Sometimes he lays the gland +upon+ the outside of the human testis, connecting part with part; sometimes he opens the testis by incision and lays the goat-gland within the cleft. Very often there are adhesions which must be broken down before the goat-gland can function rightly. Very often there are unsuspected hydroceles, forming cysts in the testicular mass, which must be cut out, or there may be varicocele requiring attention. The patient suffers very slight inconvenience; the local anesthetic is enough to dull the pain even of the breaking down of the adhesions, so that it is at its worst no more than the pain of a toothache, and lasts a very brief while. Many of the patients converse with the doctor while the operation is proceeding. The pain is negligible. The doctor proceeds according to the condition, age, etc., of his patient. He may ligate, that is to say, tie off, the tubes that connect with one testis, or the other, or both; he may not ligate at all. It will depend upon the result sought, the condition present, and the age of the patient. Suppose the patient is an old man in whom it is desired to produce rejuvenation; the doctor then will ligate both sides, in order that the new glands when they take hold, and begin to feed the testes of the man, stimulating these to a new activity, may not be overtaxed to the point of excess usage by the patient when he returns home and finds himself in possession of a sexual vigor that has been unknown to him for many years. This increase in sexual vigor +invariably+ follows, regardless of the age of the patient. The glowing letters on file in the doctor's office attest this. Here, for instance, is a letter from a man eighty-one years of age, who says, "I feel like a boy of eighteen. This is something I have not known for more than forty years. The goat-glands have certainly done the work for me, but I wish, doctor, you would fix it so that I could complete the sexual act," etc., etc. But this completion of the sexual act is exactly the thing that is to be avoided in the case of these old men. Remember the theory in the last chapter, "All animal energy is sex-energy." The conversion of this sex-energy into other forms of energy, physical and mental, is the aim, and this aim would be frustrated if these old men were given full power to do as they pleased with their new-found youthful vigor. You cannot always trust them. That is the purpose of the ligating of both sides, making the emission of the semen impossible. The life-force, then, having no other outlet, can do nothing else but reinvigorate the entire system by pouring its precious fluids into the blood.