BLEEDING FROM THE STOMACH. 139 



the blood is clotted and not much altered in colour, and sometimes it is brown, 

 of a chocolate tint, or like coffee-grounds. Sometimes, when the quantity of blood 

 poured out into the stomach is small, it may pass into the intestines and be 

 voided with the motions. In this way it may escape recognition either from the 

 stools not being examined or from the changes in appearance it has undergone 

 in its passage through the alimentary canal. 



Even when it can be shown that the blood has been vomited it is not a 

 proof that there is disease of the stomach. The blood may have proceeded from 

 the mouth or nose, and have been involuntarily and unconsciously swallowed. 

 This is very likely to happen during sleep, especially to young children, and as 

 the blood when subsequently vomited is coagulated and mixed with food, it is 

 scarcely possible to say from its mere appearance that it has not arisen from 

 bleeding from the stomach. We may in these doubtful and difficult cases succeed 

 in arriving at a correct conclusion by a careful inquiry into all the circumstances 

 of the case, and an examination of the mouth and nose. Hsematemesis is a 

 complaint which is not infrequently feigned, either for the sake of avoiding some 

 punishment, or with the view of exciting compassion. A young girl who was 

 anxious to avoid the constraints of a convent, pretended that she was suffering 

 from severe hsematemesis. In fact, on several occasions, she vomited large 

 quantities of blood in the presence of the physicians who had been summoned 

 to her assistance. It was not till long after, that it transpired that she had 

 swallowed the blood, which had been conveyed to her secretly from the neighbouring 

 shambles. 



Severe haemorrhages from the stomach are occasionally directly fatal ; and this 

 is more likely to occur when the bleeding results from cirrhosis of the liver 

 the form of liver disease caused by drink than when it originates in ulcer or 

 cancer of the stomach. In the last-named disorders haemorrhage is often dangerous 

 from the exhaustion and anaemia it produces. At the same time a very large 

 number of patients with hsematemesis recover from the most hopelessly anaemic 

 states; and we should never despair of saving the patient until life is actually 

 extinct. 



Next, as to the treatment of haematernesis. What should you do in the case 

 of a person vomiting blood 1 In the first place, keep your head steady. No noise, 

 no hurry, no talking. Stand back, please, and give him plenty of air. Make 

 him lie down, undo his clothes, open the windows, and you, sir, go and get some 

 ice, as sharp as you like. When the ice comes, break it up, give him little pieces 

 to swallow ice pills and rub a great lump all over his stomach outside. If you 

 have an astringent or astringent mixture in the house, give him a dose; you can be 

 doing this whilst they are gone for the ice. If you have either the acetate of lead 

 mixture (Pr. 30), the perchloride of iron mixture (Pr. 1), or the gallic acid 

 mixture (Pr. 29), give three table-spoonfuls at once ; or, if you have any tincture of 

 steel, give a tea-spoonful of this in a glass of water; or, if you have liquid extract of 

 ergot, give a tea-spoonful of this in water ; or, if you have oil of turpentine, give a 

 tea-spoonful of this in water or milk ; or, if you have gallic acid or tannic acid, give 

 one of these in water. The dose of either gallic or tannic acid is fifteen grains, 



