Further contributions to our knowledge of the pernicious vomiting of pregnancy / by J. Whitridge Williams.

  • John Whitridge Williams
Date:
1912
Catalogue details

Licence: In copyright

Credit: Further contributions to our knowledge of the pernicious vomiting of pregnancy / by J. Whitridge Williams. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    carefully planned laboratory experiment. The 32-year old patient, who had had three previous labours, was admitted to the ward, when four months pregnant, having vomited incessantly for the previous month, during which she lost 401b. in weight. At the time of admission she was considerably emaciated and greatly prostrated, with a pulse of 120. During the first twenty-four hours she passed 100 cc. of urine, which contained 9 grains of nitrogen and presented an ammonia co-efficient of 37 per cent. Unfortunately, the assistant who made the determinations, misplaced the decimal point in all his calculations, and did not discover the error until after the death of the patient. He accordingly reported that the first day’s urine showed ammonia co-efficient of 3'7 per cent., and that on the subse- quent days it remained within normal limits. Consequently, I made a diagnosis of neurotic vomiting, and placed the patient upon rectal feeding and suggestive treatment, which was so efficacious that her condition improved rapidly, and she was able to retain solid food by the end of the sixth day. Improvement continued until the eleventh day, when tonsillitis developed and the vomiting returned. The following morning, however, she ate with relish and retained a fair breakfast. Later in the day she became restless and excited, and passed into a comatose condition in which she died. Autopsy showed marked fatty degeneration of the liver and epithelial necrosis of the kidneys, together with other lesions which will be mentioned in the detailed history at the end of the article. In this instance, the error in calculating the ammonia co-efficient caused me to overlook the toxsemic condition, and yet the treatment employed enabled the patient to retain the usual ward diet for a week. This being the case, I consider that no one would attempt to attribute the fatal issue to inanition; while the high ammonia co-efficient, which varied between 21'5 and 38'5 per cent., associated with hepatic and renal lesions, indubitably indicated the true nature of the condition. Case vi, to which cursory reference has already been made, affords even stronger evidence of the existence of toxaemic vomiting, as in it experimental proof was adduced to demonstrate that the high ammonia co-efficient was not due to inanition acidosis. This patient, in whom a previous pregnancy had been artificially ended on account of supposed toxaemic vomiting (ammonia co- efficient, 13 per cent.), entered the hospital in November 1911. At that time the vomiting was considered as neurotic in origin, and was apparently relieved by rest in bed, rectal feeding, and suggestion. She was discharged in excellent condition, weighing 136 lb. Within a few days after returning home an indiscretion in diet brought about a recurrence of the vomiting, which gradually became so intense that she re-entered the hospital on December 7. At that time she was able to retain nothing, weighed 124^ lb