Identifier: gynecologygrav (find matches)
Title: Gynecology :
Year: 1918 (1910s)
Authors: Graves, William Phillips, 1870-1933
Subjects: Gynecology Genital Diseases, Female Women Gynecology
Publisher: Philadelphia : Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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one, as the clinical picture isvery characteristic, consisting of severe pain and frequent necessity of micturi-tion, with distressing tenesmus, a sense of fulness and pressure in the pelvis,tenderness of the bladder region, rise of temperature, and presence of pus in theurine which is usually neutral or alkaline.- A very similar picture is presentedin acute gonorrheal urethritis which can, as a rule, be differentiated from GENERAL INFLAMMATORY PROCESSES 267 cystitis by the appearance .of gonorrheal pus exuding from the urethra and bythe two-glass urine test, the second urine being clear in urethritis. The diagnosis of chronic cystitis is a much less simple matter. The subjec-tive symptoms are less characteristic and cannot always be distinguished fromthose that result from pressure or traction from affections of neighboring organs.The examination of the urine affords only incomplete evidence. The cloudyappearance of a urine that has not been freshly voided is misleading on account //
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^ Qs-v cw« Fig 65.—Unusual Result of an Exfoliative Cystitis, which has Caused Plastic Adhesionsof the Bladder Wall, with Great Contraction of the Bladder.The adhesions are being severed in order to give greater capacity to the bladder. Through thecystoscope the appearance was that of multiple diverticula. (Operation by Dr. F. A. Pembertonat Free Hospital for Women.) of the possibility of urates or phospates or bacteria causing the cloudiness. Ifthe freshly passed or catheterized urine is cloudy the condition is pathologic.If pus is found by microscopic examination an inflammation is evidently present,but its location is not indicated, as it may come from an infection higher up.Washing out the bladder gives some information as to whether the condition isone of cystitis or pyelitis. In cystitis the wash-water soon returns clear, andwill remain clear for some time, while in pyelitis there is an early reappearanceof pus. 268 GYNECOLOGY Though clinical observations give a more or less

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