Paralysis of the Bladder.—A condition usually accompanying diseases of the spinal cord. It may occur also during unconsciousness, or as a result of gradual degeneration of the muscles of the bladder from chronic inflamma tory processes : catarrh, urethral stricture, and enlargement of the prostate gland. The paralysis involves partly the sphincter and partly the expulsive muscles, so that the urine either cannot be retained in the bladder. and is constantly dribbling, or cannot he properly voided. because the expulsive power is lost and retention results. The prognosis and the treatment whether palliative, radical, or otherwise, must be left entirely to the dis cretion of the surgeon. Where there is retention of urine, catheterisation will probably be found necessary.
Spasm of the Bladder.—A peculiar disturbance of urination, due to some irritation of the neck of the bladder, all the causes of which are not as vet fully understood. It sometimes follows the use of alcoholic drinks which have not been completely fermented ; and it is often present in cystitis or inflammation of the bladder. The condition is characterised by an intense desire to urinate, which persists for some time after the bladder has already been emptied. Attempts to pass the urine result in the expulsion of only a few drops, and call forth a severe burning pain. The desire soon returns, however, and continues for some time until the normal condition is again restored. In rare cases, the yesical spasm, which may vary from a dribbling of the urine to complete retention, is the result of nervous disturbances, and this form naturally demands medical attention. The other type is usually transitory, and may be satisfactorily combated by the plentiful administration of warm drinks or alkaline waters, the use of bicarbonate of soda, and a hot sitz or a warm body bath. Persons who arc liable to this otherwise harmless form of vesical spasms, should avoid the use of incom pletely fermented beverages. A similar train of symptoms may also be present at the onset or during the course of an acute catarrh of the bladder, or when there are stones or foreign bodies in the bladder. The immediate cause in any given case must be carefully determined by the physician in attendance.
Stones in the Bladder.—Bladder-stones, or calculi, are found in adults and children, but are more often observed in men than in women. The chemical composition varies widely, and a number of substances may be present. The colour, size, form, and hardness are also subject to wide variation. Urates, phosphates, and oxalates of the alkalies, sodium, and potassium, are the most frequent components (see Plate Fig. r, a, b, Calculi are commonly formed about some particle of gravelly material, which finds its way from the pelvis of the kidney and becomes enlarged in the bladder by the deposit of the substances enumerated. Foreign bodies which have entered the bladder may also serve as a focus of accretion. The chemical composition of these stones has little to do with the symptoms which they produce. A calculus may remain in the bladder for a consider able period of time before the patient becomes aware of its presence. In fact, many patients may never know they have a stone in the bladder. As a rule no pain is felt until the stone, by constant rubbing, has produced an injury to the lining mucous membrane of the bladder, usually near the neck. The pain is ordinarily felt radiating out toward the glans penis at the com pletion of urination. Violent movements, such as riding, jumping, dancing, fighting, etc., may bring about a 11:emorrhage from the bladder. Some times there is sudden stoppage of the urinary stream, the normal course of which is resumed after the patient makes some characteristic movements.
The patient at this time may experience a feeling of some sudden mechanical obstruction. When a stone has been in the bladder for a considerable period of time, a chronic catarrh usually develops. An important point in the diagnosis of many cases is a history of previous attacks of renal colic, but in most instances judgment can be passed only after a thorough medica examination, including abdominal and rectal palpation, introduction of a stone searcher, and perhaps the illumination of the interior of the bladder by artificial light. X-ray examinations are also useful in detecting the presence of vesical calculi (see Plate XV.).
Operative interference is ordinarily indicated, for there is no internal method of treatment as yet known by means of which a stone may be dissolved in the bladder. All that medication may accomplish is the pre vention of gravel formation in the kidney, thus doing away with the pro duction of one form of focus around which calculi can be deposited when this material finds its way into the bladder. On the other hand, internal treatment or a course of waters at some mineral spring may seem to pro duce a beneficial result, because of its good effects on the accompanying vesical catarrh. In most cases, a combination of medical and surgical treatment, together with a suitable diet, is indicated. The diet depends somewhat on the composition of the calculi previously obtained, and this knowledge should also influence the selection of an appropriate mineral water. Where there is present an increase of uric acid, the patient must avoid eating large quantities of meats, sour foods, strong and acid wines and beers, and adhere mainly to a diet composed of milk and vegetables. The fancied difference between red and white meats is not based on correct chemical analysis.
Among the mineral waters, those from the following springs have been recommended : European : Fachingen, Wildungen, Vichy, Carlsbad, and Marienbad ; American ; Saratoga, Alma, Blue Lick Springs, and Alt. Clemens. If the calculi are made up of oxalates, the same waters may lie taken, and all vegetal)les c(mtaining much calcium oxalate (rhubarb. spinach, etc.) must be avoided. In the presence of phosphatic calculi, acids (especially those derived from plant sources) and carbonated waters may he recommended.
Tumours of the Bladder. New growths in the bladder may he either benign or malignant in character. An accurate diagnosis cannot as a rule be made from the examination of bits of extruded tissue that may be found in the urine. It is usually found necessary to illuminate the interior of the bladder (cystoscopy), or to expose its cavity by an incision (cystotomy). When a haemorrhage takes place from the urethra without any known excit ing cause (such as gonorrhoea), suspicion should always be directed to the presence of a growth in the bladder. During the early stages of their forma tion. these tumours are not distinguished by any clearly defined symptoms. There is present a more or less chronic process, to which urinary difficulties and evidences of catarrh are later added. After the diagnosis has been confirmed, surgical interference is necessary ; and the prognosis, based on the advances in modern technique, is usually very favourable, except in those instances where a malignant growth, such as cancer, is found. This fact should be constantly borne in mind, as it illustrates the great import ance of early operation for these malignant cases. Delay is usually fatal.
BLEEDING.—See H.ENIOPHILIA ; H.EMORRHAGE.
BLEPHARITIS.—See EYELIDS, DISEASES OF.