In chronic cases of Bacillus cull pyelitis or cystitis resort should he had to Vaccine treatment; an autogenous culture should be made, and 200,000,000 of the killed organisms should be deeply injected into the buttock at least once a week. The Anti-Bacillus Coli Serum (20 c.c.) may be injected in acute cases till a culture is made ready from the bacilli obtained from the urine, and some surgeons combine the serum and vaccine treatments in the same patient.
Kretschmer and Gaarde employ Lavage of the pelvis of the kidney through a ureteral catheter used through a cystoscopc, by a i per cent. Nitrate of Silver Solution, using 5-7 c.c.; at the same time alternating the reaction of the urine by the administration of Alkalies and Acid Sodium Phosphate combined with Urotropine, an autogenous vaccine being also injected.
Typhoid Fever Pyelitis must be treated on the above lines, and usually yields to full doses of Urotropine, which cause the typhoid bacillus to disappear from the urine.
The simple inflammation of the renal pelvis which follows the adminis tration of such drugs as cantharides, copaiba, turpentine, etc., as a rule rapidly subsides on the suspension of the irritating diuretic and the free use of weak alkaline and demulcent draughts.
All chronic cases of pyelitis not yielding to the above internal antiseptic treatment fall into the operative group. Some surgeons, however, before resorting to nephrotomy or nephrectomy wash out the renal pelvis through the ureter by a catheter passed through the bladder, and then inject weak Perchluride of Mercury or Nitrate of Silver solution.
The class of case requiring operation is usually one which, beginning in an infective cystitis, invades the renal pelvis and finally ends in a pyelo nephritis on one side. This is often described as an Ascending Suppurative Nephritis or case of Surgical Kidney. Calculous Pyelitis, which is dealt with under Stone in the Kidney, and the so-called Strumous Pyelitis, which is a chronic tuberculous condition of the kidney, Pyonephrosis and Ilydronephrosis also belong to the same category.
The surgeon, after satisfying himself by ureteral catheterisation, phlnridzin administration, freezing of the blood, or by Wright's method, that the integrity of the opposite organ is safe, proceeds to perform nephrotomy by making an incision in the lumbar region, exposing the diseased organ, which is then freely incised and explored and any calculi present removed; it is then flushed out with warm saline solution, the wound in the kidney closed, and thorough drainage established.
Nephrectomy or entire removal of the diseased kidney is decided upon in acute cases where the organ is hopelessly invaded; the operation usually is a sequel to the preliminary nephrotomy made through the loin incision, and affords in many cases of acute infective pyelonephritis the only hope of saving life.