As heretofore remarked, the remedies and methods which check nausea and vomiting, either by relieving gastro-irritation, overcoming gastric atony, removing sympathetic irritations and disease of associate viscera, are of quite as much importance as a knowledge of the means of producing emesis.
If there is any one thing which should be more thoroughly impressed upon the mind of a student than another, it is the necessity of keeping the stomach in good condition. The first inquiry in the examination of a patient is as to the condition of his stomach, for a man lives by his stomach. It must ask for food, receive it kindly, and do its part of the work of digestion. It must also receive the fluid necessary for the kindly working of the tissues, and be in a condition to permit and favor free osmose. The physician will also say that it must be in condition to kindly receive his remedies, furnish fluid for the solution of many of them, and permit their absorption through its walls.
The physician who abuses the stomachs of his patients by emetic, cathartic, irritant, nauseous, or in anywise unpleasant drugs, can not have great success in practice, and in the coming years will not be wanted. On the contrary, the physician of small doses, of pleasant remedies, for direct effect, and who has faith in a good stomach and a good dietary, will be the successful man.
Hot Water.—Hot water is an admirable means of relieving nausea and checking vomiting in ordinary cases. Many times the patient is thirsty, but throws up any fluid that is taken. The water should be as hot as it can be swallowed, and taken in moderate quantities until the stomach is settled. In cases of dyspepsia with nausea occurring during digestion, an ounce or two of hot water is an excellent treatment. In cases of sleeplessness, difficulty in going to sleep, restlessness, and nervousness, a cup of hot water will be found to give great relief, and will aid in effecting a care.
As a topical remedy in these cases, sponging the abdomen with hot water, is a very efficient means. The water should be as hot as can be borne, the sponge being rapidly passed over the surface. In from two to five minutes of this application, the abdomen may be covered with a hot dry flannel.
As an enema, hot water may be employed when there is great exhaustion, a feeble circulation, coldness of the surface and extremities, exhaustive discharges, or hemorrhage.
Cold Water. Ice.—In some cases spoonful doses of ice cold water, or simply rinsing the mouth frequently with cold water, will allay nausea, and relieve irritation of the stomach. When ice can be obtained, small pieces taken in the mouth are thought to be better than cold water.
The topical application of cold water over the epigastrium and abdomen is a very good treatment when the temperature is high. A towel wrung out of cold water is sufficient in minor cases, but in the more severe, with a temperature above 104°, the half pack will be better.
The ice bag (powdered ice in bladder, or even a lump of ice in a towel) is sometimes an admirable remedy applied over the spine in the upper dorsal region. I have used it in Asiatic cholera with success when no remedy, not even a drop of water, would be tolerated by the stomach.
As an enema cold water may be employed to relieve nausea and vomiting, when the temperature is high. I have seen it come down from 105° to 102° in an hour, by the injection of a pint of cold well water.
Chloride of Sodium.—Common salt in weak solution is a very certain remedy for the nausea and vomiting of the algid stage of diseases. I have used it in Asiatic cholera, in congestive intermittents, and in cholera morbus, with marked benefit. In some cases an enema of a weak solution cold is the quickest means of quieting the stomach. This is especially the case when the temperature is high, and there is great tlii ret.
Aconite.— Aconite in small doses (gtt. ij. to gtt. v., to water ℥iv.) is an excellent remedy to relieve irritation of the stomach, when the pulse is small and frequent.
Ipecacuanha.—As has been already noted, Ipecac in small doses (gtt. v. to gtt. x., water ℥iv.) is an admirable remedy to relieve irritability of the stomach, and check nausea and vomiting. It is usually combined with Aconite.
Nux Vomica.—Nux is the remedy for nausea and vomiting when the tongue is pallid, the lower part of the face pale or sallow, with feeling of atony in the stomach, or pain resembling colic. The dose should be small, gtt. j. to gtt. v., water ℥iv.; a teaspoonful frequently repeated.
Aromatics.—In some cases a mint water will be found an excellent remedy. Spearmint is to be thought of if there is a scanty secretion of urine. Occasionally some of the stronger stimulants may be employed to relieve atony of the stomach, and to give a better circulation and innervation.
Amygdalus.—The bark of the peach tree (the green sprouts) is an admirable anti-emetic. An infusion is made, and given cold.
Compound Powder of Rhubarb.—A cold infusion of this old-fashioned medicine gives good results in quieting the stomach.
Bicarbonate of Soda.—When the tongue is broad and pallid, a weak solution of bicarbonate of soda should be employed to relieve nausea.
Acids.—When the tongue is deep-red, a weak dilution of muriatic acid will check nausea and vomiting.