PROLAPSE AND INVERSION OF THE URINARY BLADDER. 645 



Inversion of the bladder is distinguished by the presence of a 

 spherical swelling, of variable size, either in the vagina or protruding 

 beyond the vulva (Fig. 438). It appears to be tough, elastic, with a 

 moist corrugated surface of a reddish colour, and on the upper aspect 

 of its attached or constricted extremity the orifices of the ureters 

 may be seen as nipple-like prominences within two folds of the mucous 

 membrane 



By lifting up the swelling, or pressing on it, or on moving the 

 animal, urine (from the distended ureters) trickles from it, or spurts 

 in a double stream (Fig. 438). 



The mucous membrane by continuous exposure gradually dries, 

 is soiled by dirt and dust, and may finally become necrotic. When 

 the condition has existed for a long time stenosis of the urethra may 

 lead to strangulation of the bladder, which is shown by severe 

 congestion, and sometimes ends in rupture. 



Prognosis. Prolapsus vesicae is evidently graver than inversion, 

 as the peritoneal cavity is opened and peritonitis is liable to occur, 

 a danger whch is absent in inversion. Reposition is only possible 

 in recent prolapse, where the serosa of the bladder has undergone 

 no considerable change. Otherwise septic peritonitis occurs, and 

 invariably proves fatal. The prognosis is more favourable in inversio 

 vesicae ; the mucous membrane of the bladder possesses greater 

 resistance, and even when, after successful reposition, irritation is 

 marked, cure is not impossible. The animal's progress depends 

 principally on the condition of the mucous membrane and on the 

 calibre of the urethra. As long as these allow of reposition, operation 

 must be attempted, as, in the event of its failing, nothing remains 

 but amputation of the bladder. Failure to distinguish inversion 

 of the bladder from foetal membranes has sometimes led to awkward 

 consequences both for patient and operator. 



Treatment. Provided the serous coat of the prolapsed bladder 

 is little changed, it should be carefully cleansed with disinfectants 

 and attempts made to replace the viscus. At the same time the 

 wound in the vagina must receive attention. Unless the animal 

 strain much, a repetition of the prolapse need scarcely be feared, 

 and can be provided against by injecting lukewarm fluid into the 

 replaced bladder. Riviere diagnosed prolapse of the bladder in a 

 cow soon after labour. The rupture in the vagina was 3£ inches in 

 length. After discharge of the contents, the bladder was replaced, 

 and though severe straining ensued, the condition did not recur. 

 Recovery was complete. When the rupture in the lower wall of 

 the vagina lies not far from the vulva an attempt might be made 



