CLASSIFICATION OF THE METHODS — THREE CLASSES — FIRST, IMMEDIATE AMPUTATION — SECOND, AMPUTATION AFTER APPLICATION OF HEMOSTATIC MEANS UPON THE CORD — THIRD, WITHOUT AMPUTATION, BUT DESTRUCTION OF SECRETING POWER OF THE ORGAN — SIMPLE EXCISION — SCRAPING — TEARING AND TORSION — TORSION — FREE AND LIMITED — ABOVE OR BELOW THE EPIDIDYMIS — LINEAR CRUSHING — FIRING.
The methods of performing the operation of castration may be variously classified, though in each class a varying number of modes will come under our notice.
The first class will include the operations by which, the envelopes having been cut through, the vaginal sac opened and the testicle exposed, the organ is separated by an immediate section of the cord. A number of different processes are included under this head, among which are those of scraping, of tearing, of torsion, of linear crushing, or by the ecraseur, and of firing, or the actual cautery.
The second class has also for its first or preliminary step, that of the first, viz., the incision of the bags, the opening of the vaginal sac, and the exposure of the testicle. But instead of removing the organ by the division of the cord, we proceed as a second step, to the application of an apparatus designed to operate by producing compression along the length of the cord, and in this are included but two modes of operating, that by the ligature and that by the clamps.
The third class, according to our category, presents to our view two further operations, both of which are essentially bloodless and dispense with the incision of the bags, consisting of certain peculiar manipulations which insure the destruction of the testicular structure, and consequently of its secreting power. They comprehend the process of the crushing of the spermatic cord, and that of subcutaneous double twisting—the bistournage of the French.
We now enter upon the consideration of each of the separate modes we have thus enumerated.
SIMPLE EXCISION.
This is claimed to be one of the oldest modes of operating, and though to a great extent discarded by practitioners of the present day, still finds its application in the treatment of the smaller animals. With larger patients, however, though still strongly recommended by some practitioners, it is not generally employed on account of the profuse hemorrhage which necessarily follows the amputation of the cord. Still it is conceded that this hemorrhage, as in many cases of the clean, transverse section of arterial blood vessels, will cease spontaneously by the contraction of the vessels on themselves, and the formation of a clot at the divided end, as well as in the surrounding cellular tissue. However, there is a possibility of the continuance of the hemorrhage for some length of time, and the bad effects of excessive depletion are not to be overlooked, especially in an animal whose general constitution has from any cause suffered impairment. If there is any one of the various modes of operating in which the standing position is allowable, this, in our opinion, is the one, the steps of the process being so few and so short, and admitting such simplicity and rapidity. These consist in making a free opening in the bag, reaching with a single stroke of the knife into the vaginal cavity; grasping the testicle and pulling it gently downwards; and cutting the cord right across, from the front backwards, above the epididymis, the cord returning of itself into the vaginal sac—the division being made, of course, on both sides. The animal is then kept quiet in his stall and left alone until the hemorrhage subsides.
SCRAPING.
This operation, which is said to have originated in India, is but a modification of the preceding. Instead, however, of using a sharp edged instrument to divide the cord, the surgeon, on the contrary, employs a dull knife, with which the coats of the artery and portions of the cord are scraped until the separation takes place. They are thus placed in good condition for their temporary closure. This method is probably attended with a diminished amount of hemorrhage, and if carefully performed, it may be entirely absent, the clot closing the artery, and the condition of the lacerated threads of the vessel acting favorably, as well, in preventing it. The manipulations are similar to those accompanying the simple excision, though it is better and more safely effected when the animal is on his back. The testicles being exposed by the incision through the envelopes, the posterior septum of the cord is cut through by a transverse section, and the scraping of the anterior fasciculus of the cord then performed, by a slow movement from above downwards, along a certain extent, in order to effect a solution of continuity by a sort of wearing through the tissues. This operation is slow and requires a careful hand for its execution. But as it may in some cases be followed by severe hemorrhage, it cannot, for that reason, be recommended for large animals, for solipeds especially.