Nausea and Vomiting.
This most familiar and sometimes most troublesome condition is perhaps also the most common of all the disturb ances peculiar to the pregnant state. It is not peculiar to the dyspeptic and hy perwsthetic woman alone, it occurs with all temperaments without partiality and may be most annoying to one who is least subject to physical or mental instability. The cause of this disturbance is plainly an irritability of the extensive nerve supply of the uterus, which is subjected to an unusual—even though it be a phys iological—stimulus. The nexus between the sympathetic nervous system of the uterus and the nerve-supply of the stom ach by way of the hypogastric plexus is ample for the passage of impressions of irritability from the one viscus to the other, and it is a referred or transferred irritation of this kind which causes the troublesome gastric disturbance. The disturbance begins soon after the uterus begins to enlarge, and continues with more or less persistency until the uterus is well out of the pelvis; that is, until the sixth or seventh month of gestation, or even until its termination.
No constant pathological lesion is demonstrable in hyperemesis gravi darum; pregnancy is the predisposing cause; but in most cases the exciting cause cannot be discovered. In these cases pregnancy must be regarded as also being the chief cause, either on ac count of some abnormal course—twin gestation, hydramnios—or as occurring in a person of high nervous tempera ment. Pozzi (Ther. Woch., No. 37, '97).
The pernicious form of vomiting is in variably accompanied by some patho logical condition that may yet be dis covered post-mortem, if looked for. The large majority of medical men ascribe it to pathological reflex phenomena origi nating in conditions present in connec tion with the pregnant uterus. Nervous temperament and hysteria are possibly not infrequent factors. Hedra's toxic theory has many adherents, while others follow Tumas, who believes he has lo cated a vomiting centre in the medulla in close relation to the centre that pre sides over the generative organs; this centre shares in the reflex irritation of the generative centre, and gives rise to different impulses along the pneumogas tries, which result in persistent nausea and vomiting. Temple (Dom. Med. Mo.,
Sept., '97).
Analysis of the urine in hyperemesis gravidarum. The products of metabo lism normally excreted—such as indol. skatol, and ethyl-sulphates—are found in increased amount. Abnormal constit uents—namely: albumin, urobilin, ace tone, and peptone—occur in the urine. Acute nephritis may occur. A similar condition of the urine and kidneys is found in many acute infectious diseases. such as the diarrhceas of children, Asiatic cholera, ileus, etc., and are due to the stimulation of the kidneys by poisonous products absorbed from the bowel. Should this autointoxication theory be correct, intestinal disinfection is indicated. E. Dirmoser (Wiener med. Woch., Oct. 7,'99).
With some women it is an accompani ment of the first pregnancy only, and this is especially true with women who are pregnant for the first time after the tissues are all mature and firm: e.g., after the thirtieth year of life. With others it recurs as often as pregnancy recurs. It is familiarly known under the name of "morning sickness," and is apt to mani fest itself when the patient awakens in the morning. If she remain quiet in bed nausea may be the only symptom, and even this may be wanting, but the mo ment she rises and makes any effort, how ever slight, nausea with vomiting may result. The ingestion of food usually adds to her discomfort. It may be quickly rejected or it may become a dis agreeable burden to be thrown off at a 0 later period, or eventually it may be di gested and assimilated. The disagree able symptoms may wear away as the pa tient becomes occupied with her ordinary daily cares, or it may persist with ob stinacy, unyielding from morning to night. Very few women are able to dis pose of it by mere mental effort, and it may become so troublesome that the re sulting weakness and malnutrition will prohibit attention to the daily duties. The patient may be obliged to keep her bed and even her life may be in danger from inability to retain sufficient nutri ment. I have seen one such case in nearly twenty years of practice.