125 
a comparatively large vessel ruptures and there occurs an immediate 
attack of vomiting that we see bright red blood. 
In the more severe cases the temperature will recede a little and 
the patient feels better; but this is only for a short time, seven to. 
twenty hours. During the quiescent period the outcome looks rosy 
to the uninitiated. The patient feels himself again, his headache 
and pains have left him. He commences to feel hungry and demands 
food, and talks of being out of bed in a few days. It is hard for the 
onlooker to believe the improvement is only temporary and that 
in a few hours haemorrhages and black vomit will appear. 
Unfortunately such an occurrence is too frequently the case. In a 
few hours the appearance of the patient has altered. He is vaguely 
uneasy and restless. The congestion of the mucous membranes is 
livid. The epigastric tenderness which had lessened, reappears and 
rapidly becomes worse. The liver is tender, and pressure over the 
epigastrium is exceedingly painful. The albumin increases in amount 
and the quantity of urine may decrease. The temperature 
begin to rise. The pulse rate will increase but not in proportion to 
the temperature. Tiny coffee-ground specks, may appear in 
vomitus; these increase in amount; they may coalesce an ecom 
streaky (it is rare to find fresh blood coagula at this stage), when 
suddenly, with little warning to the attendants, black or brownis 
grey vomit will occur. Should the kidneys withstand the strain and 
continue to secrete urine, the patient can recovei even if e 
several bad attacks of black vomit. If the general condition continues 
to become more serious, the icteric tint grows more an 
pronounced. The symptoms become intensified, the black vomi 
may increase in frequency and amount. The patient ecom 
steadily worse. His mind is no longer clear, he ram es 0 
become delirious. The tongue is dry and coated, the ips a 
cracked, the mucous membrane is livid. Haemorrhages ro ™ 
mucous membranes occur. There may be bleeding rom 
gums, nose and ears. The epigastric tenderness is of a 
will elicit a cry from even a delirious patient. ie 
hypodermic needle will often cause a small haemorrhage , 
on the muscles may cause subcutaneous ecchymoses, an j ntes tinal 
may become so intense as to resemble a haemophi ic s a e 
haemorrhages may occur. The bowels will move repeatedly, 
