Nausea and Vomiting: A History of Signs, Symptoms and Sickness in Nineteenth-Century Britain A thesis submitted to the University of Manchester for the degree of PhD in the Faculty of Life Sciences 2012 Rachael Russell CONTENTS List of Illustrations............................................................................................... 4 Abbreviations....................................................................................................... 5 Abstract................................................................................................................ 6 Declaration.......................................................................................................... 7 Copyright Statement............................................................................................ 8 Acknowledgements............................................................................................... 9 Chapter One: INTRODUCTION 1.1 Introduction........................................................................................... 10 1.2 A History of Nausea and Vomiting...................................................... 12 1.3 Nausea, Vomiting and Sickness in Historical Literature...................... 19 1.4 Approach and Scope............................................................................. 36 1.5 Thesis Structure.................................................................................... 42 Chapter Two: PHYSIOLOGY AND PATHOLOGY 2.1 Introduction........................................................................................... 45 2.2 Muscular Mechanisms of Vomiting..................................................... 46 2.3 Reflex Theory and the Excito-Motor Nervous System........................ 52 2.4 Diagnosis and Therapeutics.................................................................. 62 2.5 Vomiting and Psycho-Physiology........................................................ 73 2.6 Conclusion............................................................................................ 85 Chapter Three: VOMITED MATTERS IN CLINICAL DIAGNOSIS 3.1 Introduction........................................................................................... 87 3.2 The Subjective Interpretation of Symptoms......................................... 89 3.3 From Qualitative to Quantitative.......................................................... 95 3.4 Sarcina as Cause or Consequence?...................................................... 107 3.5 Acid, Digestion and Chemical Analysis............................................... 115 3.6 Conclusion............................................................................................ 124 2 Chapter Four: MORNING SICKNESS 4.1 Introduction........................................................................................... 126 4.2 Nausea and Vomiting as Signs............................................................. 130 4.3 Healthy or Pathological?....................................................................... 137 4.4 The Sick Role....................................................................................... 145 4.5 Hyperemesis Gravidarum..................................................................... 152 4.6 Conclusion............................................................................................ 160 Chapter Five: SEA-SICKNESS 5.1 Introduction........................................................................................... 163 5.2 Experiences........................................................................................... 165 5.3 Self-Medication and Experiments on Board......................................... 180 5.4 Public Health........................................................................................ 194 5.5 From Social to Medical Authorities...................................................... 210 5.6 Conclusion............................................................................................ 219 Chapter Six: CONCLUSIONS 6.1 Introduction........................................................................................... 221 6.2 General Findings................................................................................... 222 6.3 Further Research................................................................................... 228 6.4 Concluding Remarks............................................................................ 233 Bibliography........................................................................................................ 235 Word Count: 83803 3 LIST OF ILLUSTRATIONS 1 The distribution of the pneumogastric nerve............................................. 59 2 Effects of stimuli on vomiting................................................................... 60 3 Habershon’s tabulation of the central, local and peripheral causes of spasmodic vomiting................................................................................... 65 4 Beale’s image of sarcina........................................................................... 97 5 Three vomit samples: healthy, suspected cancer, sarcinous vomiting in a case of dilated stomach........................................................................... 98 6 The woolpack formation of Goodsir’s sarcina.......................................... 102 7 Hassall’s image of sarcina......................................................................... 103 8 Jakob’s image of sarcina........................................................................... 104 9 ‘The Interior of a Packet’........................................................................... 169 10 ‘Scene on board a French steamer from Havre to Honfleur’..................... 172 11 ‘A black north-east-er and a heavy swell, on the Atlantic. A situation in which human titles and dignities do not appear to the best advantage’..... 173 12 ‘Fishing for whiting at Margate’................................................................ 174 13 ‘Leaves from an Amateur Log’................................................................. 181 14 ‘Steaming it to Margate’............................................................................ 182 15 Levilly’s Thalaszone.................................................................................. 191 16 Simpson’s apparatus for preventing sea-sickness...................................... 192 17 Bordin’s specification for preventing sea-sickness................................... 193 18 Preventing sea-sickness by machinery...................................................... 198 19 Attempts to prevent rolling in steam-boats................................................ 199 20 Sections through the Bessemer Saloon in still water and with the vessel rolling......................................................................................................... 202 21 The general appearance of the Bessemer Saloon...................................... 204 22 SS Castalia before and after conversion to a hospital ship....................... 209 4 ABBREVIATIONS BHM Bulletin of the History of Medicine BMJ British Medical Journal IJED International Journal of Eating Disorders ILN Illustrated London News JHMAS Journal of the History of Medicine and Allied Sciences JSH Journal of Social History MTG Medical Times and Gazette SHM Social History of Medicine TNA The National Archives 5 ABSTRACT The University of Manchester Rachael Russell PhD Nausea and Vomiting: A History of Signs, Symptoms and Sickness in Nineteenth-Century Britain 2012 During the nineteenth century, as today, nausea and vomiting were common signs and symptoms of illness, the interpretation of which contributed to doctors’ diagnostic, prognostic and therapeutic choices. At the core of this thesis lies the research question: how did medical understandings and management of nausea and vomiting change in the period 1800-1900? In addition to being signs of bodily disorder, nausea and vomiting constituted an individual, typically non-medicalised experience of sickness. As such, a secondary thesis question is: how were nausea and vomiting experienced, interpreted and responded to by sufferers? These questions are pursued through four key themes: physiology, vomit analysis, morning sickness and sea-sickness. Medical textbooks, journals, hospital case reports, newspapers, letters and diaries are the principal source base. Throughout the nineteenth century physiological explanations for nausea and vomiting followed a generally reductionist path. In the 1830s Marshall Hall’s reflex theory encouraged new perceptions of the nervous mechanisms involved in nausea and vomiting, and helped stimulate their redefinition into local, central and peripheral causes. Changing physiological explanations for nausea and vomiting were also contemporaneous to the growth of microscopy. This thesis draws attention to the interest nineteenth-century practitioners showed in using vomited matters as pathological fluids. This is explored primarily through a case study of sarcina ventriculi, a vegetable microorganism discovered in fermenting vomit. Responses to this discovery showed that laboratory techniques were largely inapplicable to everyday occurrences of nausea and vomiting. Consequently, neither the increasing localisation of the causes of vomiting, nor interest in vomited matters as pathological fluids, contributed to specificity in diagnoses or treatments. This research thereby demonstrates the