UNCOVERED OPERATION.
The four steps of this operation are the same as those of the previous method, the first requiring the same manipulations and observing the same order, but the second involving some variations. In this the same careful dissection is dispensed with, and one free incision suffices, including all the various envelopes, in order to expose the testicle freely and at once. The incision is made with one free stroke of the bistoury extending from the posterior to the anterior extremity of the testicle, and dividing at once scrotum, dartos, and the fibrous and serous coats. Though this is to be done without hesitation, it is by no means necessary to adopt the practice of some operators, who not only divide the envelopes, but even make a large incision in the testicular structure itself, inflicting thus an unnecessary amount of pain from which the animal might, with a little care, have been spared.
When the surgeon reaches the third step of the operation, and seizes the testicle with the right hand, in order to draw it downward and outside of the vaginal sac, he may encounter great resistance to his traction, from the powerful opposition of the white muscular tissue running along the posterior septum of the cord. He must then slowly and steadily draw the testicle down, and at a given moment, with a single stroke with a sharp pointed bistoury, divide the serous band of the posterior septum, cutting at once the muscular fibres, the efferent canal and the small testicular artery. This being effected, the resistance will terminate, and the testicle may be drawn down without further difficulty. The division of the septum is not always resorted to. Still, the verdict of experience is strongly in favor of the measure. The application of the clamps ([Fig. 13]) is effected in the same manner as in the covered operation, but in this instance the clamp is placed higher on the cord. For this reason the assistant must be especially careful during the struggles of the patient when the clamps are tightened, the danger of inguinal hernia at this point being too serious to be overlooked. The clamps being in place, and properly secured, the testicles are either left in place and allowed to slough away, or are amputated a short distance below the clamps, as the case may be. The parts being carefully washed out, the animal is allowed to rise, and is returned to his stall.
Fig. 13.
CASTRATION WITH UNCOVERED TESTICLE.
An objection frequently urged against this mode of operation is that it requires a second visit of the surgeon when the time has arrived for the removal of the clamps. Estimating this objection at its proper value, we consider that it is more than balanced by the advantages attendant upon this special mode of castration, and while we fully appreciate the difficulty and inconvenience to which the surgeon may be subjected by this second visit, we cannot approve of its omission, either from a surgical point of view or in that of the interests of the employers, in whose behalf all care and responsibility should be exercised, until the patient is at least enjoying a fair prospect of recovery.
The question now arises, at what time can the clamp be removed with safety? It must be understood that there may sometimes be peculiar surgical conditions under which their removal is contra-indicated, and when they must be allowed to slough off without further interference on our part. But even in ordinary cases and under favorable circumstances, this time appears to vary. By some they are removed after thirty-six hours, while others allow them to remain for a period of four or five days. Taking a fair average, we are of opinion that it may be safely done on about the third day, and that at that period the closing of the artery is sufficiently assured to remove all further pressure.
If the clamps have been secured with twine, and especially if they were properly prepared previously to their application, the process of removal is a very simple one. The assistant, raising one of the patient’s hind legs, the operator places himself directly behind the animal, and bending down, with a sharp sage-knife, cuts the twine where it has secured the posterior ends of the clamp. If it retains the springiness it ought to have possessed at the time of its original application, the branches readily spring open, and it falls to the ground. If this does not occur, or if they should be held by adhesions with some dried parts of the cords which have been pressed between the branches of the clamps, they must be carefully separated by moving from below upwards, when they will easily become detached. But this last manipulation must be very carefully performed, if we would escape a hemorrhage which might require serious measures to control. When clamps of another make are used, the process of removal will vary according to existing peculiarities in the construction of the instrument. The clamp having been removed from one side, the separation from the other will, of course, be managed in a similar manner.