ally subsided as the patient improved in health. Turpentine in this, as well as in some other forms of hemorrhage, seems to do good. Acetate of lead, in doses of three or four grains every three hours, for five or six doses, often checks hemorrhage. This remedy was much employed by Dr. Golding Bird. It is, of course, very important not to continue giving lead for any length of time, and it should be borne in mind that some persons are more susceptible to its influence than others. If the blue line should appear near the free edge of the gums, the lead must be stopped, and its elimination promoted by purgatives and sudorifics.

Gallic acid is one of the most powerful remedies in hemorrhage from the kidneys or bladder. It may be given in much larger doses than is usually recommended. The reputation of this remedy would, I think, soon be greater than it is if those who try it would give it in sufficiently large doses, and persevere in its use for several days before replacing it by other astringents. As gallic acid probably acts according to the strength of its solution which bathes the bleeding tissue, it is necessary to ensure the introduction of a certain quantity into the blood by the frequent administration of successive doses. We must remember that gallic acid soon passes away from the blood, being carried off in the urine. It is, therefore, only by administering frequent doses that we can hope to compensate for this continual draining away of the remedy, and we must give it in quantity and often enough to more than compensate for what is removed with excrementitious matters.

In chronic bleeding from the surface of the mucous membrane of the pelvis of kidneys, ureters, bladder and urethra, and from villous growths, as well as in the very obstinate hemorrhage from large fungous tumors of the kidney and bladder, I have found gallic acid most valuable in a large number of cases, and for some years past I have been led to depend upon it more and more. In that spongy condition of the prostate where the veins are large and the capillaries of the surface considerably dilated, and forming here and there little pouches like aneurismal dilatations, hemorrhage is often not only very obstinate, but

from time to time blood escapes in such excessive quantity as to blanch and weaken the patient. The remedy should be given in frequent doses, day and night, until the bleeding is very decidedly reduced in degree, when it may be ordered once in six hours, or less frequently, being again increased in frequency if the patient ceases to improve or the hemorrhage again increases in severity.

Some patients

Gallic acid seldom disagrees in any way. complain of its taste, but it is generally well borne by the stomach. It does not cause constipation, and even when the crystals are swallowed in a state of suspension in water or mucilage, no inconvenience results, and the stomach is not disturbed by their presence. The glycerine of gallic acid is, however, the most pleasant form in which to prescribe the remedy. This contains one part of gallic acid in four. Forty minims will contain ten grains, and may be given in distilled water, peppermint, orange or other water. But it is most essential that the patient should persist in taking the doses regularly for several days. Gallic acid is absorbed by the blood, and much of it passes away in the urine, and it is probable that it acts directly on the tissues from which the bleeding is taking place, and, therefore, a certain strength of solution is necessary to get the good effects, and this can only be obtained by its persistent introduction into the stomach and so into the blood, at short intervals of time. I have given gallic acid in ten-grain doses every two hours, without intermission, for three weeks, no objection having been made on the patient's part. Whether much larger doses would be absorbed I doubt, but I am not aware to what extent the remedy may be pushed, nor do I know in what respect very large doses would be deleterious. ally found that the desired effect has resulted after ten-grain doses had been kept up for three or four days, and in cases where the bleeding did not actually cease, it was certainly well under control. In several of those painful cases of hemorrhage from fungous growth the bleeding was much lessened and the fatal result, I think, postponed; in some of my cases, I should say that death was due rather to ex

I have gener

haustion and weakening of the general health, than to hemorrhage. I therefore commend this remedy in the cases of hemorrhage to which I have referred, and I prescribe it with confidence. Its use may be steadily continued until its beneficial action is clearly established.

Ergot of rye, alum, matico and other styptics may be tried in obstinate cases.

The Liquid Extract (Extractum Ergote liquidum) is the best preparation of ergot. Fifteen or twenty minims may be given every two hours, or more frequently, for two or three days at a time, but I cannot say to what extent the use of this drug may be pushed with safety, or the symptoms which indicate that the patient is taking larger doses of the remedy or more frequently than is desirable.

Hamamelis bark (Hamamelis virginica, the American Witch Hazel), contains principles which are not only astringent but soothing, and perhaps, sedative. It has been much prescribed in diarrhoea, dysentery and irritable states of the intestinal canal; but it also acts on the mucous membrane of the urinary organs. In bleeding from any part of the urinary tract and hemorrhage from the vagina, from five to twenty minims of the tincture may be given in an ounce of water every two or three hours, but I am not aware to what extent the remedy may be pushed in serious cases, or what symptoms result if much larger doses than those mentioned above are given.

As an injection for the vagina or bladder, one part of the tincture may be diluted with from twenty to forty parts of tepid distilled water.

In some very severe cases of hæmaturia depending on renal disease, advantage has resulted from the administration of the tincture of perchloride of iron. In this, as in many other forms of disease, more relief may be afforded by improving the state of the blood than by giving remedies supposed to affect directly the particular action at fault. I have seen patients suffering from chronic renal disease, completely blanched by renal hemorrhage, who have improved immediately after they had been put upon iron and quinine, a more generous diet, and the digestive power

had been increased by the administration of hydrochloric acid. and pepsin.

Hemorrhage from the kidney which results from a blow, fall, or other injury, often ceases if the patient remains perfectly quiet for a few days. It is doubtful if recovery can take place after very decided laceration of the kidney, but it is probable that in many instances some of the delicate capillaries may be ruptured without the secreting structure being actually torn through.

In that obstinate and distressing form of hemorrhage which takes place from the prostate, the patient should remain in the recumbent posture with the pelvis raised on a pillow, to favor the gravitation of blood from the gland, and he should be kept as quiet as possible. Iron, gallic acid, turpentine or other styptics ought to be tried, but I am sorry to say they often fail to afford as much relief as is desired. Sometimes small pieces of ice placed in the rectum diminish the hemorrhage. In such cases, if we are sure of the absence of stone, and there is no other positive indication for its use, it is desirable to avoid introducing the catheter, for the operation frequently increases the hemorrhage and adds to the distress the patient already suffers. In cases in which the blood has coagulated within the bladder, and especially if the hemorrhage continues, the practice of introducing an instrument to break up the clot, and the injection of iced water, has been recommended. Dr. Prout injected into the bladder a solution of alum (20 to 40 grains in a pint of water), and says that by this proceeding he succeeded in stopping violent vesical hemorrhage which had resisted other methods.

In hemorrhage depending upon cancer of the kidney or bladder, the treatment is necessarily only palliative. Gallic acid, opium and complete rest sometimes afford great temporary relief. If, in such a case, the hemorrhage is dangerous, from its excessive amount, ice should be applied to the pubis, and styptics may be injected into the bladder.

If the blood present in the urine has escaped from the kidney in consequence of acute congestion or inflammation, as may generally be determined by the sudden accession of the symp

toms, the small quantity of the urine, the presence of casts, a considerable quantity of albumen, associated with puffiness about the face, and perhaps lumbar pain-the case must be treated by rest, purgation and sweating, and, in bad cases, the patient should be cupped over the loins. If the escape of the blood from the kidney is due to a low state of health, or to a condition of system allied to that which gives rise to purpura or to hæmophilia, the treatment must be directed to improving the general health and the action of the stomach; tonics, the tincture of perchloride of iron or gallic acid may be given; quinine, dilute acids and pepsin also do good. If hæmaturia occurs in the course of a case of scurvy, the scurvy, not the hæmaturia, must, so to say, be treated; lemon or lime juice, fresh vegetables and plenty of milk, as usually given in this disease, will be of essential service.

In cases where the hemorrhage depends upon renal calculus, rest in the recumbent posture must be enjoined. See the treatment of renal calculus.

As regards the treatment of cases of hemorrhage caused by the presence of entozoa there is little to be said. Some of the styptics already referred to, particularly gallic acid and ergot, may be given in cases where the hemorrhage is considerable; but as a general rule the bleeding gets less after a time, and if the general health be sustained by nutrient substances, and preparations of iron prescribed, the loss of blood is soon made up, and the patient may completely regain his health in a few months. Demulcent substances, such as linseed tea and barley water, flavored with a little lemon juice and sugar, seem to soothe the irritated mucous membrane. Persons who live in districts infested with entozoa should be most careful to avoid drinking any water which has not been previously boiled for at least ten minutes. It is probable that the immature parasites or ova gain admission into the system with the water, or even in the bodies of small animals which live in the water.