Lemaistre-Florian claims to have cured chronic cystitis in twenty-one days by means of solutions of sodium chloride 4:1000 and increasing, given three titnes daily for twenty-five minutes. It was formerly the custom. to draw blood locally by means of leeches and wet cups. Barnes, Parrisch, Teale, Gardner, Davidson, and many others have latterly praised rapid urethral dilatation as one of our most important weapons for fighting cystitis.
It is of great importance in the treatment of these cases, not to let the urine remain stagnant in the bladder for any length of time. but to have it emptied regularly and completely, if necessary, with the catheter. Fritch recommended a non-fenestrated rubber tube 6 inches long and .2 inch thick, and disinfected in a 5 per cent. carbolic acid solution. It was to be only introduced until the urine flowed. The bladder was to be washed out through it with a 1 per cent. carbolic solution 3 to 6 times a day. It may remain in situ 3 days, but must then be removed on account of the danger of deposition of urinary salts. Schficking recently applied per manent irrigation of the bladder in 6 cases for 1 to 3 days, using a 10 per cent. solution of sulphate of soda with the addition of 5 per cent. of gly cerine.
General warm baths are very grateful to the patient. As drinks, milk of almonds, Vichy, soda, etc., may be used.
We have already described the treatment for hemorrhages of the bladder. We can recognize with the catheter the presence of a considerable amonnt of coagula, and dilating the urethra, let them out or extract them with forceps, and then washing out the bladder with very dilute liquor ferri sesquichlorati, continue the treatment.
When membranous matter has passed per urethram, the catheter should be employed, and dilatation, if necessary, effected. Then lime water or carbolic solution 1:1000 or salicylic acid solution, or, if there be bleeding, a solution of liquor ferri sesquichlor 1:800 may be used, the membmnes having previously been extracted with the forceps.
In all these cases we shall have to use anodynes occasionally; we had best give hypodermatic injections over the mons veneris. The patient's strength, also, must be sustained by quinine, wine, analeptics, nourish ing, and readily digested food.
We will here describe two conditions which occur as sequellx to the anomalies already described. These are hypertrophy and atrophy of the
female bladder.
Hypertrophy occurs with all the displacements (cystocele, etc.,) when they are of long duration, with new growths both of urethm and of blad der, and with inflammatory processes of the vesical neck. The thickening may affect all the coats, or only the muscularis totally or in part. If only certain portions of the muscularis are hypertrophied, the mucous mem brane may be forced in between the muscle bundles, and, distending the peritoneum, form diverticula of the bladder. This happens, however, much more rarely than in the male.
Most often, however, hypertrophy is caused by some hindrance to the outflow of urine and leads to dilatation of the bladder, which in the female may attain very considerable dimensions. Thus in the case that I have already mentioned, the diameter of the bladder was 10.5 inches; its walls were .6 inch thick. Schatz describes a case in which the organ was over 6 inches in length and breadth.
the bladder is much dilated, we will be able to feel it above the symphysis, even after emptying it with the catheter as a hard tumor. Its boundaries may be determined by percussion, and the sensi tiveness of its walls by the catheter; and the examination of the urine will reveal the composition of its inner surface. We will almost invariably find the hypertrophy to be not simple, but complicated with some other condition.
To cure the malady we must attack its causes. All hindrances to the free evacuation of urine must be removed. If in spite of this, urination is still difficult, the catheter must be regularly used and the expulsive effort saved as much as possible by means of external pressure applied at the time. The use of a good ceinture hypogastrique is of service, as are also cold compresses, the cold douche applied to the lumbar region, cold vaginal injections, cold sitz or sea-baths. Of course any complications which are present, as catarrh, displacement, (cystocele), etc., must be simultaneously treated. The method of vesical irrigation which we have already described, enables us admirably to compensate for irregularities of contraction of the hypertrophied bladder, by means of variations in height of the funnel.