PYELITIS. 57 



into some neighboring organ (such as an intestine). Now and then 

 the liquid contained in the pelvis of the kidney is gradually absorbed. 

 The pelvis shrivels into an indurated tissue, which incapsulates its in- 

 spissated contents, the ureter becoming obliterated and converted into 

 a tendinous cord. 



SYMPTOMS AND COUESE. Croupous and diphtheritic pyelitis are 

 scarcely ever recognized during life, as in the majority of cases they 

 are only partial manifestations of those grave and wide-spread disor- 

 ders which attend the malignant infectious diseases, septicaemia, scar- 

 latina, small-pox, or the typhoid stage of cholera. Sometimes when ca- 

 tarrhal calculous pyelitis becomes aggravated into the croupous or diph- 

 theritic form, shreds and lumps of fibrin are discharged with the urine 



Acute catarrhal pyelitis may commence with a rigor or with re- 

 peated chills, and be attended by febrile symptoms. The patients 

 complain of pain in the region of the kidney, which radiates along the 

 ureters, toward the testicles, and which is increased upon pressure. 

 When the inflammation has been severe, I have also repeatedly observed 

 vomiting, even in the cases where the disease had spread from the 

 urethra to the pelvis of the kidney. A frequent and sometimes pain- 

 ful inclination to pass water is a constant symptom. According to 

 Oppolzer, the secretion of urine increases ; this may to some extent 

 be due to hyperaemia of the kidney, in the parts supplied by the vasa 

 afferentia; but if the pyelitis be complicated with interstitial nephritis, 

 the secretion of urine may be diminished in amount. Very often at 

 the outset the urine contains blood, in greater or smaller quantity ; and 

 it always contains pus, and in some cases, but not in all, tesselated epi- 

 thelium, lying row upon row, detached from the pelvis of the kidney. If 

 the disease be of long duration, still more pus appears in the urine. When 

 recently passed, the latter is opaque ; after standing a while, a well- 

 defined sediment is deposited, of a yellowish-white color. Owing to 

 the pus serum which it contains, the supernatant liquid shows the 

 characteristic coagulation of albuminous urine upon the application 

 of nitric acid and heat. The microscope shows the sediment to con- 

 sist of innumerable pus-cells. In pyelitis calculosa, affecting one side 

 only, the impaction of a calculus sometimes causes a temporary but 

 complete arrest of the flow of urine from the pelvis of the kidney. 

 Any urine which is then discharged from the bladder must, therefore, 

 proceed from the healthy kidney. Hence, as long as the obstruction 

 continues, the urine is usually quite limpid, although the symptoms are 

 all aggravated. When the obstruction is removed, the urine again be- 

 comes turbid. One patient, whom I have seen, had learned, by ex- 

 perience, that her suffering would be more severe as long as her urine 

 remained clear ; and she used to long for the time when pus would bo- 

 pin to pass again. 



