HJEMORRHAGIE8. 305 



Boerhaave's notion of such a matter existing in the mass of 

 blood is without any foundation ; whilst, by dissections in mo- 

 dern times, it appears very clearly that the morbus niger pre- 

 senting such an appearance of blood, always depends upon the 

 effusion and stagnation I have mentioned. 



MXXX. From this account of the melaena it will appear, 

 that vomitings of blood may arise in consequence of blood being 

 poured out in the manner I have mentioned, either into the ca- 

 vity of the stomach itself, or into the superior portions of the 

 intestines, from whence matters often pass into the stomach. 



MXXXI. Both in the case of the melaena, and in the analo- 

 gous cases from affections of the spleen or liver, it will appear 

 that the vomitings of blood occurring must be considered as 

 symptomatic affections, not at all to be treated as a primary 

 active haemorrhagy, but by remedies, if any such be known, 

 that may resolve the primary obstructions. 



MXXXI I. I believe I have now mentioned almost the 

 whole of the causes producing a haematemesis ; and certainly 

 the causes mentioned are those which most commonly give oc- 

 casion to that symptom. Possibly, however, there may be some 

 other causes of it, such as that singular one mentioned by Sau- 

 vages, of an aneurism of the aorta bursting into the stomach. 

 And it is possible that some diseases of other contiguous parts, 

 which have become closely adhering to the stomach, may some- 

 times, by a rupture into the cavity of the stomach, pour blood 

 into it, which is afterwards rejected by vomiting. It is possible 

 also that abscesses and ulcerations of the stomach itself may 

 sometimes pour blood into its cavity, to be thrown up by vomit- 

 ing. 



I' did not think it necessary among the symptomatic vomit- 

 ings of blood, to enumerate those from external violence, nor, 

 what is analogous to it, that which arises from violent straining 

 to vomit, which last, however, is much more rare than might be 

 expected. In either of these cases, the nature of the disease 

 cannot be doubtful ; and the management of it will be readily 

 understood from what has been delivered above with respect to 

 moderating and restraining haemorrhagy in general. 



VOL. II. 



