The value of urotropin depends more on whether (1) the cystitis, as a primary bacterial invasion, develops in a healthy urinary tract, in which condition 40 per cent. were personally cured, and 60 per cent. improved, or (2) whether it asso ciates itself with a pre-existing disease of the tract, as stricture, hypertrophied prostate, tumor, paresis, nephrolithiasis, tuberculosis, gonorrhcea, etc. In these cases urotropin alone is useless, yet com bined with local treatment, while there is little hope of cure, there may be much alleviation of the symptoms (in 49 cases, 4 cured and 30 improved). If (3) the cystitis is secondary to an infection of the urine, urotropin, like santal and salol, is utterly useless (10 eases, 10 fail ures). B. Goldberg (Centralb. f. innere Med., July 14, 1900).
In cases where the inflammation is too acute to tolerate irrigations, instillations of nitrate of silver are of great value. They should be given with the tiltzmann or the Otis syringe, beg,inning with a strength of a grain to the ounce and increasing the strength to ten grains if necessary. From 5 to 20 drops of such a solution may be employed at one time.
Girl of 19, under treatment for gonor rhcea which had distinctly involved the uterine mucous membrane, began to complain of pain during micturition. On examining the urine gonococci were detected in pure culture. Through the cystoscope the vesical mucosa appeared very vascular, with superficial loss of substance at certain points. The cystitis was cured by washing out the bladder with warm boric lotion and injection of a 1-per-cent. solution of nitrate of silver. Lindholm (Cent. f. Gyn., No. 21, '97).
Pyoktanin can be applied to the most delicate mucous membrane, not only in concentrated solution, but in powdered form with but slight, if any, irritation. It retards the development of pus even in solutions of 1 to 2000. When applied to inflamed mucous membrane, it stains it intensely blue; this color remains for a number of days. It is active as an antiseptic as long as any color remains. In treatment of inflammation of the bladder and urethra injections of pyok tanin solutions into the bladder produced the happiest results in four cases. R. E. Graham (N. Y. Afed. Jour., vol. lxvii, p. SSO).
Irrigations and injections of perman ganate of potash in 1/„- to 1/4-per-cent. solution is a most excellent remedy. In employing vesical irrigation it is impor tant to observe the strictest attention to the cleanliness of all instruments used.
Large injections should not be used. Better an ounce or so at a time fre quently repeated, until the washings come away perfectly clear. The temper ature of the solution should be about 100° to 105° F. When there are local causes for reflex irritability, as hmmor rhoids, varicocele, phimosis, adherent prepuce, or a narrow meatus, appropriate surgical treatment should be resorted to. Urethral causes of irritability of the bladder or of partial retention of the urine, such as stricture of either large or small calibre should be promptly at tended to. (White and Martin.) In chronic cystitis, whatever be its origin, the treatment of the inflamma tion of the bladder should be by both local and internal medication until it is in a condition that will permit of more radical measures.
Operative interference is indicated when the symptoms of pain and fre quency are very severe, and when no itnprovement has resulted from general and local treatment: distinctly, there fore, a more serious group of cases. Curetting the bladder, through the peri neum in the male and through the urethra in the female, followed by thor ough drainage, has yielded the best re-' sults. The perincal route is preferred, because it is easier, because it gives readier access to the usual situation of tubercle in the bladder, and because the drainage it affords is the best. The only advantage of the suprapubic method is that of allowing one to see the seat and extent of the lesion. Ba.nzet (Ann. d. Mal. d. Org. Genito-Urin., June, '97).
In women the lesions of cystitis are, in reality, more frequently localized around the neck of the uterus and of the trigonum, and for a long time they are rather superficial. It is only in ex treme cases that the condition of inter stitial cystitis, which seems to be be yond therapeutic resources, becomes established. .In such cases amelioration is very distinct after vesical curetting. The operation is very simple and pre ceded by thorough lavage of the blad der. For this a solution of boric acid is used to which 1 per cent. of a solu tion of corrosive sublimate of the strength of 1 to 1000 without alcohol is added.
According to Guyon, this intervention does not completely cure the cystitis, but it renders the disease more amenable to other methods of topical treatment which before could not be tolerated.