Tin-: COLON n.\< II.LUS <;ROI p 245 



process often occurs in man. In most cases of chronic cystitis the 

 ureters and pelves of the kidneys become involved; any malformation 

 of the ureters aids the process. From the pelvis the bacteria push up 

 into the urinary tubules and excite inflammation and multiple abscesses. 

 At times the bacilli force their way through the lymph channels or 

 capillaries into the blood current. Colon infection of the different 

 parts of the urinary tract may occur at any age, from infancy upward. 

 Instead of starting in the bladder it may begin in the kidney itself, 

 the colon bacilli coming from the blood or peritoneum. In many of 

 these cases the bacilli isolated from the urine are clumped in high 

 dilutions of blood from the patient. 



Although other bacteria the pyogenic cocci, the proteus, the typhoid 

 bacillus, etc. may excite cystitis, still in 90 per cent, of all cases some 

 of the colon group are found, and this percentage is even higher in 

 young children. The clinical picture of colon infection is very variable. 

 The lightest cases progress under the guise of a bacteriuria. The urine 

 is passed a little more frequently and shows a fine granular cloudiness. 

 The reaction is acid. The cell elements are but little increased. There 

 is an excess of mucus. Albumin is absent or present in only a trace. 

 The condition may last for weeks or months and then spontaneously 

 disappear or grow worse. With a somewhat more severe infection 

 there is painful urination, perhaps tenesmus, increase of pus cells, 

 and slight fever. In a conical glass a sediment of pus cells forms 

 at the bottom, and clear urine remains above. In chronic cases 

 the fever is usually absent, but anaemia and loss of tone appear. If 

 the infection passes to the kidney colicky pain and tenderness over 

 the region of the kidneys are usually present. The most important 

 symptom of pyelitis is an irregular intermittent fever resembling malaria. 

 The albumin is increased in the urine and red blood cells may be seen. 

 If a general nephritis arises the symptoms are all intensified and an 

 anaemic condition may develop. A septicaemia may finally result. 

 Therapeutic bacteriological means are employed to treat this affec- 

 tion; irrigation of the bladder with creolin, lysol, and silver solution. 

 Internally urotropin or salol are given. 



In most of these cases the microscopic examination is sufficient 

 to make a probable diagnosis, since the bacteria are so abundant. 

 The variety of colon bacillus present can, of course, only be told by 

 cultures and other means. In the urine they appear as diplobacilli, 

 or partly in short, almost coccus, forms, partly in long threads. As 

 a rule, motility is absent. Not infrequently the cultures appear to be 

 identical with the bacterium lactis aerogenes. 



The characteristics of the urine itself have much to do with the 

 probability of infection; the more acid urines being less likely to afford 

 a proper soil for growth. Some urines are bactericidal even when 

 they are neutral. The substances producing this condition are not 

 knqwn. The colon bacilli in the urine produce no appreciable effect 

 on the reaction, but give up some of their toxins, which upon absorp- 

 tion cause the deleterious local and general effects. The serum of the 



