102 PRACTICE OF MEDICINE. 



When the quantity of blood thrown up is great, the effort at ejecting 

 it may sometimes occasion irritation in the pharynx, and excite 

 coughing, and, from this circumstance, cause some doubt as to the 

 seat of the effusion ; but the history of the case will easily show the 

 nature of the disease. After an attack of hsematemesis, the bowels 

 are generally relaxed, and the dejections dark coloured, from the 

 presence of blood in them, and extremely foetid. Sometimes the 

 evacuations are quite black, and of the consistence and appearance 

 of tar. This state of the evacuations (the melcena of old authors) 

 often continues for some time after the vomiting has ceased ; and 

 they are often preceded by colicky pains through the abdomen, dis- 

 tention, flatulence, tormina, and even slight meteorismus. 



The physical characters of this hemorrhage which require notice 

 are merely those which are referable to the colour, consistence, and 

 quantity of the effused blood. The blood effused into the stomach 

 and intestines is seldom found to present its natural red colour ^ either 

 when thrown out from these organs or when contained in them after 

 death. It has oflen acquired a dark purple, and still more frequently 

 a deep brown tint, or even the blackness of soot. The dark brown 

 and sooty discolorations of the blood may always be regarded as the 

 result of the action of an acid chemical agent, formed in the diges- 

 tive organs, on the effused blood, except in those cases in which they 

 are produced by the action of an acid poison. Hence we may Con- 

 clude, that the diseases called black vomit and melcena are mere 

 modifications of gastric and intestinal hemorrhage, the black colour 

 being an accidental circumstance of no importance, and derived from 

 the chemical action of the acid product on the blood, previous to its 

 evacuation. The consistence of the effused blood is very generally 

 increased with the darkness of colour which it has acquired. It is 

 sometimes coagulated into large masses, or into a multitude of smaller 

 portions, resembling a mixture of water, blood, and soot. This ap- 

 pearance is peculiarly characteristic of the action of an acid on the 

 blood. The quantity of blood effused may vary from a few ounces 

 to several pints ; and although it is generally greatest in cases of 

 perforation of an artery of the stomach, it is sometimes no less 

 abundant when it has its source in exhalation from the mucous 

 membrane. 



Of the different local lesio7is which are found to accompany gas- 

 tric and intestinal hemorrhage, follicular ulceration is, perhaps, the 

 most common. The mucous membrane may be perfectly pale when 

 the hemorrhage has proceeded from perforation of an artery ; red 

 and vascular when preceded by congestion ; or it may be of a deep 

 red colour throughout a great extent, whatever be the source of the 

 effusion, from imbibition alone. It almost always presents this 

 deep red colour when the haemorrhage arises from a mechanical 

 obstacle to the return of the venous blood, the submucous tissue 



