550 DISEASES OF THE STOUACH. 



masses, will very rarely be necessary to determine that it is realty 

 altered blood. 



It is usually easy to decide whether the bleeding depends on the 

 erosion of large vessels or the rupture of capillaries. Besides the fact 

 that in the first case the bleeding is usually more abundant than in 

 the latter, a review of the premonitory symptoms almost always gives 

 a certain means of diagnosis. If there have been cardialgic attacks, 

 chronic vomiting, and other symptoms of ulcer of the stomach, there 

 is probably erosion of a large vessel, which is by far the most frequent 

 cause of haemorrhage from the stomach. If, on the contrary, there have 

 been ascites, enlargement of the spleen, or other signs of obstruction 

 to the portal circulation, the haemorrhage is most probably from the 

 smaller vessels, and was caused by venous congestion. If the hemor- 

 rhages occur regularly every four weeks while there is amenorrhcea, we 

 must suspect extensive fluxion to the stomach ; if it come during yel- 

 low fever, or scorbutis, or after exhausting diseases, we must suspect 

 disturbance of nutrition of the walls of the vessels. 



PROGNOSIS. We have already mentioned that only a small pro- 

 portion of patients die from hematemesis, and that in spite of the 

 waxy color of the skin, and even of the long-continued faintness, we 

 may give a favorable prognosis. It is doubtful whether haemorrhage 

 from the stomach has under any circumstances a beneficial influence 

 on chronic ulcer of the stomach ; if the patients are occasionally better 

 for a long time after it, it is probably because the severe attack has 

 frightened them, and they have become more careful in their diet. 

 The haemorrhages caused by congestion may temporarily have a good 

 effect on the other symptoms of abdominal plethora. On the other 

 hand, in scorbutis and other exhausting diseases, haemorrhage from 

 the stomach always renders the prognosis more grave. 



TREATMENT. The prophylactic and causal indications are fulfilled 

 by the treatment of the original disease. If patients, with cirrhosis or 

 other disturbance of the circulation of the liver, show premonitory 

 symptoms of haemorrhage from the stomach, we may with advantage 

 apply a few leeches to the anus ; in women, who with amenorrhoea 

 nave periodical vomiting of blood, we may from time to time apply a 

 ew leeches to the os uteri. 



The indications from the disease require a less energetic treatment 

 in haemorrhage from the capillaries, than in that depending on erosion 

 of a large vessel. At the commencement of the latter, Jaksch recom- 

 mends a venesection ; but this is rarely beneficial, and when not so, 

 increases the danger. The employment of Junotfs cupping-boot 

 would be much more advisable, but never after faintness has come on ; 

 for, after this, the use of haemospastics, which may cause even robust 



