546 DISEASES OF THE STOMACH. 



dium, is rarely sufficient to cause a rupture of the vessels; but 

 haemorrhage from the stomach is sometimes seen from these causes. 

 The haemorrhages which sometimes occur in new-born infants most 

 likely belong in this class. It is most probable that these depend OP 

 imperfect expansion of the lungs, and the obstruction thus induced tc 

 the flow of blood from the stomach. 



2. Haemorrhage from the stomach may result from the rupture of 

 diseased vessels. In rare cases varices burst or aneurisms open into 

 the stomach. More frequently disease of the walls of the vessels must be 

 suspected, without our being able to prove it either with or without the 

 microscope. Under this head come the haemorrhages occurring in the 

 so-called haemorrhagic diathesis; those coming after exhausting dis- 

 eases, in the course of yellow fever and other severe diseases ; finally, 

 those arising from improper living, especially abstinence from fresh 

 meat and vegetables, which form one of the symptoms of scorbutis. 

 In these cases it is insufficient to ascribe the bleeding immediately to 

 an abnormal quality of the blood ; this can only act by disturbing the 

 nutrition of the walls of the vessels. 



3. Finally, haemorrhage from the stomach may arise from erosion 

 and other injuries of the walls of the vessels. In this class belong the 

 cases where chronic ulcer or ulcerating carcinoma leads to haemorrhage 

 from the capillaries or larger vessels ; those where corrosive substances 

 and sharp, foreign bodies open vessels of the stomach ; lastly, those 

 where a blow over the stomach has caused rupture of one of the 

 vessels. 



ANATOMICAL APPEARANCES. Even after decided haemorrhages 

 from the gastric mucous membrane, we often seek in vain, on post- 

 mortem examination, for its source ; when the patient has died from 

 loss of blood, after washing off the stomach, we find it just as pale and 

 bloodless as the rest of the body. In other cases there has been coin- 

 cident capillary haemorrhage in the mucous membrane, in which we 

 find bluish-red or blackish-red spots, from which blood oozes out on 

 slight pressure. This haemorrhagic infiltration of circumscribed por- 

 tions of mucous membrane generally leads to superficial softening and 

 throwing off of the softened portion; superficial excavations thus oc- 

 cur, which are not discovered till the dirty-brown blood particles cling- 

 ing to them are washed off. The superficial bleeding fossae, called 

 haemorrhagic erosions, are usually numerous, small, of round or elon- 

 gated form, and are chiefly found at the summit of the longitudinal 

 folds formed by the mucous membrane. If large vessels have been 

 eroded by ulcer or cancer of the stomach, or if ruptured varices or 

 aneurisms have caused tne haemorrhage, we may in many cases find 

 the gaping mouth of the vessel. 



