H^MORRHAGIES. 301 



appearance, and when it is manifestly mixed with other contents 

 of the stomach : we can seldom have any doubt of the source 

 from whence the blood proceeds, and therefore of the existence 

 of the disease we treat of. 



MXVIII. We must allow it to be possible that a plethoric 

 state of the body from general causes, may be accompanied 

 with causes of a peculiar determination and afflux of blood to 

 the stomach, so as to occasion an haemorrhagy there, and thence, 

 a vomiting of blood; and in such a case this appearance might 

 be considered as a primary disease. But the history of diseases 

 in the records of physic afford little foundation for such a sup- 

 position ; and, on the contrary, the whole of the instances of a 

 vomiting of blood which have been recorded are pretty mani- 

 festly symptomatic of a more primary affection. 



Of such symptomatic vomitings of blood, the chief instances 

 are the following. 



MXIX. One of the most frequent is that which appears in 

 consequence of a suppression of an evacuation of blood which 

 had been for some time before established in another part of the 

 body, particularly that of the menstrual flux in women. 



MXX. There are instances of a vomiting of blood happen- 

 ing from the retention of the menses ; but such instances are 

 very uncommon ; as a retention of the menses rarely happens 

 in consequence of, or even with, a plethoric state of the body ; 

 and as rarely does it produce that, or the haemorrhagy in question. 



There are instances of a vomiting of blood happening to 

 pregnant women ; that might therefore also be imputed to the 

 suppression of the menses, which happens to women in that 

 state. There have indeed been more instances of this than of 

 the former case ; but the latter are still very rare : For, al- 

 though the blood which used to flow monthly before impregna- 

 tion, is, upon this taking place, retained, it is commonly so 

 entirely employed in ^dilating the uterine vessels, and in the 

 growth of the foetus, that it is seldom found to produce a 



t plethoric state of the body, requiring a vicarious outlet. 

 The vomiting of blood, therefore, that is vicarious of the 

 menstrual flux, is that which commonly, and almost only, hap- 

 pens upon a suppression of that flux, after it had been for some 

 time established. 



