.Paralysis.—The bladder is not an excep tion to the rule, that " all parts of the body may become unfit for the functions which they are destined to perform ;" it may lose the fa culty of contractility, which is indispensable to the accomplishment of excretion. Under many circumstances it may contract with too much force ; in a still greater number its contracti lity is enfeebled and ultimately destroyed. Apoplexy, hemiplegia, paraplegia, concussion, and inflammation of the brain and its meninges, extravasations within the cranium, and still more concussion and inflammation of the spinal marrow and its membranes, and extravasations within the spinal canal, consequences of con tusions of this part; the excessive distention of the bladder by the accumulation of urine within its cavity, either in consequence of neglecting to attend to the desire of excretion, or because the want has been resisted by false delicacy, or because an obstacle exists at the neck of the bladder or in the urethra ; inflam mation of the mucous membrane, especially. when it affects the neighbourhood of the neck of the organ ; the sudden cessation of articular pains, inflammations of the skin or of the genital organs ; exasperated gastro-enteritic af fections which are accompanied by affections of the brain and the spinal marrow ; abuse of the sexual organs ,—these are among the cir cumstances under the influence of which the bladder loses partially or completely its con tractility.
We must not therefore regard all cases of paralysis of the bladder as evidence of feeble ness, nor confound the inability to contract, with those mechanical obstacles which, acting on the bladder or the urethra, oppose the ex cretion of urine. We should always endeavour to ascertain whether there he a real paralysis of the bladder in cases where the brain or the spinal marrow is injured, and where there is detected abuse of the sexual organs. When retention is primitively the effect of inattention to the desire to pass urine, there is only exces sive distention of the muscular fibres, but that distention is formidable in its effects ; for no fact is better established than this, that when we submit muscular fibre to excessive distention or contusion, it loses the faculty of contracting. Again, in cases of inflammation of the bladder, there is less of paralysis than a suspension of contraction in the muscular tunic, in conse quence of the proximity of the mucous tunic, which by reason of its inflammatory state be comes still more painful when its tissue is ruffled by contraction. There may, however, be atony or even a real paralysis of the mus cular tunic during the existence of inflammation of the mucous tissue.
It is important to distinguish the case where paralysis is simple from those in which it is complicated by inflammation of the mucous membrane of the bladder or that of any other organ, and for that purpose it is necessary to analyse with care the symptoms. We must
also bear in mind that from simple, complete, and primitive paralysis of the muscular tunic to inflammation of its mucous tunic, the inter val is only very short, in consequence of the irritating impression which is exercised by the accumulated urine which has become much deteriorated in its qualities by its prolonged retention. From the time when paralysis is fairly established, the bladder is quite insensi ble to the stimulus of the urine—it is merely an inorganic sac, which may become enor mously distended. Haller found in a drunkard the bladder so dilated that it was capable of containing twenty pounds of water.'' Frankt saw a similar bladder which simulated ascites; he evacuated from it at one time twelve pounds of urine without removing all that it contained. William Hunter, in his Anatomy of the Gravid Uterus, plate 26, has given a fine repre sentation of a bladder which extended as far as the xiphoid cartilage of the sternum.
This affection may, according to Baillie,t exist during two distinct states, one when the muscular tunic of the bladder has lost its contractile power, the other while that power is still retained. He adds, that after death these two cases cannot be distinguished the one from the other, but that by an attentive examination of the symptoms the existence of each may be recognised during life. It may be complicated with inflammation of the organ, and in this case rupture of the bladder may occur,§ to which may be added the case of the celebrated Tycho Bralielf Zuber ¶ dis tinguishes this affection into that of the neck and that of the body, and this distinction is important, for the second being sometimes accompanied by a species of spasm or want of consent in the neck, a retention of urine must be the result, whilst the former occasions incontinence of that fluid.
of the bladder is an affec tion of frequent occurrence ; it accompanies the various forms of cystitis, calculus, and often in flammation of the urethra. In fact it may be ex cited by any kind of irritation of the bladder or urethra, or by certain affections of the kidneys and of the rectum. It is not our purpose to con sider in this place any other than what may be termed the idiopathic species of this affection. Hoffmann describes the case of a man who sank under the numerous and violent attacks of this disease, and in whom, after death, except in one particular, the bladder was found perfectly healthy ; this was in the thickening and dilatation of its vessels, in which there was still much blood. Of course, although no anatomical lesion was found in this case, some irritation capable of exciting the spasm must have existed.