Doctor’s dairy
I have a nasty pain in the lower part of my tummy, Doctor. What is wrong? "
MISS V. certainly didn't look well. "Last year, before I came to live in this district," she began, "I had rather a nasty attack of cystitis. I think that's the tight name. Doesn't it mean 'inflammation of the bladder'?"
"You're quite right, and very nasty it can be, too," I told her.
"Well, for the last few days," she went on, "I've had signs of the same kind of trouble, and I thought I'd better come and see you."
"Very wise of you. Tell me about the original attack first of all. When and how did it begin?"
"It was round about Christmas time. I found I wanted to spend a penny every few minutes, yet, when I did, the pain was quite awful."
"Can you describe the pain?"
"It was a burning sensation, rather like trying to pass red hot needles! And I had nasty pains in the lower part of my tummy, too."
"You saw a doctor, of course?"
"Oh yes. He sent me to bed, and although I felt better again quite soon, it was nasty while it lasted."
"Do you happen to remember if you had a specimen of urine examined?"
By no means uncommon
"Yes, I did;" she replied, "and I can remember exactly what they said about it because it simply terrified me! The doctor told me that it contained germs and pus. It sounded quite awful, especially when he mentioned one particular germ, the bacillus something; but he assured me that it wasn't uncommon."
"Was it the Bacillus Coli?" I asked.
"Why yes! That's right. Is cystitis always caused by that?"
"No; but in women it is one of the most common causes. You see, this is a germ which is always present in the large bowel. It doesn't do any harm, because that is where it is meant to live; but if by any chance it finds its way out and settles where it is not meant to be, it can cause trouble. In women, the urethra is quite near the anus (the opening of the rectum), so there is a greater likelihood of infection than there is in men."
"I’m afraid I don't know the meaning of the word 'urethra'," she said.
"It is the medical name for the passage from the bladder through which the urine escapes from the body," I replied. "You see, the bladder is a storage place for the urine, which is flowing into it, continuously, drop by drop, from the kidneys.
"We are not conscious of the urine in the bladder until it reaches a certain level, and then the muscles indicate that the time has come for the bladder to be emptied. Normally, the bladder holds roughly half a pint when it is full, although, as it is an extremely elastic organ, it can hold a great deal more than this when necessary."
"But why should I feel I want to spend a penny so often if, when I do, it is practically nothing to speak of?" asked Miss V. unhappily.
"That isn't difficult to explain. You remember, the word 'cystitis' means that the bladder is inflamed. And, with this complaint, the urine is very often highly acid, this, of course, stings.
"Imagine the effect of a strong acid on an inflamed surface! Very painful, to say the least of it. Even the smallest amount of urine will irritate the lining. So the bladder does what it can to get rid of it as quickly as possible, by producing the urge to urinate."
Drink plenty of water
"But why should that hurt so much?" Miss V. asked.
"Simply because the whole of the urinary tract, the lining of the bladder and the urethra, is inflamed."
"I understand. But, Doctor, what am I going to do about this, to make sure it doesn't get any worse?"
"I shall have another specimen of urine examined," I replied, "to make sure we know the type of germ we are dealing with, as I told you, many different ones can be responsible. Then I want you to drink copious amounts of bland fluid such as water, or better still, barley water."
"But, Doctor, surely that will make me want to spend a penny even more frequently! "
"Yes; but it will dilute the urine, which means that it won't be so painful. It is small amounts of concentrated urine that cause the trouble. The next step will be to prescribe medicine for you which will help to counteract the acidity."
Keep out of draughts
"I think," I said, "that with these precautions this attack won't develop. Had it been worse it would have been possible, though more difficult, to put matters right, possibly with penicillin or one of the sulpha drugs.
"There is one 'more point, Miss V.," I continued. "You must keep warm if you have tendency to this trouble, particularly round your back and thighs. Even a slight chill, especially if you are tired, is enough to start off the trouble. So is alcohol, too. That will do it, and probably explains why cystitis is such a common complaint during the festive season!"
RODERICK WIMPOLE
Dr. Wimpole regrets he is unable to enter into any
correspondence
NEXT WEEK THE DOCTOR TALKS ABOUT MUSCULAR RHEUMATISM
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