In cancer of the stomach, vomiting is one of the chief symptoms; but it occurs at irregular periods and gives no relief from pain. If the cancer obstructs the pylorus, the passage of the food will be hindered and consequently the vomited materials may have the same characters as in dilated stomach, besides containing traces of blood, or changed blood having the appearance of "coffee grounds".

Where there is an ulcer of the stomach the vomiting is also irregular. In some cases it occurs after almost every meal; in others only occasionally. It may occur half an hour or two or three hours after the meal. It is preceded by pain and followed by relief; and the material ejected consists of food which is either unchanged or more or less digested, according to the length of time it has been in the stomach. It is never fermented or putrid, but may contain blood, which varies in amount from a mere trace to "quarts" of blood.

In nervous dyspepsia the vomiting is peculiar in being about the only serious part of the malady. It is an affection which sometimes occurs in hysterical or neurasthenic women. It is often associated with a good appetite, even a voracious appetite, inasmuch as the remark is sometimes made, "She eats until she makes herself sick". This is not strictly true, because the appetite is not always abnormal; and the patient may only vomit occasionally or at some particular time of the day. The vomited food may be very little changed, but she often appears to bring up more than she ate, because she vomits the gastric juice which is apt to be abnormally abundant. This is often associated with abnormal cravings and desires, which show themselves in various ways, e.g. the consumption of chalk, slate-pencils, coal, clay, and other articles of an innutritious character. Such cases show the influence of mind over matter. Behind the reserved, moody, tricky, wilful behaviour there is nearly always some mental cause, some disappointment, or hope deferred, which being satisfied would lead to the restoration of health. These patients require judicious, but firm, handling. It is worse than useless to be harsh; no good will be done by "driving" them; you would defeat your object. It is better to cultivate a kindly manner, to mix your firmness with pleasantry, to endeavour to lead in the way you wish them to go. They are to be pitied; but you must not show them pity. They lay themselves out for all the sympathy, fuss, and attention they can get, and their bodily and mental functions deteriorate under such influence.

The peculiar nervous dyspepsia of men, which is not so common, is generally associated with some inflammation of the sheath of abdominal nerves, perhaps the pneumogastric or sympathetic nerve. It gives rise to vomiting of a similar character, pain, and other distressing symptoms. The mental changes are not the same as in women, but the patient is apt to become gloomy, pessimistic, and melancholic.

Vomiting is rarely absent from obstruction of the bowels. At first this is merely sympathetic, and the substances brought up consist of food, more or less changed by digestion. By and by, however, the character of the vomit changes; it becomes of the consistency of pea-soup and has a faecal odour owing to decomposition, but the material is seldom truly faecal, although it is called "ster-coraceous," that is dung-like.

It is an established fact that the nearer the obstruction is to the stomach the more severe is the vomiting and the sooner it begins. The vomiting is very persistent. When the obstruction does not give rise to a complete mechanical occlusion of the bowels the vomiting is constant, and may be incessant. The stomach rejects everything which is put into it. But the vomiting will not become stercoraceous or eculent in the majority of cases however long it may last, nor however obstinate the constipation may be. But if the mechanical occlusion of the bowels is complete the vomit becomes stercoraceous by about the third day, sometimes sooner, and never ceases until the obstruction is removed.

When the obstruction is acute, such as occurs in strangulation of a piece of the gut, the patient is struck with a severe pain, usually at a fixed spot. The pain is sufficiently severe to cause considerable depression approaching to faintness or collapse. Vomiting speedily occurs. The abdomen becomes tender, swollen, and distended by flatus, which causes rumbling and gurgling noises.

If the obstruction comes on slowly, or is chronic, as occurs from the growth of a tumour outside the bowel, stricture or malignant disease of the bowel, constipation is for a long time the most prominent symptom. There is then comparatively little constitutional disturbance for a considerable time. But the abdomen becomes gradually swollen and tympanitic, with rumbling and gurgling in the intestines, eructations of food and wind, much retching, and finally vomiting. Moreover, in such cases the vomiting does not begin, even when the obstruction becomes complete, until some time, perhaps a week or ten days, has elapsed; but the presence of stercoraceous matter in the vomit is then a serious symptom.

Thus we may say that if the obstruction is in the small intestines the vomiting comes on pretty rapidly and is severe; but if the obstruction is in the large intestines the vomiting is longer delayed, may never be a very prominent sign, and might be due to constipation. When the obstruction is due to strangulation of the bowels, there is nausea, hiccup, fever, and inflammation, as well as vomiting. When the obstruction is due to intussusception, impaction of foreign bodies, gall-stones, compression by a tumour, or pregnant uterus, the obstruction occurs more slowly, fever and inflammation are usually absent, and vomiting is a very late symptom.

In brain affections also the vomiting is accompanied by the special signs of the disease. In tubercular meningitis the vomiting when it occurs is more or less uncontrollable; but it is associated with some rise of temperature, headache, intolerance of light and sound, fretfulness, peevishness, the peculiar cry which is characteristic of the disease, and the "blush" on the skin which speedily follows a pencil mark or finger-nail drawn across it (Tdche cerebrale). In cerebral tumour the vomiting is often one of the earliest symptoms complained of; and it is unaccountable; there has been nothing to explain it; it comes on at irregular intervals and without obvious cause. It is usually unattended by nausea or loss of appetite; but there are headache, giddiness, perhaps a staggering gait, epileptiform attacks, and other signs showing a disturbance of the circulation in the brain; and squint or other obvious abnormal affections of the special senses arising from pressure upon the brain.