MonniD ALTKnATIOX.'i IX rilK h'KXKILlTll'E OWIJXS. 351 



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

 inversion. 



HEHNIA OF THE HLADDER INTO THE VAGINA : VAGINAL CYSTOCELE. 



Dystokia from the existence of a va<^inal 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 : — 1. When empty, it 

 may, by 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 

 c>ld 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 produce its inversion. It is not at 

 all improbable that the viscus may, in consequence of the pressure it 

 ccasionally receives, be in a spasmodic state, or the cervix may be 

 lilated 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 tumour with a corru- 

 gated surface, and attached to the floor of the vagina by a 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 tumour 

 will be obsen'ed two small openings — the aperturss of the ureters — from 

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

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

 of force during the labour pains. These characters should be suflicient 

 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 — tlie 

 vaginal mucous membrane remaining intact ; or, whicli is more frequent, 

 the muscular and mucous tissues may be ruptured. In either case 

 there is found in the vagina a round, smootli, and fluctuating tumour, 

 attached to the floor of the canal by a pedicle more or less wide, and 

 beneath which the meatus urinarius can be seen or felt. The most 

 striking pathognomonic feature of this kind of tumour is its rapid growth, 

 in consequence of the accumulation of urine in the interior of tlie dis- 

 placed bladder, the fundus of which is towards the vulva and the neck 

 directed forwards — its position being the reverse of normal ; the fundus, 

 by pressing on the urethra — which is doubled on itself — prevents the 

 urine from escaping, and we have in this way a rapidly increasing 

 vaginal tumour. In a case recorded by Violet,' the tumour had 

 acquii-ed, within eight hours, a diameter of from eight to ten inches. 

 Such a tumour must, therefore, constitute a more or less serious obstacle 

 to parturition. 



' Rtcutil dt Mill. Veterinaire de Lyon, 1S62, p. .371. 



