82 DISEASES OF THE BLADDER. 



and who go to sleep in dread of further punishment, still awake in the 

 morning with their bed wet through. On the other hand, if we can 

 excite confidence in the use of some entirely inert medicine, for which, 

 however we promise great things, so that the patient can go to bed 

 hopefully, and without fear, he is often awakened in the night by the 

 inclination to micturate, and remains for some time, or even perma- 

 nently, cured of his affection. From time to tune secret remedies for 

 nocturnal incontinence, with testimonials as to then: efficacy, are adver- 

 tised in the newspapers. That such testimonials are not all inten 

 tionally false, is certain; but it is equally certain that the success 

 of the remedies is due more to the psychical impression made by the 

 confident commendation of the article, than upon the medicinal effect 

 of the article itself. We must never tire of again and again exciting 

 the hopes of the patient, and of writing harmless prescriptions for him, 

 of the value of which he must be assured. Even in little children, 

 and still more frequently in grown persons, I have seen at first a tem- 

 porary and afterward a permanent effect produced in this way, which 

 amazed both the patient and his friends. I have usually ordered small 

 doses of carbonate of potash, and recently, according to a suggestion 

 of Trousseau's, one-fifth to one-third of a grain of pulv. herb, bella- 

 donna, with equal parts of the extract. Other remedies, such as 

 strychnine, cantharides, large doses of syrup, ferri iodidi, and injec- 

 tions of irritating matter into the bladder, are objectionable. It is of 

 importance, however, to pay attention to any indications which may 

 arise from the special condition of the patient. 1 



CHAPTER IX. 



IirPERCINESIS OF THE BLADDER SPASM OF THE BLADDER CYSTO- 



SPASMUS. 



VIOLENT contraction of the muscles of the bladder frequently arises 

 in consequence of the irritation which foreign bodies, especially stones, 

 create within it. Such spasm is usually accompanied by organic dis- 

 ease of the viscus. However, since abnormal irritability of the motor 

 nerves of an organ arising as a reflex symptom, in consequence of ex- 

 citement of the sensory nerves of that organ from structural disease, 

 is not usually counted among the neuroses, the term spasm of the 

 bladder is not to be applied to such symptomatic contractions of the 

 vesical muscles, but should be reserved to designate the abnormal con- 

 dition of the motor nerves, which exists independently of any struc- 

 tural alteration hi the wall of the bladder. 



