54:8 DISEASES OF THE STOMACH. 



there is a passage of blood from the bowels. If the haemorrhage were 

 very copious, blood is passed at stool very soon afterward, and it 

 appears in black, clotted masses ; if it be not passed for two or three 

 days after the haematemesis, it is usually changed to a black, tar-like 

 mass. In exceptional cases the blood poured into the stomach is 

 evacuated by stool alone, and there is no vomiting. If patients, suffer- 

 ing from chronic ulcer of the stomach, become very pale in a shorl 

 time, and show other symptoms that may depend on internal haemor- 

 rhage, we should not neglect to examine the passages repeatedly. 

 Many pounds of blood may be withdrawn from the circulation in a 

 short time by haemorrhage of the stomach ; and even the strongest 

 persons will then become pale, cool, and faint. In severe cases, every 

 attempt of the patient to sit up, or even to raise the head, causes 

 nausea, blackness before the eyes, and dizziness ; every attempt to 

 rise brings on fainting. Terrifying as it usually is to the , patient and 

 those around him, the fainting undoubtedly has a beneficial effect on 

 the attack, for it momentarily arrests the haemorrhage and favors the 

 formation of coagula. It appears entirely due to this fact that the 

 affection usually terminates more favorably than we should expect 

 from the appearance of the patient. Indeed, proportionately few 

 patients die of haemorrhage from the stomach, that is, by bleeding to 

 death, or suffocating from the blood entering the larynx. Much more 

 frequently, after the patients have become deathly pale and exces- 

 sively exhausted, and have lain for days in an apparently hopeless 

 state, the vomiting ceases, blood gradually disappears from the stools, 

 and a very slow convalescence begins. The patients long remain with- 

 out appetite, complain of foul eructations and an unpleasant taste. As 

 the great loss of blood is replaced by water, the patients become very 

 hydraemic, and often dropsical ; but these symptoms may also disap- 

 pear, although, perhaps, somewhat slowly, and the patients recover. 



Finally, we must mention those cases where the haemorrhage is so 

 profuse that the patient dies before the blood is evacuated either up- 

 ward or downward. We must remember this when a patient, who has 

 had the symptoms of chronic ulcer or cancer of the stomach, suddenly 

 sinks with the symptoms of internal haemorrhage and dies in a fe\\ 

 minutes. 



DIAGNOSIS. Since patients with haemoptysis often vomit at the 

 same time, and those with haematemesis frequently nave a coincident 

 cough, it is not always easy to distinguish haemorrhage of the stomach 

 from that coming from the lungs or bronchi, particularly if we are not 

 present at the time, or if it is a question of a " haemorrhage " that has 

 occurred some years before. The following points are important in 

 the differential diagnosis. 



