Hematemesis

“ In many instances it is probably independent of any secondary infection, since it occurs in both ulcerative and non-ulcerative cases. It seems to be more common in sarcoma than in carcinoma. Very large counts are rarely noted.
[p. 161] (c) Post-hemorrhagic.—Moderate leukocytosis follows hemorrhage and disappears in a few days.
(d) Toxic.—This is a rather obscure class, which includes gout, chronic nephritis, acute yellow atrophy of the liver, ptomain poisoning, prolonged chloroform narcosis, and quinin poisoning. Leukocytosis may or may not occur in these conditions, and is not important. ”

“ Experience has not yet sanctioned the benefit of copious bleeding from the arm, in incipient disease, or irritation verging to inflammation of the intestinal surface, as in small-pox; while its efficacy is admitted in measles. But conceding its doubtful character, local bleeding, as by cupping, and leeching on the abdomen, might be serviceably employed in the form of disease now under consideration; as we know it to have been in other febrile affections, where the same parts were diseased. Topical depletion does unquestionably exercise the best effect on membranous inflammation. ”

“ In females the pelvic organs are often the true source of emesis. Haematemesis accompanies gastric ulcer, cancer, chronic congestion with haemorrhagic erosion, congestion of the liver, or may follow violent acts of vomiting. In cases of ulcer the blood is usually bright and in considerable amount; in cancer, darker, like coffee-grounds; and in cases of erosion, in smaller quantity and of bright colour. The reaction of the stomach contents, if the cause be doubtful, yields valuable aid towards a diagnosis. ”

“ The PROGNOSIS is in the highest degree unfavorable, and in those cases, few, indeed, in number, in which there were symptoms like leukæmia and which disappeared under treatment, the doubt remains whether they were true examples of the disease. When once established, the spleen and glands enlarged, the hemorrhages and dropsies present, and the blood condition marked, death is the only termination to be expected. Specially unfavorable signs are a tendency to hemorrhage, persistent diarrhoea, early dropsy, rapid increase in the splenic tumor, great excess of colorless corpuscles, and high fever. ”

“ A slight exciting cause is all that is necessary to produce their rupture. The primary cause is the false membrane, and, in some cases, vascular granulations, which have rapidly formed, perhaps in twenty-four hours—conditions eminently favorable to the production of hemorrhage. In cancerous, tubercular, and dyscrasial conditions of the blood, the blood-vessels are especially weak and easily give way, owing to the defective nutritive properties of the blood itself, just as, in typhoid fever, we have nasal and intestinal hemorrhage, and in typhus, petechiæ. ”

“ A hematoma acts as an irritant, inflammation ensues around it and it is encapsuled by embryonic tissue, which, by organizing into fibrous tissue, forms a blood cyst and gradually absorbs the fluid blood, the cysts contents becoming thicker and thicker. A fibrous scar may remain, and a blood clot, with very much indurated surrounding tissue, giving a hard edge, is noticed after bruises of the periosteum. If serum is not absorbed, hematoidin forms and the fluid becomes clear. ”

“ It occurs commonly in nearly all acute diseases of the lungs, especially in bronchitis and inflammation of the voice-box. These are the common causes. In all the amount of blood spat up is very small—usually merely streaks. In consumption and some forms of heart disease blood-spitting is common and is often very profuse. Other causes of profuse bleeding are the rupture of an aneurism and some diseases of the vessels of the lungs. Or the blood may come from the stomach. This is a formidable list, but we have no doubt whatever which of these caused your blood-spitting. ”

“ Hæmatemesis is less uncommon, but is by no means frequent; the blood ejected from the stomach is usually small in quantity, but in isolated examples the bleeding is profuse, producing great exhaustion and a sense of cardiac depression which preludes speedy death. Hemorrhage from the bowels is also an ill-omened feature, completely blanching the patient and presaging early exhaustion and death. Blood may also appear as a product of a complicating dysentery which determines abundant, offensive discharges that may run on for several weeks before the patient is finally exhausted. ”

“ Lymphocytes are formed in the lymphoid tissues, including that of the bone-marrow. They constitute, normally, 20 to 30 per cent. of all leukocytes, or about 1000 to 3000 per c.mm. of blood. They are more abundant in the blood of children.
The percentage of lymphocytes is usually moderately increased in those conditions which give leukopenia, especially typhoid fever, chlorosis, pernicious anemia, and many debilitated conditions. A marked increase, accompanied by an increase in the total leukocyte count, is seen in pertussis and lymphatic leukemia. ”

“ Infants often do not live long enough for the jaundiced stage to develop, but die within twenty-four hours, the chief symptoms being vomiting and convulsions.
§ 281. Hæmorrhagic Form.—The symptoms set in as just detailed, and jaundice appears, but accompanied by a new and terrible train of events—viz., great effusion of blood. In some cases the blood has been poured out simultaneously from the nose, mouth, bladder, kidneys, and bowels. Among women there is excessive hæmorrhagia. The liver is found to be swollen and painful; the bodily weakness is great. ”

“ In acute anaemias, such as those associated with septicaemia, there is no doubt that blood destruction plays the principal part. But if the cause of anaemia is a chronic one, a gastric cancer, for instance, though there may possibly be an increased amount of destruction of corpuscles in some cases, and though there is often loss by haemorrhage, the cancer interferes with nutrition, the blood is impoverished and does not nourish the erythroblasts in the marrow sufficiently, and the new corpuscles which are turned out are few and poor in haemoglobin. ”

“ Certain persons have isohaemolysins in their blood which dissolve the red cells of other persons and in paroxysmal haemoglobinuria autohaemolysins may be present which can destroy the patient’s own red cells. This auto-haemolysis seems operative only when a low temperature is followed by a high one. When haemoglobinaemia exists the liver converts it into bile pigment causing bilious stools and jaundice. If one-sixth of the red cells are destroyed haemoglobinuria results. ”

“ A rapid loss of flesh is one of the earliest and most common symptoms. The symptoms above enumerated continue and grow worse, and in quite a proportion of the cases there is, in addition, spitting up blood, which in some instances may be so pronounced that it becomes a distinct hemorrhage. In the more rapid or “galloping” forms of the disease the patient frequently dies within a few weeks or a month or so, while in the less severe types the malady may persist for many years before death occurs. ”

“ Myelocytes are rare.
The red corpuscles show the changes usual in severe secondary anemia. Erythroblasts are seldom abundant. Blood-plaques are decreased.
3. Pseudoleukemia (Hodgkin's disease) resembles lymphatic leukemia in that there is marked and progressive enlargement of the lymph-nodes. There is, however, no distinctive blood-picture. The changes in hemoglobin and red cells resemble those of a moderate symptomatic anemia, with rather low color-index. The leukocytes are commonly normal in number and relative proportions. ”

“ Very constant also is a marked absolute, and often a relative, increase of eosinophiles and basophiles. Polymorphonuclear neutrophiles and lymphocytes are relatively decreased.
[p. 210] The red cells show the changes characteristic of a severe secondary anemia, except that nucleated reds are commonly abundant; in fact, no other disease gives so many. They are chiefly of the normoblastic type. Megaloblasts are uncommon. Blood-plaques are generally increased.
2. Lymphatic Leukemia.—This form may be either acute or chronic. There is marked loss of hemoglobin and red corpuscles. ”

“ Only it's caused by particles so small that you can't even feel when they penetrate the skin. They're large enough to poke holes in your intestines, though. Large enough to make microscopic passages for bacteria. So, you see, for every bleeding patient, there will be hundreds, thousands, coming down with peritonitis—infection of the body cavity from within. Without drugs the inflammation spreads in hours, and the temperature goes up and up. It's fatal."
I could almost feel the pain in my belly and the fire in my veins as he spoke. Doc Thorsen took another drink and handed me the bottle. ”

“ Young children stand the loss of blood badly, but they quickly recover, as the regeneration of blood takes place rapidly. In old people also, and especially when they are fat, the loss of blood is badly borne, and the ill effects last longer. Women, on the whole, stand loss of blood better than men, and in them the blood is more rapidly re-formed. A few hours after a severe haemorrhage there is usually a leucocytosis of from 15,000 to 30,000. ”

“ The rare and rapidly fatal anemia which has been described under the name of aplastic anemia is probably a variety of pernicious anemia. Absence of any attempt at blood regeneration explains the marked difference in the blood picture. Red corpuscles and hemoglobin are rapidly diminished to an extreme degree. The color index is normal or low. The leukocyte count is normal or low, with relative increase of lymphocytes. Stained smears show only slight variations in size, shape, and staining properties of the red cells. ”

“ Emphysema is generally present in the cellular tissues, but this latter symptom may also occur at times with non-penetrating wounds of the chest. If death does not occur speedily from hemorrhage by compression of the lungs or heart, there are good hopes of saving the patient, but the prognosis should be reserved. For even when the first effects of the wound of the lung are survived, the patient may die from the effects of inflammation, recurring hemorrhage, or a too sudden relaxation of regimen. ”

“ The dangerous forms of degeneration—the edematous, the cystic, the telangiectatic, and the sarcomatous—occur with sufficient frequency always to be dreaded; and, even though these dangers be avoided, the anemia from the continual hemorrhage exposes the woman to fatal results from the diseases and accidents of daily life. ”

“ Normoblasts are very numerous and megaloblasts appear later. There is both polychromatophilia and poikilocytosis. The color index is that of pernicious anaemia, above 1. The leucocytes are increased to about 20,000 with 75% of neutrophiles, among which are many immature forms or metamyelocytes. The pathological process shows its greatest activity in the bone marrow.
Malta Fever.—In this disease blood cultures offer the surest and most practical way of making the diagnosis. The blood should be taken from a vein at the time of the height of the fever rise. ”

“ The coal-dust and the iron-filings are often sharp and jagged fragments, which penetrate the delicate tissues, and the escaping red blood-corpuscles are acted upon by the amoeboid cells in the air-passages, with the consequent formation of hæmatin or hæmatoidin, as are the blood-corpuscles in larger hemorrhages. The inhaled pigment finds its way, either directly or by the agency of amoeboid cells, into the lymphatics and fibrous tissue of the lungs, and remains indefinitely either in the bronchial and pulmonary lymphatic glands or in the interstitial tissue of the lungs. ”

“ In human studies, severe malaria has been associated with increased angiopoietin-2, decreased angiopoietin-1, and decreased endothelial nitric oxide levels [75] – [76] , and the upregulation of counter-regulatory molecules including HO-1 and erythropoietin [76] – [77] .
Few studies have investigated the impact of hemoglobinopathies on these responses, though recent murine and human studies have shed light on a possible role for HO-1. Normally, HO-1 catabolizes and thus mitigates the cytotoxicity of free heme, which is released by the degradation of the RBC's hemoglobin. ”

“ In young people, who have not been reduced in health and strength by privations and hard service, the bleeding should be repeated until the desired object has been effected; the quantity required to be drawn in inflammation, particularly after injuries, is often very great. It may almost become a question, in some cases, whether a patient shall be allowed to die of the disease, or from loss of blood; for convalescence is rapid in proportion as the inflammation is of small extent, and has been early subdued. ”

“ The immediate effect of the bleeding is to alarm the patient and family, no matter how slight it may be, inducing heart palpitation and other nervous symptoms. A small bleeding is not attended with any bad result, but large ones give rise to the symptoms of shock (sometimes immediate death) combined with anemia following the loss of blood. When the bleeding is large, blood by the mouthful may be ejected with each cough, and in these instances of such profuse bleeding is shown by dizziness, faintness, cold extremities, excessive pallor, sweating and rapid, small feeble pulse. ”