PROLAPSE AND INVERSION OF THE URINARY BLADDER. 
385 
before the mucous membrane is much altered. After expelling the 
peritoneal fluid from the inverted bladder by pressure and cleaning the 
prolapsed part, the animal is placed with the hind-quarters high and a 
twitch applied. The urethra is sometimes so wide that the displaced 
bladder can be passed through it with the hand, but should it prove too 
narrow, a blunt stick, well rounded off at one end to prevent injury to the 
bladder, may be employed. Lonnecker employs a probang for this 
purpose. The hand or stick is placed on the base of the bladder and 
the latter thrust through the urethra. One proceeds here in the reverse 
order to that observed in replacing a prolapse. By injecting a luke¬ 
warm fluid like saturated boric acid lotion, diluted alum lotion (1 to 5 
per cent.) or tannin (1 to 2 per cent.), recurrence may be prevented and 
inflammatory reaction checked ; such solutions also favour contraction 
of the urethra. By slow exercise, pressure on the loins, or by watching 
the animal, the straining and consequent eversion may be obviated. 
Lonnecker replaced an inversion, but as it reappeared five days later 
he sewed up the orifice of the urethra, grasping and raising the mucous 
membrane with the left hand, and passing a lead wire through it, after 
which recovery took place. Holgen successfully effected reposition five 
weeks after the first appearance; probably the bladder was not continuously 
exposed. The same applies to the case related by Degive, in which 
reposition or reversion was successful fourteen days after the viscus first 
protruded. 
As a rule, however, the surface of the mucous membrane is so much 
injured during prolonged exposure as to become necrotic, in which case 
reposition is contra-indicated, and amputation of the bladder offers the 
only chance of recovery. Though this certainly deprives the animal of 
the natural reservoir for the urine, which, therefore, flows continuously 
or is discharged in small quantities from the vagina, yet as it does not 
render ordinary working-horses and cows useless its employment is 
sometimes justified. 
Amputation of the bladder is generally effected by ligation, best by 
using the elastic ligature. As the ligature tends to slide forwards off 
the spherical swelling and over the orifice of the ureters, two different 
methods of operation have been suggested. Some recommend transfixing 
the bladder and ligaturing on both sides, that is, applying two ligatures; 
in this case the peritoneal sac is opened and the danger of peritonitis 
increased. Others prefer the simple ligature, transfixing the bladder 
with a metal needle in front so as to secure the ligature in position. 
Bang passes a second ligature in front of and at right angles to the first, 
and after cutting away the bladder carrying the ligatures backwards and 
tying them in the form of a cross. The same result is more simply 
attained, without transfixing the bladder, by laying a tape with its two 
v.s. c c 
