4i 8 MATER i A MEDIC A AND THERAPEUTICS. 



Whilst it is in itself a natural provision for relief, there is a 

 limit to its "beneficial effect. Protracted vomiting appears to 

 increase the irritability of the mucous membrane and nerves of 

 the stomach, and thus to tend to go from bad to worse ; and 

 the same is the case with the vomiting centre, which may 

 become so sensitive as a consequence of sickness that the 

 slightest change of posture brings on the symptom afresh. 

 There is urgent need for treatment in such cases. 



V. THERAPEUTICS. 



The therapeutical relations of vomiting, rationally considered, 

 are obvious. Excessive vomiting has to be arrested ; vomiting 

 may have to be assisted when it is ineffectual, or excited when 

 entirely absent ; and the action of emetics may be taken 

 advantage of for other purposes than to empty the stomach. 



1. Excessive Vomiting, The study of the physiology and 

 pathology of vomiting serves to impress upon the student the 

 absolute necessity for diagnosis, or investigation of the cause 

 of disorder, before rational therapeutics can be carried out, 

 and the thoroughly unscientific and unsatisfactory character 

 of the practice which applies treatment to symptoms without 

 ascertaining the pathological condition on which they depend. 

 How extremely irrational it would be to attempt to relieve 

 by the same means the vomiting caused by indigestible food at 

 the commencement of acute indigestion, and the vomiting due to 

 the swelling which persists in the second stage. At the former 

 period, vomiting is relieved by temporarily encouraging it by 

 a good emetic ; at the second period, the very opposite set of 

 measures gastric sedatives must be employed. 



The first step to be taken manifestly is to attempt to remove 

 the originating cause of the reflex act. If the stomach contain 

 irritant food, it must be quickly neutralised, as we saw in the 

 last chapter ; if a poison, some antidote must immediately be 

 administered ; or either of the two may be removed from the 

 stomach by facilitating and completing vomiting, or by means of 

 the pump. Once emptied, the stomach must be quieted by the 

 gastric sedatives studied in the last chapter. If the cause be 

 discovered in any of the other abdominal organs, the same plan 

 of removal, if possible, must be pursued. Vomiting originating 

 in injury or disease of the brain will call for the special treat- 

 ment proper in such cases, and the free use of nervous sedatives, 

 such as the Bromides of Potassium and Ammonium. If the 

 vomiting centre is being irritated by some intrinsic poison 

 such as urea, or an extrinsic poison such as antimony, the ex- 

 cretion of the morbid substance by the kidneys, skin, or bowels, 

 must be hastened, or its effects antagonised by stimulants. 



