VOMITING.
The most common digestive trouble is nausea and vomiting. Although the latter is generally borne comparatively well by the patient, in some cases it becomes so severe as to be uncontrollable, 9,nd thus to seriously endanger life. Sometimes nausea alone is present, but this is rare. Vomiting is so ccgnmon in pregnant women that, in the majority of cases, it is an almost certain sign of pregnancy.
a. Simple usually appears at the beginning of pregnancy, sometimes in the first days; at other times it does not occur until later, at the second, third, or fourth month. As a rule, it begins at the first month, continues until the fourth, and then disappears, until the end of pregnancy, when it sometimes reappears. Although regarded by most writers as due to the impression made upon the entire economy by the enlargement of the uterus, it has been regarded by others as char acteristic of certain uterine lesions, especially erosions of the cervix (Bennett); but these erosions, although frequent, are not present in all women who vomit, and moreover, how do we explain its disappearance, at the end of a few months of pregnancy, and that too, spontaneously, often even suddenly ? When it reappears at the end of pregnancy, it is usually attributed to a disturbance of the stomach, resulting from en largement of the uterus. Vomiting usually occurs in the morning on changing the position from the horizontal to the vertical. The vomited matter consists of glairy mucus, fluids more or less watery, which, after u certain time, are accompanied by bile. Sometimes it is very easy, ati others it is accompanied by severe straining, and continues thus every day, sometimes once, and again at frequent intervals. At other times the women do not vomit upon rising, but after each meal, the vomited matter consisting of food; or vomiting occurs during the meal, or three or four hours after, either from some unknown cause, or from fatigue, emotion, etc. In some cases it takes place easily and suddenly, in others, on the contrary, it is preceded for some time by a condition of nausea, more fatiguing perhaps than the vomiting itself. Sometimes it is pain less, sometimes, on the other hand, it is accompanied by severe pains in the epigastrium and the entire abdomen. As a rule, women bear it very well, but sometimes, when it ois repeated t,00 often, it causes disturbance of nutrition, leading to marked emaciation, and a condition of weakness and general fatigue which is extremely annoying. Although it some
times resists every method of treatment, it occasionally disappears sud denly, either in consequence of a lively emotion, as in a case cited by Cazeaux, or because the morbid reflex impulse is transferred to another organ. I once saw vomiting cease on the appearance of a slight diar rhcea, which lasted two days. It usually has no influence upon the course of the pregnancy, remains bearable, and causes the patients annoyance and malaise, rather than actual suffering. It is not the same in other cases (unhappily too frequent), in which it assumes the character of b. Uncontrollable Vomiting. —We may, with Dubois and the majority and that due to some other cause independent of gestation.' Errors are most likely to be made in the last instance.
Prognosis.—This is exceedingly grave, above all after the beginning of the second stage, while in the third, death is almost inevitable. The death of the fcetus, or spontaneous abortion, is generally favorable, but it would be a mistake to infer that all danger has disappeared in conse quence of such an event.
Treatment.—This consists in attention to diet and hygiene, in strictly medical as well as surgical and obstetrical treatment.
1. Diet and Ilygiene.—Sinee uncontrollable vomiting rarely begins abruptly, and more usually succeeds the light form, we shall do well at the outset to establish a rigid diet, excluding heavy and indigestible food, all forms of stimulants, especially alcoholic, and recommending the use of white meats, jellies, milk-diet, in short, easily-digested articles. The physician can not, however, lay down absolute rules, but must consider the caprices of the stomach. We must vary the diet as much as possible, and, if the stomach succeeds in tolerating any fluid or solid article of nourishment, we must not spoil our chances of success by insisting on a prolonged use of it, but should combine it with others. Increase the nourishment, very gradually, since relapses are frequent. If they occur, try something else, varying the food constantly, as the main object is to gain time; vomiting often ceases spontaneously after an interval, as the pregnancy advances.