(275) More Than a Nick: Male Surgical Castration Throughout History

Abstract

Abstract Introduction Surgical castration has been present throughout human history, dating back at least earlier than 1000 BC. Eunuchs, or men who have been castrated, served as royal guards, government officials and choir singers among other professions. Objective We sought to review the early surgical castration techniques of historical Eurasia. Methods Literature review for male surgical castration techniques was performed using Pubmed and Google Scholar. Results The Ottoman Empire first started enlisted eunuchs as palace servants in Constantinople as early as 500 AD. By the 16th century, the Ottomans had institutionalized eunuchs as the harem guards. Castration was routinely performed by priests. After restraining the child in a chair, a cord was tied around both the penis and scrotum, and the genitals were excised en bloc with a razor. Hemostasis was achieved with boiling oil and wax or hot sand followed by acacia bark extract. Mortality was as high as one in three patients. Following castration, a nail was placed in the urethra to prevent urethral stricture formation. Within China castration has occurred throughout history, however the procedure was described in greatest detail during the 19th century Qing dynasty. The patient was physically restrained, and the genitalia anesthetized with a “secret agent,” known only to the surgeon, colloquially called “knifers.” The surgeon would firmly grasp both the penis and scrotum with one hand, hovering a curved knife in opposite hand. The surgeon would then ask for consent to proceed. The genitalia were removed with one cut. The wound was washed thrice with boiled pepper solution and covered with moistened paper. A pewter urethral plug was placed to prevent stricture formation. The patient was disallowed hydration and his urethra remained obstructed for three days post-operatively. On the fourth day the plug was removed, and the patient was allowed to void. Mortality was dubiously estimated at 2%. The Skoptsky were a Christian religious sect of Eunuchs within 18th century Russia. As the practice was rooted in religion the majority of Skoptsky men volunteered for castration. Men were encouraged to accept the “greater seal,” i.e. removal of penis, scrotum and testicles, rather than the “lesser seal,” i.e. sparing the penis. The genitalia were variously removed with a combination of hot iron rods, glass, razors, and knives. Again, a nail was placed in the urethra to prevent stricture. In 16th to 18th century Italy the famed Castrati Singers underwent prepubertal castration to preventing lengthening of the thyroid cartilage. The singers were highly desired in choirs and operas for their high pitch. Castration typically occurred between ages 6 and 9. Patients were placed in a hot bath and provided a “potent drink,” often containing opium. The carotid arteries were compressed until the patient became lethargic, and the spermatic cords were then severed. Conclusions Surgical castration was performed for a variety of reasons throughout human history. The techniques, anesthesia, and tools used to perform castration reflected resources and education available to the surgeon at time of castration. Disclosure No.