§ 232. Cystitis, inflammation of the bladder.

Inflammations of the bladder, are, generally speaking, rare and dangerous. They are generally accompanied with inflammation of the urethra, kidneys, and are sometimes occasioned by stones in the bladder. The pains are seated, continuous, burning, cutting, sticking, and are felt in the region of the bladder and perineum; they frequently extend over the whole abdomen towards the kidneys, frequently striking into the penis accompanied with painful erections, or into the rectum. The pain is aggravated by contact, motion, concussion; every effort to urinate is very painful, although the patient is tormented by a constant desire, with tenesmus of the sphincter vesicae and ani. The urine is discharged in drops; it is thick, dark-red, turbid, frequently mixed with mucus, blood, or pus; in some cases the secretion of urine is totally suppressed. Gradually the bladder swells up into a tight, pear-shaped, extremely painful ball; the introduction of the catheter is either impossible or attended with horrible pain. Alvine evacuations are likewise painful. The fever is generally a synocha, the pulse is tight, full, the skin burning-hot, thirst violent, tongue whitish, afterwards red and dry. Accompanying symptoms are: great restlessness and anguish, prostration of strength, cerebral and typhoid symptoms, singultus, fainting spells, convulsions.

§ 233. Cystitis runs a course of from five to fourteen days. Recovery takes place by means of critical secretions by the skin, critical urine or discharge of blood from the pelvic organs. Death ensues by paralysis. Suppuration and gangrene occur very rarely, and are extremely dangerous.

Exciting causes: cold; diuretics; frequent use of heating drinks; acrid injections in gonorrhoea; mechanical injuries, contusion, pressure, retroversion of the womb.

The prognosis is alway doubtful, particularly when the inflammation is very acute and involves a large portion of the bladder, with complete suppression of urine. It is more favourable when the inflammation was occasioned by a cold or by diuretics.

§ 234. For the synochal fever. Aconite should be exhibited and the treatment should otherwise be conducted with reference to the cause of the disease. If the inflammation should have been caused by can-tharides, frequent small doses of a saturated solution of Camphor have to be administered, after which the remaining symptoms are controlled by other appropriate remedies.

If the inflammation be caused by a retroversion of the womb, this organ has to be replaced before other medicines can be used. If heating spirituous drinks be the cause of the disease, Nux vom. will be found the best remedy. If the disease should have arisen from suppression of the piles, arthritis, etc., the treatment does not require any particular reference to those conditions.

I have cured two cases of cystitis, arising from suppressed gonorrhoea, with Cantharides; the inflammation extended as far as the neck of the bladder, and was accompanied with distressing pain; the urine was discharged drop by drop, mixed with blood, the emission being accompanied with frightful burning; the patient could not find any relief in any situation. In the course of two days, all these dangerous symptoms had disappeared, and the gonorrhoeal discharge was restored. The remaining; pains in the urethra during micturition, the painful drawing in the testes and spermatic cords, the feeling of fulness in the region of the bladder, yielded to Nux vom. Mezereum may likewise prove useful for a similar condition.

Digitalis will be found useful in Ischuria with contractive pain in the bladder, the disease being more spasmodic than inflammatory. Hyoscyam. and Puls., although not adapted to a completely developed cystitis, are likewise deserving of consideration.

In inflammation of the fundus of the bladder, with constant urging to urinate, induced by the slightest accumulation of urine, with pain at every contraction of the bladder, Squilla maritima will prove of great service.

Calc. carb., Sepia, Lycop., Caust., Graph., Kali carb., etc., should not be lost sight of in cystitis.