HAEMORRHAGE FROM THE STOMACH. 547 



When the patient dies soon after the haemorrhage, and if this has 

 been very copious and occurred rapidly, the blood contained in the 

 stomach forms red, clotted masses. If it has escaped slowly, and has 

 been retained in the stomach a long while, so that the gastric juice and 

 the acid contents of the stomach have had a chance to act on it, it ap- 

 pears brown or black. Where the haemorrhage has been very slight, 

 we find only a few black striae and flocculi, or masses like coffee-grounds, 

 in the stomach. 



SYMPTOMS AND COURSE. If the haemorrhage from the stomach be 

 not abundant and the blood be not vomited, the haemorrhage is not 

 usually recognized during life. According to Beaumont's observations, 

 small haemorrhages usually occur in the stomach during acute gastric 

 catarrh ; but blood mixed with mucus is very rarely vomited. The 

 haemorrhagic erosions also, wliich, as proved by autopsies, quite fre- 

 quently accompany chronic catarrh, cancer, and ulcer, rarely cause 

 haematemesis and consequently are rarely recognized during life. 



In other cases, it is true, the mixture of small quantities of blood 

 with the vomited matters leaves no doubt that there has been a haem- 

 orrhage from the stomach, when it is certain that the blood has not 

 been previously swallowed ; but frequently haematemesis is the only 

 symptom of the bleeding. This is daily observed in patients with 

 cancer of the stomach, who are neither better nor worse when they 

 vomit the " coffee-ground " masses. 



If there has been a quantity of blood poured into the stomach, 

 there are usually some symptoms preceding the haematemesis. These 

 depend partly on the stomach being full of blood, partly on the empti- 

 ness of the blood-vessels of the body. The patients have a feeling of 

 pressure about the stomach, a desire to loosen the clothes, feel con- 

 stricted and nauseated ; they become pale, the pulse is small, the skin 

 cool, they see sparks before the eyes, have noises in the ears, become 

 dizzy, or they even faint. I knew one case where a surgeon opened 

 a vein for his mother, while she was in such a state, thinking that she 

 was apoplectic. In robust, strong persons the faint feelings do not 

 occur, and the premonitory symptoms are limited to the feeling of 

 pressure and fulness in the epigastrium. After there has been nausea 

 for a time, accompanied by the feeling of a warm fluid rising in the 

 oesophagus, and a sweetish, stale taste, there is violent vomiting, and, 

 to the great terror of the patient, blood, partly fluid, partly clotted, 

 and usually dark brown, is evacuated through the mouth and nose. 

 Small portions of blood often enter the larynx and induce coughing, 

 and, as blood is brought up by this also, the patients relate that they 

 have " broken a blood-vessel," but they cannot say whether they vom- 

 ited or coughed up the blood. Sooner or later, after the haematemesis, 



