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Credit: The study of medicine (Volume 2). Source: Wellcome Collection.
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![the pancreas,* the stomach itself, or the smaller intestines ; and the mode of treatment should be as already advised for haemoptysis. [From the effects of that insidious disease, chronic in- flammation of the stomach, an haematemesis is sometimes produced, that rapidly cuts off the pa- tient.—{Dr. Abercrombie, in Edin. Med. Jnurn., No. lxxviii., p 2.) Haematemesis is also one of the earliest symptoms of scirrhus or cancer of that organ; taking place long before the commencement of ulceration, as well as in the ultimate stages of the disease. Then, as Dr. Watson conceives {Med. Gaz., vol. x., p. 436), it may be owing to a breach in some vessel of magnitude, though he represents it as being more commonly a general oozing or exhalation from the ulcerated surface.] In hematuria, the blood is evacuated at the urethra, and the evacuation is preceded by pain in the region of the bladder or kidneys, and accompanied with faintness. The blood is sometimes intermixed with urine, but occasion- ally flows pure and uncombined : and, in this last state, the disease is called by Vogel sty- matosis, and the bleeding is supposed to pro- ceed from the bladder rather than from the kidneys ; that from the latter being smaller in quantity, and remaining a longer time in the passages, and consequently of a darker colour. There is some ground for this opinion ; for, when the bladder is the seat affected, there is far more local pain and faintness than when the affection is in the kidneys. Hippocrates, in- deed, has observed, that when the blood flows pure, copiously, and suddenly, and without pain, it proceeds from the kidneys, but, when it is small in quantity, and of a blackish colour, and accompanied with much heat or pain, or both, its source is the bladder. But this remark, in- stead of opposing, tends rather to corroborate, the preceding ; for, according to both views, the seat of disease is distinguished by the greater or less degree of uneasiness that attends the discharge ; and this whether the quantity dis- charged be larger or smaller. It is not often, though sometimes, an entonic disease, or an active hemorrhage. Its exciting * The statement with respect to the blood pro- ceeding from the spleen, liver, or pancreas, is not correct. Disease of these organs may lead to haematemesis, or exist simultaneously with it; but the source of the blood is in the vessels of the mucous coat of the stomach itself. As Dr. Watson has observed, a great majority of cases of hemorrhage from the stomach are symptomatic. That which depends upon incipient cancer of the stomach, while it is by no means of rare occur- rence, is also more frequently obscure than other instances. In general, an attention to symptoms, and the past history of the patient, will readily elucidate haematemesis from the action of corro- sive poisons ; from the rupture of an aneurism ; from the influence of scurvy, or purpura; from cancer of the stomach in its advanced stages; from organic diseases of the liver, spleen, or heart; from an attack of yellow fever ; from sup- pressed or imperfect menstruation ; or from the pressure of the gravid uterus.—See Dr. Watson's Observations, as published in Med. Gaz., vol. x., p. 439.—Ed. cause is frequently a stone in the bladder, or a violent blow on the kidneys, or on the bladder, especially when the latter is full. It is also said by Schenck (Lib. vii., obs. i., 24), and other wri- ters, to be occasionally produced by cantharides, whether employed externally or internally.* In connexion with the general course of treat- ment already recommended in the preceding varieties, the compound powder of ipecacuanha may here be employed with great advantage : for the pain and irritation are often intolerably distressing, and, on this account, demulcent drinks are frequently found to produce consider- able relief. In uterine hemorrhage, the blood is dis- charged from the womb with a sense of weight in the loins, and of pressure upon the vagina. This is the menorrhagia of most of the nosolo- gists, and is often, but very erroneously, de- scribed as an excess of the menstrual flux. It is, in truth, a real hemorrhage or issue of blood, instead of menstrual secretion, which is often entirely suppressed, though sometimes a small but inadequate portion is intermixed with the uterine bleeding : and hence Hoffman has prop- erly denominated it uteri hemorrhagia. It oc- curs both in an entonic and an atonic state of the vessels, and especially of the general sys- tem : and, from the remarks offered under Ple- thora, it is not at all to be wondered at that * Hist. Mort. Uratislav., p. 58. The editor has known hematuria occur in several cases in which cancerous disease of the neck of the uterus had extended by ulceration into the bladder. In one woman, whom he lately attended in Bos- well-Court, Devonshire-street, the bladder would sometimes become so full of coagulated blood, that a retention of urine used to be induced, in which the catheter had little effect, unless intro- duced much further than usual. He has also known profuse harniaturia arise from a cancerous disease of the bladder ; a case that was remark- able as having been attended with a spontaneous fracture of the left thigh bone and one rib. The particulars have been published in the Trans, of Med. Chir. Society, vol. xvii. M. Andral men- tions a very curious example of haematuria.— (Anat. Pathol., torn, i., p. 339.) It took place in an old woman who had a cancer of the stomach. A fortnight before her death, numerous purple spots appeared on her skin, and a remarkable quantity of blood was daily voided with her urine. Red spots occurred on the conjunctiva, and one of them, rendered very prominent by the blood under it, formed a purple ring round the cornea, like what is observed in chemosis. On opening the body, numerous ecchymoses were found in the cellular texture on the outside of the peritonaeum and the pleura, on the inside of the cavities of the heart, and in different parts of the alimentary canal. The urinary passages contained a bloody fluid, which might also be pressed out of the ma- millae of the tubular substance of the kidneys. No blood was anywhere found, except what was of a purple colour, and quite liquid, without any appearance of coagulum. A similar case is re- corded by M. Stoltz.—(Archives de Med., torn. xv.) The patient, in the latter instance, was a pregnant woman, and it is curious that ecchymo- ses, resembling those noticed in most textures of her body, were also found in the lungs, pericar- dium, heart, and vessels of the foetus.—Ed.](https://iiif.wellcomecollection.org/image/b2112324x_0015.jp2/full/800%2C/0/default.jpg)
