An acute cystitis may persist for from two to three weeks. Such is its usual course, but under unfavorable conditions it may persist much longer or even progress to a chronic cystitis which may continue for months or years.
Stone in the bladder, stone in the kidneys, foreign bodies in the bladder, give rise to chronic forms of cystitis, in which the symp toms just enumerated may be added to by the presence of blood in the urine; pus, shreds of mucus and other forms of bladder detritus are to be expected.
There is a type of true cystitis — an inter stitial parenchymatous inflammation of the bladder wall — which is more severe than the catarrhal variety of cystitis just described. It often results in localized abscess formation of this structure.
The treatment of cystitis requires very skilled advice and careful technique. Ex tension of the infection —usually gonorrheal to the kidney results in serious kidney disease — pus kidney. All operative procedures principally catheterization (prostatic disease in older men being one of the chief disturbing necessities)— should be done with the strictest aseptic precautions. All catheters should be cleansed, boiled and used before being soiled by any contacts. Rest in bed, a quieting sup
pository and irrigation are the chief means at hand for the actual treatment Hip baths, hot applications are grateful, increased water drink ing tends to make the urine less irritating. Citrates, as in fruit juices or chemical com pounds, are advisable. The diet should be regulated. In the mild cases irrigation may not be needed, but in persistent pus states and foul urine, irrigation is desirable. The use of special drugs may be indicated by the trained physician.
Stone in the bladder is a particularly import ant affection of this viscus. These stones may be composed of uric acid, oxalate of lime or of phosphates. The symptoms are pain, fre quency of micturition, bleeding. The pain is apt to be colicky in nature, severe at the end of urination and referred down the penis or to the perineum or rectum. The bleeding is apt to be intermittent and often appears after much jolting. It may be a thin, blood-colored urine, or drops of clear blood may be expelled at the close of micturition. The treatment is by crushing by appropriate instruments. The X-ray is of considerable value in the diagnosis.