When blood is vomited by nursing infants the possibility of its coming from the breast of the mother is to be thought of.
Sometimes blood from the nose or throat is swallowed, particularly when the bleeding occurs during the night. This blood may subsequently be vomited. The inspection of the nose or throat will generally reveal the source of the hemorrhage in such cases.
The diagnosis between hemorrhage from the oesophagus and that from the stomach must be based upon the clinical history. The oesophagoscope, however, has been successfully employed for diagnostic purposes. Several cases have been reported of fatal hemorrhage from varices of the oesophagus. Such hemorrhage cannot be distinguished from gastric hemorrhage.
Much more frequently arises the question whether the hemorrhage is from the stomach or from the lungs. Sometimes the decision of this point is very difficult, and it may even be impossible, especially when the physician is obliged to trust only to the statements of the patient or his friends. Difficulty in the diagnosis results mainly from the fact that coughing and vomiting of blood are often associated with each other. With hæmoptysis blood may be swallowed and then vomited, and with hæmatemesis more or less coughing occurs. The diagnosis is to be based upon the points contained in the following table:
| HÆMOPTYSIS. | HÆMATEMESIS. |
| 1. Usually preceded by symptoms of pulmonary or of cardiac disease. Bronchial hemorrhage, however, without evidence of preceding disease, is not rare. | 1. Usually preceded by symptoms of gastric or of hepatic disease, less frequently by other diseases (see [Etiology]). |
| 2. The attack begins with a tickling sensation in the throat or behind the sternum. The blood is raised by coughing. Vomiting, if it occurs at all, follows the act of coughing. | 2. The attack begins with a feeling of fulness in the stomach, followed by nausea. The blood is expelled by vomiting, to which cough, if it occurs, is secondary. |
| 3. The blood is bright red, fluid or but slightly coagulated, alkaline, frothy, and frequently mixed with muco-pus. | 3. The blood is dark, often black and grumous, sometimes acid, and usually mingled with the food and other contents of the stomach. |
| If the blood has remained some time in the bronchi or a cavity, it becomes dark and coagulated. | If the blood is vomited at once after its effusion, it is bright red and alkaline, or it may be alkaline if it is effused into an empty stomach. |
| 4. The attack is usually accompanied and followed by localized moist râles in the chest, and there may be other physical signs of pulmonary or of cardiac disease. | 4. After the attack the physical examination of the lungs is usually negative, but there are generally symptoms and signs of gastric or hepatic disease. |
| Bloody sputum continues for some time, often for days, after the profuse hemorrhage ceases. | Black stools follow profuse hæmatemesis. |
As it is important that the patient should be as quiet as possible during and for some time after the hemorrhage, any physical examination which disturbs the patient, such as percussing the posterior part of the chest or palpating the abdomen, should be avoided.
The diagnosis of the many causes of gastric hemorrhage belongs to the description of the various diseases which have been enumerated under the etiology.
PROGNOSIS.—It is exceptional for gastric hemorrhage to prove immediately fatal. According to Fox, such an occurrence is more frequent with cirrhosis of the liver than with ulcer or cancer of the stomach. The ultimate result of the hemorrhage depends greatly upon the previous condition of the patient. If this condition was good, he often rallies from the most desperate prostration immediately following the hemorrhage. A previously enfeebled patient is of course more likely to yield to the further anæmia and exhaustion caused by profuse hemorrhage. Although the symptoms of gastric ulcer and of cirrhosis of the liver are sometimes improved after hemorrhage from the stomach, nevertheless this hemorrhage can never be regarded as a welcome event.
For the treatment of gastric hemorrhage see ULCER OF THE STOMACH.