MORBID ALTERATIONS IN THE GENITAL ORGANS, 



337 



situated towards the os, and if puncturing it be deemed inadvisable, 

 pushing it beyond the pelvic inlet out of the track of the foetus will be 

 sufficient to overcome the obstacle. 



Vaginal kysts may be mistaken for an everted bladder : a mistake 

 which we are assured if often committed, from the external aspect of the 

 tumor, its oval shape, and its color. Of course, this mistake would 

 prove most unfortunate, should the treatment we have recommended be 

 adopted ; but a careful examination should always be made before any 

 active interference is attempted, and this examination will obviate such 

 an error. • 



Hernia of the bladder through the ruptured v/alls of the vagina, may 

 also simulate a vaginal kyst ; and if this viscus is punctured in this posi- 

 tion, it will lead to the same lamentable results, in all probability, as in 

 inversion. 



This accident we will now notice, and point out the signs by \vhich it 

 may be distinguished. 



HERNIA OF THE BLADDER INTO THE VAGINA : VAGINAL CYSTOCELE. 



Dystokia from the existence of a vaginal cystocele is a somewhat rare 

 accident, and only a few instances are recorded as having been observed 

 in the Mare and Cow during parturition. 



Inversion of this viscus may occur in two ways : — i. When empty, it 

 may, by a spasmodic contraction of its walls, evert itself — the mucous 

 membrane becoming external and the peritoneal coat internal — and thus 

 turned outside-in, it may pass through the meatus urinarius into the 

 vagina ; 2. It may, without being everted, escape into the vagina by an 

 old or recent fissure in the floor of the passage. Most of the cases occur 

 during parturition, and when the animal is straining violently, whereby a 

 portion of the contents of the abdomen and uterus are pressed against the 

 bladder, and may thus produoe its inversion. It is not at all improbable 

 that the viscus may, in consequence of the pressure it occasionally receives, 

 be in a spasmodic state, or the cervix may be dilated and relaxed at times 

 (Cartwright). 



In the Mare and Cow the urethra is short, straight, and wide ; and 

 this no doubt renders the bladder liable to inversion. Zundel states that 

 it may, during parturition, acquire such dimensions from retention of 

 urine that it will entirely fill the vagina, and protrude externally during 

 the expulsive efforts of the animal. 



However this may be, it is certain that the cystocele will present a 

 different appearance in the vagina according as its peritoneal or mucous 

 membrane is visible : i.e., everted or non-everted. 



In the first case we find a somewhat hard, red tumor with a corru- 

 gated surface, and attached to the floor of* the vagina by ^ short narrow 

 pedicle. Examining the lower wall of the vagina attentively, the meatus 

 urinarius cannot be found, but on the soft pulpy surface of the tumor 

 will be observed two small openings — the apertures of the ureters — from 

 which a fluid continually escapes, and which may be recognized by its 

 odor as urine ; this fluid may even be thrown out with a certain degree 

 of force during the labor pains. These characters should be sufficent to 

 indicate the nature of the obstacle. 



In the second variety, the bladder escapes through a rent in the wall 

 of the vagina, and this rent may only involve the muscular layer — the' 



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