JAMA. 1918;70(23):1750-1751. doi:10.1001/jama.1918.02600230020005.
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A review of the work done on the etiology of hyperemesis gravidarum shows that there is probably some kind of a toxic element in all cases which disturbs the vasomotor system and renders more sensitive the vomiting center. A neurotic factor is generally present as well as peripheral irritation from the uterus. The latter generally disappears when the uterus rises out of the pelvis. The vomiting is therefore of the reflex type. A toxic element that causes central vomiting may sometimes exist, but neither laboratory nor clinical proof has been adduced. Serious injuries to the liver or kidneys or other organs may result from starvation and acidosis. The danger to these organs resulting from inanition or toxemia or both can be fairly well estimated by the relation of the ammonia nitrogen to the total nitrogen. The determination must be made by methods that are really quantitative, preferably the Kjeldahl for


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