Volume 5

The library of medicine / Arranged and edited by A. Tweedie.

  • Tweedie, Alexander, 1794-1884
Date:
[1844?]
Catalogue details

Licence: Public Domain Mark

Credit: The library of medicine / Arranged and edited by A. Tweedie. Source: Wellcome Collection.

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    blood be detected in the stools, there is not only uncertainty from what part of the canal it has been effused, but there is little suspicion of its being effused from the stomach. On the other hand, the quantity of blood poured into the stomach may be very large, and the haemorrhage very sudden; the individual sinks into fatal syncope, and no blood is vomited. A case of this description is alluded to by Dr. Watson. (Med. Gaz. voL x. p. 438.) Whenever blood is vomited, some degree of caution in deciding upon the source of the haemorrhage should be exercised. There are cases of bleeding from the nostrils, the fauces, or even lungs, in which the blood, collecting in the pharynx, provokes, from time to time, an involuntary action of deglutition, and gradually accumulating in the stomach, is at length ejected by vomiting. This may occur in epistaxis coming on during sleep, especially in young chil¬ dren. The blood which is vomited is often in considerable quantity and co¬ agulated, so that, from its appearance, it is scarcely possible to conclude that it has proceeded from any other source than the stomach itself. Haematemesis is one of the few complaints which may be successfully feigned by impostors, either for the sake of avoiding military or naval service, or with the intention of exciting the compassion of the charitable. Blood has sometimes been swallowed in considerable quantities by such persons, and then vomited in the presence of those whom they wish to deceive. Diagnosis. There is only one disease which is likely to be confounded with haematemesis, and that is a very profuse haemoptysis. In copious haemoptysis, the blood issues from the mouth in gushes, as it does in hsematemesis ; its re¬ gurgitation into the pharynx, the tickling sensation it produces there, or the violence of the cough which frequently excites retching—these causes, acting singly or together, produce sometimes a convulsive contraction of the muscles of the thorax, followed not unfrequently by vomiting. On the other hand, in sudden and profuse hsematemesis, the irritation of the blood passing over the epiglottis is very likely to provoke a violent fit of coughing. In these cases, which are perplexing when we first approach them, and par¬ ticularly so if the patient be of the lower class, we may nevertheless arrive at a correct diagnosis by a careful investigation of the symptoms that precede, ac¬ company, and follow the haemorrhage. The premonitory symptoms of haema- temesis, particularly in reference to the digestive organs, have already been described. This affection is also more frequently than haemoptysis preceded by the symptoms of approaching syncope, because the quantity effused in gas¬ tric haemorrhage is sometimes very considerable before the actual hsematemesis, but not so in bronchial haemorrhage. On the other hand, haemoptysis is usually- preceded by dyspnoea, cough, tickling in the throat, and a sensation of a bubbling fluid in the chest. Most commonly too, immediately before or after the hae¬ moptysis, there is expectoration of bloody sputa. Again, those who are con¬ versant with the practice of auscultation and percussion, will find the physical signs of structural changes in the lungs, or of the presence of the effused blood within the bronchial tubes. The expulsion of blood in gastric haemor¬ rhage ceases shortly after the first full vomiting, and is succeeded by obscure pains in the abdomen; but in haemoptysis the haemorrhage continues in smaller quantities, and is followed by increased dyspnoea and cough. It has been stated by Chomel (Diet, de Med. vol. x.) and other writers, that haematemesis is a rare form of haemorrhage; some have even asserted that haemorrhage takes place less from the stomach than from any of the mucous surfaces. There is no doubt, however, that htematuria is much more rarely met with, and that haematemesis is, in this metropolis at least, by no means a rare disease. Haematemesis, like other forms of haemorrhage, is apt to recur ; sometimes there is no recurrence, though more commonly it is reproduced by the same or other exciting causes. Though an alarming syncope may take place at the time of the haemorrhage, death is very rarely the immediate consequence of hae¬ matemesis, even when the quantity of blood vomited is very large. Its frequent