Pyogenic Infections of the Skin

of opinion that there is always an hysterical basis and that the evidences of toxaemia are the consequence of dehydration. He supports his view by striking instances of severe cases relieved by pure suggestion; and although there has been opposition from those who accept the traditional toxaemic hypothesis, I think he has gained adherents among practitioners with considerable obstetric experience. (2) Reflex Causes.-The vomiting centre may be excited by stimuli from the stomach itself and by afferent fibres from other parts of the body via the vagus. A convenient classification of all these causes will be: (a) Gastric, including emetics, improper food, excess of ordinary food, irritant poisons, pyloric stenosis including the so-called congenital hypertrophic stenosis of infants, dilatation of the stomach, ulcer and malignant disease of the stomach, venous congestion as in morbus cordis and hepatic cirrhosis. (b) General visceral causes. Appendicitis and peritonitis generally. Intestinal obstruction. Dietl's crises. Pelvic disease-possibly pregnancy may be included in this category. Pulmonary phthisis. Violent coughing from any cause. Shock from a blow in the epigastrium or on the testicle or other particularly sensitive surface. (c) Through the central nervous system. (1) The special senses-e.g., a revolting smell or taste, a repulsive or terrifying spectacle; (2) the brainconcussion, meningitis, hanmorrhage, tumour, migraine, mal de mer, hysteria. Perhaps the vomiting which is not uncommon in anaemia may be included here. (3) The spinal cord-gastric crises. It is impossible to consider all these conditions in any detail, nor is such consideration really necessary. In many the cause is obvious, or vomiting is only an incident accompanied by other prominent symptoms. So that a careful general examination and regard to the history should prevent error, and it is rarely difficult to trace the cause as an essentially gastric one when the relation of the act to food and the character of the material vomited are remembered. In most acute abdominal conditions vomiting is not the predominating symptom, but appears as the result of pain which occupies the forefront of the patient's sensations. The elementary precaution of observing the temperature is always advisable to eliminate the occurrence of acute illness. In dealing with a chronic vomiting suspected to be of gastric origin it is well to have a radiographic examination in order to define without delay whether organic pyloric stenosis is present, a condition which m-ay demand operation, whatever the cause of the stenosis.