On the Treatment of Hematemesis and Meloena. By Dr. J. M.
Neligan, Physician to Jervis Street Hospital, Dublin.—[Dr. Neligan
remarks that the greater danger of hematemesis and the greater difficulty
of controlling it, as compared with meloena, seem to depend on the size
of the stomach permitting a large accumulation of blood in its cavity
before it contracts ; its contraction “ being the natural mechani-
cal method by which the bleeding is checked.” Thus, he ob-
serves
In the administration of remedies to stop the hemorrhage, the chief
indication to be fulfilled is therefore manifestly to produce contraction of
the stomach, whether the bleeding be symptomatic of organic disease or
not. With this view we should be guided in the choice of styptics or
astringents, and they should be administered in a concentrated form,
or rather as little diluted as possible, so as not to distend the stomach.
In hematemesis or meloena, I place most reliance on the oil of turpentine
as a styptic, and on gallic acid as an astringent; the former, by its
stimulant property, excites the stomach and intestines to contract, and
the latter may be given in the solid form, and is very powerful in small
doses. Ice has often been prescribed to check hemorrhage from the
stomach; but its tendency, when dissolved, is to distend the organ, and to
favor further bleeding by diluting the blood that may have previously
escaped from the vessels, constitutes, I think, a very serious objection
to its employment. As to blood-letting, it is only admissible in those
few cases where the hemorrhage seems to be dependent on general ple-
thora, and even in these must be regarded rather in the light of after-treat-
ment than of an immediate remedy.
The diet in all cases of hemorrhage from the stomach or intestines
must be absolute. Nourishment should be given in a concentrated
liquid form, perfectly cold, and in the smallest quantities at a time; and
a return to the usual articles of diet should be permitted with the utmost
caution.
I regard gallic acid as our most valuable astringent in hemorrhage
from the mucous membrane of the digestive organs, from the uterus
—in many cases of bleeding from which I have seen it prove of the
greatest service, and from the urinary organs.—Dub. Jour., May 1850,
p. 348.