TRAUMATIC LESIONS OF THE GENITAL ORGANS, ETC. 629 



than the large intestine, puslied by the other portions of the intestinal mass by the efforts 

 of the mother, had passed through a rent on the left side of the vagina, close to the 

 cervix uteri which remained intact. The rent was irregular, and sufficiently large to 

 admit the fist ; it extended lengthways, and its borders were ragged, ecchymosed, red, 

 and thickened, with considerable extravasation of blood in the connective tissue. The 

 stomach and large intestine contained a great quantity of alimentary matters, and 

 Galtier is inclined to attribute the rupture to this condition, together with the faulty 

 position of the foal and the .ecumbent attitude of the Mare. He points out that a 

 trifling amount of manual skill in raising the head of the foetus would probably have 

 prevented the accident; that the full condition and exaggerated volume of the first 

 portions of the digestive tube may have contributed to bring about the misdirection of 

 the foetus ; that when parturition is near, animals should not receive food in too great 

 bulk ; that assistance should be sought for immediately the discovery is made that birth 

 is delayed ; and that when the life of the mother is compromised, the Caesarear section 

 should be practised without delay, in order to preserve the offspring. 



Complications of Ruptured Vagina. 



We have mentioned some serious complications of ruptured vagina, in 

 which adjacent organs and tissues were involved. These are chiefly the 

 rectum, bladder, and the perinaeum, one or more of which may be per- 

 forated and torn, along with the vagina. These ruptures vary in extent 

 and gravity, and while some of them are necessarily fatal, others are not 

 so ; though they may lead to serious deformity and inconvenience, such 

 as accompany chronic fistulae in important regions. We will follow the 

 example of Saint-Cyr, and consider them under the head of recto-vaginal 

 fistula, rupture of the perinaum, and vesico-vaginal fistula. 



Recto- Vaginal Fistula. — Injuries to the rectum are generally pro- 

 duced through the wall of the vagina, during the passage of the fcetus. 

 When the salient parts of the latter, and more especially the feet, are 

 misdirected and pressed up towards the sacrum of the mother, and if 

 the rectum chances to be distended with fasces, not only will the vagina, 

 but this viscus also may be perforated, and some portion of the foetus 

 will soon appear at the anus. If this accident is discovered in time, it 

 may be possible to push back the parts thus misdirected into their 

 natural outlet, and complete delivery by the vagina ; but, notwithstand- 

 ing this happy termination, the communication between the vagina and 

 rectum very often remains permanent, and we have a recto-vaginal 

 fistula. 



The treatment of these cases is not always satisfactory, so far as a 

 perfect cure is concerned. Sutures have sometimes been employed to 

 close the wound in the rectum, when it was sufficiently accessible. But 

 this surgical operation can rarely be resorted to, and all that can be done 

 is to keep the lacerated parts clean, by frequent injections per vaginam 

 and rectum, prevent constipation, and treat the injury on ordinary prin- 

 ciples — not forgetting the free employment of antiseptics. 



If sutures are employed to close the fistula, they may be supported by 

 a pessary or tampon placed in the vagina beneath the fistula. 



When the limbs, or other parts of the foetus, protrude through the 

 anu^ it is nearly always advisable to amputate them, in order to effect 

 the replacement of the remainder more easily in the vagina, and with 

 less risk of further injury to the parent. Once in the genital canal, then 

 the foetus can be extracted in the ordinary manner. Opiates should be 

 largely administered. 



I. Cruzel {Journal de Med. Veterinaire, 1832, p. 153) l-.ad his attention directed to a Cow, 

 which, after aborting, had a fistulous opening between the vagina and rectum, through 



