WL illH' • IffiV/iT;'' tMlVl'i'i: ._Minimii'' ffitiiii'iimii1 HtMMlMHi::1. y: 11 i' I ij 11.! I• i jIMtiilllJi:'! Wl.HH'. ilimiiHtniu fl 111| I > IH111III Jfllllll IMHU av ,, 'UIHIHH .ill'llllir'til' illllllllll'. ' ,!,' ""11111111)1: ',',, i*imii'ii»»»* lirtt:fiMiii'i->.....in. 1 1 ■ 11 U , (I i. 11. I 11 Ml ' I " ■' • • .M11•1i ' i iii11rI> i . I. inii.'Uimmiiiliun " : illlllt!»l!!llllfllll!,;' : _n;ill»»IIIIHIimmitt1l>t;-rii fi 11111111»; 111 t»ii "man::. i; 11 ,■, 111;; i; uillt HWttwtt' *> •'»•' ll l M ! 11111) < M •« ''WWW^Vl : ". f ' 1 1 1 '■'' ■'• -ii ""V (111 ' t'1'- hi W - ARMY MEDICAL LIBRARY WASHINGTON Founded 1836 Section... Number t3.^.C)..y...LjS.. Form 113c, W. D., S. G. O. >r« 3—10543 (Revised June 13, 1936) 1 HEADACHESf^SUa« */ CAUSES AND THEIR CURE. BY HENRY G. WRIGHT, M.D. M.B.C.S.L., L.S.A., FELLOW ROY. MED. CH1R. SOC. Physician to the St. Pancrr a Royal D)«peneary, ■ '•'*' i" 'Y> tT^s ^Pxg CMP*' NEW YORK: SAMUEL S. & WILLIAM WOOD, No. S89 Broadway. 1856. WL ' \VSG EDWARD O. JENKINS, PRINTER, 26 Frankfort-st , N. T. 12 Jfaifctr, THE FOLLOWING PAGES ARE DEDICATED. 'IZ Somerset Street, Portmam Square. H. G. W. SYNOPSIS. A Headaches in CHILDHOOD and YOUTH. B. Headaches in ADULT LIFE. 1. Dependant on the circulating system : a. Plethoric \ Occasional ( Persistent. b. Congestive. 2. Dependant on the Digestive Organs: a. The Headache of Indigestion. b. The Sick Headache. {Accumulation of bile in the system. Jixuoerant secretion of bile. 3. Dependant on the Nervous System : a. The ordinary Nervous Headache. 6. The Hysteric Headache. e. The Headache of extreme exhaustion and-debility. d. Megrims. e. Brow-Ague. 4. Eheumatic Headaches. 5. Headaches dependant on Organic Disease. C. Headaches in OLD AGE. 1* PART I. HEADACHES—THEIR VARIETIES AND SYMPTOMS. PART II. HEADACHES—THEIR CAUSES AND TREATMENT. BLEAJDAEECES. PART I. THE VARIETIES AND SYMPTOMS OF HEADACHES. The marginal numbers refer to other paragraphs which contain matters connected with the subject under consideration. 1. Very great is the collective amount of the suffering endured by those who 'never had a day's illness in their lives.'—The strong, broad- shouldered man tortured with the toothache; the clever man a perfect martyr to corns; the well-looking lady who plays, without faltering, her part in the world, whose life is regular as her appearance is healthy, yet on whose brow the attentive observer can detect the worn look of unrest that tells of a headache. These afford but a few illustrations of the many sufferers from the minor evils of life: Those lesser miseries which 10 HEADACHES: have more to do with folding the furrows in our faces, and ruling the wrinkles on our brows, than we are wont to admit. 2. I purpose, in the following pages, to consider briefly, and describe plainly, the varieties of head- aches ; the causes to which they are due, the symp- toms by which they are distinguished," and the modes of treatment to which they are amenable. 3. I am well convinced that it is unwise ever to neglect a headache. It is always a source of annoyance and discomfort to the sufferer, yet very few, even of those most subject to headaches, ever think of seeking medical aid. And there are none who need it more, for the pain which they feel not only misleads them as to its true cause, but incapacitates them from judging correctly as to the best means of treatment, in cases where a simple remedy, judiciously taken, would effectu- ally afford relief. Moreover, a headache is often beneficially bestowed as a warning sign (and sometimes the only one the patient notices) of a disease that becomes the more difficult to cure in proportion as the first symptoms are neg- lected, and which can be removed only by the aid of weapons that none but skilled hands should employ. 4. Thus, although the common sense of an educated person may often lead him to judge > THEIR VARIETIES AND SYMPTOMS. 11 rightly whether the simple means at his own dis- posal are sufficient to afford relief; yet, if rightly guided, it might do more. It might warn him of the risk he often runs in allowing so simple an ailment as a headache to proceed unchecked. It is true that a little knowledge is a dangerous thing: but even this is surely better than the ignorance which blindly betrays to danger. 5. Headaches occur more frequently in per- sons of adult life than in extreme youth or ad- vanced age. But in the young and old, as they 62 are the more rare, so are they the more significant, and demand more immediate attention and watch- ful care. Dwellers in towns are more subject to headaches than those living in the country, us They are more frequent in the female, than in 7 the male sex; in those of nervous and delicate constitutions than in the more robust. Head- aches occur more frequently in the middle and ra higher classes of society than in the lower; and especially affect persons who neglect the many little attentions and cares that our civilized, and is therefore in some measure artificial, mode of life requires. I may especially instance regularity in diet, carefulness in adapting the clothing to the requirements of our variable climate, attention to 12 headaches: the action of the bowels, and a sufficient amount of exercise, as essential objects of our care. If these, or any one of them, be neglected, so surely will the silver cord of health be loosed. 6. The headaches that affect the male and fe- rn male sex differ in their frequency and intensity: in their causes, their symptoms, and their effects. There are many causes giving rise to them in the female sex which are due to peculiarities in their 119 organization, &c. The sedentary lives that women generally lead also renders them more liable to headaches. 7. As intensity of thought depends much on the intellectual powers of the thinker, so intensity of pain depends equally upon the capacity for sensation of the sufferer. A beetle trod upon does not in corporal sufferance feel as great a pang as when a giant dies. The delicate scholar or toiler at the desk suffers many days from the pains and 102 penalties whereby he expiates an infringement of the laws of nature, whilst the hard-headed country squire scarce feels any ill effects on the morning after his debauch. There is no weight and no measure whereby we can gauge the amount of pain; but it is certain that its intensity in cases of headaches often depends more upon the deli- cacy of 4he constitution and the nervous develop- ment than upon the first cause of the pain itself. THEIR VARIETIES AND SYMPTOMS. 13 As the most nicely-a.djusted balance is disturbed by the slightest weight, so persons of delicate and w nervous habits are most likely to suffer from headaches. Hence, females are not" only more subject to them, but, as a rule, they suffer more in acutely than men would do from the same amount of pain; and the after effects of the attacks are more severe and persistent. 8. The difference in intensity and significance of headaches at the various periods of life nat- urally suggests the separate consideration of them as they occur in the child, the adult, or the old a person, 9. In the young child, especially, a headache should never be neglected. It often marks a dis- ordered digestion; and this can never continue long in a growing child (whose very growth de- pends upon the proper conversion of its food) without serious mischief ensuing. Pain in the head, is also one of the most constant of the general symptoms that indicate the approach of those diseases, as scarlet-fever and measles, which 69 usually occur but once in a lifetime; and that during the period of childhood. 10. But a headache is, moreover, often the only sign noticed by parents of another disease; one whose insidious approaches the physician watches with intense anxiety, and too often has to regret 2 14 HEADACHES IN CHILDHOOD: that its first warnings were unheeded. A child has, mayhap, been pettish and irritable—no un- common thing with children. Its appetite has failed, or been fickle, and the little one has seemed drowsy and "out of sorts;"—also symp- toms common enough to children. But the child complains of headache; or, if unable to express its feelings, indicates them plainly enough by burrowing its head in the mother's lap; by cry- ing when moved; by placing its hand to its head; and by the careless manner in which it allows the limbs to remain in an uncomfortable attitude rather than disturb the position of the head by rectifying its posture. It avoids the light; and, though young children are unable to wrinkle the forehead, its surface becomes rough- ened, as it were, into a frown. 11. If these signs be neglected, there soon suc- ceed others which cannot fail to arouse the fears that have slumbered too long and awaken too late. Inattention to its complaints of a headache has cost the life of many a little child. The mother, who sees her little one suffering in the manner above narrated, should not listen to the advice of any old nurse, or other unqualified judge. She should not rest, as she values the life of her child, until it has been seen by her medical attendant. A simple aperient may be THEIR VARIETIES AND SYMPTOMS. 15 adminstered, the hair cut short, a thin rag steeped in vinegar and water applied to the head, and the lower limbs may be rubbed with a coarse towel till red from the friction; but the opinion of a qualified practitioner should, in every case, be obtained as soon as possible. 12. In the years that intervene between child- hood and adult life headaches occur less frequently than at any other period. If a healthy boy or girl complain of headache on rising in the morn- ing, its cause may generally be traced to an in- sufficiently-ventilated sleeping apartment. This should always be especially airy for young per- sons; and the common practice of making a number of children sleep together in one room— ' whether in a close nursery or the long low dor- mitories of schools—cannot be too forcibly con-121 demned. 13. Young folks of both sexes, between the ages of twelve and seventeen, especially if they are of studious habits and give promise of an ability above the average, frequently complain of headaches; sometimes persistent, but more often of varying intensity, and accompanied by a sense of lassitude unnatural to youth. They are usually of the kind hereafter to be described 22 as Congestive Headaches. It is too much the custom, through a mistaken confidence or a too 16 HEADACHES IN YOUTH: fond pride, to allow youths who love their books to satisfy without check their eager thirst for knowledge. To this indulgence may often be traced the weakly frame of the scholar, for the precious time that in youth he should have spent in exercise, and in giving stability and strength to his maturing frame, was devoted to his books. That modern system of school-discipline which punishes a boy by increasing his task, and by confining him until it be completed, is often pro- ductive of lasting injury to the health. Nor are the headaches which occur at this period of life 10 always free from the peril that attends those of an earlier age. Though the tongue becomes clean and the feverishness abates; though the pulse diminishes and the appetite improves; yet still the pain in the head may remain unabated, and demands a watchful care; for it is often a warning sign of approaching danger. 14. The headaches complained of by boys and girls of studious habits, are nearly aways relieved by due attention to the food and to the regular action of the bowels; by the enforcement of ex- ercise in the open air, (not riding in a carriage, that is only exercise to aged persons or to in- valids who cannot walk,) and by a diminution of the hours of study; to which the hours of the morning should be devoted in preference to those THEIR VARIETIES AND SYMPTOMS. 17 of the evening or night. The readiness with which the school-boy learns his task in the early morning from the book that he has placed be- neath his pillow, serves to illustrate the propriety of this suggestion. A removal to the sea-side will often be of great service in these cases; and the morning use of the shower-bath, if it can be borne, will prove beneficial. 15. I shall several times, in the following pages, have to recommend the use of the shower- bath. Let me therefore at once define what is meant by the qualification, ' if it can be borne.1 I think this the more necessary as the shower- bath has deservedly risen in estimation of late. Thirty years ago it was comparatively unknown. Now-a-days there is scarcely a respectable family that has not one or more for the use of its mem- bers. And it is well that it should be so, for the continued employment of the shower-bath is as incompatible with effeminacy and feebleness as the continued use of the Turkish bath is in- compatible with true manly vigour and energy. A shower-bath should never be used during the occurence of an attack of diarrhoea or other dis- r charge from the system. The towels should be of the roughest that the skin will bear, and should be used freely and briskly; for the criterion of the value of the shower-bath,- and the test as to 2* 18 HEADACHES IN ADULT LIFE: whether it can be borne, is to be found in the re- action that ensues after its use, the presence or absence of that warm and genial glow which pervades the whole surface, and seems to invig- orate the whole system. If this re-action do not occur, if the bather remain languid and chilled, with the extremities cold and blue, and the skin rough, with a sensation of fulness in the throat and of inability to vigorously use the towel or the flesh-brush, then the shower-bath should by no means be continued, for it cannot be borne, and its employment would be attended with positive evil and even danger. 16. I come now to consider the infinite variety of headaches occurring during the middle periods of life; at the time when the frame is in its fullest m activity and vigour; when man becomes his own master, and is usually a sad tyrant to himself. Late hours, dissipation, improper food, deficient exercise and over-taxing the powers of the brain, are then prolific producers of headaches in the male sex, as are insufficient exercise, tight lacing, 123 injudicious exposure to night air when thinly clad; and last, not least, family cares in the female sex. In addition to these are many special causes 74 to be mentioned in describing the different vari- eties of headaches, and particularly considered in the part which treats of their causes and their cure. THEIR VARIETIES AND SYMPTOMS. 19 17. The contrast is very marked between the headaches of adult life and those which occur in childhood. In the latter this affection is usually 9 of grave import. In the adult the occurrence of a headache, except it be very intense and persist- ent and combined with other and more urgent m symptoms, seldom affords cause for alarm, and may be relieved, in the majority of instances, by very simple remedies. It must be remembered that the symptoms here enumerated as distin- guishing each variety of headache, will seldom be all present in any one instance. They result from the collection and comparison of a large number of cases; and this experience also teaches that headaches, especially those of a milder char- acter, often partake of the symptoms of more than one variety, according to the influence of 71 the causes to which they are due. 18. The frequency of headaches increases in communities as they advance in civilization. We therefore find, as might be expected, that those who chiefly benefit by this' advancement, who are in fact the children of civilization, are most subject to headaches. This is especially notice- able in two very opposite varieties of constitu- tion. Firstly, in nervous and hysterical people; 116 secondly, in those who are habitually free livers, whose digestion is constantly strained to the ut- 20 PLETHORIC HEADACHES: ae most to perform the work given it to do. These two classes represent a large number of the suf- ferers from headaches; and their very existence is almost necessarily identified with that of a high state of civilization. No one ever heard of a squaw afflicted with hysterics, or of an epicurean Red Indian. Indeed, I learn from good authority, that among the primitive tribes in North America and in the South Sea Islands, headaches are al- most unknown. 19. Persons of a full habit of body, or living well and pursuing employments which prevent 64 their taking a sufficient amount of exercise, are particularly subject to headaches of two kinds, the plethoric and the congestive. 20. Plethoric Headaches, or those depend- ing on a general fulness of blood, are of two varieties. The one occasional, of frequent occur- 21 rence, but seldom lasting more than a few hours. The other a continuous headache, sometimes enduring for weeks. Both of these occur more frequently in the spring and summer months. Those who suffer from them are often very reg- ular in their diet, this regularity consisting in 167 their habitually living too well. In the younger portion of those who are liable to these head- aches, the pain is usually severe and rending, and is felt chiefly on the brows and temples. In THEIR VARIETIES AND SYMPTOMS. 21 older persons it is of a heavy throbbing character; 65 is more general in its situation, or is referred to the back of the head. Those who suffer from these headaches are usually of stout frame, with the appearance to a casual observer of the most robust health, especially if the sufferer be under forty, for it is in the ten years on either side of this age that plethoric headaches most frequently occur. The Persistent Headache of plethoric per- 75 sons may endure some days, and even weeks. It is accompanied by a sense of fulness and often of throbbing over the brows and temples, with a sensation of dizziness and of mist before the eyes. The sufferer has a fear of exertion, and in fact passively evinces, in every movement, the 76 dread of a rush of blood to the head. The sleep is usually deep, but the patient awakes unre- freshed. There is thickness of the breathing, with a painful perception of the laboured action of the heart. The appetite is good, though the bowels are generally sluggish. Nature sometimes affords relief by a severe attack of diarrhoea, by the occurrence of bleeding from the nose, or from 82 piles. In fact, persons so suffering often look forward with considerable anxiety to the recur- rence of the latter mode of relief. These head- aches occur more frequently in the female than in the male sex, especially for a day or two be- 22 PLETHORIC HEADACHES: fore or at cerain periods, at the change of life, 83 and during pregnancy. In addition to the above symptoms there is then constant aching of the temples, with wandering pains and a sense of 78 heaviness in the back and loins, increased by motion. 75 21. The Occasional Headache, which is often a source of great distress to persons of a full habit of body, occurs most frequently during the night or in the morning, and is much influenced by 77 the weather. It is more common among dwell- ii8 ers in towns than among persons living in the country. It is very dependant, both in its inten- 8i sity and duration, on the amount of exercise taken. It occurs very commonly in persons 76whose occupations necessitate stooping: this al- ways' exaggerates the pain, and is followed by slight dizziness on again assuming the erect pos- ture. It is usually at once brought on by ex- 77 posure to a vitiated or impure atmosphere, as that of a heated theatre, a close cellar, &c. It is more frequent in the male than in the female sex. The bowels are generally costive; the breath short, the appetite good, though very irregular; and the tongue white at its centre and roughened at its root. For the stomach, being irritable, does its work under protest; and there never was, and never will be, a roughened and white THEIR VARIETIES AND SYMPTOMS. 23 furred tongue where there does not exist some corresponding condition of the stomach, to which the state of the tongue'is so faithful an index. 22. The Headache due to Congestion is 84 another variety with many local symptoms resem- bling that of the true Plethoric character. In the latter there is an actual excess in the blood itself. The patient lives well, and — as the sensible saying goes —' makes blood rapidly.' 75 Though tortured Avith headache he is usually the very picture of health. In the Congestive head- ache, on the other hand, the fault lies in the mechanism of the circulation; in the deficiency 85 of healthy tone in the system. The sufferer is nervous, delicate and weakly, though seldom thin or slightly made. The skin is pale and sallow; the expression of the countenance heavy; the lips pale or bluish; the hands and feet cold; the spirits depressed, and the bowels torpid. The 88 pain is usually referred to one part of the head. The pulse, instead of being strong and firm, and felt at the wrist like a chord drawn tense, is full and large, and easily stopped by pressure. The blood is, in fact, not propelled with sufficient ac- 91 tivity and force; for, as the muscles, which we can feel, are deficient in firmness, soothe heart (also a hollow muscle) is deficient in tone. It languidly performs its office of propelling the 24 congestive headaches: blood, whilst the vessels inefficiently perform their office of forwarding it by the elastic contrac- 64 tion of their walls. And hence result the weary- ing dull pain and sense of heaviness and fullness in the head; the buzzing, singing, or humming noises in the ears, sometimes resembling the roar of the ocean, at others like the humming of bees; the dizziness of sight; and the disinclination for exertion as tending to aggravate the suffering by increasing the rapidity of the heart's beat, with- out the blood-vessels acquiring any additional 84 power of urging forward their contents. Conges- tive Headaches are those which most frequently 13 occur when the mind has been over-cultivated, without due attention being paid to the require- 5 ments of the body. Earnest conversation, vivid emotions, or excessive anger, will produce a rush of blood to the head, followed by dull oppressive as pain, and a sense of coldness in the extremities. In women these headaches are even more com- mon -than those of the true Plethoric character, and at the same period. 23. A sudden and acute attack of headache, of any one of the varieties already mentioned, and happening in persons of the habit of body above described, if it be accompanied with giddi- ee ness and partial loss of speech, and a sense of numbness in one or other of the extremities, is their varieties and symptoms. 25 always attended with danger. It may terminate with a sudden outbreak of singing sounds in the ears; a tingling of the hands and feet; a sensa- tion of flushing in the face, and a little unsteadi- ness in the gait. It may be followed by an intense depression; a sense of nausea; and an uncontrol- lable ejection of the contents of the stomach. But it may directly terminate in an attack of apoplexy 64 or palsy, or, if occurring in nervous and hyster- ical ptrsons, may eventually result in- insanity. Those headaches depending on the circulating system which are so frequent in the decline of 62 life, will be further considered when describing the special varieties that occur in advanced im age. 24. Headaches of Plethora and Congestion are 20 intimately associated, as already noticed, with cer- tain peculiarities of temperament or constitution. 22 Their most prominent symptoms, the throbbing and sense of fulness, naturally direct the attention of the sufferer to the circulation; for there is an appreciable connection between the cause and ef- fect ; each beat of the heart aggravating the pain; every motion of the body (as stooping) which tends mechanically to increase the flow of blood 75 to the head, exaggerates the suffering. This man- ifest dependence of the pain on the cause from which it arises, is far less clearly marked in the 3 26 DYSPEPTIC HEADACHES : majority of the headaches which compose the large class that next claims our attention. s» 25. The Headaches depending on de- rangement of- the digestive organs for their cause are not confined to any particular age or constitution. They will assuredly happen to the strongest if the stomach be taxed beyond its endurance, and those measures neglected which in some, degree compensate for want of care or » regularity in the diet. There are few persons of adult age who have not, at one time or another, is suffered from some derangement of the organs ministering to the digestion and conversion of the food. Indeed, the number is very small, of those us living in London or in large towns, who have a clear tongue for one continuous week of their lives. 26. There are very few, moreover, who have 3s not experienced headaches due to indigestion, though not attributed to its influence. For the pain in the head arising from disturbed digestion, whether the stomach, the liver, or the bowels be in fault, is not always accompanied by the dis- tinctive and well-marked symptoms of the Bil- ious and Sick Headaches. It is true that the pain can often be directly traced to some particular 95 article of food,or to some excess in diet,the influence of which cannot be mistaken. Very frequently, THEIR VARIETIES AND SYMPTOMS. 27 however, the digestion has been for some time de- ranged; the process being still carried on, not 93 healthily, but without causing inconvenience; for the patient endurance of the stomach is almost incredible. The patient can recall no particular irregularity of diet, and attributes the headache to the weather, or to want of due exercise, or to some other cause whose influence has only been equiva- lent to that of the proverbial last feather which breaks the camel's back. 27. As indigestion may continue for a long time without the occurrence of a headache, so a head- ache due to the disorder of the digestive organs by some particular article -of food does not always immediately'cease when that cause is removed. A simple sympathetic headache may thus become permanent, and remain as an independent affec- tion long after the original symptoms of indigestion 43 have been removed. In general, however, these milder forms of headache are of short duration. Like the more intense Bilious and Sick Headaches, they occur chiefly in early and in middle life; becoming less frequent and less severe* as age advances and the irritability of the system isiw diminished; the same cause, which, in early life, produces a Sick or Bilious Headache, giving rise, 62 in aged persons, to an attack of diarrhoea. In- deed, young persons in whom diarrhoea is easily 28 DYSPEPTIC HEADACHES: produced are seldom subject to Dyspeptic Head- aches. 28. The sensation experienced in the head is rather a feeling of dull weight than of actual pain. There is great languor and disinclination to ex- ertion. The tongue is white in its centre, and of a pale red colour at the tip and edges; in weakly 101 persons it sides are often indented by the teeth. The fingers are cold' and numb, there is slight nausea, the pulse is languid and feeble, the sight dim and indistinct, and the eyes ache if employed to read, whilst the attention is with difficulty fixed 97 on the book. 29. These headaches frequently pass away after a brisk walk, or an hour or two of undisturbed repose. They exist in every possible degree, are of most frequent occurrence in persons of delicate 95 digestion on any irregularity of the diet, and in some are almost habitual. They may immediately succeed each principal meal, in which case the pain seldom lasts more than a few hours, and 31 more nearly approaches the Sick Headache in its character, and the mode of operation of its causes. 98 Sometimes the pain is not felt until several hours have elapsed after taking food; there is an irk- some feeling of distension over the brows, with luminous and coloured specks floating before the eyes, and a sense of uneasiness below the ribs. THEIR VARIETIES AND SYMPTOMS. 29 This variety approximates more nearly to the Bilious Headache. 37 30. Fertile causes of these minor headaches de- pendant on disturbance of the digestion, are, too close attention to business, over-anxiety, intense 94 study, or anything that keeps the mind long and anx- iously on the stretch. The stomach becomes weak from want of exercise, from the constrained pos- ture, from the mind being too constantly engaged, and, frequently, from the hurried and imperfect mastication of the food. And here the mutual dependence of the brain and stomach, and their reaction on one another, are well marked. In the first place, the mental excitement and its collateral evils deranges the stomach, and causes indigestion. The brain is then reacted on, and sympathetic 104 headache results. There are many persons who only suffer from these headaches when they im- prudently take certain articles of diet, or too great a variety of food, and who can otherwise bear con- tinual toil of the brain for many hours without experiencing inconvenience. • » • 31. The Sice Headache has received its com-103 pound name in order to express, thereby the sensations—constant nausea, and pain in the head —which are the chief sources of suffering during an attack. It is not a complaint of any particular age, sex, season, or constitution; but persons 3* 30 SICK HEADACHES: leading sedentary lives, and of costive habits, and toe those who are incautious respecting diet, are most subject to it. It is almost confined to the middle years of life, though occasionally met with in the young and old. Persons are often not less suf- ferers from the means employed to relieve the ailment, than from the headaches themselves. There are particular articles of diet which seldom fail to ' produce them in certain constitutions; such as fat meats, melted butter, spices, and rich pastry, meat-pies (combining all these) have been specially described as frequent causes. 32. A Sick Headache generally commences in the morning on waking from a deep sleep, espe- cially in hot weather, or if sleeping in a close room, and when some irregularity of diet has been committed on the previous day.* There is at first a dull and distressingly oppressive sen- sation in the head, merging into a severe and heavy (not throbbing) pain in the tempkv, usually more severe on the left side, and accompanied by a tenderness and a sense of fulness in the corres- 126 ponding eye, or extending across the forehead: * The time usually taken for a meal to pass through the stomach is from two to five hours ; whereas, after leaving that organ, the food (reduced to the consistence of gruel) has to traverse about twenty-six feet of intestine. The irritation, therefore, is probably produced after the food has passed the stomach and during its presence in the intestines. THEIR VARiETIES AND' SYMPTOMS. 31 sometimes it fixes itself over the inner corner of the eyebrow, and in these cases light is especially oppressive. There is a clammy and unpleasant taste in the mouth, the breath is offensive, and the tongue covered with a yellowish-white fur. The sufferer usually desires to be alone, and in the dark. The body is chill, and a sensation is often experienced as of a stream of water trick- ling down the back. The hands and feet are cold and moist, and the pulse feeble. 33. Accompanying these symptoms there is a depressing sense of sickness at the stomach, with an entire loss of appetite; the nausea being in- creased by the erect posture, and by moving about. There is usually great flatulence; for the irritat- « ing food actually undergoes a species of decom- position. Then—after several ineffectual attacks of retching, which terminate only with shudder- ing at the nauseous taste in the mouth—vomiting at length supervenes. The stomach is relieved of whatever food it contains, if any has been taken during the day, in an undigested state; but more frequently only a thin glairy fluid of an acrid sour taste is ejected. During the concussion of the system produced by vomiting there is consid- erable pressure exercised on the bowels by the muscles of the abdomen. The alimentary sub- stance is dislodged from the situation where it is 32 sick headaches: producing irritation, and passes on in its appointed course. The pain in the head, though increased 105 during the act of vomiting, subsequently becomes relieved. There remains merely a squeamishness of the stomach, and a general uneasiness and lan- guor which induces a desire for repose; and, after a short sleep, the patient may awake perfectly well, or only a little debilitated. in 34. In other cases the vomiting continues, and adds still further to the distress. The acid fluid at first ejected gives place to bile—yellow, nau- seous and bitter; and with the intense depression that always accompanies its presence in the stom- ach. This urgent sickness, if allowed to continue unchecked, may go on for two or three hours, until—worn out with the exertion—the sufferer falls asleep, and wakes to comparative ease. io6 35. Sometimes, however, the vomiting does not supervene at all. The pain in the head then usually becomes worse as the day advances, until lost fh sleep at night; and may even continue during a part of the second day. 36. When a sufferer is* restored from the imme- diate urgency of an attack of Sick Headache, it 106 is often only again to endure its recurrence in a few days or a few weeks. And in this way many persons spend the great part of their lives, until, 150" wearied perhaps with ineffectual endeavours, THEIR VARIETIES AND SYMPTOMS. 33 they at length give up all hopes of getting rid of their malady, and think patience must be their only cure."* 37. Bilious Headaches occur generally at an ios earlier age than Sick Headaches. They are more frequent during the summer and autumn. Per- sons of dark complexions with black hair and melancholy dispositions are most subject to them. There are two well-marked varieties of the Bil- ious Headache. The first of these (A) is due to an accumulation of bile in the system; the second (B), to an exuberant secretion of that fluid, either actual or relative. 38. The first variety (A) is very common to no persons who have been long resident in hot cli- mates ; to those who lead irregular lives; and to those who habitually indulge in excess of drink- ing. The skin is dingy and sallow; the spirits miserably depressed; the bowels costive, with great, flatulence; and usually there is a dull ach- ing pain on the right shoulder. 39. The headache is chiefly confined to the forehead, eyebrows, and eyelids; with sometimes an accompanying sense of smarting in the eye- lids and eyes. The latter appear prominent, and of a yellowish tint, in what should be ' the white of the eye;' this yellowness being often well ° Dr. Fothergill. 34 bilious headaches: marked on the sides of the nose. The tongue is coated with a brown fur, and usually appears cracked in its* centre. There is a peculiarly nau- seous and bitter taste in the mouth on waking in the morning; for in cases where the liver does not efficiently peform its function, the mu- cous membrane of the tongue seems to take on a vicarious action, and to produce bile on its sur- face. There is little ox no inclination for food. The patient complains of restless nights and of frightful dreams, is melancholy and despondent, and frequently haunted with an oppressive unde- finable dread; it may sometimes be a general sense of fear, but often it is directed to some special object. It is to this peculiar condition of the mind that the common name of ' The Va- pours' is applied. As a temporary relief to the depression is afforded by the use of stimulants, these are often injudiciously taken; and they not only exaggerate the symptoms after the imme- diate fillip afforded by the ardent spirits has lost 113 its effect, buj, they also add to the suffering by deranging the action of the stomach. in 40. The Bilious Headache due to an excessive action of the liver (B), and ordinarily known as ' an overflow of bile,' is less continuous than the last variety; though, during the time of its occur- rence, it is accompanied by many of the symp- THEIR VARIETIES AND SYMPTOMS. 35 toms above enumerated. But, in addition to these, there is throbbing and rending pain in the head; the skin is hot, and the face suffused. There is often a sense of soreness in the limbs, 39 and a bitter nauseous taste in the mouth. Ob- jects seem dim, and surrounded with luminous haloes, somewhat resembling the plan of a forti- fication. On attempting to read, the letters ap- pear double, or confused. There is a feeling of giddiness, which, however, seldom extends fur- ther than the mere sensation. The patient may not attempt to move about, because he has a con- viction in his mind that he would fall. If this feeling of insecurity be removed by the arm of a companion, he can generally walk without "stag- gering, and derives benefit from the exercise. The appetite is impaired, though an hour's exer- cise, followed by a moderate meal, often relieves the symptoms; or if the headache be of such intensity as to produce sickness, and bile is at once ejected from the stomach, this is usually fol- lowed by an immediate mitigation of the pain and return of the appetite. 11a 41. Where the Bilious Headache follows two or three hours after a meal—especially if that meal has included articles of an indigestible nature, or the patient has been previously sub- ject to dyspepsia—then, although the symptoms 36 NERVOUS HEADACHES: nearly resemble those already detailed, the direct eause of them is somewhat different. For the liver is, in this case, only fulfilling its function of pouring out bile as long as required to do so m by the presence of food in the stomach. But the food taken cannot be digested. The stomach is trying in vain to dissolve it, whilst the liver is all the time continuing its action. The bile con- sequently soon becomes more than proportionate io4 to the work there is to do, is mixed with the un- digested food in the stomach itself, and all the symptoms of an overflow of bile ensue. Hence the relief afforded when the refractory food and mthe excess of bile are got rid of together, by vomiting. us 42. Nervous Headaches, like those depend- ing on derangement of the digestive organs, com- prise several varieties, which are distinct and well marked in their symptoms, and include also a large number of a mixed character. 43. In nervous headaches, accompanied with 133 indigestion, it is usually found that the pain in the head has preceded the symptoms of dyspepsia, and is not relieved by their removal. Sometimes 72 the digestion has been previously impaired, and although all immediate traces thereof are passed away, the headache still remains, and seldom . fails to again derange the digestive organs. For THEIR VARIETIES AND SYMPTOMS. 37 the sympathy which produces a headache when these are disordered, will also serve to derange them when the nervous system is the direct cause of the pain in the head. There is no result depend- ing on recognized causes of disease which does not, in turn, stand itself in the relation of a cause to other effects. And in nervous affections this is especially seen. 44. The ordinary Nervous Headache most fre- quently occurs in persons possessing high suscep- tibility, both mental and physical; whCse spirits w are variable, easily elevated, and easily depressed; whose tempers are fickle, and their sensibility 120 very great. It need hardly be added, therefore, that Nervous Headaches are more common in the female sex, especially between the ages of fifteen 119 and forty; at the age of greatest susceptibility to moral and physical impressions. They are often sudden in their attack and termination. The pain is usually acute and darting, aggravated by 121 sound or light, with a sensation as if the temples were being pressed together, and a ' swimminess' in the head. Some persons become peevish and irritable during the attack; others are dull, Ian- . guid, and almost constantly yawning. There is sometimes a sense of sinking, with a dread of falling, great despondency, and a restlessness which renders the patient incapable of attention 4 38 NERVOUS HEADACHES: and of physical and mental exertion. These latter symptoms are most marked where there is extreme debility following excesses that exhaust the nervous powers. The pulse is small, its fre- quency varying with the least excitement, whilst palpitation of the heart ensues on the slightest exertion. The bowels are usually costive; the sight is dim; and, where the sufferer has long U6 been subject to these headaches, the eyes appear sunken and the countenance wan and careworn. The mentory also becomes impaired, and the powers of perception less acute. The headache comes on most frequently in the^ morning, lasts throughout the day, and abates in the evening. This being probably due to that periodical in- crease of energy in the brain and nervous system which recurs every evening, and which relieves most of the diseases characterised by deficiency of force in the system ;* whilst it exacerbates those 128 of an opposite nature, as fevers, &c. 45. The Nervous Headache which is of such fre- quent occurrence in girls and women of hysterical habits, although presenting more or fewer of the foregoing symptoms, according to its greater or * It not unfrequently happens that any excitement or shock which suddenly arouses the system relieves the nervous pain. Sauvages tells us, that Homberg cured a headache of this kind by setting a patient's head on fire. THEIR VARIETIES AND SYMPTOMS. 39 less severity and duration, has in addition, certain well-marked peculiarities of its own. It usually 123 comes on suddenly, its commencement being ac- companied by spasmodic pain in the abdomen, mounting thence to the throat (where the sensa- u tion resembles that of a ball lodged there), and finally reaching the head. 46. With the abdominal pain there is usually excessive flatulence amounting to a sense of dis- tension, this being due to impaired or deficient powers of digestion: and flatulence, in whatever 101 cases it occurs, is injurious; for it distends the coats of the stomach and bowels, enfeebling their energy, whilst it diminishes their power of action. If the flatulence be followed by eructation, imme- diate, though only temporary, relief is experi- enced. This often forms the excuse for the use, and still more frequent abuse, of that lady-like form of dram-drinking, which consists in dissolv- ing in the mouth a lump of sugar moistened with 7a a spirituous stimulant—as Eau-de-Cologne; a me- dicinal stimulant—as Sal Volatile; or a combi- nation of both—as in Spirits of Lavender. The purpose with which these are taken (to communi- cate an unnatural exaltation to the spirits, and to dispel the uneasy sensations in the stomach) is precisely that whi^h influences the drunkard to swallow his stimulant—gin or brandy; and these 40 NERVOUS HEADACHES: only differ from Eau-de-Cologne in the flavouring. The result is the same whichever be taken—mis- erable subsequent depression, and aggravation of 131 all the causes of suffering. 47. The sensation of a ball rising in the throat —the 'globus hystericus'—is one frequently ex- perienced by nervous and hysterical people on the slightest excitement; and when the nervous susceptibility is evidenced otherwise than by the occurrence of a headache. 48. The pain in the head where it is essentially dependant on that eccentric insanity of the nerves known as ' hysteria,' usually presents certain dis- tinct characters. It is confined to one small space or to a single spot, frequently over one eyebrow. It is often likened to the sensation of a wedge or nail* driven into the skull, or pressing on the brain, accompanied at times by darting pains; and although it often resembles very closely the headaches which arise from some diseases of the 58 skull, yet its occasional occurrence, the hysterical habits of the patient, and the ready relief afforded 134 by treatment, will not fail to sufficiently distin- guish it. 49. The headaches that accompany excessive de- m bility from any exhausting drain on the system, —as great loss of blood, &c^ over-suckling, or * Hence its Latin name of ' clavus'—a nail. THEIR VARIETIES AND SYMPTOMS. 41 prolonged diarrhoea,—are most nearly allied to the Nervous Headaches, and are also of most fre- quent occurrence in the female sex. The cheeks are blanched and the lips pale, there is a dark halo round the sunken eye, the sight is impaired, the legs swell if allowed to hang down, and the whole frame is greatly wasted and debilitated. The pain is generally referred to the top of the head, and is frequently described as resembling a ' ticking,' or the beating of a small hammer on the skull. 11 50. There is a well-marked form of the Ner- vous Headache that is in no way peculiar to per- sons of nervous disposition, and which equally affects both sexes when occurring in its most se- vere form. Its common name is 'Brow-ague,' its scientific appellation 'Ilemicrania.' It is most 127 frequent during the spring and autumn, prevails especially in damp and marshy districts, and is often brought on by exposure to cold and moist- ure. It is intermittent in its character; in this, as in its causes and mode of cure, bearing a strik- ing resemblance to ague. It sometimes depends on the local irritation of a nerve by a decayed tooth, or other cause ; and, in some cases, seems ra to be hereditary. 51. A modification of this variet}- of headache, presenting to a certain extent the same symptoms, 4* 42 NERVOUS HEADACHES. 125 is that known by the English name of' Megrims.'* This is more frequent in the female sex. Though often dependant on the same cause as the true ' Brow-ague,' it frequently occurs as a result of anything that tends to debilitate the frame or ex- haust the nervous energy; as protracted watch- ing, over-nursing a child, anxiety and distress of ui mind, disordered digestion, &c. 52. In both Megrims and Brow-ague, the pain is of an intermittent character, seldom lasting more than a few hours, and distinguished by the regularity of its accessions. These may be of daily occurrence, returning in the morning or at noon; but in some cases they recur only at inter- vals of a fortnight, or even longer, f The pain is often acute, and resembles that of tic-doloreux, from which it may be distinguished by the regu- larity of its paroxysms, and by the freedom from tenderness of the affected part during the periods of intermission. The «pain in Megrims usually commences at the inner angle of the eye, extend- ing towards the nose; the parts affected frequently feeling sore and appearing red, the eye-ball itself e From the old French word • Migraine,' itself a corruption of the Greek 'Hfuicpdvia. f Perhaps the most singular case of periodic headache on record, is that of the well-known French author Marmontel. He suffered from a pain over the eyebrows for seven succe'ssive years, for fifteen days in each year, and four hours in each day. THEIR VARIETIES AND SYMPTOMS. 43 being very tender. In the Brow-ague, the pain 126 and excessive tenderness involves one entire half of the head; the patient often describing it as re- sembling ' an opening and shutting of the skull.' It usually begins with uneasy feelings and a creep- ing sensation over the scalp, and differs greatly mo in the degree of its intensity. 53. Many persons suffer from severe headaches only during the prevalence of a north or north- east wind. These attacks seem, in the character of the pain and their mode of origin, to hold a mid-place between Megrims and Brow-ague. The pain, in general, affects only one side of the face and head. It often periodically occurs at certain periods as long as the wind sets in the obnoxious quarter. 54. Eheumatic Headaches are of most fre-142 quent occurrence in persons who have been pre- viously subject to rheumatism, and usually ensue after exposure to cold, or if the head be uncovered when perspiring. The pain particularly affects the brow, the back of the head, or the temples. It is often preceded by a sense of coldness over the head and face. Sometimes it remains constant to one place; at others it shifts from the forehead to the back of the head, extends to the face, and implicates the teeth; or even affects the muscles of the neck and shoulder. The pain is in all 44 RHEUMATIC HEADACHES. 145 cases dull and aching, rather resembling intense soreness than actual pain. There is no throbbing of the temples,~though each wave of blood is often felt to aggravate the pain. This is due to the increased susceptibility of the affected structure 143 through which the blood-vessels pass. There is excessive tenderness on pressure of the painful part; the skin of which is probably moist, though not hotter than natural; indeed the sensation usually complained of is one of coldness, and re- lief is experienced from warm applications. The 143 headache is generally worse in the evening, and better in the morning. The appetite is seldom affected, and very rarely is the pain of such in- tensity as to distract the thoughts or impair the powers of attention. It lasts longer, and is more 144 likely to recur in persons of full habit of body. 55. The specific headaches of gouty subjects are of much more rare occurrence than usually supposed, except when they ensue in the course, and form a part, of an attack of the disease itself. The generality of the so-called gouty headaches, when they occur alone, are due to the same causes that usually give rise to the gout itself, over- 20 feeding and laziness. The symptoms are almost identical with those of the Plethoric Headaches already described, and are relieved by the same 78 plan of treatment. THEIR VARIETIES AND SYMPTOMS. 45 56. Organic Headaches. Those in which the head itself is the seat of actual disease. Our know-147 * ledge is more precise concerning the headaches that owe their origin to sympathetic causes, than it is concerning those which directly depend on disease of the head itself—that is, of the brain, its enveloping membranes, or the bony skull. It is, in fact, more difficult to explain how disease of the brain produces headache than that of any other organ, for the brain itself is perfectly insen- sible.* Not unfrequently there is disease which leads to structural changes of the most marked m character within the head, whilst the whole pro- gress of the disorder is entirely unaccompanied by pain. And diseases of the brain are the more 0 This was well seen in a case of great interest (related by Mons. Pierguin in the " Journal des Progres") where the brain was exposed by disease. The patient was a woman. " When seated," he writes, " we entered into a conversation with her on some topic that might fix her attention. The moment she became engrossed and interested, the movement of the brain became at once stronger and more rapid. Pressure was now applied upon the brain as strongly as possible, and in an in- stant the patient lost the use of all her senses and ceased to speak ; terminating the conversation suddenly in the middle of a word, which she finished when we removed the compres- sion. The different experiments were not only unattended with the slightest pain, but were unknown to the patient, who never perceived the interruption to her intellectual exist- ence which we thus occasioned at pleasure.'' 46 ORGANIC HEADACHES. deceptive and dangerous, in that they often give rise to those very symptoms of indigestion or of general debility which are themselves so fre- quently the causes of headaches, where they exist alone in the system. The temporary relief afford- ed when the headache becomes ameliorated, or is 150 removed under treatment, may thus mislead; for the disease of the brain, having no direct connec- tion with the pain in the head, remains therefore unalleviated. 57. The headache, although directly dependant on disease of the brain or skull, is not at all an index of the extent of that disease; but frequently 149 it is the only obtrusive symptom in the early stages of diseases of the head, at the period when there is most chance of effecting any good by treatment; and it may remain for a long time un- accompanied by any more prominent symptoms. Its early recognition is, therefore, of great mo- rn ment; and its occurrence is important, for it pre- sents many characters that greatly assist the judg- ment in endeavouring to arrive at a correct deci- sion concerning the nature of the disease. 58. The pain is usually more fixed, deep-seated, and unchangingly persistent in its character, than 48 in other varieties of headaches. It is more obviously increased by mental application, by close or heated rooms, and by stooping. It is not so much affected by any change in the state of the digestive organs. THEIR VARIETIES AND SYMPTOMS. 47 Cheerful conversation, which rather relieves an ordinary headache, becomes laborious and insup- portable in cases of organic headache. Stimu- lants, as wine, &c., produce an immediate aggra- vation of the pain. In more advanced stages the isa slightest motion of the head will often be pro- ductive of suffering, or induce the vomiting that is always so grave a symptom in diseases of the brain. This intense vomiting may be distin- guished from that which accompanies Sick Head- aches, by it's independence of any* error in the diet or affection of the stomach (which is often perfectly healthy), -and by its occurring when the pain is most severe, although it affords no relief. 153 59. When the disease arises from inflammation of the membranes of the brain, the pain occasion- ally assumes an intermittent character, and affects 149 only one side of the head. It may therefore be mistaken for the true Brow-ague. But its de- pendence on some local cause, as disease of the internal ear, or the presence of the decided symp-151 toms which usually usher in and attend the pro- gress of diseases of the membranes of the brain, in addition to the absence of the special causes that give rise to Brow-ague, will readily enough distinguish the two affections. 152 60. The symptoms that subsequently ensue, as the disease of the head progresses, are little likely 48 HEADACHES IN OLD AGE : to be mistaken; when headache becomes a less prominent cause of suffering, and when decided 153 indications of pressure or inflammation manifest themselves. The powers of the mind become gradually enfeebled, and finally, convulsions, ep- ilepsy, paralysis, or imbecility, indicate the terrible progress of the disease. 61. There is a rare variety of headache, minute- ly described by Ploucquet, wherein the eggs of insects have found ingress through the nostrils, and lodged in. the cavities of the frontal bone. In these cases there is a fixed pain across the eye- brows and at the root of the nose. The eyelid of one side is contracted, and the eye itself red and watery. There is dryness of the nostril on the same side, and frequent sneezing, with restlessness and occasional giddiness. Sheep so affected run wildly about, and roll themselves on the ground. 62. Though Headaches in Persons of Ad- vanced Years are. of less frequent occurrence 154 than in youth or middle life, their importance and significance are proportionally greater, es- pecially when they are first felt in old age. For 27 the causes which give rise to so large a number of the transient headaches in adults, as dyspepsia and nervous irritability, for the most part lose ii6 their influence in age. The susceptibility to ner- vous impressions, whether of mind or body, di- THEIR VARIETIES AND SYMPTOMS. 49 minishes with the advance of life, and wisely ordered is that callous indifference which only remains in extreme old age; for the weakened frame and worn-out intellectual energy would be all unable to bear the sharp bodily pain or acute mental anguish over which man, in his strength, rises triumphant. In advanced life the stomach is less irritable, though the food submitted to it is often excessive in quantity and seldom properly masticated. The bowels also are more tolerant, 154 though the food often reaches them in an ill-di- gested condition. Where irritation from this cause does ensue, it usually results in an attack of diarrhoea in place of the Dyspeptic or Sick Headache which would have enevitably accrued in youth or middle age. When, therefore, a head- ache occurs in advanced life, it is clue to no trivial nervous sympathy, and thus the path becomes far more open to form a correct judgment of the true cause of the pain. And it must be remembered that age, as influencing disease, is not to be meas- ured altogether by number of years, but in part by the condition of the physical and mental pow- ers. This is recognized by the Life Assurance Offices, which are often compelled to refuse a policy on a life free from any actual disease, ex- cepting at a higher rate than is warranted by the years of the insurer. Many a man at fifty is 5 50 HEADACHES IN OLD AGE : more worn, and presents more of the special cha- racters of declining life, than another at three score years and ten, whose age ' is as a lusty winter, frosty but kindly,' on whose heart Time hath laid his hand; ' But as a harper lays his open palm Upon his harp—to deaden its vibration.' 154 64. During the years that herald the decline of life, when the first impressions of old age are stamped upon the frame; whilst they— ' Not once perceive they're growing old, Nor think of Death as near ;' when the failing strength is unequal to the ac- customed work and is over-tasked in endeavouring to perform it; the headaches of most frequent occurrenccare those of the kinds already described was depending on the circulation; Headaches of Plethora and Congestion. But in advancing life there is associated with headaches of this nature i.^,a greater danger of a far more serious disease, namely, apoplexy; for the wear and tear of the system is no longer repaired with the ceaseless ac- tivity evinced in youth and middle age. The 155 vessels of the brain are unable to resist the pres- sure of an increase of blood in their canals ; they have lost their elasticity, and it is fortunate if their over-fulness afford timely warning before the dis- THEIR VARIETIES AND SYMPTOMS. 51 tended vessels give way, and effusion of blood takes place into the substance of the brain. 65. The symptoms of Plethoric Headache already 20 enumerated are modified by the diminution of power that attends the decline of life. The force of the circulation, the throbbing of the temples, 155 and the intensity of the pain are lessened. The face is red, becoming flushed on the slightest ex- ertion, and frequently has patches of a florid hue on the cheeks and forehead; the nose is of pur- plish colour; the eyes suffused, and the veins of the temples distended. There is a growing dis- inclination to exertion, and dulling of the facul- ties ; whilst the full portly figure becomes fat and flabby. There is occasional giddiness, especially on stooping or suddenly looking up to the sky. The bowels are sluggish, though the appetite 157 continues good. But there is a drowsiness after so meals, with, frequently, an indistinctness of ar- ticulation on waking ; and the occurrence of this latter symptom, especially if it be also observed when the headache i%most severe, should never be lightly passed over. 66. The Congestive Headache is of frequent oc-159 currence both on the confines of age and through- out the years of waning life. Old persons of thin and spare frames suffer equally with those who are more robust from Congestive Headaches; for 52 HEADACHES IN OLD AGE : they are due to a diminution of power in the ves- sels by which the blood is propelled, or to some obstruction to the free flow of its current, and its 22 consequent tendency to stagnation. They are frequent in those who, during middle life, have been subject to Sick Headaches. The patient has often suddenly sunk into the weakness of old age, leo rapidly losing flesh, vigour,-and strength. The Veins of the legs swell on walking, the face is pal- lid, the pulse feeble, the hands cold and clammy, the sleep unrefreshing, and there is often a com- plaint of weakness in the joints. There is a tendency to fainting, especially on any sudden change of temperature. The pain in the head is often likened to the sensation of an iron band con- stricting the forehead, and is frequently associated with recurring attacks of giddiness. There is great cause for anxiety when to these symptoms 23 are superadded the occurrence of imperfection in speech and indistinctness of utterance, sudden sickness and fainting, often preceded by a stumb- ling and uncertainty in the gait from deficiency of nervous power on one side of the body; this side having been* previously noticed to become sooner chilled on a cold day. 67. The approach of an insidious disease of the 154 brain, which especially occurs in advanced life, and has, of late years, attracted much attention, THEIR VARIETIES AND SYMPTOMS. 53 is often marked by symptoms of headache nearly resembling those already described. I refer to Softening of the Brain.* When acute in its attack the symptoms at once arouse anxiety and excite alarm; but in its chronic form it may pur- sue an insidious course for a long time unnoticed. 57 In addition to that failing of the mental and 62 physical powers which accompanies old age, and in addition to frequent giddiness and headache, usually most severe across the forehead, there are various uneasy sensations experienced in the limbs; constantly recurring numbness; frequent cramps, or a sensation as of insects crawling on the skin. The temper becomes irritable and pet- tish as in the head-ailments of the first childhood. * The frequency of this disease at different periods of life, has been thus calculated from cases recorded by numerous observers. The whole population is assumed to be 20,000, about one-half of whom die before the age of 20. Age. Number of cases of soft-ening of the Brain. Population at this age. Proportio n of cases per 1,000. 20 to 30 30 to 40 40 to 50 50 to 60 60 to 70 70 to 80 80 and upwards. 18 14 28 33 50 64 14 3000 2500 1800 1300 1000 500 200 6.0 5.6 15.5 25.4 50 0 128.0 70.0 5* 54 HEADACHES IN OLD AGE: The speech is often confused; inappropriate words being unconsciously used, and things called by their wrong names. An arc of pearly white tint often appears in the eye above and below the coloured iris, gradually surrounding and form- ing a kind of frame to it. The power of firmly grasping objects in the hand is lost; the lower limbs no longer obey the will, are cold- and rapidly become wasted, sometimes being slowly drawn up and remaining permanently contracted. Other and more grave symptoms gradually su- pervene, unmistakably marking the progress of the disease; and very pitiable is the condition 162 into which the sufferer sinks before death finally closes the scene. 68. The difficulties and dangers which sur- round the diseases of advanced life are in great i5o part due to the deficiency of that conservative vital power which, by its struggle to maintain the equilibrium of health, affords so important a guide in the diseases of youth and of middle life. In the latter the diseases of the enclosing 59jmembranes of the brain present symptoms that are little likely to be overlooked. But in old 149 age their approach is often masked or obscure; and thus symptoms of great moment may be neglected until too late. The patient complains fretfully of a headache; is dull and stupid in the THEIR VARIETIES AND SYMPTOMS. 55 morning, becoming peevish as the day advances with the head hot and the tongue dry and brown. Questions are often incoherently answered; and the sufferer, being early put to bed, is sometimes found unconsciously wandering about the bed- room at night. These signs, and the querulous complaints of constant pain in the head, are pro- bably attributed to the failing of the faculties, or considered as incidents natural to the ebb of life; until total loss of sensibility, and a sleep that is only broken by death, too late points out the 162 fatal error. 69. The foregoing descriptions are only in- tended to include those cases wherein the head- ache is the chief source of suffering. There is no species of fever, and scarcely any kind of in- 86 flammation, which is not accompanied by a head- ache. It is of constant occurrence in every case of disease of the alimentary canal,* and the pre- sence of any irritation, as that produced by worms, f frequently gives rise to the most intense pain in' the head. Inflammation of the eye or e The sufferings of Napoleon Buonaparte were greatly en- hanced by the seventy of the headache that accompanied*the disease of the stomach, from which he died. t Hoffman relates a case where a patient suffered for four years from a headache, in addition to other symptoms, due to the presence of worms in the alimentary canal. The true cause of the pain never being once suspected. 56 ORGANIC HEADACHES. ear, or the presence of foreign bodies in either of 128 them; the cutting a wisdom tooth, or any disease of the upper double teeth; may be, and usually are, accompanied with more or less of headache. But in all these cases the suffering from the pain in the head is only secondary in degree, and therefore falls not within the scope of these pages. PART II. HEADACHES-THEIR CAUSES AND CURE. PART II. THE CAUSES AND TREATMENT OF HEADACHES. 70. Having described the Varieties of head- aches, and the distinguishing features of each, I proceed to point out the Causes to which the symptoms and signs enumerated are due. The kinds of headaches being known, the influence of various causes in their production will be more clearly recognized, and the description of the means to be employed for their relief will be more readily understood. 71. In the majority of headaches—where they are themselves the chief sources of suffering and not merely the symptoms of other and graver ea diseases—the causes are two-fold. Those which render a person susceptible to suffer—or predis- posing causes; and those which directly bring on the pain, and to which it is usually attributed— or exciting causes. In well-marked instances the i* different kinds of headaohe already enumerated 60 HEADACHES : are not more distinct than the causes on which they depend. But it far more frequently hap- pens that a headache partakes of the characters n of more than one of the particular varieties de- scribed, and that the causes are similarly modi- » fied. Thus the intensity of the headache result- ing from excess often depends as much on the 102 wild excitement of the drunkard, and the conse- quent nervous depression from re-action, as on the injury done to the stomach by the stimulants imbibed. 72. Where a headache is of this mixed charac- ter, it is the more difficult to appreciate the effect 43 of different causes, as the result of one only serves to aggravate the influence of the rest. Thus, in- 30 tense mental application produces headache; but it also, pretty surely, leads to evident disorder of the digestive organs, itself a fertile cause of pain in the head. And frequently the causes and their results become still more tangled. The di- gestion is slightly impaired,—producing a trifling headache ■> the mind is unoccupied, or unhealthily employed,—giving rise to a little nervous head- ache ; and the amount of exercise taken is small, —a slight congestive headache being the conse- quence. Many persons, especially females, and no mostly those who enjoy the comforts of life, suf- fer from headaches of %s mixed character.1' They THEIR CAUSES AND CURE. 61 pore over the tambour-frame, or the contents of the circulating library, from sheer want of better employment, till the head aches, the sight be- comes dim as if a cloud had obscured the light, and the mind is lost in a painful and confused reverie. When courage can be mustered to ring the bell, a cup of strong tea is ordered; and, before it arrives, a dose of aether or ammonia is 46 probably taken. Day by day this kind of life is led, until at length the digestive organs are dis- ordered, the tone and energy of the mind dimin- ished, and the powers of the system enfeebled for want of fitting exercise, of proper mental em- ployment, and of regular diet. n< 73. It was with the object of more nearly and more clearly contrasting the various symptoms which mark the different kinds of headache that the classification in the first part was chosen. I purpose pursuing the same arrangement in de- scribing the causes and treatment: considering first those varieties which directly depend upon the circulation of the blood—Headaches of Ple- thora and Congestion: next those due to some derangement of the Digestive Organs—Dyspep- tic, Sick, and Bilious Headaches: and lastly, those dependent on thj nervous system, or on local disease—Brow-agvj 3, Organic Headaches, &c. 74. In describing the characteristics of the 6 62 HEADACHES: several varieties of headaches, the more import- ant causes were cursorily mentioned in order to »trace their connection with the effects due to them The re-enumeration of these causes in the part specially devoted to their consideration, even if it appear like needless repetition, will serve more clearly to denote their respective import- ance, and mark their relative value. More- over the several influences of the predisposing 71 and exciting causes in each variety of headache requires that these should be separately consid- ered; whilst the importance of care in diet and .36 regimen as much demand attention when describ- ing the treatment as do the kinds of medicines most suitable. For in proportion as the causes become tangled and intermixed, so the treatment (whether dietetic or medicinal) requires to be modified according to the variation and relative influence of the causes to which the pain is due. u 75. The Causes and Treatment of Head- aches from Overfulness of Blood. I have already endeavoured to mark the distinction be- tween the symptoms of the headaches which arise from a general repletion of the circulating sys- tem, i.e.—Plethoric Headaches; and of those in which the overfulness is confined to the head it- w self, i.e.—Congestive Headaches. In plethoric persons the whole system is in an energetic state THEIR CAUSES AND CURE. 63 of health. The appetite is correspondingly great, whilst the large supply of material thus intro- duced into the circulation is not expended by the body; either in exercise—as is necessitated in cold climates, or by an excessive action of the skin—as occurs in hot countries. The whole system of blood-vessels is thus working at high pressure. The effects of this plethora are of course most felt where the vessels are weakest, and least able to resist the force of the current of 64 blood. This is especially seen in the Brain. The blood-vessels here are not only weaker in struc- ture than those of any other part of the body, but, moreover, they derive no support, as other vessels do, from the elastic pressure of surround- ing muscles. When, therefore, the rapidity of the general circulation is enhanced by exercise, the effect is virtually the same as when the stream 25 of blood that flows to the head is mechanically influenced by stooping. Giddiness, fulness, and throbbing ensue; for the vessels of the brain are strained to the limits of their endurance, and these are their signals of distress. 2 76. It will hence be apparent that whatever increases the natural tendency to repletion, pro- 2 duces a predisposition to suffer from plethoric headaches; whatever accelerates the flow of blood towards the head, or retards its passage 64 PLETHORIC HEADACHES: from the brain, acts as an exciting cause, which need only be very slight where the predisposition 154 is strong, and vice versa. The habit of body, and the age of the patient, high living, indolence of mind and body, with insufficient exercise, over- si indulgence in sleep, wearing too much clothing, long thick hair, &c, may be enumerated as fre- quent predisposing causes. 77. Those which immediately produce the head- ache are far more numerous. Chief among them may be noticed, the suppression of any accus- tomed discharge, excess in eating and drinking, 20 a stooping posture, or frequent alternations of the erect and recumbent position; unwonted exposure to the sun with the head uncovered; any unusual strain on the powers of the mind, vivid emotions 121 or mental excitement, especially fits of passion; (.^impure air, as in cellars, &c.; and, above all, a sudden arrest or diminution of the action of the skin by exposure to cold, and in a moist condition of the atmosphere. This result might be antici- pated when it is remembered that every alteration of an inch in the mercury of the barometer adds or removes a weight of 1080 pounds from the • average weight which the body of a man of mean stature sustains. The effects of any sudden alter- ation of this pressure are abundantly evidenced in 122 the frequency of apoplexy, headaches, and other THEIR CAUSES AND CURE. 65 diseases, when the barometer is subject to great 21 and rapid variations. But the human frame can habituate itself to very different degrees of atmos- pheric pressure. On the summit of Mont Blanc the famous Saussure had scarce strength to consult his instruments; whilst at a height scarce inferi- or to this in South America, young girls dance for a whole night without being extraordinarily fatigued. The influence of barometrical changes is even more marked in animals than in man; indeed their actions are often regarded as indica- tions of the probable condition of the weather.* 78. In the Treatment of Plethoric Headaches the employment of medicines should be as far as possible dispensed with. They should only be resorted to when the necessities of business pre- vent, or the solicitations of indolence interfere 136 with, a Strict control over the diet and regimen. In these cases a saline diuretic [formula 30] taken twice a day; and an occasional aperient at night 100 [formula 35], followed by a sedlitz powder in the morning, seldom fail to afford great benefit when persevered in. » 79. Persons subject to Plethoric Headaches 20 should not partake of animal food more than once a day, and even then should let fish and vegeta- *' When rain depends the pensive cat gives o'er Her frolics, and pursues her tail no more.'—Swift. 6* 66 PLETHORIC HEADACHES: bles form a principle part of the meal. The appetite should never be indulged to satiety. Beef, spirits, coffee, and all stimulating beverages should be avoided, or very sparingly taken. The head may be freely bathed at night, and elevated during sleep. The bedroom should be airy; and as the more nourishing articles of diet are to be carefully restricted, so also over-indulgence in sleep, ' the chief nourisher in life's feast,' is to be avoided. As soon as the brain is thoroughly awake it is time to rise; otherwise the thoughts become active, and all intense thinking, when in the recumbent posture, tends to produce conges- tion of the head, and causes it to ache. 80. Drowsiness after dinner (if no extraordinary fatigue has been undergone, or the night-rest not been disturbed) is a sign of having eaten too heartily. It is best avoided altogether ;* but, if indulged, it is better to sleep upright in a chair than to repose on a sofa. In the former position the sleep is generally short, and never very pro- found ; but when the whole body is recumbent, and the stomach full, the sleep is heavy, pro- * The hint afforded in the following extract might be ad- vantageously borne in mind. ' Til eschaip the euil accidentis that succedis fra the onnatural dais sleep, as caterris, Hede- verkis (Headaches) and indigestione, I thocht it necessair til excerse me vith sum actyue recreatione.—Compl. s. p. 56. THEIR CAUSES AND CURE. 67 longed, and accompanied with snoring. The person who thus indulges awakes drowsy and unrefreshed, with a sense of fulness and weight in the head, with the eyes red and painfully sen- sible to light, and 'the body chilled and very susceptible to cold. 81. Exercise in the open air should be regu- larly taken, but all violent exertion or sudden change of posture, should be carefully avoided. 21 The clothing should be, as far as possible, accom- modated to the season, and hot close rooms guarded against. The hair should be kept short. It has been observed that monks who neglect shaving their heads, after having once habitu- ated themselves to do so, suffer severely from w headaches. 82. The bleeding at the nose which sometimes 20 occurs, should not be too suddenly checked, as it often affords a salutary relief. When the patient has been imprudently exposed to cold, and the headache comes on severely at night, with the head hot, and the skin harsh and dry, a sudorific with antimony [formula 20], taken at bed-time, is often of great service; the body being kept warm during its action. 83. Plethoric Headaches, with a sense of 20 throbbing or of fulness, and a feeling of drowsi- ness, often prove troublesome to pregnant women, 68 CONGESTIVE HEADACHES: although not necessarily of a full habit of body. It was formerly much the custom to recommend blood-letting under these circumstances. A more enlightened physiology has now proved, that in none but the most urgent cases is bleeding admis- sible during pregnancy. For the perfection of the frame of the child depends upon an abundant and constant supply of rich blood in the system of the mother.. These cases are usually greatly relieved by the use of saline medicines [formulae 5, 36] ; the occasional employment of gentle and unirritating aperients, as eastor-oil, and the avoid- ance, as far as possible, of fluids. Sea-air, and sponging the body with tepid salt-water, gener- ally prove beneficial. 84. The Headaches of Congestion are directly due to an increase of the quantity of L22 blood in the brain, usually combined with a de- terioration of its quality. This increased quantity is not accompanied by any corresponding reple- 38 tion of the vessels of the rest of the body, whose natural fulness is, on the contrary, often rather diminished. The congestion of the head is due to the triumph of physical over vital force. The stream of the blood having the same tendency 73 to stagnation as a current of any other fluid. 85. The Congestion may be due either to a diminution of the propelling power, as in very their causes and cure. 69 thin and weakly persons; or to a want of tone, of active elasticity, in the vessels whose office 22 it is to aid the propulsion of the blood by their contraction on the contained stream, as often occurs in stout heavy people of feeble strength and broken-down constitutions; in women who have borne many children; and in men who have lived dissipated lives. 160 86. Congestive headaches often follow attacks of fever, or of any disease which much enfeebles the system, and may continue for a long period. They are frequently brought on by the inhalation of impure air, as in crowded rooms; by the employment of narcotics.; or by any stricture 76 that interferes with the freedom of the circulation, as tight neck-cloths, the use of stays, &c. Pro- longed mental occupation, and a low, posture of the head, are also fertile causes, especially # in 6« advanced life. 87. The precautions already suggested (when treating of Plethoric Headaches) in reference to 78 sleep, exercise and clothing, should be observed in cases of Congestive Headache. The diet should be light and nutritious, care being taken that the stomach is not at any time overloaded. The meals should be regular; animal food is requisite once a day at last, and all watery vegetables should be avoided. Fat and all things of an oily 70 congestive headaches: nature, as butter, &c, should be very sparingly used, and a glass or two of good wine, according to the degree of debility, be daily taken. as 88. The coldness of the feet and hands so much complained of, is best remedied by wearing gloves and hose of wool, and other materials which are bad conductors of heat from the body. Friction and exercise are invaluable where they can be employed, and should as far as possible supersede the habit of warming the extremities at the fire. It is advisable never to retire at night with the feet cold; or the hot water bottle may be used after getting into bed, taking care, however, that it is removed as soon as its purpose has been fulfilled. Fresh air, gentle exercise, and cheerful society are important advantages if they can be'obtained. 89. The aperients so frequently required by ieo persons who suffer from Congestive Headaches, should be cordial and saline [formula 47], and is9 adapted to the age and constitutional powers of the patient. The bowels should act once every day, and the aperient be taken on any deficiency of their regularity, especially where the patient is of stout habit. A mixture that combines a tonic and gentle stimulant often proves very beneficial. And there are no medicines so invariably useful in cases of Congestive Headache, attended with their causes and cure. 71 debility, after establishing a regular action of the bowels and due regulation of the diet, as the preparations of iron. Incases where there exists great debility, the ordinary compound iron mix- ture of the Pharmacopoeia [formula 32], or the still more valuable saccherated carbonate [for- mula 33] are very beneficial. If the patient be of stout, phlegmatic habit, the tonic may be 22 advantageously combined with a cordial and saline [formula 37] ; and in females past the middle period of life, especially where these headaches accompany alterations of the whole system at the great climacterical period, the mu- riated tincture of iron combined with cinnamon [formula 31] usually proves exceedingly service- able, 90. There is a form of headache which pre- sents many of the characters of both the plethoric and congestive; and which is almost peculiar to young women with irregularity or deficiency in the healthy powers of the system. Early hours, spare but nutritious diet, exercise in the open air, but not to produce fatigue, and the use of the shower-bath in the mpming and a warm foot- 15 bath at night, with an occasional aperient [formulae 4, 26, or 28], seldom fail to afford relief. 91. Both in Plethoric and Congestive Head- 72 CONGESTIVE HEADACHES: aches, great evil results from a foolish and too-frequent practice prevalent among persons suffering from them, who, without consulting a medical man, ' get themselves bled.' Temporary rehef is usually experienced from the removal of the blood, as the local congestion is, pro tanlo, relieved; and hereby the evil is increased, the fallacious advantage derived leading to a repeti- tion of the bleeding. In plethoric persons the removal of the blood by this means seems to act as a stimulus to the still more active formation of it, and hence, the interval is not long before the headache recurs with increased severity. In 22 Congestive Headache, as the amount of the vital fluid in the system does not exceed that required by the body, so the removal of a part of it by general bleeding only weakens the patient and increases the deficiency of tone already existing. The most serviceable method of depleting, where the suffering is very great and the strength tolerably good, is that of cupping at the back of the neck. The action of the cupping-glasses :si proves beneficial in addition to the effect pro- duced by the abstraction of blood. In weakly persons, the simple application of the glasses, several times repeated, without the removal of any blood, often proves advantageous. In cases where the pain is very severe and the patient of THEIR CAUSES AND CURE. 73 very debilitated constitution, the use of the croton-oil liniment applied tp the central part of the nape of the neck generally affords relief by the counter-irritation it produces; but the dis- comfort often caused by it proves a hindrance to its frequent employment. 92. The Causes and Treatment of Dys- 25 peptic Headaches. The headaches due to de- rangement of the digestive organs have ma$y causes common to their several kinds ; whether of the variety that ensues immediately after taking food, or that which comes on a few hours after a meal: the Bilious or the Sick Headache. 93. Sedentary habits, especially when com- bined with anxiety of mind and insufficient ex- ercise, seldom fail to weaken the powers of 30 digestion, and are frequent predisposing causes of headaches. They are, moreover, often com- bined, with irregularity in diet; too long an interval being allowed to elapse between the meals, or an excessive quantity of food being 99 taken to subdue the sensation of hunger. The golden rule that ' you should eat when you are hungry, but not as long as you are hungry,' is neglected. The stomach is over-loaded, and al- though (with the aid probably of a spirituous stimulant) it may struggle through its work with- out producing further inconvenience than a sense i 7 74 DYSPEPTIC HEADACHES: 26 of repletion, yet, sooner or later, its powers of en- durance will fail; and frequently the years of suf- fering from various forms of dyspepsia, with or without sympathetic headache, that follow long abuse of the powers of digestion, more than coun- terbalance the previous period of immunity, and i6 impunity. It is in mid-life, when the powers of the* system are strongest, that these predisposing causes are most active, and the length of time du- ring which the stomach may be thus ill-treated depends much upon the constitutional strength of the individual. 30 94. The hurry and excitement of business, of speculation and of the Stock Exchange; the brain-wear of literary occupation, &c, especially predispose to the occurrence of headaches arising , from dyspepsia, on very slight errors in diet. It i6 need hardly be mentioned, that previous habits of intemperance are frequent causes. Even those, however, do not more certainly lay the founda- tion for indigestion and its accompanying head- aches, than the sudden relinquishment of intem- perate habits; the convert rushing into the other extreme, and positively avoiding the diet that his debilitated frame actually requires. ii 95. In the consideration of the exciting or direct causes, the force and influence of those which predispose to the production of a headache THEIR CAUSES AND CURE. 75 must never be forgotten. An article of food may disagree, may give rise to a headache to-day— when the stomach or brain is unusually excitable —which might have been taken with impunity yesterday, when those organs were less irritable. Mental excitement, it must be remembered, exer- cises a powerful influence over the first process ne of digestion, as well as over the appetite for food. *" It is well known how frequently the sensation of hunger is destroyed by any sudden intelligence or shock; and, under the dread of an impending operation, food has been ejected from the stomach in an unaltered state hours after it has been taken. The propriety of allowing the brain to lie fallow whilst the process of digestion is active, may be judged from the natural antipathy to any strong mental exertion experienced by every one after a full meal. 96. It is seldom that the headache cannot be traced, by careful consideration, to some previous excess in drinking, or to the quantity, quality, or variety of solid "food, acting as an immediate cause of the pain. Some persons can never take particular articles of diet without suffering from m a headache. This peculiarity is often only devel- oped when the powers of the digestion have become impaired. And, hence, its influence may 76 DYSPEPTIC HEADACHES: 26 not be observed or appreciated, and the pain fail to be attributed to the true cause. 97. The Treatment of the Headaches dependant on derangement of the Digestive Organs requires a careful consideration of the peculiarities of each case. The removal of the immediate cause of suffering should not be so much an object as the " permanent relief of the unhealthy condition of the stomach ; for, without the accomplishment of this by steady perseverance and self-denial, no power can avert the recurrence of the pain on any irregularity of diet. 98. When the headache comes on very shortly 23 after a meal, especially where it can be directly traced to one or more indigestible articles of food, and where the patient is tolerably strong, an emetic [formula 11], followed by draughts of warm chamomile tea to facilitate its operation, will usually remove the offending food and the pain together ; any continuance of the headache being relieved by an hour's quiet and the appli- cation to the forehead of a thin cloth damped with Eau-de-Cologne, with essence of verbena, 29 or with simple spirit and water. Where the pain ensues some hours after taking food, a warm draught, with rhubarb and magnesia [formula 14] is generally beneficial. Although stimulants THEIR CAUSES AND CURE. 77 (as a glass of Cognac, &c.) often afford temporary relief and are therefore too frequently indulged in; 98 their use eventually proves injurious, especially where the headache is of habitual occurrence, the momentary immunity being assuredly follow- ed by an increase in the frequency and intensity of future attacks. The headache that comes on some hours after a meal may often be warded off by taking a few grains of rhubarb and aloes [formula 21] as a dinner pill. But it must be remembered that as long as this is necessary there is an unhealthy state of the stomach to which the dose only serves as a temporary palliative, and which requires other and further treatment to do away with the need of coaxing it to good beha- viour by a dinner pill. 99. The first and most essential requisite to- wards the permanent relief of the headaches that accompany impaired digestive powers resulting from sedentary habits, is a determination on the part of the patient to strictly regulate the diet; to carefully attend to the action of the bowels; and to shift the burden of the work, giving rest to the mind and exercise to the body. The effects of various articles of food should be noticed, and whatever manifestly disagrees should be forth- 96 with shunned. More than six hours (exclusive of sleep) should never elapse without taking 78 DYSPEPTIC HEADACHES: food. The luncheon should purposely and liter- ally be allowed to spoil the dinner. Persons of sedentary lives, leaving the desk for the dinner 25 table with only an interval of a few minutes between them, should endeavour to obviate the tendency to indigestion thus produced, by making as simple as possible the work that the stomach is called on to perform; not partaking of more than one dish, and avoiding taking too much at one meal. The best diet is the plainest, and those subject to dyspepsia should shun rich soups and broths, and avoid over-diluting the contents of the stomach by fluids of any description.* The quantity of food taken at a meal should be espe- cially restricted; for persons of delicate digestions will often complain of the ill effects of some par- ticular article of diet, when their sufferings are in reality due to the quantity of all, rather than to the disagreement of any one part. ' The how much,' it has been well observed, ' must be de- termined by every individual; and those who are happy enough to abstain at the first sensation of * John Hunter says : ' A fluid is difficult of digestion. We may observe, that nature has given us very few fluids as ar- ticles of food, and to render that few fitter for the action of the digestive powers a coagulating principle is provided to give them some degree of solidity.'—Observations on certain parts of the Animal Economy. THEIR CAUSES AND CURE. 79 satiety have made great progress in the art of maintaining a command of appetite; one of the greatest aids in recovering, as it is one of the greatest preservatives of health.' And'in per- sons subject to dyspepsia even this is not always a sufficient restraint; for sometimes, when the stomach itself has become unhealthy in its action and its influence, there is a constant craving for food, a sort of false appetite, that must be com- bated and conquered. Where, on the other hand, the appetite is simply deficient, a little ice, or a draught of ice-cold water, taken half an hour before dinner, usually proves very serviceable; its efficacy depending simply on the re-action that follows the first effect of the cold on the stomach. In this way the keen appetite, often excited by taking a few raw oysters, is probably produced. The strict observance of a very meagre diet is seldom advisable, though great discrimination is required in the food that is chosen* Suppers * The following plan of daily diet, if rigidly continued, very seldom fails to prove beneficial where the precautions in reference to medicines and exercise are at the same time observed. For breakfast, a cup of tea (not too hot), with a biscuit or dry toast, a fresh egg lightly boiled, or a small portion of cold fowl or game. For dinner, a tender beef- steak, dressed on a gridiron, care being taken that each mouthful be carefully masticated ; no vegetables or only a well-cooked potatoe ; brown bread; and a light pudding. • 80 DYSPEPTIC HEADACHES. should be avoided,* or a little sago or Carrageen- moss jelly, with dry toast only, may be taken if the craving for food be very great. Spirits should be shunned at night. The use of a flesh-brush, or a coarse hair-glove, over the surface of the body, especially in the region of the stomach, is often very beneficial. Exercise, either walking or on horse-back, should never be omitted a single day. The regular action of the bowels should be care- fully attended to, and where the diet and exercise prove insufficient, an occasional aperient should be taken. 100. Now the composition of this aperient is of great importance, not only to persons of dyspep- tic habits, but to all who value their health. Various constitutions require different combina- tions of the numerous kinds of aperient medi- cines included in our Pharmacopoeia. It is as Mutton or poultry, with a little fish (of the fresh-water kinds and plainly boiled), may be substituted on alternate days. A cup of tea and a slice of dry toast may be taken in the evening. ° ' But would you sweetly waste the blank of night In deep oblivion ; or, on Fancy's wings Visit the paradise of happy dreams, And waken cheerful as the lively morn; Oppress not nature sinking down to rest With feasts too late, too solid, or too full.' Armstrong. 9 THEIR CAUSES AND CURE. 81 impossible to combine them in a form suitable to every constitution, as it would be to fit the feet of a whole generation from one last. Where the necessity exists for an occasional aperient, it is far better for a person to seek from his family medical attendant a prescription suitable to his constitution, than to take any of the cheap and pernicious drugs that usually compose the quack aperient pills. 101. In cases of headache depending on dys- pepsia, the combination of blue pill and rhubard [formula 16] or colocynth and ipecacuanha [for- mula 17 or 35] usually prove beneficial in their effect and gentle in their action. When the system is debilitated, it is often more advisable to employ a warm aperient draught [formula 48] in i» the morning, in place of the night pills; a slice of bread or a biscuit being previously taken. Great benefit is generally derived from the combination of a bitter with an alkali [formula 50] taken twice a day. If the stomach be very irritable » with excessive flatulence, a mixture in which the nitrate of bismuth is suspended by means of tragacanth mucilage [formula 29] is more suita- ble. The same medicine, combined with soda and capsicum [formula 34], proves also service- able in cases where there is much acidity, with loss of appetite and general want of tone. But 82 DYSPEPTIC HEADACHES: where the tongue is pale at the tip and edges, and 28 the system weakly, there are few drugs prove so unvaryingly successful as the oxyde of silver,* especially when combined with a bitter [formula 12]. 102. The headache that ensues after a debauch is greatly relieved by a full dose of the acetate of ammonia, combined with an aromatic and tonic [formula 1]. The severity of the headache 7 in these cases is a criterion and a salutary warning of the susceptibility of the stomachf. 3i 103. The causes that predispose to the occurrence of the Sick Headache nearly resemble those which induce a tendency to other varieties of 94 Dyspeptic Headache. It less frequently occurs from previous intemperate habits, and more often results from a continued neglect of the due action of the bowels and want of fitting exercise. The exciting causes which produce it may be very 32 slight. The most frequent are sudden changes in the weather, constipation, the reaction from * This valuable medicine owes much of its repute to my friend Sir James Eyre, who has for ten years ably advocated its merits and recommended it to the notice of the profes- sion. f ' Where the pleasures of drinking accompanied the very moment with that sick stomach and aching head, which in some men are sure to follow, I think nobody would ever let wine touch his lips.'—Locke. THEIR CAUSES AND CURE. 83 any excitement, irregularity of the diet, and in- sufficient sleep. 104. Most persons have, now-a-days, a general and correct idea of the manner in which the food that we swallow is disposed of; how a certain acid fluid is mixed with it whilst it is moved about in the stomach, and how this fluid has a wonderful power of dissolving the swallowed food, which then passes on, is subjected to the action of the bile, and finally has its component 41 parts sorted, arranged, and developed into the structures of the body by an apparatus of mar- vellous simplicity and perfection. It must, how- ever, be borne in mind, that if any part of this complicated series of actions be over-tasked or badly used, the whole range is more or less dis- turbed. It is thus that a Sick Headache is pro- duced, being simply due to the intense sympathy 32 between the brain and the organs of digestion/-"*) on which the brain and all the rest of the body depend for their maintenance. The headache is, in fact, a beneficent warning that an important part of the economy is out of order, and that the knowledge which man alone possesses must be employed to restore it to health. I doubt if 36 animals, notwithstanding the diversity of their food, ever suffer from sick headaches. 105. The treatment of Sick Headache.—During 84 SICK HEADACHES: the severity of an attack the intense nausea is first to be combatted. If any food has been taken and vomiting has not yet supervened, a draught of warm chamomile tea, or a little weak brandy- and-water, seldom fails to relieve the stomach , from its load. If the sickness continue, soda- water, with the addition of a little ginger, usually checks it; or if very distressing it may be neces- sary to apply a mustard poultice over the region of the stomach. The valuable calmative powers of sedatives and narcotics (as hydrocyanic acid, opium, conium, &c.,) demand the judgment of the medical attendant to decide on their neces- sity and mode of employment. Perfect rest is absolutely necessary. As soon as it can be borne, an active dose of aperient medicine should be ta- ken ; after which the headache usually begins to abate in two or three hours, and ceases altogether in six or eight. The purgative (which should be an antacid and stomachic, [formula 9]), does good i»32.)l°ng before the body is relieved from the offend- ing matters. If the headache continue after the sickness is relieved, calumba combined with an aromatic [formula 22] is very useful; it especially clears off the sense of heaviness that remains 33 after the urgency of the attack has passed away. 99 106. The restrictions of diet which have been already advised, apply with equal force in cases THEIR CAUSES AND CURE. 85 of Sick Headache. The attack is only in a minor degree due to any sudden or accidental causes. It generally results from an influence that has been long undermining the system and disposing it to succumb to very slight causes of irritation. 26 Hence whatever plan of treatment be pursued, steady perseverance therein is absolutely required, and regularity in taking the medicines advised, or there is little chance of their being efficacious in 36 restoring to health. In these cases it is especially desirable that medicines should be made pala- table ; for whatever is repugnant to the taste is pretty certain to be rejected by the stomach.* It must be remembered also that unless the whole plan of the diet be duly regulated, the benefits 136 arising from medicine are hourly annihilated by neglect and indulgence. 107. Care in these matters, and a steady per- severance in the use of a combination of .tonics with alkalis [formulas 18, 24 or 50], with aroma-' tics [formula 22] if there be much debility, or with the mineral acids [formula -23, or 46] if there be great want of tone in the system, seldom fails to produce the happiest results. Pills con- taining aloes [formula 28] are most suitable as ° ' I hold it for one of the best rules in Physic* (says an old anthor) ' always to content" the patient when it can be done without doing them any prejudice.' 8 86 sick headaches: ordinary aperients for persons subject to Sick Headaches, if there be no special contra-indica- tion to their employment. Change of air and scene are always attended with advantage. The use, in moderation, of the chalybeate mineral wa- ters, as at Tunbridge Wells and in very many parts of England, usually proves of great service. 37 108. The predisposing causes of Bilious Head- aches are frequently more or less associated with some natural proclivity to affections of the liver. This organ forms one thirty-sixth part of the whole body, its average weight being about three pounds and a half, its average bulk about eighty- eight cubic inches. This mass is entirely com- posed of delicately organised secreting glands, none of them larger than a pin's head. The ex- quisite structure and design of these minute glands, and the simplicity of their action, cannot fail to impress the most casual student with admiration. To the anatomist, whose researches are more ex- tensive, who sees an equal perfection of construc- tion in every part of the body, the sole wonder is that all should work so well, "that the harp with a thousand strings should stay in tune so long," that, in fact, we should suffer so little from dis- ease, or indeed should ever know a moment's health. 109. In some persons the tendency to affections THEIR CAUSES AND CURE. 87 of the liver seems to be constitutional and even 37 hereditary. The slightest irregularity in diet, or any of the causes already mentioned as producing dyspeptic headache, will induce in them a bilious 94 attack, with an accompanying pain in the head. In those who are not thus constitutionally suscep- tible, long residence in a hot climate is a frequent predisposing cause; especially if the unwise plan of indulging in diet only suitable to a colder country be followed, whilst the protests of the lan- guid appetite are disregarded, and its energies un- naturally stimulated by hot curries, chillies, and other stimulants. 110. It is" in persons who have thus injured 38 their constitutions, or whose natural tendency to bilious derangement has been still further aggra- vated by residence in a hot climate, that the more persistent variety of Bilious Headache, already described, arises; where the dingy yellowish hue of every part of the body sufficiently evidences the unnatural presence of bile present, because the sluggish, inactive or diseased liver is unable to accomplish the work of separating-it from the blood. 111. The causes that give rise to an overflow 40 of bile are in a great measure dependant for their operation on the close relation existing between the action of the stomach and that of the liver. 88 bilious headaches: 34 This is well seen in all cases of continued vomit- ing," as in sea-sickness. Over-indulgence in the pleasures of the table; partaking of fat meats or 41 rich pastry in excess ; vehement fits of passion, and sudden changes from a low to a high temper- ature may be enumerated as a few of the more frequent causes of this variety of Bilious Head- ache. The avoidance, as far as possible, of these causes will, in a corresponding degree, diminish the frequency of the seizures. 112. During the severity of the attack (especi- ally in persons not subject to their frequent oc- currence), if the suffering be very great, and the sensation of nausea very urgent, an emetic [for- mula 11] may be taken with advantage; warm demulcent drinks, as barley water or linseed tea', being swallowed until it has fully and freely acted. In milder cases an antacid, with a little stimulant, will usually relieve the pain ; the most useful being a wine-glass-full of Dinneford's solu- tion of magnesia with a little essence of ginger; or, failing that, a dose of carbonate of soda with a teaspoonful of brandy, in water; or the draught [formula 14]. Constipation should be carefully ioo avoided in persons who are subject to bilious at- tacks. When an aperient is necessary, a blue pill and a saline draught may be occasionally taken, or the formula 7, 10, or 16, followed by a seidlitz THEIR CAUSES AND CURE. 89 powder in the morning. Exercise is a most essen- tial adjunct to the treatment, especially brisk walking, riding, rowing, and gardening. 113. Where the headache depends upon a re- 39 tardation of bile in the system, a dose of blue pill, or the combination of this medicine with other drugs to facilitate its operation [formula 7, 16 or 17] followed, after a few hours, by an aperient draught [formula 9 or 15] will afford relief by its action. This rftay be repeated on alternate days for three or four times with mani- fest advantage. The diet should consist chiefly of vegetable food, and over-cooked meat should be especially avoided. The light French and German wines are often very serviceable to per- sons of debilitated and relaxed habits, but stronger stimulants always prove injurious. The clothing should be warm, and every care be taken to en- sure the free action of the skin. Gentle exercise 77 not continued long enough to produce fatigue, is advisable. Medicines that contain a combination of tonics with alkalies [formula 18, 24 or 27] when steadily continued, usually prove beneficial where no actual disease of the liver itself is pre- sent. A simple remedy, and one frequently found to be singularly serviceable, is a fresh dan- delion root, chewed during a before-breakast walk. The taste is by no means disagreeable, 8* 90 NERVOUS headaches: but it should be carefully handled, as the juice will stain the fingers or clothes. Change of scerre, society, and occupation, and the moderate use of the saline mineral water, as those of Leamington, Cheltenham, Marienbad, &c, are to be recom- mended. 114. Persons who have been long resident in hot countries often suffer from severe headaches on returning to colder climates. . They have, per- 38 haps, none of the symptoms of bilious derange- ment, and are unable to suggest any reason for the singular regularity which often characterizes the attack. Careful inquiry will usually detect the cause. The habits and diet fitted to a warm cli- mate are often found to be persevered in from cus- tom when their continuance becomes unsuitable and even hurtful. A morning headache may thus be frequently remedied by making the break- fast more substantial; taking a slice of meat or an egg in addition to the customary tea and dry toast. This, or some alteration equally simple in the habits or mode of life, often at once effects a cure. It need hardly be added that the influence of medicine in these cases, is nine times out of ten, positively injurious. 42 115. Nervous- Headache. There is a very broad distinction between the different causes that give rise to the several varieties of head- THEIR CAUSES AND CURE. 91 ache included under the title of Nervous. The headache which occurs in hysterical girls differs 45 very widely from the true 'Brow-ague.' Yet50 both kinds often baffle all attempts to trace their origin beyond the nervous system. We know that there necessarily has been, or is, some other tissue or organ primarily affected; for the nervous system receives no direct impressions from without. It has always some special apparatus to serve as a medium of communication with the external world. The eye and the ear, wonderful as is their mechanism, bear only the same relation to the optic and auditory nerves that the tele- graph clerk bears to the electric wire. And the more clearly this first cause, on which a nervous affection depends, is made out, the greater will be the probability of affording relief. 116. The causes which predispose to head- aches of a nervous and hysterical character may often be traced through many previous years of 7 the sufferer's life. They are generally influenced, in some measure, by a constitutional tendency in the patient, who is of a nervous temperament; susceptible to slight impressions; easily worried at trifles, with an excitable disposition that en- dures until dulled by age, and which no education 62 or training ever thoroughly subdues. 117. Nervous Headaches are more frequent in 6 92 NERVOUS HEADACHES: women. There is good cause to believe that their 44 nervous susceptibility is, on the average, higher than in the male sex, and good anatomical reason to account for this. Yet the greater frequency of nervous affections in towns than in rural dis- tricts, and in females of the upper and middle classes, cannot be so explained. 5 118. The particular prevalence of nervous dis- eases among the inhabitants of large cities is well authenticated, and can only be attributed to the difference in habits and in the air they breathe, between those who dwell in towns and those who live in the country. This influence is directly personal, and not hereditary; for there are ex- ceedingly few, even in London, who can trace all their ancestors, for three generations, to have been natives of that city. 72 119. In females of the upper and middle classes much of the predisposition to Nervous Headaches and allied affections, may be doubtless attributed to the mode of education and of life to which they are subjected. The body is too frequently cramped in defiance of its natural tendencies-—to produce that artifiicial shape known as a ' good figure.' The mind is trained, in despite of its natural bias, to acquire a knowledge of what are considered accomplishments, whether there be any natural aptitude or not for such studies. The THEIR CAUSES AND CURE. 93 feelings are more excited than the understanding. Exercise of the body, as well as of the mind, is 72 restricted. The bright sunshine and the bracing breeze are shunned, for they produce freckles, and roughen the cheek;—signs, it is true, of the Beauty of Health, but that, unfortunately, is not our standard of beauty. 120. Men of nervous temperament are excited 44 by causes of anxiety that scarcely affect the equilibrium of the mind of the more robust. They usually learn to command the speech and coun- tenance, seldom manifesting that hurry, confusion, and trembling of the voice in speaking, which, in nervous women, is produced by very slight im, pressions. On the other hand, in men who are nervous, there is usually noticed a fidgeting and .trepidation of the feet and hands when at all ex- cited. The little troubles and numerous minor cares that beset the lives of all induce, in them, 94 undue excitement and worry, and predispose to the occurrence of headaches of a simply nervous character. 121. The direct causes that produce these head- aches are exceedingly numerous. Where the predisposition is strong, very trifling causes, as a loiid noise, a vivid light, or a disagreeable smell, will suffice. Impurity of the air beathed, whether resulting from freshly painted rooms, from open 94 NERVOUS HEADACHES: drains, from the presence of flowers in the sleep- ing apartment, or the collection of a large number of persons in a close room or an ill-ventilated 44 theatre, are common causes of Nervous Head- aches.*' 122. But the headaches that arise from these causes are seldom so directly due to the influence of the impure air on the texture of the lungs as the headaches arising from indigestion are de- 96 pendant on irritation of the stomach and bowels, produced by unfitting food. It is only when the actual constitution of the inhaled air is not altered, that this direct sympathetic influence suffices to give rise to the headache. In most cases the head is indirectly affected through the medium of the circulation. The alterations produced in the 84 blood during its passage through the lungs are owing to its being brought in relation with the air. But these changes are not fully effected if the inspired air be deficient in oxygen, the ele- ment most essential for their production; or if it * It has been calculated that the lungs, after a full inspira- tion, contain 220 cubic inches of air ; thus making the inner Burface of the lungs equal to 440 square feet. This is nearly 30 times greater than the surface of the body. The lungs, on the average, make from 21,000 to 25,000 respirations in the 24 hours. Hence, it will be easily understood, that an atmos- phere even very slightly contaminated must in time produce an injurious effect. THEIR CAUSES AND CURE. 95 contain other constituents, as carbonic acid, sul- phuretted hydrogen, &c, whose influence on the blood is directly injurious. Such a deterioration 12 cannot long continue without a corresponding effect on the nervous system, most frequently manifested by the occurrence of a Nervous Head- ache. Close weather is a very frequent cause of 77 these headaches. Some persons are never free from them whilst there is thunder about. In these cases, though the nervous temperament usually forms the predisposing cause, the headache is 22 often of the Congestive variety. It need hardly be mentioned, that the influence of mental suffer- ing, in the production of every variety of nervous affection, is very great. Grief for the loss of a beloved object; disappointed hope ; mental strain beyond the powers of the intellect; all these give rise to headaches of the most varied characters; the true cause being often a secret locked in the 12s sufferer's breast. 123. Hysterical Headaches, accompanied by the peculiar sensations already mentioned, are gener- 46 ally produced, in persons of hysterical habit, by some unfitting excitement, or injudicious expo- sure. The attack may often be traced to over- dancing, followed by exposure to cold, and fre- quently ensues after an hysterical fit. 138 124. Those pitiable headaches the predisposition 96 NERVOUS HEADACHES: to which is produced by any long-continued drain *9on the system, are frequently brought on by the influence of any of the exciting causes that give rise to other Nervous Headaches. In these cases it is not- that the nervous system is unduly ex- cited or irritated, but that the rest of the body no longer retains a proportionate force or develop- ment ; and therefore, with returning strength, as the balance between the nervous system and the other structures of the body becomes re-estab- 129 lished, the excessive excitability proportionally 139 diminishes, and the Nervous Headache ceases. si 125. The Periodic Headache, known by the com- mon name of Megrims, seems to hold a position between the Nervous Headache and the Brow- ague. On carefully tracing back the pain to its commencement, there can frequently be detected some trivial and half-forgotten cause which suf- ficed to produce the first attack. The same influ- ence being repeated probably established the pe- riodic character of the first few seizures. Among such causes have been recorded, watching for seve- ral successive nights; periodic anxiety of mind; exposure for a certain time to a current of cold air, as in an office or whilst riding in an open car- riage ; sitting always on one side of the fire, per- sons of sedentary habits thus rendering one side of the face more tender and susceptible to cold. THEIR CAUSES AND CURE. 97 The subsequent regularity of the attacks and their continuance after the cessation of the influ- ence that originally gave rise to them, is a strik- ing illustration of that periodicity in disease which has, of late years, attracted much attention. ui 126. There is one symptom that is common to 62 many varieties of headaches, nervous, and other- wise, and equally a source of suffering in all;__ a sense of weight, of pressure on the eye-ball, much as if it were too large for its containing cavity. The explanation of these symptoms seems to be as follows: To the front of the eye-ball, beyond the limits of the coloured circle or iris, are affixed four muscles; one above, one below, and one on either side, serving to move the eye directly upwards and downwards, inwards or out- wards, and, by their combined action, to retain it firmly in its cavity or orbit, like the cup in a ball and socket-joint. This pressure is borne by a cushion of fat placed at the back of the orbit, which, whilst supporting the eye-ball, in part surrounds and, as it were, contains the sensory nerves of the eye. In health this pressure is not appreciated, but is painfully perceptible in that exalted state of nervous susceptibility which so ne frequently accompanies a headache. The rehef afforded to this symptom, when the patient lies with the face turned downwards, is due to the 9 98 NERVOUS HEADACHES: weight of the eye-ball counteracting, in a measure, the tractive force of the muscles. That remarka- ble prominence which the eye assumes, after divi- sion of one or more of its muscles, in the opera- tion for squinting, seems also due to the partial removal of pressure which immediately follows the operatien. so 127. The true Broiv-Ague, or Ilemicrania, though usually dependant on exposure to the causes which indupe intermittent fever, is some- times the evidence of a far less tractable affection; pressure on, or irritation or actual disease of, one or more of the nerves of sensation on one side of the head. A decayed upper tooth, though not m itself sufficiently tender to excite any suspicion, may in this way prove cause sufficient to account for the suffering, its extraction affording immedi- ate relief. The Periodic Headache, so frequent in marshy districts, may succeed an attack of aguei or supervene on any ordinary cold or rheumatic affection arising from a cause that in other in- stances produces ague. It has been also noticed that, in many districts, ordinary nervous head- 45 aches and hysterical complications connected with them often cease on an attack of ague, and give place to true Hemicrania. The influence of the cause that produces an intermittent fever has been observed also to endure long after the dis- THEIR CAUSES AND CURE. 99 appearance of all signs of the disease itself. Thus the course of an ordinary headache, a common catarrh, or other complaint, has its progress di- vided into distinct stages corresponding, and often bearing a striking resemblance to those of an at- tack experienced years before. 140 128. In the treatment of Nervous Headaches the first indication is to subdue the intensity of the pain, although the accomplishment of this is, in reality, but a minor object in the treatment There is little chance of affording permanent re- lief unless the attention be unswervingly directed beyond the pain itself to the cause from which it arises. If this be recognised, the reason why medicines often fail to afford relief will be at once so understood. For where the cause is mechanical or organic in its nature (as a decayed tooth pro- mi ducing irrritation,* or the pressure of a tumour, &c, in the course of a nerve), it will be readily perceived that the means of relief lie in the hands of the surgeon or the dentist, and that little help can be expected from medicine. 129. The pain which is the immediate cause of 44 suffering in Nervous% Headaches depending on functional derangement, may, in most cases, be e A case is related by Mons. Descot, where a severe neural- gic affection of the face and head of ten years' standing, was cured by the extraction of a carious tooth. 100 NERVOUS HEADACHES: temporarily relieved by the employment of ano- m dynes combined with stimulants. The amount of the latter must be proportioned to the degree of nervous debility; for in all cases of that mor- 124 bid excitement which characterises and accompa- panies extreme exhaustion and debility, there is a great diminution of susceptibility to the influ- - ence of medicines which simply lull to sleep, if they are given alone. The energy of the nervous system is below par. Obviate this by the combi- nation of a stimulant with the anodyne, and, as the nervous energy is aroused and approaches nearer to the standard of health, so will the influ- ence of the sedative develop itself, and calm ease or tranquil sleep result. The exhaustion of reac- tion which produces the delirium tremens of the drunkard, and the intense nervous debility that ensues after a lingering and wearing illness are thus, notwithstanding their great apparent differ- ences, amenable to one and the same principle of treatment. 130. There are some medicines that combine in themselves both stimulant and anodyne pro- perties. They are called narcotics; their primary influence being stimulant, their subsequent effect sedative. First among these is opium, a medicine that has saved more lives by its use, and destroy- ed more lives by its abuse than any other drug. THEIR CAUSES AND CURE. 101 But although its influence is very great, it is far inferior to that of aconite and its preparations in relieving nervous pains; the most intense cases of tic-doloreux, the most agonising local sensa- tions, often yielding to the influence of the latter drug as if by magic. Like all the more powerful sedatives, these medicines should only be em- ployed under the direct guidance of a medical man; indeed I believe that many of the worst cases of Nervous Headache owe their intractabil- ity to the unadvised, pernicious, and often con- cealed use of opium, its compounds or its alka- loid. 131. The combinations of hyoscyamus with camphor [formula 39], with chloroform [formula 43], or with a diffusible stimulant [formula 8], generally afford great relief to the intensity of the pain in common Nervous Headache, and in 44 cases of Megrims. Hysterical women are usually too well aware of the relief afforded to their sen- sations by the use of aromatic stimulants, and often indulge in them to an injurious extent. If 46 there be much flatulence in these cases, the com- bination of a little aromatic confection with an antispasmodic [formulas 2, 38], proves of advan- tage, and is often temporarily beneficial also in cases of headache from sheer debility. 49 132. In the general treatment there are three 9* 102 NERVOUS HEADACHES: special points to which attention should be di- *36rected: diet, exercise and medicine. Diet is of most importance in the simple Nervous Head- ache; exercise in Hysterical cases; medicine in the headaches directly dependant on extreme ex- haustion. 43 133. There are few cases in which the diges- tion is not in some degree disturbed; and the pain in the head is frequently in part due to this cause. The particulars of treatment already de- 99 scribed when considering Dyspeptic Headaches, should therefore be first attended to, for the chance of medicine doing all the good of which it is ca- pable is directly in proportion to the condition of * health of the stomach at the time it is taken. When the tongue continues foul, in despite of every care and attention, and if the patient be tolerably strong, an emetic [formula 11], taken about four hours after dinner, will often prove serviceable in changing for the better the un- healthy condition of the stomach. I believe that the great relief sometimes afforded by foreign travel is often partly due to the preliminary sea- sickness in crossing the channel. 44 • 134. In cases of Nervous and Hysterical Head- aches, the diet should be proportioned to' the amount of exercise taken. The meals should be regular, everything beyond the plainest dishes THEIR CAUSES AND CURE. 103 being carefully avoided. Simply cooked animal food of a nutritive and easily digested nature should be taken once, and only once, in the day. All rich pastry, fat meats, and condiments, must be avoided. Bitter ale is usually serviceable, and the light French and German wines are useful in relaxed habits. The amount of fluids, however, especially of warm drink, as tea, &c, should be restricted. The hours should be regular, exposure 123 to cold and damp, or the risk of wet feet should be guarded against, particularly in certain condi- tions of the system. All enervating habits should be broken through. Sea-bathing is very benefi- cial, or cold sponging of the surface of the body; or the shower-bath when the progress towards recovery is somewhat advanced, for it can seldom is be borne before. This free use of cold water is especially advantageous to hysterical females. It acts as a tonic; and if combined with regular and brisk exercise and careful diet, will often suffice to remove the hysteric tendency without the ne- cessity for medicine. 135. In cases of headache clearly traceable to 49 debility or exhaustion, the first indication is, of course, to remove the 'drain on the system that has so enfeebled the frame. The diet should be in the highest degree nutritious. Wine at first, and subsequently stout are usually requisite. A 104 NERVOUS headaches: httle warm wine, with a slice of dry toast, taken the last thing, will often insure a night's repose. The temperature of the body should be carefully maintained by judicious clothing. Any undue exertion or excitement must be carefully avoided. Bemoval into the country, especially to the native air or to a warm spot at the sea-side, is often al- most magical in its effects. 136. Persons suffering from Nervous as well as other varieties of headaches often fail to obtain re- lief on account of their not giving a fair and steady trial to any one plan of treatment. Years have been producing a condition of the system which a few week's medicine is vainly expected to 116 reheve, unaided by medicine's best help, the care- ful obedience of the patient to the rules laid down and the regimen prescribed. If due attention be 132 paid to the diet, habits, and other matters already mentioned, then the employment of tonics, conti- nued for some time—what, in fact, was formerly called 'a course of strengthening medicine,' sel- dom fails to eventually afford relief 137. In the administration of tonics, as of all other medicines, great care is required. The diges- tion may be healthy, but. in nervous persons it is always delicate. If too powerful a tonic or too large a dose be given, it produces a sensation of tightness across the forehead, a tendency to cos- THEIR CAUSES AND CURE. 105 tivenesss, and a sense of restlessness and irritation mo of the whole body. The milder bitters, as infu- sion of orange or gentian, should be first taken, the more powerful tonics being substituted as the system gains strength to bear their action. In cases of nervous and hysterical headaches the mineral acids [formulas 23, 46], or the phosphoric acid [formula 41], combined with vegetable bit- ters, are very serviceable. When there is great debility and sluggishness of the system, quinine usually proves beneficial, especially 'when com- bined with aloes [formula 6]; and where the pa- tient is a female, and somewhat passed the period of middle life, a combination of iron with cinna- mon [formula 31], is often exceedingly useful. ieo 138. In Hysterical cases, the mineral tonics, 4^ iron, zinc, &c. [formulae 31, 32, 33, and 44], some- times succeed in effecting a cure when all others have failed, although the previous administration of these milder tonics has probably beneficially paved the way for the more powerful drugs. An aloetic aperient should be. occasibnally taken [for- mulas 4,-28], especially if the patient be of phleg- matic habit. 139. In the cases of headache from extreme ex- 49 haustion, the preparations of iron prove especially valuable, but often produce great distress if not exhibited with proper caution, commencing with 137 106 NERVOUS HEADACHES: some one of those very elegant preparations of the drug now so much employed, the ammonio-cit- rate, the citrate of iron and quinine, &c. It,is ad- visable in all cases that a gentle aperient be taken 100 before commencing the use of the tonic, and that it be occasionally repeated as the appetite begins to improve, and the influence of the medicine is evinced by the disappearance of the pallor of the lip and cheek, and by the returning strength. 50 140. The Headaches that assume a Periodic character in their attacks, where the cause is sim- ply functional, usually give way under the contin- ued use of quinine. Its employment should be 187 commenced in small doses, and gradually increas- ed. It is in general owing to the neglect of this precaution that we so frequently hear persons de- clare their inability to bear quinine. . They have begun with too large a dose. A brisk aperient or an emetic if the patient be strong and stout, fol- lowed by the re-administration of the medicine after a few days in gradually increased quantities, often satisfactorily proves where the error lay. In delicate and weakly persons it ds often advis- able to combine with the quinine^ that most valu- able preparation of iron, the saccharated carbon- ate [formulas 49]. Where the intensity of the pain during an attack is so great as to demand a 53 temporary relief, the combination of camphor THEIR CAUSES AND CURE. 107 with morphia [formula 13], usually affords relief. The occasional use of an aperient is always ad-ioo vantageous where the pain is simply dependant on a functual cause. 141. If the headache more nearly resemble in its causes and symptoms that known by the name of ' Megrims,' the restrictions already enjoined in 5i reference to diet, habits, and exercise, demand careful attention. The preparations of iron [for- m mulas 32, 37], will then seldom fail to produce the most beneficial results. Jn all cases of Ner- vous Headache, and especially where it is peri- odic, the mouth should be carefully examined, as 128 the presence of decayed teeth often serves to keep up the irritation. These should be extracted, or their nerves destroyed,*, before having recourse to medicine. 142. The Eheumatic Headache can general- 54 lyf with a little care, be traced to its true cause. This is usually some imprudent exposure to cold and damp; sitting bare-headed in a current of ah, especially when the body is heated; sleeping in a damp bed, &c.; all the causes in fact that give rise to general rheumatism are equally prone to e The destruction of the pulp of the tooth-nerve, formerly so. painful an operation, can now be effected in most cases with a very slight amount of suffering. I speak with more confidence having myself undergone the process without experiencing any pain. 108 RHEUMATIC HEADACHES : produce a local attack. Previous liability to headaches, of whatever kind, seems to specially determine the affection towards the head. An at- tack of acute rheumatism is often followed by severe occasional headaches, becoming rarer as the patient gathers strength. This is usually a somewhat protracted process, for persons who have suffered from acute rheumatism, take a long time to regain a healthy look. 143. The brow, the back of the head, and the temples, are generally most complained of as spe- cially painful; though the sensations of the patient are not to be altogether trusted; for it Ayill be found on examination, that the soreness and ten- derness on pressure is not restricted to these par- ticular parts, the continued pain referred to them being due to the position and attachments of the muscles that lie b'eneath the skin, of the forehead, the temples and the occiput. Their frequent and involuntary contraction, necessarily produces some degree of pressure. This transient motion 54 of the muscles is not appreciated, but the recurr- ing pressure on the tender fibrous tissue (the true seat of the rheumatic affection), produces pain pre- cisely as the finger does when pressed on other parts of the scalp. During sleep, these muscles are at rest, and hence it is that the patient always feels better in the morning. THEIR CAUSES AND CURE. 109 144. Kheumatic Headaches, when not compli- cated with neuralgia, succumb speedily to judi- cious treatment. Attention to diet is requisite, not only as influencing the rheumatic tendency, but also on account of the increased pain occa- sioned by any derangement of the digestive func- 99 tion. Animal food should be sparingly taken, and all kinds of malt liquor avoided. Vegeta- bles are suitable when well and plainly cooked. All light articles of diet, as arrowroot, isinglass, tapioca, sago, &c, may be recommended, and wine is advantageous if there be much debility. The clothing should be warm, and exposure to damp, or the risk of wet feet, should be carefiilly guard- ed against. Removal to a warm climate, seldom fails to alleviate chronic rheumatic pains of all kinds. Great advantage is derived in similar cases from the hot alkaline baths of Vichy and Ems. 145. When the local pain is very severe, great relief is experienced from the application of hot fomentations of poppy or chamomile, or the fre- quent and brisk employment of a stimulating lin- iment (formula 3]. Mustard poultices applied to the neck are also exceedingly useful as a means of counter-irritation. An aperient, containing colocynth with colchicum [formula 42] taken at night, is of advantage at the commencement of 10 110 RHEUMATIC HEADACHES: the treatment, and may be repeated at occasional intervals ; the pills being followed, in persons of a costive habit, by a morning draught [formula 9]. The administration of an alkaline medicine con- taining potash [formula 40], if continued with regularity, will then generally be followed by ?7 rapid amelioration of the pain and tenderness. If imprudent exposure to cold has produced an ag- gravation of the headache, and especially if the patient be subject to catarrh, it is advisable to ad- minister a sudorific at bed-time, [formula 19] fol- lowed by a posset of white-wine whey, &c, taken about an hour afterwards. 146. Every endeavour should be made to pre- vent the recurrence of the attack, by exercise, regularity of living, and the use of the shower- is bath, commenced during the summer months, and gradually increased in force. se 147. Headaches dependant on Organic Disease. It is .seldom possible, in these cases, to fully recognize, during life, the nature and ex- tent of the morbid change that causes the suffer- ing ; owing to the enclosure of the brain in its bony skull. Yet this affords less reason for regret when it is remembered how seldom there is any cause to believe that assistance could much avail, even if the disease were patent to the view. Com- parison of the changes discovered after death, THEIR CAUSES AND CURE. Ill with the symptoms that characterised the disease during life, has, however, sufficed to teach the meaning of many obscure points, and to direct 57 the judgment with increased precision. And this knowledge is ever on the advance; for the pio- neers of its path are observation and experience. 148. Organic diseases of the brain include those accompanied by alterations of its substance, as induration and softening, atrophy and hypertro- phy; and those dependant on new formations encroaching on the space appropriated to the brain itself. The latter class comprises tumours of various size and consistence, from the fluid hydatid to the hardness of a stone; the deposit of tubercle or cancer in the brain; the abnormal de- velopment of bone on the inner surface of the skull 'or in the membranes of the brain, &c. 149. Alteration of the substance of the brain itself seldom occurs without the accompaniment, in some stage of its progress, of intense pain in the head. Where the membranes that enclose m the brain become the seat of tumours or disease, &c., headache is usually one of the earliest (as it 59 is sometimes one of the most deceptive) symp- toms. Where pressure is directly exercised on the substance of the organ itself, the headache can only for a time mask the more urgent symptoms that denote the progress of the disease. But, 112 ORGANIC HEADACHES: during this period, there are* often combined with 48 the pain symptoms that bear a striking resemb- lance to those occurring in the course of other diseases, and which may thus be attributed to a wrong cause. This error is more likely to occur from the gradual mode of ingress of these anoma- lous symptoms. The most frequent among them are affections of the special senses, as a failing of the sight; convulsions, terminating in palsy, but commencing so gradually, that they have been mistaken in youth for St. Vitus's dance; inter- missions of pain so nearly complete, that the headache has been attributed to ague, and treated accordingly; paralysis- and total failure of the in- tellect, commencing with a slight weakness of one 68 side, and a transient loss of recollection. 150. Though the neglect of these symptoms may be productive of evil by omission, there is a still more important class which lead to evil by commission. Cases whereof the symptoms, though really dependant on Organic Disease of the brain, closely resemble those arising from 56 some disorder of the digestive organs. In many instances, dyspepsia has actually been present for some time; and the supervention of the fresh symptoms may thus appear to be only an ag- gravation of the previous attack. It is to the 32 Sick Headache that the resemblance is usually THEIR CAUSES AND CURE. 113 most close. And, to add to the obscurity, it has been observed that the headache is often less in- tense in these cases than in others where the cerebral disease, although equally slow in its pro- gress, is unaccompanied by any marked derange- ment of the process of digestion. It is, therefore, of the greatest importance, to recognize at an early stage the influence severally exercised by the disease of the head and the disorder of the 58 stomach in causing the headache, and to adjust the treatment accordingly. 151. In many cases the cerebral disease is undoubtedly due to constitutional or even hered- m itary causes. In others the symptoms may be traced to some direct or exciting cause. Injuries of the head sometimes lead to Organic Disease long after the occurrence of the accident. Insid- ious inflammation of the membranes of the brain may depend on a neglected discharge from the ear. A careful investigation into the history of 57 every case must therefore form the preliminary step, and afford the guiding clue, to the plan of treatment to be pursued. 152. The knowledge of an existing tendency to disease of the brain, whether hereditary, con- stitutional, or acquired, must necessarily influence the regulation of the diet and habits, and modify the treatment to be pursued in each individual 10* 114 ORGANIC HEADACHES: case. But the principle is the same in all; to carefully avoid whatever is likely to cause dis- tress, or give rise to symptoms which experience has shown to be intractable. Thus the pain pro- 58 duced by stimulants, by anxiety or distress of mind, by noise, or by confinement in a close atmosphere, is a warning that these should be avoided. The iritability of the stomach, and the i5o readiness with which intense vomiting is induced, point out the necessity of carefully regulating the diet, excluding whatever is likely to derange the digestion, or produce nausea. 153. The medical treatment, for the most part, consists in the administration of alteratives, mer- cury, iodine, silver, &c,—according to the require- ment of each case. Counter irritation, depletion, and change of air, form also important adjuncts to the treatment. In the more advanced stages of disease, powerful anodynes to afford ease, and direct sedatives to check the nausea, are usually necessary. All the mechanical appliances de- vised for the alleviation of suffering, water-beds, air-cushions, &c, should be taken advantage of. But there comes a time at length, when all that medicine can do, and all that art can effect, is to render smooth the downward path to death. 62 154. Headaches in Old Age, are also often associated with alterations in structure of the THEIR CAUSES AND CURE. 115 brain and its blood-vessels, that amount to or- ganic disease. These, however, differ from the 64 organic diseases of adult life in being usually de- pendant on natural changes incidental to old age. As life advances, the blood-vessels of the brain undergo a greater or less alteration and deteriora- tion of their structure, which tends to render them inelastic and brittle, impedes the circulation through them, and hence interferes with the pro- per nutrition of the organ. The common occur- rence of Congestive and Plethoric Headaches in 65 old people on the slightest excitement of the cir- 66 culation, and the increased frequency of apoplexy as life advances,* are in a great measure due to these changes. The alteration in structure which charaterises softening of the brain in old age has 67 also been referred to defects in nutrition and the reparative process. Nor are these changes con- fined to the organs of circulation. The energy of the nervous system is diminished; and to this cause may be indirectly attributed the chilled extremities and susceptibility to cold observed in waning life. The stomach and bowels are less 62 • Apoplexy increases progressively in each decade of years from 20 upwards. It is ten times more frequent between the ages of 60 and 70 than it is between 20 and 30; five times more frequent between 70 and 80 than between the ages of 30 and 40. 116 HEADACHES IN OLD AGE : sensitive, their mucous membrane being thickened throughout the whole length of the alimentary canal; and hence the rarity in old age of these sym- pathetic headaches that arise from indigestion* The muscular tissue is no longer renovated with the ceaseless activity Qf adult life, and has even a tendency to degenerate into a lower form of struc- ture; hence the failing strength and inaptitude for exertion. The task which was formerly ac- complished with ease, now demands an effort and an undue putting forth of the strength; the cor- responding excitement being followed by conse- 64 quent exhaustion, and a headache which warns us that too much has been attempted. 155. Old age itself, therefore, with the physical changes that naturally accompany the decline of life, may be considered as predisposing to the oc- currence of headaches. But the effect of these changes on the various parts of the system, may not be uniform. The balance of life is not always equally sustained. Thus, the heart, after a life of 65 much muscular exertion, often retains, even in advanced life, much of its vigour; this prepon- derance necessarily influencing the circulation of which it is the prime-agent, and rendering the inelastic vessels of the brain liable to injury. 156. It necessarily follows that first among the direct causes of Headaches in Old Age, must be THEIR CAUSES AND CURE. 117 reckoned whatever tends to excite the circulation or impede the return of blood from the head. Atmospheric changes, exposure to cold, or to the 77 direct rays of the sun, mental exertion or anxiety, costiveness, and too good living, are also frequent exciting causes. 157. There is no more common mistake made by old people than that of supposing their sys- tems to ' want nourishment;' that high feeding will prolong life. Every day experience shows the reverse to be the case. There are very few aged persons in prosperous circumstances who would not derive advantage from curtailment of their daily diet; but all alterations, whether of diet or habits, should be very gradually effected in declining life. Animal food should be only sparingly taken, and lean, hard, or over-cooked meat, be avoided. Made-dishes,—even when rather highly seasoned—can frequently be par- taken of with less inconvenience than more simple fare; but whatever requires much mastication should be especially avoided. Light and farina- ceous articles of diet, as freshly-made jellies, arrowroot, sago, gruel, &c, usually prove very suitable; and milk, in small quantities, is often readily taken when everything else disagrees. Chocolate or cocoa is preferable to tea or coffee for old people, and care should be taken that the so 118 HEADACHES IN OLD AGE: body be not chilled during the process of diges- tion. The clothing should be well^aired and warm, even during the summer months, and in the win- ter time the temperature of the bed-room should be maintained throughout the night. There is good reason to believe that many old persons found dead in their beds have perished for want of this precaution; chilled and killed by the in- gress of the cold night air. 158. The apophthegm of Cullen, that we should endeavour, in treating disease, to ' avert fhe ten- dency to death,' is specially applicable in the 154 ailments of advanced life. The diminished power of resistance to disease and to the action of reme- dies, warns us to be heedful in the employment of medicines—to use all gently. Unfortunately this warning is not always regarded by patients. Persons advanced in life, especially those of the better class and in comfortable circumstances, often acquire a most injurious love for 'physic- ing' themselves. Their thoughts, being less dis- turbed by wordly affairs become more isolated and concentrated on their feelings. They have usually acquired, during their lives, some ac- quaintance with the properties of the contents of the domestic medicine-chest, and this knowledge they indiscriminately bring to bear upon them- selves. They are tolerably sure to suffer for THEIR CAUSES AND CURE. 119 their imprudence, and very many might have appropriately inscribed on their tombs the famous epitaph of the hypochondriac: ' Stavo bene; ma per star meglio, sto qui.' There is however, one rule that might always be advantageously borne in mind, No person in the decline of life should ever take mineral medicines, except they are professionally prescribed. I refer to the appar- ently simple preparations of chalk and magnesia, as well as to the more energetic ones of mercury, antimony, &o. 159. It is important, in advanced life, that the 100 bowels be carefully regulated without irritation. To the want of proper caution in this respect are due very many of the Congestive Headaches of old people. The aperient employed should be in a fluid form. Pills are with difficulty dissolved by the weakened digestion, and their power is thus developed too gradually to insure their effi- cacy. Senna, with an alkali to dissolve the resin, and an aromatic to prevent griping, is an excel- lent general aperient [formula 26], the dose being proportioned to the patient's age; the addition of a saline proves advantageous where there is any tendency to plethora or congestive headaches 89 [formula 47]. After the action of even the most gentle aperients, it is often advisable that a little 120 HEADACHES IN OLD AGE: warm wine, coffee, or other stimulant be taken to counteract the depression so readily induced in old age. Frequently, however, a roasted apple, or a few stewed prunes at night, will supersede the necessity for any medicine whatever. 66 160. In persons who have led a 'hard life,' who are thin, and worn, and weakly, the head- aches that so frequently arise on slight changes of weather, or from other trifling causes, are be- nefited by a slightly stimulant and cordial mix- ture [formula 45], or %■ a tonic [formula 25 or 41]; a glass of wine being taken before retiring to rest, and repeated once or twice during the day. 161. It is very seldom that old people can bear depletion. Where absolutely required, cup- ping on the back of the neck is the method most frequently and serviceably employed. Repeated 91 application of the cupping-glasses, without re- moval of blood, proves of very great advantage in the Plethoric and Congestive Headaches of old people, especially if there be any apoplectic tendency. ct 162. In those perilous cases where actual dis- organization of the brain itself, or inflammation 68 of its membranes, is present, it is important that every symptom be watched for, and its progress disputed inch by inch. The nicest attention to THEIR CAUSES AND CURE. 121 every minute phase of the disease is necessitated; for the fortress of Life can be maintained only by a vigilant guard. Its ramparts are fallen and its walls are broken, and the besieger, Death, will assuredly allow no weak point to escape his attack. :i FORMULA. \ FORMULA. 1. R. Liquoris Ammonise acetatis § ss. Tincture Aurantii. Syrupi Aurantii aa 3j- > Tincturge Capsici m xx. Infusi Aurantii compos. 3yj. Misce : fiat haustus. To relieve the Headache that ensues after Inebriety, &f. (Paragraph 102.) 2. R. Confectionis aromaticae gr. x. Tincturae Lavandulae compos. 3ss. Infusi Cascarillae 3x. Syrupi Papaveris 3j. Spiritus iEtheris chlorici 3ss. Misce : fiat haustus. In Hysterical cases with much flatulence. (Parag. 131.) 11* 126 FORMULA. 3. R. Linimenti Saponis § iiss. Liquoris Ammoniae 3ss. Tincturae Opii 1 ss. Misce : fiat linimentum. For external application in Rheumatic Headaches (Parag. 145.) 4. R. Decocti Aloes compos. 3vj. Spiritus Ammoniae aromatici 3ss. Infusi Aurantii compos. 1 ss. Syrupi 3iss. Misce : fiat haustus. To he taken in the morning. (Parag. 90, 1§8.) 5. R. Magnesias Sulphatis 9ij. Infusi Rosas compos. 3xss. Syrupi Rosas centifoliae 3iss. Misce : fiat haustus. To be taken twice a day. (Parag. 83.) 6. R. Pulveris C amphorae Quinae Disulphatis aa gr. x. Extracti Aloes gr. xij. Extracti Hyoscyami 3ss. Mucilaginis Gummi Acacias q. s. Ut fiant pilulas xviij. Two pills to be taken twice a day. (Parag. 131.) FORMULAE. 127 1. R. Pulveris Ipecacuanhae gr. iss. Hydrargyri Chloridi gr. ij. Pilulae Colocynthidis compos, gr. vj. Olei Carui m j. Misce : in pilulas ij divide. Aperient.— To he taken at bedtime. (Parag. 112, 113.) 8. R. Tincturae Hyoscyami Spiritus Ammoniae aromatici aa 3ss. Syrupi Aurantii 3j. Aquas Menthae piperitae 3x. Misce : fiat haustus. In Nervous and Hysterical cases. (Parag. 131.) 9. R. Magnesias gr. xv. Liquoris Potassae m. xij. Tincturae Sennas compos. 3j. Infusi Sennas compos. 3vj. Syrupi Zingiberis 5j- Infusi Aurantii compos. 5 ss. Misce : fiat haustus. Aperient, in cases of Sick and Bilious Headaches, Sfc. (Parag. 105, 113, 145.) 128 FORMULA. 10. R. Hydrargyri Chloridi Saponis Castilliensis aa gr. iv. Pulveris Ipecacuanhas gr. ij. Misce : fiant pilulas ij. To be taken at night. (Parag. 112.) 11. R. Pulveris Ipecacuanhas gr. xxv. Ammonias Carbonatis gr. v. Aquae Menthae viridis § iss. Misce : fiat haustus. Emetic, followed by draughts of some warm fluid. (Parag. 98, 112, 133.) 12. R. Argenti Oxydi gr. xij. Pulveris Piperis Capsici gr. iv. Extracti Gentianas gr. xxiv. Misce : fiant pilulas viij. (Deaurentur.) In Atonic Dyspepsia. One pill twice a day. (Parag. 101.) 13. R. Morphias Hydrochloratis gr. j. Pulveris Camphoras gr. xxiv. Mucilaginis Gummi Acacias q. s. Ut fiant pilulas vj. (Deaurentur. In Intermittent Headaches.— One pill to he taken when he Headache is very intense.—Five hours being allowed o elapse before repeating the dose. (Parag. 140.) FORMULA. 129 14. R. Pulveris Rhaei. gr. xij. Magnesias Carbonatis gr. x. Spiritus Ammonias aromatici 3ss. Syrupi Zihgiberis 5j Aquae Anethi 3x. Misce : fiat haustus. Or, R. Tincturae Rhaei compos. 5iss. Sodas Carbonatis gr. viij. Solutionis Magnesias (Dinneford) 3ix. Syrupi 3j. Misce : fiat haustus. In cases of Headache from deranged Digestion. Parag. 98, 112.) 15. R. Magnesias Sulphatis 3iiss. Acidi Sulphurici diluti m viij. Olei Limonum m ij. Pulveris Tragacanthae compos, gr. x. Infusi Gentianas compos, f iss. Misce : fiat haustus. An Aperient draught in Bilious cases. (Parag. 113.) 16. R. Pilulas Hydrargyri Pilulas Rhaei compos, aa gr. iv. Extracti Hyoscyami gr. ij. Misce : fiant pilulas ij. To he taken at night. (Parag. 101, 112, 113.) 130 FORMULA. 17. R. Pulveris Ipecacuanhas gr. j. Pilulas Colocynthidis compos, gr. vij. Extracti Gentianas gr. ij. Olei Cariri m ^. Misce : in pilulas ij divide. Aperient.— To he taken at bedtime. (Parag. 101, 113.) 18. R. Sodas Carbonatis gr. xij. Infusi Gentianas compos. 3xj. Syrupi Aurantii 3j. Misce : fiat haustus. To be taken twice or three times a day. (Parag. lOt, 118.) 19. R. Pulveris Ipecacuanhas compos, gr. xij. Pulveris Camphoras Pulveris Guaiaci aa gr. iv. Misce : fiat pulvis. A Sudorific in Rheumatic cases, when the head is cold. — To he taken at bedtime. (Parag. 145.) 20. R. Pulveris Antimonii potassio-tartratis gr. \ Pulveris Jacobi veri gr. v. Pulveris Potassas Nitratis gr. viij. Misce : fiat pulvis. Sudorific.—To he taken at night, when the head is hot. (Parag. 82.) FORMULA. 131 21. R. Pulveris Rhssi gr. xviij. Pulveris Capsici gr. v. Sodas Carbonatis exsiccat. Pulveris Aloes Saponis Castilliensie aa gr. xij. Misce : in pilulas xij divide. Dinner pills.—One Jo be taken an hour before each meal. (Parag. 98.) 22. R. Spiritus Ammonias aromatici m xl. Tincturae Calumbas 3j. Infusi Calumbas 3x. Syrupi Papaveris 3j. Misce : fiat haustus. To he taken three times a day. (Parag. 105, 107.) 23. R. Acidi Sulphurici diluti m xij. Acidi Hydrochlorici m v. Tincturae Aurantii 3j. Infusi Gentianas compos. 3yj. Syrupi Rhasados 3j. Misce : fiat haustus. To he taken twice or thrice a day, an hour before meals. Parag. 107, 137.) 132 FORMULAE. 24. R. Potassas Bicarbonatis gr. x. Tincturae Gentianas compos. 3j. Infusi Calumbas 3x. Syrupi 3j. Misce : fiat haustus. In Sick or Bilious Headaches To he taken twice or thrice a day. (Parag. 107, H3.)„ 25. R. Guaiaci contriti gr. vj. Aloes gr. iss." Quinas Disulphatis gr. j. Olei Menthas piperitas m \. Mucilaginis Gummi Acacias, q. s. Ut fiant pilulas ij. For debilitated Old people.—One or two pills night and morning. (Parag. 160.) 26. R. Magnesias Sulphatis 3j- Spiritus Ammonias aromatici 3ss. Syrupi Rhasados 3j. Infusi Sennas compos. 3yj. Infusi Gentianas compos. § ss. Misce : fiat haustus. An Aperient for aged persons—To be taken in tht, morning. (Parag. 90, 159.) FORMULAE. 133 27. R. Tinctures Aloes compos. 3iss. Liquoris Potassas m xij. Potassas Chloratis gr. viij. Tinctures Aurantii 3ss. Syrupi Aurantii 3j. Infusi Gentianas compos. 3ix. Misce : fiat haustus. To be taken twice a day, an hour or two before food. Parag. 113.) Or, R. Pilulas Aloes c sapone P. L. gr. x. In pilulas ij divide. R. Pilulas Aloes compos. P. L. gr. x. Fiant pilulas ij. Aperient in Hysterical and other cases.— The second formula is most suitable when there is great want of tone. (Parag. 90, 107, 138.) 29. R. Bismuthi Nitratis 3j. Pulveris Tragacanthas compos. 3ij. Tincturae Cardamomi compos. Tincturae Zingiberis aa § ss. Aquas Anethi § vij. Misce : fiat mistura. Dyspepsia.— Two tablespoonsfid to betaken twice a day. (Parag. 101.) . 12 134 FORMULAE. 30. R. Potassas Acetatis gr. xv. Potassas Nitratis gr. viij. Spiritus Juuiperi compos, m xl. Syrupi Rosas 3j. Aquas Menthas sativas J j. Misce : fiat haustus. In cases of Plethoric Headaches. To he taken twice a day. (Parag. 78.) 31. R. Tincturae Ferri Sesquichloridi m x. Acidi Hydrochlorici m v. § Tincturae Cinnamomi compos. 3j. Syrupi Rhaeados 5iss. Aquas Cinnamomi 3ixss. Misce : fiat haustus. To be taken twice a day, about an hour after food. fParag. 89, 137, 138.) 32. R. Misturas Ferri compos. P. L. 5 viij. Tonic.— Two tablespoonsful to be taken twice a day, after meals. (Parag. 89, 138, 141.) 33. R. Ferri Carbonatis c Saccharo P. L. 3ss. In chartulus x divide. One powder to be taken twice or three times a day.. (Parag. 89, 138.) FORMULA. 135 34. R. Bismuthi Nitratis Sodas Carbonatis exsiccat. aa gr. vj. Pulveris Piperis Capsici gr. j. Misce : fiat pulvis. In Dyspepsia with acidity.—One powder twice a day. (Parag. 101.) 35. R. Pilulas Colocynthidis compos. B iiss. Saponis Castilliensis gr. ix. Olei Anethi m ij. Misce : in pilulas xij divide. An ordinary Aperient.— Two to. be taken at bedtime. (Parag. 78, 101.) 36. R. Sodas Sulphatis 3iss. Acidi Sulphurici diluti m x. Syrupi Rhasados 3j- Tinctures Cardamomi compos. 3j. Aquas Anethi 3x. Misce : fiat haustus. To he taken twice a day. (Parag. 83.) 37. R. Ferri Sulphatis gr. ij. Magnesias Sulphatis Dy^ Acidi Sulphurici diluti m viij. Tincturae Cardamomi compos. 3j. 136 FORMULA. Syrupi Rhasados 5iss. Aquas Pimentas 5ix. Misce : fiat haustus. Tonic—In Congestive Headaches, Sfc.— To be taken twice a day. (Parag. 89, 141.) 38. R. Confectionis aromaticas gr. x. Sodas Carbonatis gr. iv. Tincturae Cinnamomi compos. Syrupi aa 3j. Aquas Menthas piperitas 3x. Misce : fiat haustus. To relieve the pain in Hysterical and Nervous cases, with much flatulence. (Parag. 131.) 39. R. Extracti Hyoscyami Pulveris Camphorae aa gr. iiss. Misce : fiant pilulas ij. (Deaurentur.) In Nervous Headaches.—To be taken when the pain n very severe. (Parag. 131.) 40. R. Potassas Carbonatis gr. vj. Potassas Chloratis gr. viij. Tincturae Cinnamomi compos. 3ss. FORMULAE. 137 Infusi Aurantii 3xss. Syrupi Aurantii 3j. Misce : fiat haustus. To be taken twice or three times a day in Rheum* Headaches. (Parag. 145.) 41. R. Acidi Phosphorici diluti 3ss. Tincturae Rhasi composite 3j. Spiritus JLtheris nitrici m xl. Infusi Gentianas compos. 3ix- Syrupi Aurantii 3j. Misce : fiat haustus. To be taken twiee or thrice o» day. (Parag. 137, 160.) 42. R. Pilulas Colocynthidis compos, gr. vij. Extracti Colchici acetici gr. ij. Olei Carui m j. Misce : in pilulas ij divide. Aperient.—To be taken at bedtime, in Rheumatic cases, Sp. (Parag. 145.) 43. R. Pulveris Tragacanthae compos, gr. viij. Olei Limonum m ij. Aquas C amphorae 3xj. 12* 138 FORMULAE. Tincturas Cardamomi compos. Tinctures Hyoscyami aa 3ss. Chloroformi m xv. Misce : fiat haustus. To rdieve the pain in Nervous Headaches. (Parag. 131.) 44. R. Zinci Sulphatis gr. x. Extracti Anthemidis 9j. Olei Lavandula m iij. Misce : fiant pitulas vj. Tonic.—One to betaken twice a day. (Parag. 138.) 45. R. Spiritus Juniperi compos. 3j. Tincturas Cinnamomi compos. 3ss. Syrupi Zingiberis 5j. Infusi Cascarillas 5vj. Aquas Menthas piperitas 1 ss. Misce : fiat haustus. To he taken twice or three times a day. (Parag. 160.) 46. , R. Acidi Xitrici diluti in x. Acidi Hydrochlorici m v. Infusi Cascarillas 3xj. FORMULA. 139 Syrupi Rhasados 3j. Misce : -fiat haustus. To he taken twice a day. (Parag. 107, 137.) 47. R. Tincturas Sennas compos. Magnesias Sulphatis aa 3ij. Acidi Sulphurici diluti m vj. • Spiritus Athens nitrici 3ss. Infusi Rhasi 3x. Misce : fiat haustus. A morning Aperient in cases of Congestive Hcadaclie. (Parag. 89, 159.) 48. R. Infusi Sennas compos. Infusi Rhasi aa 3v. Tincturas Cardamomi compos. 3ss. Syrupi 3iss. Misce : fiat haustus. For Dyspeptic persons of weakly constitutions.— To be taken in the morning. (Parag. 101.) 49. R. Quinas Disulphatis gr. iss. Ferri Carbonatis c Saccharo gr. ij. Pulveris Cinnamomi compos, gr. viij. Misce : fiat pulvis. To be taken twice or three times a day, commencing uith half a powder. (Parag. 140.) 140 FORMULAE. 50. R. Sodas Carbonatis gr. x. Spiritus Ammonias aromatici 3ss. Tincturas Aurantii_ Syrupi Aurantii aa 3j. Infusi Gentianas compos. 3x. Misce : fiat haustus. To he taken twice a day. (Parag. 101, 107.) THE END. Vw>