ON THE TREATMENT OF 
Chronic Catarrh of the Bladder 
/ 'A - AND OF SOME 
Forms of Acute Cystitis. 
BY 
-THEODORE DEECKE, 
Special Pathologist, New York State Lunatic Asylum, Utica, N. K 
Reprinted from the Buffalo Medical and Surgical Journal, February, 18 
BUFFALO: 
Baker, Jones & Co., Printers, 220 Washington Street. 
1879 ON THE TREATMENT OF 
Chronic Catarrh of the Bladder 
AND OF SOME 
Forms of Acute Cystitis. 
BY 
THEODORE DEECKE, 
Special Pathologist, New York State Lunatic Asylum, Utica, N. Y. 
Acute cystitis and chronic catarrh of the bladder or cystorrhoea 
are not to be considered as stages of the same disease. Acute cys- 
titis may develop, when neglected, a chronic catarrh, yet more 
frequently the latter makes its appearance as a characteristic 
chronic affection from the beginning. It is not the aim in the 
following pages to give a history and a description of the diseases 
which have been so well described in all their particulars in the 
"Treatise on the Diseases of the Bladder," by S. D. Gross, 1851, 
and by other authors in this country and abroad. 
As the most important direct cause in the majority, if not in all 
cases of chronic catarrh ol the bladder, we must denominate the 
involuntary retention of urine in the bladder, a condition which 
may be brought about by various local or general disorders. Such 2 
Chronic Catarrh-Deecke. 
are, strictures of the urethra; hypertrophy of the prostate; paraly- 
sis from atrophy, or from morbid affections of the central nervous 
system; foreign bodies, which produce a decomposition of the urine 
in the bladder:-air and germs of microscopic forms of life. 
The chronic catarrah usually developes in a slow, gradual and in- 
sidious manner, and the inflammation which accompanies the same 
is, at least in the beginning, almost always of a very mild grade; 
while in acute cytitis the symptoms of a severe and painful 
local inflammation, in early stages, point toward the site and the 
nature of the affection. In the course of the latter disease, however, 
morbid conditions may develop to some degree similar to those of 
the chronic catarrh, which may require the same interference 
in the way of medical treatment. This, for instance, will be 
the case when, as frequently occurs, for some length of time, 
only an incomplete evacuation of the bladder can be performed. 
The involuntary retention of urine, therefore, and its consequences 
is a feature in both diseases, and this may justify a consideration of 
both from a common point of view. 
It has long been known that in chronic catarrh of the bladder as 
well as in acute cystitis of some standing, the urine which is passed 
is in an altered condition. Aside from being mixed with blood, 
pus or mucus corpuscles and degenerated epithelium cells, it is gen- 
erally more or less alkaline in its character, emits a peculiar am- 
moniacal, often offensive, odor, is rapidly decomposed, inside the 
bladder as well as out of it, and precipitates, either fresh or after a 
short standing, numerous crystals of the triple-phosphates and of 
urate of ammonia. A constant occurrence, furthermore, are 
micrococci or globular masses of bacteria (gliococci, Billroth), to the 
fermentative action of which the rapid decomposition of the urine 
must be ascribed. 
It is evident, and has long.been acknowledged, that the alteration 
and decomposition of the urine inside the bladder in these affec- 
tions, especially its alkaline condition, the crystalline deposits, the 
growth of the bacteria, etc., that they all must act as steadily irritat- 
ing agents upon the already inflamed mucous membrane of the 
organ. An important part of the treatment, therefore, for the 
last ten years has been directed with more or less success against Chronic Catarrh-Deecke. 
3 
these urgent and uncontrollable influences. L. Wilcox* recom- 
mended the use of sulphite of soda. The urine was fetid, alka- 
line, contained pus and was passed every fifteen minutes. After the 
internal use of the remedy the urine became normal and could 
soon be retained for hours. Mineral acids were administered in 
these cases without success. Dubrueilf made injections into the 
bladder of silicate of soda (solution of i per cent.) in a case of 
hypertrophy of the prostate and had good results in preventing a de- 
composition of the urine. Th. ClemensJ injected the urine of healthy 
persons into the bladder of patients suffering from chronic in- 
flammation. He ascribed the good effects of it to the favorable 
influence of a healthy urine upon the walls of the affected organ!!! 
and even he found a successor in H. S. Purdong. Benzoic acid, 
first recommended by Ure, was administered by Robin and Gosse- 
lin ||, especially in cases of highly alkaline reaction of the urine. 
Benzoic acid is in the system transformed into hippuric acid and 
in place of carbonate of ammonia hippurate of ammonia is formed 
in the urine which is claimed to be less poisonous and less apt to 
form concretions than the ammonio-triple phosphates. Internal 
doses and injections of carbolic acid were first administered by 
Declat^f with remarkable effect. Braxton Hicks** recommended in 
acute stages injections of morphine; in later stages, nitrate of 
silver, tannin and chloride of iron. The first who studied the effect 
of salicylic acid, in doses of one to two grammes pro die, in cystitis 
with alkaline fermentation was P. Fiirbringerff. According to his 
experience salicylic acid removes the causes and the products of 
the fermentation, but it does not arrest the formation of pus. Also 
injections of the acid have been tried by him without much suc- 
cess. The newest essay on the treatment of chronic catarrh of the 
bladder has been written by Max SchullerJJ. Even the largest 
doses of salicylic acid had not the desired effect. Schuller puts the 
*The use of sulphite of soda in chronic cystitis. Brit. Med. Jour., Sept. 19, 1868. 
tinjections de silicate de soude dans la vessie contre 1' etat ammoniacal des urines. Gaz. 
des Hopit., 1872, No. 136. 
JUeber Heilung chronischer Blasenkrankheiten mittelst Einspritzungen, etc. Deutsche 
Klinik. 1873 No. 7. 
§Note on the treatment of cystitis, Dublin Jour., October, 1873. 
|| I'raitement de la cystite ammoniacale par 1' acide benzoide. Arch. gen. de Therap ,etc., 1874. 
IL'efficacite des injections d' acide phenique dans la vessie et de '1 administration interne 
du sirup d' acide phenique dans les cas de cystite avec. urines ammoniacales. Comp. rend. 
LXXVIII, No. 4. 1874. 
** 1'he local treatment of cystitis in women. Brit. Med. Jour., 1874, July 11. 
ttBerliner Klinische Wochenschrift 1875, 19. 
t jUeber die Lokalbehandlung des chronischen Blasencatarrhes. Berlin, 1877. 4 
Chronic Catarrh-Deecke. 
most weight on the local treatment, and he distinguishes between 
remedies which prevent a decomposition of the urine and others 
which produce an effect upon the inflamed mucous membrane of 
the bladder. Of the first, carbolic acid had not in all cases the 
desired effect of producing an acid reaction of the urine. It is 
purely an antiseptic and gives good results in solutions of one to 
one and a half per cent in higher stages of alkaline fermentation 
and in diphtheritic affections. Salicylic acid in solutions of 0.3- 
0.5 per cent, locally applied, gave better results than by internal 
administration. It is a good antiseptic and dissolves purulent 
deposits into a liquid emulsion which can be easily removed. It 
prevents an agglutination of the pus-corpuscles and acts favorably 
upon the catarrhal inflammation of the mucous membrane. It is 
less active against the glairy mucoid deposits. Hyper-manganate 
of potassa in solutions of 0.05 to 0.2 per cent is a good antiseptic, 
yet only useful without pain in very weak solutions. There is no 
better medium for the purpose of dissolving the muco-purulent 
deposits than chloride of sodium in solutions of 5 per cent, by 
which a uniform emulsion is produced which can be completely 
evacuated. Nitrate of silver 0.5-1.0 per cent and chloride of 
zinc 1. to 2.0 per cent, are recommended in ulcerative processes of 
the mucosa and copious formations of pus. 
It is about two years ago that my attention was called to the 
almost constant occurrence of micrococci and gliococci in the urine 
of patients who suffered from chronic catarrh of the bladder, or 
from those forms of acute cystitis which were accompanied by an 
excretion of urine of a neutral or alkaline reaction. This occur- 
rence induced me to a series of experiments with different sub. 
stances, prominently acids, for the purpose of studying their 
action upon the development and the growth of those organizations, 
and of exploring their influence upon the alteration of the liquid 
which served as their pabulum. The experiments were first made 
in open test tubes, and were repeated by excluding the air as much 
as possible. The pabulum was normal urine and urine of a patient 
who had been suffering a number of months from a mild chronic 
catarrh of the bladder and who had been treated, as he related, 
for u some form of Bright's disease of the kidneys," the general Chronic Catarrh-Decoke. 
5 
dread of all who experience some chronic disorder in the uropoetic 
system. The tried substances were: silicate of soda; sulphite of 
soda; permanganate of potassa; sulphuric, nitric and muriatic 
acid; acetic, citric and tartaric acid; carbolic acid ; salicylic acid j 
and lactic acid. 
As the experiments were of a decided result in one direction, it 
is of no interest and consequence here to enter in the narration of 
any details combined with them. 
There is among all these substances only one the effect of which 
was found to be far beyond comparison with any of the others, and 
this is lactic acid. An addition ot one per cent of lactic acid pre- 
vents a decomposition and alkaline fermentation of normal urine 
and the development of micrococci and glioeocci for a long period; 
in pathological urine it arrests their growth and multiplication 
almost instantly. It seems to be a specific poison for these micro- 
scopic forms of life. 
As the antiseptic properties of lactic acid have been known for 
years, it is the more surprising that it has not been tried long ago 
in these special cases, since all remedies hitherto recommended, 
according to the experience of the latest expert, Dr. Max Schuller* 
of Greifswald "only met the one or the other demand with the 
desired effect." 
It may be remarked here at once that the antiseptic action of 
lactic acid, by local application, is by far not the only effectual 
property of this drug. Its dissolving power for catarrhal and 
diphtheritic exudations is likewise known, and should not be un- 
dervalued; it is superior to that of any other acid. It further- 
more dissolves easily the ammonium compounds, the ammonio- 
triple-phosphates and the calcium phosphates. And, best of all, 
it permits also of an internal administration in a most agreeable 
form, as a kind of lemonade, or in the form of buttermilk or 
added to it. It will be discovered in the excreted urine, after a few 
good doses, a fact which was established by a number of careful 
analyses of the urine after internal administration of the acid. 
This generally occurs when three or four grammes of the drug 
have been consumed, an effect which will be accelerated by a 
*1. c. page 50. 6 
Chronic Catarrh-Decoke. 
cotemporary use of buttermilk as a beverage. The latter property 
of course makes the remedy the more valuable, especially in all 
acute cases and those of a milder course, or where the condition of 
the patient or other circumstances are not favorable to a local 
treatment. As to the administration of the drug, the acid may be 
given in doses of 1.0 to 1.5 even to 2.0 grammes three times a day 
in sugar and water. Even the large doses administered in a diluted 
form or in a mild bitter tonic, when continued for a longer period, do 
not interfere with the digestion. A hypnotic influence has not been 
observed. For local treatment solution of 0.5 to 1.0 per cent, will 
suffice, and I recommend two injections at one session for the be- 
ginning, with the cotemporary internal use of the acid; and, not to 
repeat the injection sooner than absolutely necessary. In the ma- 
jority of cases, even of long standing, only a few injections will be 
required. 
As to the instruments for injection into the bladder, a simple sil- 
ver catheter is preferred to those with a double tube; for a syringe I 
recommend a fountain syringe or syphon syringe (like the common 
nasal douches) with a rubber tube of about three feet, in length. 
If the catheter is provided with a stop-cock at its base part, or 
with a short rubber tube closed by a clamp, it can be introduced 
tilled with the injecting fluid and the connections can be made 
with the fountain tube in such a manner that all air is excluded 
inside of the apparatus which will be found of great convenience 
to the patient as well as to the attending physician. The manipu- 
lations are simple. The tumbler containing the injecting fluid, the 
temperature of which should be raised to about 100° F., is placed 
on the floor, the tubes are filled with the fluid and the connections 
are made with the catheter in position, which mustbe supported 
by the left hand or by the patient himself. The right hand then 
raises the tumbler from the floor, slowly, to the desired height. 
The bladder fills up by this arrangement without any inconvenience 
to the patient, or any sudden shock, and the pressure from the 
column of the injecting fluid can be entirely controlled and the 
bladder can be expanded ad libitum. 
During about eighteen months twenty-one cases have been 
under treatment, of which a record was made, for the most part Buffalo Medical Association. 
7 
by practical physicians of my acquaintance. Among these there 
is only one case to be mentioned of a chronic catarrh of the blad- 
der from a stricture in which the recovery remained doubtful be- 
cause of an interruption in the treatment. In six acute cases (5 m., 
1 f.) the cystitis had originated from an inflammatory condition 
of the urethra; in only one of these it was found necessary to have 
recourse to a twice repeated injection into the bladder. Five acute 
cases (3 m., 2 f.), developed without any known cause, recovered 
rapidly from an internal use of the acid. One case of a chronic 
catarrh from partial paralysis of the bladder required three double 
injections; one case of hypertrophy of the prostate four injec- 
tions. From eight cases of chronic catarrh of long standing only 
in one the injection was repeated ten times, three recovered from 
the internal use only and the remaining four cases submitted to 
two, to three and four injections. 
In conclusion it might be found of some interest that George 
Johnson (Lancet 2, 1876, page 847) in affections of the bladder 
highly recommends a " milk diet."