138 THE TREATMENT OF DISEASES. 



age of fourteen. She had never menstruated in the usual way. This occurred until 

 she married, and in due time became pregnant, whereupon the haematemesis ceased. 

 She brought forth her infant, but during the period of suckling the haemorrhage did 

 not recur. It came on again soon after she ceased to nurse the child. No regular 

 menstruation from the womb ever happened. This form of haemorrhage is not, as 

 a rule, dangerous, and has little tendency to shorten the life of those who are 

 afflicted with it. Sometimes, however, it does prove 'dangerous, the exhaustion 

 from the mere loss of blood causing considerable alarm for the patient's safety. 

 Two instances are recorded of suppressed menstruation being followed by copious 

 haemorrhages from the stomach, which ultimately proved fatal. In neither of these 

 cases was the health seriously deranged, nor previously to the onset of bleeding 

 was there any debility or constitutional disturbance which could have afforded the 

 slightest suspicion as to the unfortunate termination of the illness. 



In the majority of cases haematemesis is dependent on some injury to, or disease 

 of, the stomach. The affections of the stomach in which it is most likely to arise are 

 ulcer and cancer. It is sometimes a consequence of swallowing irritant poisons. 

 Haemorrhages from the stomach may be the result of congestion of the stomach, 

 arising from disease of the heart, or liver, or spleen. People who have injured 

 their livers by excessive drinking often bring up blood from the stomach. 

 Haematemesis may also occur in the course of yellow fever, sea-scurvy, and some 

 other diseases. 



Vomiting of blood is more common in women than in men. It is usually pre- 

 ceded by a sensation of weight and uneasiness at the pit of the stomach, and by 

 nausea. It may also be ushered in by paleness of the face, dimness of vision, and a 

 feeling of faintness. The haemorrhage commonly produces great depression, owing 

 partly to the alarm which, naturally enough, is always engendered by " spitting 

 blood," and partly from the quantity of blood actually lost; In bleeding from the 

 lungs, as we shall see presently, the blood is brought up by coughing, in mouthfuls 

 at a time, is of a florid red colour, is frothy, and is frequently mixed with sputa. 

 Moreover, bleeding from the lungs is usually preceded by cough, shortness of breath, 

 with palpitation, tickling in the throat, and a peculiar sensation in the chest. We 

 shall have more to say on the mode of distinguishing bleeding from the stomach from 

 bleeding from the lungs, when speaking of the latter complaint. A difficulty in 

 making the diagnosis may arise either when the blood is vomited immediately after 

 its effusion into the stomach, so as to escape the action of the gastric juice, or when 

 that proceeding from the lungs has been swallowed and subsequently vomited in an 

 altered condition. Haemorrhage from the stomach is seldom, if ever, the first 

 symptom of disease of that organ. The patient has usually for some time been com- 

 plaining of dyspeptic symptoms, and has suffered from pain in the stomach, nausea, 

 or vomiting. 



When a large quantity of blood is poured out into the stomach, it appears 

 to have a nauseating and emetic effect, and is soon rejected by vomiting. The 

 dark colour which it presents is due to the action of the gastric juice, and the 

 degree of blackness will be in proportion to the relative quantity of the acid 

 which it meets in the stomach, and the intimacy of the admixture. Sometimes 



