There seems very little doubt that we have to recognize the existence of two distinct types of cystitis: one associated with acid and the other with alkaline urine. In the latter some of the or ga.nisms capable of decomposing urea and liberating ammonia are present, e.g., the diplococcus ure liquefaciens, the proteus Hauser, the bacillus pyo eyancus, etc., with or without the bacillus coli communis; in the acid forms of cystitis the la.tter organism is alone present. Tbe former type has long been recognized and its characters noted; but practitioners are not so fre quently on the lookout for cystitis with acid urine. Melchior (Centralb. f. d. Krank d. Ham- u. Sexual-organe, May, '97).
In a case of cystitis the symptoms— pain, pus in the urine, and frequency of urination—must be present, and they must emanate from the bladder. They may come from other causes, singly or combined. If singly, the disease is not cystitis; if combined, they may result from two or more diseases. In the be ginning of acute cystitis there is often fever, depression, nausea, loss of appetite, constipation, etc. Mematuria is also often present. In chronic cystitis the urine is generally light in color, alkaline, of a lowered specific gravity, containing a slight amount of albumin, perhaps some blood, and pus in abundance. When allowed. to settle, pus forms a more or less dense deposit on the bottom of the glass, above which there is a cloud of muco-pus. Bladder-epithelium is found, especially in the forms where ulceration is present. In all cases cer tain microbes of suppuration are present. Guiteras (N. Y. Med. Jour., Mar. 19, '9S).
Cystitis papillomatosa occurs in the female as a form of chronic cystitis, and may present the clinical picture either of the catarrhal or of the suppurative form. Its symptoms are frequency of urination, accompanied by more or less pain, and tenesmus, the urine passed be ing clear or turbid. Bleeding does not occur spontaneously, although it may follow instrumentation. Its seat is at the trigone, \Ville11 it usually covers, and it may extend over into the urethra, from which at times it appears to start. Its villi, or papillie, spring from an in flamed base, and are discrete. Frederic BierhofT (Med. News, Alay 26, 1900).
I The greater alkalinity thus resulting reacts upon the pus and converts it into a glairy matter similar to mucus, thus further increasing the difficulties of uri nation. (Tyson.) Diagnosis.—This is usually easy. Yet there sometimes occur mild forms which it is difficult to differentiate from mild degrees of interstitial nephritis, while it not very rarely happens that these two conditions are associated. In contracted
kidney there are sometimes many leuco cytes also. The presence of hyaline casts, even when scanty, points to nephri tis, while hypertrophy of the left ven tricle and increased arterial tension settle the question. Still more emphatic is the diagnosis if there be retinitis albumi nnrica (Tyson). According to the same authority, the question whether there is pyclitis, separate or associated with cystitis, is still more difficult to deter mine. Catheterism of the ureter by the method of Howard A. Kelly, if a possible procedure in the given case, would, of course, clear up all doubt. Tyson places most reliance on the symptom of tender ness in the region of the kidney.
Usually the symptoms of the diseases under discussion leave scarcely any room for doubt; the sense of uneasiness in the neighborhood of the bladder, the fre quent desire to empty the bladder, and junction with microscopical tions, will render the diagnosis certain.
It is very important to ascertain whether the cystitis is idiopathic or the result of disease of the urethra, prostate, etc., and especially whether a foreign body, such as a calculus, is present in the bladder. It is also important to differentiate spasm of the bladder, which is also attended by pain and frequent micturition; but the quality and the daily quantity of the urine passed remain normal.
There is a series of diseases with blad der manifestations in which no patho logical condition exists in the bladder usually diagnosed as cystitis. The blad der symptoms in such are the result of nervous reflexes, principally from an affected posterior urethra, but they may also come from the anterior urethra, from the ureter, and even from the kid ney. The diagnosis is often extremely difficult and depends finally on careful local examination. In cases of false cystitis the symptoms are always ag gravated by intravesical medication. Guepin and Grandcourt (Med. Rec., Sept. 18, '97).
Differential diagnosis between cystitis ancl pyelitis: 1. An alkaline reaction is not found with uncomplicated pyelitis. 2. The limit of albumin in the urine even with severest cystitis is 0.1 per cent. (maximum, 0.15). 3. If nearly all the pus-corpuscles are crenated, the condition is pyelitis. 4. If the red corpuscles pres ent are chemically or morphologically de composed, provided the hiemorrhage is only microscopic and there is no vesical tumor, pyelitis exists. 5. The character istic symptom for diagnosis is the rela tion of the albuinin-content, which is from 2 to 2 'A or even 3 times greater in pyelitis than in cystitis.