COVERED OPERATION.
Modus Operandi.—The animal being thrown on either side, as already described, and kept as nearly as possible on his back by bundles of straw packed under him on the lower side, and the right hind leg secured in its proper position, and the instruments placed within easy reach, the surgeon proceeds with the fourfold steps of the operation, consisting first, in the prehension of the left testicle, or lowest in position; second, the incision through the envelopes; third, the enucleation of the testicle; and fourth, the application and constriction of the clamps.
First step.—The operation must always begin with the prehension of the gland which corresponds with the side—the lower—upon which the animal is lying. This obviates any danger of interference by any little hemorrhage which might occur, and so facilitates the application of the clamps. Then, placing himself toward the back of the patient, the operator reaches over and grasps the lower testicle with both hands, bringing it downwards in such a manner as to stretch the scrotum over its surface. This manipulation is not always of easy performance, the contraction of the cremaster muscle being sometimes so powerful that the gland successfully resists all the operator’s efforts of traction. It is sometimes necessary to divert the attention of the animal, in order to facilitate this part of the process, by pricking him with a pin on the lips or about the anus, the effect of the new sensation being such that his opposition is withdrawn, and the contraction ceasing, he suffers passively the traction of the envelopes over the organ. Or, the same advantage may be obtained by the inhalation of a little ether or chloroform. Then grasping the cord with the left hand and bringing the organ well forward, the surgeon proceeds to the
Second step, or that of the incision of the envelope. Holding the sharp convex bistoury in his right hand, he takes, with the thumb, a point d’appui upon the prominent organ, and carries it carefully over the surface of the scrotum in a direction parallel with the median raphè ([described] in the first chapter), and following the great curvature of the testicle, and being careful with the first movement of the instrument to divide only the scrotal skin and the dartos, until the most superficial layers of the cellular tissue of the third testicular envelope are reached. The skin and the dartos being divided, the edges of the wound separate, and the testicle, still pressed downwards and outwards with the left hand, protrudes more or less, still included, as it is, within its fibrous covering. A careful dissection, with a few light strokes of the bistoury, or laceration with the thumb nail of the hand, now suffices for the separation of the fibrous envelope from its external covering, an entire separation of both of which can thus be easily obtained by pressing the most external layer upwards through the laceration of the cellular coat which unites them.
Third step.—The operator now relieves himself of his instrument—not, we may venture to suggest, by placing it between his teeth, as some careless surgeons are apt to do, but by handing it to an assistant—and, changing his position, places himself in front of the inguinal region, and facing it. He then proceeds to the enucleation of the testicle, by separating the adhesion which exists between the internal face of the dartos and the external surface of the cremaster muscle and of the fibrous tunic. The separation being completed, and the scrotum and dartos being carefully pushed upwards, the patient is now ready for the last step of the operation.
Fourth step.—The testicle, well enucleated from its superficial envelopes, but still covered by the fibrous coat, and the vaginal sac still remaining intact, the operator, facing, as before, the inguinal region, proceeds to the application of the clamps. The cutaneous covering and the dartos being pushed well upwards, the clamp is placed upon the cord above the epididymis, from before backwards, the assistant, armed with the castrating forceps, taking both of its branches between the jaws of that instrument, carefully bringing them together, and closing them as tightly as possible. The instant of the pressure of the clamp upon the cord is marked by very severe pain, and the suffering animal is excited to powerful struggling. It is important that the assistant should be aware of this, and he should be forewarned to refrain from pulling on the cord, and reminded, in order to avoid injury from this accident, to keep the clamps and the forceps steadily in contact with the inguinal canal. It is probably with a view to the avoidance of this possible injury that the use of a peculiarly constructed vise or forceps has been recommended. The forceps being in place, and tightly confining the branches of the clamps, well adjusted, the operator now applies the twine, and after taking several turns around the grooves of the free ends of the clamps, secures it carefully with a double knot.
The operation is then repeated on the right or uppermost testicle in the same manner, and with the same precautions.