-In this category are included those small but frequent losses of blood which ensue from superficial ulceration of the growth or from engorgement of its vessels and of those of the surrounding mucous membrane. The bleeding may occur spontaneously or it may be excited by the ingestion of food ; while occasionally the use of alcohol, severe retching, straining at stool, or pressure upon the epigastrium appears to be the determinant factor in its production. The liability to this form of haemorrhage is also increased by any condition which increases the pressure of the blood in the gastric vessels or which materially alters the composition of that fluid. Thus, frequent venous oozing is very common when the disease is complicated by a valvular affection of the heart, cirrhosis of the liver, interstitial nephritis, enlargement of the spleen, or leuchaemia. In some women it is especially apt to occur just before the catamenial period. The amount of blood effused on each occasion varies from a drachm to three or four ounces. If vomiting occurs the ejecta present a brown tinge and gritty appearance (coffee-grounds), owing to the conversion of the albuminous constituents of the blood into globulin and the reduction of the haemoglobin to insoluble haematin. Several substances besides blood impart a brownish tint to the vomit, as, for example, red wines, coffee, and the various preparations of iron ; while a similar colouration of the stools may be produced by the administration of bismuth and calomel. It is therefore important that in every case the vomit should be carefully examined for brownish-black masses or flakes. Under the microscope these minute particles are seen to be composed of granules of pigment mixed with shrunken red corpuscles ; and if there is any doubt as to the nature of the colouring matter, resort should be had to the following process, devised by Korczinski and Jaworski. A small quantity of the suspected material is mixed in a porcelain dish with a few grains of chlorate of potassium and a drop of hydrochloric acid, and gently evaporated to dryness. If any altered blood is present, the addition of a dilute solution of ferrocyanide of potassium to the residue produces an intense blue colour. The filtered vomit may also be examined for blood by Weber's modification of the guaiacum test. The filtrate is mixed with one-third of its bulk of glacial acetic acid, and after being well shaken is allowed to stand for a short time. Ten cubic centimeters of the fluid are then measured off into a test-tube, and to them are added ten drops of a freshly prepared tincture of guaiacum and twenty-five drops of turpentine. If any blood is present the mixture acquires a violet-blue colour, but under other circumstances it appears reddish brown.
Frequent slight oozing of blood, although it may not be accompanied by immediate symptoms, always exercises a deleterious influence upon the general health. In addition to progressive debility, the skin and mucous membranes become manifestly anaemic, and shortness of breath, giddiness, or faintness is experienced on exertion. The appetite disappears, thirst is often excessive, and sleep is disturbed by attacks of palpitation and flatulence. If vomiting is absent and pain an unimportant symptom, the haemorrhage almost invariably escapes detection, and the case is usually regarded as one of pernicious anaemia. When, however, a soft tube is inserted into the stomach during the period of digestion, it is by no means unusual to find that the gastric contents are largely mixed with altered blood. This unexpected discovery was made in several cases which came under our notice for anaemia and indigestion, and in every instance where the bleeding appeared to be continuous a necropsy showed the existence of an ulcerated growth, usually of the scirrhous type. In several of these it was also observed that the degree of anaemia varied with the severity of the haemorrhage, and that when the latter was controlled by treatment the anaemia became less intense. Boas has lately called attention to these facts, and states that he has observed twenty cases of cancer of the stomach in which constant haemorrhage was detected by means of the tube. It must, therefore, be admitted that frequent oozing of blood may take place without the objective symptom of haematemesis, and that its existence can only be determined by a methodical examination of the contents of the stomach. Furthermore, there is reason to believe that this loss of blood is one of the chief causes of the so-called cachexia of gastric cancer.