METASTIC CYSTITIS. Metastatic Cystitis. —It is not uncommon to find cystitis, in various degrees, occurring as a consequence of gonorrhoeal urethritis, and, like other metastatic inflammations, the primary disorder often abates as the change in locality takes place. In the slighter forms of cystitis resulting from gonorrhoea, or those pro voked by such causes as exposure to cold, we have this condition indicated by a frequent discharge of urine more or less loaded with mucus. In the severer forms, in addition to constitutional fever, the bladder is intolerant of the presence of urine within it, as indicated by frequency of micturition, and tenesmus produced by the contractile power necessary to expel. The urine becomes purulent, and a discharge of blood not infrequently terminates the act of its expulsion. I have observed the greater liability to cystitis and bladder irritation, as a complication of gonorrhoea, at seasons of the year when sudden changes in temperature are apt to occur. Hence the importance of providing against this by suitable clothing and by avoiding exposure to keen winds.
The treatment of this kind of cystitis must be in correspondence with the degree of inflammatory action that is taking place. In the milder forms, where irritation best describes the extent to which the bladder is implicated, the suspension of any kind of abortive local treatment, so far as the gonorrhoeal discharge is concerned, is neces sary. Rest, in the recumbent position, and soothing applications, in the form of hot opiate fomentations and sedative suppositories, must be substituted. Of the demulcents I have been in the habit of pre scribing, I find the decoction of the ulmus fulva or slippery elm, in combination with the succus hyoscyami, affords the speediest relief. In cases of gonorrhoeal cystitis, where the disorder has a tendency to become chronic, frequency in micturition and purulent urine re maining after the more acute symptoms have subsided, benefit will be found from the use of copaiba, or the oil of yellow sandalwood ; these remedies are, however, not well borne where there is general febrile disturbance.
When there is evidence from the symptoms and the presence of gonorrhoeal bacteria that the bladder is similarly affected with the urethra as a consequence of the specific inflammation, local treatment is generally required in addition to the sterilization of the urine from within by such bactericides as quinine or boracic acid. This is best done by passing a small rubber catheter well anointed with carbolized vaseline into the bladder and then moderately distending it with half a pint or so of some disinfectant. The catheter is then withdrawn and the patient spontaneously expels the contained fluid. In this way not only is the mucous membrane acted upon but the urethra is flushed in the most thorough manner. This process should be car ried out once or twice in the twenty-four hours. By this means the urine will soon present a normal appearance. Where there has been a chronic infective gleet this will often also permanently disappear under this process of irrigation. I usually prefer nitrate of silver in the proportion, to commence with, of two grains to the pint of warm distilled water, the strength of the solution being gradually increased until half a grain to the ounce of water is reached. Neutral sulphate of quinine, one grain to the ounce of water, is also very efficacious. Bichloride of mercury, 1 in 20,000, may also be used as an efficient bactericide, but even in these proportions it is apt to cause pain and subsequent irritation.