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Am J Dis Child. 1922;24(3):179-185. doi:10.1001/archpedi.1922.04120090002001.
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Until recently we have been unable to determine definitely whether a given case of pyuria is one of pyelitis, cystitis, or pyelocystitis. Common custom has been to designate all cases presenting the more or less characteristic symptoms when associated with a definite excess of leukocytes in the uncentrifugated urine or definite pus in the sediment pyelitis. Particularly was this diagnosis considered very probable if the urine was acid and colon bacilli were found in smear and on culture. It is only possible, however, to diagnose pyelitis definitely by means of the cystoscope which enables one to differentiate the portion of the renovesical system from which the pus is coming. It is possible to demonstrate this by means of kidney massage and a certain technic which I described fifteen years ago,1 but the cystoscopic method is by far the best method and instruments are now made small enough to pass


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