[ Read before I.H.A., Bureau of Clinical Medicine, July 27, 1939].
A. DWIGHT SMITH, M.D.
Pyelitis is an inflammation of the mucous membrane lining the pelvis of the kidney. It may be associated with cystitis, also there may be an inflammation of the ureter or of the kidney. It may result in the accumulation of pus in considerable amount in the pelvis of the kidney. It may be acute or chronic. It may occur as a complication of scarlet fever or typhoid fever, diphtheria, influenza, pyemia, etc.; but these cases are not common.
The common form appears as a primary infection. It may be found in the course of any disease and frequent follows acute disturbances of the gastrointestinal tract, especially diarrhoea. Pyelitis is more common in infancy than in childhood and is much more common in girls than in boys.
I have considered pyelitis only in children as it is much more common with them and especially in the acute primary form. Most of the pyelitis case in adults are a complication of other diseases.
The organism present with great uniformity is one of the colon bacillus group, usually alone, although many other organisms have been found occasionally. The infection can occur theoretically in three ways: through the urethra, through the surrounding tissues by way of the lymphatics, and through the blood. The predominance of the cases in girl babies suggests that it is most often ascending through the urethra. However, the infection may take place through the intestinal walls. Infection through the blood is not very likely. Pyelitis cases are quite frequent during the first two years, after that time the number of cases diminishes but may be found at any age.
In the majority of cases to call attention to the whatever in the symptomatology to call attention to the urinary tract, the symptoms being merely an elevation of temperature and those common to all febrile disturbances in infancy, such as restlessness, drowsiness, fretfulness and indefinite signs of discomfort. Symptoms of disturbance of the gastrointestinal tract, sometimes primary, sometimes secondary, are especially common. Anorexia is the rule is often very marked. Vomiting is not uncommon.
The stool are usually abnormal, sometimes as the result of some disease to which the urinary infection is secondary, sometimes as the result of the infection itself. The temperature is usually irregular and in no way characteristic. Usually the fever is high. There may be a chill or recurring chills. Many cases are so mild as to cause no symptoms but a slight elevation of temperature. It would escape detection but for the examination of the urine. In some the location of the pain is in the bladder or kidneys. The pain is often paroxysmal. During the attack of pain there is sometimes swelling and tenderness over the kidney and relief follows the passage of considerable amount of urine containing microscopic lumps of pus.
Painful micturition is uncommon. Most cases have no pain. There is almost always a polynuclear leucocytosis, which may be quite marked, even as high as 50,000. In most cases the urine is pale and uniformly cloudy or turbid. The urine is almost invariably acid, not infrequently highly so. Microscopically the sediment is composed almost entirely of pus cells, usually single, sometimes in clumps. Hyaline and fine granular casts are occasionally seen, and red blood cells may be found in acute cases. The characteristic symptoms of acute pyelitis are chills, which may be repeated, high and widely fluctuating temperature, scanty urine containing pus, and rarely pain and tenderness over the kidneys.
All of these may be absent except the fever and the pyuria, and these may be intermittent. The diagnosis of pyelitis is made only by an examination of the urine, which particularly in infancy, should never be omitted in cases of obscure high temperature. Many of the cases of fever in children, especially small girls, without other symptoms or findings, are due to pyelitis and can only be diagnosed by examining the urine. Voided specimens are usually satisfactory in the case of males, but in females a catheterized specimen is preferable because of possibilities of contamination.
According to the regular school textbooks, the prognosis is good. It is seldom fatal. There are two main types of the disease. In one, recovery ensues in two or three weeks under any form of treatment, or without treatment, although relapses and second attack are not uncommon. The other type drags on for weeks or months in spite of all sorts of treatment. Sometimes it persists intermittently for several years. In older children, cases may be found which will persists for years, with a persistent pyuria as the only symptom.
REGULAR SCHOOL TREATMENT.
All are agreed that water should be given freely. Different authors recommend various methods but all seem to be agreed that none of them are very effective. Most of them prefer the alkaline treatment, giving enough soda bicarbonate or other alkalis to make the urine alkaline. Marriott says that the administration of alkalis is for the purpose of rendering the urine less irritating to the injures mucosa, not to exert an antiseptic effect, for colon bacilli actually grow better in alkaline than in acid urine.
The most widely used drug is Hexamethylenamin or Urotropin. The urine must be kept acid while using the preparation. In obstinate cases some recommend alternating the reaction of the urine. It should the strongly alkaline for three or four days, then acid for three or four days. Autogenous vaccines are used in some of the obstinate cases but both Holt and Morse say that this method is seldom successful. Osler says that there are practically no remedies which have much influence upon the pyuria.
Has homeopathy anything better to offer than orthodox medicine? It certainly has! These cases respond very readily to the indicated homoeopathic remedy. An acute case should not last over a few days. I have treated a good many cases and have always depended on the homoeopathically indicated remedy to do the work and I have not been disappointed. I have never attempted to render the urine alkaline, except what might be done by giving the patient fruit juices. Any one of a great many remedies may be indicated. Lycopodium has been more often indicated in my experience. Some of the most frequently indicated remedies are Lycopodium, Silica, Mercurius, Pyrogen, Hepar sulph., Mercurius corr. Arsenicum alb., etc.
The following is rather a typical case and quite a severe one:.
Q.D., age 52 years. Feb. 19, 1937. His mother called me on the phone and said that he had a high fever. The family belonged to the Ross-Loss Medical Group and a doctor from there had attended the body. This doctor said that he did not know what the trouble was and advised taking him to the hospital where he would have all kind of laboratory work done, so he could make a diagnosis. The mother said that they preferred my method of treatment and wanted to know what I thought about the case. After some questioning over the phone, I told her that I was sure that he had pyelitis. I told her that he could be the only laboratory work he would require. He presented the following symptoms and findings:.
Temperature 105. Pulse 120. Temperature irregular, ranging from normal to 106. Some vomiting. Tenderness in region of the kidneys. < right side. Lies quiet. Thirsty at first, later not thirst. Tongue white. < toward evening. Urination painful at times. He would hold it back as long as possible.
Urine analysis showed the following: slightly cloudy; reaction acid; specific gravity 1.020; sugar negative; albumin, a trace.
Microscopic: 10 t0 12 pus cells, per HpF. Large clumps in places, impossible to count. Red blood cells, 4 to 6 per HpF. A few epithelial cells. Casts, a few hyaline and occasional granular.
I gave him Silica 200 but he did not respond to it. Two days later, I gave him Lyc. 10M. He was better the next day, although it took about five days before his temperature was normal all day. About a week later, he started to have a temperature again. This responded quickly to repeating Lyc. 10M. I did not report this case because of any spectacular results in prescribing but because it was a rather typical case of the severe type of pyelitis.
While I was at the Childrens Homoeopathic Hospital in Philadelphia, a child was admitted who had been sick with pyelitis most of the time for two years. I do not have the history of this case so cannot give the symptoms, history of this case so cannot give the symptoms, history, etc., but I remember that Dr. William B Griggs. gave him Pyrogen (high) and he was cleared up entirely in a very short time. I mention this case to show that the indicated homoeopathic remedy will take care of the protracted case as well as the recent one.
DR. SCHWARTZ: I would like to know Dr. Smiths experience with remedies like Berberis and Vesicaria.
DR. GOBAR: With regard to a never remedy I have used in chronic case- I havent used it in acute cases-it is Juniper. It is a very valuable remedy, and I became familiar with it quite accidentally.
This particular person who had pyelitis was bettered by the use of small doses of gin. On taking a small quantity of gin, the patient would feel very good. I found that in gin there was anise, caraway and juniper, and the Juniper hit the symptomatology perfectly.
DR. SHERWOOD: Is this a gin-drinking child you are talking about?.
DR. GOBAR: No. this was an adult.
DR. GRIMMER: IT is true there are some remedies that seem more specific by their symptoms. We can mention quite a number of remedies that might be needed along with what the doctor has suggested. Sabal serrulata is one that could be thought of in some of those cases, and is frequently a very useful remedy.
The doctor didnt mention Cantharides, which is a remedy that will very often be needed and is very often indicated.
He mentioned Mercury, but MErc. corr. is more specific than the Mercury itself.
DR. Gobars mention of the remedy Juniper in connection with gin drinkers might be a valuable thing for some of us. We come in contact with those people, and are glad to hear that point. We will investigate that.
DR. SMITH: I think Berberis is quite frequently indicated. The other remedy, Vesicaria, I havent had any experience with, so dont know.