Post - Operative Vomiting

(A paper read before the Liverpool Society of Anaesthetists). '"pHERE are not many subjects in medicine more fruitful • * • than anaesthesia for stimulating discussion. Perhaps this is because in no branch of our science is practice more varied, and it is an interesting fact that with this variety of method the results obtained by competent anaesthetists are very much the same ! But put yourself into the position of the patient and you will find that the phenomenon of anaesthesia most feared by those who have had any experience is the vomiting that occurs post-operatively. Men in busy practice, who have not the good fortune to be physiologists like the late S. R. Wilson, find out how difficult it is to do research work on really scientific lines; so if this paper is somewhat empiric and unscientific, it must be put down to the fact that the present position of anaesthesia and anaesthetists does not allow many men to practice this branch alone, much less to give time to laboratory research. Post-operative complications, besides the one already mentioned, include ileus, bronchial and pulmonary troubles, shock, and that catastrophe dreaded by all surgeons, pulmonary embolism. The scope of this paper does not include these, and it is proposed to confine it to the complication referred to in the title. In 1922 I published some observations made since the Armistice, in which out of 441 cases 20.1 per cent were followed by vomiting to a greater or less extent (7.2 per cent for more than ten hours); of these the major or abdominal operations showed 27.6 per cent and the minor, or vaginal ones, 12.7 per cent. Both before and since that time a great deal of work has been done on the chemistry of