5. Ridgling (cryptorchidism)
Not everyone will know what a ridgling (or ridgel, ridgil) is. Chambers Twentieth Century Dictionary states:
'a male animal with but one testicle in position or remaining'.
During pregnancy or shortly after birth the testicles of a male horse descend from the abdomen into the scrotum. If an uncastrated stallion is found to have only one testicle in its scrotum, then this means that the other one stuck somewhere on its way down from the vicinity of the kidney through the inguinal canal into the scrotum. In most cases the ‘hidden’ testicle is in the groin, ‘just around the corner’ in the ridgling’s abdomen.
Hormone and sperm
As a horse matures, the testicle is given two tasks: it must produce the male sex hormone and it must produce sperm. The hormone is responsible for the male physical features and the macho behaviour with the urge to mate. The sperm sees to the reproduction. A testicle that stays behind in the abdominal cavity will produce male hormone, but will not supply sperm because the heat inside the body is too high for sperm to survive. So if the single testicle in the scrotum of a ridgling is removed and the other testicle remains in the abdomen, then the animal will still demonstrate macho behaviour because it still has male sex hormone running through its veins. And so he will cover mares in heat. But these mares will not become with foal, as the testicle remaining in the abdomen does not produce sperm. Testicles become sterile at a temperature of 38ºC or more. That is why they must hang outside the abdomen in the scrotum.
Before gelding a stallion, it is desirable to examine the scrotum first to check if it contains two testicles. If one testicle is still in the abdomen, then the abdominal cavity will have to be opened up during the operation and that is a delicate matter in horses, as they are very susceptible to developing peritonitis. It can also become evident from an examination that the scrotum is not lacking content, but rather contains too much. In addition to the testicles, the scrotum can also contain intestines if there is a groin rupture (inguinal hernia). If such a stallion is gelded, his intestines may fall out on the ground. That is the end of the line for the horse and the beginning of a lot of misery for the person performing the procedure. A pre-examination therefore has its advantages.
It takes a while to find the address. The house is in the woods. I meet two brothers, the owners of the stallion. It is a Gelder horse. I stand next to a front leg to feel the contents of the scrotum between the two rear legs. You have to bend over deeply from that position, but it is a relatively safe spot. Relatively safe, as a horse can also kick its rear leg forward. Things are not in order: the scrotum contains only one testicle. I stretch my fingers to try and reach the second testicle high in the groin. But there is nothing there. This will require a further examination. To that end, the stallion is given an injection with a sedative, which will calm him down and also relax the muscles. Relaxing the cremaster muscle may allow the retracted testicle to descend on its own. The retraction may also be caused by my cold hands: they make this examination quite unpleasant for the horse. Because the injection needs time to take effect, we have time for a cup of coffee. Is there even coffee? There is always coffee in this part of Noord-Brabant: even after working late at night, we still drink coffee in the wee hours of the night. Afterwards, we return to the stallion. He looks sleepy and has little interest for what I am doing. But again, no testicle is found on the left side.
My proposal to have the operation in the clinic in Utrecht does not go down well. “Can’t you do it yourself?” It doesn’t sound like a question, but rather a reproach. Yes, I do have some experience with the procedure, but the sterility of an operation room is preferable to outside on the grass. That’s why. They clearly think I am making excuses: he cannot geld but refuses to admit it. I then describe the risks of abdominal surgery in more detail and repeat my recommendation. Unsuccessfully. On the contrary: the distrust is even stronger. Can this veterinary surgeon actually ‘cut’ a stallion? My reputation may be at risk. Or it already is. And these men are riders and members of the local riding association ‘De Cowboys’. You can be sure this incident will be discussed at the club. Because everybody gossips, but the horse world takes things to a higher level. It doesn’t matter what I say: their stallion needs to be gelded, end of story. All right then, let’s do it: tomorrow afternoon at two. I will need five men to assist me, strong types please; four long ropes, two buckets of water, a couple of towels and a few barley sacks. The stallion has to be kept in his box from now on and must not eat. Laying him down with a full stomach is risky. I give him a dose of antibiotics in preparation of what is to come. See you tomorrow.
Laying the horse down
Everyone is present and ready to go when I arrive the next afternoon. First off, the stallion – still in his box - is administered an injection with a sedative. All six of us then proceed to a stroke of grass between the trees. I lay out the hobbles and ropes and explain what is about to happen. The stallion must be laid down on his right side. The strongest man will hold the head. Two guys pull the rope through the hobbles on the four feet to the left side. The fourth man takes the line that is fastened high up the left front leg and then runs over the horse to the right side. When he pulls it, the horse will fall onto his right side. The fifth man will pull the tail, also to the right.
The patient has an unsteady walk as he leaves the stable, with his head low and his penis out. A long needle is positioned in the jugular vein for the drip: half a litre of chloral hydrate. It is an old-fashioned anaesthetic, but reliable and not expensive. When the stallion begins to wobble, I count to three and all of the men pull at the same time. “Put all of your weight on the head. And all of you: keep pulling!” I check whether the needle is still properly in the vein and then connect the drip again.
laying the horse down
The resistance is fading and the patient is lying quietly once the bottle is empty. Three legs remain in the hobbles. The upper left rear leg is tied up to allow access to the groin for the operation. I position the folded barley sacks under the right front leg because there is a nerve that runs just below the skin at the top of the front leg and it may be pinched off under the pressure of the animal’s weight. This may cause paralysis if the operation takes longer than expected. The left groin and the scrotum are shaven, disinfected and treated with an anaesthetic. He is again administered injections with antibiotics in the buttock. I lay my instruments on a piece of sterile plastic on the ground behind the horse, then wash my hands above the bucket and put on sterile gloves. The operation can begin. Three helpers leave for home. The skies begin to become overcast.
ready for gelding; the scrotum contains but one testicle
I am sitting on my knees against the butt of the horse. The knife is only needed for the cut through the skin. Everything else is finger work because of the major blood vessels and nerves in this area. Via a weak spot in the inguinal canal I penetrate the peritoneum with my index finger. The hidden testicle is ‘around the corner’. It is a small, spongy ball not larger than a walnut and with a similar irregular surface. When I place the crushing forceps (ecraseur) on the spermatic cord, it starts to rain. The spermatic cord is crushed and tied off and the testicle is removed. It then begins to pour. The remaining helpers retreat to the car: “Holler if you need us.” It is essential to quickly suture the abdominal cavity shut. The rain is beating down on the patient. A puddle of water is forming in the groin that has just been operated on.
The right testicle is the size of a man’s fist. This one is removed in a closed castration, that is to say, the peritoneum remains intact around the spermatic cord. So I do not open up the abdominal cavity on this side. Which is why I leave the fiercely closed crushing forceps on the thick spermatic cord for five minutes. That always seems to take a while, but now – in the pouring rain – it seems to take forever. There is a large puddle of water around and under the horse. The rain has meanwhile penetrated my underwear and I am getting cold. The rain soon subsides somewhat and the skies clear up once we have concluded the operation. I feel the water in my boots when I stand up. We hastily untie the ropes and remove the hobbles. I remove the barley sacks from under the horse’s front leg.
But the now gelding makes no effort at all to stand up. He is still sound asleep. He has cooled down considerably because of all of the water on and beneath his body. I myself am shaking and I dry myself off as much as possible. But he is lying stock-still in the puddle. How much rain had entered the belly before I had sutured it shut? And just how sterile is rainwater? It gave me a queasy feeling in my stomach. I check the animal’s body temperature and the mercury in the thermometer does not even reach the graduated scale, not even after holding it in his rectum for five minutes. His temperature is therefore less than 35ºC. A horse’s temperature is normally around 37.5 to 38º. And the amount of anaesthetic that is required to achieve unconsciousness depends upon the body weight and the metabolism, which is expressed in the body temperature: the lower the temperature, the smaller the amount of anaesthetic that is needed. As a guiding rule it is said that the amount of required anaesthetic reduces by 10 % for each degree Celsius lowered body temperature. As this horse is now hypothermic by at least three degrees, it has a minimum of thirty percent too much chloral hydrate in its body and that is why he will not wake up. The three of us pull him a bit to the side to a drier spot and rub him with the towels. His skin is stone cold. Now all we can do is wait and see. It is getting towards dinnertime and the men want to go home.
But hadn’t I said that this would be a much more difficult operation compared to a normal gelding? Well then! Meanwhile I am worrying. It is almost seven o’clock, three hours after the procedure ended.
The horse is finally awake and attempting to stand up. But that seems to be a problem: his right front leg gives way, because he cannot stretch his leg. The nerve that controls these muscles is no longer functioning. In medical terms, this is called radial paralysis: the animal’s body weight has pinched off the underlying nerve because I removed the cushion of burlap sacks under the front leg after the procedure. A patient normally stands up shortly afterwards; but this horse has remained lying down all afternoon. It takes great effort to carefully steer him back into the stable. Fortunately I can go home now and have a shower to warm up and eat something. I am not on call tonight and so I can sleep through the night. I return for the horse the next two days for the follow-up treatment with antibiotics and anti-inflammatory agents.
How it ends
Thankfully, nature shows its mild side again: he does not develop a fever and the swelling of the wound is minor. He can soon make normal use of his front leg. He is backed a few months later and is taken along to the riding association. He remained active in local equestrian sports for more than fifteen years after that.
But since then, whenever I set an appointment for an operation outdoors, I always have one condition ‘provided it is not raining’. It usually goes quiet. No one has ever said so but they do find it strange: A veterinary surgeon who will only work outdoors if the weather is nice!
© Leo Rogier Verberne