BACTERILTRTA, CYSTITIS AND PYELITIS To Escherich is due the great merit of having pointed out in ISO4 the frequent occurrence of cystitis in children, especially in girls. The bacterium coil is a frequent cause of vesicle catarrh in adults, but still more so in childhood. liseherieh observed in his Clinic, amongst 60 cases that the bacterium coli alone or in mixed infection was present 5S times, and the confirmation of his observation by nearly all other writers (Finkelstein, Trumpp and others) has led to the establishment and definite recognition of the conception of colicystitis. Next to the bacterium coli, and far less frequently, there are seen as exciting causes of cystitis in childhood, streptococci, staphylococci, gonococci, proteus, bacterium lactis aerogenes, bacillus mesentericus, bacillus pyoeyaneus and the bacilli of diphtheria and tuberculosis.
Different writers have separated the bacteriuria more or less sharply from cystitis, i.e., the inflammatory reaction of the bladder membrane upon the intruded bacteria.
Krogius defines the bacterfuria as characterized on the one hand by the appearance of a very large number of bacteria in the freshly dis charged urine, and on the other by the absence of marked inflammatory symptoms in the mucous membrane of the urinary tracts. He does not include under this affection cases in which the presence of bacteria in the urine is simply a secondary symptom of an infectious ne.phritis or of a general infectious disease (we know, for instance, that the correspond ing bacteria are discharged in the urine in the general infection of typhoid, staphylococci, streptococei and sepsis pyocyaneus). In bacteri uria, the urine looks like a bouillon culture of bacteria. Its smell is vapid, its reaction acid, and the sediment contains nothing but bacteria. There is seldom any increase in the cellular, round cells and bladder epithelium. The only symptoms, therefore, are the peculiarities of the. urine just described, and in a minority of cases, increased micturition or urinary continence. According to Moffitt, who observed ten cases, this affection is frequent. The only reason why it is so rarely diagnosed
is that no direct disorders result from it, and the diagnosis is arrived at only by an examination of the urine. The younger the child the greater the predisposition towards it. A great many of the cases are found in infancy. The exciting cause is generally the bacterium coli (8 out of 10 of Mellin's cases, the other two being due to the staphy lococcus albus).
Other writers take a wider view of the condition, and include under the term bacteriuria cases which show general symptoms: fever, headache, pallor, vomiting and diarrhcea. Escherich is probably cor rect in emphasizing, on the contrary, that these symptoms suggest an inflammatory reaction of the discharging urinary tracts, and that it would therefore be better, under these conditions, t.o speak of them as cystitis or cystopyelitis. The pathogenesis and therapeutics of bacteriuria are exactly the same as in cystitis.
Symptomatology and we are able to dis tinguish two forms of cystitis in infancy. The first is attended by general symptoms, restlessness, fever, pallor, debility, anorexia; but not a single symptom pointing to a disease of the uri»ary tract. On the other hand the second form presents in addition to more or less general symptoms, indications arising from the urinary tract; increased mictu rition, difficulty in passing the urine, colic in the abdtaninal region, tenderness of the bladder to imessure, and inflammatory reaction in the neighborhood of the meatus. While we have to deal with obscure febrile conditions, a uranalysis is absolutely necessary where general symptoms are prominent, and local symptoms are absent, which will be the case in a large proportion of cases, especially during infancy.
In the case of infection resulting from the coli bacilli the freshly discharged urine is turbid, contains acid and albumin, but the quan tity of the albumin never goes above 0.15 per cent. The turbidity is due to the presence of pus corpuscles and bacteria, which are fre quently pure cultures of the bacterium coli tFig. 14).