HAEMORRHAGE FROM THE STOMACH 545 



the course, the larger the tumor becomes and the more rapidly it 

 grows, the more probable it is that the new formation is medullary 

 cancer. 



TREATMENT. As the indications from the cause and from the dis- 

 ease cannot be fulfilled, we must restrict ourselves to the treatment 

 of symptoms. The diet must be regulated according to the rules pre- 

 scribed in the treatment of chronic gastric catarrh ; if milk be well 

 borne, it is the most suitable nourishment ; if milk cannot be used, con- 

 centrated broths, yolk of egg, and other nutritious substances may be 

 ordered, but always in small quantities, and where there is stricture 

 they should be given in fluid form or finely divided. Wine also, par- 

 ticularly red wine, may be given, and it is usually well borne. For 

 the excessive acidity, the alkaline carbonates do well, especially in 

 the form of soda-water; they often fail, however, and sometimes, 

 as in stricture of the pylorus, we cannot in any way prevent the 

 acidity. In such cases it is well at each meal to give pills containing 

 gtt. 1 1^- of creasote, as recommended by Budd. Pills of aloes and 

 colooynth may be given for the obstinate constipation. For the severe 

 pain and the sleeplessness, narcotics, particularly morphia, must be 

 given. 



CHAPTER VIII. 



HAEMORRHAGE FROM THE STOMACH. 



ETIOLOGY. 1. Haemorrhage from the stomach results from rupture 

 of the over-filled blood-vessels without previous change of texture. 

 Arterial fluxion is rarely so decided as to cause rupture ; besides the 

 slight haemorrhage seen in inflammation of the stomach, this occasion- 

 ally occurs in anomalies of menstruation. It cannot be denied that 

 ripening and detachment of an ovum are sometimes accompanied by 

 fluxions and haemorrhages in other organs and not in the uterus, 

 although we can give no explanation of the fact. Venous congestion 

 of the gastric mucous membrane is a much more frequent cause of 

 haemorrhage. The most decided congestions result from impediments 

 to the circulation in the liver. Haemorrhage from the stomach may be 

 caused by obstructions of the portal vein by blood-clots ; by pressure 

 on its branches due to cirrhosis of the liver, or to the enlargement of 

 the gall-ducts, caused by closure of the ductus hepaticus or choledochus ; 

 by plugging of the capillary vessels of the liver with clumps of pig- 

 ment in pernicious fever (Frerichs) / finally, by destruction of the 

 capillaries, in the so-called yellow atrophy of the liver. The hyper- 

 semia of the gastric mucous membrane, due to obstruction of the cir- 

 culation in the chest by diseases of the lungs, pleura, heart, or pericar- 

 36 



