8(5 DISEASES OF THE BLADDER. 



A distention of the bladder, which perhaps has occurred but unce, and 

 to which a mechanical obstacle to the discharge of the urine, or<a false 

 shame in some over-modest person, has given rise, may result in penna 

 nent vesical paralysis. It may also proceed from a vesical catarrh, 

 especially in aged persons, from implication of the vesical muscles in 

 the disease. 



The symptom* of vesical palsy vary according to the muscles 

 affected. When the palsy is complete and is confined to the sphinc- 

 ter, the urine flows away involuntarily as soon as the bladder has be- 

 come full enough to overcome the tone of the sphincter. When the 

 paralysis is incomplete, the patient is able to resist the pressure of a 

 somewhat fuller bladder, but he must hasten to find some befitting 

 place to pass water, as his sphincter will fail of its office if he wait too 

 long and the pressure increase. This incomplete palsy of the sphincter 

 is of very common occurrence in conjunction with partial paralysis of 

 the lower extremities, and is attributable to an incomplete interruption 

 of conducting power of the spinal marrow. 



In palsy of the detrusor, the tone of the sphincter is not overcome 

 by such a degree of tension of the bladder as, under normal conditions, 

 would excite contraction of the detrusors sufficient to overcome it. 

 Unless artificially emptied, the bladder is distended excessively, and it 

 is only after the distention has reached an extreme point, or by the 

 action of the abdominal muscles (where they are not paralyzed also), 

 that a portion of the contents of the bladder is expelled. If the 

 palsy be pure and uncomplicated, the patient can arrest or postpone the 

 outflow of urine. When incomplete, the bladder does not become so 

 full before evacuating a portion of its contents as it does in complete 

 palsy. The patient, however, endeavors to assist the action of the 

 detrusor, by bringing his abdominal muscles into play, so that he 

 often 'jreaks wind while passing water. In spite of all his efforts, 

 he cannot eject a strong arched stream, but the urine dribbles verti- 

 cally down between his feet. This form of incomplete palsy of the 

 detrusor is chiefly seen in marasmic subjects, and individuals weakened 

 by sexual excess. 



Finally, in patients in whom both sphincter and detrusor are pal- 

 sied, the bladder is in a state of permanent over-distention, the tone 

 of the sphincter yielding later than it normally should do. Every ad- 

 dition made to the contents of the bladder induces a corresponding out- 

 flow from it, and the patient is unable to hinder or to arrest this flow. 

 The patient usually, indeed, is quite unaware that his bladder is full, 

 and only seeks medical aid on account of the continual enuresis, and 

 generally is greatly surprised when we evacuate the urine from the 

 bladder, which often contains an enormous quantity of it. 



