TREATMENT OF PYURIA.
Stimson wisely draws attention to the necessity of preventing pyelitis, and this is possible to a considerable extent in those classes which furnish the largest number of cases—the calculous and ascending forms. For prevention of the former the reader is re ferred to the article on stone in the kidney, and I have attempted, both in this section and in that on hematuria, to emphasize the amount of damage surgery can do to the renal functions by rough and inju dicious action in treating diseases of the lower urinary tract. I am convinced that much of the destruction caused by the ascending form of pyelitis might be prevented, for it is not only those patients that die rapidly from renal suppression after instrumental interference, who are the sole victims. Many leave our care with more or less crippled kidneys, and though they are regarded and recorded as cures, yet some intercurrent disease or some subsequent chance con gestion accentuates, or renders irreparable, the renal damage which might in the first instance have been avoided. The subject will be attended to in the various sections on treatment, but, as a general rule, no operation on the lower urinary tract should be undertaken unless the patient has rested for some time previously in bed, or unless the urinary passages have been disinfected as far as possible by the. inter nal exhibition of drugs, such as boric acid and benzoate of soda, saki, naphthol, diuretin or what appers to be its equivalent, sodio-salicyl ate of theobromine, in ten-grain doses every four hours (Stimson).
The treatment of pyuria is so intimately linked with its causation that those forms which are more commonly encountered must be considered separately, and this mainly under the head of Instrumen tal Interference. For there are few cases of confirmed pyuria, if we except tuberculosis, which may not be benefited by surgical aid.
Genes l Treatment.—If the pus appears as the result of a simple catarrh, it will probably subside after rest in bed, and the free exhibi tion of bland diluents, to which some form of alkali is added, hot fo mentations being applied and opium given if necessary. If the pus is small in amount, but constant, and is not developed during some acute infectious fever, it may be subdued by boric acid and sodium ben zoate, this mixture being especially useful when the urine shows phosphatic tendencies. The chronic pyelitis of gouty people is
greatly benefited by a course of Contrexeville or Wildungen water.
Failing this, the balsams in small doses are valuable—santal oil, copaiba oil, and turpentine.
To subdue the pus in ordinary pyelitis, .nitro-muriatic acid and quinine; alum, or tannic acid in two-grain doses, if much mucus is pres ent; iron in large doses ;* acetate of lead, three grains, cautiously in creased, three times a day—are strongly recommended. When poly uria in pyelitis is marked, Morris recommends half-drachm doses of liquid extract of ergot. If the urine is fetid, creasote may be tried (Dickinson). A liberal diet, a change of air, preferably to the sea, when the pus is of pyelitic origin and passed in large quantities, is often of the greatest value.
Acute Primary Pyelitis and Pyelonephritis.—Little can be done by the surgeon in acute forms of primary inflammation of the kidneys and pelvis, for usually the disease is bilateral, and the changes are too extensive and too rapid to be amenable to operation.
Chronic Pyelitis and Pyelonephritis.—When the disease is unilat eral and a fair percentage of urea is found in the urine, demonstrat ing the working power of the other kidney, the surgeon may interfere with a reasonable chance of success. In calculous pyelitis, after medi cal treatment has been fairly tried, no time should be lost in clearing out the pelvis by the lumbar route. Each year adds to the dangers of pronounced calculous pyelitis and to the difficulty of removing the calculus without damage to the future working capacity and stress resistance of the kidney. Moreover Turner's" post-mortem statistics, which represent the condition of calculous kidneys which have run their course, are pregnant with the lesson of early interference. Of forty-three cases of renal calculi described in the post-mortem records of St. George's Hospital for the past twenty-one years, pyonephrosis was present in twelve cases. In nine the ureter was completely blocked, and in eight of these the obstruction was at the renal end. With regard to the condition of the unaffected kidney in those cases in which only one side was calculous, it was granular and cystic in nine, lardaceous in two. There remained only eight cases in which the other kidney was either healthy or hypertrophied.