PALSY OF THE BLADDER. . 87 



In treatment of palsy of the bladder, the causal indication can rarely 

 be met. Especially is this the case in the forms of it arising from dis- 

 ease of the brain or spinal marrow. When it is due to immoderate 

 distention of the organ, it is of importance to use the catheter assidu- 

 ously, partly in order to prevent further distention, which might aggra- 

 vate the palsy, partly to excite more vigorous contraction of the de- 

 trusor, by the irritation which the catheter induces. In cases of in- 

 complete palsy, instead of passing a catheter, Pitha recommends the 

 introduction of a solid wax bougie as far as the neck of the bladder, 

 claiming that " the catheter " relieves the muscles of all exercise, and 

 thus encourages " their indolence." The indications from the disease 

 call for the use of cold baths, douches, and clysters. If these fail, and 

 if the source of the palsy be peripheral, we should proceed with due 

 precaution to the injection of water into the bladder, which at first 

 should be lukewarm, and afterward should gradually be reduced in 

 temperature. If this be of no avail, the application of electricity, as 

 recommended 'by Duchenne, will also prove ineffectual. We shall 

 hardly find a well-authenticated case of cure of vesical palsy by the 

 .use of strychnine, which has also been recommended. 



ADDITION TO THE REVISED EDITION OF 1880. 



SECTION III. DISEASES OF THE BLADDER. 



1. P. 82. 



I have now and then earned the thanks of an adult by recom- 

 mending to him a contrivance which has been advertised in the 

 newspapers. A bit of leather or caoutchouc, of the size of a bean, 

 is to be pierced through its middle by a fine opening, through 

 which the loop of an elastic band is to be drawn, so as to slide 

 stiffly. Upon going to bed, the prepuce, having been stretched 

 over the glans, is to be inserted into this loop, which must then be 

 tightened just enough to close its orifice, but not closely enough to 

 cause discomfort, and so that upon urinating the prepuce will be 

 put on the stretch by the water which is held back. The patient 

 will be awakened by the distention of the prepuce if he passes water 

 during sleep, and may then take off his apparatus, confident that 

 for that night his bed will not be soiled. One young man tells me 

 that only since obtaining this contrivance has he ever dared to sleep 

 away from home. 

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