Urinary Diseases



179.- Cystitis-Inflammation of the Bladder.

(a) ACUTE CYSTITIS is a disease of rare occurrence, except when arising from Gonorrhoea, wounds, Calculi, the introduction of instruments, or other mechanical causes. Occasionally cold or damp may conduce to it.

SYMPTOMS.- There is usually pain, sense of weight, tenderness on pressure, and extreme irritability in the region of the bladder, with rigors, and often alarming constitutional disturbance. The urine is ejected by a sort of spasmodic action as soon as it collects, with straining, and, generally, much suffering; and there may be discharge of mucus or pus, tinged with blood.

(b) CHRONIC CYSTITIS is more common; it may be the sequel to an acute attack; or it may be caused by Calculi, disease of the prostate gland, Stricture, etc.; often by infection after passing of a catheter. The decomposing urine then becomes a source of irritation to the mucous lining of the bladder; the urea is soon decomposed into carbonate of ammonia, and this salt is acrid and irritating, and the bladder in time acquires a condition which has been aptly compared to that of a badly-washed utensil. The symptoms are the same as described under the acute form, though to a modified extent; but while the pain is less, the discharge generally greater. The mucus is often very abundant, a pint or more being often passed in the day, and it becomes very tenacious on standing, so that when a vessel containing the urine of such a patient is emptied, an abundance of ropy mucus follows the urine in a mass.

Cystitis may thus be diagnosed from Inflammation of the kidneys; in the former the pain travels upwards, towards the loins; while in the latter the pain extends from the loins down to the bladder.

TREATMENT.- The treatment of Cystitis must be regulated by its causes and associations. When simple, and resulting from cold, Aconite in alternation with Cantharis; if from exposure to damp, Dulcamara; if there be much nervous irritability, Belladonna For the chronic form of the disease, Cantharis, Cann.-Sat., Apis., Eup.- Pur., Kali Hyd., Pulsatilla, and Chim., are the best remedies. The last remedy is likely to be specially valuable.

ACCESSORY MEASURES.- For the relief of pain, hot fomentations; and in acute cases, rest in the horizontal posture. The warm hip- bath; the abdominal compress; and mucilaginous drinks, favour recovery. Washing out the bladder is often useful; but only small quantities of tepid water-one to two ounces-should be introduced at a time; a little boric acid should be added to the water; as far as possible; too, the water should be introduced slowly.

180.- Calculus-Stone-Gravel.

A urinary calculus or stone, consists of solid urinary constituents held together by an organic basis or network of an albuminous nature possibly derived from cells shed as a result of catarrhal processes. Stones are frequently multiple and may attain a large size.

Certain individuals pass little gritty cayenne-pepper-like particles, popularly known as sand, or gravel. When these particles become aggregated they from a stone whose size may vary from that of a hemp-seed to that of a pigeon egg or larger.

Stone is more frequent in certain families, and it is much more common in some countries, particularly Hungary, India, and China, than in others. In this country it is most prevalent in Norfolk, and is met with chiefly in boys under ten, and in adults after middle life. It occurs with almost equal frequency in the two sexes.

A urinary calculus may originate in the kidney (renal calculus), and if of small size pass thence down the ureter into the bladder, and be voided from there with the urine during the act of micturition. Or a renal calculus may remain in the kidney until by constant accretion it attain a size too considerable to permit of its passage down the ureter. Again, a renal calculus may pass into the bladder and there by accretion reach considerable dimensions. Lastly, stones may originate in the bladder itself.

STONE IN THE KIDNEY.- In the absence of bacterial infection a stone may lie in the kidney for years without giving rise to symptoms-latent stone. It may be said that it is a rule the larger the stone, the fewer the symptoms. As a rule, however, the patient complaints of dull aching and weight in the loin, or of recurrent attacks of colic, or of blood in the urine (haematuria).

Renal colic is characterized by agonizing pain shooting from the loin to the bladder, testicle, or thigh; nausea and vomiting, shivering and collapse, with cold perspiration. There may be frequent desire to urinate with the passage of a little blood- stained urine. The muscles of the belly-wall on the affected side are more or less rigid. The colic may recur at intervals till the stone is passed, or after one or two attacks may disappear altogether, the stone settling down in the kidney. The patient may complain of a persistent boring pain or feeling of weight in the loin, excited or aggravated by exertion, jolting, local pressure, or errors of diet.

STONE IN THE BLADDER.- The great majority of calculi found in the bladder have descended from the kidney, and after entering the bladder have increased in size. The minority take origin in the bladder. Men suffer from stone in the bladder much more frequently than women. This comparative immunity of women depends partly on the fact that the female urethra permits small calculi which have passed down from the kidney to escape, and partly on their exemption from those forms of chronic cystitis attended with stagnation of urine which lead to the formation of secondary stone.

STONE IN BOYS.- Sometimes stone forms in the bladder of boys, the symptoms being frequent micturition, even to incontinence, severe pain in passing water, occasional sudden stoppage of the urine, with accession of pain at the end of the penis, sometimes discharge of blood, muco-pus in the urine, and constant pulling at the foreskin, which becomes elongated.

SYMPTOMS OF STONE IN THE BLADDER.- There are four leading symptoms that are very suggestive (1) Increased frequency of passing water, chiefly during the day, and when moving about, and less so that night when at rest. Riding on horseback, for example, greatly increase the frequency. (2) Pain in the glans penis during and immediately after micturition, and a continuous desire to pass water for a few minutes, until fresh urine trickles down and separates the stone from the lining of the neck of the bladder, which is a highly sensitive part. As soon as sufficient urine collects relief is experienced. Pain low down in the abdomen may be due to chronic inflammation of the bladder. Pain before urinating is generally caused by a sensitive or inflamed mucous membrane. (3) The urine may contain muco-pus. This is due to the accompanying cystitis. (4) Blood may be passed from the to time in slight quantities at the end of micturition.

All symptoms are aggravated by movement and, therefore, worse by day than night, and so long as the bladder is not inflamed, are relieved by rest in bed. There may be sudden cessation of micturition or actual retention of urine from impaction of the stone at the orifice of the bladder.

Sooner or latter the symptoms of cystitis are added to those of stone. The urine undergoes alkaline decomposition and the stone increases in size by the deposition of phosphates. The symptoms are no longer so markedly relieved by rest, and the patient suffers by night as well as by day. In the final stages the health is further undermined by the ascent of the inflammation to the kidneys.

FURTHER EVIDENCE.- The four symptoms above enumerated, occurring simultaneously, point to stone in the bladder. But if additional evidence be desired, there are the microscopical and chemical tests of the urine, involving the application of various chemical reagents, the X-rays, the sound, and the cystoscope. The latter is an instrument by means of which every portion of the bladder can be explored by the eye of the surgeon.

Calculi in the kidneys, ureters, and bladder are, moreover, often distinguishable by means of the X-rays.

TREATMENT OF THE DIATHESIS.- Patients having a predisposition to the formation of Stone, especially if they have passed Calculi with their urine, require medical treatment and careful supervision to correct the tendency; for although useless to remove a Stone of size, remedies and in the expulsion of sand or gravel, and also correct the tendency to such formations. Under our treatment many patients who formerly passed small Calculi have entirely ceased to do so.

First and foremost, all avoidable causes must be removed-high living, the use of alcoholic liquors, and insufficient exercise, on the one hand; and overwork, anxiety, and excesses of all kinds, on other. Dyspeptic symptoms should be met by such means as are pointed out in the Section on Dyspepsia; and any other concurrent disorders should be corrected. Removal to a locality where pure soft water can be procured is often alone curative.

Edward Harris Ruddock
Ruddock, E. H. (Edward Harris), 1822-1875. M.D.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.

Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."