In an operation which I performed for an obstruction which had been caused by inflammation following labour, and which had a prosperous result, on half-dividing the extremity of the womb, the patient became sick. The vomiting of pregnant women is caused by sympathy of the stomach with the womb; it is a sudden indigestion produced by consent with a remote and labouring organ*.

In sea-sickness, the nausea and vomiting result from sympathy of the stomach with the senses and brain. It is the feeling of disturbed equilibrium which, in this instance, deranges the organ of digestion. This any one newly at sea may soon ascer

* To some of my readers the following relation of the subject may appear interesting. Such is the force of sympathy which the womb exerts, that almost every functional disturbance may be produced through it. Salivation has been produced by pregnancy. The case which I have to narrate is one in which a disease, which pregnancy arrested, has been equally arrested by salivation.

I attended a patient with Mr. Angus, of Greek Street, who was the subject of violent spasms of the limbs, leading to fits of insensibility, when at the worst. These spasms, at one time, suddenly ceased; soon after, she found that she was pregnant; and her delivery took place nine months all but two days after the sudden cessation of the spasms. Eight days after her confinement, the spasms returned; and when she had suffered with them for some weeks, I was consulted. I advised that some local means should be applied at the back of the neck where she felt pain that seemed to shoot thence down the arm, and prescribed mercury to affect the mouth; she recovered. She has since had four serious relapses; each time she has completely recovered by taking mercury in large quantities. Her amendment has invariably commenced as soon as the mercury has affected the system.

tain to be the fact. If you walk or stand upon the deck, all is seen and felt to be unsteady and shifting; the vessel moves even on a calm sea with a gentle undulation, and the masts and sails and lines of cordage now sink, now rise; all is visually unsteady, and you have, at the same time incessantly to adapt your body to the varying inclination to the horizon of the plane on which you stand; unaccustomed to these impressions, you become giddy and sick. If you have partaken of a meal shortly before sailing, the effect is but the more certain and rapid; the stomach is contending with the ingesta, and all the more readily disordered.

That it is the sense of disturbed equilibrium which produces the sickness, is shown by the following proof. If instead of maintaining the erect posture, you lie down, or, in other words, assume a posture of more stability, the nausea abates; and if, in addition, you close your eyes, and exclude the visual disturbance or unsteadiness, the nausea is further lessened.

Upon these facts the treatment of sea-sickness

turns.

If your voyage is to be a short one, from ten to thirty hours, go on board with an empty stomach, betake yourself to your cot, and lie down. It is better to go on board fatigued, which will enable you to sleep at once; when you wake, preserve the recumbent posture; some nausea may super

vene, but it will be slight, and soon pass off; if you feel an appetite for food, eat very sparingly of the lightest and plainest food.

If your voyage is to be a longer one, still it should commence in the same manner; and during the sleep into which you fall from fatigue, your senses will become, in a degree, accustomed to the motion of the vessel; and the training will have begun, by which the art is acquired of preserving one's equilibrium on a rocking surface.

Nausea and vomiting are liable to occur after important surgical operations, or grievous bodily accidents, in three forms.

One kind has been already adverted to; it goes with the general prostration, and follows the bodily injury immediately. It is comparable to that which is experienced by those upon whom mercury acts as a poison; they have headach, feeble intermitting pulse, nausea and vomiting. Small quantities of brandy in soda-water, form the best remedy. If the vomiting is obstinate, an opiate plaister or liniment to the pitof the stomach will assist.

A second kind is bilious vomiting, the nature of which has been fully noticed at page 30. After the amputation of a limb, in twenty-four or fortyeight hours, the patient will sometimes experience such a seizure.

A third kind, which sometimes follows within

forty-eight hours after surgical operations, is vomiting of large quantities of a transparent grassgreen acid and acrid fluid, without the bitterness of bile. This commonly goes with great debility, and is of most unfavourable augury. Effervescing alkaline draughts, with laudanum and a mustard plaister or blister applied over the stomach, and if the bowels have not been relieved, a purgative injection, are the proper remedies.

Vomiting occurring habitually as a mode of indigestion from primary disorder of the stomach, is not less distressing from the suffering it occasions, than alarming from the possible nature of its source. Cancer of the stomach is uniformly attended with this symptom, although in some cases of this fatal disorder, it is much more prominent and constant than in others. In the last stages of the disease, when no ingesta are received into the stomach, the matter thrown up resembles coffeegrounds, and consists of blood changed by the action of the stomach. Uneasiness of the præcordia, loss of appetite, vomiting when food is taken, tenderness on pressure, and sensible tumour or hardness of the epigastrium, are the pathognomic features of cancer of the stomach, under which the patient gradually becomes emaciated, and finally dies of exhaustion and inanition. But fortunately there are few cases absolutely without hope. And it has frequently happened that when the symptoms have

been such as to lead to the greatest apprehension of the worst results, under fortunate treatment they have been dispelled.

To some which I have already given, (pages 41, 43), I will add the following, as exemplifying the efficacy of another plan of treatment.

A young woman in the family of the English consul-general at the Hague, in the spring of 1818, was subject to intractable vomiting, which had gradually supervened in three months. At first, the vomiting took place occasionally only; after a short time, she observed that it occurred after those meals at which she took meat; in time, after every meal, and occasionally when nothing had been taken into the stomach. However, she threw up no blood or coffee-ground fluid; and although there was pain at the præcordia, and tenderness on pressure, there was no hardness. She had become greatly emaciated; a variety of remedies had been tried, and had proved ineffectual. I recommended that she should take three times a day a quarter of a grain of sugar of lead, and a third of a grain of opium, and that a blister should be applied to the pit of the stomach. On the following day the vomiting ceased, and never returned; the lead and opium were however continued for a week, (opening medicine being likewise given,) and a second blister applied.

These were cases of vomiting without alteration of structure of unusual severity; commonly the