Diseases of the urinary and male sexual organs / by William T. Belfield.

  • Belfield, W. T. (William T.)
Date:
[1884], ©1884
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the urinary and male sexual organs / by William T. Belfield. Source: Wellcome Collection.

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    veloped from this venous obstruction caused b}^ prostatic enlargement; just as eczema occurs on the leg from varicose veins. The nerve supply to the bladder is also a matter of clinical interest. The neck of the bladder, including the sphincter, is suppKed directly v^ith spinal nerves, which proceed from the anterior roots of the thu'd, fourth, and fifth sacral; the body of the bladder, on the other hand, obtains its nerves from the sympathetic hypogastric plexus. The spinal centre of the motor fibres is in the vicinity of the third lumbar vertebra. This anatomical difference in the nerve supply of the different muscles of the bladder corresponds to the known physiological antagonism between the sphincter and the detrusor muscles. The former is, in the normal state, completely under the control of the will, while the latter is practically in- dependent of volition. The act of micturition consists simply in the vol- untary dilatation of the sphincter ; the expulsion of the urine is an invol- untary act, except as it is assisted by the contraction of the abdominal muscles. In cases of injury to the spine above the third luml ar vertebra, whereby communication between the brain and the spinal centre of the vesical nerves is interrupted, there occurs retention of urine in consequence of the inability of the patient to dilate the sphincter; when this muscle is dilated mechanically by the introduction of a catheter into the bladder, the detrusor muscles contract as before. Another fact of clinical importance is the distribution of the same nerve (the pudic) to the base of the bladder and prostate, the integument of the penis, scrotum, and perineum, the urethral muscles and mucous membrane, and the sphincters of the anus ; in the female the uterus, vagina, and vulva are supplied by branches of the same trunk, which is distributed also to the base of the bladder and urethra. As a result, irritation exerted upon these various organs—the urethra, rectum, anus, perineum, vagina, etc.—may be manifested by functional abnormality at the base of the bladder. It is a famihar clinical observation that irritability of the bladder, indicated by frequent and painful urination, may be caused by conditions of the most diverse nature in other portions of the area supplied by the pudic nerve. Thus fissures and ulceration of the rectum, habitual constipation, the pres- ence of worms in the bowel, ulceration and inflammation of the uterus, the accumulation of smegma under the prepace, phimosis, stricture, etc., may not only be accompanied by an irritable state of the bladder without actual lesion of this organ, but may even manifest themselves subjectively by sensations referred to the bladder rather than to the actual seat of the irritation. Hence it is necessary, in every case of obscure difficulty affect- ing the bladder—especially if the subject be a child—to examine also the various other organs to which the pudic nerve is distributed. Conversely an actual irritation of the bladder or prostate may produce abnormalities in the area named—rectal tenesmus, urethral spasm, nocturnal pollutions. The sphincters of the bladder are in the male two in number : one con- sists of a ring of unstriped muscular fibres contained in the vesical border of the prostate ; the other is the striped muscular tube which surrounds the membranous portion of the urethra. Strieker and Dittel demonstrated the function of these two muscular rings in the following way : A dog was curarized, whereby all striped muscular fibres, including those surround- ing the membranous urethra, were paralyzed. The bladder remained full, no urine escaping. Even after a vertical section had been made through the prostate (excluding the posterior edge) no urine escaped. This con- stituted circumstantial evidence that the prostatic muscular ring performed the function of a sphincter. Positive demonstration was furnished by in-