is held by its left handle, the right one being tucked under the spermatic cord from before backwards. By supporting the right handle with one of the fingers of the right hand it can be grasped by the left hand behind the cord. The clamp is not closed tightly on the cord, the handles being kept apart by the little finger. Then in like manner to that in which the other instruments are used, the clamp is passed up the cord, pushing the scrotum and tunics in front of it. When at the proper level the clamp is closed upon the cord and the testicle released by the right hand.
It is necessary that the vascular portion of the cord should be at the hinged end of the clamp, for it is the more compressible part of the cord, and will be more securely held than if the non vascular part, which is denser in structure, be at the hinged end. In the latter case the jaws might not grasp the vascular part sufficiently tightly to prevent its slipping through them after it is severed.
The cord is then seared about half an inch from the jaws of the clamp by the hot-iron held in the right hand. The posterior or non-vascular part is cut through first, not by a sawing motion but by pressing upon it with the iron at right angles to the blade of the clamp. The anterior or vascular part is severed similarly, but less pressure should be exerted with the iron than on the posterior part. The iron should be allowed to sink slowly through the tissues: very little more searing will then be required, and if by any chance the cord escapes from the clamp, due to the animal struggling or to some other cause, there is no need to worry further, for no severe hmmorrhage will occur. After the cord is severed the flat of the iron is lightly applied to the edges and whole surface of the end of the cord, chief attention being paid to the anterior part. It is also necessary to sear in the region of the vas deferens, which is usually about the middle of the cord as grasped in the clamp, because close to it is the cremasteric artery, though when once this is severed by the iron no severe haemorrhage will occur from it. When the searing has been done the grip on the handles of the clamp by the left hand is slackened and they are gradually opened. This can be done easily, with a little practice, by the little finger of the left hand; or the right hand can be employed, either while still holding the iron or after having laid this aside, not on the ground. The slackening on the cord should be gradual and continuous. Avoid any opening and shut ting action with the clamp when releasing the cord, for that will give a false idea of the artery not being properly seared: blood passes along the vessel when the clamp is slackened, and when closed again the pressure exerted upon this will burst open the seal formed on the end. If no bleeding occurs when the clamp is only just holding the cord, while the animal is exerting no pull upon it, it should be released by widely and quickly opening the jaws. If when the jaws are first slackened bleeding occurs they must be closed again, and the iron lightly applied to the part where bleeding appeared. The amount of searing done, however, should be the minimum necessity requires.
The artery should appear as a light-coloured ring more or less in the centre of the vascular part of the cord. Occasionally, if the cord has not been grasped high enough, a curved whitish mark is seen in the vascular portion after its surface has been seared, from which blood will escape on the clamp being slackened. The best i way to deal with this is to cut across it at right angles with the edge of the iron. It is a convolution in the spermatic artery, and if one goes on using the flat of the iron the bleeding is most persistent; the reason being that the vessel is seared in a very slanting direction, or there may be a hole burnt in the side of it.
The right testicle is removed in the same manner.
The animal is then released and allowed to rise, and kept quiet until the surgeon has made his final inspection.
Although there is practically no difference in the actual method of operating on adult or old animals, a slight difference in restraint should be adopted. The animal, if not anaesthetized before casting, is thrown on the near side by some pattern of casting-hobbles that includes all four legs: Bracy Clark's, or for a thoroughbred and the lighter breeds a set after Miles's pattern, the hobbles being made of webbing with metal D's, and the one for the off hind limb having a special releasable D (Fig. 306, B). They have the advantage of being noiseless and less liable to bruise the heels when the animal struggles. A neck-rope, as already described, is put on and used as the"pull over"rope. The animal is anmsthetized with chloroform, and when ready the neck-rope is passed round the off hind pastern, the hobble on that limb released, and the leg pulled up and secured in a similar manner to that followed in the young unbroken animal.
Immediately following any method of opera tion, a varying degree of haemorrhage often occurs. Although this would cause no uneasi ness whatever to the surgeon, it often does upset the owner considerably, appearing to him a much more serious circumstance than it really is, and lowering his opinion of the operator's skill. A comparatively small amount of blood spread out on clean straw will give to the inexperienced the impression of a considerable loss to the animal. For this reason, if for no other, there is a preference for the clamp in the standing position and the actual cautery in the recumbent position when operating upon old animals.
There are several other methods of castration in which the recumbent position is necessary. They will not, however, be described in detail, since, apart from personal opinion, the infre quency with which they are adopted points to a very decided lack of reliance on them.
Castration by Torsion.This method or a modification of it is still used in the smaller animals, but is not employed in castration of the horse as commonly as in former times. The testicle is exposed as in other methods, and the cord, after division of the posterior part, is seized high up with a pair of forceps or clamps which are held firmly. The testicle is then removed by twisting the cord and testicle until the cord tears below the forceps. This is done by hand or by grasping the spermatic cord about one inch lower down with another pair of forceps, which are rotated till the cord tears through.
Castration by Ligation of the Spermatic Blood vessels. Theoretically this method, applied under strict aseptic conditions, is the most rational. When careful attention to surgical
conditions has been observed it has been success fully employed. In practice, however, owing to the unavoidable conditions under which the general practitioner works, operation by ligation has never become popular.
Vasectomy.In this method the function of the testicle is destroyed by removal of a portion of the vas deferens.
Here again strict aseptic conditions must be followed. The vas deferens is exposed by making a small incision through the scrotum and tunics above the testicle. Two ligatures are applied to the duct about an inch and a half apart, and the intervening portion removed. The tunics and scrotum are closed by sutures. Though suc cessful in abolishing the direct and indirect functions of the testicles, it is not recommended for general use.
Young animals that have been castrated at the usual period of the year, between May and September, should be turned out to pasture on completion of the operation. Those do best that are so treated. The weather would have to be very unfavourable indeed to be as harmful as a closed stable or yard. In fact, it is very doubtful if inclement weather can of itself cause any harm.
There is always the possibility of an accident occurring during the casting of an animal for castration just as there is when casting for any other operation. The more common are injury to the back and limbs, fracture of bone and straining or bruising of muscles. In addition to these, however, are some peculiarly related to castration.
Fracture of Tibia.Fortunately this is of rare occurrence. If the animal is secured in the laterocumbent position it is the tibia of the off hind limb that is fractured; if in the dorsi cumbent position it may be that of either hind limb. It is the result of muscular contraction. A predisposing factor to its occurrence is the complete extension of the limb when secured.
This allows a greater muscular force to be exerted than when the limb is flexed. Any method then of securing the limbs that tends to limit the ability of the animal to extend it completely will lessen the chance of the occurrence of this accident and should be attempted.
Haemorrhage.This may be primary, occur ring immediately after the operation, or secondary, occurring at a variable period, from one or two days up to seven or eight, after the operation.
A variable degree of haemorrhage often occurs during or immediately following castration, and cannot be looked upon as an accident unless it is of such degree as to necessitate surgical interference. Unless it is profuse there is no cause for alarm, and in the great majority of it will cease spontaneously. And in any case there should be no undue haste in applying remedial measures, for if these be adopted and the bleeding is from the cord this will be sub jected to a handling that is better left undone unless really necessary.
If bleeding is profuse the animal must be secured in the recumbent position, and the vessel picked up and any one of the recognized measures for checking haemorrhage that may commend itself to the operator applied—ligation, torsion, or actual cautery. Every care as to surgical cleanliness must be observed. Plugging is most unreliable, and unless sterilized material is employed is likely to cause harmful results.
Prolapse of Omentum or Bowel.This may occur either during or after the operation. It may not occur until a few days after. The writer has observed prolapse of omentum ten days after the operation. Examination of the prolapsed portion readily determines its nature.
Prolapse of Omentum.If this occurs at the time of operating, either in the standing or recumbent position, remove the testicle being dealt with, taking care not to include any part of the omentum in whatever instrument is being used; then seize the prolapsed tissue and withdraw any further part of it that comes very easily. The whole of the exposed portion is then removed. If it contains any prominent blood vessels the removal can be done with an emascu lator or ecraseur; a pair of scissors will usually suffice, however, and is effective. As a pre cautionary measure a suture should be put across the scrotal wound, because the fact of the descent of the omentum indicates the likelihood of a somewhat abnormal condition of the internal inguinal ring. The suture should be removed in one or two days' time.
If the descent of the omentum occurs some time after the operation, the external part will be more or less congested and inflamed and is sure to be soiled. The amount prolapsed may vary considerably, and although some uneasi ness may be exhibited by the animal very little systemic disturbance usually occurs. Treat ment can, as a rule, be carried out with the animal standing. The scrotal region should be thoroughly cleansed and disinfected. The prolapsed portion is then dealt with in an exactly similar manner to that already described, being cut away well above the inflamed part. No suture need be inserted into the scrotal wound.
Prolapse of Bowel. This is a much more serious condition. Here again prolapse may occur at the time of operating or shortly after. Violent pain very soon occurs, and the amount of protruding bowel—usually small intestine— is increased during the struggling and strain ing of the animal. Unless remedial measures are immediately applied the bowel rapidly becomes congested and changed in appearance; signs of shock and subsequent collapse soon become manifest, and death occurs in a few hours.
The animal must be secured in the dorsi cumbent position and anaesthetized. Every endeavour must be made to protect the pro truding bowel from soiling and injury, and to prevent further prolapse. The bowel is then cleansed thoroughly with some suitable anti septic or preferably with warm sterile normal saline solution, if this is quickly procurable, and reduction carried out. The opening through the testicular tunics should then be secured, and after giving them one or two twists a strong wooden clamp placed as high as possible on them. The end of the spermatic cord should be included in the clamp if possible, as this helps to support the clamp and tissues in such a position as to prevent the descent of bowel into the vaginal sac. The animal should be kept quite quiet and prevented from struggling; an anodyne being given, if necessary. He should be fed on light diet and the scrotal region kept clean with antiseptics. If progress is maintained and no bowel is present in the vaginal sac the clamp may be removed in four or five days' time, or it may be allowed to fall off of its own accord.
If any tearing or much bruising of the pro lapsed bowel occurs before attention can be given to it, the animal should be destroyed: such cases are invariably fatal.
Other sequelm of castration are the results of various degrees of bacterial infection. In fection may occur at the time of operating or subsequently.
Septic Infection.This can be looked upon only as a serious sequel of castration in proportion as the results of it are serious. Slight septic infection almost always occurs, even if only in the scrotal wounds. The normal peritoneum, of which the tunica vaginalis is, of course, an extension, is capable of dealing with slight infection, having a particularly good defence against bacterial invasion. The degree of septic invasion may range from infection of the scrotal wounds to infection of the spermatic cords and inguinal canals, and even extend to the ab dominal cavity, setting up peritonitis; it depends upon the degree of infection, the virulence of the organism, and upon any factor that may tend to lower the vitality of the animal in general and the invaded tissues in particular, e.g. unhealthy condition of the animal at the time of operation, exposure, etc., handling of the spermatic cords and tunics at the time of operation, and the undue applica tion thereto of antiseptics.
If the post-operative swelling is well forward and chiefly confined to the prepuce, if the dis charge from the wounds is not excessive or offensive in odour, and if the animal is moving about freely and feeding, no attention to the wounds is necessary. But if the swelling is distinctly posteriorly situated in the scrotal region, the discharge copious and offensive, and the animal disinclined to move and off feed, he should be caught and the scrotum and thighs carefully cleansed, and the scrotal wounds syringed out with some suitable antiseptic and all accumulated discharge removed. Any of the commonly used antiseptics will do, but they must be properly prepared and of suitable strength, and clean utensils must be used. Care must be taken not to use too much force and that the fluid can escape easily, otherwise infective material may be forced higher up the canal and even into the abdominal cavity. If the fingers are introduced into the scrotal wound after they have been well cleansed and disinfected, the spermatic cord can be distinctly felt as a tumified mass extending upwards.
Abscess formation in the groin, just inside the flank, may occur. Under suitable local treatment, good feeding, and exercise, the majority of cases soon improve and complete recovery takes place.
In a small number of cases the condition may either become more acute, infection extending to the abdominal cavity and setting up peri tonitis, or may assume a more chronic char acter, giving rise to the condition known as scirrhous cord.
Peritonitis.This should be very infrequent.
The writer, deservedly or undeservedly, has yet to see his first case as a sequel to castration.
The condition is set up by septic invasion through the inguinal canal. The majority of cases in which the affection is definitely estab lished prove fatal. The symptoms shown are: disinclination to move or eat, high temperature —up to 107° F.; fast thready pulse; short jerky thoracic respiration—a distinct pause between inspiration and expiration; dirty in flamed mucous membranes; and a dull, decidedly anxious, and pained countenance Treatment, other than local antiseptic applica tions to the scrotal and inguinal regions, is given elsewhere, but is of little avail.
Scirrhous Cord.It is necessary to distin guish under this heading a subacute circum scribed inflammatory condition limited to the extreme end of the divided spermatic cord from a much more chronic inflammatory condition having a tendency to extend up the cord and to the surrounding tissues. The former, to which the term granuloma of the spermatic cord might be applied, and to which the French term"champignon"is more applicable, owing to its quick growth, than to chronic scirrhous cord, occurs as a well-defined spongy mass of excessive granulations growing from the extreme end of the spermatic cord—sometimes under the scrotal integument, but more commonly externally to it. Growth is rapid and exuberant. As a rule, one cord only is affected, but cases do occur in which both are more or less equally affected. The size of the growth may vary from that of a large orange to two or three times that size. The condition may occur after any method of castration. The cord being divided too low down is a predisposing factor. In the writer's experience it has occurred more frequently in animals operated upon for scrotal or inguinal hernia by the covered method than in ordinary castrations.
The actual cause is probably an infection of the stump of the cord by some benign organism setting up a slight, prolonged, and persistent irritation. The condition is not serious and is easily cured by total excision—the mass being removed by division of the cord with the ecraseur well above the inflammatory tissue.
Chronic Scirrhous Cord.The commonly accepted cause of this is infection with a specific type of organism—botryomyces.
Infection may take place at the time of operation or subsequent to it. An especial feature of the condition is its chronic nature— its presence not being discovered or suspected until some considerable time after the opera tion. It may be ascertained on examination that in some cases the scrotal wound has never quite healed; while in others healing has been completed and the condition not become manifest till months or even years afterwards.
From the frequency with which the remains of the spermatic cord is affected it would appear that the original infection is at the end of this, but extension of the infection with induration of the surrounding tissues gradually occurs until the area of affected tissue is in some cases enormous. Extension occurs up the cord as far as the inguinal ring, and even subperitoneally beyond.
The external symptoms, and those generally first noticed, are intense induration of the scrotum with abscess formation. An abscess may form, burst, and heal, and the surrounding inflammation appear to subside temporarily only to be followed by further abscess forma tion. In older-standing cases there are multiple surface abscesses or open sinuses leading into the depth of the indurated mass. One or both cords may be affected. Occasionally one meets a case in which lameness or a certain degree of stiffness in movement of one or other of the hind limbs may be the first symptom noticeable. There is, as a rule, no marked systemic dis turbance or loss of condition in the animal affected.
Treatment consists in removal of the affected tissues. The sooner the condition is diagnosed and the sooner operated upon after discovery the simpler is the operation and the quicker the cure.
The animal must be secured in the dorsi cumbent position and an anaesthetic given. If the condition is only in the early stages entire removal of the affected tissues is comparatively easy, but if the condition is old-standing and the infiltration extensive the operation is a serious and always a bloody one. All, or as much as possible, of the affected tissue must be removed.
Blunt dissection, with the fingers and handle of a knife, should be employed, but sharp dis section will have to be done on some parts.
Bleeding from large vessels must be controlled by forceps, torsion, and ligature. The large blood-vessels in this region must be avoided. If possible, one should endeavour to get to sound healthy tissue of the cord above the mass. This can be cut through with an ecraseur, but unless quite healthy tissue can be reached the knife is necessary, for no ordinary ecraseur chain will stand the strain owing to the fibrous nature of the tissue to be cut.
The operation should be of course performed under aseptic and antiseptic conditions. The cavity, after removal of the affected mass, should be dressed with strong tincture of iodine (1 in 8), and plugged with sterilized gauze. The wound afterwards should be dressed with suitable antiseptics.
The administration of potassium iodide and biniodide of mercury internally should accom pany the local treatment.
Paraphimosis. So-called paraphimosis some times occurs as a sequel to castration. It is seen following more or less serious infection of the spermatic cords or scrotum, where there has been pronounced inflammatory cedema of the surrounding tissues. It is not a true para phimosis in that retraction of the penis is pre vented, not by a constriction of the prepuce, but rather by the extension of the inflammatory cedema to the prepuce, to its secondary internal fold over the base of the free portion of the penis, and to the penis itself. This causes the penis to become straightened out and pro truded from the prepuce. When this has occurred the added weight of the transudated fluids into the preputial and penile tissues acts as a greatly aggravating factor, causing the organ to become all the more pendulous and the circulation all the more difficult.
In some cases of so-called paraphimosis a true phimosis exists. It is caused by a great accumulation of cedematous fluid in the loose connective tissue of the secondary internal fold of the prepuce, resulting in this fold becom ing protruded and so swollen and cedematous that the orifice at its free end is more or less closed, preventing the protrusion of the glans and free portion of the penis.
The condition may vary in severity, but under suitable treatment recovery usually takes place. Rarely, however, the condition is per manent even after the oedematous condition has subsided—a paralysis of the retractor penis muscle, resulting from a degeneration of its fibres, following a myositis set up at the time of the original inflammatory condition, or owing to the continued over-extension of them.
Treatment. Besides the local treatment to the scrotal wounds already described, anything that will tend to lessen the further transuda tion of fluid and assist in the removal of that already accumulated should be carried out. In order to remove the aggravation due to the pendulousness of the organ, a bandage or sling should be adjusted so as to suspend the penis in line with the prepuce. An ordinary triangular bandage with three tapes, one from the apex up between the thighs past the root of the tail to meet the two from the other corners brought up by the flanks to tie across the loin, is never effective. The bandage—made of ordinary washing flannel or part of an old blanket— should be folded as follows: Six tapes are adjusted: the posterior one passes up between the thighs past the root of the tail under the lateral ones, which are brought up by the flanks and tied across the loin, and tied to the top of a surcingle. The anterior one is tied to the bottom of the surcingle, and the two others to the top of it or at such a level at the sides as will maintain the bandage on the abdominal wall.
Massage, fomentation, and astringent lotions may be beneficial. Exercise is especially so. Scarification of the penis is adopted by many. This, by allowing expression or draining of the cedematous fluid, reduces the weight consider ably and so far acts beneficially. It should be accompanied by suspension. There is, however, a possibility that aggravation may result from an added local infection of the tissues. It is not recommended in advanced cases when there is tumefaction and surface abrasion and exuda tion. Previously to its being done the surface of the penis should be always cleansed and disinfected.
When paralysis of the penis has occurred the animal may be made workable by attempting a plastic operation. The instruments required for this are: A sharp scalpel, scissors, dressing forceps, several pairs of artery forceps, medium sized suture material and needles, a catheter or whalebone-sound, and a hank of broad tape. The animal may be secured in the dorsicumbent position or the laterocumbent with the upper hind leg fixed up as in castration, the penis and prepuce having been cleansed previously. The slinging bandage should be allowed to remain on during casting so as to prevent bruising or other injury to the organ. The tape is put on behind the glans in the form of a clove-hitch and the free ends tied. By this an assistant holds the penis extended. After the skin of the penis has been disinfected two incisions completely encircling the penis are made through the skin, one immediately below the prominent ridge of skin that forms the lower limit of the skin covering the base of the free portion of the penis, and the other some three or four inches above this close up to the opening into the sheath. These incisions should be made by gradually extending them alternately—not by completing one before com mencing the other. They are then connected by a longitudinal incision; and by dissecting in one or both directions from this connecting incision, this band of skin, with its underlying cedematous connective tissue, which is of variable thickness, always greatest in front, is completely removed, care being taken not to damage any of the large blood-vessels external to the tunica albuginea. The now widely-separated edges of incised skin are approximated and held in posi tion by interrupted sutures, dressed, and the animal allowed to rise. Suitable antiseptic and dry dressings are applied and the use of the suspensory bandage continued till healing is complete.
Failing this, amputation of the penis must be carried out.
Tetanus. This as a sequel to castration is the result of infection by a specific organism— the tetanus bacillus. Although this may occur anywhere, it is noticeable that its occurrence is much more common in some localities and countries than in others. Several of a number of animals operated upon at one place or on one day becoming affected would point to some carelessness in regard to the cleanliness of the instruments or the operators' hands. But isolated cases may be due to accidental infection either at the time of operating or subsequently. In localities where tetanus is known to be common a dose of antitetanic serum should be given to the animal at the time of the opera tion. This may not act as a certain protection, but it will lessen the severity of the affection and render recovery more possible.
Castration of a Horse suffering from Inguinal or Scrotal Hernia An animal suffering from either of these con ditions, provided it is not subjected to repeated attacks of colic, nor shows any symptom of threatened strangulation, should not be cas trated until two years old. Not only is there a tendency up to two years old for the hernia to become cured spontaneously or lessened in size, but all the animal's tissues, including those upon which one has to rely for effecting a cure, become stronger and more definitely developed; the operation is rendered easier, and better results are obtained.
Inguinal or scrotal hernia is by no means an uncommon lesion among horses, occurring perhaps more commonly among the coarser breeds. Scrotal hernia is present in quite a large number of foals at birth or soon afterwards. In a few the hernia assumes such proportions, or such symptoms are shown, that immediate surgical interference is necessary. In the majority, however, it has disappeared before the animal is one year old. If still present it is likely to be permanent, though it may become reduced in size.
Hereditary predisposition or inherited de formity is considered to be a cause in young stock. And although the evidence of the more frequent occurrence of the condition among foals of a certain sire or from a certain dam appears to substantiate this opinion, there are undoubtedly other predisposing factors. One such in the experience of the writer appears to be worth mentioning—and there must be others.
The condition was extremely common among the male colts bred at a certain stud. About fifteen colts was the average number for castra tion yearly, and among these two or three usually had to be left to the following year and specially operated upon. A larger proportion than this had suffered from the condition at or soon after birth. There was no pleasure in operating on animals at this place, but un pleasant as it was, confidence, however, in the reliability of careful preliminary examination of the scrotum was gained. The possibility of the stallion being to blame was considered, and since he was used almost solely for the owner's mares, there was no evidence to prove him guiltless. Following the purchase of another stallion, not on account of the other's possible deformity, but because his stock were coming round for service, the trouble continued. This stallion, however, was travelled in the district, and since it could not be ascertained that any number of his other foals were ruptured, closer investigation was made. As a result of this it was found that there appeared to be undue interference on the part of the man who looked after the foaling mares, the custom being to get help as soon as the mare showed signs of foaling, and forcibly draw the foal away —not being content with assisting the mother in her normal efforts.
It was reasoned that in delivery by traction there is a tendency for the whole abdominal contents to be forced into the posterior portion of the abdomen, especially so if dilatation of the vaginal passage is not yet complete; and with the foal in an unnaturally extended posi; tion there is the possibility of some part or other of the viscera being forced through one or both inguinal rings down the canal; whereas in delivery by propulsion—the normal method —directly opposite influences are at work. Whether this be the or not, the trouble at this place ceased, following the strict forbiddance of unnecessary interference during normal delivery; and castration of colts for this owner could be undertaken without fear or trembling.
The extent of the condition may vary from a small knuckle of bowel or omentum which does not descend further than the inguinal canal, to a quite considerable amount descended into the vaginal sac; this, along with the overlying scrotum being distended and pendulous, reach ing in some cases almost to the hocks. The sac, although distended, maintains its normal shape, being curved downwards and backwards and having at its extreme postero-inferior limit a definite hemispherical bulge, which normally accommodates the tail of the epididymis. The abnormality is usually unilateral—more fre quently on the left side. It may, however, be bilateral.
The animal must be secured in the dorsi cumbent position, some method being em ployed whereby the hind limbs are well flexed and held apart so as to allow free access to the scrotal and inguinal regions, similar to that required for"rig"operation.
A method which is a combination of that of Miles, described in Fleming's Veterinary Surgeryy, and of that of Donald, described in the Journal of Comparative Pathology and Thera peutics, vol. i. (p. 332), is particularly effective. A combined neck-rope and surcingle is used, which consists of a rope fourteen feet long, which has spliced into one end a metal ring two inches in diameter; four inches from this is a loop in the rope having a metal eye about one and a half inches in diameter. At a point fifteen inches further along the rope is a plain spliced loop in the rope, and another one similar some six inches from it, and again fifteen inches from this another loop having a metal eye in it similar to the other one. The rope is applied by passing the ringed end over the neck from the near side—it can be done from either side —and the free end passed through the ring, thus forming a loop round the neck. This loop is tightened so that it fits closely to the base of the neck just in front of the shoulders and in such a position that the two rope loops lie on either side of the middle line at the under side of the neck and in front of the chest, and the metalled eyes lie backwards over either scapular region. The rope is fixed by making a bowline knot with the ring. The free end is then passed round the chest behind the withers and elbows, and secured also in the form of a bowline knot. These knots can always be undone easily. This loop back from the collar and round the chest does away with the possi bility of the neck loop slipping up the crest when the animal struggles.
Two side-lines, each twenty-five feet long, and having a spliced loop at one end, are fixed on to the bottom loops of the collar by passing the loop of the line over the loop of the collar and then threading the free end of the line through the latter. The benefit derived from these separate loops on the bottom of the neck collar is that the collar maintains a better position and does not draw to one side, causing pressure across the bottom of the windpipe and blood-vessels, as happens when the collar is improvised out of the combined side-lines and when the side-lines leave the neck loop at its lower middle point. The side-lines may be attached to the neck-rope before this is placed in position, or afterwards, whichever seems the more convenient. The two side-lines are then passed backwards, quite free of one another, between the fore and hind limbs, each one being brought round the back of the thigh outwards to its own side, from where they pass forwards through the metal eyes on the neck rope, on the way being looped once round itself in front of the stifle. The near side-rope is then passed over the back to the off-side, where it is held along with the fellow off-side rope suffi ciently taut to prevent their slipping below the hocks.
Four webbing hobbles with metal D's and a fifteen-foot rope with a spliced loop at one end are used for casting. A hobble is placed on the near fore pastern, one on each of the hind pas terns, and the fourth on the cannon of the off fore limb. The looped end of the shackle rope is put round the off fore limb, threaded and pulled up tight on the pastern; the free end is passed through the D of the hobble on the near fore from off-side to near side, across to the off-side and then to the near side through the D's of the hobbles on the hind limbs. From here it again crosses to the off-side to be passed through the D of the hobble on the off fore back again to the near side, when it is held by three good men. If the hind limbs are very straggling they are brought together in a more forward position and any slack in the shackle rope taken up. The operator then goes to the off-side, where, with the man already holding the side-lines, they will use the near side one, which has been passed over the back, as a"pull-over"rope. The man at the animal's head, which he should be holding with a hand on each side of the bit or head-stall, or by the twitch if it has been necessary to apply one, should, on the signal being given to pull, give the animal's head a sharp push upwards and backwards.
The advantage of the hobble on the fore limb of the side on which the animal is to fall being the last the shackle-rope passes through, does not appear to be sufficiently widely appreci ated. Taking the near hind pastern as a fixed point, the primary effect of the pull on the shackle-rope to the near side is for the D of the hobble below the knee on the off fore limb to act as a pulley and this limb to be pulled in under the body, which is then easily thrown out of equilibrium. It is undoubtedly due to this fact that animals cast in this manner appear to go down very easily.
When the animal is on tIle ground the four feet are pulled together and secured by making a double hitch with the shackle-rope round the near hind pastern. The animal is then anaes thetized. In order to save time the securing of the animal in the proper position for operating may be proceeded with before the surgical stage of anaesthesia has been reached. The loop of the side-line above the near hock is placed below the fetlock and the rope drawn taut and securely held. The shackle-rope is freed from the near hind pastern and unthreaded from the hobbles on the off fore and near hind limbs, and is again given a half hitch on the near fore pastern. The two freed hobbles are removed. The near side-line is now tightened slightly, and at the same time the operator, standing behind the croup, reaches over and grasps the cannon of the near hind limb with his left hand, and by pulling in a line with the croup flexes the limb so that the foot is -just in front of the stifle. The side-line is tightened with the foot in this position, but not so as to pull the foot too far forward. To secure the foot at this length a couple of hitches of the line coming from the collar eye are placed over the foot in such a way that they form a clove-hitch round the pastern.
The estimating of the correct position of the foot is a matter of a little experience. If the foot is drawn too near to the collar the back of the animal, when he is finally secured, will be arched and the hind leg in a position that will not allow of the freest access to the inguinal region. If there is too great a length of side line between the collar and the foot then there will be too much play of the limb, and other parts of the securing will be thereby affected.
The free end of the side-line coming from where it is hitched round the near hind pastern is now passed in from behind between the lower quarter and the ground so that it is in front of the angle of the haunch. It is pulled taut, its direction being up the near flank and across the back just in front of the croup. The animal is now turned on to its near side by means of the shackle-rope. The off side-line is passed down into the heel and tightened, the shackle rope being released and unthreaded from the hobble on the off hind limb, and the hobble removed. The fore limbs are now secured by flexing the knees, and by passing the shackle rope under the near forearm round the front of it, high up towards the shoulder, from where a loop in it is passed between both forearms and passed over the near fore foot; this loop is tightened by pulling on the free end, which is passed round the front of the off forearm, which is uppermost, across the outside of it to be hitched round the off fore pastern. The off side-line is now fixed and passed under the croup to the near side in exactly the same manner as the near side one was dealt with. The rope from the near hind foot is now pulled on so that the foot is drawn up close to the flank. The operator takes this rope and passes it across the off quarter and gastrin so that it gains the inner side of the limb, crossing the inside of the tibia and round in front of the off pastern, above the rope coming to the off pastern from the collar. It is pulled backwards as tight as possible and secured by making a couple of hitches round the pastern. By this means the near hind limb is held flexed and the off hind prevented from being thrust forward. The animal is now rolled on to its back and main tained in that position by placing on each side a sack stuffed, not too tightly, with straw or sawdust. The rope from the off hind foot is held securely meanwhile, and then fixed on the near hind pastern similarly to that on the off hind.
By securing the animal in this manner there are no ropes crossing the scrotal region as there are in Miles's method; neither is there any need for using a spreader, rather the reverse. A small cord can be passed from one hind foot to the other to prevent any overspreading of the hind limbs.
Although the securing occupies a little time, this is not time lost, for it can be completed almost as soon as the animal has reached the surgical stage of anaesthesia. Any exertion on the part of the operator in doing it is repaid him a hundredfold when it comes to operating. Especially is this true when he has no profes sional assistance, as is generally the case in the country.
To release the animal the side-lines are untied from both hind pasterns and pulled out from under the croup. Then, according to which side the animal is intended to lie on, the clove hitch on the pastern on that side is removed, the sacks taken away, and the animal allowed to roll on to that side. The fore feet are now released, the shackle-rope taken off the off fore pastern and withdrawn from the hobble on the near fore and removed. The bottom side line is slackened and removed from the pastern. The upper one is now released and removed; and lastly the combined surcingle and neck rope is untied and the animal allowed to rise.
Instruments. A sharp scalpel, two or three wooden clamps, the ordinary strong, grooved, straight, wooden clamps (Fig. 310), a pair of strong forceps for closing them, and strong cord for securing them. An ecraseur, right and left hernia needles, one or two ordinary strong suture needles and silk, a few pairs of artery forceps, scissors, and dressing - forceps. All instruments should be sterilized by boiling just previous to operating. They can be used direct from the sterilizer; or, considering the environ ment in which the operation is usually performed, it is as well for them to be immersed in a suitable antiseptic solution in an enamel tray. Just as with regard to attention to detail of securing, so attention to detail in endeavouring to obtain aseptic and antiseptic conditions throughout is well repaid by results.
Preparation. The animal should be restricted to a non-bulky nutritive diet for a short period, and suitable exercise allowed. It should also be taught to stand tied up, if this has not already been done. The sheath should be cleaned three or four days before operating, and if possible, the hind legs and feet well cleaned the morning of the operation. The hind feet should be wrapped in damp cloths when the animal is secured, in order to prevent dirt soiling the wounds if the animal should struggle.
Food should be entirely withheld for at least twenty-four hours previous to the operation, a small quantity of water only being allowed.
When the animal is finally secured the scrotal and inguinal regions and the inside of the thighs are well sprayed, or painted, with tinc ture of iodine.
Operation. The animal should be inclined a little to the side opposite to that affected, or if the condition is bilateral, then to that chosen to be operated upon first.
In many cases the hernia has become reduced spontaneously, owing to the position of the animal and to the anaesthetic. Whether this is so or not, the first thing for the operator to do is to secure the testicle. The incising of the scrotum and laying bare of the underlying tissues is greatly simplified if the testicle is present. Occasionally it will recede into the abdominal cavity along with the intestine, but even if this has occurred the testicle may be secured by exercising a little patience.
The thumb and fingers of one hand should be thrust in the direction of the external inguinal ring and the fingers of the other hand thrust into the deep inguinal region and used as directors. Moving the animal slightly from side to side will often cause the testicle to float up into the scrotum, If the operator has an assistant he can, after well soaping or oiling a hand and arm, insert it into the rectum and endeavour to locate the testicle and direct it towards the operator's hands. The operator should not do this himself, as it is quite out of the question for him to render surgically clean again at the time the hand and arm he has so used.
If the hernia has not become reduced the testicle will almost certainly be present, and there will be no difficulty in securing it. This having been done, the hernia is reduced by careful and definite manipulation. As a rule this is easily accomplished in young animals, ' adhesions being rare. Adhesions are more likely to follow a hernia occurring in an older animal as the result of accident, a primary inflammatory process having been set up. If, however, reduction cannot be accomplished thus, intra-abdominal traction on the bowel may be practised by an assistant with a hand and arm inserted into the rectum. Failing this, opening of the testicular tunics at a later stage of the operation will be necessary, and any adhesions will have to be broken down, and possibly the internal inguinal ring enlarged.
The testicle covered by the scrotum is lifted as high as possible by the right hand; the left grasps securely the scrotum and enclosed spermatic cord below the testicle, and by exert ing a squeezing action renders the scrotum over the testicle very tense. An incision, four or five inches long, either parallel to the scrotal raphe and a couple of inches from it, or from the direction of the inguinal region backwards and inwards to the scrotal raphe, is carefully made through the scrotal integument only. The squeezing action of the left hand—as though trying to bulge the testicle out of the opening— is maintained, and is very necessary. The under lying tunic, the dartos, is cut through, by a succession of short shallow cuts the whole length of the incision: the sharper the scalpel is, the less likelihood of cutting too deep. Cutting is continued to such a depth that the edges of the incision begin to separate, and the underlying testicle covered by its tunics to bulge out, under the pressure exerted by the left hand. It will be seen that the yellowish-red tissue of the dartos has been completely severed before this happens, and the transversely crossing, white, glistening, fine fibres of the underlying tunics can be made out.
It is quite immaterial as to exactly what tissue has been or is necessary to be cut under the dartos. For when once the bulging of the testicle has started freely for the whole length of the incision the knife can be laid aside and the further enucleation of the testicle in its tunics completed by separation by the thumb and fingers only, first of the right hand and then of the left. By this means little or no haemorrhage will occur; and there is no fear of opening the tunics. A definite attachment, however, through which it is necessary to cut with the knife, exists in the form of the scrotal ligament from the postero-inferior extremity of the tunics toward the perineal region of the scrotum.
The vaginal sac is liberated as high up as possible. If the bowel has again descended, the hernia is finally reduced. The testicle in its sac, held high by the right hand, is given one complete twist. This not only prevents any further descent of the bowel while the clamp is being put in position, but assists in maintaining it in position after the clamp is applied. The clamp is put on from four to six inches above the testicle and pushed well home on the cord and tunics. The open end of the clamp is closed by the thumb and index finger of the left hand, and the right, having released its hold of the testicle, applies the steel forceps to the clamp between the point where the spermatic cord passes through it and the encircling groove for the securing cord. The clamp is then slowly and firmly closed by exerting pressure with the forceps, which an assistant then holds firmly while the operator ties the clamp securely with strong cord.
It is not necessary, in fact it is not advis able, to place the clamp as high as possible on the cord. It must be remembered that as a result of the position of the animal and the consequent sinking in of the abdominal wall the inguinal canal is considerably shortened. By pulling on the vaginal sac when this is exposed the canal can be made to be practically non existent. If then the clamp is put on as high as possible, the downward pressure upon it con sequent upon the animal rising and the abdo minal wall resuming its normal position will place such a strain upon the vaginal sac and cord in the region of the internal inguinal ring that tearing of either, followed by escape of intestine, may result. Even if this tearing does not happen, the pressure of the clamp on the scrotum will cause necrosis of the skin, followed by granulation, a condition which will aggravate the local inflammatory swelling, which always occurs to a greater or less extent, and may render the removal of the clamp somewhat difficult.
If the clamp is put well above the testicle and epididymis it will be held up in the inguinal region firmly enough when the animal is on its feet, and will prevent any re-descent of the hernia, which will be cured as well as the animal castrated.
In cases where the testicle is very big it should be removed, so as to lessen the drag on the cord. This is done, after the clamp has been securely adjusted, by making an incision through the tunics large enough to liberate the testicle, which is removed with the ecraseur. This part of the operation should be performed under the strictest antiseptic conditions, and the opening in the tunics closely sutured after removal of the testicle as a precautionary measure in case of any accident to the clamp.
In operating upon a case in which the hernia is irreducible on account of the existence of adhesions, the tunics containing the testicle and the herniated viscus are carefully exposed and freed in a similar manner to that already described. An opening large enough to admit one finger is made at the bottom of the sac and the adhesions between the bowel and tunic carefully broken down and the hernia reduced.
If this does not succeed, then the vaginal sac must be laid open sufficiently to enable reduc tion to be accomplished. By temporarily suturing the tunics over the testicle again a much better purchase is obtained on the tunics and the operation is completed in the same manner as when the tunics are not opened. Needless to say, every precaution must be taken to prevent infection of the vaginal sac and con sequent peritonitis.
The clamp is allowed to remain on for five or six days, when it is removed, or it may be allowed to drop off of its own accord.
The other testicle is treated in the same manner if a hernia, or any suspicion of one, exists on that side. If not, the testicle can be exposed in the ordinary manner and removed with the ecraseur.
In those cases in which the hernia has been a very large one, or in which there may be any doubt of the tunics standing the strain, the clamp may be placed inside the scrotal incision and the lips of the wound brought together over it by interrupted sutures. If satisfactory pro gress is maintained the clamp is allowed to remain in position for about a week, when it is removed. In those cases, however, in which it is thought advisable, one or two of the sutures in the scrotum should be removed two or three days after the operation. It should be rarely necessary to have to resort to this covering up of the clamp.
The animal should be released in such a manner that he is lying on the side on which the hernia existed, and he should have quite recovered from the anwsthetic before being allowed to rise.
After-treatment consists in placing the animal in a clean stable and tying it up so that it cannot lie down. The food should be restricted and light for a few clays, and then, if progress is satisfactory, an increased quantity of a more normal diet, containing some corn, may be given. The animal may also be untied so as to be able to move about and get some slight exercise.
Very little in the way of really effective dressing of the scrotal region can be accom plished, nor does it appear to be necessary. Attention should be paid to the cleanliness of the surroundings. If flies are at all trouble some, spraying of the scrotal region with 2i per cent carbolic acid or 1 per cent lysol, followed by dusting on boric acid, may be carried out two or three times daily.
Castration of the Donkey and the Mule The male donkey and male mule are castrated by the same methods as those which are em ployed in the horse. These animals are usually operated upon in the recumbent position.
Although the testicles of the donkey are com paratively larger than those of the horse, the tissues composing the spermatic cord appear to be of thinner structure and are more friable. No matter by what method, or how carefully, the operation is performed, a variable amount of hemorrhage usually occurs immediately following the operation, especially in adult animals. This hemorrhage should cause no alarm, because it will almost invariably cease spontaneously.
The testicular sacs of the mule show a much greater tendency to persist after castration than do those of the horse, in which they usually become obliterated by becoming adherent to the spermatic cord and the whole structure atrophying.
Fluid accumulates in these non-obliterated sacs, giving the animal the appearance of not having been castrated, or of being ruptured.
The precise cause of this phenomenon, how ever, in the mule is somewhat doubtful. Gener ally speaking, the tissues of the mule are without doubt more resistant to, or are more capable of dealing with, infection by pyogenic bacteria. A possible explanation, therefore, of this per sistence of the testicular sacs is that there is less local inflammatory reaction following cas tration in a greater proportion of mules than horses, and a correspondingly proportional number of cases in mules in which adhesion of the parietal and visceral layers of the tunica . vaginalis, resulting in obliteration of the sac, does not take place.
In order to lessen the occurrence of this condition the lower part of the testicular sac should be removed along with the testicle at the time of castrating.
When it has occurred the only effective remedy is removal of the sac. The animal is cast and secured as for a scirrhous cord or hernia operation. An elliptical incision is made round the cicatrix in the scrotal integument and the sac dissected out. Sharp dissection with the knife will be necessary at first, in order to expose the tunics of which the sac is composed, then blunt dissection with the thumb and fingers will be possible. The sac when it has been freely exposed, and the remains of the sper matic cord which it contains, are removed high up by an emasculator or ecraseur.
Castration of Cattle The bull is usually castrated at the age of from two to eight months. Often, however, animals up to two years old are castrated— animals that have not developed up to the desired standard, or are otherwise unfit for breeding purposes. Occasionally older animals are castrated, but more frequently these are sold for slaughter uncastrated.
There is no particular season of the year much more favourable for the operation than another. The same remarks that were made in connection with the horse are applicable to cattle. The fact that the majority of these operations are performed in summer and autumn is governed chiefly by the time of the year at which the majority of animals are born.
An animal that is going to be castrated should be kept short of food for some hours previously. He should be in good health and placed in clean, healthy surroundings.
Restraint. — This varies according as to whether the animal is operated upon in the standing or recumbent position.
To secure an animal in the standing position a stall is the best place in which to have the animal. It is stood with its right side along side a wall or partition and secured by means of a rope noosed round the horns or by a long shank from a suitable strongly made headstall. The rope is passed through a ring low down on the manger or head post and secured to another ring or post some four or five feet away. This precaution should be taken so that the rope may be released in the event of the animal throwing himself down in an awkward position. A pair of bulldogs, with a few feet of cord attached, may be applied to the nose, but if the animal's head is pulled well down these are not necessary. The end of the tail is passed forward between the thighs and to the left of the scrotum out by the left flank, where it is securely held by a man standing on that side of the animal pressing it against the wall. The operator stands directly behind the animal.
To secure the animal in the recumbent posi tion, animals that are not too big can be cast as follows: Whoever is going to put the animal down seizes its right ear with his right hand and the narrow part of the lower jaw with his left, the thumb passing through the mouth behind the incisors and the fingers round under the jaw. He stands facing the same way as the animal, then by turning himself half round, and at the same time forcing his left hand up and pulling his right down, he twists the animal's head and neck and it falls easily on to its left side. It is then held by the man placing his left knee on its neck close behind the ear, and, having leant forward and grasped the right hind leg, pulling this up and holding it well pressed down on to the ribs by both hands, one above and one below the hock. If the animal is fairly large the leg is held by another man, or it may be secured by a short cord, which is tied on to the cannon, passed round under the neck over the withers, then under and round the leg above the hock, where it may be secured or the free end held.
To cast an adult animal a side line, which may be used in various ways, is necessary, or the animal may be cast with hobbles placed above the fetlocks, or by Reuff's method, a neck rope being used to secure the right hind limb.
The recumbent position is preferable for the young animal, since it can be so easily cast, and more easily held and dealt with than when standing. In larger and older animals the standing or recumbent position is a matter of choice for the operator.
The more commonly employed methods include: the use of Burdizzo's emasculator, and various other patterns of emasculator, which are usually made a size smaller than those for the horse; the ecraseur; ligation; a method of combined torsion and tearing; and the actual cautery; all of which methods— even the last—can be carried out upon the animal in either the standing or recumbent position. Another method employed, though not in this country, is subcutaneous torsion, bistournage; and yet others: crushing of the testicles, and ligation of the neck of the scrotum, either with cord or with an elastic band.
Whatever method is adopted, the same attention to sterilization and disinfection of instruments and cleanliness of the operator's hands is as necessary as in the case of cas tration of equines.
The quickest, easiest, cleanest, and safest method for all ages is, without doubt, the employ ment of Burdizzo's emasculator, Fig. 311. The efficacy of this instrument depends upon its being jointed in such a manner that great pressure is exerted at the jaws by the application of com paratively small force at the handles.
The jaws are made so heavily and strongly that no pressure is lost by springing of the jaws, which are also wide, rounded trans versely on the edges, and quite smooth. The edges of the jaws come together so intimately when the instrument is closed that any tissue interposed between them is completely crushed. In action they embody a perfection of Siebold's method, in which a screw clamp is used to crush the neck of the scrotum and the included sper matic cords.
Precision in their use is necessary. The instrument lends itself admirably for use in the standing position, but is of course equally applicable for the recumbent position. The operator standing behind the animal grasps with his right hand the right testicle, in the overlying scrotum, at its junction with the spermatic cord, and draws the gland down wards to its full extent. The thumb and index finger of the left hand are put round the neck of the scrotum from left to right, and being approximated at about the middle line they push the right spermatic cord in front of them towards the right side of the neck of the scrotum, against which they firmly squeeze it. The thumb and index finger of the right hand are now moved into a position about two inches lower down than those of the left hand, and here they too squeeze the spermatic cord up to the right side of the scrotum, the remaining fingers and the palm of the right hand maintaining a hold on the testicle. An assistant then places the jaws of the instrument across that part of the right side of the neck of the scrotum between the thumbs of the operator, leaving about one inch of the width of the jaws overhanging the side of the scrotum. He then completely closes the instrument and opens it again immediately. A second crushing is made in precisely the same manner about an inch and a half or two inches lower down, the operator lowering his hands this distance and holding the cord as before. He then reverses the position of his hands and the left testicle is dealt with similarly.
The second crushing of the cord is by no means necessary, but it is painless and very quickly done and renders the obliteration of the testicular function absolutely certain. A possible explanation of the incomplete success, in a number at least, of a small percentage of cases in which the instrument has been applied to each cord once only, is that the cords were improperly held and so were incompletely crushed. There is a tendency for them to roll away from the jaws of the instrument unless held as described.
No after-treatment is necessary. The tes ticles and scrotum are swollen for a day or two, but the animal exhibits no systemic dis turbance or any inconvenience whatever. The swelling soon disappears and the testicles become atrophied.
In other methods the testicle is exposed by incising the scrotum. This is done by grasping the testicle at its upper extremity with the left hand, and by exerting a downward pull upon it so as to render the scrotal skin and tunics tense over the gland. These are then freely incised along the whole length of the gland. As the testicle escapes the left hand releases its hold on the scrotum, but maintains it on the testicle, which is pulled downwards, causing it to take a horizontal position compared with its normal vertical one. As a result of this the spermatic cord spreads out. The knife is passed through the cord close to the vascular portion some two or three inches above the testicle, and the vas deferens and non-vascular portion of the cord is cut through. The vascular portion is freely exposed to above the pampini form plexus, where it is severed by an emascu lator or ecraseur, or by the actual cautery, or by the knife after applying a ligature, the ends of which should be left fairly long. In young animals the cord may be twisted some five or six times after it has been freely exposed and freed from any accompanying fat, and then either scraped through with the knife or broken across the edge of it.
Some operators, who use the emasculator, ecraseur, or actual cautery, liberate both tes ticles and then remove them at the same time. Any advantage gained—which is problematical —is nullified by the greater risk of infection as a result of the ends of the cords coming in contact with the outside of the scrotum.
Castration of Sheep Nearly all males of this species are castrated when from one week to one month old. They are done in batches irrespective of their age between those limits. They are generally docked at the same time, and since this is done by simply cutting off the tail and making no attempt to arrest the bleeding the operation is performed at an early age. The time of the year at which young animals are operated upon is solely dependent upon the time at which they are lambed, a few days of promising weather being chosen. Weather that is wet and cold, and in which there is a north-east wind, should be avoided if possible, as should also very hot sultry weather in which there is a likelihood of the animals being"struck"by fly. Lambs bred for the early market and born at, or soon after, Christmas are usually left uncastrated and undocked.
Lambs should be separated from the ewes and penned so that they can be easily caught. An assistant holds the lamb by seizing a fore and hind limb of the same side in each hand and then pressing its back, tail downwards, against the side of his chest and in front of his shoulder; or the lamb may be held by the assistant grasping a hind leg in each hand with its back towards him and then swinging its head between his thighs and holding it there. The latter is the better position, for by allowing its hind legs to come to the ground while still maintaining the grip on its head the lamb is in the right position for docking. The animal should not be put back with the others awaiting operation, but turned loose into a grass field, where it will probably lie down for a few minutes.
Since the operation is nearly always carried out by the shepherd, some of the methods adopted are necessarily simple and crude in the extreme, and though carried out without any pretence whatever to surgical cleanliness they appear, judging by results, to be eminently satisfactory for dealing with the large numbers that are operated upon, several hundreds in the day being quite commonly disposed of. Occasionally a more or less severe loss will occur, which would appear to be directly due to this uncleanliness: such, for example, as the occurrence of a large number of cases of tetanus among one particular batch, and none among another batch castrated at the same place and in the same manner.
One is left wondering on hearing that there were no losses among a large number of lambs that one has seen operated upon, the shepherd, between about every third lamb, sharpening his knife on his dirty boots and leggings, covered with the dried-on placental fluid and blood and other filth, and laying his knife down on the ground between each operation in order to lift the lamb out of the pen while his assistant caught another one.
Operation. — The operator seizes the tip of the scrotum and with one cut removes about three-quarters of an inch of it. Each testicle covered by its tunics is pressed out, the tunic incised, and the testicle removed either by an emasculator or a pair of special torsion forceps, or it may be removed in the same way as described for calves, by giving several turns to the testicle and cord and then scraping through the cord with the knife or breaking the cord over the edge of it.
A common method followed by shepherds is, after removing the end of the scrotum, to seize the testicle with the teeth, either covered by its tunics or after these have been laid open, and draw the testicle away, allowing the cord to break where it will.
The lamb is then allowed to stand on the ground and its tail grasped by the left hand, the index finger of which is used to guide the blade of the knife under the tail to a joint at about the position it is desired to sever the tail. The tail is removed by a sharp upward cut with the knife, which should have a straight blade of about three inches long.
Castration of the adult sheep has always been looked upon as a most unsatisfactory operation, with a high rate of mortality, no matter what method of performing the operation is employed.
In any method in which the scrotum is opened there is a great risk of infection of the scrotal wounds, on account of the size and position of the scrotum, rendering it prone to contamination from the ground. Apart from this, however, quite a considerable percentage of the animals would appear to die not so much from infec tion as from intention. They will lie down after the operation and make no further effort to live.
As a result of this high degree of mortality many different methods of performing the operation have been tried, and among those methods that have been the most successful are those that would appear to be the most bar barous. Ligation of the neck of the scrotum, causing sloughing of the whole scrotum and testicles, is one such. The same object has been attained by putting on a clamp in the same position and leaving it on for about six days, when the scrotum and its contents are cut away and the clamp removed.
There is one method that stands out alone as regards its successfulness, namely, the use of Burdizzo's emasculator. The ram is"turned"on to his buttocks and the fore and hind limbs of the same side tied together. The wool is cut away from the neck of the scrotum, which is then painted with tincture of iodine. The instrument is then employed in exactly the same manner as that already described for cattle. After releases the animal will lie down for a few minutes, but will soon get up and show no more ill effects.
Other methods may be employed: the covered operation, in which the scrotum only is opened and a clamp put on the cord over the tunics. The caustic clamp and the actual cautery arc employed with varying degrees of success.
Castration of the Boar The young male pig is castrated when from five to eight weeks old. The best time is a week or so before it is weaned, as its general health is probably better maintained than if castrated just after being weaned, at which time there is a tendency for the young animal to lose condi tion. Food should be withheld for some hours before the operation.
An assistant holds the pig by its hind legs grasped above the hocks, one in each hand, the pig's belly towards him. He then swings the fore part of the animal between his knees, where he holds it firmly. The back of the pig will thus be towards the operator, who stands directly in front of his assistant.
There is no well-defined scrotum in the young pig, the testicles in their separate sacs causing a bulging only of the perineal region. For this reason it is practically impossible to grasp the testicle and freely incise its coverings as in all other domesticated mammals. However, by using the last three fingers of the left hand to guide the testicle from between the animal's thighs to the perineal region, the thumb and index finger can render tense the skin over the Then by a short, deep incision the testicle can be freely exposed. As it escapes from the opening it is grasped by the thumb and index finger of the left hand, and drawn clear of the incision; the posterior or cremasteric portion of the cord is divided by passing the knife through the double layer of the tunica vaginalis propria just behind the vascular portion of the cord and in front of the vas deferens, and cutting backwards. Slight traction is then put on the testicle, the edge of the knife reversed, and the vascular portion of the cord broken across its edge. Several twists may have been given to the cord before breaking it, but this is not really necessary in the very young animal, although it may be advisable to do it in those over two months old. The vascular portion of the sper matic cord of the pig is more friable than that of any of the other domesticated mammals. The second testicle is removed in a similar manner.
The absence of any well-defined scrotum in this animal, and the underlying fat that has to be cut through, render the use of a knife with a well-rounded cutting edge a necessity, if the making of an excessively long opening is to be avoided. The incision made as described will have a posterior rather than an inferior position when the pig is standing on the ground, and will be less likely to become soiled. In making the incision, however, the testicle should not be pressed too near to the anus, otherwise, should infection occur and the formation of pus result, this will be held in a pocket and will not escape freely. After being operated upon the young pigs should be put in clean surroundings, and not allowed to run loose in a manure yard. No attention to the operation wounds is, as a rule, necessary. If, however, there should be much swelling at the seat of operation, and the animal appear ill, then it must be caught and the usual opening, cleansing, and disinfecting of the opera tion wounds carried out.
To castrate a young pig suffering from scrotal hernia the following method is as successful as any. The animal is held as already described and the hernia reduced. Then, if a unilateral hernia only is present, the testicle on the sound side is first removed and the other testicle brought into position behind the existing external wound. An incision is made through the scrotal septum only sufficiently large to enable the testicle to be squeezed through. This testicle is then removed in the usual manner, and two or three sutures inserted into the external wound. If a hernia exists on both sides castration may be performed in the ordinary manner after reduction has been carried out, followed by suturing of both external wounds, or the operation as described for unilateral hernia may be carried out.
Orchitis is not infrequently met with in the pig. It is often mistaken for scrotal hernia while the pig is running loose, but digital examination of the swelling with the pig held in the ordinary manner as for castration renders definite diagnosis easy. The swelling is firm and irreducible. Adhesions between the gland and the tunics usually exist, but these are easily broken down after the tunics have been incised, and although a varicose condition of the veins in the cord is generally present removal of the testicle is safely effected by torsion and fraying of the cord; no suturing of the scrotum is neces sary. It is probable that the condition is more often the result of injury than disease.
In dealing with adult animals and those that have become too big to be held by hand some method of restraint is necessary. Several methods are employed. The use of a small set of side-lines similar to those used for horses is probably the best. The animal is first caught by applying a rope to the upper jaw behind the tusks in the form of a running, quick-release loop.
The side-lines consist of a neck strap having a ring on either side and two ropes leading from the lower part. Each rope is passed between the fore-legs and through a hobble on the cannon of the hind limb and then through the ring of the neck strap on its own side. The animal is east and secured on its left side in the same manner as a horse. Several other methods of fixing the animal are employed. One method is to fix him in a standing position with his right side next to some strong rails. He is caught as before, and his head pulled high on to the rails so that a great part of the weight of the fore part of his body is taken on the cord, which is securely fastened. Another cord is put round his body at the flanks and made secure to the rails. The operation is performed with the animal in the standing position. In whatever way the animal is fixed the scrotal area is cleansed and disinfected. The testicle is exposed by incising the scrotum somewhat posteriorly, and is then removed either by an emasculator, by the ecraseur, or by the actual cautery. Before releasing the animal it should be ascer tained that no hmmorrhage is taking place, and any accumulated blood-clot should be After-treatment is the same as for all animals.
Castration of the Dog Castration is occasionally performed upon the dog at the request of an owner in order to check, sometimes natural, sometimes unnatural, habits. Probably, however, its performance is dictated more frequently by surgical needs than by sexual deeds.
The exposed position of the testicles and the means of offence in this species render the testicles more liable to injuries which may necessitate their removal. Tumours of the testicles are by no means infrequent in the dog. Chronic prostatitis, too, for checking or alleviat ing which castration is the most effectual line of treatment, is quite common in this animal.
A general anmsthetic—morphia followed by chloroform being the most suitable—must always be given if an aseptic operation is to be performed. An aseptic operation is easily secured in this species, and very much better subsequent conditions can be obtained than in any of the larger domesticated animals.
The instruments required include a scalpel, dressing forceps, scissors, several pairs of artery forceps, and fine suture needles and silk. These must be sterilized by boiling at the time of operating, and they should be used direct from the sterilizer.
The animal is fixed on an operating table in the dorsi-recumbent position. The hair on the scrotum and any long hair in its immediate neighbourhood is removed with scissors, and the whole area painted with tincture of iodine. A piece of sterilized calico or lint large enough to cover the abdomen, thighs, and perineal region, and having a small circular hole through it only large enough to expose the scrotum, is placed in position and tucked in under the animal's back. The scrotum is again painted with tincture of iodine, and meanwhile the operator has thoroughly cleansed his hands. A final rinsing in absolute alcohol causes no inconvenience whatever, and is very efficient in rendering them aseptic.
The scrotum and tunics overlying one of the testicles are incised, and the gland laid bare. The posterior non-vascular portion of the cord, excluding the vas deferens, is severed with the scissors. The vas deferens is then drawn tight, and a fine suture put on it as high up as possible, and the duct severed close up to the suture. Lastly the anterior vascular portion of the cord is securely ligatured high up and severed, leaving only sufficient of the cord to prevent the ligature from slipping. Any blood-clot is now removed from the vaginal sac and scrotum, and if there is still any haemorrhage from them it must be arrested before closure of the external wound. The edges of the wound through the scrotum are brought together by closely placed, interrupted sutures, very fine needles and silk being used. In closing external wounds situated in positions in which there is little or no tension on the skin, the finer the needles and silk used the better will be the results obtained. There is less chance of infection, and consequently fewer sloughing sutures.
The other testicle is dealt with similarly. The scrotal skin is mopped clean and dried by being painted with alcohol, after which it is painted with Friar's Balsam (compound tincture of benzoin). One or two single layers of fine gauze large enough to cover the scrotum are then applied, and painted over with Friar's Balsam. A pad of gauze and cotton-wool is fixed in posi tion by a bandage, the anterior tails of which are fixed round the loin and the posterior tails brought up one on each side of the animal's tail, and then tied to those across the loin. The animal is put into a clean kennel and an Eliza bethan collar put on in order to prevent the animal interfering with the dressings. If no suppuration occurs the sutures may be removed on about the fifth day, the collar being left on for a day or two longer.
In those cases in which injury to the scrotum or testicles has occurred the operation may be performed in the same manner with the excep tion of leaving the scrotal wounds unsutured.
Methods similar to those used in other animals are also employed, the testicles being removed by an emasculator, an ecraseur, the actual cautery, or by scraping and tearing through the cord. Antiseptic conditions should be observed with any one of them, and the scrotum left unsutured. An Elizabethan collar should also be put on the animal in order to prevent the continual licking of the wounds that would otherwise take place.
Castration of the Cat The male cat is castrated in order to check its nocturnal wanderings, and to lessen the offensive odour of its urine.
This animal is best held by rolling it up in a stout towel or apron, the tail and hind legs being kept towards one edge. When securely rolled up the opposite end is turned on itself and held closed, thus preventing the escape of the animal from that end. This turning over of the end does away with the necessity of putting any pressure on the head or chest of the animal, which may be attended with fatal results. The hind legs are then grasped above the hocks and pulled free from the open end.
Another way of holding the cat for castra tion is to grasp the crossed fore and hind legs of the same side in each hand. The thumbs of each hand are put behind the ears, and the head pressed forward between the legs in order to prevent the animal from biting the holder. Although the cat is in a very satisfactory position for the operation the holder has need to be practised in the method if he is to hold the animal securely, and not get bitten or scratched. There is always the risk of one or other of these injuries occurring while the holder is securing or releasing the animal. The method is more suitable for kittens than adults. Another way of safely securing the cat is to put it head downwards into a jack-boot.
The fur is carefully removed from the scrotum with scissors and tincture of iodine applied. A testicle is liberated by incising the scrotum in the usual manner. It is necessary to make sure that the tunics are also incised. This by no means always occurs at the same time that the scrotum is incised, since the tunics are very tough, and whereas they are very intimately applied to the testicle they are very loosely connected to the scrotum, and shoot out readily with the enclosed testicle when the scrotum is incised. It is essential that the testicle should be liberated from its tunics in order that it can be properly and easily removed.
The testicle is removed by cutting through the non-vascular part of the cord and the vas deferens, and twisting and scraping through the vascular portion. The non-vascular part should be cut through separately from the vas deferens. The latter structure is very tortuous and long in this animal, and unless pulled down and severed high up is apt to protrude from the wound in the scrotum.
The scrotum should be picked up after both testicles have been removed in order to ensure that the severed ends of the spermatic cords have receded properly within the scrotum and tunics. E. B. R.