502 
INVERSION OF THE BLADDER. 
surface of the vagina, but found no meatus urinarius. The flap 
of membrane commenced at this place, and, after some violent 
efforts, the ureters lanced the urine to a considerable distance. 
It was now plain enough to me that it was the bladder which I 
saw hanging from the vulva. I examined it anew, and I found 
that the proprietor, in endeavouring to force it back, had torn it 
at the fundus. 
What was I to do ? Force the bladder back ? The urine 
flowing into the abdomen would inevitably produce peritonitis, 
that would be speedily followed by death. Was I to continue 
to let it hang thus projecting? Gangrene would soon attack it, 
and already it was of a violet colour, and exhaled a putrid smell 
at the part where it was rent. I informed the owner of the im- 
minent or irremediable danger which threatened the patient ; 
but, as he could not resolve to destroy her, he entreated me to do 
all that I possibly could for her. 
[ abstracted nine pounds of blood, and ordered a restricted 
diet and repeated injections. I saw her several times every day. 
The bladder became more and more black and swelled, and the 
thighs were excoriated by the flow of the urine. We bathed the 
bladder with warm water, to which a little vinegar had been 
added. 
On the 29th, I chanced to meet my friend M. Diquet, Director 
of the Stud at Pin. My first care was to talk to him about this 
poor animal, and he went with me to see her. After careful ex- 
amination, we resolved to try to cure her, although we very much 
despaired of the result. We passed a ligature round the portion 
of the bladder inferior to the orifices of the ureters, and charged 
the proprietor to tighten the ligature from time to time. Gruel 
only was allowed, and occasional injections thrown up. M. Di- 
quet returned to Pin, and I was left in charge of the patient. 
30 th . — A messenger came to inform me that she was much 
worse — that she had violent colic, and was sadly beating herself 
about. I hastened to her, and found that the ligature had risen 
more than an inch, and had closed the orifices of the ureters. It 
was the stoppage of the urine in these canals which produced 
the apparent colicky pains. The bladder being eight inches in 
diameter inferiorly, was of a pyramidal form, pointing upwards ; 
and this had caused the difficulty of keeping the ligature in its 
place. In order to accomplish this, I fixed two nooses to the 
ligature, and which I made to pass under the middle of the 
bladder. Every day I tightened the first ligature, and then that 
beneath, until there remained nothing more than a little pedi- 
cle, to which was attached a mass six pounds in weight, and ex- 
haling a most infectious odour. I cut through this without 
any haemorrhage. There was immediately a retraction of the 
