PREGNANCY-VOMITING 
BY 
J. MARION SIMS, M. D., LL. D. 
[Reprinted from the Archives of Medicine, June, 18S0.] 
NEW YORK 
G. P. PUTNAM’S SONS 
182 Fifth Avenue 
11-80 PREGNANCY-VOMITING. 
J. MARION SIMS, M.D., LL.D. 
PREGNANCY-VOMITING has long been regarded 
as a reflex symptom, but has never been treated 
as such until very recently 
A few years ago Graily Hewitt enunciated the doctrine 
that it was due to flexure and malposition of the uterus,, 
and published cases confirmatory of this view. 
In February, 1878, Dr, M. O. Jones, of Chicago, pub- 
lished a paper on this subject, in the London Lancet, in 
which he took the ground that it was due to congestion or 
granular erosion of the cervix uteri, and that it was to be 
treated locally by nitrate of silver or other escharotic, and 
he related several cases relieved by this treatment. 
Three or four years ago the late Dr. Copeman, of Nor- 
wich, England, brought the subject prominently before the 
profession by various articles published in the British 
Medical Journal, in which he maintained that it was due to 
induration of the cervix uteri and contraction of the canal. 
On this theory he simply dilated the cervix mechanically 
with the happy result of curing his cases in two, three or 
four days. 
Many of them were cases of a very rebellious character, 
Reprinted from the Archives of Medicine, Vol. iii, No. 3, June, 1880. 2 
/. MARION SIMS. 
in which the patients were greatly prostrated from pro- 
longed vomiting and consequent inanition. 
Others have reported cases in the British Medical Journal, 
treated successfully and speedily by Copeman’s method. 
I have seen several cases relieved in a few days by Dr. 
Jones’ method. In all of these there was granular erosion, 
to which I applied a solution of nitrate of silver, 3 i to the 
ounce. In 1878 I saw a case in Paris, at the third month, 
where the vomiting was excessive and uncontrollable by 
ordinary means. The cervix was small and indurated ; but 
there was no granular erosion. However, I applied a solu- 
tion of nitrate of silver two or three times, but without any 
decided improvement, I then tried dilatation of the cervix 
according to Copeman’s plan. There was marked improve- 
ment in three or four days. But she was not wholly re- 
lieved. The uterus was ante-flexed. The fundus was 
bent slightly forward toward the pubic arch, while the 
os tincae looked directly in the direction of the vaginal out- 
let, and the whole organ seemed to sink deeply in the 
pelvis. A Meigs ring elevated the uterus and gave relief 
to the distressing symptoms. 
Possibly my patient would have been relieved by the 
dilatation if I had persevered with it. However the pessary 
was a valuable adjunct to the dilatation, and rendered the 
cure complete. 
Copeman’s method consists in gradually forcing the 
finger into the os and carrying it along till the first joint 
of the finger enters the cervical canal, taking care not 
to push it so far as to impinge against the os internum. 
Theoretically this would appear to be hazardous; there 
would be some risk of producing abortion. But so far we 
have reports only of successful results. 
I desire to place on record here the history of a case 
which may serve as a guide and warning in similar cases 
hereafter: PREGNANC Y- VOMITING. 
3 
Mrs. E. aged 35, a blonde, of medium height, weighing 120 
pounds, was married at 16, and at 17 gave birth to a child at 
full term. 
She had puerperal convulsions; was in labor thirty-six hours ; 
and a dead child was delivered with forceps. She was in convul- 
sions for twenty-four hours before the forceps were used, and was 
dangerously ill for two or three weeks afterward. She lost her 
mind entirely for several days; forgot even how to comb her 
hair , and had to learn how to do many things like a child. 
A whole month passed away before she recovered her faculties 
entirely. Eighteen months after this she gave birth to a second 
child at full term. The labor was natural and her recovery 
prompt. But remembering the dangers of her first confinement, 
and having had a constant dread of convulsions in the second, 
she determined if possible, to avoid another pregnancy. She 
consulted medical men in various parts of the country, and 
thought herself perfectly justified in refusing to become a mother 
again. In 1869 she had a miscarriage which was produced 
because she was afraid of puerperal convulsions if she should 
go the full teim. Ten years after this, in September, 1879, she 
had another miscarriage at the third month, which was wholly 
accidental. 
Prof. Reamey attended her in this miscarriage. She was ex- 
ceedingly ill and barely escaped with her life. 
The business affairs of her husband compelled him to leave 
Cincinnati before his wife entirely recovered, and she insisted on 
accompanying him, contrary to the advice of her physician ; so, 
about ten days after the accident she came to New York, and 
was under my care for a month before she entirely recovered. 
Then on April 3, 1880, she returned again to New York after an 
absence of four months, and I found her pregnant two months 
and a-half. She suffered exceedingly with nausea and vomiting 
—vomiting almost everything she ate. 
For three or four days I gave her the ordinary remedies under 
such circumstances, but without avail. I then examined critically 
the condition of the uterus and found it flexed at the os internum, 
the fundus looking toward the pubes, and the os tincse toward the 
ostium vaginae. The cervix felt rather indurated and the canal 
was contracted. There was no granular erosion—and I concluded 
to try Copeman’s method. I forced the point of the index finger 
into the os to the depth of the finger nail, about half an inch. On 
the next day I did the same thing, carrying the finger a little further, 4 
J. MARION SIMS. 
and after this she had less nausea. On the third day I repeated 
the operation, passing the finger into the cervix uteri, but could 
not pass it any further than I did on the preceeding day, because 
as the body of the uterus was flexed forward, the cervix would be 
driven back toward the sacrum by the pressure, so that it was im- 
possible to pass the finger in deeper than I had previously. To 
overcome this difficulty I pushed the fundus of the uterus back- 
ward with the left index finger in the vagina, and held it there by 
pressure of the right hand above the pubes, when it was easy 
enough to pass the left index finger nearly to the depth of the 
first joint into the cervix, which is about three-tourths of an inch. 
I held the uterus in this position for a minute or two, forcing 
the fundus back toward the promontory of the sacrum with the 
right hand externally, while the index finger of the left was used 
for the dilatation of the cervix. 
After this the nausea disappeared entirely, and my patient was 
able to take food freely. Two days after this I found her com- 
plaining of intermittent uterine pains threatening miscarriage. I 
resorted to large doses of opium but with no effect, for on the 
next day the foetus was thrown off. 
The placenta partially protruded through the os tincae, and 
the neck of the uterus was sufficiently dilated to allow the pas- 
sage of the finger into the cavity. I found the placenta adher- 
ent to the anterior wall near the fundus where it was with diffi- 
culty separated by the finger, and removed, and all bleeding 
ceased. After this my patient recovered rapidly. 
I report this case to show that the Copeman method is 
not always free from danger, and I believe it is the first one 
on record in which any accident has occurred. Of course 
a woman who has had one or two miscarriages, is always 
more liable to have another on very slight provocation, and 
this seems to have constituted the danger in this case, for 
my patient had had two miscarriages. 
During my residence in Paris some years ago, I saw two 
deaths from pregnancy-vomiting, and I saw two cases 
that were snatched from the jaws of death by the induction 
of abortion. Prof. Trousseau and Dr. Johnston of Paris, 
were consulted in these two cases, and both agreed that 
prompt abortion was the only means of saving life PRE GNA NCY- VO MI TING. 
5 
In this connection I wish to put on record the history of 
a case, which, from mere personal considerations, I ought 
long ago to have published. I report it now to clear my- 
self from censure which I have (not very patiently) en- 
dured for the last seventeen years. 
On January 4, 1863, I was consulted by Mme. X., young, beau- 
tiful, and representing two of the first families of the aristocratic 
Faubourg St. Germain. This young woman had been married 
three or four years, and consulted me on account of her sterility. 
She had complete vaginismus, and the marital relation was a physi- 
cal impossibility. 
I explained the nature of the operation necessary for her relief ; 
she was exceedingly anxious for offspring, and gladly submitted to 
the operation. It was performed on January 20, 1863. 
Sir Joseph Olliffe and Dr. Johnston assisted me. Dr. Johnston 
gave ether. She was well of the vaginismus in a fortnight, and 
she conceived three months afterward. Within a week after con- 
ception she began to vomit. She had retroversion, and I replaced 
the uterus and applied a Hodge pessary, which held the organ in 
its place. 
In June I went to Baden-Baden, and my patient and her hus- 
band followed me there soon afterward. The nausea and vomit- 
ing grew worse from day to day, although the uterus was held 
perfectly in place by the pessary. They remained at Baden about 
six weeks. I became very anxious about my patient, and I told her 
husband that I feared it would be necessary to produce a miscar- 
riage, if his wife did not soon change for the better. And he re- 
plied that she must determine this question for herself. 
A few days after this, early in August, they returned to Paris. 
I went with them and placed my patient in the hands of Dr. 
Campbell, then the fashionable accoucheur of Paris. After exam- 
ining Mme. X’s case carefully, he said that he had safely brought 
through many cases of severe vomiting in pregnancy and he 
thought he could tide Mme. X. over all danger. 
She was failing fast, and I did not believe it possible for her to 
live, and insisted on his producing miscarriage. He said, “ no, let 
us wait a few days longer, I see no immediate danger.” I was so 
anxious about Mme. X. that I then went to her mother, and told 
her that I considered her daughter’s life to be in great danger, and 
advised abortion at once as the only means of safety. 6 
J. MARION SIMS. 
She objected most positively, saying that she was the mother of 
five children, that she had vomited from the beginning of concep- 
tion to the sixth and seventh month of each pregnancy, and went 
through safely, and she did not see why her daughter should not 
be as fortunate as she was. 
Lastly I laid the subject before Mme. X., telling her frankly 
that her life was in danger if we should allow the pregnancy to go 
on. She said she had hoped and prayed for conception for the 
last three years ; now that her prayers had been heard she would 
not for a moment entertain the thought of miscarriage ; and then 
she told of her mother’s patient sufferings under like circumstan- 
ces. I then left Mme. X. in the hands of Dr. Campbell, and re- 
turned to Baden. 
A week afterward I received a letter from Dr. Campbell saying 
that my patient was growing weaker every day, yet he hoped to 
bring her through in safety. A few days after the reception of 
this letter Mme. X. arose at seven o’clock in the morning, 
against the express orders of her physician, and got out of bed to 
attend to a call of nature. In doing this she fainted and fell over 
on the floor. The nurse, sleeping in the adjoining room, heard 
the fall, and rushed to her assistance. She was taken up and laid 
in bed in a state of unconsciousness. Dr. Campbell was imme- 
diately summoned. He arrived at eight o’clock, and found her 
in a very restless and nervous condition, with hurried breathing 
and rapid pulse. He could not understand the nature of this sud- 
den attack, and sent for Prof. Trousseau, As soon as Trousseau 
saw the distressed panting, and rapid breathing, and felt the flick- 
ering, irregular pulse, he said that when she had fallen over in 
syncope, a clot had formed in the heart, and that she would die 
of embolus in three hours. She died at half past twelve—two and 
a half hours from the time of Prof. Trousseau’s visit. 
The death of this young woman was a great shock to 
society in the Faubourg St. Germain. And the daily press 
in noticing her death, said, “ her physician is to blame for 
it.” It was immediately reported all over Paris that I had 
performed an operation on the cervix uteri for sterility on 
Mme. X., and that it had caused her death. And to 
this day, this is believed by the medical profession in 
Paris. PR EG NANG Y- VOMI TING-. 
7 
Only last year a lady from the Faubourg St. Germain 
came to consult me on the subject of her sterility, and 
when I examined her case, I told her it was one that no 
treatment could relieve short of an incision of the cervix 
uteri. Her mother was with her, a lady of great intelli- 
gence and high social position (speaking English ad- 
mirably), and she replied: “I can never consent to that 
operation, because it is the same that you performed many 
years ago on Mme. la Comtesse X., which resulted in 
her death.” When I explained to her the nature of the 
operation I had performed on that lady, she said that 
everybody in Paris was laboring under an error in regard 
to it ; and that she had heard more than one medical man 
speak of it who had told her that I had incised the cervix 
uteri in the case of Madame X., and that she had died in 
consequence of the operation. 
Now it is to disabuse my brethren of the medical pro- 
fession in Paris, that I have related the history of this case, 
hoping that they will at this late day do the same justice 
by me that they would have others do by them under like 
circumstances. All that could have been done at that 
time to save the life of Madame X. was to produce a mis 
carriage. I did my whole duty in the mater by urging this 
upon her and her husband and mother, and upon Dr. Camp 
bell. 
They unfortunately took an opposite view and my pa- 
tient died. Her mother is now dead. Sir Joseph Olliffe, 
the consulting physician, died in 1868, and Dr. Campbell 
died a year ago. But Dr. Johnston, who was consulting 
physician and assisted at the operation I performed on 
Madame X., still lives in Paris, and can testify to the truth 
of my statement in regard to this unfortunate case. 
With the light before us now, let us hope that we shall 
hear no more of deaths from pregnancy-vomiting, nor even 
of miscarriages induced to save the lives of mothers. 8 
y. MARION SIMS. 
To the writings of Graily Hewitt, Jones and Copeman, we 
are indebted for direct and practical methods of treatment 
which seem to promise success in the management of these 
troublesome cases. 
Yet these methods are not without a certain amount 
of risk, and must be cautiously tried. 
In Graily Hewitt’s plan we must be careful not to make 
undue pressure on the cervix uteri with the pessary. In 
Dr. Jones’ plan, we must place the patient in the left lateral 
semi-prone position, apply a Sims’ speculum, expose the 
cervix without touching it with the speculum, and then 
pencil the caustic solution on the granular surface and on 
that alone. 
In Copeman’s plan, we must gently insinuate the end of 
the index finger in the os tincae and pass it into the cervi- 
cal canal not more than three-fourths of an inch deep. 
This is to be done with the patient on her back. If the 
uterus should be flexed anteriorly (as it usually is in such 
cases), I must caution the operator not to throw the fundus 
up and push it back toward the promontory of the sacrum 
with the bi-manual method. For this bi-manual pressure 
in the early months of pregnancy may provoke abortion. 
Of course we should not resort to this heroic method of 
treatment unless the case is urgent and rebellious. ARCHIVES OF MEDICINE FOR 1880. 
Edited by Dr. E. C. Seguin, in conjunction with Thomas A. Mcßride, M.D,, Lecturer on 
Symptomatology in the College of Physicians and Surgeons, New York, in charge of general medi- 
cine ; Matthew D. Mann, M.D., of Hartford, Ct., Clinical Lecturer in Gynecology in the 
Medical Department of Yale College, in charge of Obstetrics, and Diseases of Women and Chil- 
dren ; and Lewis A.’Stimson, M.D., Professor of Pathological Anatomy in the Medical Depart- 
ment of the University of New York, in charge of Surgery. 
A 81-MONTHL V JOURNAL. 
The Archives of Medicine will continue to be published every two months. 
Each number is handsomely printed in large octavo form on heavy paper, and the articles are 
liberally illustrated whenever their subjects render this desirable. 
The Archives will not be a neutral or impersonal journal. The views of its Editorial staff 
upon topics of current interest and upon books will be expressed without favor or enmity, over the 
writers’ initials or full names. 
Prior to entering upon the second year of the Archives existence, the Editor does not desire 
to make any loud promises of things to be done, but prefers simply to point to what has appeared 
in its columns, and to call the attention of the profession to the list of. physicians who have ex- 
pressed their intention to be collaborators. 
Among Original Articles published in the first five numbers of the Archives, we may cite the 
following as possessed of general interest. 
Supplementary Rectal Alimentation by Dr. A. H. Smith ; The Self-limitation of Phthisis by 
Dr. Austin Flint, Sr. ; Fibroids of the Uterus by Dr. T. G. Thomas ; Phthisis Pulmonalis by 
Dr. J. R, Teaming ; The Pathological Anatomy of Tetanus by Dr. R. W. Amid.on ; A Contribu- 
tion to the Study of Cancer of the Rectum by Dr. L. A. Stimson ; The Use of the Actual Cautery 
in Medicine by the Editor ; Diarrhoea, Entero-colitis and Cholera Infantum by Dr. J. L. Teed ; 
Psycho-physiological Training of an Idiotic Hand by Dr. Edward Seguin ; and Mr. Delafikld’s 
series of Lessons upon Electricity. 
The five Editorial Articles have treated of the following subjects : The Present Aspect 
of the Question of Tetanoid Paraplegia by the Editor ; The Utility of the Sphygmograph in 
Medicine by Dr. Thomas A. Mcßride ; Obstetrics in Siam by Dr. Sam’l R. House; Ulceration 
of the Cervix Uteri by Dr. Matthew D. Mann ; Lunacy Reform, Historical Considerations by 
the Editor. 
In the Department for Original Observations twenty valuable cases have been recorded, several 
of which might have formed the basis of original articles. 
COLLABORATORS. 
London.—Drs. J. Hughlings Jackson, J. Burdon-Sanderson, and Sydney Ringer. 
Paris.—Profs. J. M. Charcot, J. Marey, and A. Ou.ivier. 
Germany—Prof. Dr. W, Erb, of Heidelberg. 
Philadelphia,—Profe. D. Hayes Agnew, M.D., J. M. DA Costa, M.D., William Goodell, M.D,, Roberts Bar- 
tholow, M.D., S. W. Gross, M.D., and Drs. Thus, G. Morton, E. O. Shakespeare, and J. C. Wilson. 
Boston.—Drs. James R. Chadwick, Charles P. Putnam, James J. Putnam, Samuel R. Webber 
Baltimore.—Prof. E. T. Miles, M.D. 
Hartford, Conn.—Dr. Samuel B. St. John. 
Albany, N. Y.—Prof. Samuel B. Ward, M.D. 
NEWYORK CITY AND BROOKLYN 
Prof. C. R. Agnew, M.D., Prof. Fordyce Barker, M.D., Prof. Francis Delafield, M.D., Prot. W. D. 
Draper, M.D., Prof. Austin Flint, Sr., M.D., Prof. William A. Hammond, M.D., Prof. A. Jacobi, M.D., Prof. 
Mary Putnam Jacobi, M.D., Prof. E. G. Janeway, M.D., Prof. E. L. Keyes, M.D., Prof. Alfred L. Loomis, 
M.D., Prof. F. N. Otis, M.D., Prof. M. A. Fallen, M.D., Prof. Thos. R. Poolkv, M.D., Prof. D. B. St J. Roosa, 
M.D., Prof. H. B. Sands, M.D., Prof. A. J, C. Skene, M.D., Prof. R. W. Taylor, M.D., Prof. T. Gaillard 
Thomas,' M.D;, Prof. W. H. Van Buren, M.D., Dr. R. W. Amidon, Dr. Wm. T. Bull, A. Floyd Delafield, 
A.8., Dr. H. J. Garrigues, Dr. V. P. Gibney, Dr. L. Carter Gray, Dr. E, Gruen.ng, Dr. C. Heitzmann, Dr 
P. P. Kinnicutt, Dr. Jas. R. Teaming, Dr. C. C. Lee, Dr. P. F. Munde, Dr. J. C. Perry, Dr. N. M. Shaffer, 
Dr. J. C. Shaw, Dr. J Marion Sims, Dr. A. H. Smith, Dr E. 0. Spitzka, Dr. Clinton Wagner, Dr. Robert 
Watts, Dr. David Webster, Dr. R. F. Weir, and the Editorial Staff. 
Subscription, per year, $3 00. Price, per number, 60 cts, Specimen number sent on receipt of 25 cts. 
G. P. PUTNAM’S SONS, Publishers, 
182 FIFTH AVENUE, 
NEWYORK.