PALSY OF THE BLADDER. 85 



than that in which the use of the catheter is required. If, however, 

 the paralysis finally extend from the cerebro-spinal system to the sym- 

 pathetic; if the power of involuntary movement be also impaired; 

 if the patient can no longer swallow ; if the abdomen become tympa- 

 nitic from palsy of the intestinal muscles ; the detrusor urinae also takes 

 part in the paralysis, and the distended bladder rises above the sym- 

 physis. There is another very common circumstance, however, which 

 also contributes to the occurrence of incontinence of urine in cases of 

 disease of this kind, namely (as happens in a variety of conditions of 

 other peripheral organs), the overfilling and overflowing of the bladder 

 (KoJilrauscK) make no impression on the consciousness, and hence no 

 impulse is derived from the will to contract the sphincter and to close 

 the bladder. At the same time, however, it must be admitted that, in 

 some cases of apoplexy and of severe typhus, palsy of the detrusor sets 

 in early, and before there is any general palsy, and without our being 

 able to account for this phenomenon. In disease of the spinal marrow, 

 likewise, palsy of the sphincter *is of far more common occurrence than 

 palsy of the detrusor. Most paraplegic patients have to wear a urinal, 

 in order not to wet themselves, because the conducting power of then* 

 spinal marrow is iftterrupted. The use of the catheter, on the other 

 hand, is but seldom necessary, on account of palsy of the detrusor. 

 However, the fact that such necessity does sometimes occur, perhaps is 

 owing to the locality of the lesion. It seems to be the ganglia which 

 transmit the impression from the sensory nerves of the bladder to the 

 motor nerves. It is possible that, if that portion of the spinal cord be 

 destroyed at which this transmission takes place, the detrusor will be 

 palsied ; on the other hand, that, if the lesion of the spinal marrow be 

 above this point, transmission of impressions from the brain to the 

 sphincter will be interrupted, while that from the sensory nerves of 

 the bladder to the motor fibres of the detrusor continues unimpaired. 

 The result of comparison of a large number of cases of this kind, which 

 I have examined within the last few years, fully supports this hy- 

 pothesis. 



Besides this form of vesical palsy, the cause of which is central, 

 there are others in which the peripheral expansions of the nerves 

 have suffered lesions, through which they are deprived of then: function ; 

 although, indeed, it is generally out of our power to furnish anatomical 

 proof of such structural disorder. 



Finally, there is a myopathic palsy of the bladder arising from dis- 

 ease in the minute texture of the muscular fibres of the organ, and in 

 the nerve-tips which terminate in them. The most common cause for 

 this form of vesical palsy is the severe stretching of the vesical mus- 

 cles, and their participation in the affections of the mucous membrane. 



