42 
gravitation. If then the patient tried to extend the hand, this 
movement immediately took place. From this it is quite evident, 
that by the will-impulse to move the paralysed extensors the tonus 
of the flexors diminishes. 
Would it not be possible that similar restraining phenomena 
accompany the act of micturition? In the bladder we have two 
muscles working antogonistically, the detrusor and the sphincter 
vesical. The empty bladder is shut off by a reflex closure of the 
sphineter. As soon as the quantity of urine, gathered in the bladder, 
is so large as to cause an efficient stimulus by distension of the 
bladder, the muscle fibres of the detrusor come into contraction. 
Simultaneously with this contraction of the detrusor, the sphincter 
relaxes. Here, therefore we have an inhibitory influence of simultan- 
eous reflexes, just as for the patellar tendon reflexes. In this manner 
micturition sets in at regular times for newly born children. The 
reflex contraction of the detrusor can also be promoted by cold, 
and by other cutaneous stimuli, by emotions, ete. At a later age 
the peripheral stimulus is perceived as a desire, and as the child is 
brought up the attention is directed upon it. The desire can be 
voluntarily diminished or increased by distracting or concentrating 
the attention, and this is accompanied by the weaker or stronger 
reflex contraction of the detrusor and reflex relaxation of the sphincter. 
Micturition is therefore voluntary only in as far as the feeling of 
desire can be voluntarily increased or diminished to a certain extent 
by the concentration of the attention. 
The influence of consciousness upon micturition is experimentally 
easily determined. During some days the quantities of urine were 
measured of some psychical normal and of some psychical abnormal 
individuals. The object of the experiment was kept cautiously secret. 
Only the quantities discharged simultaneously with defaecation, were 
not measured. (See tables following pages). 
From these tables it is evident that during preoccupation and 
during diminution of consciousness, almost always greater quantities 
of urine are collected in the bladder. Due to distraction the desire 
is diminished, and consequently the contraction of the detrusor is 
retarded, and the restraining action of the sphincter is postponed. 
When as a result of lesions of the spinal cord the desire is no 
more felt, and the micturition can no more be regulated, due to 
more or less concentration of the mind, then the bladder is again 
emptied regularly after certain filling. The quantities of each invo- 
luntary discharge of urine of a patient with total transverse lesion 
of the spinal cord is given below: (See Table) 
