Symptoms.—If a large quantity of blood, escape suddenly into the stomach there may be faintness, pallor, insensibility. Sometimes the sudden lots of large quantities of blood pro duces convulsions because of the want of blood in the brain. Immediately, or within a short period, vomiting of the blood will occur and reveal the cause of the faintness. Vomiting of blood is to be distinguished from spitting up of blood from the lungs. The former occurs after some feeling of sickness ; the latter is not vo mited but coughed up, after sonic tickling in the throat. Blood from the lungs is usually bright and mixed with air, that from the stomach is usually dark.
It should be noted that blood that is vomited does not necessarily proceed from the walls of the stomach. It may have proceeded from tile back of the nasal passages or throat,- and may have been swallowed unconsciously, to be after wards vomited. In all cases, therefore, the back of the throat should be examined. Sometimes a streak of blood will be seen passing down from the position of the opening of the nasal cavity behind, indicating the source of the blood.
Treatment should never be adopted without proper medical advice. The reason of this is readily understood. Suppose the bleeding to be due to opening of some blood-vessel by ulceration, what are called styptic remedies are employed, remedies like gallic or tannic acid and tincture of steel, which act by contracting the bleeding vesi;c1c. But suppose the bleeding to be due to escape of blood from gorged blood vessels, whose congestion is due to the liver, plainly styptic remedies are useless, and a suc cessful plan of treatment must remedy the liver defect and so relieve the too full vessels. Again, should the bleeding be an effort of nature to get rid of a discharge by this channel, when the ordinary channel of the monthly flow is denied to it, it is clear that, besides giving medicines like tincture of steel, or ordering the sucking of ice, to arrest the discharge from the stomach, efforts must be made to restore the usual and ,regular discharge. It is necessary to repeat, therefore, that if rational treatment is to be adopted qualified advice should be sought, so that not merely the escape of blood, but the cause of that, should be taken into due consideration. However, it is well to know, in case of some delay in getting advice, and where copious discharge of blood exists, that the person should be kept quiet and at rest in the hori zontal position, that ice should be given to suck, and If) warm food or drink permitted, and that doses of tincture of steel (15 drops) or gallic acid (5 grains) should be gifen to contract the vessels.
Dilatation of the Stomach has been com mented on in the preceding paragraphs on can cer. Mechanical obstruction to the passage of
food from the stomach to the small intestines, such as a tumour can produce, will readily cause dilatation or expansion. Dilatation may exist without any such obstruction. It may be the result of habitual overfeeding, or habitual swallowing of badly-chewed food, or the habitual use of indigestible kinds of food, or any other cause which gradually deprives the muscular wall of the stomach of its tone, so that its walls yield and fail to contract upon their contents.
The symptoms are fulness in the region of the stomach, flatulence, heartburn, uneasiness, and vomiting. The quantity vomited is often very large, several meals being sometimes re tamed and then rejected together. Owing also to the want of regular complete emptying of the stomach, fermentive changes are set up in the stomach, and as a result the vomit may have a sweetish taste.
The fermentation in such cases is frequently set up by the presence in the stomach of the yeast fungus, or of another active agent in fer mentation called sareinw. They are detected by means of the microscope.
Treatment of such cases requires patience and adaptation to the particular instance. Thus a case of dilatation pure and simple would ob viously be much more easily treated than one due to obstruction. In any case small quanti ties of light easily-digested food should be given at a time. Liquid foods are not, as a rule, so well borne as small solid meals in a very fine state of division, given at intervals of not less than four hours. The regular daily use of the stomach-tube, nightly or in the morning, to empty and wash out the stomach, effectually relieves the symptoms as a rule. Electrical treatment, for the restoration of muscular tone, and tonics like strychnine are the main agents in treatment.
In some cases of simple uncomplicated dilata tion remarkable results have been obtained by administering, early every morning before breakfast, four tea-spoonfuls of the Carlsbad Spreudel-saltz dissolved in a pint of water, the whole pint to be taken at once. The salts are obtained in bottles from chemists, but they are rather expensive.] Where sarcinte are suspected to be the cause of fermentive changes in the food in the stom ach, 20 to 60 grain doses of the hyposulphite of soda should be given.
If the case is one of obstruction, there are several operations, one, already named, gastro enterostomy, by which a new outlet is provided, and another, pyloroplasty, by which the nar rowed pyloric outlet is widened.
Obstruction at the Outlet of the Stomach (Pyloric Stenosis) may exist from birth (see DISEASES OF CHILDREN), or may be a conse quence of ulceration or a new growth. It leads to dilatation. Its remedy is operation.