HÆMATURIA.                                    235

passed well into the rectum, the bladder may be felt distended (the
bladder is situated immediately below the rectum).

Treatment: Local.—Frequent hot fomentations to the loins.
Empty the rectum with the hand and throw up soap and warm water
enemas, to which chloral hydrate (half an ounce) may be added.
Insert the arm and apply gentle pressure to the bladder if that
organ is distended.

General.—A brisk purgative, and afterwards linseed or rice
gruel-ad lib.

               HÆMATURIA OR BLOODY URINE.

Blood in the urine may arise from three sources, namely : (a) the
urethra, (b) the bladder, (c) the kidneys.

If the passage of urine be preceded by the passage of a clot, or
if blood be passed involuntarily and independently of the act of
staling, it is certain that the source of blood is from the urethra
or passage. When the blood is not well mixed with the urine and
clots are passed towards the close of the act of staling, we may
assume that the blood is from the bladder.

If the blood be from the kidneys it is intimately mixed with the
urine, giving it a reddish smoky tint.

It is not an easy matter by ordinary inspection to determine
whether blood is from the bladder or kidneys.

Causes.—The common cause of discharge of blood from the
urethra is an injury. Blood from the bladder may arise from acute
inflammation, stone, ulceration, tumours, etc. In the case of the
kidneys, blood may arise as the result of injury, acute inflammation
of the organs, stone, parasites, growths. Blood may also follow on
the excessive or indiscriminate use of drugs, notably cantharides or
turpentine, or after feeding on certain acrid plants.

Treatment.—This depends of necessity on its cause, it being
a symptom of several diseases. The bowels must be kept regular ;
the patient allowed complete rest ; the diet should be nutritious and
moderate in amount. In order to control the bleeding, if very exces-
sive, good results may be expected by the exhibition of such drugs
as gallic acid, acetate of lead, alum and some preparations of iron.

             Twice or thrice daily.