Seasickness

Sea voyagers who last week wanly looked at their stateroom ceilings or hung dejectedly over ship rails, wished from their hearts that everyone knew as much about seasickness and its prevention as does Dr. P. H. Desnoes, port medical officer at Manhattan for the United Fruit Co. Dr. Desnoes has been having the company ship-doctors gather data on the malady, known also as mal de mer and nausea marma, to which most people, even sailors, are subject. He as found that there are five theories for its causation: 1) the labyrinthine (the ear contains two tiny sacs, the utricle and the saccule, and three semicircular canals, all of which aid in special orientation); 2) "muscle sense" disturbance (the muscle nerves localize in space the position of the limbs, head, eyes and other parts of the body); 3) eyestrain (the patient gets dizzy looking at the ever-changing sea); 4) peripheral vagus-nerve irritation (the insides get shaken up by the complicated motion of the boat and by the minute, incessant vibration of the engines); and 5) psychic stimuli (the patient sees others kharouping and vomiting over the rail and gets sick). All influence to varying degrees the maelstrom of nausea. Most nostrums hit at only one of the causes and so are frequently inefficacious.

Dr. Desnoes gives a beautiful clinical picture of the symptomatology in the Journal of the American Medical Association:

"The symptoms of seasickness are too well known to merit detailed description. Suffice it to list the following, which may come on in an ordinary case, from six to thirty-six hours after departure, normal weather conditions prevailing: discomfort in the epigastric region, varying with the rise and fall of the ship; anorexia; salivation, with frequent swallowing movements; headache, dizziness; weakness, progressing to faintness; cold perspiration of the skin, and pallor of the face, with the oft-described greenish hue. The facial expression, which is one of great dejection and apathy, faithfully records the internal feelings. Waves of nausea finally get so strong that the desire to vomit is overwhelming, and after that act is consummated great relief is experienced. The vomiting is very often projectile in character, and there may be little or no nausea preceding. Objectively, one usually finds a strong, slow pulse with increased blood pressure in the early stages, and later a lowered blood pressure with rapid pulse.

"As stimulation of the horizontal semicircular canals is the least objectionable, passengers soon learn that the recumbent position is most comfortable. They should select the midship region of the ship, where the motion is minimal, and the weather side of the vessel, as the wind is fresher there and in small ships not so apt to convey an undesirable odor from the galley. Cases that persist in spite of simple remedial measures, demand careful examination. A slight pre-existing cardiac incompetence may be aggravated by the efforts of vomiting and may cause a passive congestion of the abdominal viscera, with deficient oxygenation of those tissues. This has been shown to be productive per se of nausea and vomiting, both experimentally and clinically. Careful questioning and search must be made to rule out chronic inflammatory foci, as well as kidney calculus and other diseases of the urinary tract. In women, diseases of the uterus, tubes and ovaries are very likely to cause prolongation of symptoms, and pregnancy in the early months may be an exciting factor, but is usually not such in the later months. It may be interesting to note here that one writer thinks the likelihood of conception is increased by a voyage in which slight seasickness is experienced. This, we think, is due rather to the exhilarating and tonic effects of the usual sea trip."

Treatment and prevention: Abundant sleep; open air exercise (horseback riding and aquatic sports before sailing are recommended); proper bowel elimination; diet restricted to such foods as appeal. For vomiting in excess: rest; the prone position. "Iced brandy, champagne or strong coffee may be given through a drinking tube, but if nausea reasserts itself it is best to continue the administration of [certain drugs]."