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As in the case under D'Andrade's observation, the exudation was found by microscopic examination to consist of the true constituents of blood. An additional element of complication in this case was the occurrence of occasional attacks of hematemesis. Menstruation from the Breasts.
D'Andrade cites an account of a healthy Parsee lady, eighteen years of age, who menstruated regularly from thirteen to fifteen and a half years; the catamenia then became irregular and she suffered occasional hemorrhages from the gums and nose, together with attacks of hematemesis.
If the left ventricle becomes dilated the mitral valve may become insufficient, when the usual lung symptoms occur, with hypertrophy of the right ventricle; and if it fails, the usual venous symptoms of loss of compensation follow. This lesion not infrequently causes epistaxis, hemoptysis and hematemesis. Digitalis is always of value in these cases, but it should not be pushed.
Gardiner mentions a woman of thirty-three who swallowed two false teeth while supping soup. A sharp angle of the broken plate had caught in a fold of the cardiac end of the stomach and had caused violent hematemesis. Death occurred seventeen hours after the first urgent symptoms.
Channing gives an account of the case of Helen Miller, a German Jewess of thirty, who was admitted to the Asylum for Insane Criminals at Auburn, N.Y., in October, 1872, and readmitted in June, 1875, suffering from simulation of hematemesis.
"Remark it well, gentlemen: oppression heat at the epigastrium, all these symptoms certainly announce hematemesis, probably complicated with hepatitis, caused by domestic sorrows, as the yellowish coloration of the globe of the eye indicates; the subject has received violent blows in the regions of epigastrium and abdomen; the vomiting of blood is necessarily caused by some organic lesion of certain viscera.
The affection of the stomach, often mentioned in vague terms, and occasionally as a vomiting of blood, was doubtless only a subordinate symptom, even if it be admitted that actual hematemesis did occur. For the difficulty of distinguishing a flow of blood from the stomach, from a pulmonic expectoration of that fluid, is, to non-medical men, even in common cases, not inconsiderable.
Menstruation after hysterectomy and ovariotomy has been attributed to the incomplete removal of the organs in question, yet upon postmortem examination of some cases no vestige of the functional organs in question has been found. Hematemesis is a means of anomalous menstruation, and several instances are recorded. Marcellus Donatus and Benivenius exemplify this with cases.
Denonvilliers has described a perforation of the esophagus and aorta by a five-franc piece. A preserved preparation of this case, showing the coin in situ, is in the Musee Dupuytren. Blaxland relates the instance of a woman of forty-five who swallowed a fish bone, was seized with violent hematemesis, and died in eight hours.
In this connection may be mentioned the case reported by Hanford of a man of twenty-three who had an attack of hematemesis and melanema two years before death. A postmortem was made five hours after death, and there was so much destruction of the stomach by a process resembling digestion that only the pyloric and cardiac orifices were visible.
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