Nausea and vomiting historical perspective

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The medical term ‘nausea’ is derived from the classical Greek terms ναυτια and ναυσια, which designated the signs and symptoms of seasickness. The descriptions of the development of seasickness in monographs from the latter half of the 19th and early 20th centuries provide a context for understanding the evolution of the demarcation of symptom clusters associated with the original term ‘nausea”. The term ‘nausea’ has been used to denote both a disorder (diagnosis of seasickness) and a symptom (or symptom cluster) associated with other disorders. This pattern also appeared for terms for vertigo, such as ‘vertigine’, dinos, scotomatikos and skotodininos. Hence, one must ask whether the term nausea denoted seasickness explicitly or whether it denoted the appearance of a ‘cluster of signs and symptoms of seasickness’ as a component of other primary disorders.

Historical perspective


  • In 1830, Marshall Hall was the first to discover the reflex theory and the association between nervous mechanisms and the development of nausea and vomiting
  • In 1865, Gianuzzi speculated on the possible existence of a regulating center of the emetic reflex in the brain .
  • In 1881, Thumas, pointed to an area on the floor of the fourth ventricle in animals which, if damaged, made apomorphine’s emetic action impossible
  • In 1889, Clarke described a case of an 8-year-old boy with uncontrollable hiccups and vomiting. The outcome of the case was the death of the patient, and a tumorin the middle of the fourth ventricle was found at the postmortem examination, leaving the author curious about the absence of manifestations other thanvomiting.
  • Retzius produced the most important work on the macroscopic anatomy of the encephalon and he described a structure on thefloor of the fourth ventricle, adjacent to the nucleus of the solitary tract, named it as the area postrema (AP), in Latin meaning, the hindmost area. [1]
  • In 1906, Wilson in a descriptive work on the human bulb, mentioned the AP as being richly vascularized, as well as detailing histological aspects and pointing out the high density of neurons in area postrema.
  • In 1924, Wislocki and Putnam speculated about the postrema region as an area of diffusion between blood andcerebrospinal fluid, after observing dye granules deposited in the perivascular space, especially amongependymal cells.
  • In 1942, Dow and Berglund, in an article on the vascular patterns ofmultiple sclerosis lesions, also described the case of a 38-year-old woman with some of the symptoms involving incessantvomiting, and showing postmortem plaques on the pons andmedulla oblongata.
  • In 1951, Borison and Brizzee while studying the medulla oblongata of cats, identified the AP as a chemoreceptor zone sensitive to the vomiting reflex, integrating the hypothesis of the researchers of late 19 th century, and in 1974, Borison published a review article condensing the advances made by countless other researchers since the early 1950s, concluding that the AP acted primarily as a chemoreceptor trigger zone to the emetic response.
  • In 1979, McFarling and Susac13, reported on patients with multiple sclerosis with intractablehiccups, a symptom not reported within their clinical manifestations, relating to probable disinhibition of the hiccup reflex by the multiple sclerosisplaques.
  • In 1986, Leslie published a meticulous comparative study between several animal species and humans, detailing the microscopic ultrastructure of the AP, and demonstrating that it was an area of permeability of the blood-brain barrier serving as a zone of fine control of autonomic and neurochemical information.
  • In the 2000s, a profusion of papers correlated area postrema syndrome cases to neuromyelitis optica spectrum disorders, with AP in a central role as the target of anti-aquaporin 4 antibodies.[2]


  1. DE SOUZA, Thiago Ferreira Simões (2020). "A concise historical perspective of the area postrema structure and function". Arquivos de Neuro-Psiquiatria. 78 (2): 121–123. doi:10.1590/0004-282x20190118. ISSN 1678-4227.
  2. Sarikcioglu, Levent; Yildirim, Fatos Belgin (2008). "Area Postrema: One of the Terms Described by Magnus Gustaf Retzius". Journal of the History of the Neurosciences. 17 (1): 109–110. doi:10.1080/09647040701236578. ISSN 0964-704X.

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