Diseases of the urinary and male sexual organs / by William T. Belfield.

  • Belfield, W. T. (William T.)
Date:
[1884], ©1884
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Licence: Public Domain Mark

Credit: Diseases of the urinary and male sexual organs / by William T. Belfield. Source: Wellcome Collection.

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    montlis. Generally speaking the acute justifies a more favorable prognosis than the chronic form ; when it can be traced to pregnancy or exposure to cold, the prognosis is usually good. On the other hand, cystitis, whether acute or chronic, occurring in a patient who has long suffered from prostatic enlargement, m^ethral stricture, vesical calculi, or who is the sub- ject of tuberculosis or myelitis, is unfavorable. Diagnosis.—Acute cystitis can rarely be overlooked or mistaken for other affections; the pain, tenesmus, and features of the urine are pro- nounced and characteristic. Inflammation affecting only the neck of the bladder may be overlooked when it occurs during the course of a gonor- rhoea. Sach oversight may have serious consequences from the neglect of the patient to avoid exposure and exertion ; it is therefore important to remember in treating gonorrhoea, that intense pain localized in the peri- neum and extreme vesical tenesmus indicate an inflammation of the blad- der-neck. Croupous, diphtheritic, or gangrenous cystitis is indicated by the appearance of threads of tissue and by the frightful odor of the urine. The extension of the inflammation to the substance of the bladder- wall (interstitial cystitis) and to the perivesical tissue, may be suspected if a doughy, exquisitely sensitive tumor in the location of the bladder be per- ceived from the rectum or vagina ; also if irregular chills, fever, and ex- treme prostration mark the attack. Possible complication with pyelitis has been discussed in the appropriate chapter. Chronic cystitis may long exist in old men with prostatic difficulties, without giving rise to pronounced subjective symptoms. Its existence ]nay be inferred from the turbidity of the urine. Spasm of th3 bladder without inflammation may cause frequent and painful m^ination ; but the urine exhibits none of the abnormal features found during cystitis, unless the vesical irritability be caused by pyelitis. In this case the urine contains pus and blood, and a careful analysis of the symptoms is often necessary for a differential diagnosis. Long-continued spasmodic contractions of the bladder, produced by irritation of the urethra (stricture of large calibre, contracted meatus), may gradually pro- duce cystitis and hypertrophy, even in children. In recent years several cases have been reported, under the name of hacteruria, in which several of the symptoms of cystitis are present. Uri- nation is frequent and somewhat painful ; the urine is turbid from the presence of bacteria, and emits a most offensive odor. There is, however, no pus nor evidence of catarrh or ammoniacal fermentation ; indeed, the urine preserves for an unusually long time an acid reaction. The affection lasts in intermittent intensity for years. It should be remembered that vesical irritation without inflammation frequently masks various morbid conditions of other organs, the kidneys, uterus, and rectum. Even when accompanied with pus and blood in the urine, the symptoms may be caused by pyelitis without cystitis. Treatment.—Tliis is determined to a great extent by the cause ; and it cannot be too often nor too emphatically maintained that cystitis is a symptom, a result, and not a primary affection. Moreover, if the condi- tions which may produce cystitis be kept in mind in the treatment of uri- nary affections, this complication can often be avoided ; for it is certain that many cases are produced quite unnecessarily by the physician. Aside from the injudicious use of irritating drugs—copaiba in the treatment of gonorrhoea, etc.—cystitis is certainly produced by the use of the catheter. Unnecessary violence in the employment of catheters and sounds is proba- bly responsible for vesical inflammation, though in comparatively rare