The sickness of pregnancy is one of the commonest forms of "morning sickness". As a general rule morning sickness is due either to pregnancy, gastro-duodenal catarrh, or alcoholism. These conditions should always be in the mind when one is considering the origin of persistent vomiting. In married ladies there is usually no difficulty in arriving at a conclusion as to the first of these conditions. To begin with, the lady has missed one or two "periods" and is probably beginning to show other signs of her condition. The sickness generally commences at the beginning of the second month of pregnancy and terminates when the quickening occurs. It comes on as soon as she assumes the upright position, and the vomit usually consists of some glairy fluid. As a general rule there is no other vomiting throughout the day, and, the appetite being good, nutrition does not suffer. If this were all that was likely to happen we should have no need to draw attention to the subject. But unfortunately there are cases where the vomiting occurs throughout the day, and consequently the patient becomes emaciated and weak, and the prospect is rather threatening. Indeed the vomiting may be so severe and prolonged as to cause extreme danger, not only from starvation but from the general condition. The most dangerous cases are those in which the patient becomes restless, sleepless, has a fetid breath, and passes little urine. Sometimes the urine contains a little albumin; and, as the patient passes very little urine, the waste products of the tissue changes are retained in the organism, and bring about some degree of uraemia. Probably the temperature rises two or three degrees, and the mind becomes wandering. The danger is very great when the pulse rises to 120, and delirium and diarrhea occur.

Vomiting of pregnancy is regarded as being reflex, as a general rule, due to the irritation of the nerves in the growing uterus. It may be expected to be rather severe in first pregnancies, presumably because the resistance of the uterus to expansion is greater than in one which has already borne several children, Again, it is likely to be rather severe in the first pregnancy of young ladies who have been accustomed to experience a great deal of pain at their periods (dysmen-orrhcea). Excessive vomiting also occurs in others who have suffered from displacements of the uterus, especially forward displacements; and in those who have been neurotic.

When women have borne one or more children, the vomiting is generally normal; but very severe and prolonged vomiting may occur when a previous pregnancy has resulted in chronic inflammation or ulceration of the neck of the uterus. The vomiting may then be due to the stretching and irritation of inflamed or ulcerated tissues.

In some extremely bad cases of vomiting in pregnancy called hyperemesis, the patient dies; the post-mortem examination then reveals a degeneration of the cells of the liver or kidneys, or both. On this ground, therefore, we are compelled to the opinion that such cases are really different from any others, and that the degeneration of the liver and kidneys predisposes to the fatal result.

The treatment of mild, but ordinary vomiting of pregnancy is not difficult. It is important that the patient should have some food before getting out of bed. This gives the stomach something to do in the right direction, and may ward off the nausea, and will certainly reduce the exhaustion which is a disturbing element in the case. The avoidance of foods which are liable to cause indigestion is essential. Constipation must be treated. Perhaps a change of diet may be necessary on this account; avoiding milk, milk puddings, white bread, and other foods which tend to constipate the patient; and taking brown bread, oatmeal, treacle, jam, fruit, vegetables, and meat, which have the opposite effect.

In severe cases of vomiting, the patient must be kept in bed, and lie on her back or right side. Her food must be the same as for other cases of severe sickness. It must be given at very short intervals, and only a spoonful at a time. Milk, milk and lime-water, milk and bicarbonate of potash or one of the gaseous waters, e.g. soda-water, potash-water, Perrier or Apollinaris will be useful. Milk and barley-water are not to be despised, although the barley-water contains very little nutriment. In extremely severe cases, ice, iced milk, albumin-water, iced champagne, brandy and soda, Valentine's meat juice, Brand's essence, Mosquera's beef jelly, Plasmon, Sanatogen, are all proper things to use. One thing must be tried after another. If they fail, we must resort to rectal feeding; but that can only be carried on for a few days. Sometimes the application of an ice-bag over the pit of the stomach, or to the back of the neck, will help to check the vomiting.

If the irritation ceases, and the stomach begins to retain food, we can give peptonized milk, peptonized milk gruel, beef-tea, Benger's or Mellin's food, Savory and Moore's food; and from this foundation we can gradually build up a diet consisting of light and nourishing articles, to be taken for some time before the patient returns to the normal dietary.

In some of the exceedingly severe cases it may be necessary for the doctor to relieve the uterus of its burden in order to save the patient's life. It is often necessary to resist the desire of the patient or the patient's friends for this operation to be done. The legality of the operation has always to be considered. As a matter of protection for himself, the medical attendant will probably request the opinion of somebody else before he does it. Perhaps the supervention of uraemia, convulsions, or delirium, may determine the necessity for it. In other instances a pulse of 120, a red, glazed, or brown tongue, considerable emaciation and great exhaustion are sufficient indications for the expediency of obtaining that mode of relief, and saving the patient's life.