MORBID ALTERATIONS IN THE GENITAL ORGANS. 339 



the displaced viscus. This, however, is not always, if ever, an easy task. 

 In a case of simple hernia, the bladder is soon distended by the urine, 

 and owing to the increase in size, it cannot be returned by the opening 

 through which it passed when it was empty. Compression of its walls 

 will not suffice in the majority of cases to evacuate its contents, because, 

 as has been shown, the weight of the organ lies upon the doubled urethra. 

 To empty the bladder a catheter must be employed ; the shoot of an elder 

 tree deprived of its pith has been successfully used for this purpose on 

 an emergency. Once emptied, according to Saint-Cyr, the bladder easily 

 resumes its normal situation. 



Puncture of the organ has been practised when catheterism was not 

 tried ; a fine trocar been inserted obliquely into the upper part of the 

 viscus — which was now of course the inferior part — so as to make it pass 

 for a certain distance between the membranes before entering the cavity 

 of the sac, in this way imitating the entrance of the ureters. The opera- 

 tion was completely successful, as the bladder had been little more than 

 half emptied before the hernia was spontaneously reduced. 



Cartwright says, with regard to treatment : " Provided we are called to 

 the case at an early period, and before a thickening of the parietes of the 

 bladder and sphincter has taken place, we most probably will succeed. 

 We should, with the left hand, press gently upon the sides, and with the 

 right hand the fundus of the iDladder, until we feel it gradually receding 

 from us ; after which we may carefully introduce a pessary or catheter, 

 so as fairly to force it into its natural situation. If there should be 

 violent straining at the moment w^e are employing the taxis, we had better 

 desist for a time until we have abstracted four or five quarts of blood, or 

 give a dose of opium in solution, to allay any irritation or spasm. But if 

 we cannot succeed in this way, I think a far more preferable plan will be 

 to get a stick with a round blunt point that will pass through the sphinc- 

 ter, and force it against the base of the protruded fundus. A very 

 excellent instrument would be a female catheter, such as is used for the 

 Cow or Mare, as it would have the necessary curve. In thus trying to 

 rein vert it, we may use considerable force without rupturing it ; though, 

 of course, we must be cautious in our pressure." 



Should the distended cystocele be immediately in the track of the 

 foetus, and the expulsion of the latter urgent, if the bladder cannot be 

 returned before birth, it must at least be emptied, to allow the young 

 creature to get through the vagina. As the latter passes over it, the 

 viscus should be protected from injury by the fingers. 



We will return to a consideration of this condition when treating of the 

 accidents occurring as a sequel of parturition. In the mean time, we will 

 give one or two illustrative cases to show the importance of exercising 

 care in diagnosing, g.nd skill in treating, this accident. 



Youatt [Cattle, p. 522) relates that a Cow had been three days in labor, and little ad- 

 vance had been made. It was lying on the right side, exhausted, and at intervals lowing 

 mournfully, and making violent efforts to expel the foetus. A round, fibrous white 

 tumor presented itself; it was evidently distended with some fluid, fluctuation being 

 detectable on the slightest touch. Not dreaming that it could be any thing but the mem- 

 branous bag that contained the natural uterine fluid, he punctured it, and found that 

 what escaped was urine. It was the bladder which had protruded through a rent in the 

 vagina, adds Youatt, and which he might have recognized by its smaller bulk and firmer 

 texture, and by the ease with which the neck would have been discovered on a slight 

 examination. 



Baker ( Transactions of the Veterinary Medical Association, vol. ii. p. 57) records a case 

 of inversion of the bladder in a Mare while in the act of foaling. It was replaced three 



