VOMITING. 417 



the afferent nerves from the stomach, such as Hot "Water, Ice, 

 Diluted Hydrocyanic Acid, Carbonic Acid, Bismuth, Dilute 

 Alkalies, Opium, Ipecacuanha and Calomel in small doses; 

 measures which act indirectly upon the stomach and reduce 

 the irritability of its nerves, such as poultices or blisters to 

 the epigastrium; and sedatives of the afferent nerves to the 

 vomiting centre from other organs, for instance, demulcents to the 

 throat, poultices to the abdomen, or applications to the os uteri. 



III. PATHOLOGICAL KELATIONS. 



Vomiting being regarded for our present purpose as a 

 physiological ace, it may be considered to be disordered, (1) if 

 excessive; and (2) if defective, insufficient, or absent when it 

 would be salutary or desirable. We will illustrate each of 

 these conditions. 



1. Excessive vomiting occurs as the result of disorder or dis- 

 ease of the stomach ; morbid conditions of other parts of the 

 abdomen, such as hernia, cough, severe pain, injury or disease 

 of the brain, or disturbance of the circulation and senses, 

 including sea-sickness. The cause of vomiting may be in the 

 centre itself, especially as a consequence of previous violent 

 vomiting, or of urea and certain extrinsic poisons, such as anti- 

 mony. 



2. Defective vomiting may be said to occur when only 

 attempts at retching ensue on the presence of direct or indirect 

 stimulation of the centre. In the vast majority of cases, how- 

 ever, we have to deal with conditions in which, whilst vomiting 

 is urgently demanded, no attempt at vomiting is made by 

 nature, the substances which require to be expelled from the 

 stomach being of a non-irritant or even sedative nature, such as 

 narcotic poisons. This introduces us, further, to the use of eme- 

 tics for other purposes than simple evacuation of the stomach. 

 Vomiting may be desired for the sake of obtaining one or more 

 of the associated effects on other viscera. In certain inflamma- 

 tory diseases of the larynx and bronchi, such as croup and 

 bronchitis, which are attended by the production of thick or 

 solid products, or whooping cough, which is characterised by 

 defective or disordered expulsive power, an emetic will be indi- 

 cated to empty the respiratory passages and restore the free 

 entrance of air. Similarly, rigidity of the cervix uteri in the 

 first stage of labour is believed by some obstetricians to call 

 for emetics which shall relax the uterine sphincter. 



IV. NATURAL RECOVERY. 



Vomiting usually ceases with the removal of its cause, but 

 it may persist indefinitely, until the therapeutist steps in. 

 2 B 8 



