NAUPATHIA OR SEA-SICKNESS. SYMPTOMATOLOGY, PATHOGENESIS, AND EFFICACIOUS TREATMENT

W. W. SKINNER
1889 Journal of the American Medical Association  
It is not without much reflection that I venture to bring before the Association a paper upon such an old subject as sea-sickness. This subject, how¬ ever, which I have the honor to develop anew be¬ fore this assembly, has recently become enriched both by new theories regarding. the nature and pathogenesis of sea-sickness and, what is still more practical, by new methods of treatment which bring into action medicinal agents not hitherto exhibited in this affection, and which are recognized to
more » ... are recognized to have beneficial and even cura¬ tive effects. There is much in this matter that is new and important ; the Academy of Medicine of Paris recently discussed it in one of their séances; and it may be profitable to briefly review it here, in order that we and our patients may be spared that atrocious suffering to which those who ven¬ ture upon old Neptune's domain are exposed. The author of this paper does not come before you without having had some experience in the treatment of naupathia. He has, in fact, made it the object of special research during the last two years, and the voyages he has made amount to nearly 60,000 miles of ocean, made upon French steamers plying between France and South Amer¬ ica, between Belgium and the United States, and between France and the United States. He was the medical officer on board these ships, and in that capacity he has come into direct relation with more than 2,500 passengers. With the object oLdiscovering, if possible, the nature of sea-sickness, I have carefully examined all observable symptoms in this affection, and have found many which had not before been ob¬ served. Let us, then, enumerate these symptoms, which, when intelligently interpreted, will, I am convinced, lead to the true understanding of this hitherto mysterious affection. We will suppose an otherwise perfectly healthy person suffering from a complete attack of sea¬ sickness. The nervous system yields the follow¬ ing symptoms : Great prostration, indisposition to make the least effort, vertigo, intense frontal or temporal cephalalgia, insupportable sensation of uneasiness, weakness and discomfort, sometimes causing the patient to groan continually ; and finally, insomnia which may extend over a period of several days. All the modalities of reflex ac¬ tion are preserved intact. One important symp¬ tom remains, myosis, which is often observed in these cases. This symptom is of great importance in the study of the pathogenesis of naupathia, as will be seen a little later. The digestive apparatus furnishes the most striking and best known phe¬ nomena: anorexia, adypsia, paleness and coldness of the lips, salivation, nausea, emesis, gastralgia (which is frequent after three or four days of sick¬ ness), and especially constipation. The tongue, liver and spleen are normal in uncomplicated cases. From the circulatory apparatus we have : Diminished force of the cardiac pulsations with consequent abnormal depressibility of the pulse ; decrease or increase in the number of cardiac rev¬ olutions per minute (constant decrease in men, descending so low as 57, 51, and in one case 45 beats per minute, and decrease in one-half the cases in women ; with the latter there is often in¬ crease [114 without fever has been observed] ; while in children of both sexes there is almost always increase-the maximum I have observed is 120 beats per minutes without fever) ; the cap¬ illary circulation appears diminished, as may be inferred from the coldness of the extremities, ears, lips and nos"e, and from the extreme paleness of the skin. The muscles composed of unstriped fibres which receive their motor nerves from the great sympathetic system are evidently paretic, as is denoted by the inertia of the intestine and by the myosis. The urine, as is well known, is excreted in exceedingly small quantity. It pre¬ serves its normal color, precipitates no sediment, is acid, clear, and free from albumen and glucose. Finally, sea-sickness is an apyretic affection ; it has no period of incubation, properly speaking. Its period of invasion is exceedingly variable, being from a few seconds to several hours accord¬ ing to the predisposition of the person concerned. For all these varied phenomena there is, I think, a simple explanation to be advanced ; one which clears away much of the mystery which has hith¬ erto enveloped this peculiar affection, and which points the way to its rational treatment, as the re¬ sults of the new method show. Sea-sickness ought to be regarded as the expression and result of certain purely functional or dynamic perturba¬ tions of the organism, for organic lesions there are none known. These perturbations can all be referred directly or indirectly to the sympathetic ner¬ vous system. Every symptom named above can be explained by invoking a paralysis, or at least a pa¬ resis, of this system, and sea-sickness can be cured by those alkaloids which stimulate the great sympa¬ thetic and the unstriped muscular fibres to which it is distributed. It is really remarkable how this theory harmo¬ nizes with the phenomena observed and with the results obtained. The constipation, for instance, must be due to the defective action of the great sympathetic upon the muscular coat of the intes¬ tines ; the myosis, as is well known, to its defec¬ tive action upon the radiated fibres of the iris ; the slowness and weakness of the heart's action to defective action of the cervical portion upon the intracardiac motor ganglia (as Brücke, of Vi-Downloaded From: http://jama.jamanetwork.com/ by a Michigan State University User on 06/18/2015
doi:10.1001/jama.1889.02400800012001e fatcat:7qrwxlhzzvgcldel6qrw4ieowq