. Diseases of the stomach : including dietetic and medicinal treatment . can be inferred to originate from the stomach. We distinguish, there-fore, visible hemorrhages and occult hemorrhages. 128 ACUTE AND CHRONIC ULCER Types.—Visible Hemorrhages.—Visible hemorrhages in the form ofhematemesis or meleiia occur in a large number of cases of ulcer ofthe stomach, variously estimated by difierent observers. SO per cent,of Leberts cases were marked by hemorrhage, 71 per cent, of Fen-wicks, 50 per cent, of Ewalds. Hemorrhage complicated SO per cent,of ulcer cases at the University College Hos])ital,
. Diseases of the stomach : including dietetic and medicinal treatment . can be inferred to originate from the stomach. We distinguish, there-fore, visible hemorrhages and occult hemorrhages. 128 ACUTE AND CHRONIC ULCER Types.—Visible Hemorrhages.—Visible hemorrhages in the form ofhematemesis or meleiia occur in a large number of cases of ulcer ofthe stomach, variously estimated by difierent observers. SO per cent,of Leberts cases were marked by hemorrhage, 71 per cent, of Fen-wicks, 50 per cent, of Ewalds. Hemorrhage complicated SO per cent,of ulcer cases at the University College Hos])ital, and 00 per cent, ofsimilar cases at the Royal Victoria Hospital. ^Stockton, on the otherhand, finds hemorrhage in only 25 per cent, of cases, and his compiledstatistics show that only 2S per cent, of ulcers give rise to visible hemor-rhages. Statistics on this point are apt to be very misleading. Inhospitals the severer forms of ulcer, especially those with hemorrhage,are relatiAely more frequent than ulcers which do not give rise tosuch alarming symptoms. Fig. 27. Duodenal ulcer showing erosion of an artery in the base, from wliieh fatal hemorrhage occurred. In the writers cases 49 per cent, of tliose in hospital i)ractice gavethe iiistory of vomiting of blood, while in his })rivate i)ractice only25 per cent, gave this history. It is not because the type of ulcer isdifferent, !)Ut because those ulcers which do not bleed are aj^t to betreated in disjuiisaries, while i)atients with hemorrhages are alarmed,and naturally enter the h()S])ital wards. rnd()iil)tedly many cases oflu-morrhage from es()|)hag<al \arices are iiHliidecj among the ulcercases. The souree of llie lieiiiorrliage is usually from an eroded artery—less frer|iieiilly of xciioiis origin. Savariaud in 54 cases found a venous origin in 4 eases, the sj)leiiicartery in 17, coronary artery in (i, gastric artery in 10, pancreatico- HEMORRHAGE IN ULCER 129 duodenalis in 7, while in 10 the source of the hemorrhage
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