VOMITING. 575 



have arranged the peculiarities which characterise these two forms of vomiting side 

 by side in parallel columns. 



Brain Vomiting. Stomach Vomiting, 



1. There is little or no nausea, and the vomit- 1. The nausea is relieved, at all events tern- 



ing continues in spite of the discharge of porarily, by the discharge. It returns 



the contents of the stomach. directly food is taken. 



2. There is no tenderness over the stomach, 2. There is tenderness over the stomach, and 



and pressure is borne without inconveni- pressure induces an inclination to retch, 



ence. 



3. The tongue is clean, the breath sweet, and 3. The tongue is dirty, the breath offensive, 



the bowels obstinately confined. and there are griping pains in the stomach 



with diarrhoea. 



4. Headache comes on early, and is a promi- 4. Headache comes on after the other symp- 



nent symptom. toms. 



5. The stomach is emptied without effort. 5. The vomiting is preceded by retching. 



6. There is no disgust for food. 6. There is complete disgust for food. 



These statements must, of course, be taken with a certain amount of qualification, 

 but, speaking generally, they are correct. We give the rule, but disregard the 

 exceptions. 



Vomiting, and especially morning vomiting, is of frequent occurrence in those 

 who habitually indulge to excess in alcoholic liquors. In the victims of chronic 

 alcoholism, or, to use less refined phraseology, in drunkards, the vomiting usually 

 occurs before breakfast, and is often excited by the act of cleaning the teeth. In 

 women, a common cause of morning vomiting is pregnancy, or some disorder of the 

 womb. In some cases it occurs only in the morning, and is excited by the first 

 waking movements j in others, the vomiting occurs not only in the morning, but 

 frequently during the day, returning whenever food is taken. It may be so severe 

 that the stomach rejects all nourishment, and the patient is quickly reduced to a 

 very critical condition. Sometimes the vomiting is absent in the morning, but 

 comes on later in the day, and increases towards evening. Many women are 

 troubled with nausea and vomiting during the whole time they are suckling. Cases 

 of vomiting are occasionally met with for which no adequate cause can be detected ; 

 the food is rejected without pain and without nausea, and sometimes so suddenly 

 that the patient has hardly time to escape from the table. 



Next as to the treatment of vomiting. Of late years no remedy has been more 

 extensively employed in the treatment of this complaint than ipecacuanha wine. 

 It should be given in drop doses in a little water three times a day or every hour, 

 according to the urgency of the symptoms. A tea-spoonful of the mixture (Pr. 

 50) contains a drop of ipecacuanha wine. It is essential that it should be given 

 in the manner here indicated. It often aggravates the mischief if given in 

 larger doses, and seldom succeeds if given with other drugs, or in any other vehicle 

 than water. Ipecacuanha wine is not to be used indiscriminately in the treatment 

 of vomiting ; there are some forms in which it acts like a charm, and there are 

 others in which it does little or no good. Fortunately the indications for the 

 use of ipecacuanha in vomiting are perfectly well understood, and for the accuracy 



