Rupture of the Perineum 857 



After replacement, any irritation present may be ameliorated 

 to some extent by irrigating the cavity with a warm saline solu- 

 tion. If this does not suffice, local anaesthetics may be applied, 

 such as cocaine with adrenalin chloride. General anaesthetics 

 or narcotics, like chloral and morphine, may also be used in order 

 to overcome the expulsive efforts, by which the replacement or 

 retention of the organ i§ made difficult. 



The prognosis in prolapse of the bladder is usually favorable, 

 if it is handled early and properly. 



14. Rupture of the Perineum. 



Ruptures of the perineal tissues may consist of a rupture of the 

 vulvo-vaginal roof and ano-rectal floor in front of the sphinc- 

 ter muscles of these two openings, to constitute recto- vaginal or 

 ano-vulvar fistula. The lesion may extend backward from this 

 opening and involve a complete division of all the tissues com- 

 prised between the floor of the anus and the superior commissure 

 of the vulva, so that the two openings are converted into one 

 cavity, into which the rectum, the vagina and the bladder empty 

 in a common cloaca. In other cases it may consist of a more or 

 less extensive rupture at the superior commissure or other part 

 of the vulva, without involving the anus. 



The symptoms of a rupture extending from the vulva or va- 

 gina into the anus or rectum, without involving the sphincter 

 muscles, are not well marked externally at first, but may be fol- 

 lowed soon by swelling. At the time of the accident the obstet- 

 rist or attendant may observe that some portion of the fetus has 

 passed from the vulva or vagina upward into the anus or rectum. 

 Later feces occasionally drop from the vulva. The relative 

 amounts of feces which may escape from the vulva and anus re- 

 spectively will depend upon the size of the opening between the 

 two passages. There is frequently an involuntary passage of 

 flatus, especially when the animal is driven at a trot. 



When the rupture of the perineum is complete, and involves 

 the floor of the anus and roof of the vulva, the symptoms are well 

 defined and very evident. At first there is more or less 

 hemorrhage from the lacerated tissues. The tissues are greatly 

 lacerated and befouled with feces, which drop into the wound, 

 and thence into the vulva. There is intense infection, followed 

 by extensive swelling and suppuration, accompanied by necrosis 



