The general treatment is of great importance in all cases of pros tatic hypertrophy. Temperate habits and dietetic abstemiousness are essential. If the gouty or rheumatic diathesis exists the usual preparations of colchicum, lithia, and the salicylates are indicated. Alkaline diluents, mineral waters, or pure distilled water in largo quantities are of service in rendering the urine bland and unirritating. Certain remedies have an excellent effect in preventing or correcting decomposition of the urine, by their inhibiting or destructive effect upon the bacteria which bear so important a relation to the chronic cystitis present in advanced cases of prostatic hypertrophy. The best remedy the author has tried is the oil of eucalyptus in doses of ten minims, four times daily, preferably after meals and at bed-time. Salol and boric acid have been disappointing. Benzoate of soda, naphthol, guaiacol, and small closes of carbolic acid are sometimes beneficial. The remedies previously mentioned as having a special effect upon the vesical mucous membrane are especially indicated where cystitis exists.
Exercise in moderation is to be recommended. Horseback rid ing, bicycling, and all exercises involving jolting movements of the body or pressure on the perineum should be avoided, especially if a complicating calculus exists. Exposure, particularly such as in volves chilling or wetting of the feet and legs, is apt to bring on acute retention of urine. Warm underclothing and protection from expo sure to the weather should therefore be insisted upon.
In advanced cases it is to be remembered that the principal source of discomfort consists in the presence of decomposing residual urine in the bas fond. The resulting frequency of urination necessarily enhances the irritation and inflammation of the parts about the neck of the bladder. The first indication, therefore, is to prevent the re tention and decomposition of residual urine. Inasmuch as the patient finds it impossible to empty his bladder, it is necessary to supplement the normal function of micturition by complete evacua tion of the viscus by means of the. catheter. In the incipiency of the disease a single complete evacuation of the bladder daily is often sufficient to prevent serious discomfort from the hypertrophy for an indefinite time. When the patient can afford the necessary time and expense it is best that this be done by the physician.
When it is practicable for the patient to evacuate his own bladder with the catheter, a suitable instrument should be selected for him. The only instrument with which the average patient should be en trusted is some one of the many forms of soft catheters. The best of these is the Jacques catheter, a soft and perfectly flexible rubber affair, with. which the patient cannot possibly do himself injury.
In some instances this catheter is rather too flexible and it is nec essary to substitute some other variety. There is a form which is of a rather more substantial consistency known as the silk catheter, and another equally serviceable, the foundation of which is Belfast linen. The writer much prefers these to any other, and they are usually perfectly safe to entrust to the patient. When there is pro nounced obstruction at the neck of the bladder, such as would arise from the existence of marked median hypertrophy or a bar, cier's catheter coticle, which is also a soft instrument, but which has its end permanently bent at a slight angle or elbow, will be found more serviceable than the ordinary flexible varieties. The elbow at the end of the instrument serves to direct the point up over any barrier which may obstruct its passage into the bladder. In some instances the ordinary old style English catheter with the stylet will be found most useful to the surgeon, if certain little details in its manipulations are observed. Care should be taken to keep the catheters scrupu lously clean; they should be washed out with a five-per-cent solution of carbolic acid each time they are used, and when introduced should be smeared with bichloride of mercury and vaseline, 1 in 2,000, a little cocaine being added to the ointment if the urethra and neck of the bladder be intolerant of instruments. In advanced cases it is desirable that the bladder be evacuated three or four times in the course of the twenty-four hours. In some instances it is best for the patient to depend entirely upon the catheter for the evacuation of the urine. The bladder should be washed out daily, and in severe cases several times daily, with a warm antiseptic solution; bichloride of mercury, 1 in 20,000, carbolic acid in half-per-cent solution, and a saturated solution of boracic acid are all useful for this purpose.
The following combination is of service : The irrigating lotion should be moderately warm, or, if it seems desirable, as hot as can be borne. There is no better apparatus for irrigation than an ordinary fountain syringe with or without a soft catheter. The fluid should be allowed to enter the bladder in a small quantity at a time, for if the inflamed bladder be distended greatly an increase of irritation will result, and perhaps pain will be pro duced by the operation. After each irrigation it is advisable to leave about two ounces of fluid in the bladder. When cystitis is severe the daily prolonged use of the hot sitz-bath, preferably on retiring for the night, is of service. Further expatiation upon the treatment of complicating cystitis is hardly necessary, as it has received full consideration in the chapter on diseases of the bladder.