Juvenile Vomiting

This condition occurs in young persons attending school, especially if they are overworked. Symptoms of cardialgia and vomiting develop, the latter appearing either once or twice every day, or presenting a rather periodic character. Occasionally there is a train of the following symptoms associated with this vomiting: severe headache, marked pallor, very slow pulse, and dilated pupils. The diagnosis of this form of vomiting is easily made by the symptoms just mentioned. The best treatment is the temporary removal of the patient from school, and a good, strengthening diet.

1Stiller: "Die nervosen Magenkranklieiten," Stuttgart, 1884. 2Boas: l. c, p. 238.

Periodic Vomiting (Leyden)

Leyden first described periodic vomiting, which is characterized by the following points: 1. It appears in apparently healthy individuals; 2. The paroxysms occur periodically after intervals of equally long duration; 3. When the attack is over, the patient is perfectly well and no gastric symptoms persist.

The attack is very similar to that of acute suc-corrhoea gastrica continua, and may be described as follows: In the midst of perfect health the patient experiences for a short time uneasy sensations (slight headache, nausea, slight chilly feeling) which are followed by vomiting. At first the entire gastric contents are ejected; later the vomited matter consists of mucus, alone or with admixture of either bile or shreds of blood. The latter is more frequently found if violent retching has preceded the act of vomiting. Frequently, although not always, there exist an intense pain in the epigastric region and a sensation of utter prostration. The abdomen is, as a rule, sunken and the extremities are cold. At this time no food whatever is borne by the stomach; even a drink of water is very soon ejected. This condition of utter irritability of the stomach and persistent vomiting may last from one to ten days, when suddenly the disturbances disappear, the nausea subsides, and a feeling of hunger returns, which can be satisfied with impunity.

All kinds of food are now well borne by the stomach, which but an hour before could not retain the lightest food.

The periodic vomiting of Leyden is a rare affection, and it does not seem to me that the condition of the gastric secretion plays an important part in its causation. While most of the cases mentioned in literature seem to have been associated with a normal condition of the gastric juice, I have observed a case of periodic vomiting in a patient who was affected with achylia gastrica. This patient (J. S.), thirty-seven years old, had been troubled for the last six years with periodic attacks of vomiting, which appeared once in either six or three months and lasted from four to five days. During the intervals the patient could partake of all kinds of food without much inconvenience. The only complaints referred to were frequent belching and constipation. During the attacks the patient could not ingest anything for the entire five days and as a rule presented the most alarming symptoms. I examined him frequently during the intervals and also during the attacks and never found any traces of gastric juice in the contents.

The treatment consists in absolute rest, in the administration of ice pills, and in the use of morphine (subcutaneous injection) or of opium in the form of suppositories. During the intervals between the attacks a sojourn in the country and hydropathic procedures may prove of value.