58 DISEASES OF THE PELVIS OF THE KIDNEYS AND URETERS. 



Owing to persistent suppuration, and to the slow fever which gen- 

 erally accompanies it, chronic pyelitis may lead to marasmus and 

 dropsy, terminating in death. When due to stones in the renal pelvis, 

 the chronic disease is liable to acute exacerbations, particularly after 

 any jolting of the body ; or else periodical haemorrhages occur, which 

 accelerate the exhaustion of the patient. Violent pain in the back, 

 difficulty of motion of the spinal column, pain on drawing up the 

 thighs, aggravation of the fever, and repeated chills, are indicative of 

 threatening perforation of the wall of the renal pelvis. After per- 

 foration has actually occurred, and when an abscess has formed in the 

 surrounding tissues, the disease assumes the characteristics of perine- 

 phritis. A tumor which fluctuates more or less distinctly is found in 

 the region of the kidney, etc. (see Sec. I., Chap. VII.). When the ab- 

 scess bursts into the peritoneal sac, the patient speedily perishes, with 

 the symptoms of acute peritonitis. If the pus burrow downward, a 

 cold abscess forms, which makes its appearance in the lower part of 

 the back, beneath Poupart's ligament, or in the perinaeum. If the 

 perforation take place into the intestine, masses of pus are discharged 

 with the stools ; the tumor which had formed diminishes or disappears 

 entirely, and a more or less permanent recovery takes place. 



It is not always easy to decide if a pyuria originate in the bladder 

 or in the pelvis of the kidneys. In a pyelitis without implication of 

 the bladder, the desire to micturate may be very troublesome, and the 

 act of urinating may be accompanied by pain in the urethra. In 

 chronic pyelitis as well as in chronic cystitis, the urine contains 

 quantities of pus-cells, which render it cloudy, and when it stands 

 for some time they sink to the bottom as a whitish-yellow sediment. 

 The idea that the acid reaction of such urine indicates a pyelitis, while 

 alkaline reaction speaks for a cystitis, is not absolutely correct ; for in 

 chronic vesical catarrh even when of long standing it is generally acid, 

 and only becomes alkaline in the bladder under certain circumstances, 

 of which we shall speak when treating of catarrh of the bladder. 

 Another criterion also, which I formerly considered valuable in the 

 diagnosis of pyelitis from cystitis namely, that in inveterate vesical 

 catarrh the purulent sediment was usually mixed with quantities of 

 mucus, while in chronic pyelitis the urine did not contain a trace of 

 mucus is not always true. The mucous masses evacuated in the urine 

 in some cases of chronic vesical catarrh are the result of mucous trans- 

 formation induced in the purulent secretion from the vesical mucous 

 membrane by alkaline fermentation of the urine. If the urine does 

 not undergo this decomposition in the bladder, when freshly passed, it 

 will contain no mucous masses ; but, if we leave urine with a simple 

 purulent deposit (wnether it come from the bladder or the pelvis of 



