The frequency of catheterisation will depend upon the symptoms and amount of residual urine present; the intervals can be gradually lengthened till a morning and night or 8 hours' rule becomes practicable. A soft rubber instrument of the coude shape is to be preferred when such is passable, and the patient must be thoroughly initiated in the sterilisation of it. The best lubricant for the rubber instrument is K.Y. Jelly, a pro prietary preparation composed of glycerin, pule. tragacanth, gelatin, and an antiseptic, which in addition to its lubricating properties possesses antiseptic virtues, and it tends also to preserve the rubber elasticity intact, whilst oils are liable to cause brittleness. When it is found necessary to tie the catheter in position for any length of time, a rubber instrument when possible should he selected.
Irrigation will he necessary in all cases where the urine is putrid or contains pus and blood-clots. The simplest and most efficient apparatus for this purpose consists of 2 or 3 feet of soft rubber tubing to one end of which a small funnel of glass is attached, while into the other extremity a piece of glass tubing is inserted which fits into the lufnen of the catheter.
After catheterisation and the withdrawal of the bladder contents through the apparatus as the patient lies in the recumbent posture on his back, the funnel is raised and the injecting material—warm saturated Boric Acid solution or Permanganate of Potash (3 grs. tor pint)—is poured into it, and flows into the bladder, which should never be distended beyond moderate dimensions. By depressing the funnel the solution as readily flows out as it flowed in, and the operation should be repeated till the washings show no traces of turbidity or odour. Two, three or more pints may he required for this purpose when the urine is very foul. Many other solutions have been recommended, and the following amount of each drug may he added to 40 oz. water to form a liquid for bladder irrigation: Carbolic Acid, 3 drs.; Nitrate of Silver, 2 grs.; Sulphate of Copper, 3o grs.; Chloride of Zinc, 1. dr.; Perchloride of Mercury, 2 grs.; Resorcin, 4 drs.; Creolin, 4 drs.; Protargol, 2 drs.; Argyrol, 4 drs.; Argentamin, 5-10 mins.; Lysol, 4 drs.
When the bladder has been thoroughly washed out with boric acid or weak permanganate solution, any of the above liquids may be injected in double or treble strength, and the injection permitted to remain for a few minutes. 2-4 oz. of a 2 cent. solution of Nitrate of Silver may be safely used in this way, or a small quantity (3o mins.) of a stronger solution (5 per cent.) may be instilled drop by drop into the neck of the bladder by Guyon's method; 2 oz. of solution of argyrol of the latter strength may be left in the bladder.
Of urinary antiseptics for administration by the mouth Boric Acid is very efficacious in daily doses of 20 grs., but this amount is very liable to produce gastric irritation and skin eruptions if continued for any length of time, and always upsets digestion seriously when the kidneys are diseased. Urotropin in similar dosage (6 grs. ter die) is equally efficacious and less liable to produce irritation even when given more freely. Salol, Benzoate of Soda, I;etol, Aspirin, Alphol, Ilelmitol and many other drugs of the same class act as urinary antiseptics after their elimination by the renal organs. Creosote when given in 2-5 min. doses in capsular form is a
far more reliable urinary antiseptic than is generally appreciated. Any of these drugs or each of them in turn in short courses should be adminis tered when the habitual use of the catheter is necessary, since no patient can be trusted always to have the instrument in a thoroughly aseptic condition; by their judicious administration the washing out of the bladder may frequently be dispensed with. Many vegetable drugs formerly prescribed as bladder sedatives, such as Pareira, Buchu, Uva Ursi, Triticum Repens, Zea Mays, Copaiba, Cubebs, Alchemilla Arvensis, &c., are steadily falling into disuse; those of them that possess any marked action owe their virtues to some antiseptic principle as the arbutin con tained in uva ursi, or the volatile oil in buchu. Ilyoseyamus and Bella donna exercise a sedative influence over the bladder, and either drug may be combined with antiseptics advantageously; but in full doses they are sometimes liable to precipitate an attack of retention of urine. Oil of Sandal Wood is perhaps the most reliable of the entire group; it has both antiseptic and local sedative action, and when combined with Saw Palmetto, as in the proprietary compound known as Sanmetto, most decided benefit is obtained in the treatment of chronic cystitis, and especially of the type accompanying enlarged prostate.
Alkalies (the Liquor Potasse and Bicarbonate) are often valuable, and still are favourite agents when combined with Hyoscyamus, but the strongly alkaline reaction of urine is a barrier to their prolonged use. Chloride of Ammonium in full, and Cantharidin in minute doses, are occa sionally beneficial, and the Acid Phosphate of Sodium in 3o-gr. doses is most valuable where there is excessive alkalinity and much deposition of lime salts. For the relief of urgent pain and tenesmus Opium is often indicated; the best way in which to obtain all the benefits of morphia or opium without any of their drawbacks is to inject into the rectum, with a glycerin syringe, the proper dose of laudanum diluted with 3o mins. of water. In severe and intractable cases it may be necessary to open and drain the diseased bladder from a small median incision in the peri neum, or by continuous irrigation after suprapuhic cystotomy. The diet of the patient suffering from Chronic Cystitis should be carefully regulated to his requirements. As a rule animal food should be sparingly used, and it is a common mistake to prohibit the free use of diluents on account of the frequent call to micturate; this is often accentuated by a concentrated state of the urine, which is removed by copious draughts of barley water or other mucilaginous drink. Alcoholic stimulants should be avoided. Often benefit is obtained by a sojourn at a warm spa where alkaline waters may be freely administered.
Exposure to cold and damp should he avoided; the clothing should be warm and the feet protected by woollen stockings and thick-soled hoots, rubber over-boots being worn during wet weather and in frost. Bodily fatigue, especially such as is induced by long carriage or omnibus drives, is injurious.