Sick of travelling
MEDICINE JOHN ROWAN WILSON
When I was a small boy I vas troubled greatly by motion-sickness. This used to loom particularly large on long car journeys, when it would become necessary to stop every half- hour or so for me to take gulps of fresh air or to retire behind a convenient hedge and say farewell to the remains of my lunch. It was worst, I recollect, when I was going back to school. Curiously enough, I didn't suffer quite so much on the return journey.
As I grew older I began to have less trouble. I never knew whether I had simply grown out of it or whether it was because I had learnt to drive the car myself—certainly motion- sickness affects drivers far less often than passengers. Whatever the cause of my improve- ment, it was a great relief to me. I suppose there is hardly any condition which causes so much distress to the person involved while arousing so little concern to those around him. The non-sufferer tends to feel a lofty superiority which can easily turn, if he is per- sonally inconvenienced, into downright exas- peration. Beneath the conventional expressions of sympathy he harbours a feeling that the nausea could easily be controlled with a little will-power.
We are perhaps a little more enlightened about this than we used to be, partly because of the development of a wide range of motion- sickness remedies. (There is really nothing like the development of a form of drug treat- ment for a disease, for getting people to take it seriously. They reason that if it can be cured by medicine, it must be of physical origin and, therefore, important.) Nowadays, hardly anyone gets on to a ship or a plane without a pocketful of assorted pills.
These remedies—or more accurately pro- phylactics—fall into several different groups. The oldest established is the drug hyoscine, usually sold under the trade name of Kwells. All the others are various types of antihista- mine. They include meclozine (Ancolan, Sea- legs). cyclizine ( Marzine, Screen, Valoid) and dimenhydrinate tDramamine). Each of these has its enthusiastic supporters. Of recent years experiments have been carried out, particularly in America, to try to establish on a scientific basis exactly what action these drugs have and how they compare with each other. The experimental conditions have in- cluded the testing of individuals exposed to artificial waves and a device known as the human centrifuge, a slowly rotating room in which the subjects perform head movements in a plane at right angles to that of rotation. From these studies a number of facts have emerged.
It has been established that a number of antihistamine drugs, including the well-known drugs Benadryl and Phenergan, are effective against motion-sickness, but cyclizine and meclozine seem preferable on the grounds that they are more effective and less likely to lead to side-effects. In particular they are not so prone to cause sleepiness as the others. However, they are by no means completely free from this disadvantage, as I can per- sonally testify, having slumbered my way across the Atlantic on one occasion on meclo- zinc. Hyoscine is extremely effective, particu- larly in the short term. The effect begins quickly, sometimes within twenty minutes of taking the tablet, and lasts for up to three hours. But side-effects tend to be troublesome, especially drowsiness, double vision, and dryness of the mouth. So it is hardly to be recbmmended for long sea voyages.
All these drugs are useful, though none of them is ideal. They can be supplemented by certain common-sense precautions. Heavy meals, particularly with alcohol, are inadvis- able just before or during a choppy sea voyage. Adequate ventilation and an avoidance of engine fumes are both important. Seasickness can often be minimised by lying flat on one's back in a long chair or preferably on a bunk. To avoid car sickness it is better on the whole to travel in the front seat than the back seat and to avoid reading when the car is in motion. Frequent stops are also a help. In all forms of motion-sickness, psychological factors are important. Howeyer, they are certainly not the primary cause, which appears to be located in the balancing mechanism of the ear—patients in which this function has been altered by surgery or disease may be totally freed from motion sickness.
Finally, if all other methods fail and you are badly seasick on an ocean liner, you can always consult the ship's doctor. The only trouble is that he is quite likely to be just as seasick as you are. His distress is, in fact, even greater, since he cannot confess to it without being exposed to the derision of his fellow officers. When I was a doctor on a passenger liner I used to spend the first few days of each Atlantic voyage lying on my bunk with a bottle of pills at my bedside. Every so often Sister would knock on the door and drag me off, pale and sweating, to treat a passenger similarly affected.
We used, I remember, to have a set routine of treatment. We started with good advice and a hyoscine tablet. Then, if the weather remained bad, we went on to antihistamines. If there was no response to any of these we held in -reserve what was known as the Ulti- mate Deterrent. This was a vast purple suppository with an unpronounceable German name. It was presented to the patient with great pomp, resting in a special dish on a bed of snowy white cotton wool. It was explained to the patient that this was an extremely rare and expensive medicine reserved (as indeed it was) for very special cases. On the one occasion when I used it, the female patient kept shaking her head excitedly throughout my introduction. When I had finished she said, 'You're wasting your time, doctor. I shall only bring it up.' I gave her an inscrut- able smile and left Sister to explain the situation.
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