In pregnant and puerperal women, and in patients suffering from ty phus and dysentery, the bladder should be constantly watched.
If we cannot find any local causes for the paresis, we must search for the rarer central ones. Active and mechanical incontinence has been differentiated (llertzka) from the dribbling of urine which occurs in is churia paradoxa or incontinentia paralytica. The latter is regarded as a symptom of vesical hyperEesthesia, while the former is considered as due to hindered extensibility of the bladder either from the enormous mass of its contents or from pressure of neighboring organs or tumors.
Vesical paresis from endarteritis occurs either in old people or in indi viduals in whom the premature calcification of the arterial eoats will be easily recognized in the accessible radial, vesical, and uterine arteries.
Prognosis.--Paralyses and pareses due to local causes may usually- be removed in a short time when the cause is remedied. But when they are complicated with disease of the vesical wall, as occurs in chronic and ne glected cases, and especially when there is retroflexio uteri gravidi, they are very obstinate and more serious. V esical paresis from central or other causes, as apoplexy, meningitis, etc., increase the original trouble, and hasten death by the rapid formation of decubitus. The paralysis of typhus, dysentery, and peritonitis is not dangerous, and is usually entirely cured when the process is ended.
Enuresis nocturna is a very obstinate and very unpleasant malady; it injures the general health and is very difficult to cure. Sometimes it stops spontaneously at puberty. Recent c,ases are sometimes quickly cured.
Treatment. —Many c,ases of vesical paresis in women may be avoided by a regular use of the catheter in conditions where the hindrance to evac uation might lead to paralysis of the detrusor. That is especially the case with retroflexio uteri gravidi and in puerperal ischuria. In typhus, dysentery, peritonitis, the complication may be prevented by warm baths, by regular evacuation of the bladder, cold alxiominal application, and the use of the catheter if the patient does not completely evacuate her bladder. The best means to prevent ischuria is complete evacuation of the bladder with the catheter and then washing out the viscus with a 1 per cent. salicylic acid solution.
If paresis or paralysis has already set in, there should be regular cathe terization every four hours. But the best remedy at our disposal is in duced electricity, which has given good results after a few applications in ischuria, in paralytic and paradoxic incontinence, and even in enu resis nocturna. One pole is introduced into the bladder, and the other placed upon the symphysis or the os sacrum or in the rectum. In atom! and paresis of the bladder with vesical catarrh left after hyper-distension, vve may use besides the direct faradic current the galvanic one, but only externally. Erdmann recommends that the anode be applied to the back of the head and the third cervical vertebra, while the cathode is placed over the symphysis or upon the perineum. Fifteen to twenty elements may be used for two to four minutes. In children the poles are only ap plied externally The applications are to be made daily, and should last from three to five minutes. If there are signs of hyperfemia or vesical catarrh, the course of treatment laid down on page 184, should be begun.
In some cases irrigation of the bladder with a 1 to 1000 salicylic acid solution through a lIegar's funnel every three to four hours will suffice to remedy a vesical paresis. Internally we should order a robirant diet, good wines, especially champagne, and weiss-beer, since it contains so much carbonic acid. Camphor in small doses and tra. of cantharides five to twenty drops one to three times a day may be employed; but they are liable to irritate.
In a recent paresis of the bladder from catching cold, or long-continued retention, secale has often done good service, given as fresh powder ten to fifteen grains four to five times a day, even when the affection occurs in consequence of cerebral apoplexies and other affections of the nerve centres. Allier claims that this drug has done great good in 3 i doses daily. (Roth, Jacksch, and many others.) Strychnine has been used both internally and externally in paralysis vesicm; internally in iluth grain doses (Cory).