Vomiting is a symptom that often prevents the utilization of food and makes it necessary to administer nourishment by the rectum, or at least in other ways than by the mouth.

There is no one dietetic treatment for vomiting. Indeed, it is best, so long as it occurs with great frequency, to give no food until the cause of emesis has been removed. When this cannot be done quickly, nourishment must be given by the rectum, and possibly in very small amounts, one or two tea-spoonfuls at a time, by the mouth, at intervals that will prevent its accumulation in the stomach.

It is important to recognize the cause of vomiting and to treat this. Overeating, eating unwholesome food or mixtures of food, gastritis, dyspepsia, gastric cancer, and ulcer are common causes of the symptom. Vomiting that originates from indiscretions of diet is usually acute, quickly relieved by abstinence from food for a few hours, and preventable thereafter by avoiding such indiscretions. Rest for a time and careful dieting will often lessen vomiting or stop it entirely in the other conditions just mentioned.

Emesis occurs also because of intense pain in abdominal organs, as when there is hepatic, renal, ovarian, or intestinal colic. It also arises reflexly, as in cases of pregnancy. It is due to lesions of the nervous system - as, for instance, in the gastric crisis of tabes and other nervous diseases. Mental depression or disgust excited by the sight or thought of uninviting food will sometimes provoke vomiting. It is frequently secondary to other troubles - whooping-cough, scarlet fever, anemia, and many others. The modifications of dietetic treatment that this symptom necessitates are discussed fully in connection with each of these maladies.

When there is a tendency to vomit, only the blandest foods and those that are not distasteful may be used. Highly spiced and seasoned foods must be avoided. Cold food is frequently retained better than hot - for instance, cold milk, ice-cream, or iced bouillon with a lemon in it. Liquids and soft food are usually retained better than solids. Occasionally there are exceptions to this, and very dry articles will remain in the stomach when liquids will not. Dry crackers, ginger snaps, even popcorn, have been known in these exceptional cases to be better retained than milk, broths, or custards.

It frequently happens that a spoonful, or sometimes a few drops, of nourishment let fall into the mouth from a medicine dropper will be retained when a quarter or half a glass is rejected.

Bits of cracked ice allowed to melt slowly in the mouth often lessen the frequency of vomiting. Milk is generally better retained when lime-water, or Seltzer, Vichy, or other alkaline or sparkling water is added to it. Whey, kumiss, or matzoon will be better tolerated by other patients. Strong coffee taken in sips sometimes helps to settle the stomach.

In all acute cases, abstinence from food for some hours, and the removal, when necessary, of offending material from the stomach, does more good than the administration of anything.

Barley-water or beef-juice and the meat-juices of the shops given in very small quantities well diluted with water may serve a useful purpose when complete abstinence from food for hours or for days may be necessary, and yet, for various reasons beyond the physician's control, cannot be enforced.

When vomiting occurs during pregnancy, it is usually only in the morning or after eating too heartily. Sometimes it is well to omit or to postpone breakfast. At all events, this should be a small meal and consist of the simplest foods. Overeating and the eating of indigestible foods must be avoided. In some cases, when almost everything eaten is rejected, no kind or combination of food will stop the vomiting; then rectal alimentation must be resorted to and chiefly relied upon, although, as a rule, a little food can also be given by the mouth. Under these circumstances a patient must be kept in bed. It is necessary, in the most severe cases, to produce an abortion in order to prevent death from inanition. These are, fortunately, very rare.