URETHRAL FEVER.
This is also known as Catheter Fever, and has been already incidentally dealt with in the description of stricture of the urethra, enlarged pros tate, etc.
If the condition he regarded from the pathological point of view its prevention and treatment become a simple problem in rational:thera peutics. It is always caused by septic absorption in a patient whose kidneys are damaged, usually by back pressure, the poison being either conveyed by a catheter which has not been properly sterilised or by a sterilised instrument which has caused some slight abrasion of the urethra, through which some toxic urinary product finds its way into the circula tion. In very neurotic subjects obviously a minute close is sufficient to excite a violent constitutional reaction.
The surgeon should find no difficulty in accepting this view if he reflects upon the smarting pain which invariably accompanies micturition after the passage of even a soft rubber catheter for the first time.
Prevention of catheter fever therefore consists in rigid asepticism and the utmost gentleness in the use of all urethral instruments. When a catheter is used for the first time, the patient should previously he put to bed when this is at all possible, or he should be immediately sent to a warm bed till after the first micturition„ and he should be directed to delay the emptying of the bladder for a reasonable time after the passage of the instrument.
A hot bath before or immediately after the operation may prevent the attack, and at the commencement of treatment for stricture, which is the usual cause of this complication, the previous hot bath serves a double purpose. Where rigors are anticipated an opiate should be given one or two hours previously, and immediately before operating a few drops of weak cocaine solution should be injected down the urethra. Quinine, which is often valuable after the rigor, generally is useless in preventing it, This the writer often demonstrated in a patient who had intermittent fever in his youth, and who had alarming rigors after every time a hougie was passed through his stricture. Soft instruments when possible should
be used, and the most rigid attention to asepsis is imperative. The best lubricant is K.Y. Jelly or the thick Glycerin of Borax of the B.P.
When a catheter or sound is to be passed for a patient who is already passing septic urine, it is necessary when time permits to delay operation till the urine has been rendered aseptic by the administration of Urotro pine, Boracic Acid, Creosote, or other urinary antiseptic.
Once the fever or rigors have appeared after catheterisation the symptomatic indications are clear ; in the cold stage the patient should be enveloped in warm blankets and have hot-water bottles placed at his feet. A full dose (so to 15 grs.) Quinine with 20 min. Laudanum should be administered, or a moderate dose of whiskey made into hot punch may be given. In the sweating stage external warmth may be removed, but the perspiration should not be checked. Urinary antiseptics should be given in full doses for a few times.
When suppression of urine accompanies urethral fever the case should he regarded as serious, and should be treated by a very hot blanket bath (sec p. 91), or the ordinary hot bath, hot poultices to the loins, dry cupping, or a copious warm or hot water enema may be administered, the general treatment of acute Bright's disease being indicated, including Pilocarpine, in severe cases. Those who regard catheter or urethral fever as always of renal origin caution against the administration of opium or alcohol in any form, and rely upon smart Salines, warm fomentations to the kidneys, or hot baths. Normal Saline solution should be injected hypo dermically and the rectum.