PROGNOSIS OR PYURIA.
As some stress has been laid upon the necessity of operative in terference in the treatment of obstinate and aggravated pyuria, it is but right that the prognosis of the untreated forms should be touched upon. There is no doubt but that cases of pyelitis have resulted in a spontaneous cure. Moreover, on the post-mortem tables small atrophic kidneys containing a cheesy material or the dried chalky re mains of pus, or a large urinary calculus, have been frequently dis covered, and the corresponding ureters have been found thickened and contracted. This fortunate termination cannot, however, be reck oned upon, and it is noteworthy that many of these cases had had no history of symptoms referable to the disease. Hence probably no accentuation of their condition, by the well-meant but mischievous exploration of the bladder, had been undertaken. The gravity of pye litis is in direct relation to its cause. I believe I have seen undoubted cases of tubercular pyelitis recover, temporarily at least, under favor able dietetic and hygienic conditions, and I have met with unquestion able cases of vesical and prostatic tuberculosis which have been in abey ance for as many as twenty years. This, however, is the exception, and most cases of this kind end fatally. The calculous form of pye
litis without pyonephrosis is perhaps the most favorable disease of all. As a rule definite pyonephrotic tumors, unless relieved by art or unless they discharge themselves through the loin, are undoubtedly fatal in the end. Of the ascending chronic forms of pyelitis, that which follows pregnancy may be considered as being the most favor able. Probably the great improvement which now obtains in the treat ment of vesical stone, enlarged prostate, and stricture, will improve the prognosis of pyelitic complications of these disorders. These have hitherto being considered as extremely grave. One remark only need be made : A patient with a pyelitis or a slight pyonephrosis may continue well, or apparently well, for years. Suddenly, without any previous warning or appreciable cause, a change for the worse occurs. Rigors, high temperature, vomiting, thirst, extreme pain in the side or back, and prostration, mark the sudden general absorp tion of pyogenic poisons from a sac which has for long intervals been quiescent. Often the patient is beyond hope even when an operation is immediately undertaken.