488 
VETER IN A RY O BSTETRIC Y. 
and forced into the bladder while inverted. 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 in aspect 
from its ordinary colour to that of an inflamed surface, and, if it has 
existed long, to a darker colour. Sometimes it will become gangren- 
ous, and will slough ; its surface at other times appears chopped and 
rugose, and on occasions pints of blood have been known to ooze from 
its exposed mucous surface. Should there exist any doubt concern- 
ing the nature of the parts protruding, we should try to find the 
meatus urinarius : if we cannot discover that, the circumstance 
should make us very suspicious how we act. In such cases we 
should ascertain the attachment and situation of the protrusion, 
and learn whether it is contiguous with the vagina, which will at 
once point out to us its real nature. Another important point in 
our diagnosis should be that of discovering, if possible, the nipple- 
like shape of the orifices of the ureters, to be found at the superior 
surface of the upper end of the suspended part, and generally 
pretty near together ; and, by careful observations, urine will pro- 
bably be seen oozing from them, and on occasions, during the 
throes of the animal, jets of it may be seen forced out. 
I think, whenever this takes place, that the lig amenta lata or 
broad ligaments of the bladder, must be either ruptured or put very 
much on the stretch : were they not ruptured, the inverted bladder 
would not be able to protrude out of the vagina to so great a dis- 
tance. 
Treatment . — Provided we are called to the case at an early 
period, and before a thickening of the parietes of the bladder and 
of the sphincter has taken place, we, most probably, may succeed. 
We should, with the left hand, press gently upon the sides, and 
with the right hand the fundus of the bladder, until we feel it 
gradually receding from us ; after which we may carefully intro- 
duce a pessary or catheter, so as fairly to force it into its natural 
situation. If there should be violent straining at the time we are 
employing the taxis, we had better desist for a time until we have 
abstracted four or five quarts of blood, or given a dose of opium, in 
solution, to allay any irritation or spasm. But. if we cannot suc- 
ceed in this way, I think a far more preferable mode will be to get a 
stick with a round blunt point that will pass through the sphincter, 
and force it against the extreme protruded fundus. A very excel- 
lent instrument would be a female catheter, such as is used for the 
cow or horse, as it would have the necessary curve. In thus try- 
ing to re-invert it we may use considerable force without rupturing 
it, though, of course, we must be cautious in our pressure. If we 
cannot succeed in this way we have another method, but which is 
rather an uncertain and dangerous one, and one rather difficult, I 
