DIFFICULT PAKTUBITION. 187 



RTIPTUBES OF THE VAGINA. 



These are attended by dangers similar to those belonging to rup- 

 ture of the womb, and in addition by the risk of protrusion of the 

 bladder, which appears through the lips of the vulva as a red pyri- 

 form mass. Sometimes such lacerations extend downward into the 

 bladder, and in others upward into the terminal gut (rectum). In 

 still other cases the anus is torn so that it forms one common orifice 

 with the vulva. 



Too often such cases prove fatal, or at least "a recovery is not at- 

 tained, and urine or feces or both escape freely into the vagina. The 

 simple laceration of the anus is easily sewed up, but the ends of the 

 muscular fibers do not reunite and the control over the lower bowel is 

 never fully reacquired. The successful stitching up of the wound 

 communicating with the bladder or the rectum requires unusual skill 

 and care, and though I have succeeded in a case of the latter kind, I 

 can not advise the attempt by unprofessional persons. 



BLOOD CLOTS IN THE WALLS OF THE VAGINA. 



(See " Effusion of blood in the vaginal walls," p. 169.) 



INFLAMMATION OF THE WOMB AND PERITONEUM. 



These may result from injuries sustained by the womb during or 

 after parturition, from exposure to cold or wet, or from the irritant 

 infective action of putrid products within the womb. Under the 

 inflammation the womb remains dilated and flaccid, and decomposi- 

 tion of its secretions almost always occurs, so that the inflammation 

 tends to assume a putrid character and general septic infection is 

 likely to occur. 



Symptoms. The symptoms are ushered in by shivering, staring 

 coat, small rapid pulse, elevated temperature, accelerated breathing, 

 inappetence, with arched back, stiff movement of the body, looking 

 back at the flanks, and uneasy motions of the hind limbs, discharge 

 from the vulva of a liquid at first watery, reddish, or yellowish, and 

 later it may be whitish or glairy, and fetid or not in different cases. 

 Tenderness of the abdomen shown on pressure is especially character- 

 istic of cases affecting the peritoneum or lining of the belly, and is 

 more marked lower down. If the animal survives, the inflammation 

 tends to become chronic and attended by a whitish muco-purulent 

 discharge. If, on the contrary, it proves fatal, death is preceded by 

 extreme prostration and weakness from the general septic poisoning. 



Treatment. In treatment the first thing to be sought is the removal 

 of all offensive and irritant matters from the womb through a caout- 

 chouc tube introduced into the womb, and into which a funnel is 

 fitted. Warm water should be passed until it comes away clear. To 



