Acute Cystitis.

Definition.—An acute inflammation of the mucous membrane of the bladder.

Etiology.—The causes producing cystitis are numerous, and may be mentioned in the following order:

Catarrhal.—All mucous membranes are exceedingly sensitive to impressions, and that lining the bladder is no exception; thus we find that atmospheric changes, whereby a wide range of temperature occurs within a few hours, or sudden cooling after severe exertion, often gives rise to a catarrhal inflammation of the lining of the bladder. Extreme distention of the bladder may give rise to cystitis, even though there be no change in the quality of the secretion; and where decomposition has taken place from long retention, the irritation is greatly increased. The teasing effect of an enlarged prostate gland, a cystocele or urethral stricture, may be the exciting cause.

Septic.—Under this head will come the irritating action of septic matter introduced by unclean catheters, sounds, irrigators, etc.. The cystitis found in puerperal women and gonorrheal patients are of this class, as well as those suffering from stricture and enlarged prostates, who are compelled to resort to the catheter.

The cystitis that occasionally accompanies the infectious fevers is also to be included in the septic class. Especially, diphtheria, typhoid fever, scarlet fever, and tuberculosis.

Drugs.—The ingestion of certain drugs, by their toxic effect, not infrequently causes cystitis. The most common are cantharides, turpentine, copaiba, cubebs, mustard, and methylene blue. Workers in dye-houses are subject to cystitis, the result of the irritating dyestuffs used.

Traumatic.—The traumatism induced by the rough or un-skillful use of instruments used in breaking up a stricture or sounding the bladder, may give rise to cystitis; also the presence of a calculus or foreign body in the bladder, or the pressure of the fetal head during a prolonged and difficult labor, or a mass of impacted or hardened fecal matter may be sufficient to produce like results.

Extension from Neighboring Parts.—We have already seen. that the bladder is frequently involved in nephritis, ureteritis, or urethritis. The same results may follow disease of the ovaries and tubes, or of the vagina and rectum. Tumors and abscesses of the pelvic tissue are apt to be attended by cystitis.

Pathology.—The anatomical changes are similar to those of any other mucous surface; viz., intense hyperemia, the membrane being smooth, red, and edematous, and covered with a mucopurulent secretion. There will be patches where the epithelium is denuded, the edges being shaggy from the hanging shreds of epithelium. Where the inflammation is intense, the submucous tissues become involved, and not infrequently ulcerated patches are to be seen. Hemorrhagic effusions may occur about the denuded patches.

As a result of the more malignant forms of scarlet fever, diphtheria and kindred infectious diseases, a diphtheritic ulceration occurs, with necrosis of the entire, bladder wall. The urine may be acid in reaction, though usually alkaline, and contains pus, blood, and epithelial cells, all of which decompose rapidly.

Symptoms.—"Acute cystitis commences with pain in the hypogastric region, of a subacute character, with soreness on pressure. There is a frequent desire to urinate, and these calls are attended with an aggravation of the suffering. From the sympathy existing between the bladder and the kidneys, the urinary secretion becomes scanty and high-colored, and its increased acidity gives rise to a painful burning and scalding sensation when it is passed. When the disease has attained its greatest intensity, there is an almost constant desire to micturate, with an intense tenesmus, so that the patient is sometimes obliged to take hold of something with his hands when passing water, and will frequently bite his lips to keep from crying out with the severe suffering.

"With the commencement of the pain the patient is usually-seized with a chill or well-marked rigor, which is followed by febrile action, generally of a remittent character, and not very severe. The disease runs a course of from six to twelve days, and terminates in resolution, or in the chronic form; or, in some rare cases, extending to the peritoneum and adjacent fascia, gives rise to the formation of a pelvic abscess."

Diagnosis.—"Acute cystitis is readily determined by the seat of the pain, and by its aggravation during micturition; the change in the character of the urine and its difficult passage, with tenesmus, is additional evidence." In nephritis there are tube-casts, and the quantity of albumin is much larger.

Prognosis.—Simple, uncomplicated cystitis terminates favorably in from five to ten days without any structural change. Where the inflammation extends to the kidney, the outlook is more grave, and should septic processes be set up, with ulceration of the membrane, diphtheritic in character, the disease may prove fatal.

Treatment.—Gelsemium in full doses, combined with the appropriate sedative, gives good results, and may be the only agents required. We add thirty to sixty drops to a half glass of water, and give a teaspoonful every hour. Where there is smarting and burning in voiding urine, apis and rhus tox. will replace the gelsemium, thus:

Sig. Teaspoonful every hour.

Where there is great tenesmus, cantharides, five to ten drops in a half glass of water, given every hour, will often bring prompt relief. Eryngium is a useful agent where the desire to urinate is almost constant and the water is highly colored or bloody. When these specifics fail to give the desired results, we will usually get relief from an infusion of triticum repens given freely, or an infusion of marshmallows, epigea repens, polytrichum, or eupatorium.

In this day of small doses and pleasant medication, we have failed to make use of the infusions many times at: the expense of pain and much suffering to our patients. Their efficacy may be increased by adding to the infusion small doses of the acetate or citrate of potassium or the benzoate of sodium.

When there is evidence of sepsis, echinacea, baptisia, the sulphites, chlorates, or mineral acids will be the better remedies. In the way of local treatment, the hot sitz-bath will be found to give better results than hot packs. The use of opium suppositories acts kindly, and, should other means fail, should be used. Where the suffering is intense and the tenesmus almost constant, a hypodermic of morphia, should be used.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.