Essentials of Dietetics

1908 Journal of the American Medical Association  
In regard to the etiology of the vomiting of pregnancy, the author refers to his monograph, published in 1906, in which he stated that the present knowledge of the subject justified the differentiation of three types of serious vomiting of pregnancy: reflex, neurotic and toxemic. The reflex variety, of course, is dependent on some abnormality elsewhere in the body. The neurotic type he considers allied to hysteria and readily amenable to suggestive treatment. The toxemic variety is associated
more » ... ety is associated with profound disturbance of metabolism manifested by characteristic changes in the urine and the presence of definite changes in the liver and kidneys. He refers to the fact that it was first shown in his clinic that the urine in these patients presents a high ammonia coefficient, indicating that a much greater proportion than usual of the total nitrogen is being excreted in the form of ammonia. He shows the difference in the urine in neurotic and in toxemic vomiting by means of charts showing the relative amounts of ammonia ami nitrogen. He discusses at length eclampsia and the theories of its causation and then quotes Zweifel's apt designation of it as "the disease of theories." As Williams says : "Unfortunately, exact knowledge is still lacking." He does not agree with Davis and Edgar that eclampsia is always a preventable con¬ dition, though he states that prophylactic treatment is pro¬ ductive of untold good in many instances. In treatment, if the patient is not markedly improved after delivery, he advises bleeding-from 500 to 800 c.c.-the amount of blood with¬ drawn to be replaced by physiologic salt solution. He has followed out this procedure with good results, even in patients in whom the pulse was thin and weak. He refers to Krönig's employment of lumbar puncture in these cases, but does not comment on it; he also mentions renal decapsulation as per¬ formed by Edebohls, but states that it has been done in too few cases to permit of a proper estimation of its value or indi¬ cations. The value of veratrum viride, he thinks, is much over-rated. Pubiotomy, Williams believes, will practically displace Cesarean section for borderland cases, though he states that it is not indicated in cases in which the conjugate vera meas¬ ures less than 7 centimeters. He describes in detail the tech¬ nic followed in his clinic and reports good results. The book is profusely illustrated and a complete bibliog¬ raphy is appended to each chapter. It is commended as one of the most practical text-books on obstetrics. Die Pr\l=u"\fung Nichtoffiziellen Pr\l=a"\parate. Part I. Von Dr.
doi:10.1001/jama.1908.02540090057017 fatcat:54h775d3yza4blacvndao6auli