HiEMATEMESIS. 101 



Treatment. — When the pulse is full, strong, and vibratory, bleed- - 

 ing is required, and the quantity of blood abstracted will necessarily 

 depend on the strength of the patient. One bloodletting of twenty 

 or twenty-four ounces on the first or second day, will have more 

 effect in checking the hemorrhage than several pounds taken away 

 in the course of a fortnight. When the patient's powers will not 

 admit of general depletion, cupping or leeches should be resorted to. 

 A free current of cold air should be allowed to pass over the patient, 

 who should be lightly covered ; the bowels should be opened with 

 Epsom salts and sulphuric acid ; and the best remedy is the acetate 

 of lead with opium. Perfect silence should be enjoined ; the diet 

 be very meagre, and comprise lemonade or other acid drinks. If the 

 hemorrhage assumes a passive character, alum, with dilute sul- 

 phuric acid may be administered. In slighter cases, saline draughts, 

 with small doses of digitalis, may suffice. Any inflammatory or 

 irritative symptoms must be treated by blisters and other remedies 

 that have been adverted to when speaking of phthisis. 



H.EMATEMESIS {^Hemorrhage from the Stomach). 



Causes. — Whatever irritates the mucous surface of the stomach, 

 or interrupts the return of blood from that organ, will occasionally 

 produce this disease. Blows and injuries on the abdomen, particu- 

 larly on the hypochondria and epigastrium ; violent concussions of 

 the trunk ; external or internal pressure on the stomach ; the inges- 

 tion of irritating or hurtful matters into this viscus ; intemperate in- 

 dulgence in food or stimulating liquors ; the presence of worms in 

 the stomach or upper part of the small intestines ; powerful or irri- 

 tating emetics, especially when given in the advanced stages of fevers, 

 or in cachectic or visceral diseases ; the suppression of accustomed 

 discharges, particularly the menstrual or hsemorrhoidal ; the appli- 

 cation of cold, or of cold and moisture, to the lower extremities or 

 surface of the body during perspiration or the catamenial period ; 

 neglect of the bowels, and consequent accumulation of faecal matters ; 

 diseases of the vessels of the stomach and neighbouring viscera ; the 

 gravid uterus, and large tumours developed in any part of the 

 abdomen. 



Symptoms. — In most cases, there are premoriitory symptoms, 

 such as tension or pain about the epigastrium, with faintness, or a 

 sense of sinking, or of anxiety, at this region ; flatulent or acrid 

 eructations ; lassitude with irregular chills and flushes of heat. The 

 pathognomonic phenomena of the disease are, nausea, followed by 

 vomiting of blood, either fluid or coagulated, pure, or mixed with the 

 contents of the stomach. The blood and other matters thrown up 

 come away with more or less effort, frequently with comparative 

 ease, even when the hemorrhage is greatest, and seldom with much 

 previous retching ; it is sometimes gulped or eructated upwards. 



9* 



