TRAUMATIC LESIONS OF THE GENITAL ORGANS, ETC. 635 



rupture of the perinasum — an irregular laceration rather to the right side, and which 

 made the anus and vulva one long slit. When the great cavity was freed from the mass 

 of faeces it contained, the half-open os uteri could be seen at the far end, while above 

 were the remains of the recto-vaginal septum. The latter was destroyed throughout its 

 entire length, so that the rectum and vagina communicated freely with each other for at 

 least five inches, and their union formed a vast cloaca, in which the faeces gradually col- 

 lected. The borders of the rupture had commenced to granulate. On the floor of the 

 vagina, not far from the bulb, there were two other wounds of some length, which in- 

 volved the mucous membrane throughout its thickness — one to the right, the other to 

 the left — from which escaped a quantity of pus. 



Rather for the instruction of the pupils than in the hope of effecting a cure, the auto- 

 plastic procedure adopted by Dupont was resorted to. The remains of the recto- 

 vaginal septum were made raw, and united by the interrupted suture : six sutures being 

 made without nmch difficulty ; so that, when the operation was completed, the margins 

 of the rupture were in exact apposition and the septum re-established. This was the 

 most difficult part of the operation, as the perineal sutures were easily placed. The 

 rectal and vaginal cavities were thus once agam separated, as in the normal condition. 

 During the day of the operation, the anfmal appeared to suffer and was restless ; it was 

 unable to defecate spontaneously, and the rectum had to be emptied several times, dur- 

 ing which manceuvre the sutures were interfered with, the tissues strained, and next 

 morning it was discovered that several of the stitches had given way; so that the edges 

 were not exactly in contact, excrement had passed between them, and it was necessary 

 to again attempt the task of restoration This, however, was not ventured upon, and 

 nothing was done but to keep the parts clean Cicatrization occurred without any note- 

 worthy circumstance except the formation of an intermuscular abscess, which developed 

 towards the middle of the right thigh, discharged a large quantity of pus, and healed 

 slowly. In a month the animal had recovered, so far as general health was concerned, 

 but the infirmity still existed, and rendered the creature almost valueless. 



Vesico-Vaginal Fistula. 



When the floor of the vagina is ruptured, it may happen that the neck 

 or walls of the bladder are involved in the lesion, just as that viscus may, 

 as we have seen, become prolapsed or hernied through the vaginal rent. 

 When rupture of the bladder occurs in this manner, the case is indeed 

 serious. The urine is no longer confined to its receptacle, but escapes 

 through the laceration and becomes infiltrated in the pelvic connective 

 tissue. Hence arises most serious complications : pelvic cellulitis and 

 urine-ahscess, which rapidly lead to a fatal termination. In less, formid- 

 able cases, the urine may escape by the vagina, but involuntarily ; so that 

 the incontinence of urine not only proves a troublesome infirmity, but the 

 constant passage of this fluid over the membrane lining the vagina gives 

 rise to intense inflammation of the canal, and leads to the formation of a 

 vesico-vaginal fistula. This fistula may also be produced by usure or 

 bruising. When the foetus is very large it occasions over-stretching of the 

 vagina, and if it remains for any length of time in the passage, this dis- 

 tention weakens the vitality of the soft tissues ; so that the compression 

 to which they are submitted between the fcetus and the floor of the pelvis 

 will produce mortification, which may extend to the neck of the bladder. 

 The resulting sloughing, should the animal survive, will establish a direct- 

 communication between the vagina and bladder. 



An animal may live with a fistula of this description, provided urine- 

 abscess, uraemia, or other serious complications do not result. 



The symptoms need not be specified. The chief is incontinence of 

 urine. When this fluid is observed to be constantly dribbling from the 

 vulva after parturition, the existence of the accident may be suspected, 

 and an examination /^r vaginam will confirm the suspicion. 



Treattnent must be mainly palliative. 



