Among fruits, the common blackberry appears to exercise a sedative effect on the mucous Membrane of the urinary passages. My attention was first directed to this by two old practitioners who were in the habit of prescribing it in cases of chronic cystitis. I have often found blackberry-tea, prepared from the jelly, an efficient and not a disagreeable demulcent in these cases. There are other fruits and vegetables which will occasionally be found useful. For instance a distinguished member of our profession writes me : " It is a curious thing that when I eat gooseberries, not only is the urine increased in quantity but it is always clear and free from mucous deposit, and normally acid." The ordinary table celery, well boiled, is often ser viceable as part of the diet of persons liable to cystitis. I have, on the other hand, met with an instance where the eating of much aspar agus invariably caused hoematuria. An excess of mucus in the urine may sometimes be corrected by ten minims of terebene in a capsule three times a day, and the same may be said of a combination of the oils of eucalyptus and of cubebs. In the treatment of chronic inflam matory affections of the bladder many of the balsams and terebin thinates may be recommended. The use of saccharin has been also advocated for this purpose by Dr. Little " of Dublin.
Opium must not be used indiscriminately. To give a few hours' repose in this way to a patient who really requires his urine drawn off and the bladder washed out is, on the face of it, not good prac tice; though when such points have been attended to, it is often in valuable in removing the extreme sensitiveness of the parts which is clue to the disease. The constipation that follows the use of this drug in chronic sufferers from cystitis negatives the good otherwise gained by the sleep and repose that are obtained. The addition of belladonna to the opium sometimes removes the constipating effect of the latter. I cannot say that the bromides are of much service in this class of cases, unless the trouble arises more from nervous than from physical causes. Some persons' annoyances seem invariably to gravitate toward their large prostates.
Though, as a rule, retained and decomposing urine is the cause of the offensive smell sometimes noticed in these eases, still, in spite of catheterism and irrigation, a disagreeable odor may remain. Under these circumstances, the administration of in a pill, con taining two or three grains, enclosed in a gelatin cachet, will be found useful. If given three or four times a day the odor of the drug will be found to overcome the disagreeable oue the urine generates. Benzoic and boric acid, benzoate of ammonia and chlorate of pot ash, administered internally, are also of service where the urine un dergoes change of this kind. It is by sterilizing the urine that med icines of this character do good.
To alleviate the extreme irritability of the bladder which often remains after the more active symptoms of inflammation have passed away, a solution of morphine, injected into the bladder with a gum elastic catheter to which a ball syringe is attached, often gives the patient a good night after rectal suppositories in various forms have been tried.
For a similar object, I sometimes employ vesical suppositories, containing morphine, belladonna, bismuth, and other soothing agents. I put these into the bladder by means of a made for me by Messrs. Krohne and Sesemann, of London. The instru ment consists of a silver catheter, open at the end, in which the sup pository is placed. By means of this instrument the whole of the urine is first drawn off, after which, by pressing the stylet, the sup pository is projected into the bladder. They are made of the oleum theobromie, and are so shaped as to fit in the open end of the catheter, thus giving it the appearance of an ordinary instrument, and facili tating its passage into the bladder. , The shape of the suppository is
shown in the sketch (Fig. 40, A) ; they contain various medicinal ap plications. A grain of morphine, introduced into the bladder in this way, and repeated twice in twenty-four hours, has completely relieved distressing symptoms of irritation. I have extended the application of drugs in this shape to other cases where astringents are indicated.
A member of our profession writes me : "I have received more benefit from the suppositories of cantharides than from all the remedies I have tried during the twelve years I have suffered from retention." Dr. Dennis, of New York, thus refers " to this method of medi cating the bladder in a case of hemorrhagic cystitis complicating typhoid fever : "After the bladder had been washed out with the an tiseptic solution, iodoform suppositories were introduced into the bladder by an instrument invented by Mr. Reginald Harrison. The antiseptic solution cleansed the bladder, and the iodoform supposi tories disinfected the residual urine. It was a remarkable clinical fact, that eleven days after the discontinuance of the suppositories the odor of the iodoform was present in the urine." There are causes of cystitis other than those I have previously enumerated as the commoner ones. A paralyzed bladder, as we see in disease and injury of the spinal cord, is, sooner or later, al most sure to become an inflamed one in the way that has already been explained. Catheterism and washing out the bladder will do much toward mitigating the distress of these patients and averting a fatal issue; for, where recovery has followed, much of the success was due to the absence of inflammation of the bladder. In employing cathe terism in these cases, we ought not to forget that, owing to the absence of sensibility in the parts, much damage may be inflicted by an in judicious employment of instruments, without the patient expressing that consciousness of pain which otherwise he would do. The great est care should consequently be exercised in drawing off the urine to avoid any lesion of the urethra or bladder, which, considering the state of the urine, would be sure to prova e further complications. Almost the whole comfort of the patient suffering from fracture of the spine depends upon the manner in which his urinary symptoms are anticipated and managed. Perineal cystotomy with tube-drain age has been practised in these cases by Mr. D. Harrisson, with the oh ject of dispensing with catheterism altogether, but I have no experience of it myself under these circumstances. Mr. Wallis" also records an instance where perineal cystotomy and drainage was practised, with temporary advantage, in a patient with fractured spine who was dy ing from cystitis. The use of the catheter was thus rendered unnec essary. I can, however, indorse the remark made by the late Dr. Hilton Fagge, that the tendency of urine in paraplegia to putrefac tion may be checked by the administration of salicylic acid by the mouth. There are cases of chronic cystitis in the male where the ex pediency of performing cystotomy and of draining through the peri nceum may with much propriety be considered for the purpose of giving the bladder a complete rest, both from the operation of cathe terism as well as from its own irritable contractions or spasms. In some instances, where all other means have been tried and failed, very satisfactory results have been obtained, that is to say, the. pa tients have derived permanent advantage. The details of this pro ceeding will be discussed in connection with the operation of perineal puncture and drainage.