Manual of surgery / by Alexis Thomson and Alexander Miles.

  • Thomson, Alexis, 1863-1924
Date:
1904
Catalogue details

Licence: Public Domain Mark

Credit: Manual of surgery / by Alexis Thomson and Alexander Miles. Source: Wellcome Collection.

    615/764 (page 595)
    formly turbid, and remains so after standing; the quantity of pus is scarcely influenced by washing out the bladder, there is more albumin than is accounted for by the pus, and the micro- scope often shows tube casts. Except in acute cystitis, the source of the pus should be determined by cystoscopic ex- amination, and the cause of the cystitis at the same time be cleared up. The prognosis depends chiefly upon whether or not the pre- disposing cause can be got rid of ; if so, then in the majority of cases the infection readily yields to treatment. Treatment.—In addition to the removal of the predisposing cause the objects in treatment are to relieve the congestion and irritability of the bladder, and to render the contents as unfavour- able a soil for the growth of bacteria as possible. In acute cystitis the patient is confined to bed with the lower limbs and pelvis raised, and hot fomentations are applied to the hypogastrium and perineum. Spasm is relieved by hot baths, as hot as can be borne, by full doses of henbane, and by supposi- tories of belladonna and morphin. The urine is rendered bland and non-irritating by abundant diluent drinks, such as milk and hot water, or barley water, and by mineral waters such as those of Wildungen and Contrexéville. If the urine is highly acid and tends to deposit uric acid, the bicarbonates and citrates of soda and potash may be given. The bowels are freely opened, preferably by saline purgatives. When the acute symptoms have subsided, solid food may be allowed in the form of fish, milk-puddings, white meat, and fresh fruit, but the amount of fluids taken must not be diminished. Urotropin (ten grains thrice daily) or salol (five grains every four hours) should be given, especially if there is the slightest tendency to alkaline fermentation of the urine. Boracic acid acts beneficially on the urine, but is liable to derange the stomach. Treatment applied to the inflamed bladder is not called for unless the organ is unable to empty itself completely, or the inflammation persists in spite of the measures above indicated. Drainage of the Bladder.— To keep the bladder empty, continuous suction drainage should be employed after the method devised by C. W. Cathcart. The method is founded on the principle of the Sprengel pump. A full-sized soft rubber catheter is tied in the bladder. The catheter is connected, by means of about two inches of glass tubing, with one end of a flexible rubber tube, the other end of which is attached to the stem of a T-shaped glass tube pinned to the edge of the bed. To each end of the transverse limb of the T-tube a