BMJ 08 May 1999       Cite this as: BMJ 1999;318:1297

Andrew Lloyd Webber musicals, drugs reps personally demonstrating thixotropic nasal sprays; the world is full of unattractive things, and vomiting is reckoned among the worst of them. Nobody likes vomit; it’s like the opposite of parfait.

Vomiting, and the presence of a vomiting centre in the brain, seem like yet more arguments against the existence of a benevolent God. There are other physical activities with better public relations which perhaps seem more deserving of a centre of their own, and in Thomas More’s Utopia, all other methods of elimination were recognised as being among the pleasures of the flesh; he seems to have specifically excluded vomiting, perhaps to further annoy Henry VIII.

I can understand this attitude, however misguided it is, as I myself have vomited once or twice, and it wasn’t pleasant. But to a physiologist, vomiting is actually an exquisitely elegant and fascinating manoeuvre, and there are irrefutably positive aspects to driving the porcelain bus.

Vomiting, like Gaul, is divided into three parts; first of all nausea, you feel you want to vomit; then comes retching, all the sound effects and tumult and all the unique sensations—but nothing comes out; as W.B. Yeats said, sound and fury, signifying nothing.

Finally, the real thing… the vomit. The stomach starts to dance, the valves open, and whoop, up it comes, a wild trumpet blast on the unfortunate palate, and you think, “I don’t remember eating that.”

But no pain without gain, and vomiting is in fact a protective mechanism to get rid of poisons in a determinedly unforgettable manner; you might forget your birthday or anniversary, even your last columbine kiss, but nobody forgets their last vomit, or, more importantly, the circumstances which caused it. It’s learning experience, and with every vomit, we all become a little wiser.

Such a complex activity requires part of the brain all to itself; the vomiting centre is devoted to coordinating the messages coming in from the stomach and the blood, and to sending them back to the stomach telling it to throw up immediately and damn the embarrassment. It’s coincidently a great way of getting rid of unwanted company.

So the next time you get on the great white telephone to God, transcend the misery and remember that your body is presenting you with a most precious gift; emerald and ruby, amethyst and amber, a liquid bird of paradise, a spectacular, technicolour yawn, only Cecil B DeMille could direct the movie. A thing of beauty is…

Next week; Satan, not such a bad chap.



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