[Reprinted from The Medical News, July 22, 1893.] 
4 CASE OF VOMITING OF PREGNANCY, 
RESULTING IN THE INDUCTION 
OF ABORTION.1 
BY JOHN O. POLAK, M.D., 
OF NEW YORK, 
INSTRUCTOR IN CLINICAL OBSTETRICS IN THE NEW YORK POST-GRADUATE 
MEDICAL SCHOOL AND IN THE LONG ISLAND 
COLLEGE HOSPITAL, BROOKLYN. 
In presenting the history of this case, it is not because 
of anything atypical in its clinical course, but rather to 
emphasize some of the methods of treatment that may 
be of value in the management of such cases. 
Mrs. J., thirty-five years old, tertipara, bore her first 
child in 1887, her second in 1890. She menstruated 
first at fourteen, and has since been regular, the flow 
lasting four or five days, though small in amount. Great 
pain preceded and accompanied the flow. The woman 
was of neurotic temperament. She last menstruated 
November 27, 1892, the flow lasting three days, and 
being about normal in amount. A slight show was no- 
ticed December 25, 1892, and again January 22, 1893. 
Upon December 26th, when gestation had progressed 
about four weeks, nausea and vomiting began and con- 
tinued to a greater or less extent until March 13, 1893. 
At no time during this period was solid food taken. The 
emaciation was rapid and progressive, though for periods 
of from twelve to twenty-four hours the patient would 
retain small quantities of liquid food, only to be followed 
1 Read before the Long Island Medical Society, May 4, if 93. 2 
by nausea, retching, or the vomiting of bloody mucus, 
sometimes bile-stained and containing what appeared to 
be gangrenous masses. All treatment usual in such 
cases, such as dietetic measures, cocaine, chloral, argentic 
oxid, morphine, calomel, cerium oxalate, etc., was used 
without avail. 
On March 5th I was asked to see the patient in con- 
sultation. She was emaciated, pale, almost cadaveric 
in appearance, and very nervous. The pulse was 120, 
small, though wiry, varying from 130 to 140 under the 
least excitement. She had been confined to her bed for 
six weeks, vomiting almost constantly, not only every- 
thing that was ingested, but also the mucous secretion 
of the stomach, which was often streaked with blood, 
together with the gangrenous masses already spoken 
of. There was a point of exquisite tenderness in the 
median line in the epigastrium. 
Upon bimanual examination I found a uterine tumor 
about one and one-half inches above the pubes. The 
uterus was greatly anteflexed, the cervix softened; the 
bellying of the lower anterior segment was easily recog- 
nized, and the canal was somewhat patulous. Neither 
subjective nor objective fetal movements had been ap- 
preciated, but intermittent uterine contractions could be 
elicited in the usual manner. After this examination I 
had no hesitancy in saying that the woman was preg- 
nant, notwithstanding the behavior of her menses. I 
advised that everything, solids, fluids, etc., be withheld 
from the stomach, and that rectal alimentation be 
resorted to. I applied a twenty per cent, cocaine solu- 
tion freely to the portio vaginalis and within the cervix, 
at the same time introducing my finger to the os inter- 
num, after the method of Copeman. This treatment 
was rigorously carried out for seven days without suc- 
cess, the patient getting progressively worse. Upon 
March 12th, with counsel, Dr. Cox induced labor by the 
introduction of 5j of sterilized glycerin between the 3 
membranes. At 6 p.m. of the same day, pains set in, 
but were insufficient. The membranes ruptured and the 
bleeding became annoying, though as yet not dangerous. 
With each pain there was retching, and oftentimes 
emesis. By 5 a.m. of March 13th the patient was in 
such an alarming condition from continued loss of 
blood that Dr. Donaghue was asked to see the case. He 
immediately tamponed the vagina tightly with iodoform- 
gauze, thus relieving the hemorrhage. The woman's 
temperature at this time was 102.2°, her pulse varying 
from 145 to 160, and being weak, almost imperceptible, 
and often intermitting. 
At 9.30-a.m. I again met Drs. Cox and Donaghue in 
consultation. The woman's temperature was now 1030, 
her pulse 170 and almost imperceptible at the wrist. 
The respirations were sighing in character; the face was 
blanched, the eyes fixed, the surface cold. Before un- 
dertaking operative measures I injected Oj of a normal 
salt solution at ioo° F. into the rectum, most of which 
was retained, and giv of the same solution into the 
loose connective tissue below the clavicle on either side. 
The pulse almost immediately improved in character 
and volume. Two hypodermatic injections of rr^xx 
each of tincture of digitalis were also given. 
Then, under chloroform, after thoroughly disinfecting 
hands, parts, and instruments, I emptied the uterus of a 
pair of four months' male twins, with one placenta. 
The uterus and vagina were immediately tamponed with 
iodoform-gauze to prevent further hemorrhage. The 
patient was in such a critical condition from acute 
anemia that hypodermatic injections of digitalis, whiskey, 
and ammonia were resorted to; she was additionally 
placed in bed, with the hips elevated, and a pint of 
normal saline solution at ioo° F. was injected into the 
subcutaneous tissue between the scapulae. The reaction 
was prompt and satisfactory. The nausea and vomiting 
immediately ceased with the evacuation of the uterus, 4 
and small quantities of champagne were retained. The 
convalescence, though slow, was entirely satisfactory 
under the use of stimulants, tonics, and electricity. 
As to the management of these cases, induction of 
abortion is often resorted to before all other methods 
have been exhausted. In two other cases in which I 
was consulted, abortion was contemplated, but the 
woman was saved by rectal alimentation and the intro- 
duction of a solid stick of argentic nitrate into the cer- 
vix to the os internum. This plan has been more satis- 
factory in my hands than Copeman's dilatation or the 
application of cocaine to the cervix. 
In my opinion the vomiting in this case was due to 
the extreme anteflexion of the uterus and the neurotic 
temperament of the patient. 
An interesting fact first brought to my attention by 
Dr. King, of Washington, is illustrated in the following 
history. Mrs. S., twenty years old, pregnant two and 
one-half months, applied to me for relief from distress- 
ing vomiting, which the usual therapeutic methods had 
failed to check. Upon close questioning I elicited the 
fact that she was having coition at least three times a 
week. I placed her upon wine-glassful doses of mag- 
nesium citrate, and left, with her promise to abstain 
from intercourse. The improvement was prompt and 
marked, so much so that, at the end of a week, feeling 
perfectly well, she again permitted coition, and the vom- 
iting immediately returned, ceasing at once upon absti- 
nence from that unphysiologic practice. 
Since then I have had two marked instances of coition 
during pregnancy acting as the exciting cause of vom- 
iting.