BLADDER, Inflammation of.
Of the causes of acute cystitis one of the most common is the extension backwards of a gonorrhoeal urethritis. The best treatment will consist in absolute rest in bed with the free use of the hot Sitz bath (temp.roe) at short intervals, and a 2-gr. Morphia suppository containing r gr. Extract of Belladonna. If the pain and straining resist these measures, 1-s gr. Eucaine Hydrochloride in 3o-6o mins. of water may be injected through a soft instrument passed gently down the urethra. A large linseed poul tice to the lower part of the abdomen often gives relief. All injections for the cure of the gonorrhoeal urethritis should be stopped till the strang,ury and tenesmus are relieved. A milk diet with the free use of barley water or linseed infusion and the avoidance of alcohol, coffee and tea should be ordered. A mixture containing Hyoscyamus,, Bicarbonate of Potassium, or the Liquor Potassse with a small amount of Opium can advantageously be given in the linseed infusion. After the subsidence of the acute symptoms, urethral injections of a weak warmed solution of Permanganate of Potassium may be commenced, and continued every hour or two, gradually increasing the strength of the solution till r gr. per oz. is reached. Oil of Sandal Wood in capsules (so mins.) is very efficacious. Where the attack of acute cystitis follows the use of a catheter, lithotrite or other instrument, the treatment is essentially the same.
Gout sometimes declares its presence by a severe attack on the mucous membrane of the bladder, when a smart saline purge followed by Colchi cum and Alkalies should be administered.
Cantharidin applied to any part of the cutaneous surface in the form of a large blister may be absorbed and cause severe cystitis with strangury. The treatment in such cases consists of the use of the hot Sitz bath with large drinks of barley water or other diluents and Morphia by the rectum after the removal of the blister and the letting out of any bullT. Saline
purgatives are indicated in all cases.
Bacilluria is the name given to the condition in which micro-organisms are found in the urine, and their presence sometimes excites acute in 6 flammation of the bladder, even when they have been absorbed from some distant site and eliminated by the kidney, as in typhoid fever and in Bacillus coli infection. The treatment of acute cystitis of this type consists of urinary antiseptics like Urotropin (5-so grs. ter die). In B. cell cystitis the acid reaction of the urine must be changed to alkaline by large doses of Bicarbonate or Citrate of Potash, after which antiseptics should be given.
Stapky/ococcic cystitis is often of the acute type supervening upon retention of the urine from obstructed flow in prostatic enlargement, calculi, stricture and spinal disease. Streptococcic cystitis is still more common, being usually the result of infection by soiled catheters and other instruments, or the organisms may reach the bladder from foci of septic inflammation in the female pelvic organs and from perinea] wounds. In many instances the infection will be found to be a mixed one. The treatment in these cases will consist of urinary antiseptics by the mouth till the violence of the acute inflammation has been somewhat abated, after which the bladder is to be thoroughly washed out or irrigated by Boric Acid or Permanganate of Potassium solution; it is not safe practice to resort to the passage of instruments and irrigation in the presence of a very acute inflammation of the bladder.
In the acute septic cystitis following bladder injuries as well as in the most severe types of acute inflammation just mentioned it may sometimes be necessary to drain temporarily the bladder through the perineum or to continuously irrigate it by Cathcart's apparatus after a suprapubic cystotomy has been performed.