Treatment may be summed up as fol lows: Treatment of the uterus and its adnexa and general treatment. Local treatment of cystitis, although easy in light cases, becomes insufficient in pronounced cases. Surgical treatment becomes necessary in cases in which the pain is intense. Cystotomy, particularly colpocystotomy, should be reserved for very serious cases. Very often recov ery or a step toward recovery, by means of local topical treatment, may be ob tained by curetting the bladder through the urethra. This operation is simple and easy; it does not require any com plemental operation, and it gives ex cellent results. M. C. Camero (Gaz. Ileb. de MM. et de Chin, Sept., '97).
The use of the curette advocated in cases of non-tuberculous chronic cystitis that will not yield to ordinary treatment, or even the radical surgical means, such as drainage of the bladder by either the perineal or suprapubic routes. N. W. Soble (Buffalo Med. Jour., May, 1900).
In chronic cystitis in the female subli mate instillations will often produce a. very great improvement in the distress ing symptoms met with in both tubercu lous and non-tuberculous cystitis. In some cases a complete cure may be ob tained when the instillations fail to pro duce the desired effect by curettement of the bladder in both tuberculous and non-tuberculous cystitis; in gonorrhceal cystitis instillations of sublimate are particularly efficacious; under favorable circumstances a radical cure of tubercu lous cystitis may be obtained by curette ment w-hen the vesical lesions are local ized and the kidneys free from the dis ease. When the lesions are extensive, they should be directly treated by suprapubic cystotomy. When cystitis is caused by a prolapsus of the genital or gans, and when hysteropexy, combined with anterior and posterior colporrhaphy does not relieve the bladder symptoms, curettement of the bladder, followed by sublimate instillations, is the proper treatment. C. G. Cumston (N. Y. _Med. Jour., Sept. 22, 1900).
The next step is to remove the cause of the trouble, if discoverable. Strict ures of the urethra must be dilated, for eign bodies must be removed, retention of the urine from enlargement of the prostate or paralysis, etc., must be treated by the regular use of the catheter and then by such operative interference as is deemed best suited to the individual case.
A soft catheter should be used and as often as the viscus will allow without adding to the irritability present,twice or three times in the twenty-four hours not being too frequent.
A large percentage of female patients suffering with subacute vesical symptoms —as painful micturition, bearing-down sensation, and a feeling that the bladder is not emptied after micturition—can be readily relieved by dilatation of the urethra. The greatest amount of prac
tical good that bas been obtained in bladder troubles is by the use of the cystoscopc. J. Baldy (Phila. Poly clinic, No. IS, p. 100, '95).
The ordinary bougie, either metallic or soft, can be rendered sterile by wash ing carefully and drying with a towel or gauze rendered sterile by boiling. The use of antiseptic solutions is unnecessary. ...ks soon as they become scratched or injured, metal bougies should be polished and replated, while soft ones must be thrown away. Metal or Jaques's soft rubber catheters can be rendered posi tively sterile by boiling or washing, and soaking in strong. antiseptic solutions that do not injure them. It is impossible to render gum-elastic or varnished cath eters sterile when, for any reason, they have to be employed. A gum-elastic catheter that is smooth and well finished inside may be rendered reasonably secure by having the patient holcl it for a time under a tap and then lay it aside im mersed in a boric solution, a weak per chloride, or other weak antiseptic solu tion. When the urine is purulent or sep tic, the catheter must be destroyed if rt. is not metal or soft rubber. Where there is not much pus or infection, it can be washed, immersed in antiseptic solutions, and steamed internally. Nicoll (Annals of Surg., June, '99).
The best internal remedies,—i.e., those usually praised—are benzoic acid, about 30 grains a day in divided doses; ben zoate of sodium, 10 grains four times a day; salol, in a similar dosage; and uro tropin, 7 1/2 grains three or four times a day, well diluted with water.
If there is residual urine in the blad der, it is only a question of time as to when that urine will decompose and give rise to cystitis. Women seldom completely empty the bladder while lying. perfectly flat on the back. Hence, when, on account of illness, they are placed on the back sufficiently- long, cystitis may occur. Cases cited in which cystitis supervened after an interval of ten days, and in another as soon as three days after operation. In appropriate cases, the recumbent posture should be changed to the sitting posture when at all possible. To correct the offensive odor, salol and betol are useful. A. dose of 5 grains, three times daily, of betol, will, as a rule, completely correct the odor in twenty-four to thirty-six hours. W. H. Bennett (Clinical Jour., Mar. 27, '95).