2i8 OPERATIVE TECHNIQUE. 



consists in opening the tunica vaginalis and exposing the testicle, 

 but when applying the clams, grasping and drawing down the edges of 

 the vaginal sheath so as to include them in the clams. The vaginal 

 sheath having been exposed as above described, the testicle is grasped 

 with the right hand and drawn slightly forwards, in consequence 

 of which the outer skin and tunica dartos retire, and a portion of the 

 vaginal sheath is exposed. A fresh hold of the spermatic cord is 

 then taken with the left hand, whilst with the right the base of the 

 tunica vaginalis is opened sufficiently to allow the testicle to be extruded. 

 The anterior and posterior portions of the base of the sac thus 

 come to form blind sacs. Into the posterior of these the operator at 

 once thrusts the index finger of the left hand, into the anterior the 

 thumb of the right, and drawing the vaginal sheath forward, together 

 with the spermatic cord, enables an assistant to pass a clam from in 

 front backwards just above the epidid3anis, embracing both the vaginal 

 sheath and the spermatic cord. The ends of the clam are pressed 

 into contact and fastened with a surgical knot, and the spermatic cord 

 is divided about an inch below the clam. 



This represents a middle course between the operations of castra- 

 tion with and without exposure of the testicle, being, in fact, castration 

 with exposed testicle, but with covered spermatic cord. It requires 

 some practice, because the vaginal sheath is very apt to elude the 

 operator, and it is difficult to again grasp and draw it forward. 

 Attempts were made by apph-ing a pair of forceps to overcome this 

 difficulty and facilitate operation, but they necessitated the presence 

 of a skilled assistant. Moreover, the onh' ad\-antage this method has 

 over the covered operation is, that when the common vaginal sheath is 

 short, it is less likely to be overstretched. It is, however, useful 

 when one has to deal with scrotal hernia which has only been dis- 

 covered at the moment of opening the tunica vaginalis. In old 

 stallions in which castration by the covered operation, or by Degive's 

 method just described, is particularly necessary, the processus vaginalis 

 is usually so long that clams may easily be applied. 



The removal of the clams is of scarcely less importance than their 

 application. In castration with exposure of the testicle the clams are 

 usually removed after twenty-four hours, in many parts even earlier ; 

 in }'oung animals especially they may be removed without danger 

 within five to six hours after operation. In Sweden and Denmark, 

 Tidholm's method is commonly used for castrating horses. Clams are 

 applied to the spermatic cords, which are firml}- compressed. The 

 clams, however, are almost immediateh^ removed, a ligature is applied, 

 and the testicles removed. In castration by the covered method, the 



