Further contributions to our knowledge of the pernicious vomiting of pregnancy / by J. Whitridge Williams.

  • Williams, J. Whitridge (John Whitridge), 1866-1931.
Date:
1912
Catalogue details

Licence: In copyright

Credit: Further contributions to our knowledge of the pernicious vomiting of pregnancy / by J. Whitridge Williams. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    particularly manifested by an increase in the proportion of the total nitrogen excreted as ammonia. This so-called ammonia co-efficient, which in normal pregnant women varies between 3 and 5 per cent., may become markedly increased, rising in one of my cases to as high as 48 per cent. After discussing the various factors which might be concerned in bringing about such changes, I was obliged to confess my ignorance concerning the mode of production of the high ammonia co-efficient, but I held that it indicated the existence of a toxaemia, and concluded that when it exceeded 10 or 15 per cent, it should be regarded as an indication for the prompt termination of pregnancy. Accordingly, I recommended the utilization of the ammonia co- efficient as a means of diagnosis, and held, if it were markedly elevated in a given case of pernicious vomiting, that one had to deal with the toxsemic type; while if it were normal the diagnosis lay between the reflex and neurotic variety; the differentiation between the latter being made by the presence or absence of palpable abnormalities of the generative tract. The diagnosis having been established, treatment followed as a matter of course. In the reflex variety, relief followed the correction or removal of the abnormality of the internal genitalia; in the neurotic variety cure should be promptly effected by suggestive treatment, rest in bed, and forced feeding; while in the toxsemic variety prompt interruption of pregnancy was essential in order to check the underlying toxaemia, and, if possible, to give Nature a chance to bring about repair of the organic lesions. The immediate result of these teachings was a marked reduction in the number of cases requiring the induction of abortion; the discovery that most cases of serious vomiting were neurotic in origin, and therefore amenable to suggestive treatment; and, finally, the recognition that the reflex variety of vomiting occurred but rarely, and even when cure followed the correction or removal of the condition which was supposed to give rise to the reflex irritation, that one remained uncertain whether it was the result of the treat- ment employed or was merely due to its suggestive influence. In my original article I was not dogmatic concerning the signifi- cance of a high ammonia co-efficient, but, in justice to myself, I feel that I should direct your attention to what I said in that connection in 1905, more particularly because certain of my critics appear to have assumed that I held that the only explanation for such a finding was the existence of a toxaemia complicating the early months of pregnancy. In view of the fact that in fatal cases the liver presents evidences of extensive fatty degeneration, and occasionally of central necrosis of the individual lobules, quite as extensive as in advanced stages of acute yellow atrophy, I suggested that the high ammonia co-efficient, might be due to the inability of the diseased organ to effect complete