Certain conditions exist which present most of the symptoms of cystitis, but no infection; the most difficult of which to diagnose is probably urinary hyper acidity of neuropathic origin, the suc cessful treatment of which depends upon the successful recognition of both its urinary features and its general basis.
Although the diagnosis of' renal in fections can be made with absolute cer tainty only by ureteral catheterization, a probable differentiation between renal and vesical infections can be made by a careful study of the urine alone. Tuber culous infections of the urinary tract frequently occur with no other demon strable tuberculous lesions elsewhere in tile body. Probably a tuberculous gland would be demonstrable post-mor tem in most of these eases. The colon bacillus seems to be the commonest cause of pyelitis, while the bacillus pro teus vulgaris and members of the staphylococcic group are also found less frequently. And finally to be able to thoroughly understand the cases of cystitis, pyelitis, and pyelonephritis brought to our notice, to make the proper diagnosis, to inaugurate and carry out a rational line of treatment, and to give a correct prognosis, a care ful chemical and bacteriological study of the urine is absolutely essential. T. R. Brown (Johns Hopkins Hosp. Reports, vol. x, Nos. I and 2, 1901).
Prognosis.—The prognosis will depend tbe ability of the surgeon to remove the cause and on the duration of the disease. Ordinary acute cystitis, when uncomplicated, is not attended by any °Teat dancrer. Protracted cases of acute vesical catarrh do occur and may run a very chronic course. The chronic form is to be regarded as troublesome and very intractable, rather than dangerous to life. In young and middle-aged. patients, and in those of good constitution, the prog nosis is more hopeful and the treatment is more effectual than in those who are advanced in years or enfeebled by disease.
Treatment.—In the acute form the pa tient should be ordered to bed at once. The diet should be light and unstimulat ing: milk, broths, eggs, etc. Stimulants are to be avoided. The bowels should be regulated by the administration of a saline. In point of fact, all such cases are better for the use of some drug as the citrate of magnesia, epsom salt, Hun yadi water, etc., employed to the point of free purgation. Tyson claims that leeches should be applied to the per ineum more frequently than they are.
If the urine is acid, it should be rendered neutral by alkaline drinks. For this pur pose H. C. Bloom recommends Vichy water containing much soda. In most cases the urine is alkaline, though not as frequently in the acute cases as in those that are chronic. The best remedy for neutralizing an alkaline urine is benzoic acid, either administered in solution well diluted with water, or in capsules con taining 5 grains of the drug, administer ing every three hours until the desired result is obtained. Considerable water should be taken after each capsule. When there is much ammoniacal decomposi tion, salol, in capsules of 5 grains each, given every two hours until the urine is rendered acid,is a valuable remedy. Boric acid, in 10- or 20-grain doses is often efficacious. A weak nitrate-of-silver so lution is recommended by some surgeons.
When the urethro-vesical tract is in such a condition that interference can be tolerated, irrigations with a nitrate of-silver solution, beginning with a strength of 1 to 16,000 and increasing gradually, are effective. This is allowed to flow into the bladder through the anterior urethra by the force of gravity from a fountain-syringe, the height of the receptacle being sufficient to pro duce enough pressure to overcome the resistance of the cut-off muscle. So soon as the patient feels the tension of the fluid in the bladder the flow is dis continued and the patient is directed to stand and empty the viscus. These irri gations may be given every day, or every second day, as the patient's symp toms may indicate. Ramon Guit6ras (.N. Y. Med. Jour., Mar. 19, '98).
In cystitis the first and main indica tion for treatment must be to render the urine antiseptic. Urotropin is a non toxic and non-irritating derivative of formic aldehyde. In cases of cystitis and of phosphaturia its action has per sonally been almost specific. In some cases it causes a slight burning sensa tion in the bladder if large doses are taken, but no patient to whom it has been personally given has ever com plained of this. In prescribing urotropin the reaction of the urine should first be discovered. If it is very acid a little citrate or acetate of potassium, or if it is very alkaline a little dilute mineral acid should be given in addition to the drug. T. G. Kelly (Therap., Oct. 15,'98).