Fig. 26.
LIGATURE-CARRIER.
Ligature.—When this mode of procedure is adopted, the tumor having been dissected and the cord well freed from its adhesions with surrounding parts, and the ligature being applied, the tumor may either be amputated immediately or be left to slough off in its own time. The ligature may be either of twine, silk, or elastic cord. We have ourselves operated by this method in the successful removal of growths of very considerable size. So long as the upper portion of the cord, which retains its healthy structure, can be reached, the application of the ligature is attended with no difficulty, the manipulations required being similar to those which attend the removal of all growths by the process of ligation. But if the diseased process extends so far that the ligature cannot be applied at the proper point, as in the case of intra-inguinal champignon, it will be necessary to have resort to the ligature-carrier recommended by Serres ([Fig. 26]). In using this instrument the loop of the ligature being passed over the tumor around the cord, is carried into the inguinal canal as high up as possible, pressure being made by holding the instrument against the cord, while strong traction is made on the ends of the ligature, which is then secured by a knot upon a small stick placed across the opening of the instrument, with a view to the prevention of slipping. If an increase of pressure is found to be necessary, it can easily be obtained by tightening the ligature from day to day as required. If the size of the cord should be such as to prevent a proper application of a single ligature, it may become necessary to divide it in applying a double, triple, or multiple ligatures, in accordance with the rules for such ligating.
In whatsoever manner the ligature may be applied, even when it is of the elastic kind, the process of sloughing of the tissues is always a slow one. It is for this reason that we agree with Prof. Bouley in considering the treatment of champignon by the linear crushing very much to be preferred.
Ecraseur.—The steps of the operation with this instrument are similar to those required in the other methods already considered. The champignon is isolated from its surrounding parts, the chain is placed on the cord above the base of the tumor, and the amputation is completed by a slow pressure upon the cord, which, crushing it by degrees, permits its immediate removal. It must be done slowly, occupying from ten to twenty minutes for the complete separation of the champignon, according to the size of the tumor. The operation being finished, the parts are left in the condition of a simple wound, where no cause exists to interfere with its rapid cicatrization.
Cauterization.—This is a mode of treatment which we have never had occasion to submit to trial, having always given the preference to the process we have just referred to. It is recommended, however, by European authorities. Some of these advocate the “melting” process, or the introduction of sharp points deeply into the thickest parts of the enlargement, while others advise a removal of a portion of the growth and deep cauterization afterwards. If cauterization can be advantageously employed, the best method, in our judgment, would be the process of amputation with Paccalin, or with the galvanic cautery. We may here, while referring to the application of electricity in this connection, appropriately refer to our own experience of a number of years ago, in treating an animal suffering with intra-scrotal champignon, by electrolysis, and succeeding after two applications, in obtaining the complete removal of the tumor. This method, however, consumes too much time to justify its employment in general practice.
FISTULA OF THE SCROTUM.
Being already aware of several causes of this complication of the operation of castration, we may readily appreciate the treatment they require. It must be remembered that in a majority of cases, the cause of this lesion is the presence of a foreign body in the wound, and that until it is removed, it is in vain to look for a cure. Prof. Bouley has reported a case in which the fistula was due to the presence of a pair of clamps over which the skin had almost entirely cicatrized.