=Hyperemesis Gravidarum.=—The nausea and vomiting of pregnancy is so usual as to be regarded as normal. It usually ceases from the fourth to the fifth month spontaneously; has no ill effect upon the ovum, and may respond readily to treatment. Hyperemesis comes on at the same period and exhibits all stages of violence, from the mild form above described, to cases that end fatally. Three classes of this serious disorder may be distinguished as associated (Eden), neurotic, and toxæmic vomiting. Associated vomiting is the vomiting that comes with gastric ulcer or cancer, chronic gastritis, cirrhosis of the liver, and cerebral disease. These conditions must be excluded in diagnosis. Neurotic vomiting—severe and persistent nausea and retching—is common in pregnant women of the nervous type. It does not lead to loss of flesh ordinarily; the urine is somewhat diminished in quantity from the lack of fluids, but the amount of nitrogen excreted remains normal. This is important. Toxæmic vomiting includes a small but very important class of cases, for all are severe and intractable and some end in death. _Clinical Features._—The normal nausea and vomiting may seem unusually severe. It persists and gets worse. Then vomiting occurs when no food is taken and nothing is held on the stomach. The vomit is stained with bile or blood. The tongue remains clean, and the general condition is good. Next, weight is lost and the pulse quickens. A persistent pulse of over 100 is serious. The tongue becomes coated, sordes develops, sleeplessness and muscular twitching appear, and the patient complains of epigastric pain. Abortion may now occur and the condition clear up. In its final stage, the urine becomes scanty and albuminous, icterus may appear and the temperature rise to 100° F. or more, though sometimes it is subnormal. The pulse may go to 120. Delirium and coma supervene, and emptying the uterus is of no value. Fifty per cent of these bad cases die. The especially prominent points to be noted are the urine, which shows acetone, albumin and blood, either one or all, as well as an increased amount of ammonia. A persistently rapid pulse, marked loss of flesh, coated tongue, jaundice and delirium are regularly present. _Treatment._—Organic disease must be excluded and a diagnosis of pregnancy strongly evident. For the neurotic type, the patient must be segregated from her friends, and a competent, cheerful nurse put in charge. A cool, darkened room is best. If the patient can be transferred to a hospital, the results are more satisfactory. Here the isolation from external interests and irritations can be made complete. The patient does not talk, even the nurse comes with food, attends to the obvious necessities, and departs in silence. Once a day a sedative bath is given (see Baths, p. 325) and medication in kind and frequency as the conditions demand.