352 MATERXAL DYSTOKIA. 



"We have pointed out the necessity for a careful examination of the 

 tumoui", in order to avoid making a mistake, as the cystocele resembles 

 other tumours, and especially the cysts we have already described, or 

 even the " water-bag," and an error in diagnosis may lead to grave 

 consequences. Such an error is recorded by Chariot, ^ who, being called 

 upon to attend a Cow which had been attempting to calve for three 

 days, found on separating the labia of the vulva a whitish, tense, and 

 fluctuating tumour. Thinking that this was only the " water-bag," he 

 punctured it, when the colour and odour of the fluid which escaped 

 quickly undeceived him. When the bladder had collapsed, he then 

 recognised the tear in the vagina through which the viscus had passed. 

 The Cow being in a dying condition and the foetus still alive. Chariot 

 had recourse to the Caesarian section ; the Calf was saved, but the 

 mother died. 



As the diagnosis of this accident is of so much importance, we will 

 notice the symptoms in greater detail. 



Protruding through the opening of the vulva, or immediately within 

 the labia, will be discovered a tumour of a pyriform shape, and varying 

 in size and colour according to the duration of the accident. Sometimes 

 this tumour will be seen hanging from within the vagina by a kind of 

 pedicle, for at least eight or nine inches, and will contain two or three 

 pints of fluid. At times the protruded part will be nothing more than a 

 thickening of the bladder, produced by strangulation and inflammation ; 

 and it will be changed from its normal colour to that of an inflamed 

 surface, or, if it has been hernied for some time, to a darker hue. Some- 

 times it will become gangrenous and slough ; at other times its surface 

 appears rugged and plicated, and on occasions a large quantity of blood 

 has exuded from its surface. Should there exist any doubts as to the 

 nature of the tumour, the meatus urinarius must be looked for ; if that 

 cannot be discovered, then the greatest circumspection should be exer- 

 cised. The attachment and situation of the protrusion should be noted, 

 and also whether it is continuous with the vagina. The nipple-shaped 

 prominences which mark the openings of the ureters into the bladder 

 should likewise be looked for, as their presence will at once denote the 

 case as inversion of this viscus, as will also the escape of urine from 

 them. 



Treatment. 



The chief indication in vaginal cystocele is reduction or reposition of 

 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, the bladder readily 

 resumes its normal situation. 



Puncture of the organ has been practised when catheterism was not 

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

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



^ Joiu-nal Pratique de Med. Vtterinaire, 1826, p. 165. 



