SPASM OF THE BLADDER. 83 



Momberg divides the causes of spasm of the bladder into cerebral } 

 spinal, and reflex. With regard to the first, I would call to mind the 

 fact that the irritability of the sympathetic nerve, though independent 

 of the influence of the will, is by no means entirely independent of 

 the irritability of the fibres and ganglia of the brain. Mental emotions 

 have a distinct action upon the sympathetic system; and just as the 

 muscles of the skin contract under the influence of terror, producing a 

 " goose-skin," so we often, under like circumstances, see violent con- 

 traction of the detrusor urinse muscles, with intense inclination to pass 

 water. So, too, in inflammation of the spinal marrow and in struc- 

 tural disease of the brain, spasm of the detrusors occurs, according to 

 Romberg a fact which is not easy to explain, as the innervation of 

 the detrusor is derived from the sympathetic ; although, indeed, we see 

 an analogous condition in the occurrence of vesical spasm from mental 

 emotion. Yesical spasm is generally of reflex origin. In an irritable 

 subject the impression upon the sensory nerves of the urethra, pro- 

 duced by the*, introduction of a catheter, will provoke spasm of the 

 sphincter vesica. In other cases, irritation of the rectum and, very fre- 

 quently, irritation from the womb give rise to spasmodic contraction 

 of the bladder. Finally, there are cases of vesical spasm which are 

 merely local manifestations of a general neurosis, and must be ascribed 

 to a morbidly exalted irritability of the entire nervous system, which 

 we usually call hysteria. 



The symptoms of spasm of the bladder vary according as the af- 

 fection involves the detrusor urinse or sphincter vesicse muscles. In the 

 former case, a very slight degree of fulness excites intense desire to 

 urinate. The patient can scarcely prevent a constant escape of water 

 by closure of the sphincter ; or else he is quite unable to do so, so that 

 the urine is constantly flowing away a condition generally termed 

 enuresis spastica. On the other hand, when the sphincter muscle is in 

 a state of spastic contraction, the patient can only pass water drop by 

 drop, or in a very fine stream, and with great effort (dysuria spastica). 

 Sometimes the closure of the sphincter is absolute, and there is com- 

 plete retention of urine (ischuria spastica). Finally, the antagonistic 

 muscles, both detrusor and sphincter, may be attacked simultaneously. 

 A condition of great distress then ensues, in which, in spite of violent 

 desire to void the urine, there is inability, more or less complete, to 

 satisfy such desire. In these cases the spasmodic affection sometimes 

 extends to neighboring organs, giving rise to spasm of the rectum, to 

 tremors of the entire body, and occasionally to general convulsions. 

 One characteristic of spasm of the bladder is the alternation of violent 

 paroxysms and intervals of exemption. The former often last but a 

 minute or two, although sometimes they last half an hour or more. 



