Bleeding is frightening. Bleeding from the nose is fairly frequent, as is bleeding from a tooth socket or a cut. But a sudden hemorrhage from the lungs or the vomiting of fresh blood or the passing of blood in the urine or in the bowel movements is a cause of anxiety. Because the appearance of blood from the interior of the body is shocking, the statements of people as to the amount of blood lost are seldom dependable. A teaspoonful may seem like a pint. Blood in the stomach or intestines when it appears in the stools has a black or tarry appearance, but it takes at least an eighth of a pint to make the coloration visible.
The severity of the shock that may come from internal bleeding depends on the amount lost and the suddenness with which it occurs. Fever may occur after a hemorrhage, particularly a large one.
The most common cause of vomiting of blood – in forty to eighty per cent of cases – is ulcer of the stomach, or duodenum. Usually the person concerned will have had a previous diagnosis of ulcer. The bleeding usually comes from erosion of a blood vessel in the ulcer. In about five per cent of the cases the cause of vomiting of blood is cancer; that is the reason for having a complete and scientific diagnosis as promptly as possible when this symptom occurs. Hardening of the liver and enlargement of the spleen may back up the circulation so that there are varicose veins in the esophagus or swallowing tube; like other varicose veins these may break and cause the person afflicted to vomit blood. Among miscellaneous and less frequent causes are diseases of the blood like hemophilia and thrombocytopenia in which bleeding is easy.
The first step after vomiting of blood or large hemorrhage from the bowel is to control shock and save life; then comes a careful scientific study to determine the cause and prevent additional bleeding.