Sir William Roberts " has suggested that the lactic fermentation may be made use of as a counter-septic agent in cases of ammoniacal decomposition of the urine, and that thus the formation of phosphatic concretions may be prevented.
I have availed myself of this suggestion with obvious advantage in some cases of ammoniacal urine where there was every disposition to form stone. For this purpose, as a preliminary, the bladder should be washed out with a solution of citric acid in the proportion of ten grains to a pint of tepid water. After this has been done, an ounce of water containing a drachm of malt extract (bynin) is injected into the bladder, and retained there.
The mucous membrane sometimes remains sensitive after the acuter symptoms of inflammation have subsided, when a soothing or anodyne solution will be serviceable. For this purpose a solution of borax in glycerin, with tepid water added, makes a good wash. Sir Henry Thompson's formula is as follows (" Diseases of the Urinary Organs") : Glycerin, two ounces; biborate of soda, one ounce; dis solve, and add two ounces of water; half an ounce of this solution to four ounces of warm water is a suitable proportion. Some of the most troublesome cases of irritable bladder, arising from this cause, yield entirely to the daily use of a solution of bismuth. A table spoonful of the lac bismuthi (Symes SE Co.) to six ounces of warm water represents an appropriate strength. As a local application I , have found this salt as useful in bladder affections as it appears to be in other disorders of the mucous tract, where it acts mechanically in protecting or coating over the irritable membrane. Other cases of this kind yield to irrigation of the bladder with tolerably hot water. We may commence with it at 98° Fahr., and gradually increase the temperature to 115° or 120° Fahr.
In tubercular ulceration of the bladder no application is so useful as a wash of corrosive sublimate; under its use as an antiseptic I have known the bacilli disappear from the urine and the ulcers heal. It must be used in a dilute form; 1 in 20,000 parts is strong enough to begin with. In operations on the interior of the urethra, where a wound is inflicted or the canal is abraded, I generally leave an ounce or two of this solution in the bladder so as to act as a protection to the sore by sterilizing the first portion of urine that is passed, and connect immunity from rigors and fever principally to this practice.
For the same purpose, in tubercular ulceration of the bladder, a solu tion of iodoform in mucilage, in the proportion of five grains to an ounce, is used, and I have frequently seen good from it, but the offen sive smell of the drug is an inconvenience. In free hemorrhage from the bladder, injections of extract of witch hazel and hot water have proved of service, but as a rule the less we interfere instrumentally in these cases the better. To wash out a clot causing irritation to the bladder there are no better means than warm water and Clover's catheter and suction bottle used for withdrawing debris after lithotrity.
When washing out the bladder care should be taken to examine the fluid employed in the process, when expelled, by putting it into a glass receptacle. So long as flakes or masses of mucus and lymph are seen, we have evidence of material existing which can cause and maintain bacterial life. Further, the microscope shows that such products of inflammatory action going on in the bladder are capable of acting as minute foreign bodies, and of furnishing nuclei upon which phosphatic concretion may take place. Especially is this pre caution necessary after a stone has been removed from the bladder.
Catheters employed for these and all purposes should be carefully sterilized, either by dry heat if metal instruments are used, or, if flex ible, by immersing them in solutions of nitrate of silver, bichloride of mercury, or boracic acid. This is a precaution that it is well to take, though, on the other hand, we must all know instances where the indi vidual has practised catheterism for a number of years with no other lubricant than his saliva. In elderly persons, particularly, the first introduction of the catheter should be accompanied by strict antisep tic precautions when this is possible. It is quite possible to under stand how disastrous the sudden invasion of the bladder with bacteria may be.