Vomiting occurs as a symptom of so many diseases and functional derangements that it will be advantageous to consider collectively the general dietetic means for its relief. The details of treatment will be explained under the headings of the various diseases in which vomiting may become a serious or prominent symptom.

Pathological Physiology

Vomiting as far as it is related to dietetics may be caused by: 1. Excess of food. 2. Foods and drinks improperly combined (as crabs and milk, beer and champagne, etc.). 3. Fermenting or poisonous food. 4. Irritating and indigestible food, including that which is improperly cooked. 5. Hastily eaten food.

In hysterical patients and in very neurotic conditions of the system, either the sight, taste, smell, or mental suggestion of food may excite nausea and vomiting.

Instances of the influence of the mind over stomach digestion and the mechanism of vomiting are too familiar to need elaboration here. Food which is in itself nourishing may promptly nauseate through disgusting association or environment. For example, a party of early California settlers while crossing the continent were lost during a severe winter in the Sierras. When nearly dead of starvation some friendly Indians took compassion and fed them upon a delicious finely ground meal, which for some days was their staple article of diet, and on which they rapidly gained strength. Being at first unable to understand the Indians, the emigrants could not learn of what the meal was composed. When at length they found out that it was made from pounded dried grasshoppers it produced such nausea that none could touch the food again.

Dietetic Treatment

The first principle in the dietetic treatment of vomiting from any cause is to give the stomach rest. If it has been overloaded with a large bulk of food, or with indigestible material, it is well to encourage emesis, and distressing retching may be overcome by taking large draughts of lukewarm water. A quart or two will rinse out the stomach and allay irritation to a marked degree.

Well-nourished patients when serious vomiting first occurs should usually refrain from taking food of any kind for from ten or twelve to even twenty-four hours. Exceptions to this rule are sometimes found in that type of seasickness, and sometimes in the vomiting of pregnancy, in which, as soon almost as the stomach is emptied, there is a desire to replenish the loss.

In any case in which the gastric irritation is persistent it is necessary to give fluid food, and only in small oft-repeated doses, preferably in predigested form. The food is best given cold, as a rule, although some persons can relieve nausea by sipping very hot water.

A teaspoonful of prepared milk, or in extreme cases but a few drops, given with a medicine dropper once in ten or fifteen minutes, may be all that the stomach will at first tolerate.

The following is a list of dietetic substances which are commonly prescribed for the relief of nausea and vomiting, or for nourishment while those conditions exist: Cracked ice; pancreatinised milk; milk with sodium bicarbonate (ten grains), and cerium oxalate (five grains); milk and lime water; milk and Vichy, soda, Seltzer, or carbonic-acid water; whey; koumiss and zoolak; beef extracts and peptonoids, such as Johnson's Fluid Beef and Carnrick's Beef Peptonoids, somatose, Valentine's or Liebig's meat juice; raw meat pulp, scraped; strong black coffee; sour lemonade or lemonade and Vichy; clam broth. Dry crackers, dry toast, and ginger-snaps will sometimes be retained in seasickness, or a cracker buttered and sprinkled with a little Cayenne pepper; brandy and soda; iced dry champagne; iced brandy diluted with water, soda water, or Apol-linaris.

Very severe and protracted cases may require lavage or nutrient enemata. Vomiting after abdominal surgical operations is often controlled by lavage.