In the case just cited, I must say that I believe it was the fright, caused by the thought of abortion being performed, more than the effects of introducing the bougie, which operated so successfully; I say now, as I said before, I believe that the pre-eminent cause of this kind of sickness must be looked for i the nervous system. Flint speaks of this form of sickness as being decidedly neurotic in its origin, and cites a number of cases of a chronic variety of dyspepsia frequently occurring in young girls. I had one such case come under my personal care.
There was a persistent morning sickness, with this young lady, and a disagreeable nausea whenever food was taken; this patient was at some distance from her home, in a boarding school, and she will probably never know that the lady principal entertained very grave thoughts at one time in regard to her virtue.
It certainly was very difficult to differentiate between this and the vomiting of pregnancy; it was, however, simply due to a vitiated nervous system. My theory is supported by Alt, who records a number of such cases; I cite one only, the case being that of a highly hysterical woman, six months pregnant, suffering from the gravest vomiting, and anxious that miscarriage be induced. She was making preparation for entering the hospital for this purpose, when one of her children was seized with pneumonia. The anxiety felt over the child, forced all thought of self from the mother’s mind; from that moment the vomiting ceased and she remained well until the termination of pregnancy.-Minchener Medicinische Wochenschrift.
Whilst saying that I believe this disease to be in the majority of cases of purely nervous origin, I would not imply thereby that it is not to be feared, far from it; if neglected, we know how likely it is to pass quickly beyond treatment and our patient succumb from sheer exhaustion.
In the treatment cited such as insertion of bougies, dilation of the os, pelvic massage, etc., I believe it is merely the “doing something,” no matter much what it is, so long as you have gained the confidence of your patient, that does good. We have seen how suddenly Hyperemesis will cease if the patient be alarmed; it may be, has often been, and will to again, cured by a process skin to suggestion.
Kattenback had a case where the patient, a primipara, was seized with an incorrigible vomiting. It was suggested to her that her stomach contained some lumps of unwholesome material and their removal would cure her. Some milk was given her, and the stomach ceremoniously washed out. its contents bore no indications of either over-acidity or abnormal ferment She was informed that she was all right and the vomiting would not return; neither did if, and she was safely delivered at term.
There is a familiar and now well-know phenomena, by which these neurotics can be influenced; I speak of hypnotism; it is due to purely subjective conditions.
There is an identity of the hypnotic susceptibility with the condition of hysteria, and it is along these lines that we can work. Just as many times as I have tried this method of treatment, for these cases of excessive vomiting, just so many times has it given me gratifying results.
The patient can be to sleep by bi-ocular pressure, and the idea of cure suggested; the operation may have to be repeated several times, at intervals of a day or so, but you will be rewarded by the cessation of the vomiting, often with but one suggestion. Where the patient is not easily controlled by means of the bi-ocular pressure, Luy’s revolving mirror is a never failing resource.
