Atony of the bladder is often seen in connection with cystitis. When occurring suddenly, the question sometimes arises, Should a catheter be permanently retained in the bladder? My opinion corre sponds with the following remark by the late Mr. W. Hey, of Leeds : "I feel sure that a patient sooner regains the power of emptying his bladder spontaneously when the catheter is withdrawn after each time it is used than when it is retained." Temporary atony is sometimes seen following pressure from over-retention of urine, just as the arm may be temporarily paralyzed by lying on it. To prevent atony be coming permanent much may be done by the mechanical measures that have been advocated. In addition, medicines such as iron, nux vomica, and strychnine have proved useful. The tincture of canthar ides is an old-fashioned remedy, which, in addition to its diuretic properties, probably exercises a direct stimulating action upon the bladder by its presence in the urine. Von Langenbeck has found benefit from the hypodermic injection of ergotin.
Care must be taken to draw a distinction between the inflamed bladder that is either entirely or partially atonied because the patient is ataxic, and the commoner form of local paralysis to which refer ence is here made. Inflammatory atony is not unfrequently seen as a remote consequence of syphilis in middle-aged men. Here both local and general treatment will be requisite. Atony with cystitis, though associated with urethral stricture, is sometimes due to a cen tral and not a peripheral cause; hence it is well not to promise too much even after the stricture has been disposed of. I have known, the bladder treated somewhat actively, with the view of arousing its supposed dormant action, where attention should also have been de voted to the state of the nerve centres, which was the prithary cause of the suspended action in the part.
In the following case reference is made to the treatment of ataxia by suspension, so far as the bladder symptoms seemed to be influenced by the process :