34 DISEASES OF THE BLADDER. 



They recur at longer or shorter intervals, and usually cease as suddenly 

 as they have begun. 



Diagnosis of spasm of the bladder in its stricter sense demands 

 caution, as its occurrence is somewhat rare, and as it is often extremely 

 difficult to distinguish it from other maladies of that viscus. It is only 

 when the latter can be excluded from diagnosis, after careful examina- 

 tion of the urine, and scrupulous attention to the attendant symptoms 

 of the case, and after we have assured ourselves by repeated sound- 

 ing that there is no foreign body lodged in the bladder, that we are 

 warranted in supposing tne existence of a pure vesical hypercinesis. 



Treatment of spasm of the bladder, first of all, demands removal 

 of the exciting cause. In some instances, the cure of a fissure of the 

 anus, or of a chronic hyperaemia or inflammation of the womb, consti- 

 tutes the chief, or, indeed, only remedy, for vesical spasm. In other 

 cases, it will subside if we can succeed in altering the nutritive con- 

 dition of the patient, by a thorough modification of external relations, 

 and thus quiet the morbid irritability of the nervous system. For the 

 paroxysms themselves we should have recourse to warm baths, clys- 

 ters of camomile or valerian tea, with the addition of a narcotic ; and, 

 above all, to the internal exhibition of opium. In addition to this, 

 Pitha warmly recommends the cautious and gentle introduction of 9 

 wax bougie into the bladder. 



OHAPTEK X. 



ACINESIS OF THE BLADDER VESICAL PALSY CYSTOPLEGIA. 



PALSY of the bladder may involve the sphincter muscle, the detru- 

 sor urinae, or both of these muscles simultaneously. Contraction of the 

 detrusor is not dependent upon volition, but arises reflexly from the 

 stimulus of the urine collected in the bladder. Contraction of the 

 sphincter, on the other hand, is subject to the will. Up to a certain 

 point of distention, the tone of the sphincter suffices to counteract the 

 action of the detrusor, which presses upon the contents of the bladder 

 and strives to open its outlet. If this point be exceeded, the tone is 

 overcome, and the sphincter requires the action of volition to keep it 

 closed. From these physiological facts, the causes of vesical palsy be- 

 come somewhat more comprehensible. In the first place, it is quite 

 plain, both in structural disease of the brain and in grave febrile consti- 

 tutional disease, in which the function of the brain is overthrown, why 

 palsy of the sphincter should be a very common symptom, and why 

 palsy of the detrusor should be somewhat more rare. In apoplexy 

 and in typhus, the number of patients who wet their bed is greater 



