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cial reference must be made. It is one of frequent occurrence, and it receives its appellation from the fact of the rejection of a thin watery mucus. The poorer classes of society, and especially its female portion, are the ordinary subjects of this disease, but it is not confined to them. Half a pint of watery fluid, somewhat resembling the white of an egg, is sometimes vomited or regurgitated at once; the discharge is generally neutral in its chemical reaction, and often tasteless, but sometimes it is found to be slightly alkaline, and the patient complains of its saltness. The period at which the discharge of fluid takes place varies both as to the hour of the day and the frequency of the recurrence of the attack. The vomiting, however, generally occurs when the stomach is empty, and it is accompanied with a sense of contraction and of pain at the epigastric region and at the spine. With some patients the attacks come on in the forenoon, with others during the night, at one or two in the morning, and even several hours after retiring to rest. The tongue may be clean, the pulse normal, the patient fairly nourished or anæmic and enfeebled; headache is often present, and in some instances, water brash alternates with more severe gastralgia. It may be the only symptom of disease, but more frequently it is associated with others of a distinctive character. Thus it may be present with chronic ulcer, and we have witnessed a form of pyrosis in connection with colloid disease of the stomach; still,

in simple functional disease, pyrosis may be so severe and so persistent as to lead to the diagnosis of organic mischief.

It is the opinion of Dr. Handfield Jones that pyrosis is a chronic catarrh of the stomach similar to blenorrhoea from the bronchi. Dr. Chambers, however, favours the idea that the œsophagus is the source of the discharge. We know that bile often flows backward into the stomach, and it is possible that the pancreatic secretion may take a similar course, for with relaxed condition of the pylorus, and contraction of the duodenum, this would readily be the case. Pyrosis often occurs during fasting, and also at night, when the recumbent position would favour a retrograde course from the pancreatic duct. The discharge is not ordinary mucus, and if it were from the stomach we should expect more generally an acid reaction.

This condition comes on after the continued use of oatmeal, and hence it is more common in the north. It may follow symptoms of chronic gastritis: it is produced by great anxiety of mind, by over fatigue, or by an over-worked frame. It also occurs during pregnancy, and it is met with amongst the symptoms of commencing cancerous disease of the stomach.

We may briefly state that the remedies which relieve pyrosis are astringents and tonics, as the sulphate of iron with the extract of logwood; quinine with aloes and myrrh; nitrate of bismuth alone, or with conium

and nux vomica; an alterative of blue pill with rhubarb is sometimes beneficial. Solution of potash, with hydrocyanic acid and bitter effusions, is of great service where there is much pain. Other astringents may be advantageously employed with sedatives, anodynes, and tonics, as the compound kino powder, catechu with morphia or opium, oxide of silver, sulphate of copper, strychnia or the infusion, tincture or extract of nux vomica.

BLEEDING FROM THE STOMACH. Hæmatemesis.— Another symptom of disease of the stomach, to which we must separately allude, is bleeding from the stomach, inducing either vomiting of blood, hæmatemesis, or its discharge by the bowels, melana.

Great alarm is naturally excited by the rejection of blood from the stomach, whether in small or large quantities; but the import is very different, for whilst in some cases it is a symptom free from danger, in others it is the indication of serious, if not of fatal disease. The causes of hæmatemesis are,

1. Ulceration of the stomach.

2. A congested or obstructed state of the portal circulation.

3. Vicarious menstruation.

4. Cancerous disease.

5. A vitiated state of the blood, as in purpura, yellow

fever, typhus, &c.

6. Aneurism.

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The hæmorrhage may, however, have its origin in parts connected with the mouth, the throat, and the cesophagus, arising from ulceration, cancerous disease. aneurism, varicose condition of the minute esophageal veins; and the rejection of blood from these sources may be erroneously regarded as hæmatemesis; or, it may proceed from the nose, the larynx, and the lungs, and in some cases considerable difficulty arises in distinguishing the source of the discharge, for the blood may be swallowed and afterwards vomited.

As to the quantity of blood exuded, there is the greatest diversity; sometimes it is only recognised by the most careful, or even microscopical examination; at other times several pints, or even quarts, are rejected at once; and if a large vessel have been divided, the first hæmorrhage may cause fatal syncope. which is thus discharged into the stomach, is generally Blood, coagulated, and is often deepened in colour by the action of the gastric juice; it is devoid of the bright frothy appearance presented by blood from the lungs, which is consequent on the admixture of air. portion of the blood in the stomach becomes still A further acted upon by the gastric juice, and passes into the duodenum. As it extends along the small and large intestine the depth of the colour is increased, and at last it is discharged as a pitchy liquid stool, constituting melæna. Sometimes this black evacuation or melana is the only symptom of hæmorrhage into

the stomach, for no blood may be rejected by the mouth; and when the blood is effused into the small or large intestine, and discharged, the depth of the colour is proportionate to the length of the tract through which the blood has passed, but it never assumes the black colour to which we have referred.

The green fluid which is sometimes vomited in states of great irritation of the stomach has been regarded by Dr. Fraser as altered blood; and the coffee-ground substance, so often rejected towards the close of organic disease of the stomach, consists also of blood which has slowly exuded, the hæmatine being acted upon by the gastric juice. In some cases of purpura a similar appearance is presented, and from a like cause. Much discussion has arisen as to the possibility of the transudation of blood through unruptured capillaries; but the examination of a portion of intestine distended with blood, and presenting points of ecchymosis, as found after disease of the mitral valve, will suggest the probable explanation of instances in which blood has been vomited or discharged, and in which no apparent perforation of vessels has subsequently been found. In such a portion of intestine as is present with mitral valve disease, some of the capillaries are found to be beautifully injected, whilst others are collapsed, and blood is extravasated around them, but limited by the basement membrane, thus constituting a point of ecchymosis; if the basement membrane had given way,

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