CHAPTER II.

Hæmatemesis.

EXCEPT where hæmatemesis was occasioned by external violence, or took place in consequence of a partial destruction of the stomach itself by ulceration, I have never known it to terminate fatally. It is for the most part induced by the suppression of some natural or long accustomed evacuation, and we must direct our curative intentions to the re-establishment of this evacuation, or the introduction of some substitute for it.

I have known women labouring under suppresssion of the menses lose blood every month with great regularity, from the stomach, lungs, nose, and open ulcers.

Under these circumstances it will be useless for us to attempt to restrain the hemorrhage from the parts themselves; it can only be affected by restoring to the uterus its natural healthy action. The most powerful means we possess to attain this object are, periodical venesection, and active purgatives: upon the former however we must chiefly rely.

Hæmatemesis frequently occurs in consequence of an over-distended state of the blood-vessels of the messentary or liver. When originating from such a cause, active purgatives will be found of most avail. Bloodletting will likewise be sometimes demanded.

When the disease is brought on by the sudden suppression of a hæmorrhoidal defluction, leeches should be from time to time applied about the verge of the rectum; aloetic purges administered, and such other means employed as are calculated to restore the discharge, which is afterwards to be diminished gradually and with great caution.

Although blood may be, and frequently is, thrown from the stomach in immense quantities and for a great length of time, without materially injuring the patient,

hæmatemesis must not be regarded as an insignificant disease.

CHAPTER III.

Ulceration of the Stomach.

WITH the exception of the female breast, there is no part of the body more frequently the seat of scirrhous induration and subsequent ulceration, than the pyloric extremity of the stomach. It is one of the most deplorable diseases to which the human frame is liable. Its wretched victim is doomed to drag out a protracted and miserable existence without a prospect of cure, or even a suspension of suffering for any length of time.

A clear conception of its irremediable nature will be most readily acquired by a description of the destruction which it sometimes occasions.

CASE XXIV.

A poor emaciated creature, aged fifty-two years, was admitted, after having for more than two years suffered excruciating pain in the stomach, attended sometimes with a total inability to retain food.

The disease commenced with all the symptoms usually termed dyspeptic. I could not learn that at any time she had vomited pure blood.

After remaining in the Hospital six weeks she died. During this period, she complained of excessive pain in the epigastric region, and threw up almost every thing she swallowed mixed with a sanious fluid. The only thing she could keep upon the stomach was oil of cinnamon given upon pieces of refined sugar.

Examination.

A firm, thickened, inflamed ridge, extending along the upper surface of the stomach, and pursuing the direction of the edge of the left lobe of the liver, was the first diseased appearance which attracted attention.

It was found that the stomach had formed adhesions with this edge. But for this circumstance its contents would have escaped into the abdomen; for upon making use of slight force to separate the liver from the stomach, the fingers passed directly into the cavity of the latter. The liver, stomach, spleen, and pancreas were removed together from the body, that they might be examined more at leisure.

The pancreas was very much enlarged and indurated at its duodenal portion; and by its pressure must have retarded, or even almost prevented the passage of food along the first intestine.

The spleen was free from disease. The liver had externally a healthy appearance. The stomach was very much distended with fluids. Upon cutting it open in the course of its greater curvature, more than one third of its inner surface was discovered to be in a state of ulceration. At its upper part its coats had been entirely removed and an extensive cavity made in the substance of the liver. The excavated liver truly formed at this place a substitute for the stomach. The pyloric extremity of this organ was much thickened, and its opening into the duodenum nearly closed. The cardiac extremity was perfectly healty. A few patches of a dusky hue were here and there scattered upon such parts of the inner surface as had escaped the ulcerative process.

CHAPTER IV.

Gastritis.

Pyrexia typhodes; anxietas; in epigastrio ardor et dolor, ingestis quibuslibet auctus; vomendi cupiditas, et ingesta protinus rejecta; singultus. Cl. i. O. ii. G. xv.-CULLENI.

Gastritis is for the most part attended with symptoms which clearly point out the nature of the affection; sometimes however, in its attack and progress, it is but imperfectly marked. I have seen it destroy life without a single circumstance occurring by which its existence could be known, or even suspected, till within a few hours of dissolution. The following case illustrates this statement.

CASE XXV.

Henry Hancock, aged twenty years, was admitted on Monday, the 28th of August, 1815, labouring under symptoms of slight pyrexia. His pulse was moderately full and frequent; his skin rather dry; and his tongue white at its centre, and red at its edges. He complained of no particular pain; the epigastric and abdominal regions were destitute of tenderness; he felt neither nausea nor sickness. A cathartic powder, and some saline medicines were directed.

During Tuesday and Wednesday he continued nearly in the same state. On Thursday the limbs became swollen and extremely painful; in short all the symptoms of acute rheumatism manifested themselves.

He was directed another cathartic powder, and sixteen ounces of blood were taken from the arm. The blood speedily exhibited the buffy coat; the crassamentum was in full proportion; the serum very transpa

rent.

On Friday morning he appeared much relieved; his joints were less painful and inflamed; but the pulse con

tinued full and frequent. Sixteen ounces of blood were again drawn away, which were likewise much buffed and cupped.

On Saturday morning a most extraordinary, unexpected, and inexplicable alteration had taken place. His features had assumed the complete Hippocratic aspect; his tongue was dry and brown; his skin covered with a cold clammy prespiration; and his pulse scarcely perceptible. It was evident that he had only a few hours to live.

Had a person unacquainted with his previous history been asked his opinion of him, he would have unhesitatingly pronounced that he was in the last stage of typhus gravior. I knew not what to think; I suspected however that some blood vessel had suddenly given way, and that he was dying from internal hæmorrhage.

Examination.

The whole surface of the peritoneum exhibited traces of inflammation. In some parts this increase of action had been excessive and the coats of the intestines were involved in it. The pelvis was full of serum and flakes of coagulable lymph; and the small intestines were almost inseperably united by the adhesive process. Some lymph and serum was likewise met with in the abdomen.

The stomach was remarkaaly small, but externally presented no diseased appearance. Nearly one half of its inner surface however was found to be in the highest possible state of inflammation. At the pyloric extremity it was of a deep red colour, which became gradually brighter as it diffused itself upon the coats. The duodenum for a short distance partook of the disease.

Queries. Did inflammation of the stomach and intestines exist at the time this patient was admitted, and increase so gradually as not to excite the symptoms by