The disease named by Sauvages Melæena, and by other writers commonly termed the Morbus Niger, (772), consisting in an evacuation either by vomiting or by stool, and sometimes in both ways, of a black and grumous blood, can hardly be otherwise occasioned, than by a venous hæmorrhagy from some part of the internal surface of the alimentary canal.

It is indeed possible, that the bile may sometimes put on a black and viscid appearance, and give a real foundation for the appellation of an Atra Bilis but it is certain that instances of this are very rare; and it is highly probable that what gave occasion to the notion of an atra bilis among the ancients was truly the appearance of blood poured into the alimentary canal in the manner I have mentioned ; and which appearance, we know, the blood always puts on when it has stagnated there for any length of time. I suppose it is now generally thought that Boerhaave's notion of such a matter existing in the mass of blood is without any foundation; whilst, by dissections in modern times, it appears very clearly that the morbus niger presenting such an appearance of blood, always depends upon the effusion and stagnation I have mentioned.

1030. From this account of the melæna it will appear, that vomitings of blood may arise in consequence of blood being poured out in the manner

I have mentioned, either into the cavity of the stomach itself, or into the superior portions of the intestines, from whence matters often pass into the stomach.

1031. Both in the case of the melæna, and in the analogous cases from affections of the spleen or liver, it will appear, that the vomitings of blood occurring must be considered as symptomatic affections, not at all to be treated as a primary active hæmorrhagy, but by remedies, if any such be known, that may resolve the primary obstructions.

1032. I believe I have now mentioned álmost the whole of the causes producing a hæmatemesis; and certainly the causes mentioned are those which most commonly give occasion to that symptom. Possibly, however, there may be some other causes of it, such as that singular one mentioned by Savages, of an aneurism of the aorta bursting into the stomach and it is possible that some diseases of the other contiguous parts, which have become closely adhering to the stomach, may sometimes, by a rupture into the cavity of the stomach, pour blood into it, which is afterwards rejected by vomiting. It is possible also that abscesses and ulcerations of the stomach itself may sometimes pour blood into its cavity, to be thrown up by vomiting.

I did not think it necessary, among the symp

tomatic vomitings of blood, to enumerate those from external violence, nor, what is analogous to it, that which arises from violent straining to vomit; which last, however, is much more rare than might be expected. In either of these cases, the nature of the disease cannot be doubtful; and the management of it will be readily understood from what has been delivered above with respect to moderating and restraining hæmorrhagy in general.

SECT. II.

OF THE HÆMATURIA, OR THE VOIDING OF BLOOD FROM THE URINARY PASSAGE.

1033. It is alleged that an hæmaturia has occurred without any other symptom of an affection of the kidneys or urinary passages being present at the same time; and, as this happened to plethoric persons, and recurred at fixed periods, such a case has been supposed to be an instance of idiopathic hæmaturia, and of the nature of those active hæmorrhagies I have treated before.

1034. I cannot positively deny the existence of such a case, but must observe, that there are very few instances of such upon the records of physic; that none have ever occurred to my observation, or to that of my friends; and that the observations adduced may be fallacious, as I have frequently observed an hæmaturia without symptoms of other

affection of the kidney or urinary passages being for the time present; whilst, however, fits of a nephralgia calculosa having, before or soon after, happened, rendered it to me sufficiently probable that the hæmaturia was owing to a wound made by a stone present in some part of the urinary passages.

1035. The existence of an idiopathic hæmaturia is further improbable, as a general plethora is more likely to produce an hæmoptysis, (1022), and, as we do not well know of any circumstance which might determine more particularly to the kidneys. An idiopathic hæmaturia, therefore, must certainly be a rare occurrence; and instances of symptomatic affections of the same kind are very frequent.

1036. One of the most frequent is, that hæmaturia, which attends the nephralgia calculosa, and seems manifestly to be owing to a stone wounding the internal surface of the pelvis of the kidney or of the ureter. In such cases, the blood discharged with the urine is sometimes of a pretty florid colour, but for the most part is of a dark hue: the whole of it is sometimes diffused or dissolved, and therefore entirely suspended in the urine; but, if it is in any large quantity, a portion of it is deposited to the bottom of the vessel containing the voided blood and urine. On different occasions, the blood voided puts on different appearances. If

the blood poured out in the kidney has happened to stagnate for some time in the ureters or bladder, it is sometimes coagulated, and the coagulated part is afterwards broken down into a grumous mass of a black or dark colour, and therefore gives the same colour to the urine voided; or, if the quantity of broken-down blood is small, it gives only a brownish colour to the urine, resembling coffee. It some times also happens, that the blood stagnating and coagulating in the ureters takes the form of these vessels, and is therefore voided under the appearance of a worm; and if the coagulated blood happens to have, as it may sometimes have, the gluten separated from the red globules, these worm-like appearances have their external surface whitish, and the whole seemingly forming a tube containing a red liquor. I have sometimes observed the blood which had seemingly been coagulated in the ureter, come away in an almost dry state, resembling the half-burnt wick of a candle.

1037. These are the several appearances of the blood voided in the hæmaturia calculosa, when it proceeds especially from the kidneys or ureter: and many of the same appearances are observed when the blood proceeds only from the bladder when a stone is lodged there; but the attending symptoms will commonly point out the different seat of the disease.

In one case, when a quantity of blood from the