HEMATEMESIS.
This has been dealt with under Gastric Ulcer; only a brief résumé is necessary here.
Absolute rest in the horizontal position, and physiological rest to the stomach, as far as possible, should he maintained. Ice sucked in the mouth or swallowed in small pieces should be the only substance permitted to enter the stomach, but often much harm is done by permitting the patient to distend his stomach with water in this manner, as the tempera ture of the liquefied ice is soon raised to that of the body, and no hterno static action is procured. Stimulants, food and even medicines must be administered by the bowel.
Iced compresses in thin subjects, and dry cups and smart sinapisms, where the abdominal walls are thick, may be employed externally in severe cases. If iced compresses are used, they should not be kept on longer than 3o minutes at a time, as congestion of the gastric membrane will occur. Hot mustard foot-baths tend to diminish luemorrhage by acting as revulsants.
Morphia, given as a suppository or by hypodermic injection, arrests pc] istaltic action in the stomach, allays nervous excitement and calms the circulation, putting the patient into the most favourable conditions for recovery.
Chloride of Calcium should be given as a routine in all cases; by rapidly increasing the coagulability of the blood it tends to seal up the open mouth of the bleeding vessel. I t should he administered in r dose of Go grs. dissolved in 3 to 5 oz. water injected slowly into the rectum. Suprarenal Gland in the form of Adrenalin Solution nay he given by the mouth (3o mins.) mixed with r dr. water. If given hypodermically, it may increase the kernorrhage l V raising the general blood-pressure. It may he given by I he mouth when tile lime salt hos been injected into the bowel.
In desperate eases, where mither of these remedies is retained, the only resour( c left to the physician is to inject normal Saline solution into a vein or into the subcutaneous cellular tissue at different parts of the body, using 20 to Go oz. \\ ith the hypodermic injection the Chloride
of Calcium may be combined. Intravenous injection in these cases may be very difficult, owing to the empty condition of the superficial veins. and the hypodermic route answers all requirements.
Gelatin hypodermically in 2 per cent. solution or even up to to per cent. has been injected deeply into the gluteal region; it must be most carefully sterilised, as death from tetanus has several times followed these injections. It is now procurable in sterilised glass tubes ; the contents of each when mixed with 5 oz. boiled water make a z per cent. solution for injection. The drug may he combined with the saline injection, or in mild recurring gastric ha.morrhage it may he given by the mouth.
When vomiting is severe and the haemorrhage moderate in amount, the writer has obtained ,good results by administering a 3 min. Creosote capsule after the stomach has been emptied by spontaneous emesis.
When the is not due to ulcer or cancer, its source is probably a ruptured varicose vein at the lower end of the gullet. The underlying hepatic congestion will require prompt treatment: 5 to so grs. Calomel may be placed on the tongue and washed down with a teaspoon ful of water, or a saline purge may be given. Nitrite of Amyl may he tried, but all agents which increase the blood-pressure arc to he acoided. Adrenalin by the mouth may be useful from its local action. In purpuric cases Chloride of Calcium Isv the rectum is the hest routine.
The surgical treatment of kematemesis has been already discussed under Gastric Ulcer, and the necessity has been emphasised of the im portance of operating in recurring hsemorrrhagic cases during the intervals of bleeding in order to prevent the occurrence of a fatal hxmorrhage. Gastro-enterostomv meets all the requirements of these cases, as the haemorrhage usually is promptly arrested by making a new route by anastomosis of the stomach with the jejunum. and the same practice holds good in gastric cancer accompanied by haemorrhage.