Reflex Vomiting

Nervous vomiting frequently occurs as a result of derangements of various other organs. Thus abnormal conditions of the pharynx, an elongated uvula, disorders of the genito-urinary organs may be associated with vomiting. The vomiting of pregnancy must also be considered as belonging to this group. Floating kidney, hydronephrosis, he-patoptosis may likewise be the cause of vomiting.

The treatment of this class of cases will have to be directed toward the seat of the original trouble. An elongated uvula must be amputated, and ptosis of the different abdominal organs must be remedied by keeping them in place by means of a suitable bandage. All the genito-urinary disorders should be treated as such. The vomiting of pregnancy must be considered as a physiological phenomenon as long as it occurs during the first months of pregnancy and appears only once or twice a day, not interfering much with the general nutrition. In this case it is hardly necessary to use any therapeutic means. If, however, the vomiting appears more frequently and obstinately, so that the patient begins to lose in weight, then we have the following remedies at our disposal: Bromide of sodium, 1 gm. (gr. xv.), to be taken twice daily; cerium oxalate, 2 dgm. (gr. iii.) three times daily.

℞ Menthol,....... 1.0

Aq. (lest.,....... 100.0

Spir. frument. rectif., .... 50.0

Syr. zingib.,...... 30.0

D. S. One tahlespoonful four times daily.

Other remedies, such as cocaine, codeine, belladonna, or chloral hydrate, may occasionally be useful. If medicinal treatment fails, then a change of surroundings, as a sojourn in the country, may be tried. If all these means prove useless and the vomiting continues undiminished, so that the life of the patient is in danger, then as utimum refiigium, artificial abortion has to be resorted to.

Idiopathic Nervous Vomiting

Besides the above-named two groups of vomiting, namely, the juvenile and the periodic, which appear without any apparent cause, there exist cases of vomiting in adults which do not show any periodicity. The vomiting occurs, as a rule, after meals. Usually only a portion of the meal is ejected; occasionally, however, the wholemeal may be vomited. The vomiting may exist for months and sometimes even for years without remission. The nutrition, as a rule, in these instances is not disturbed. Neurasthenic and hysterical individuals form the greater contingent of sufferers from this form of vomiting. Sometimes, however, persons with an apparently normal condition of their nervous functions may be affected with this trouble, which is by far more frequent in women than in men.

The treatment consists in regulating the mode of life of the patient and in advising him to suppress vomiting whenever possible. In neurasthenic and hysterical patients the treatment must be directed against the original trouble; in others change of climate may be tried. Of medicines the bromides play a great part. Arsenic and iron are useful in many instances. In severe cases of vomiting, feeding through the tube for a period of two weeks may be resorted to. During this time no food is to be taken in any other way. When this period is over, then small quantities of food are administered per os, besides continuing the gavage (feeding through the tube). If the food which is taken by the mouth is no longer vomited, then after a while gavage may be discontinued and the feeding done in the natural way. Intragastric faradization may also prove useful. Several cases have come under my observation in which nervous vomiting, after having lasted for many years and resisted the most diverse modes of treatment, has been perfectly cured by the faradic current.