In all cases the patients need to have their toxicity lessened by dilution, and this is accomplished by giving fluids, copiously, and by increasing elimination by promoting the activity of the skin, kidneys and bowels. And since the nervous system is irritated by the toxins, sometimes slightly and sometimes profoundly, the patient must be protected from outside irritation and stimulation. This means quiet; a soft light, or even darkness in the room; gentle handling; and with mildly toxic, conscious patients, a pleasant, reassuring and encouraging manner. With those who are unconscious, each touch must be the lightest and gentlest possible. These are the main features of the nursing care: forcing fluids and keeping the patient warm and quiet. They offer the nurse wide scope in adjustment and adaptation to each patient, according to her immediate condition and to the methods of the physician in charge. There is a difference of opinion among doctors as to details of treatment, but the fundamentals of the care are the same. In taking up, in turn, these manifestations of disturbed metabolism during pregnancy, we find that vomiting is the first to appear. PERNICIOUS VOMITING OF PREGNANCY usually occurs during the first three months. We learned in the preceding chapter that a milder form of the malady, known as “morning sickness,” is present in about half of all pregnancies. This mild type ordinarily consists of a feeling of nausea, possibly accompanied by vomiting, immediately upon raising the head in the morning, and a capricious appetite. It appears at about the fourth or sixth week and subsides in the course of a few weeks, sometimes after no more care than the nursing which was described, leaving the patient none the worse as a result of the attack. With some women, however, the distress does not disappear in this prompt and satisfactory manner, in which case it is described as “pernicious vomiting.” The nausea in the morning may then persist for hours; it may occur later in the day, or even at night; it may come on during a meal and consist of a single attack of vomiting, after which food is taken and retained; or it may be so persistent that the patient will be unable to retain anything taken by mouth at any time of the day or night. Such a condition, is, of course, serious, and may terminate fatally. The patient may become exhausted from lack of food or because of the toxic condition which is responsible for the vomiting, or both.