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"But his countryman, Pinel, would not have spoken thus of Newton. On the contrary, he affirms, that " in consulting "the Registers of Bicetre, we find many Priests and Monks, as well as country people, terrified into this Condition by " the anticipation of Hell Torments, many Artists, Painters, " Sculptors, and Musicians, some Poets extatised by their "own productions, a great number of Advocates and Attornies: but there are no instances of Persons whose Professions require the habitual Exercise of the judging Faculty;" not one Naturalist, not a Physician, nor a Chemist, and " for the best Reason in the World, not one Geometrician." --An Essay on Headaches (1825) by Walter Vaughan

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An Essay On Headaches, and on Their Cure (1825) is a medical book written by Walter Vaughan.

Num igitur aut Haruspex, aut Augur, aut Vates quis,aut somnians melius conjecerit, aut è morbo evasurumaegrotum, aut è Periculo Navem, aut ex Insidiis Exercitum,quam Medicus, quam Gubernator, quam Imperator.

Cicero, de Divinatione, Lib. secund.

W. Wildash, Printer,

High-street, Rochester.

ΤΟTHE RIGHT HONOURABLETHEEARL OF DARNLEY,MY LORD,&c. &c. &c.

I humbly presume to inscribeto your Lordship the following Essay on Headachs, in Testimony of my great Esteem andRespect; and as an acknowledgment of howmuch I have been delighted, and how much Ihave been improved at Cobham Hall, by thatExample, ever shown there, of Regard to theObjects of moral Duty; the Deity, our Fellowcreatures, and ourselves.He, however, who would do Justice toyour Lordship's Character, should himself bepossessed of more Merit and Distinction than Iam: but I cannot suppress, that I shall everbe sensible of the Favours received from yourLordship, and shall ever retain those Sentimentsof Gratitude and of Duty which become me,Your LORDSHIP'Smost obliged andmost devotedServant,WALTER VAUGHAN.

PREFACE.As the following Essay (for I give it no higherTitle, ) however defective, will, I apprehend, befound to contain some things new and important,I publish it, not with false humility, but withthat modest ambition which conceited Sciolistsonly condemn, of one whose whole Life has beendevoted to the Profession of Medicine, and tothose Branches of Physiology (using this word inits largest signification,) which that Professionrequires.I never had such an opinion of my own abilities as to think that I could compose a completeTreatise on Headachs; but yet I always thoughtthat as a Physician, it was my duty to labourincessantly, lest on any sudden and uncommonoccasion, a Patient committed to mycare, shouldbe lost, or should suffer through my ignorance.As we have opportunity, let us do good untoall Men. Gal. vi. 10.Indeed, I have known many, whose conception of things was vivid, and whose expressionviii PREFACE.was correct and luminous, who, if they had hadthe leisure, could have supplied what was somuch wanted, and might have favoured theworld with a Performance far more likely thanmine to become popular, far more comprehensivethan mine, and far more free from faults. Perhaps, they felt a diffidence in attempting a Task,from which the venerable Cullen had shrunk;Cullen, whose experience was guided by penetration and genius, and whose new Languageand splendid Eloquence had contributed to raisethe University of Edinburgh so high among theSchools of Medicine.JCullen however has not neglected Headach;he has only omitted it in his Nosology: * andwhatever motives may have deterred others fromthe attempt to fix on its proper place in an arrangement of Diseases, I shall not, I trust, bedeemed presumptuous for an Essay, to makewhich I was urged by my excellent Friend, nowno more, Dr. William Saunders, late Physicianto Guy's Hospital, and the Founder, or, as Dr.Curry calls him, the Institutor of the MedicalSchool there.}The Lectures of Dr. Saunders on the principles and practice of Medicine, were the first Iever heard. I became his perpetual Pupil in

  • See page xxi. of the Prolegomena to the fifth Edition

of his Synopsis Nosologiae Methodicae; and page 411 ofhis Synopsis itself.PREFACE. ix1784. As a Lecturer, Dr. Saunders's presenceof mind (Ayxivota), his command over Language,and his intimate knowledge of every Branch ofMedical Science rendered him pre-eminent. Always intent on securing the attention of his Pupils, he never forgot to lessen the fatigue of it,when undivided and protracted; not by bedizening his Lectures with low and flippant witticisms,but by seasoning them with such ingenious anddelicate allusions as exquisitely illustrated hisDoctrines, and left them indelible in the mindsofhis hearers. Those Sceptics who came to hisTheatre, in order to debase the minds of his scholers, by leaving them no ground to believe anyone thing, rather than its contrary, as if nothingis perceived, but what is in the mind whichceives it, he boldly drove back. He encouraged noprejudice against Christianity; a Religion whichrecommends the Love of God and of Mankind asthe Sum of all true Religion. Till his death, hecontinued to show a warm and lively interest formy success in life, to honour me with his correspondence, and seldom to possess a book,domestic or foreign, which he did not lend me.He sent for me to Enfield, after his retirementthere. Need I say that I loved and revered him as a Father? and shall I not say thatI never think of him without feeling that all myinclination to commend, and all my talents forcommendation are disproportionate to his merits?per-X PREFACE .Ante leves ergo pascentur in aethere cervi,Et freta destituent nudos in litore piscis:Ante, pererratis amborum finibus, exsulAut Ararim Parthus bibet, aut Germania Tigrim,Quam nostro illius labatur pectore vultus.To detain the Reader no longer, who may beimpatient to know what he is to expect from me,I would tell him that I have endeavoured1. To remove all ambiguity from the termHeadach, by pointing out what is essential to thedisease signified by that term, and what is notessential:fi2. To show that there is a distinction ofHeadachs in the nature of things; and accordingly to make a division of them so perfect as tocomprehend them all; that such errors ofjudgment as have too often arisen fromthe confounding of mere pains in the Head with Headachs,and different Headachs one with another, mayin future be avoided: and3. To give an enumeration of the most common occasions, on which Headachs take place;so as to trace out those principles, resting not onhypotheses, but on facts, upon which, as data,all reasoning concerning the nature and cure ofany Headach should proceed.How I shall have succeeded , the Reader willjudge and all must be desirous that it shouldcease to be repeated, that " the same means for" no obvious reason have had such opposite" effects in relieving and in exasperating similar"6pains in the Head, that it must be left forPREFACE. xi" more enlightened posterity to lay down a more" certain method of cure. "* But I shall not reflect on my time as mis-spent, if I shall have fortunately shown the road to others of greaterability, and shall myself have advanced one steponly in it, towards that truth which, like the Sun,has enlightened human intelligence throughoutall ages.The Introduction, certainly little more thanan analysis of Sauvages' account of Headachs, Ishould have omitted, if some friends, not of theprofession, who had neither heard before of Sauvages, nor were aware of the imperfect state ofour knowledge of Headachs, had not resisted theomission: for the sake of those friends, and ofothers, who have not studied Medicine as aScience, I have also entered occasionally intosuch digressions, and such verbal criticisms, asthe Medical Reader must see, could not havebeen intended for him.To be lucid and succinct, to connect pathology with practice, to steer safely between discordant doctrines, and to be settled and decisivein my own opinions without dogmatism, I haveconstantly endeavoured. I have given no cases,as some have done, no doubt, to display theirquicker discernment in marking the peculiar circ*mstances of them, and their superior skill andfelicity in adapting remedies to them. I havegiven no formulae of remedies, convinced that

  • Haberden.

xii PREFACE.it was unnecessary to do so. In a word, Icould never be persuaded, that the magnitude ofa book is a recommendation of it;* and I haveoften lamented that the second edition of a bookwas inferior to the first, in proportion as it wasenlarged by the addition of such cases as maynever occur again; of such explanatory matteras so dilated the original, as to render it, if notmore obscure, at least less impressive; or of suchornaments as Editors and Printers know wellhow to apply to even the most putid and senseless productions, that they may glide easily intopopular favour.

  • Quin etiam Voluminibus ipsis auctoritatem quandam et

Pulchritudinem adjicit magnitudo. Plin. Epist. Lib. i . Ep. 20.CONTENTS.CHAPTER I.Page.REVIEW OF SAUVAGES ON HEADACHS 1CHAPTER II.DEFINITION OF HEADACH 30CHAPTER III.SYMPTOMS OF HEADACH 63CHAPTER IV.KINDS OF HEADACH 93CHAP. IV. SEC. I.PREDISPONENT CAUSES . 101CHAP. IV. SEC. II.OCCASIONAL CAUSES . 126CHAPTER V.CURE OF HEADACHS • . 221

AN ESSAY, &c.CHAPTER I.INTRODUCTION.A REVIEW OF SAUVAGES ON HEADACHS.HE, who wishes to know what any disease is, or,what Physicians mean by the name they give toany disease, will probably expect to find it in thewritings of those Nosologists, who, professing tohave imitated the procedure of Botanists, havereduced diseases to a few classes, orders, genera,species, and varieties, so that there should no longer be any dificulty in ascertaining the precise extension and comprehension of the scientifical termset for any one ofthem. Who, if he consider, thatno part ofthe human body is so subject to pain asthe head; that even the slightest pain in it mayincrease and be followed by apoplexy, by epilepsy, by insanity, &c.; and that headach, as a symptom, may occur in almost every disease, does notwish to know what headach, as a disease, is? ButCullen, the greatest Nosologist, of whom this orany other Country can boast, has intentionallyomitted Headach in his arrangement of diseases,and has even left it doubtful, whether he was ableto form such a character of it, as to entitle it to aB2place there . Ought I therefore not to endeavourto supply his omission, lest some one should accuse me of presumption? It is gratifying to me,that Cullen has not neglected Headach: and although one of his most humble scholars, yet Iwill not affect a diffidence , which I do not feel:for it has always been mywish, that one adequateto the task would perform it, and my inclinationto attempt it myself, rather than that it should beleft undone.But for what is not to be found in Cullen, it isnot improbable that the Reader may search inSauvages. I purpose, therefore, by way of Introduction to this Essay, to make a slight review ofthat part of Sauvages' Nosology, which relates tomy subject: and to this I am led by no other motive, than that the reader may be somewhat acquainted with what others have written on Headach, before he appreciates the merits ofthat whichwill, I hope, be found more consistent with thesounder doctrines ofthe present day.It may not be amiss, however, even in doingthis to premise, that, no disease is so simple as toconsist of only one symptom: for although asSauvages says, * in defining a disease, it may besufficient to mention one or two symptoms only,yet it is certain that there are many at the sametime.Headachs are, he says, pains in any part ofthe head, as the skull, the eyes, the ears, theteeth, or the jaws, without fever or convulsion,unless the pains be considered as accedents to

  • Prolegomena ad F. B. de Sauvages Nosologiam Methodicam, &c. a C. F. Daniel, Lipsiæ 1790 editam. Tome i, p. 72.

3diseases, and not, as we say, essential diseases *The genera ofthis order are the following: viz .1. Cephalalgia, Mal de Tête, a heavy pain of the head.2. Cephalaea, Cephalée, a periodical, chronic, tensivepain of the head.3. Hemicrania, Migraine, a pain of either side of theforehead.4. Ophthalmia, Ophthalmie, a pain of the eye, withredness, and intolerance oflight.5. Otalgia, Douleur d' Oreille, a pain ofthe ear.6. Odontalgia, Mal de Dents a pain of the jaws, orteeth.Of the genus Cephalalgia, his species are thirteen: viz .Headach from<Plethora.Menstruation.Hæmorrhois, Costiveness, &c.Disorder of the Stomach.the hot Fit of Fevers.Pulsation ofthe Temporal Arteries.the same cause as Intermittents, and, likethem, returning every day, or every otherday.Pregnancy.Inflammation caused by Blows on the Head,Wounds, Fractures, &c.Catarrh.the South Wind, & perhaps from Insolation.the Hysteric Disease.the Vapour of Lead, and of other Metals.

  • Ordo secundus. Dolores Capitis. Tomus iv. P. 69.

I have taken the liberty of rendering the clause, nisi Dolores pro horum morborum accidentibus habeantur, as if Sauvages had written, not accidentibus from accido, but accedentibus from accedo, because I do not believe, that any thingoccurs by chance.B 24All these species agree in this, that there is aheaviness of the head, at the forehead especially,or a disagreeable sensation of it, as if it were distended, turgid, and loaded with a weight. Thepulse is less frequent than in health: * and thereis a dificulty of thinking, of reasoning distinctly,and ofrecollecting.Ifthe seat of this disease could be known byaccurate signs, it might be distinguished by itsseat from Cephalaea and Hemicrania; for Cephalaea, as it is accompanied with a tensive andvivid pain, should belong to membranes, withoutor within the skull; and Hemicrania to the frontalsinuses, or parts receiving nerves fromthe littlesympathetic .Ofthe genus Cephalaea his species are seven:viz.Headach from<Latent venereal disease.Scurvy, repelled Itch, and any acrimony ofthe humoursRetrocedent GoutA latent IntermittentDesires, passions, cares, &c.A retention ofthe Plica PolonicaSerous effusion within the skullAll these species agree in this, that the pain,which is acute and of obstinate continuance

  • In Dolore dirissimo Pulsus exilior, debilior, rarior: Respiratio similes Pulsui patitur mutationes, &c. Sauvages,

Nos. Method. Doloris Theoria, cl. VII .Semper observavi, in gravibus Capitis Doloribus, Pulsumrarescere. Sauvages Nos. Method.Medical Transactions ofthe College of Physicians in London. vol. ii , p. 32.5occupies the whole head, and returns with violenceon slight occasions, Cephalaea differs in degreeonly, not in kind, from Cephalalgia; so that itwould perhaps be better to refer them both to onegenus . The moderns and followers of Stahl, distinguish Cephalaea by the pain in it being notheavy, but tensive, and spastic .Of the genus Hemicrania his species are ten:viz .Pain of eitherhalf of theHead, fromInflammation of the Eye.A carious tooth.Obstruction of one ofthe frontal sinuses .A Cold.Hæmorrhois.The Hysteric disease.Pus filling the frontal and maxillary sinuses,Insects in the frontal sinuses.A stone in one of the Kidneys.The Moon, following its phases every eighthLday.Ofthis Headach, says Sauvages, the principalsymptom is a vehement and often a periodicalpain in either side of the head, especially at thetemple, the forehead, and near the eye . It differs from Cephalaea in this, that its seat is not inthe Encephalon, nor in that part of the skull,which immediately covers the brain, but in thefrontal sinuses, and at the orbit, so that eitherthe eye-ball is violently affected with a retractionand lachrymation, or the patient has generallyan obstruction of the nostril , a coryza, or a similar disorder of the frontal sinuses , or the affectionis confined to a spot, which may be covered with6.a nail, or with the thumb, which is not the casein Cephalaea. He says, in another place that Hemicrania is seated in the frontal sinuses , or placesreceiving nerves from the sympatheticus parvus.Such is the sketch of Sauvages' Nosology, asit relates to Headachs, which I thought it necessary to lay before the reader, without interposingmy own judgment. That it will be unsatisfactory to him, I am well aware: but I have nodoubt, that the whole, of which it is an abridgement, has been equally as unsatisfactory to thosewho have perused it; for such an illogical arrangement, such a mixture of facts and hypothesis,and such a confusion of symptoms with genera,species and varieties are, I believe, scarcely tobe found in any other author, capable of markingthe distinguishing peculiarities of objects, and ofperforming generalization and abstraction .have, however, endeavoured to be faithful in representing the statements of this learned Physician; and I shall now offer a few remarks, forwhich perhaps I may not again find so propera place.IThe first is, that Sauvages differs from theancient Physicians, and from the modern, in referring pains of the face tothe head: he differsfrom the ancient Physicians; for Celsus wholived at Rome in perhaps the age of Augustus,when he is about to treat of the diseases ofparticular parts, says that he shall begin with thehead, by which he means that part which is covered with the hairy scalp; and that of pain ofthe eyes, of the ears, of the teeth, and of anysimilar pain, if there be any, he shall treat at7another time. * Sauvages differs from the modernPhysicians; and not only from them, but alsofrom Anatomists, Naturalists, Painters, Sculptors, &c. for although these may all, in commonconversation, give such latitude to the word head,as to comprehend in it the face, yet they alwaysdistinguish the head from the face, when they'would direct attention to the one of them, andnot to the other. And, if I say, that I have apain in my head, every peasant as well as everyPhysician supposes me to mean by the word head,that which Celsus defines it: but if I say that Ihave a pain in my head, when the pain is in oneof my eyes only, or of my ears, or in a tooth, neither Peasant nor Physician understands me, orallows that I speak the truth.The distinction between the head and the faceis indeed the more necessary, because as of allanimals, man has the largest head with the smallest face, so the more this proportion differs inother animals, mammalia, birds, reptiles, and fishes, the more they are stupid and ferocious . Everyone knows that children have a large head, andthat they become less beautiful, as the relativemagnitude of the head and face becomes altered .Again, in all the pictures and statues of greatmen, ofheroes, and more especially of gods, theancients represented the head as larger thanit is naturally, in proportion to the face; thefacial line of Camper-a line passing along the

  • Caput: -sub quo Nomine nunc significo eam Partem,

quae Capillitio tegitur: nam Oculorum, Aurium, DentiumDolor, et, si quis similis est, alias erit explicandus. DeMedicina. Lib. iv, Cap. 2.8edge of the upper incisores teeth, and the mostprominent part of the forehead-forming a larger angle with the basilar line -a line bisectinglongitudinally a plane passing through the passages of the external ears and the inferior edge ofthe anterior opening of the nostrils . Thus, in theOurang Outangthis angle is only 65°; in the adultnegro 70°; inthe adult European 85°; in the infantEuropean 90°; in the pictures and statues of Heroes 90°; and in those of Gods 100° . * Lastly, ifthe human brain be not larger, in proportion to therest of the body, as Aristotle asserts it to be, thanthat of all other animals, some mammalia andsome birds excepted, yet this seems to be certain, that the human adult has the largest brainof all animals in proportion to the rest of his nervous systemt for in all other warm-blooded animals, as their spinal marrow is larger, and as theirnervous ganglia are larger, and more numeroustheir brain is smaller. It has, however, been noticed by Professor Tiedemann, that the spinalmarrow is much larger in proportion to the brainduring the early months of uterine life.Another remark is, that Sauvages by comprehending in one genus Cephalalgia and Cephalaeaand by maintaining that Hemicrania is neitherseated in the Encephalon, nor in any part of theskull which immediately covers the brain, makesonly one kind of headach.

      • Cuvier Leçons d' Anatomie, Comparée. Tome ii .

Soëmmering, Corporis hum. Fabrica. Tome iv, § 92.Differt a Cephalaea ex eo, quod ejus sedes non est inEncephalo nec in Calvariæ Parte, quæ immediate Cerebrumtegit, sed in Sinubus Frontalibus, &c. Nos. Method .9Athird remark is, that if the pain of Cephalaea, differ in degree only from that in Cephalalgia,it should in both depend upon the same cause.This cause in Cephalalgia, Sauvages states to bean infarction of the bloodvessels in the cortical partof the brain, which, if cut, he says, is not acutelypainful, but if its bloodvessels be distended andturgid, becomes thereby obscurely painful.That Cephalaea is a less tractable headachthan Cephalalgia, is sufficiently plain; but thatit is a greater degree only of it, is not so: and Ishall endeavour to show, that Cephalaea differsin kind from Cephalalgia. First, the assertion ofSauvages, that the pain in Cephalaea is tensive,spastic, and vivid, for he givès all these epithetsto that pain, is not supported by the authority ofeither Celsus or Aretaeus: the former applies noother epithet to the pain in Cephalaea, when fully formed than intolerable; * and the latter, saysthat the attack of diseases ofthe head is tolerable,becausethe pain is slight. † Nay Aretaeus, wholived in perhaps the reign of Nero, cautions usagainst a disregarding of pains of the head, whilethey are yet slight, and may sometimes be cured.Secondly, is it likely that a Cephalalgia ever becomes a Cephalaea; that a slight degree of infarction of the vessels of the cortical portion of thebrain causes a sensation of heaviness in the head,and a great degree of it a tensive, spastic, andvivid pain? And lastly, as to the pain occupying

  • Intolerabalis.

† ευπαθὴς, μικρός, σμικρος.The Reader may consult pages 27 and 114 of the edition,of Aretaeus, edited at Leyden by H. Boerhaave, in 1735.10the whole head in Cephalaea, but only part of it,as the forehead, in Cephalalgia, I appeal to thecommon experience of medical men, whether itdo so.Is it not a gratuitous assumption then, that anover-distended and turgid state of the bloodvessels in the cortical part of the brain gives rise toCephalalgia and to Cephalaea? Will any one contend, that the pressure of over-distended bloodvessels gives rise to that intense pain in the head,uncommon giddiness, and sudden loss of strength,which are the first complaints of those, who areseized with the plague?* Will any one contend,that the pressure of distended bloodvessels, givesrise to that pain in the head with somnolence,lassitude, despondency, and faintness , which ushers in malignant fevers, and of which many complain, who escape those fevers, when they prevail? Although a pain in the head, arising in thecourse of any fever, may require blood-letting,yet in that pain with giddiness which precedesit, there is not yet any alteration of the pulse, asthe most acute and cautious have remarked, noris the pain diminished, but increased, by openingthe jugular vein and letting blood flow downfromthe head. †

  • Thucydides. Hippocrates. Lucretius, de Rerum Natura. Russel's account of the Plague at Aleppo, page 230.

+ Dignissimum est notatu, quod Principio horum morborum tota Tragoedia in genere nervoso agitur, antequam sanguinis massam turbari pulsus indicet, vel aliquam magnammutationem pati. Quod quidem in variolis, morbillis , febribus, cujuscumque generis quotidie conspicitur, ubi aeger primomomento dolore capitis corripi solet et levi quadam Vertigine,11I could never believe, that there is too muchblood in the brain in that pain of the head inchlorotic girls, who have scarcely any red particles in their blood, or of those women, ( I knowthat thin persons have most blood, ) whose bodiesare thin, whose muscles are flaccid, whose wholecomplement of blood is daily decreasing, andwhose pain in the head preceding menstruationabates or ceases as soon as this begins, and ceasessometimes as entirely when the discharge hasnot exceeded a few drops, as when by the fifthor sixth day, it may have amounted to severalounces. Indeed the quantity of blood in thebody of a female has less connection with thissecretion than some seem to imagine; for themost plethoric do not menstruate more regularlynor more plentifully than those who are not atall so and venesection before menstruation neither protracts it a day, nor during menstruation,ever checks it. * Professor Hoffman maintains,that the menstrua may be suppressed by consequence of a plethora; and that venesection before&c. Ric. Morton Pyretologia. App. Curat. Morbor, universal. page 12.Morbum saepe incassum frequenti Venæ Sectione in Jugulari vel ejus Ramulis celebrata cicurare tentavi . Id . Exercit.i, cap. IV, page 32. Edit. Geneva, 1727.See Sydenham, Opera omnia. Edit. Lugd. Batav. 1726 .page 307.Chalmer's on the Diseases of South Carolina, page 150.Lieutaud, Hist. Anat. Medic. page 111, obs . 55.

  • The system of the Womb, &c. by Thomas Simson,

Chandos Professor of Medicine and Anatomy in the University of St. Andrew, page 9.An Introduction to th Practice of Midwifery, by ThomasDenman, M. D. vol. i, page 165.12their appearance promotes them. There is, perhaps, as much blood in the head of emaciated persons as of others, owing to the importance of thecerebral functions; but I can see no reason, thatthere should be more, although some assert it.I could never believe, that there is a greaterquantity of blood than usual in the head of those,who have ever so long laboured at times under aHeadach, and in whose head some morbid changeofstructure is going on, or some tumour is slowlyforming.I could never feel myself convinced by theexperiments of Dr. Seeds and others, that thereis too much blood in the head in that Headachwith occasional giddiness, dilated pupils, muscaevolitantes, flushed cheeks, &c. which follows sudden and considerable losses of blood, uterineHæmorrhages especially, nor do I think it likelythat such experiments on healthy dogs will everthrow light on the diseases of the human body,There certainly was not an extraordinary proportion ofblood in the head of those workmen ofa gallery in the coal mine at Anzain, at Frenes,and at Vieux Condé near Valenciennes, who weretormented with a most violent Headach: for Professor Hallé attests, that their brain was foundto be white, and the cortical portion of it, whichconsists chiefly of bloodvessels, so pale as to behardly distinguished from the medullary portion:no blood was detected in their aorta, or in anyof the sinuses of their dura mater. †

  • Marherr, Pralectiones in H. Boerhaave, Inst. Med.

DCLXV.+ Edinburgh Medical and Surgical Journal, vol. iii , p. 170.Lieutaud, Synopsis univ. Praxeos Medicæ, &c. p. 3.13I shall make no remarks on the several speciesof Headach imagined by Sauvages: but as heplaces the Ecplexis of Hippocrates as if it were aHeadach, and consequently depended upon overdistention of the bloodvessels in the cortical partof the brain, I cannot properly pass it over insilence; and I am the less disposed to do so, because I cannot recollect any writer who, beforeSauvages, had taken such a view of it .Ecplexis is said by Hippocrates to be theimmediate consequence of a blow on the head: *and all his interpreters agree that the literalmeaning of the word Ecplexis is stupidity, or adiminution of sensibility. The common Englishword corresponding with the Greek Ecplexis isCommotion or Concussion of the brain: and aperson, while he has a concussion of his brain, isvulgarly said to be stunned . Now, how can a person who is stunned, and upon whom impressionscall forth no sensations, have a pain in his head?When a person has received a shock, or ablow on his head, and is stunned by it, he nosooner breathes again easily, has in some measure recovered his usual warmth, and is able toanswer questions put to him in a loud voice, thanhe complains of a pain in his head: but pain isnot in the extension of the word Ecplexis.Ifthe reader be startled at the number ofspecies of Headach made by Sauvages, how much

  • Ἐπὶ πληγῆ ἐς τὴν κεφαλὴν, έκπληξις, η παραφροσύνη,

Kaкóv. Sec. VII, 14. I. Heurnius thus latinises it: -Plagæin Capite acceptæ, Stupor aut Delirium si supervenerit, malum. the word ' EKTλns Foesius, in his Oeconomia Hippocratis, renders Stupor, Obstupescentia.14more must he be startled at finding that his editor, C. F. Daniel, adds thirteen to that number;and that Aretaeus makes the species to be innumerable? It is Le Clerc, who says, that Aretaeusdoes so; but I do not believe it: the allusion ofAretaeus is, in my opinion to the cases, or instances, or forms of Cephalalgia, in different individuals, not to a first generalization.Before I conclude this Introduction, as Sauvages assigns Headach to an infarction of bloodvessels, I shall speak of those signs, which areoften considered singly, but oftener conjointly asdenoting a greater distention of the bloodvesselsof the brain, or, what is not very properly called,a determination of blood to the head: I mean aflushed countenance, a dilatation of the pupils,and an increased pulsation of the carotid, thetemporal, and the facial arteries.First, of a flushed countenance. Perhaps itis impossible to tell exactly of any person, whatloss of blood would be sufficient to kill him; although it has been fairly ascertained, that a person may lose the more blood from a vein, themore slowly he loses it; and that he may losemore blood without fainting in a recumbent thanin an erect position.Haller supposes that, if a person weigh 150pounds, his blood weighs 30 pounds; of which4th is in his arteries, and ths are in his veins . †

  • His words are ἰδέαι δε μυρίαι.

+ Elementa Physiologiæ, Tom i, page 3 .The veterinary Surgeon , Percivall, says, " supposing a man"to weigh 12st. or 168lbs. the quantity of Blood contained" in his body may be rated at 21lbs. , or, 2gals. 2qts. 1pt. '15This is probably an approximation to the truth:but what can we suppose to be the quantity ofblood circulating through the vessels of the head,when Malpighi thinks that rd, Haller that th ,Monro that th and Magendie that th , of allthe blood sent out of the left ventricle of the heartis carried to the brain by the two internal carotid,and the two vertebral arteries? These are subjects which admit dispute: but it is clear from theangles ofthe carotid and vertebral arteries beforethey enter the cranium; from their anastomosingafter they have entered it, so as to form the circle of Willis, between the base of the brain andthe cranium; and from their minuteness as theypass out of the pia mater into the cortical portionof the brain; -it is clear, I think, that with whatever force the blood is propelled into the aorta bythe contraction of the left ventricle of the heart,the shock which is then felt in all its branches inother parts of the body is scarcely sensible at thecircle of Willis: and, therefore, that the arteriesof the brain must have an inherent power of theirown, by which they carry on the circulation ofthe blood. No other organ is of such delicatetexture as the brain, and therefore needs to beso fearfully and wonderfully defended against thesudden rush ofblood into it: for other organs arepenetrated by large arterial trunks, which divide and subdivide within those organs.66Sauvages, who attributes Headach to a disagain, 66 we may reckon the loss of a pint from a man to beequivalent to that of a gallon from a horse, or, 4oz . from a"dog See his " Series of Elementary Lectures on the vete-"'rinary Art, &c.16tension ofthe bloodvessels in the cortical part ofthe brain, does not say, that apoplexy is alwaysaccompanied with a flushed and tumid countenance: nay, he asserts that the face in headachis not always of a blood- red colour, or as if it contained any blood. And very credible authorsallow that when both the brain and its membraneshave been found loaded with blood, in apoplexy,the face had sometimes been pale.In short the signs ofdistension ofbloodvessels,within the cranium, are not those of Headach:in apoplexy according to Dr. Cook, "the animal"functions are suspended , while the vital and na-"tural functions continue: respiration being ge-"nerally laborious, and frequently attended with"stertor"? but in Headach there is more or lessquickness of sensation and of perception, butnone of the operations ofthe mind are performedwithout an increase of pain in the head: thepatient is more or less watchful; and his respiration corresponds, as in health, with his pulse.Quick sensation is not peculiar to Headach: anacuteness of vision , and of all the senses attendspersons dying of inanition, labouring of hydrophobia, and suffering from some poisons: nay,and it accompanies pain in several textures ofthe body, in skin, in muscle, and in celular texture more especially. There is this differencehowever, between the pain in headach (when thestomach does not sympathise with the brain soas to produce sickness), and the pain in partswhich is not attended with sickness, as pain inthe stomach, the intestines, the testes, the uterusis always, and pain in tendon, ligament, and bone17is often, that the operations of the mind increasethe pain of headach, so that the patient lies withhis eyes closed, prefers darkness to light, avoidsodours, and noises, and lies motionless, so thathe seems to some as if asleep or stupid; * whereas the operations of the mind diminish the painof skin, of muscle, and of cellular tissue , so thatthe patient is roused by it to both mental andbodily exertion, and vociferates incessantly, andturns and even throws himself out of one position into another; or perhaps even forgets his pain,in his earnestness to account for some phenomenon, or to state to others the grounds of somedecision, in doing which, if advanced in years,his memory, although before on the decline,seems to be revived, and his conception to bemore quick than usual. Cases are on record ofpatients, who, during a chirurgical operation suppressed the language of pain, but died for havingdone it.It may be a question, whether apoplexy everoccur, unless some ofthe arteries within the cranium be organically diseased, and all of themhave a tendency to become so. The whole ofthearterial system was found disposed to aneurism,and in many places changed in its structure, in aman, who had an aneurism of the carotid artery.Indeed, it seems to me, that a diseased state oftheblood vessels precedes the congestion of blood,and is more essential than it to apoplexy. Asto that compression ofthe brain, which sometimes

  • Burserius, Instit. Med. Prac. vol. III , page 13. But

Lommius says, In Dolore Capitis omni, eo Periculum vertitur, quia coutinentur excruciat, et Somnum tollit . Obs.Med. Lib. ii. с18takes place, by consequence of the return ofblood to the heart being prevented by compression of the jugular veins, &c. although it produces a suspension of the animal functions, and,if continued long, death; yet it is so far from producing apoplexy, properly speaking, that, if Imistake not, that condition which it does produce, bears no more relation to apoplexy, thanthe condition of the sanguiferous system produced by violent exercise, bears to fever. Whena person dies from being hung bythe neck, hedoes not die of apoplexy; but he dies as if thetwo pneumogastric nerves had been divided . Hecannot inspire.To return from this digression, a flushed countenance can no more be a sign that an unusualquantity of blood is present in the brain, thanthe circ*mscribed spot ofbright red in the cheeksof consumptive persons, which is attended with arapid diminution of the quantity of blood in theirbodies. Besides, when persons blush, nobodymaintains, that the sudden rush of blood into thearterial capillaries of the face is consequent to anextraordinary fullness of the small arteries supplying them. It has at times come into my mind,that in certain passions and emotions, somethinganalagous to blushing takes place in the mucousmembrane lining the pylorus, the hepatic ducts,the kidneys, the ureters , the urethra, the ductsof the prostate gland, the fallopian tubes, &c. andthat the foundation of an irritation totally distinctfrom active inflammation is occasionally laid thereby a mere act of the mind. Bichat thinks it probable, that there are vessels in the capillary system, which are habitually empty, and intended19to receive fluids under certain circ*mstancesonly. The ureters, the excretory ducts in somecases, and the lacteals in the intervals of digestion, he says, contain nothing; and he adds, thatit is difficult to conceive the rapidity of the bloodentering the capillaries ofthe face and of severalother parts of the skin , if these vessels contain afluid, which must be displaced to make room forit. * For my own part, all this, which the ingenious Frenchman thinks probable, I do not thinkso: for I can see no analogy between the capillaries and the ureters: &c.Secondly, dilated Pupils. A dilatation ofthepupils is said to be another of the signs of compression of the brain; but it is also a sign ofworms in the intestines; and it follows the rupture of a large vomica in the chest, when it announces danger. † Weak, relaxed, scrophulous,and leucophlegmatic habits, and persons whohave swallowed certain poisons, or have hadthem applied externally, have generally dilatedpupils . A dilatation of the pupils does not alwaysattend amaurosis; the iris being sensible insome cases, when vision is entirely lost, and being fixed and unalterable on exposure to light inother cases, when the retina is not at all affected .Besides, the pupils are not always dilated evenin apoplexy. Dr. Cooke, whose opinions are always intitled to respect, thinks that a contractionof the pupils is one of the worst symptoms in

  • Anatomie Generale. Tome ii, page 475.

+ Landre Beauvais SemeiotiqueMaladies. Edit. 2. § 1190.ou Traité des signs desc 220apoplexy, He says, " I never knewa person reco-" ver from apoplexy, when the pupil was greatly"contracted. My opinion on this subject is con-"firmed by that of Sir Gilbert Blane and Dr."Temple. " But I can assure these justlyesteemed Physicians, that on the 13th of February, 1822, Sir James Yeo's father had an apoplectic fit, with such contracted pupils, that ontheir authority, it was judged to be immedicable;and yet, that after some hours, he recovered fromit. Nay, he had three fits afterwards, from allwhich he recovered, no paralysis remaining, buthe died of a fifth fit, at Chatham, on the 20th ofJanuary, 1825.Lastly, an increased pulsation of the carotidarteries . Why this occurring in a headach,should be deemed a sign of an extraordinaryquantity of blood in the head, I am unable totell. As the veins and the canals, or sinuses,serving as veins within the cranium, surpass thearteries in number and in capacity, and communicate freely with one another, if there be noobstruction to the return of blood by the internal jugular veins, I should think that when moreblood is sent to the brain, then more returnsfrom it.How could there have been a congestionof blood in the vessels of the cortical part ofthe brain in the headach of that woman, towhom Sauvages refers, whose sleep was prevented by the throbbing of her temporal arterries? Sauvages does not say that her face wasflushed, that her pupils were dilated , that herhead was hot, &c. although he certainly intimates,21that she was plethoric . But how could she havebeen plethoric, when she was every month suffering a very profuse menstruation, an uterine hæmorrhage, no doubt, and was by consequencechlorotic, that is , pale, and eating chalk, coal, andother indigestible things? There is a violent pulsation of the carotid arteries in that headach fromexcessive and repeated venesection for the cure ofacute diseases, in which there is also pain of thehead, with giddiness, and dilated pupils; buthow can there be a congestion of blood in thecortical portion of the brain in this headach?In the recovery from fainting and from concussionof the brain, there is a violent pulsation of thecarotid arteries , and a very remarkable pulsationat the wrist, if the patient be roused; and nobody supposes that in either case, there is a redundance of blood in the head. † Mr. Abernethysays, that the man, who had been gored in theneck by a cow, and had lain ten minutes, or more,without any blood being carried to his brain bythe left carotid artery, recovered from his extreme

  • His words are Menorrhagiam uberrimam quovis mense

patiente. quæ inde chlorotica, i. e. pallida, picansque evasit.Nos. Method.+ Morgagni de Sedibus et Causis Morborum, &c. Epis. iv.§ 32 Epis. li , § 9, 10.Sabatier Traite d'Operations.Nosographie Chirurgicale par Ant. Richerand. Tome ii ,page 218.Précis Elementaire des Maladies reputèes chirurgicales,par J. Delpech. Tome i, page 328.Hunter's Treatise on the Blood , Inflammation , &c . p. 192.Abernethy's Surgical Observations, containing a classification of Tumours, &c. Case, page 193.22faintness during that period, and became perfectly sensible. And it is a curious fact, that cutting off the supply of blood to the left side of thebrain, should seem by this case, as Mr. Abernethy remarks, to affect the opposite side of thebody in the same manner as an effusion of blood ·on the left hemisphere of the brain does. *The greater pulsation in a headach may beof one carotid artery only, or of one temporalartery only it may be of one external carotidonly, which is smaller than the internal; or itmay be of one internal carotid only, which furnishes no branches till it has arrived within thecranium or, if a headach be connected with adisease of the heart, and the whole venous system be overloaded, the pulsation may be not ofthe carotid arteries, but of the jugular veins,which are contiguous to them. Sometimes thegreater pulsation is not referred to the carotidarteries, but to the base ofthe brain.In a word, if the most obvious of all the deviations from health be a disordered state of thewhole, or of some part of the sanguiferous system, there is always an antecedent change in thewhole, or in some part of the nervous system;and this antecedent change influences, generallyor partially, not only the blood vessels, but alsothe blood itself; so that in defining any thing,and therefore a disease, if we would enumeratethose qualities ofit, which are the most obvious,and which may serve to distinguish it from other

  • Surgical Observations, containing a classification of Tumours, &c. page 199.

23things, we ought not to forget that the most obvious and palpable qualities of it are generally discovered before that other quality, which is theprincipal and paramount, in which its obviousqualities originate, in which its specific differenceconsists, and to remount to which is the mainbusiness of the philosophy of medicine.There is a disease strongly resemblingphrenitis; a very common disease Hominum,et Virorum et Mulierum, as I know by painfulexperience. It is called delirium tremens, andit may be distinguished by the following symptoms: headach, flushed cheeks, suffused eyes,and throbbing of the temporal and facial arteries,great debility of body and of mind, trembling ofthe hands, and of the tongue, if this be put outofthe mouth, faultering of the voice, chilliness ,watchfulness, delirium, subsultus tendonum,hiccup, picking of the bed clothes, and imagination of frightful objects, to avoid which the patient sometimes endeavours to destroy himself;pulse small, quick, and so frequent as scarcelyto be counted; and sweat profuse, cold , clammy,and fetid. I believe blood- letting, in this disease,is as prejudicial as it is beneficial in phrenitis .In the brain of those who have died of this disease, which so much resembles phrenitis, thereis not the least appearance of vascular fullness .There is perhaps less blood in the body in delirium tremens; and the little that is there, isquickly being diminished; because the patient'ssweat is so abundant and so full ofanimal matter;because he neither eats nor drinks; and becauseopium, in large doses, often restores him to24health. Does not the increasing frequency ofthepulse, in this disease, keep pace with the increasing diminution of the quantity of blood, as inanimals bleeding to death in a slaughter- house?After inflammatory diseases, which could nothave been overcome without large, repeated,and debilitating blood- letting, the pulse generallyremains for some time too frequent. Dr. Darwinsays, that " when a muscle is supplied with but"little sensorial power, its contraction soon 66 ceases, and may in consequence soon recur," as is seen in the trembling hands of people"weakened by age, or by drunkenness. "66Perhaps Dr. Mead errs then in supposingthat most diseases of the head have a greataffinity with each other, and commonly pro-"ceed from repletion." For, if he mean byrepletion, the state of being over full, and referto the cranium, it may be doubted, that it isever so; but, if he refer to the blood vessels ofthe brain, as he certainly does, there can be nodoubt, that their diameters may be enlarged, andthat they may be distended far beyond what theyever are in a healthy state, without their distention depending upon the impulse given to theblood by the systole of the left ventricle of theheart. Nay, although a greater fullness of thearteries ofthe brain is kept up bya plethoric stateof the body, yet it may exist when the body isnot at all plethoric. Instances of this are common enough: and, I believe, it is universallyagreed, that when there is a Headach from depletion, it is increased by blood-letting, eitherlocal or general. It has already been observed,25that a flushed countenance, dilated and immovable pupils, and a greater pulsation of the carotidarteries do not denote a congestion of blood inthe head; but that they often attend a diminution of the blood there. I would now remark,that when, together with those three symptoms,there is a sensation of weight in the head, a dreadoffalling forwards, a noise in the ears, flashes oflight or luminous sparks on straining, stooping,lying down, &c. and on other occasions, obliqueor double vision, a perception ofany of the choroidal vessels reflected, and of their pulsation,then it may be concluded, that the head laboursunder repletion: but that when together withthose three symptoms, there are others like thoseaffecting persons, who have suffered great lossesof blood, as a violent pain confined to some partof the head, as if the brain there was pressed inwards bya lump of lead, great and sudden debility, with coldness of the extreme parts, sometimes vertigo, smallness and inequality of thepulse, noises in the head, and various nervousaffections, then it may be concluded, that thehead has suffered depletion.If, however, the cranium and the brain beunaltered, if the ventricles of the brain containthe same quantity offluid, and if no extravasation have taken place, the quantity of bloodcirculating within the head must always benearly the same, because the cranium cannotbe distended byits contents, and blood and brainare both incompressible, or nearly so.It is commonly said, that it is difficult to account for repletion of the cerebral vessels, when26there has not been a greater action of the heart,and ofthe large blood vessels; and also for depletion of them, when there has not been a considerable loss ofblood from any part: but assumingthat the circulation ofthe brain is necessary to itsfunctions, I cannot see how a merely increasedaction ofthe heart can be productive of repletioninany part, or howa merely diminished action canbe productive of depletion. That the brain shouldbe secure against sudden repletion, and suddendepletion, seems to me to be a law ofnature andconsidering that there is neither the least dilatation of the arteries during the systole of the leftventricle of the heart, nor the least contraction ofthe arteries, during the diastole of that ventricle,I would rather suppose that repletion dependsupon a weakness of the arteries ofthe brain; forwhere opium induces insensibility and death, congestions of blood are found in the internal organs;and depletion upon the arteries ofthe brain receiving less blood from the carotid and ventebral arteries, while the veins continue to take it up, andto carry it to the sinuses. I can easily conceive,that if the arteries contain less blood than is requisite to the energy of the brain, there shouldbe various degrees of debility; and that if theycontain still less blood, and the circulation of itin them be suddenly suspended, there shouldbe syncope.The coats of the arteries in the brain, howeversmall, may be supposed to be, as other arteriesare, accompanied with nerves from the great sympathetic nerve: for ramifications from this nerveare easily enough traced on the larger arterialbranches.27But although I cannot conceive how an enlargement ofthe diameters of the arteries of thewhole brain, can give rise to any sensation, yetI would not deny that there may be a sensationofpain with a sensation of weight, or with stupor,&c. if the vessels of only one part of the braincontain more blood than usual, and those ofotherparts less; for a part of the pericranium, or ofthe dura mater, or of the pleura, being inflamed ,a pain is felt in the whole of their extent; andwhere patients have complained of pain and heaviness in the head, some of the blood vesselsof the brain have been found over distended withblood, and others not at all distended: therefore if we assume a temporary enlargement ofthe blood vessels in some spot within the cranium, as the sine qua non of Headach, we arguefrom a fact fairly and fully ascertained . Nor isour argument invalidated, although no enlargedarteries should be discovered after death; for ifthe cessation and the cure of Headach dependupon the removal of the enlargement of the vessels, it is not at all improbable, that such removal may be the effect of death That intenseinflammations of serous membranes often leave notrace of their existence after death, is known toevery one, but is particularly noticed by Bichât,Bricheteau, and others.Now, I do not suppose, that the blood vesselsso distended, give rise to pain by their mere pressure, but rather by occasioning a change in thecirculation of the blood. Nor, indeed, does itseem to be proved, that slight pressure on thebrain is productive of pain, and of such other28effects as were formerly attributed to it.* As toPortal's experiment of compressing the brain ofa dog, through a hole made in the skull, with atrepan, and as to his inference from it, " que le" Cerveau est fortement comprimé dans apo-' plexie, et qu'el est moins lorsqu'il y a des 6666 Convulsions . " I would remark, first, thatpressure on the brain when the cranium has anopening made in it, is no proof that the brain iscompressed by distended blood vessels, or byextravasated blood, when the cranium is entire;secondly, that the experiments of Laghius showthat the brain of dogs may be depressed six lines,without producing any uneasiness; and thatwhen the dogs begin to complain, they soon become quiet again, if the pressure be not increased; and thirdly, that we are not authorised tocompare the result of experiments on healthydogs, with the symptoms connected with morbidappearance in the human subject. Dr. Kirklandsays, " there are abundance of instances which" show that extravasated blood and serum do not" cause apoplexies:" and considering what is soingeniously advanced by Sir Everard Home, onthe Fluid of the Ventricles equalising internalpressure; by Dr. Kellie on the peculiarity ofthe circulation within the head; || by Bonetus,Abernethy's Surgical and Physiological Essays, part 1 ,sec. 1 and 2.+ Memoires sur la Nature et le Traitement de plusieresMaladies. Tome ii, page 248.Morgagni de causis et signis Morbor. Epis. Ix, § 13.§ Philosophical Transactions, 1814, page 471 , 1821 , p. 32|| Transactions of the Medico Chirurgical Society of Edinburgh. Vol. i, Art. 1.29Morgagni, Lieutaud, &c. as to appearances detected bydissection in those cut off by apoplexy;and by Dr. Cooke, and the authors referred tohim, on the effect of blood letting in this disease, * I am inclined to believe that apoplexydoes not depend on a mere distention of bloodvessels. Dr. Baillie could find no morbid appearance in the head of a person who died oferysipelas in the face, although he had beenaffected with coma: nor could Dr. Wells detectany extraordinary fullness of the vessels of thebrain in a stout young soldier, who had diedcomatose, while labouring under scarlet fever. †Surely the blood vessels, and perhaps the brainitself must be diseased in apoplexy; and the distention of the blood vessels, when it is found,must be the effect of it.2ATreatise on Nervous Diseases. Vol. i , page 285, &c.+ Transactions of a Society for the improvement of Medical and Chirurgical Knowledge. Vol . ii, page 225.30CHAPTER II.DEFINITION OF HEADACH.ALTHOUGH Galen declares, that they whodo not distinguish Headachs, but prescribe indiscriminately the same remedies for them all,do more harm than good; yet even in Willis'stime, the cure of Headachs was rather tentativethan scientifical: and at this very day the mostlearned and experienced in the profession do notscruple to confess, that we have no certain method of curing the more tractable Headachs. *This confession, coming from great authority,is most humiliating; but I would attribute thewant of success in curing Headachs, in part tothe want of a symptomatology founded in pathological anatomy, and in part to the vaguenessand ambiguity of the medical nomenclature. Asto physical changes of structure in dead bodies,if we cannot reason from them to the morbid

  • Thomae Willis Opera omnia. De Anima Brutor. part ii

Cap. 1.Gulielmi Heberden Comment. de Morbor. Historia etCuratione. Cap. 17.31action which produced them, it seems to me thatno useful knowledge is to be derived from themere contemplation of them. Congestions ofblood in the vessels ofthe brain, of the gastroenteric mucous membrane, &c. do not throw anylight on the nature of fever; they are the mereeffects of the fever. And as for all that reasoning relating to Headachs, which no sound, andsober and well- educated Physician any longermaintains, however some conceited patients maypretend to understand it, and to be satisfied withit, fascinated, as it were, sometimes by the mereeuphony of metaphysical and technical terms,and sometimes by mean and vulgar metaphors,which seem always to pass with the ignorant asan ingenuous opening for them of a via regia, asI have long endeavoured to forget it, I shall allude to it as little as possible. My sole aim is ,laying aside all pretensions to depth, to subtilty, and to innovation, to identify the experienceof others with my own, and to convey it in simpleand perspicuous language.I shall tell, first, what, I think, a Headachis; and shall next show what is not a Headach.I purpose, then, to confine the word Headachto every disagreeable sensation, which the patientrefers either to the inside, or to the outside of hishead, provided that the disagreeable sensationbe so increased bythe exercise of his intellectualpowers, that he is alarmed, reserved, and shrinking from the impression of internal objects, hispulse and his respiration being not more frequentthan in health, but his temperature, that of hisextremities especially, being more or less dimi-32nished. This conjunction of symptoms is, I believe, established by nature; for it has at alltimes, and in all places, been found in differentindividuals. It is the character of all Headachs:and perhaps the term Cephalalgia has from Hippocrates downwards been given to all Headachs.Indeed I am mistaken, if Cephalalgia was notamong the Greeks, as Headach is among us, notonly a popular word, but also a scientifical term:for if Headachs be recent, or of short duration,we are told by Aretaeus that no other name thanCephalalgia was given to them: but if they be oflong duration, although not violent, or if they return periodically, and be daily worse, every succeeding paroxysm surpassing in violence thatimmediately preceding it, that they were distinguished bythe technical term Cephalaea. Galen,who flourished at Rome, in the reign of the Emperor Commodus, and was, Morgagni says, * contemporary with the grammarian Julius Pollux,also says, that Cephalaea is a Cephalalgia inveterate and of difficult cure. † Therefore, it is clear,not only that the term Cephalalgia was more generally known than Cephalaea in the time ofAretaeus and of Galen; but also that Cephalaeawas then distinguished from Cephalalgia as wenow distinguish a species from a genus, by showing its greater comprehension. If any otherproof of the legitimacy of this inference were

  • De Sedibus et Causis Morborum, &c. Epis. xxxix, § 6.

+ His words are, ἡ λεγομένη κεφαλαία χρόνιὺς τε καὶδύσλυτός ἐστὶ κεφαλαλγία. De Comp. Pharm . secundumLocos. Lib. ii , cap. 2.33necessary, I might observe, that I have not beenable to find the word Cephalaea in any of thosewritings of Hippocrates, which all allow to begenuine, * nor more than once in all those, whichhave been ascribed to him.WeI would restrict the term Headach to a disease, in which, whether the pain be referred tothe integuments of the head, or to some partwithin the cranium, it is of such a nature as Ihave described it to be; that is, it is increasedby the exercise of the intellectual powers.oftener hear an internal pain referred to an external part, than an external pain to an internalpart; the reason of which is, that we are generally unconscious of internal impressions .Impressions on internal parts are, however, feltsometimes, as when volition is troubled by thepassions .The only epithet which Celsus gives to thepain of Headach is intolerable (intolerabilis) , andunless the pain be intolerable (nisi intolerabilisest Dolor) , he says, there is no necessity for theremedies of Headach; meaning, I suppose, thatthere is no Headach. He does not allude to themere degree of the pain; for this, according toAretaeus, as already remarked, is sometimes soslight as to be disregarded by the patient; andaccording to Galen, it is always less than the

  • The following have always, according to Pinel, been regarded as legitimate Works of Hippocrates . " 1. Aphorismi .

"2. Liber Praenotionum 3. Liber primus et tertius Epide-"miornm, 4. De Aere, Locis , et Aquis. " See Pinel'sNosographie Philosophique, ou la method de l'Analyse appliquée a la Médicine.D34pain of cholic, or of tooth-ach. But if Celsusdid allude to the degree of pain, a degree of paincannot be measured: it is not capable of beingexactly doubled, tripled, halved, or of bearingany assignable proportion, as proper quantity is,to another quantity of the same kind: neither isit capable of being measured, except by means ofsome proper quantity related to it, as velocityof motion is by the space passed over in a giventime, which is an example of improper quantity,according to Aristotle. Again, a patient's owncomplaint is no evidence of the degree of pain,which he may be suffering: for some endure verygreat degrees of pain without a murmur, whileothers, scarcely scratched with a pin, shouldseem to be diminishing a torture by their heartrending scowls, grins, and writhings.and I may add, that more complain of Headachthan of any other disease, from a persuasion, Isuppose, that they cannot be convicted of theirdeceit. * Nobody contends that it requires aDemosthenes to feign a Headach.Nay,Neither does Celsus allude to any of thosequalities, heat, cold, acuteness, itching, torpor,or numbness, dullness, lightness, swimming,weight, distension, contraction, &c. any one ofwhich may accompany the sensation of pain, butis a distinct object of consciousness . Celsusdoes indeed notice a numbness and itching,which are one time felt over the whole head, andanother time in a particular part, and a sort of

  • Quis ignorat maximam Illecebram esse peccandi Immunitatis Spem? Cic. pro Mil. § 16.

35coldness of the head, extending to the tip ofthetongue, as signs ofdanger acceding to a Headachof long continuance: but this he does, where hetreats ofthose signs, which are favourable or unfavourable in diseases, not where he treats particularly of Headachs. By using the adjectiveintolerable, and by not affecting to give a logicaldefinition of the pain in Headach, Celsus seemspurposely to leave it for us to find out what thatadjective stands for; and shows, that he knew,as well as we do, that in treating ofthe powersand operations of the mind, and of the body, weare frequently obliged to use words for things,which we cannot logically define, however clearand distinct our notions of them may be. I haveno doubt, that the pain in Headach is peculiar, because the structure affected is peculiar:nor do I admit it as an objection, that the pain isnot always the same, but rather rely on it as aconfirmation of my opinion, there being a varietyof structures within the cranium, all which arepeculiar. Must it not be a peculiar pain, whichso affects our intellectual powers as to obstructentirely our pursuit both of knowledge and happiness? This is the meaning, which I understand, in the adjective intolerable, as it is appliedby Celsus to the pain of Headach. I must notomit, however, to observe, that the intellectualpowers are not so affected in Headach as Burserius asserts: for he asserts, that the patient isstupid. I have never found him so: his sensation has always seemed, to me, to be more acute,

Lib. ii, cap. 8.D 236his perception, as to superficial extension, figure,colour, illumination, and more especially as tothe distance at which objects were from him,more precise, and his reason clearer, prompter,and more correct. I could never detect any lossof memory, or any disability of his mentalpowers, but always thought that, if he had received a liberal education , he could perform amental analysis well, although he could not doso without an aggravation of his symptoms.The pain in the head is often attended with apain and a tension of the neck, both which sometimes cease when a flow of blood from the nosesupervenes; but they sometimes do not go offwith the haemorrhage, and they generally denotedanger. When the pain is deep seated in theback of the head, constantly extending from theforamen magnum down the cervical vertebrae,and there is laboured respiration, impededspeech, difficulty in moving the head, numbnessof the upper part of the chest, or tingling of theskin there, weakness of the arms, and throughthe medium of the great sympathetic nerve, disorders of the thoracic and abdominal viscera,there is , perhaps, sanguineous congestion at thebase of the brain, and for some way down thespine, or some other affection there. But thepain sometimes leaves the head, extends lowdown the spine, and is then often mistaken forrheumatism: but numbness of the lower extremities soon following, shows, that there is somedisorder of the spinal nerves.The pulse at the wrist being unaltered inHeadach, or being less frequent, is accounted37for by the action of the heart not depending uponthe brain. The action of the heart is, however,occasionally rendered more frequent, throughthe medium of the brain, by the passions: andit is so, perhaps, for some seconds, when a Headach suddenly begins, although in this case, thepulsations of the radial artery are never so frequent as those of the heart. To the slowness ofthe circulation may, perhaps, be attributed the.polypi which Lieutaud found after Headach. * Iknow, that a Headach is , sometimes attendedwith a fever, at least with a more frequent pulse,and a white tongue: but I regard this as accedent, and not at all as essential . It begins during the Headach, and it ends long before it ends .It has no regular exacerbations or remissions. Itis a febricula, depending, perhaps, on an affection of the vasa vasorum of the arteries.2The respiration in Headach generally corresponds with the pulse; so that if there be fewerrespirations in a minute, there are fewer pulsa+tions . But I have known the respiration to bedisordered in a Headach, and the patient to bedisturbed with horrible dreams, the pain in hishead extending all down his cervical vertebrae,and even to his shoulders and his axillae .་ {We suppose that, during one respiration,there are about four pulsations. On an average,we make 20 respirations in a minute; and therefore 28,800 in 24 hours . Dr. Menzies made experiments on a man, who breathed 14 times onlyin a minute and Landre- Beauvais says, that a

  • Hist. Anat. Med. Obs. 482.

38man at Paris had a pulse, which never exceeded24 or 25 in a minute. * But if the blood continueto undergo that destined change, which dependsupon the atmosphere rushing into the lungs during inspiration, how are the chilliness or thecoldness of the extremities in the exacerbationsof Headach to be accounted for? Dr. Parrywould refer it to a disturbance of the balance ofcirculation, as if when there is an excessive determination of blood to the head, less is sent tothe lower extremities: but as I do not believe,that there is any determination of blood to thehead in Headach, I would rather refer it to a disturbance of the vital powers. There is certainlyno determination of blood to the head in syncopeand in concussion of the brain, in both which theextremities are very cold . Besides, Mr. Brodieand Mons. Chossat have shown that poisons,which impair the vigour of the nervous system,diminish the temperature; † and Dr. WilsonPhilip, that lessening the extent of the nervoussystem, by destroying part of the spinal marrow,does the same; so that animal heat does notdepend entirely upon respiration, but in partupon the nervous system. When, however, thecirculation is languid, the temperature is alwaysdiminished.Thus then, if the symptoms, on which I havefixed, constitute a Headach; if, in other words,

Séméiotique, &c. §. 56.+ Philosophical Transactions for 1810 and 1812An experimental Inquiry into the Laws of the Vital Functions. Edit. 2. page 161.K39they be never absent, when a Headach is present,to distinguish a Headach from other diseases ofthe head, presupposes nothing more than aknowledge of these other diseases. Sauvagesenumerates twenty-seven diseases of the head, *besides Cephalalgia, Cephalaea, and Hemicrania; so that, if a disease be a Headach, it cannotbe one of that twenty- seven.Many wish for positive and direct evidence,where, it seems, no other than that obtained bythe method of exclusion is to be had and yetthey acknowledge, that this method seldom failsto assist in forming a right judgment; and whatis more, in leading to a just prognosis. Now,to inquire into the evidence of decisions in thosesciences, which have absolute truth for their object, and in those sciences which have conditional or hypothetical truth, would draw meinto a digression very unsuitable to my presentscheme, and to that point of view, in which Iconsider it but I cannot help avowing, that themethod of exclusion seems to me to be the onlyone, which ought to be employed in medicine.It is the method adopted by Morgagni from thebeginning to the end of his stupendous and invaluable work, de Sedibus et Causis Morborum.tAnd is it possible that there can be a better wayof obtaining general truths in the sciences of factand experience, than by observing and examining particulars, by rejections, and exclusions, or

  • See the Prolegomena to his Nos. Method. § . 49, &c.

Also his Methodus Anatomica Morborum.+ See more particularly his Epist. xxxix, § . 16, 17, 18, &c ,40by analysis, so as to separate and decomposenature? If any one do seriously believe thatthere is a better way, let him once more, andwith greater attention peruse the 15th, 16th, 17th,and 18th Aphorisms, in the second Book of theNovum Organon Scientiarum of the immortalBacon; and let him peruse Sir Isaac Newton'sLetter, concerning his Theory of Light and Colours, to Mr. Oldenburgh; * and the " Opusculesde feu G. L. Le Sage relatifs a la Méthode, " whichare annexed to Pierre Prevost's " Essais de Philosophie, ou Etude de l ' Esprit Humain. "I shall now proceed to tell, what a Headachis not. And I shall not err, I am persuaded, ifI maintain, that the division of Headachs intoexternal and internal, is most unphilosophical.For to give the name of Headach to a disease ofthe integuments of the head, which neither differfrom the integuments of other parts, nor, whendisordered, require different means of cure, whatis it, but to confound things most distinct andsimple in themselves? I am convinced, thatevery texture of the body, has its own propersymptoms, its own proper pain, &c.But although external Headachs, as they arecalled, are not, in my opinion, properly includedin the extension ofthe term Headach, yet it maynot be amiss to consider a little by what signsthey have been said to be distinguished . †

      • Horsley's edition of Sir Isaac Newton's Works, Vol. iv,

page 320.+ Externas affici Partes cognoscimus, si Capilli quasi rigent, et Dolor solo eorum Attactu, aut Cutis Compressione41B3One sign is, if the pain be attended with anerection of the hair of the head, as of bristles,which being merely touched, and more especiallyturned the wrong way, the pain is increased.But this is an ambiguous sign: for it may depend not only upon a disease begun in the integuments of the head, but also upon the integuments of the head having sympathised with somepart, in a state of disease, either within the cranium, as the dura mater, or in some remote partof the body. Besides, a part may be in painfrom its sympathising, without being tenderwhen pressed; and it may be tender to the touch,and even diseased because it has sympathised.Sydenham observes, that the pains, which affectthe external parts of hysterical patients leave theparts, they had affected, as tender to the touch,as if they had been well cudgelled: and Heberden, that the pain of a Headach will sometimesleave a soreness of the integuments of the headfor a day.Nor should it be omitted, that a disease within the cranium, and even death, are sometimesthe consequence of a disease in the integuments ofthe head, as of a carbuncle, or erysipelas, fromthe removal of a small encysted tumour, &c.there being a free communication by vessels between the outside and the inside of the cranium,not only at its sutures, but also in every otherextrinsecus facta intenditur; si Rubor aut Tumor aliquisOculis pateat, Functionibus interim Cerebri nihil, aut parumomnino laesis. Contra ejus Sedem intra Calvariam esse indicant contrariæ Notæ: in primis tunc, cum dolore mens stupet,&c. Burserius Inst. Med. Prac. Vol. iii .p. 13.42part, because there are foramina in every otherpart of it.Another sign is, if there be any redness ortumour on the scalp . But if the scalp shall havebecome inflamed, by sympathising; or if stimulant and rubefacient liniments shall have beenemployed for a pain depending upon a diseasewithin the cranium, inflammation in the integuments can be no better sign than the former.4A third sign that the pain, as well as theproximate cause of it, is seated in the integumentsof the head, is said to be an obscure redness ofthe skin, together with a suffusion of the eye.Galen, who divides Headachs into external andinternal, distinguishes the latter by the paindarting to the roots of the eyes, because, he says,the sclerotic coat of the eye is a continuation ofthe dura mater. And, considering that the duramater extends into the orbit, or is continuous withthe periosteum lining it, so that when, on the onehand, the dura mater is inflamed, the eye is redand irritable; and that when, on the other hand,an injury has been done to the orbit, suppurationof the dura mater sometimes follows it, I am ofGalen's opinion. Besides, the origin of the ophthalmic artery being within the cranium, and itscourse into the orbit, would lead one to think aninflammation ofthe eye denotes a disease withinthe cranium. Then Lomminus pronounces an inflammation of the eyes to be a bad symptom inHeadach, which it can scarcely be, if there be nodisease, except that of the integuments. Again,Whytt and Quin mention an ophthalmia as occurring in the third stage of dropsy of the brain.43And lastly, the two first cases of Headachnoticed by Morgagni, in his first Epistle, and thatin the sixth Section of his twenty-fifth Epistle,were attended with a suffusion of the eyes, andan increased flow of tears, and they could nothave been external Headachs.666666A fourth sign is noticed by Sir Gilbert Blanethus: " There are many cases of Headach depending on indigestion, and the seat of theseseems to be the integuments, as there is generally in such cases a tenderness to the externaltouch. " Now, with all due deference to thislearned and able Physician, if indigestion precede a pain in the head, is it not more likely thatthe brain should sympathise with the stomach,by means ofthe eigthth pair of nerves, than thatthe integuments ofthe head should do so? I donot mean to deny, that the skin of the head maysympathise with the mucous membrane of thestomach: but as there can be no doubt that someof the extremities of the pneumo- gastric nervesterminate in the papillae of this membrane, ifthere be a pain in the anterior part of the head, affecting more particularly one eye-ball, subsequentto indigestion, there is often no concomitant tenderness of the skin of the head; never, I believe, till the pain has continued long, or hasbeen frequently felt there at short intervals.A fifth sign of an external pain in the head,mentioned by Dolaeus, is a falling off of thehair. * I know no other author who takes notice

  • Si exterius oritur Dolor, quando scilicet Vitium non in

ipsa Penetralia descendit, sed tantum intercus est, tunc Capilli ut Folia Tempore autumnali decidunt. Ency. Med.Theoretico-pract.44of this sign; nor did I ever see it in a pain ofthe head, nor except in the Area of Celsus, thePorrigo of Willan and Bateman, in the progressof Consumption, and as a consequence of somefevers.. >3So much for the signs of an external Headach. I proceed next to notice some of the painsin the integuments ofthe head, which are improperly called Headachs. These pains are suchas occupy one half only of the head, extending no farther from the hairy scalp than an imaginary line, dividing perpendicularly the noseinto two equal parts. Dr. Heberden has heardof a hemicrania oftener on the left side, than onthe right; but does not know how it differs fromother pains in the head, except in the circ*mstance which its name denotes; and thereforebelieves its occurrence on the one side, or on theother, to be merely accidental, Aretaeus certainly thought it accidental; for he first called itHeterocrania. But allowing, that the right hemisphere of the brain is the larger, that the rightcarotid artery, and the right subclavian are theshorter, and that the right side of the body ispossessed of more vigour in its functions than theleft side, as Petit shows that some have believed, * I do not see, that these circ*mstancesthrow any light on the question.1Celsus does not use either of the words, Hemicrania and Heterocrania; but says, that allHeadachs, at one time, affect the whole head,

  • Petri Petiti Comment et Animad. in prim. Aretaei Cappad. Libr. de Morb. diuturn . p. 176..

45at another, a portion of it, and sometimes sothat their pain extends to that part of the facewhich is next the mouth. The pain must, therefore, be in the head, and extend to the face.Caelius Aurelianus, who lived at Sica, a town inNumidia, in Africa, in the fifth century, as Reinesius and Saxius conjecture, says, that when avehement pain is of half the head, it is called bythe usual name Hemicrania; but that when thepain is of the temple at least, or extends no farther from the hairy scalp than to the temple, it iscalled Crotaphos . * He would not have called ita Headach, if the pain did not extend from thehead, or if it were confined to the temple.But it is not certain that Celsus or Caeliusconsider Hemicrania as an external Headach.Aretaeus describes it as a Cephalaea; and Morgagni, who does not object to the division ofHeadachs into external and internal, expresslycalls Ramazini's Headach an internal Hemicrania.However, why one half only of the head shouldbe in pain, whether the cause of it be external

  • His words are: Sequitur in Passione constitutos Dolor

vehemens Capitis totius, aut dimidii, quem consueto nomineHemicraniam vocant, vel certe Temporum, quem DoloremCrotaphon appellant. Morb. chronicor. Lib. i. cap. 1. OfCaelius it has very justly been said , Stilus redolet Patriam:but Theod. Janss ab Almeloveen gives this reason for hispreference of Temporum to Temporis in the above quotation:"κpórapoi, Haec Tempora, singulare non habent. " LexiconCaelianum. Could the learned Editor have forgotten that theMedicorum Cicero uses the singular number for one of theTemples? At Facies Suturam habet maximam, quæ a Tempore incipiens per medios Oculos, Naresque transversa pervenit ad alterum Tempus. Lib. viii . cap. 1 .46or internal, I can no more tell, than I can why aprofuse perspiration, or a jaundice, should sometimes be confined to one half ofthe body, dividedby the medium line, cases of which are recordedby credible authors. And, perhaps, no morecan be said of such facts as these, that a pain ismore frequently on the right side of the head,when there is a disease of the right mamma, ofthe right lobe of the liver, of the right kidney, orof the right ovarium; and that a pain is ofteneron the left side of the head, when there is a disease of the left mamma, of the left lobe of theliver, of the spleen, ofthe left kidney, or oftheleft ovarium, &c. than that they have been forcedon the mind by the lessons of experience.I shall speak more particularly of sympathy,when I shall have come to the division ofHeadachs,First, there is a Hemicrania or a Heterocrania, which is periodical, returning everymorning, at sun-rise, arriving at its heighth bynoon, and remitting and ceasing about sun-set.This seldom lasts beyond the fourteenth day.But it may return every evening, or every night,and observe the same times: this, however, isvery rare. A Hemicrania may also return at thesame hour every other day, or every eighth day:hence it has been considered as a topical intermittent, or a febris larvata, and has been curedby the Peruvian bark. But I cannot consider anintermittent as a fever, and the paroxysm of apure intermittent as an example, model, orepitome of all fevers . I know no reason, thatan intermittent should not occupy the integuments of one half the head, as well as those of.47one arm, without affecting the rest of the body;the cold stage, the hot stage, and the sweatingstage, being as fully and distinctly marked, although in a part, as if the whole body sufferedthem.The reader may recollect, that Sydenhamdetected an intermittent under the mask of anapoplexy, by the redness of the patient's urine,and by its depositing a lateritious sediment: sothat after waiting till its mask had fallen off, heattacked the intermittent with Peruvian bark,and so overcame it.Secondly, another Hemicrania, which mayreturn, and be periodical, is a Neuralgia, or Ticdouloureux. The Baron Van Swieten mentionssome cases of it, but does not expressly callthem cases of Hemicrania. He relates, that aNobleman consulted him for a pain in one side ofhis head, which returned every day at the samehour, raged for eight hours, and then graduallyceased. The Nobleman pointed out the part,where the pain began, which was at the supraorbital Foramen of the Os Frontis, from whenceit extended over the whole half of the head, onthe same side . While the pain lasted, there wasno alteration ofthe pulse at the wrist; and theNobleman was well in every other respect. * Iwould say, that he had an orbito-frontal neuralgia,together with a topical intermittent, and that theformer was modified by the latter. † How he

Comment. in Boerhaavii Aph. §. 757.+ Ou a vu des Céphalalgies, la Cophose, l ' Odontalgie, deConvulsions hystériques, une Hémoptysie, la Ménorrhagie,48came by the predisposition to Neuralgia, it isimpossible to tell. When Tic douloureux is exactly periodical, and returns without any evidentcause, it is always, I suspect, complicated withan intermittentIf the integuments of the head have beencontused in a certain point, and compression ofthat point excite a disagreeable sensation there,and sometimes convulsions, more especially ifthe pain extend and follow the branches of somenerve of the fifth pair, there can be no doubt, thatthe disease is Tic douloureux. Compression isnot always necessary to occasion it; a breath ofair is sometimes sufficient. I have known Ticdouloureux follow a blow on one of the temples,and the pain to follow the divisions of the temporal artery.Tic douloureux is seldom to be traced to theinjury of a nerve; neither are all nerves , equallysusceptible ofit . Indeed the causes which predispose any nerve to it, are not clearly ascertained,for it may affect other nerves, as well as thebranches ofthe fifth pair, although it oftenest affects the superior maxillary nerve, or secondbranch of the fifth pair. But sensation in theinteguments of the head must depend upon thefifth pair of nerves, or upon the tenth, whichsupplies those parts, to which the branches ofthefifth do not extend . Whatever nerve is thela Fièvre, etc. dénaturer entièrement les Charactères decette Maladie ( Néuralgie) et lui donner les apparencesd'une affection hystérique, d' un Rhumatisme, ou de quelqueLésion organique grave. Delpech, Précis Elémentaire deMaladies reputées Chirurgicales . Tome iii, p. 207.49subject ofTic douloureux, there is no visible alteration of it; neither is any increase of heat andof vascularity necessary to the attack of Ticdouloureux, although they are frequently consequences of it. But whatever may be thecondition of any cranial or spinal nerve, uponwhich its predisposition to this disease depends,that condition seems to be increased by a weakand irritable state ofthe system; so that, till thisis removed, neither topical applications, nor thedivision of the nerve is always of any utility;and when it is removed, the disease seems tocease spontaneously. It is in confirmation ofthis,that the carbonate of iron, cinchona, sulphateof quinina, an extensive cuticular eruption, &c.have all been found so effectual in removing thisdisease; and that disorders of the digestive organs, the depressing passions, the abuse of fermented liquors, and the irritation of some nerveat a distance, so powerful in occasioning it.It may astonish some, who are not medicalmen, that the occasional cause of a pain in theinteguments ofthe head, or of the face has beenfound in the great toe: but there is nothing remarkable in it. Tulpius cured a Headach, whichalternated with a pain in the great toe, byapplying a cupping glass to it. * Dr. Short cured anepilepsy by extracting a hard cartilaginous substance about the size of a pea from the leg at thelower end of the gastrocnemii muscles, wherethe disease had always begun: † and the Editor

  • Obs. Med. Lib. i. сар. 33.

† Medical Essays and Observations by a Society in Edinburgh. Vol. iv. p. 416.E506666of the Medico- Chirurgical Review states, that" in a conversation which he lately had with SirHenry Halford, on the subject of this complaint, that experienced Physician mentioned" several remarkable cases, many of them inhigh life, where it ultimately turned out, that" some bone was diseased and kept up this sym6666 pathetic irritation in the fifth pair of nerves.—" One of them, was that of an officer, who had" lost a limb, and had afterwards become affect-" ed with neuralgia facialis , on which nothingcould make an impression. At length, a piece" of bone exfoliated from the stump, and theneuralgia disappeared.66Mr. Wardrop has related the case of a woundin a gentleman's thumb, which readily healed byadhesion, and the cicatrix seemed perfectly natural; but the patient still complained of pain init, and in the fore finger, and the radial side ofthe middle finger, which extended up the arm,and as far as the neck and side . He divided theinjured nerve, all the symptoms abated, and thethumb remained numb: but even now, whenfrom any cause the gentleman's stomach is disordered, he feels a pain in his thumb. †I have known the head affected with a painin a single point, by consequence of a blow on it,which pain extended around that point, and wasthe less the farther from it, but was for twelvemonths afterwards renewed by disorders of thestomach, as after a debauch; perhaps all painful affections of the nerves of the integuments ofthe head and face, are cases of Tic douloureux.

  • Medico- chirurgical Review for June 1822. p. 177.

+ Medico-chirurgical Transactions . Vol. xii . p. 205.151Thirdly. When the external table of theskull has been fractured, if there be any fragments of bone detached and unconnected withthe soft parts, they ought to be removed: but ifthey be attached to the soft parts, they ought notto be renewed, but to be replaced, and coveredcarefully by the integuments drawn smoothlyover them. This it is necessary to remember,because, when the pain in a Headach is fixed toa spot in the head, and returns always to thesame spot, it may be known to depend upon adiseased state of the external table of the skullby its being increased, and by its being renewed,during an intermission of Headach, by pressureofthe integuments over it . But pain, a symptomof Headach, always returns to the same spot,when the internal table of the skull is diseased;and in this case, pressure of the integuments ofthe head, neither increases, nor renews the pains .It may, however, be known to depend upon adiseased state of the internal table of the skull,"by making the patient hold his breath for a fewseconds, and, during those few seconds, use anyeffort for then, the blood vessels of the brainbeing distended, the dura mater and cranium arecompressed by the brain.After a fall or a blow on the head, there issometimes a pain in one half of it, which soonceases, whether the means of preventing and ofcuring inflammation have been employed or not:but the integuments of the head remain tender,and are at times affected with lancinating pains,so that the disease is called an external Headach,and is very little regarded, till months, perhaps,$E 252afterwards, when symptoms of inflammation ofthe brain supervene, the patient dies, and anencysted abscess is found in his brain, with inflammation of the cerebral substance surroundingit. It should seem, in such cases, that the abscess is the termination of a chronic inflammationunattended with alarming symptoms, such symptoms as there may have been, ceasing as soonas the abscess is formed; but that the supervening inflammation of the cerebral substance surrounding the abscess, which destroys the patient,is not chronic, but acute. Here an inflammationof the brain is mistaken for an external Headach.-Mons. Lallemand remarks, that patients seldom die of chronic change of structure, becausethe symptoms of them disappear, but of acuteinflammation, or hæmorrhage in their vicinity.Fourthly. A pain of one side of the head isvery common to those, who during the winter,sit always on the same side of the fire, and sorender the integuments of one side more tenderthan those of the other. This pain may, however,be occasioned by exposing the feet, and I thinkthe hands, to cold, the membranes of the headbeing then affected by them, as they are by thetorpor and coldness of a dying tooth, by the debility of the stomach after drunkenness, &c. andthe pain recurs periodically like an intermittent.The cutting of a dens sapientiæ, late in life, wasattended with a pain affecting the cheek, the eye,the temple, and all the corresponding side ofthehead, and assumed a quartan type, which yieldedto no medicine, but ceased as soon as the gumwas lanced.53The first or second dens molaris of the underjaw, ifdecaying, may occasion a pain of the headon the same side, which pain, if it be most violent about the middle of the parietal bone, is thatusually called clavus hystericus.When a pain in the integuments on eitherside ofthe head is traced to a carious dens molaris , in a person, who has not yet arrived at theadult age, he has generally a bad constitution,and weak lungs.Fifthly. Persons overheated and perspiringfreely from exercise, or from any other cause,and persons not overheated, if they suddenlyexpose one side of their head to the north-eastwind from a window, or while riding in a carriage, with one or both ofthe side windows down,are often seized with a paralysis of the musclesof their face on that side, which by consequenceloses its expression, so that in smiling, laughing,crying, coughing, sneezing, &c. a ludicrous appearance is given to their countenance. An abscess or tumour behind the angle of the jaw, compressing the portio dura of the seventh pair ofnerves, often does the same. So does a division of the portio dura after its emergence fromthe stylo-mastoid foramen . And as the orbicularis palpebrarum and the corrugator superciliimuscles receive the superior branches of the portio dura, so when these branches are divided, orare no longer capable of controuling these muscles, neither the eye can be closed, nor the eyebrow knitted, so that the eye remaining uncovered by night, as well as by day, is consequentlyexposed to light, dust, &c. and inflammation,54opacity of the cornea, and loss of sight generallyfollow. Sometimes an inflammation in the ear,and a discharge from it precede the paralysis ofthe face, and during this inflammation, there isa pain in the integuments of the same side of thehead. This partial pain alarms the patient, whoattributes it to an affection of the brain: but thesensibility of the palsied cheek remains, and theactions depending on the fifth pair of nerves areall perfect. *Sixthly. An exostosis on the cranium, fromwhatever cause arising, may occasion a pain onone side of the head, which, if the exostosis bevenereal, is felt most during the night, and isdull and obtuse. But when a circ*mscribed tumour is formed, the pain is no longer extendedover half the head, but is confined to the exostosis , or node. So while a node is forming on thetibia, near the insertion ofthe sartorius and gracilis muscles, the whole tibia is in pain.All tumours on the head may be attended withpain of one whole half of it; but encysted tumours there are often without any pain.An exostisis from scrophula is more to besuspected in young persons, than in those whosegrowth is completed .Seventhly. A pain in half of the head hasbeen traced to some disease of a cavity connectedwith the nostrils: the antrum Highmori, whichis lined with a membrane less vascular than theSneiderian, has been inflamed and suppurated,has contained an hydatid, or has been the seat .

  • Medico- chirurgical Transactions, Vol. xii, p. 110.

55of cancer; and in all these affections, one side ofthe head has been in pain. And suppose aninsect, or any foreign body to be in one of thefrontal sinuses. Examples are not wanting ofinsects nestling there, and even of lumbrici coming thence, which had occasioned a vehementhemicrania for twelve months, when they wereat length dislodged . It is easy to conceive howminute eggs may be drawn into the frontal, ethmoidal, and sphenoidal sinuses, while a personinhales the odor of flowers, or when flies are attracted to his eyes or to his nose by mucous, purulent, or putrid discharges. It may not be improper to enumerate the chief of the signs ofthings in one of the frontal sinuses: the mostconstant of these are a fixed pain at the bottomof the forehead, and at the root of the nose, aspastic contraction of the eye-lid, a red and watery eye, sneezing, dryness of the mucous membrane of the nostril on the same side, perhaps adisagreeable smell from it, restlessness and sometimes giddiness, and convulsions or delirium.Sheep so affected run and roll themselves uponthe ground. These symptoms are not to bewondered at, since the membrane lining the sinuses and the nostrils is supplied with nervesfrom the fifth pair as well as from the first butthese symptoms are plainly not the symptoms ofHeadach and were I told by a patient that hehad a Headach, while I saw him rolling about,and heard him complaining aloud, I should notbelieve him.Eighthly. There is sometimes a pain on oneside of the head, when the eye of the same sideis inflamed.56Perhaps the inflammation of only the TunicaConjunctiva which is a mucous membrane, isnever the occasion of pain in the head. Indeed,the inflammation of it is justly observed to partake more of venous than of arterial action. Itsarteries however, as well as those of the Sclerotica come from the ophthalmic artery; and itsnerves, although too fine to be seen, are probably from the fifth pair, and from the portio duraof the seventh pair.The sclerotica is generally inflamed by consequence of the conjunctiva being so: but thesclerotica is sometimes inflamed, when the conjunctiva, the cornea, and the iris do not seemto be so.If the sclerotic coat be inflamed, its propervessels are enlarged and may be seen running inconverging lines from the beginning ofthe visiblehemisphere ofthe eye-ball to the circumferenceofthe cornea, and not passing over it, but forming a dark coloured, vascular, and prominentzone around it. This is generally attended witha dull pain of exactly half of the head, like thepain of fibrous membranes; and rheumatic painsoften attend it, or alternate with it. In the beginning of this ophthalmia, the pain is chiefly inthe head, but is most severe in the temple. Thepain is constant, but remittent, the paroxysmbeginning at four, six, or eight o'clock in theevening, arriving at its acme by midnight, and atit* paracme towards morning. The patient complains of fulness and distension rather than ofpain in the eye-ball: and Mr. Wardrop says,his eye bears the light, which it does not do in57most other inflammations of it; but Dr. Vetchsays, intolerance of light attends it.When the choroid coat and the iris are inflamed, there is a whitish circle round the cornea,and the anterior ciliary arteries are chiefly affected. The pupil is contracted, square, oblong,rhomboidal, or polygonal; and lymph is deposited upon the iris , but seldom upon its ciliaryborder. The humours ofthe eye are dull, themotions of the pupil are slow and limited, thereis impatience of light, and dimness of sight . Inthis case, the hemicrania sometimes comes on inthe morning, and the eye is not in so much painas the head.When the retina is inflamed, the predominantsymptom is a sudden vehement pain extendingfrom the bottom of the eye-ball to the occiput, orin the reverse direction, and there is the supervention within a few hours of total blindness.In some cases, inflammation of the choroid coatattends, when the pupil is motionless, and thereis a livid red hue of the sclerotic coat around thecornea. The pain is attended with an alarmingkind of confusion, as if the patient were about tolose his intellects .Hemicrania generally precedes amaurosis;and generally ceases, when the amaurosis iscomplete. *An Aneurism by Anastomosis in the orbit wasattended in Frances Stoffel's case, with Hemicrania ofthe same side, a constant noise in the head,resembling that of a pair of bellows, and a cold

A Synopsis ofthe Diseases of the Eye, &c. , by Benjamin Travers, Surgeon to St. Thomas's Hospital.58obtuse pain at the crown of the head shootingoccasionally across the forehead and temples. *66Ninthly. There is often a pain in the integuments on one side of the head , when a foreignbody, an insect, a pea, a stone, a roll of paper,&c. is lodged in the meatus auditorius externus.Du Verney relates an instance of this from Fabricius Hildanus: " A young girl, twelve yearsold, having by chance let a glass ball enter" into the hole of her left ear, which could not" be extracted by any means, was seized with" acute pains, which were communicated to the" same side of the head. These pains, after along space of time, produced a numbness in" the arm and hand, afterwards in the thigh andleg, and at last in all the left side . This" numbness was accompanied with very greatpains, which increased in the night, and in" cold and wet weather, with an irregularity in" her menses, with epileptic fits , and with an" emaciation of her left arm. F. Hildanus,6666666666 eight years afterwards, extracted the glassball, and then all the symptoms ceased, to" which all the other remedies which were used" for so long a time, could not give the least" relief. "†All the cases of pain in the ear, and in theinteguments of the head do not end so favourably; for where the endeavours to extract a foreign body from the ear have forced it farther in,

  • Medico- chirurgical Transactions. Vol. ii . p. 1.

+ A Treatise of the Organ of Hearing, &c . , by Mons. DuVerney. English Translation . p. 101 .59´a very violent pain has ensued, and death; afterwhich a caries of the petrous portion of the temporal bone has been found, and an abscess nextit, communicating with the tympanum.Inflammation in the meatus externus, whether occasioned by external violence, the extension of some cutaneous eruption, a cold, a fever,is very apt to extend to the internal ear, inducingcaries of the bones and deafness, or fatal affections of the brain itself; and it is in almost allcases attended with a pain on the same side ofthe head.The lining of the meatus auditorius externusis, perhaps, not a mucous membrane, * strictlyspeaking: but, whatever it is, it is possessed ofgreat sensibility, as is every membrane so nearto bone. Its nerves are from the superficialbranch of the inferior maxillary, and from thesecond cervical pair, as well as from the portiodura of the seventh pair.A discharge from the ear is generally an attendant on inflammation of the membrane liningthe meatus externus. Mons. Lallemand has,however, seen cases of it, without any such discharge, but with a dull pain in the internal ear,and other symptoms, such as a depraved taste,nausea, and sometimes vomiting.Whena pain in the ear is attended with a discharge from it, or is followed by a discharge fromit, whether there be herpetic ulceration of themeatus externus, or suppuration of the tympa-

Bichât, Anatomie Generale. Tome iv. p. 429.Bichât, Anatomie Descriptive. Tome ii. p. 483.60num, there is often a pain in the integuments ofthe head onthe same side; and if the dischargestop suddenly, or be stopped by medicamenta exsiccantia, we are told, that the patient, whetherinfant or adult, is rendered somewhat deaf, orthe discharge being turned inwards, falls into convulsive and epileptic fits; and, therefore, that weshould be contented with merely keeping theparts clean by washing them with tepid water.Mr. Saunders declares, on the contrary, that ifthe discharge be from the meatus externus, medicamenta exsiccantia are the only medicineswhich ought to be employed, and that they willnot turn the disease inwards to the brain, butwill cure it, and prevent deafness: he maintainsalso, with respect to suppuration of the tympanum, that the parts affected are too essential toperfect hearing to be neglected; and he provesby the event of cases, that they may be healedwithout detriment to the constitution . He reasons on the subject thus: " the brain can only" be injured by the exposure and ulceration of" the dura mater, and the application of sub- 66 stances capable of destroying the bone and" dura mater can only be an act of madness, orignorance. Injury of the brain is more likely" to result from the continuance of the disease," than the judicious interference of art. For the" puriform discharge naturally advances to ul- 86 ceration, and ulceration to denudation and" caries ofthe bone, and separation of the chain" ofbones. A caries of the tympanum is there-" fore ultimately produced. But this will de- 66 stroy the bone, and expose the dura mater:616666“ and if it were not for that principle, by whichmembranes that line cavities thicken as theneighbouring parts are ulcerating, and thuspreserve their integrity, the brain would, perhaps, always suffer in the ultimate stage of thepuriform discharge from the tympanum. "*66(666Although an inflammation of the ear oftenoccasions a caries of the bones, and extends tothe membranes of the brain, and to the brain itself; yet an inflammation of the brain seldomextends to the temporal bone, so as to make anopening into the ear. The instance of a livingtumour in the brain, or in the pia mater makingits way to the skin without the formation of anabscess was seen by John Hunter in a Highlandsoldier, in the Dutch service .† However, according to M. Lallemand, chronic inflammationof the brain is far more frequent from caries ofthe temporal bone than of any other composingthe cranium .Whenever there is a pain in the head, and aparalysis ofany of the muscles of the face, as thisdepends upon an affection of the portio dura,whether there be any discharge or not from theear, it should be carefully examined, For ifthe portio dura be affected in its course throughthe temporal bone, the affection of it may beextended to the cerebellum. Ofthis an instanceis given by Mr. Shaw, who tells us, besides,Saunders on the Anatomy and Diseases of the Ear.Edit. 8vo. 1817.+ATreatise on the Blood, Inflammation, &c. p. 455.Medico-chirurgical Transactions. Vol. xii. p. 124.62what it is very useful to remember, that theremay be a paralytic affection of the face, and adisease of the brain co-existent, and unconnectedwith each other, although from the same cause,for example, a fall on the head.Tenthly. A pain in one half of the head issometimes from pus collected either under thetemporal muscle, so that the patient cannot openhis mouth, or under the occipito-frontal, fromwhence it may make its way to a considerableextent.63CHAPTER III.SYMPTOMS OF HEADACH.I MAY now be expected to give a generaldescription of Headach, properly so called: buthow few are they who have not had a Headach?or who do not think that they have had it? andwho, in reading what I could write, would notoften exclaim, I knew this before? The generaldescription ofany disease is founded in particularhistories of it, written by those, who often hadit before their eyes, while their mind was yetwarm with the contemplation of it. * The general description of a disease is, therefore , not aminute specification of all its symptoms, but aselection of only such as are most constant, moststriking, and most resembling, in a number ofindividuals labouring under it . It is, as it were,

  • Historia proprie Individuorum est, quæ circ*mscribuntur

Loco et Tempore. Bacon, de Augm. Scientiar. Lib. ii . cap. 1 .+ Hence Huxham says, "I begin with a description of the"slow nervous Fever, which hath been very exactly taken"from too many who have fallen victims to this insidious"and dangerous enemy." An Essay on Fevers, &c. SixthEdition. p. 74.64an outline, drawn byan artist, the effect ofwhichon those, who examine it, is the more lively andexpressive, the more qualified they are to fill itup. * The general description of a disease has norelation to time, or place, or patient: the historyof a disease has a relation to time, and place,and patient.An abridgement of the description of any disease is, as it were, a definition of it; and anabridgement of the definition of any disease is, asit were, a general term.All this I should have omitted, if it had notbeen for Maittaire's Eulogy of Aretaeus, † fromwhich it may be inferred, that his writings consist in part of histories. The truth is, that Aretaeus gives the history of no disease: but he

Quelque Degré d'Instruction est requis pour parvenir ála connoissance de la Vérité. Et certaines Vérités supposentbeaucoup de connoisances acquises. Essais de Philosophie&c. , par Pierre Prevost. Tome ii . p. 125.+ Prefixed to Maittaire's Commentary on the Dialect ofAretaeus, is his Letter to Dr. Freind, in which he says " Quis" enim Author Editorem doctum meretur magis ac requirit," quám qui summam peritiam cum exculta dictionis elegantia"conjungit; rerumque, quas tractat, copiam ea verborum"brevitate complectitur, ut neque illa taedium, nec haec ob-"scuritatem pariat. Limatum est Aretaei in vocibus deli-"gendis judicium, egregia Ars in componendis; tam mira" demum in tradendis morborum naturis accuratio, ut credas" illum non tam scripsisse, quam pinxisse; imò potiùs Ae-"grotos ipsos tibi vivos corám cernendos admovisse; ut vide-" aris non legere aut inani pictura oculos pascere, sed miser-"rimis illis decumbentibus interesse, varios illorum labores" intueri, clamores, gemitus, et suspiria audire; ut sentias te' pro diversis malorum, quibuscum conflictantur, generibus," horrore concuti, et misericordia commoveri. " p. 509.65scarcely omits any symptom that has ever occurred in a disease; and in this is one of his excellencies. As for philosophical investigation , hecontains scarcely any, which, if he had writtenhistories, would probably have found a place inthem, because philosophy is generally, if not always necessary in a historical narrative. Had Aretaeus been acquainted with the different textures,which enter into the composition of our organs,and with the symptoms belonging exclusively toevery texture, how lucid an order, and how enchanting a vivacity might he have imparted to hisdetails? But the fulness of his descriptions isone only of his excellencies: another is his omission of scarcely any circ*mstance, which maycontribute to a patient's comfort and recovery.His particularity, in this respect, surpasses, Ibelieve, that of any preceding, and of any succeeding writer. Caelius Aurelianus, althoughcommendable, in this way, is vastly inferior toAretaeus. Then, the choice of Aretaeus's words,the turn of his expressions, the perspicuity, thebrevity, the art to conceal his art; -but I willnot aspire to blazon the fame of Aretaeus.Instead of a description of Headach then, Ishall make a short comment on those signs onlyofCephalaea, which are selected by Celsus: andI shall follow the order, in which he has placedthem; because to distinguish Cephalaea fromother Headachs presupposes a knowledge of itssymptoms separately considered . For it is asimpossible to tell what a combination of symptoms means, unless the signification of the symptoms composing it be known, as what a sentenceF66means, unless the signification of the words composing it be known. But there is another advantage derived from a thorough knowledge of symptoms, which is, that it enables one to discoverwhat symptoms are compatible with one another,which it is often very necessary to do on occasions, which I shall not here name. The intellectual analysis of a disease is the seeing of it indetail: it consists in fixing the attention successively on all the symptoms, in order to give themin the mind that simultaneous order, in whichthey really co- exist. He, therefore, who hasever fairly analysed a Headach, will easily applythe result of his analysis, as a principle by synthetical reasoning to the symptoms ofother Headachs which may occur. Nor will it escape him,that the signs enumerated by Celsus, as belonging to Cephalaea, have the same relation to thewhole of this disease, as the most striking, andpredominant parts of a landscape have to thewhole of it . *Celsus expresses himself thus: In capiteautem interdum acutus et pestifer morbus est,quam Kepadatav Græci vocant, cujus notae suntHorror validus, nervorum Resolutio, OculorumCaligo, Mentis Alienatio, Vomitus, sic ut voxsupprimatur; vel sanguinis ex Naribus Cursus,sic ut Corpus frigescat, Anima deficiat. Praeterhaec, Dolor intolerabilis, maxime circa Tempora,vel Occipitium.Interdum autem in Capite longa Imbecilitas,

  • La Logique, où les premieres Developpemens de l' Art

Le panser, par M. l' Abbe de Condillac. Partie. i. chap. ii.67sed neque gravis, neque periculosa, per HominisAetatem, est.Interdum gravior Dolor, sed brevis, nequetamen mortiferus, qui vel Vino, vel Cruditate,vel Frigore, vel Igne, aut Sole contramhitur.Hique omnes Dolores modo in Febre, modosine hac sunt: modo in toto Capite, modo inParte; interdum sic ut Oris quoque proximamPartem excrucient.Præter hæc etiam invenitur genus, quod potest longum esse: ubi Humor Cutem inflat, eaqueintumescit, et prementi Digito cedit vdpoκépadovGracci appellant.And again, in allusion to this last kind ofHeadach, he says, Dissimile est id genus, quodHumorem in Caput contrahit. *

  • The Baron Van Swieten, whose mind was stored with

various learning, and to whom the medical science ofhis timewas familiar, contends that Celsus knew nothing of the Dropsy of the ventricles of the brain; as if in Caput should beenglished upon the Head, not in or within the Head: butalthough the preposition in may not here denote motion toa place, yet it is not uncommon in the best Latin writers tofind the accusative case after it: numerò mihi in mentemfuit. Plant. Amphitr. Act. i . Sec. i . Ille ubi miser famelicusvidet me esse in tantum honorem. Ter. Eun. ii . 2. 29. Essein Amicitiam Populi Romani. Cic. I. verr.Professor Whytt likewise affirms, that inì cannot be rendered in or within; and therefore, that Hippocrates does notnotice the Dropsy of the ventricles of the brain: but thesymptoms, as the Coan enumerates them, and as he expressesthem, do not convince me that he does not notice it. And Iam inclined to think, that inì may be rendered in or within,and under as well as upon . In our Creed we read that ourSaviour suffered under Pontius Pilate, ἐπὶ Ποντίου Πιλάτου.F 268From Celsus's Collocation of the signs orsymptoms of Cephalaea, some may conclude,that a violent horror is the first ofthem, in theorder of time; but it certainly is not. There isno more early sign than an intolerable Pain inthe Head; and no more prominent, inseparable,and diagnostical sign, if a disease be a regularconjunction of symptoms, a whole indivisiblefrom beginning to end. Hence it is , I conceive,that Celsus enumerates the other signs , before hementions the intolerable pain as being beforethem, or as being above them in importance, andas being obvious, for all signs, strictly speaking, are addressed to either the eye, or the ear,that he may the better secure for it that placewhich, to use the language of painters, may giveit the highest relief. * Celsus does not say, thatCephalaea begins with a violent horror.It has been stated more than once, that byan intolerable pain, Celsus means, not a great,or an acute pain. A sudden and violent pain ofthe head very seldom attends an incipient Cephalaea: for in this Headach, the pain generallyAnd what can be more natural than that, telling what theGreeks did, Celsus should imitate their very expression?When Celsus wrote Humorem in Caput contrahit, I have nodoubt that he had in his mind the very words of Hippocrates;ὴν ὑδωδ ἐπὶ τῳ ἐγκεφάλῳ γινηται; for there is a parallel clausein Dionysius Halicarn. κινήσεις ἔγενοντο ἐπὶ τῇ πολει.

  • Praeter haec dolor intolerabilis, &c. Although praeter

haec for praeterea belongs to the silver Age, and is often putfor it by Celsus, yet I doubt that it is put for it in this affirmative sentence. I would therefore consider it as synonymouswith maximé, supra, or prae. Praeter is the comparative ofprae, as inter is of in.69becomes violent by degrees. If, therefore, aviolent pain in the head be felt on a sudden, andthe breathing be extremely irregular and laboured, there is reason to expect either apoplexy in afew hours, or palsy of one side.+The violent Horror, to which Celsus alludes,is, I presume, not such as ushers in fever, oradhesive inflammation, or as takes place with thedisposition to suppuration, or as recurs at statedperiods. No chilliness attends it; no increaseof heat, no greater frequency and fulness of thepulse follow it . It is confined to the upper partof the body which is in a profuse perspiration.Therefore it depends, perhaps, upon a shockreceived in the very centre of the nervous system, which is instantly felt in its whole extent,as when a portion of the brain is suddenlyremoved in any ofthe mammalia. Perhaps this horror,or tremor of the muscles is a convulsive effort ofnature, of a salutary tendency. Portal says,that convulsions in apoplexy are so, and I canreadily suppose them to be so. For in cases ofAsphyxia from submersion, when the inflationof the lungs has been persisted in for someminutes, convulsions becoming stronger andstronger have been observed to precede the return of natural respiration.Besides an emetic, the perfusion of coldwater upon the head, a catarrh, and sneezing,have all cured Headachs: and Sauvages says,that Homberg cured a Headach by setting thepatient's head on fire.The subsequent paroxysms of Cephalaea I70have known to be attended in the beginning witha tremor of one arm only, which soon becameweaker than the other, or numb, or paralytic.In some cases, while one arm was thus affected,and the affection seemed always to begin in theextremities of the fingers, the other arm was,more or less agitated by convulsions. In suchcases, I always suspected that some disorganization was taking place within the cranium, although no acute symptoms had yet denoted it. *剩Nervorum Resolutio . That a paralytic affection should follow such a a horror, when it isan ineffectual effort of the vis medicatrix et conversatrix naturae, seems to me, natural enough;but not so to the learned Dr. Grieve: for, hesays, " Resolutio nervorum, Celsus commonly" uses for a palsy, yet he cannot intend that here," but a langour or slight relaxation of the solids. "If, however, so correct a writer as Celsus hadmeant any thing different from palsy here, wouldhe not have said so; as when he speaks of apples,in particular, (for he calls cherries and mulberries, as well as apples, poma, ) he says, quæqueproprie Poma nominantur?Vossius neither annexes any other meaningto Resolutio Nervorum than palsy, nor cites anyother authority for doing so, than Celsus's. IfCelsus, therefore, commonly uses Resolutio

  • Nic. Tulpii Observ. Medic. Lib. i . cap. 12. also cap. 23.

↑ Paralysis, τáρáλvois est Nervorum Resolutio, ut Celsusvocat. Lib. iii . cap. 27. a πapáλveiv, quod est resolvere.Vossius, Etymologicon Ling. Lat. Vossius might have referred to Celsus. Lib. ii . cap. 1. where he says, ResolutioNervorum, quam rapáλvoi Græci nominant.71Nervorum for palsy, this alone is , I think, areason, that he cannot here intend any thingelse for it will scarcely be denied, that the precise and appropriate meaning of any Author'swords and phrases is most certainly ascertainedby his own common use of them.66 As for Dr. Grieve's supposition, that the wordLanguor" expresses the meaning of Celsusbetter, in this place, than the word palsy does,as languor is felt in the voluntary muscles, notin the involuntary, I can find no foundation forit:* neither am I more satisfied with Dr. Grieve'sother translation of Resolutio Nervorum, " aslight relaxation of the solids:" for what an absurd analogy does the fancy suggest, when suchlanguage is applied to a living body? When, forexample, the illustrious Commentator on Boerhaave's Aphorisms, compares a paralytic muscleto several stones bound together by a ring, whichstones fall asunder as soon as the ring is loosened,is his similitude argumentative? It is not so tomy comprehension. But he would prove by it,that palsy is the lax immobility of a muscle, orthat it depends upon such a laxity in the fibresof a muscle, that it is no longer capable of beingset in action by the will: † and yet it is verywell known, that a muscle is not paralytic, beLanguor apɛσıç, nihil aliud est quam Corporis, aut Membrorum ejus veluti Dissolutio et Remissio, cum non aliter acresolutis sive paralyticis dissolutae appareant. Castellus,Lexicon Græco-latinum.+ Boerhaave's Definition of Palsy is this: Paralysis vocatur Musculi laxa Inmobilitas, nullo nixu voluntatis , vel videsuperanda. Aph. 1057.72cause it is lax; but that the laxity and the diminution of the muscles of a paralytic limb areconsequent to its palsy, and never antecedent.A limb may, therefore, be paralytic, without itsmuscles being lax: and it is so in the beginning,although its temperature is diminished; althoughit is more disposed to partake of the temperatureof surrounding bodies; although it cannot bearwith impunity unusual degrees of heat or ofcold;although it is disposed to ulcerate; and although,when ulcerated, the power of restoration in it isdiminished. It is without a sufficient reasonthen, that the very learned Baron attributed thepalsy of a leg to a conversion of its muscles intoa confused mass, resembling the contents of asteatoma.1In 1813, I noticed such a conversion of almost all the muscles, serving for voluntary motion, in a sheep: but I had at that time forgotten, that any thing of the same kind hadoccurred in the human subject. My friend, SirAstley Cooper, however, favoured me with a"See alittle pamphlet with this title: "Some Account ofanuncommon appearance in the Flesh ofa Sheep, &c." printedfor John Harding, No. 36, St. James's-street. On the subject of this pamphlet, I was honoured with two letters bySir Joseph Banks, who was then the President of the RoyalSociety; one requesting " a sample of the curious Mutton; "and another acknowledging its safe arrival, containing SirJoseph's opinion of it, as follows:-" DEAR SIR,"Allow me to return you my best Thanks for being put" in possession of what I esteem a Curiosity, interesting in" the extreme both to the Farmer and the Physiologist. I་ ་" received it last night in good condition, &c. &c. &c." Jos. BANKS."73letter on the subject, in which, he says, " I have" thrice seen a similar change in the human sub- 66 ject to that which you have described in yoursheep, and under the following circ*mstances:" First, the musculus semi-membranosus ofa subject, (otherwise perfectly healthy, and allhis other muscles red) apparently useless, and“white, or rather yellow.66 Secondly, muscles of a limb long out of"use from Paralysis similarly changed.66 Thirdly, the muscles of a club-footed per-" son, which had never been employed, con-"verted into this yellow matter." Fat at first seemed to occupy the place of" muscle in all these cases: but still its texturediffered from that of adeps: for it appeared" fasciculated.66" I had not an opportunity of injecting the" limb in these cases, but will take the first opportunity that offers, as the vessels of the part" appeared to me to have almost disappeared. "But to return from this digression. Therecan be no doubt that, if the muscles of a limbhave lost that power of contractility, whichis their characteristic property, the voluntarymotion of that limb is as entirely lost, as if itsmuscles were removed: but from every thingthat I have been able to learn, it seems that thepower of the muscles is not at all diminishedeither in palsy, properly so called, or in apoplexy; so that, in these diseases, the musclesdo not cease to obey the mandates of the will ,because they are unable to obey them, but because the mandates of the will have ceased to be74conveyed to them. The only stimulus of thevoluntary muscles is the nervous influence; andthis is directly sent to them from the brain, orspinal marrow, * by the will.}

John Hunter, alluding to the practice of stimulating paralytic limbs, shrewdly remarks, thatwe may with exactly the same propriety stimulate the fingers, when their muscles are torn topieces.But not to lose sight of some paralytic affection being a sign of Cephalaea, I never saw aninstance of this disease without palsy. What ismore common in Cephalaea than a torpor ofthe hands, an impediment of speech, a palsyof the Levatores Palpebrarum , and Iris? Inshort, I have somewhat like conviction, thatCephalaea and Cephalalgia have a relation toeach other, like that of cerebral to meningealapoplexy; in the former of which there is alwayssome degree of palsy. It should, however, beremembered, that not only the portio dura ofthe seventh pair of nerves after it has emergedfrom the stylo- mastoid foramen, but also somebranches of the fifth pair may be affected in theircourse, and even in their passage through thebones, without the brain being so, for a Cephalalgia may be mistaken for a Cephalaea.Even Hemicrania, if it be a Cephalaea, isattended with palsy or convulsion.I have seen many instances of Cephalaea inwhich there were both palsy and convulsions,

  • See Cuvier's Analysis of Fleurens's Experiments in Ann.

de Chimie et Physique. Tome 20.75sometimes of the same part, alternating witheach other, but sometimes of different parts.They who admit John Hunter's doctrine ," that no two actions can take place in the same"constitution, or in the same part, at the same"time;" and who are aware, that the higherdegrees of sensation, and of volition, are incompatible with each other, a position which thelate investigations of Mr. Charles Bell, into thedistribution and uses of certain nerves, confirmand elucidate, will not wonder at palsy and convulsions alternating with each other; nor at Dr.Darwin having put both in one class, entitled" Diseases of Volition . " However, althoughI believe that sensation and volition are in opposite directions, yet I can see no reason to ascribe an objective existence to ideas, to assumethat ideas are material, and to consider Thoughtand the modifications of it, as vibrations of ideas:but this I would say to those only, whom themention of Dr. Darwin may lead to a perusal ofhis very ingenious, although very hypotheticalPhysiology .Need I remind any medical reader of what isnow so well known, that if the brain be injuredor diseased, and paralysis be the consequence,this paralysis is very seldom on the same side asthe disease or injury of the brain; but that if thespinal marrow be diseased or injured, the paralysis is on the same side? That the power oftransmitting impressions productive of sensationis in the posterior roots of the spinal marrow,andthe power of exciting motion in the anteriorroots? and that, if a nerve of sensation be76divided, the part to which it imparted sensibility,becomes insensible, as the division of a nerve ofvoluntary motion renders the muscle, to whichit went, paralytic?Oculorum Caligo, in Celsus, I take to bean expression of great extension, and to standfor almost every disorder of vision, in which thereis no organic change either in the coats of theeye, or in its humours, or in the capsules of itshumours. There is no Headach so often attended with caligo as Cephalaea, whether this caligodepend upon an affection of the optic nerve, orof any of the other nerves, which enter the orbit. *The dull appearance of the eyes in Headachis very remarkable, and depends, perhaps, inpart, on a deficient secretion between the laminaeof the cornea; in part on the drooping conditionof the upper eye-lids; and in part on the retraction of the eye-balls into the orbits. The eyeballs are not sunk into the orbits , because theadeps, in which they lie embedded, has beenabsorbed, as is the case in emaciated persons;but they are drawn back into them by the concurrent action of the four recti muscles. Thesemuscles begin to act, as soon as the Headachbegins: and when the Headach ceases, the eyesin an instant resume their usual situation.As I have shown, or have endeavoured to show,that Headach may be attended with too littleblood in the head, as well as with too much, so amere caligo may, perhaps, exist when there istoo little blood in the head, as well as when there

See Mr. C. Bell's two Papers in the Philosophical Transactions for 1823.77is too much The blindness from fainting, andthe dimness of sight in aged persons should seemto be owing to too little blood in the central artery of the retina: the blindness from vomiting,from pregnancy, and from parturition to too muchblood there.WIf Caligo Oculorum, and redness and itchingof the forehead, or ofthe whole head, accede topains ofthe head, these pains are removed by aflow of blood, whether this be spontaneous ornot. *卺Celsus notices the affection of one sense onlyin Cephalaea: but hearing, smelling , and tasteing may all be affected in it. When Celsustreats of sounds in the ears, he mentions a dulness of hearing after pains of the head of longduration. Of all the organs of sense, the earis the most complex; and more are deprived ofthis sense from birth, than of any other. According to my experience, deafness is a verycommon occurrence in Cephalaea, and is usheredin by noises in the ears, when the patient is notyet deaf, but seems to be so, because the noisesdivide or engross his attention .According to Hippocrates, if there be a ringing in the ears, with slowness of speech, andtorpor of the hands, we may expect the Headachto be converted into apoplexy, or epilepsy; andif there be deafness, with eruginous vomiting,we may expect the Headach to be followed byinsanity.

  • Celsus. Lib. ii. cap. 8.

+ Celsus. Lib. vi . cap. 7. § 8.178It is difficult, if not impossible, to accountfor noises in the ears. Such noises as sometimesattend the end of typhus, with a degree of deafness, should seem to depend in a great degree onthe rush of arterial blood through some part ofthe vascular system ofthe ear: for I have knownthose, who could number with accuracy the pulsations at their wrist, in a given time, by counting the corresponding beats in their ears , or thecorresponding increments of sound . But, if anyrush of blood could alone produce all the noises ,which are at times referred to the head, andsometimes to the ears, they should occasionallyoccur to every one in health.I can fancy, in a Cephalaea, when the patientcannot catch the articulation of sound in the monotony ofcommon conversation, and when he isdistressed by noises in his ears, that the auditorynerve has undergone some change, either at itsorigin or at its termination; and that in the lattercase, it conveys a different impression than usual,and that in the former case it receives impressions, which are felt more acutely; but fancywhat I will, how can I account for it, that thereis no cry of animals, no sound occasioned by themotion of air, of water, &c. by the rustling ofwings, by the rattling of paper, of parchment, ofleaves, of silk; by the ringing of bells, bytheclank of chains, &c. to which those, who have aCephalaea, or even the predisposition to it, donot sometimes compare the noises in their head?How can I account for it, that patients with Cephalaea, and so deaf as not to enjoy conversationamong strangers, at the crack of a whip, at the79fall of a cinder from the fire, at the scream ofany animal, in short, on every occasion, whenany clang, any noise is made, in which there aremany vibrations, feel sometimes as if their tympanum were suddenly burst, or as if a swordwere thrust through their brain?It has been my misfortune to know many suchpatients, and to witness the signs of their mentaldistress, while dreading every noise, they wereready to conjure up as much evil, as if they expected to hearOn a sudden open flyWith impetuous recoil, and jarring sound,Th' infernal Doors, and on their Hinges grateHarsh Thunder.I have seen them motionless, speechless, pale,aghast, and losing for a second or two their veryconsciousness: and I have watched their recovery, and listened to them breaking silence, whentheir expression was slow and almost metrical,and their very words were such as flow fromgrief and melancholy.How can I account for it, that some patientswith a Cephalaea have an increasing susurrationor jarring sound in their ears, whether their pulseat the wrist be accelerated , or not? How can Iaccount for it, that some of them have that.complex sensation, the musical, and detect in an instant the slightest error in music, and then sufferan interruption of that ease, which music hadafforded them? The analysis of the sensation ofmusic must be very difficult; the pleasure derived from it consists in a perception of the numerical relations of its constituent parts, which are80melody, harmony, and rhythm. How can I account for it, that some hear music, where thereare no combined and succeeding sounds to beappreciated? I have known a patient who,having for years from his infancy heard the 104thPsalm chimed daily, could scarcely be persuadedthat it was not chimed constantly; and that evenin the intervals ofthe paroxysms of his Headach.How could I be present at such scenes, and notbe thinking of the diseases of the carotid andvertebral arteries, ossification, aneurism, &c.?Bichat is of opinion, that the ramifications ofarteries are not so frequently the seat ofincrustations; and that the capillaries are never the seatof them. And assuming this as a fact, he concludes, that the inner coat of the arteries doesnot extend into the capillaries, but degeneratesby degrees into a different texture. * But Mr.Hodson relates a case, in which " all the arteries," both the larger ones on the basis of the brain," and their minute ramifications on the pia mater"were extensively diseased . In some places,"their cavities were obstructed by a deposition" of atheromatous matter between their coats;"and in others, they were converted into complete tubes of a calcarious structure, the sec-" tion of which afforded a wiry sensation. "†66Ossified arteries, as they are called , although rare in young persons, ossification not beginning till the seventh or eighth week after con-

  • Anatomie Generale. Tome ii. p. 294.

+ A Treatise in the Diseases of Arteries and Veins, &c.page 27.81ception, * have nevertheless been found in someinfants, the ossification of whose bones was notfar advanced. But nothing like bone in appearancé and composition is , I believe, ever detectedin arteries, nothing like cartilage.There are many reasons, that persons far advanced in years should be deaf in some degree, 'even if they have no Headach: as their Dentesmolares, which are better conductors of the impressions occasioning Hearing than either air orwater, being carious , or loosened, or lost, thealveolar processes having been absorbed; thevery vascular membrane lining the labyrinth receiving less blood, and secreting less ofthe liquorCotunni, which should fill the labyrinth, to convey to the expansion ofthe auditory nerve withinit, the vibrations of sonorous bodies from themembrana tympani, through the medium of thelittle bones ofthe ear; the auditory nerve itself,

  • D. Jo. Frid. Blumenbach. Instit. Physiologiae §. 642..

+ Portal, Anatomie Medicale. Tome iii. p. 133.The Concretions alluded to, according to Mr. Brande'sAnalysis, consist of onlyPhosphat of LimeAnimal matter65 534 5100 0Calcined human Bones, according to Berzelius's Analysisconsist ofPhosphat of Lime 81 9Fluate of LimeLime -Phosphat of MagnesiaSodaCarbonic Acid3 010 0- 1 1" 02 0G100 082in the labyrinth, having undergone some change,so that it is less susceptible ofthose impressions,which give rise to sensation, &c.66When Dr. Saunders had left London, and hadretired to Enfield, he invited me there to see him:and in a letter, describing his sufferings, he says," I am very susceptible of sound and noise, but" deafto articulation. A trumpet gives me pain,by making the sound too loud . I have a very" irritable head, and the most unpleasant noise" in my best ear from eructations, or even motions of the body. My sight is good. Theparoxysms of excessive noise are accompaniedwith a tensity of the muscles and vessels ofthescalp, so that every external part is as tense" as a drum: after which a relaxation takesplace, and seemingly a diminution ofthe bulkand size of the head."66666666As to smelling, like every other sense, if thenerves, upon which it depends, the first pair, benot paralytic, it is generally too acute in Cephalaea but it is so also in other Headachs.It is difficult to account for this; but I takeit to be a fact; and I know that , Headachs aremore frequent in the morning, and again in theevening, at both which times the pulse is slowand weak; and that they generally cease or remit at mid-day, when the pulse is quick andstrong.Morgagni relates the case of a noble Lord,subject to fits ofthe epileptic kind, beginningfromthe hypochondria, and preceded by the sense ofa fetid smell, although the breath of his mouthand nostrils was not at all fetid to bye-standers.83Morgagni supposes in this case, that a branch ofthe intercostal nerves being irritated in the hypochondria, an impression is communicated to themembrane of the nose, like that excited by fetideffluvia, not the first pair ofnerves communicatingwith the intercostals , but with the fifth, branchesofwhich are distributed in the mucous membraneof the nose.*Some women judge that they are pregnantearlier from a depravation of smell, than fromany other circ*mstance; and then, if they haveno Headach, they are, I believe, very likely tohave it, and also puerperal convulsions.Hysterical, hypochondriacal, and catarrhalpatients, when they have a Headach, frequentlycomplain of something stinking near them, tillthey find that their smell is depraved.Mr. Shaw says, that in three cases, in whicha deposit of bone was found in contact with theolfactory nerves, the patients had suffered muchfor a considerable time, previous to death, fromthe sensation of unpleasant odours.Some have been able to smell with one nostril only, because the passage of the olfactorynerve through the cribriform plate of the osethmoides was obstructed on one side by anoblique position of the crista galli.As to taste, I have often known it to be disordered in Cephalaea, increased, diminished, orperverted; and, I think, I have known it so inother Headachs.

  • De Sedibus et Causis Morb. Epist. xiv. §. 28.

1G 284The reader knows, that taste belongs to thefifth pair of nerves, the motion of the tongue tothe ninth pair, and swallowing to the glosso- pharyngeal nerves.Mentis Alienatio is set by Celsus among the signs of Cephalaea: but Mons. Pinel calls his Book on Insanity, Traité sur l'Alienation mentale. Shall we, therefore, suppose that Celsusmeans Insanity? Dr. Grieve puts Delirium forthe Mentis Alienatio of Celsus: but I never knewa Headach in which the patient did not know hisfriends. If the word Delirium had better expressed Celsus's meaning, he would, no doubt,have used it here, as he does elsewhere. Forexample: cui Calor et Tremor est, Saluti Delirium est. * I have known several instances ofCephalaea, and of Cephalalgia followed by insanity but when the insanity began, the pain inthe head ceased: therefore, the Headach ceased.These were, I suppose, cases of Headach converted into insanity. I never knew a case ofHeadach, in which the patient's imagination wasat all employed.I have said, that in Cephalaea, it is painfulfor the patient to think; and, therefore, that heavoids both it and speaking, as much as possible.I shall now add that, if he be obliged to think,and to return an immediate answer, his earnestness to have finished a painful task may inclinehim to make his speech keep pace with the quickness, with which his thoughts are generated; so

  • See Pinel's Definition of Delirium. De l'alien mentale. Sect. 111. iii . §. 176. Pinel properly considers melancholia and Mania as Species of Insanity, not as Genera.

that in his solicitude to convey his meaning, heattends so little to his words as often to put onefor another. I have many times known personsto do so, and instantly to correct themselves,which they could not have done, if they had beendelirious . They did not mistake one thing foranother; neither did they form to themselvesvain images; which they would have done, ifthey had been insane . They had, perhaps, analienation of their mind from invention; or ratheran aversion to the intension of their mental faculties, and even to the exercise of them. *Vomitus. After mentioning an intolerablepain in the head, a violent horror, a palsy, adisorder of vision, and an alienation of mind,Celsus adds, as I understand him, and eithervomiting, so that the voice is suppressed, or aflow of blood from the nostrils, so that the bodybecomes cold. Cephalaea may have been a moredesperate disease, where Celsus saw it, than itis in our climate: but he can neither intend theantecedent to loss of voice to be the mere vomiting, nor the antecedent to coldness of thebody to be the mere bleeding from the nose; but,in both cases, the conjunction of all the precedingsymptoms..:Vomiting is an act performed chiefly by thediaphragm, the muscles of the abdomen servingrather to keep the viscera of the abdomen in theirproper place: and the stomach has no more to dowith vomiting, than the lungs have with cough-

  • Seethe word Alienatio in Nizolius, sive Lexicon Ciceron.

Cura Facciolati.86ing. This is the doctrine of John Hunter: andit is confirmed by Mons. Magendie, who hasshown, that vomiting may in some manner takeplace, without a stomach; the stomach being solittle concerned in vomiting, that a hog's bladder,substituted for it, answers just as well. Mons.Magendie's Memoir was read to the ImperialInstitute of France, March 1 , 1813, and waspronounced by M. M. Cuvier, Pinel, Humboldt,and Percy, all of them aware that birds and otheranimals without a diaphragm vomit, destined tobe for ever cited in physiological works.According to Mons. Magendie, vomiting isproduced by an affection of that part of the medulla oblongata, from which the eighth pair ofnerves arises: for if that part be disorganised , onboth sides, tartarised antimony, whether takeninto the stomach, or injected into the jugularvein, occasions neither vomiting, nor the sensation of vomiting. i•The vomiting in Cephalaea is frequent, andis at the first of a green bile, together with thecontents ofthe stomach. But if the patient donot vomit, he is sick and inclined to vomit onrising from his seat, on sitting down, and onmoving his body or his head . In the progress ofCephalaea, what is vomited is sometimes black,and such vomitings perhaps show, that their causeis at the origin ofthe par vagum or pneumo-gastric nerve. Besides, as the patient has no inclination to sleep, if nervous vomitings be attendedwith deafness and a trembling ofthe hands, theyare a dangerous sign, and sometimes precedethe conversion of Cephalaea into insanity.87

Eruginous vomiting never occurs in other

Headachs, or in the pains, which being seatedexternally, are improperly called Headachs: forif the patient vomit in these, the matters firstejected are not even tinged with bile: nor doesbile appear, till the stomach has been entirelyfreed from the food that was in it.This vomiting depends, perhaps, upon animpression on the nerves of the stomach, whichis communicated by them to the origin of the parvagum: for when the nerves of the par vagumgoing to the stomach are divided, the irritationoccasioned by the division is communicated totheir origin, and generally causes vomiting; sothat since the muscles of respiration, as well asthe stomach, receive their nerves from a commonsource, it is easy to conceive how an emetic,taken into the stomach, produces vomiting.The impression on that part of the medullaoblongata, which gives origin to the par vagum ,must be different in the vomiting of Cephalaea,from the impression on it, which excites vomiting, when an emetic has been either taken intothe stomach, or injected into the jugular vein.The former impression must be more like that,which sometimes produces obstinate vomiting inapoplexy; and may possibly be connected withdisorganization, or with the tendency to it. Vomiting from an emetic, must be more like vomiting in simple concussion of the brain, when it isalways a good sign. Spontaneous vomiting isallowed by all to be a good sign, when it mayremove that affection, upon which it depends,and cannot increase it.88I have, I think, seen cases of Cephalaea, inwhich hiccupping for days, and even weeks, wasvicarious of vomiting, as it is sometimes whena stone is irritating one ofthe kidneys or ureters.M.Vox supprimitur. * Does Celsus mean, thata patient with Cephalaea will not speak, that heis silent by intention, or that he cannot speak?A loss of voice in Cephalaea presupposes sometimes pressure or disorganization at the origin ofthe eighth pair of nerves, as it does in apoplexylikewise; the recurrent branches of those nervesbeing the true vocal organs. Galen knew a lossof voice from opium introduced into the ear tocure a pain of it. Strammonium infused in wine,Belladonna, and Hyoscyamus have all producedaphonia. Soëmmering, Scarpa, and Portal, allof them, attribute the loss of voice, occasionedby the ingurgitation of inebriating liquors, to thepressure ofthe distended vertebral arteries on theninth pair of nerves: but this loss of voice generally ceases, as soon as the subject of it has recovered from his drunkenness, although Portalhas known it not to cease then.But if the recurrent nerves, or the par vagumbe divided in the neck, on both sides, the voiceGroaning, Gemitus, is not Voice, Vox. Caesar receivedthree and twenty wounds uno modo ad primum Ictum Gemitus, sine Voce, edito. Suetonius Tranquillus de XII Caesaribus. Lib. i. §. 82. Neither is voice Speech: Voice is thatappreciable sound which is produced by the vibrations of theair driven from the lungs through the Glottis: Speech isvoice modified by the motion of the tongue, the lips, andother parts of the mouth. Speech may be lost althoughyoice remains.89is lost it has, therefore, been lost by the removal of tumours from the neck, by luxations ofthe arytenoid cartilages, &c.When the voice is lost from a disease of thebrain, it is a dangerous symptom; as it is also,when it is lost from debility. It may be lostwhen there is no sign of plethora, and no reasonto suppose any pressure within the cranium, fromspasmodic affections of the Larynx, and from affections of very distant parts, by sympathy, or bycauses that prevent the full dilatation of thelungs. Thus, hysterica, epilepsy, and gastricand verminous diseases are often attended witha loss of voice. Aphonia during pregnancy isgenerally cured by parturition.Difficult Menstruation is sometimes attendedwith a loss of voice, which is perhaps owing tosome affection of the ovaria. Every one knowsthe change of voice at the period of puberty;and that some birds whistle during the pairingseason only, when their testes are enlarged, although in winter they are shrunken to almostnothing. And every one may have heard oftheoccasional swelling of the testes, when the glandsof the neck are swollen, in cynanche parotidea,or mumps. Hysterical women are very subjectto loss of voice; and in most cases of Hysteria,the ovaria are said to be diseased.ཆTulpins tells us of a Brabant merchant, whowas every spring so shockingly tormented with aHeadach, that he could scarcely open his eyes,or speak a word, although loquacious and turbulent at other times. * Was his voice voluntarily

Observat. Medic. Lib. I. cap. 13.90suspended? This is uncertain. Was his voicesuspended by consequence of a violent effort torelieve his pain? I do not think so . If historyabounds in examples of spasmodic affections originating in violent voluntary exertions to relievepain, in Headach, the patient makes no voluntary exertions.Sanguinis ex Naribus Cursus. This I wouldtranslate a dribbling of blood from the nostrils,because where Celsus speaks of such a dischargeof blood from the nose as relieves a Headach, hecalls it Sanguinis Profusio, or says Sanguis Prorumpit, or employs similar expressions; and because Caelius Aurelianus, who places, as Celsusdoes, a bleeding at the nose among the signs ofCephalaea, calls it Sanguinis è naribus parvissimus Guttarum Fluor, nihil relevans. NeitherAretaeus, nor Galen, nor Lommius, nor Hoffman,nor Burserius, has any thing concerning such ableeding in Headach: and Hippocrates remarks,that in all diseases, it is a bad sign. It is, perhaps, like the bleeding from the nose at the endof diseases of the heart, and lungs, and liver,depending upon, what Bichât calls, a diminutionof organic sensibility, and of insensible organiccontractility in the exhalants of the mucous membrane. There is no increased momentum of theblood, which is not as it is in inflammatory diseases, ofa scarlet colour, but of a dark red, andcoagulates as it flows.Corporis Frigus. Nobody can suppose, thatthe coldness of the body depends upon the loss ofblood in Cephalaea, or upon any other causethan the flow of blood does. But I need not91dwell upon this subject; for it has been knownfrom time immemorial, that whether the bloodtrickle down, or gush out in a continued stream,if it be attended with a coldness of the body, ora cold and clammy sweat, it is a bad sign. *Animae Defectio. Galen asserts, that a personnever faints from the pain of Headach. By fainting is perhaps to be understood, a more or lesssudden and entire suspension of all the mentalfunctions, and of the functions of the heart andlungs, all the muscles of voluntary motion beingflaccid, and all the joints flexible, the face paleand Hippocratic, the extreme parts cold, and thetemples bedewed with a clammy sweat. This,I am aware, is not Cullen's definition of fainting:but Cullen comprehends in the term Syncope,other diseases , which he calls degrees of it; andhe does not sufficiently distinguish it from Epilepsy and Hysteria, in both which the pulse isalways to be felt, the face is always flushed, andswollen, and the muscles, those at least of thefingers, or of the lower jaw, are always convulsed.Hoffman says, that there are three kinds ofdeliquium animi; and confines the term Syncopeto the highest or worst kind, in which there is noappearance of either tremour or convulsion . †But Celsus allows that convulsions ofthe legs and

  • See the Prorrhet. and the Coacae Praenot. of Hippocrates.

+ Siquidem omni Sermonis Usu privati subitó corruunt,alto quasi Sopore oppressi, absque Convulsionis aut TremorisApparentia immobiles jacent. F. Hoffmanni Medic. Ration ,Syst.92hands may concur with his Animae Defectio: *therefore, his Animae Defectio, and Hoffman'sSyncope, cannot be the same.In my opinion, when Celsus says, animadeficit, he means no more than that sudden diminution of the sensorial, the nervous, and themuscular powers, which is common to the end ofall diseases of debility, when the patient feels asensation of fluttering and of sinking somewhereabout the solar plexus, and manifests by his paleness, his coldness, his slow and weak pulse, andhis frequent sighs, that he is alarmed lest heshould be unable to continue his respiration.

  • Celsus says in his chapter on Cholera, Praeter ea vero,

quae supra comprehensa sunt, saepe etiam Crura Manusquecontrahuntur, urget Sitis, anima deficit: quibus concurrentibus, non mirum est, si subitò quis moritur.What he means by contrahuntur, he renders clear by saying: Frigus modo nervorum Distensionem, modo Rigoreminfert: illud σπασμὸς, hoc τέτανος Graece nominatur. Lib. ii.cap. 1.爨น1493CHAPTER IV.1 KINDS OF HEADACH.As for the division of Headachs into bilious,nervous, spasmodic, gouty, rheumatic, &c. asevery one of these epithets contains a hypothesis,which I do not understand, and which I am persuaded, nobody else does, I shall not enter intoa formal refutation of it: but I would ask those,who affect to reason so consequentially of a bilious Headach, what they mean by it? Is it aHeadach depending upon a redundance of bile,or upon an alteration of its qualities?* If it be,where in the body of a patient must the bile be,

  • Ou donne le nom de maladies bilieuses aux affections

qui dépendant de l'Abondance et quelquefois de l' Alterationdes Qualites de la Bile. Nysten's Dictionnaire de Medecine,&c. I cannot help thinking that Dr. Nysten should have followed the French Academy; and that Dr. Johnson shouldnot have brought forward Spencer to sanction a manifest Error. "Abundare pro redundare, supervacaneum, seu super-"fluum esse perperam ponitur: nam abundare, copiam significat, non superfluitatem: adfert satietatem; non nauseam. ”Nolten, Lexicon Antibarb.<694to produce a Headach? Bile, even cystic bile,in the stomach, produces not Headach, but vomiting an excess of bile in the intestines produces not Headach, but Diarrhoea: bile in theblood might be supposed to produce a Headach,if pain in the head were a symptom of jaundice.But I do not think it proved, that bile ever entersthe blood, either by regurgitating in the hepaticveins, or by absorption from the excretory ductsofthe liver; first, because bile is never found inthe lacteals, and never imparts its colour, or itstaste to the chyle: secondly, because a jaundicearises sometimes in an instant from anger, in thetwinkling of an eye from the bite of a viper, saysCardan; * therefore, sooner than its regurgitation, or its absorption, can take place: thirdly,because one-half of the body, and sometimesonly one extremity is jaundiced, which it couldscarcely be, if bile were generally diffused in theblood fourthly, because there is a yellow colourin the white of the eye, in the skin, in the expectoration at the end of peripneumony, andsometimes in scurvy, although there is no disorder of the liver: fifthly, because the skin isyellow after Ecchymoses: sixthly, because thematter discharged by vomiting and purging incholera, and in yellow fever, is at length ascertained to be not bile, but some part of the bloodexhaled and modified in a particular manner:and seventhly, because the serum of the blood,in the jaundice of new-born babes, contains noneMorgagni, de Sedibus et Causis Morborum, &c. Epist.lix . §. 36.95of the principles of bile. But they, who wouldknow more of this subject, may consult M. M.Breschet, Desmoulins, and Lassaigne. To meit seems plain, that jaundice depends upon theblood itself.And what is a nervous Headach? or rather,what Headach is not nervous? for every diseasemay, according to the two Professors of Medicine, Whytt and Cullen, be in some sense callednervous. And I would ask, what Headachdiffers so much from others that the epithet nervous belongs exclusively to it? I believe that inall Headachs, the nervous system is affected, andthe pain is produced , before there is any turgescence of blood vessels, or any phenomenon cognizable by the senses. It appears to me, that,if the situation of the blood is an object withnature in the commencement of most diseases,there is an antecedent state ofthe nerves of thatsituation, upon which the state of blood vesselsdepends. Nay, I know no reason, that I shouldnot conclude, that even an apoplexy sometimeskills a patient, before there is any sanguineouscongestion in his head.There is a division of diseases into idiopathicand sympathetic, concerning which I must say afew words. And our countryman, Sydenham,treating of Hysteria, shows how very well heunderstood it: for he there says, " this Disease" is not moreremarkable for its Frequency, than" for the numerous Forms under which it ap- 66 pears, resembling most of the Distempers"wherewith mankind are afflicted. For in"whatever part of the body it be seated, it im-96mediately produces such symptoms as are pe-" culiar thereto. *" This position of Sydenham's" is adopted by John Hunter, who lays it downthus: that when one part has a greater aptitudeto sympathise with a local irritation than therest, that part sympathises according to its ownpeculiar action . †Ifdiseases had not been so long distinguishedinto idiopathic and sympathetic, I would propose that sympathetic diseases should now becalled ideopathic: for it seems to me, that a sympathetic disease is as proper to a part, that is,is as idiopathic (from idios, proprius , specialis,)as that which is emphatically called so; whereasits difference from the real disease of a part wouldbe signified bythe adjective ideopathic (from ' Idéa,Imago, Species .) I know no better example ofa sympathetic disease than that given by Mr.Abernethy, in these words: " I have examined"a child who was supposed to have died ofHydrocephalus, accompanied by great Disor-" der ofthe Stomach and Bowels. In this case,"the Bowels were inflamed, the Liver sound," and the Brain perfectly healthy in appearance;"yet there had been so great a diminution of" Sensation and Motion as to leave no doubt of" the existence of Hydrocephalus. "66It is certainly of great importance, at alltimes, to distinguish a sympathetic from a realdisease. But, although, this is easy enough insome few cases, in which the sympathetic disease

  • Swan's Translation. p. 370.

† A Practical Treatise on the Diseases of the Teeth, &c .by John Hunter. p. 114, &c.97is consequent to an affection in some ofthe organssubservient to the natural functions; yet in themajority of cases, the sympathetic disease is firstknown; and unless the attention be directed byit to the primary disease, it is treated as if itwere a primary disease.Granting then, that a Headach may arisefrom the affection of some part of the body, remote from the head, it may, I am inclined tothink, be always known to be sympathetic, byits own internal evidence. For, from my mostcareful observation, such as it is, I have concluded, that a purely sympathetic disease of anypart, has no accedent symptoms, no Epiphaenomena, no Epigenomena; but corresponds exactly with, what ought to be, the logical anddiacritical definition of some real disease of thatpart. I can, I am so bold as to think, trace theconversion of the sympathetic disease of a part,into the real disease of it, by the superventionof accedent symptoms.Some may doubt the legitimacy of this conclusion: but, if they do, I beg them to recollectthe cases they have attended themselves, and

  • Consensus quam σvµñáßɛlav Graeci vocant. Cicero. Sympathy offellow-feeling is when we participate the joys and the

sorrows of one another, and feel disposed to console and torelieve one another. If I am distressed, because my patientsuffers pain, and am therefore disposed to cure him, I sympathise with him. Every one is acquainted with this meaning of the word sympathy. But in medicine, it has no reference to the state of any thing external to the individual; itsignifies the consent of one part of his body with another part,or with all the other parts. It is natural or morbid: and itis through the medium of the brain or spinal marrow: for asDr. Wilson Philip remarks, there is no proof that impressionsarecommunicated from one nerve to another in any other way.H98

then to say, if some ofthem do not confirm it.They will not, I hope, object that such simplicityis not to be expected in the great variety andcomplexedness of the vital phenomena. Bethat as it may, if I am not ignorant, that somediseases are not so simple and so distinct asNosologists represent them; I am persuaded,that others are far more simple. And afterhaving ruminated on the unqualified abuse ofNosology, I can collect nothing more fromits bitterest enemies, than that, because thesame disease never appears alike in two individuals, but is varied by accedent symptoms; andbecause diseases are often complicated one withanother; therefore they should be studied intheir varieties and complications, before they arestudied apart in their most simple state; a conclusion evidently absurd. For the very notionof a thing being varied, or complicated, impliesthat it may exist without variation or complication; and it is the object of Nosology to representdiseases so. If Nosology be not yet adequate toits end, is it fair to conclude, that it will neverbe so? Will it not become more useful in pro-

  • Dr. Brown's Abuse of Cullen's Nosology is omitted in the

Second Edition of the Elementa; but it was too delicious amorsel to be lost; and, therefore, he gave it a place in hisOutlines. Quin Nosologia Morbos pro Symptomatis, et haecpro illis recipiens, communes affectus cum localibus permiscens, distantia natura conjungens, affinia dissocians, incertapro certis habens, atque á proprio Artis Negotio in Nugas,Errores, Discrimina ficta, verorum neglectum, et rectam medendi usus Perniciam, sine Fine, Modoque seducens, in cuniselidenda.See a Paper on the Measles by Dr. Heberden, inMedical Transactions, published by the College of Physicians,in London. Vol. iii. p. 389.99portion as we shall be able to trace diseases tothe very texture of the organs in which they begin, to mark the successive changes of this texture, the successive changes of the contiguoustextures, the symptoms peculiar to each, and thevarious stages of the diseases, in which accedentsymptoms occur.That Headach, which Dr. Fothergill has described, commonly called the Sick Headach, issometimes distinguished bythe adjective spasmodic; and this for no better reason, which Ican find, than that the pain, occupying a partonly of the head, often shifts to another part.Where are the spasms or convulsions in thisHeadach? in the limbs, in the face, in thelarynx, in the pelvis and abdomen, or in the intercostal muscles and diaphragm?*Dr. Parry takes the Headach from suppressedmenses to be the Sick Headach: and it is certainly a Headach in a subject very irritable, andliable to convulsions. Is it, therefore, a spasmodic Headach?In short, every Headach being equally attended with spasm in some part, seems to me tobe equally entitled to the epithet spasmodic.But is there a spasm of the brain itself? I haveread of such a spasm. †

  • See Dr. Park on the Laws of Muscular Motion, in the

Journal of Science and the Arts. No. iv. p. 36.+ Le Spasme du Cerveau, comme dans une vive frayeurpeut produire une morte subite. Commentair. sur lesAphorismes d' Hippocrate, par M. le Chevalier de Mercy.Aph. 44.H 2100Rheumatic is an epithet prefixed to pains ofthe head, when they are supposed to be seatedin the aponeurotic Expansion of the temporalmuscle, in that connecting the occipital with thefrontal muscles, or in any of the adjacent membranes of the fibrous class . Whether Rheumatism ever affect the dura mater, is uncertain;but it probably does so, and also the tendinousfibres of the recti muscles, which are firmly attached to the sclerotic coat of the eye, and thesclerotic coat itself. But it is unnecessary tosay more of this; for if a Headach be that whichI have defined it, it cannot be rheumatic.Of a gouty Headach I shall speak in another place.When I shall have spoken of the causes ofthe predisposition to Headach, I shall resumethis subject, the Division of Headachs, and shallpropose such a division as, if it do not so exhaustthe subject that nothing relating to it is omitted,is however, I hope, more adequate by far thanany other.101CHAPTER IV.SECTION I.PREDISPONENT CAUSES OF HEADACHS.By the word Cause, nothing more is meantthan the constant antecedent of some particularevent therefore, as often as I shall use the wordCause, as if it signified something agent, efficient,and productive, I shall do it in compliance withestablished usage, and the use of the world. For,as the very learned Author of SIRIS says, " in"compliance with established Language, and the" Use ofthe World, we must employ the currentpopular Phrase: but then, in Regard to Truth,"we ought to distinguish its meaning. "66Now, for a person to have any disease, hemust be susceptible of it. Some may not be atall susceptible of it; and others may be susceptible of it at one time, and not at another. Pregnant women are said to be less susceptible of theplague and very young children, and very oldpersons to be not very liable to fever. The susceptibility of a disease is that, which is calledits predisponent Cause, or simply the Predispo-

102sition to it. The Predisponent Cause ofa diseaseis, therefore, in the person himself: and the Predisponent Cause of Headach depends upon thatpeculiarity in his head, which, whatever it maybe, whether natural or acquired, produces no sensation, but renders him liable to Headach oncertain occasions, when other persons are not so.A disease then presupposes that some otherCause has acceded to the predisponent; neitherthis Cause alone , nor that other Cause alonebeing sufficient for its production. If the predisponent Cause of Headach were sufficient toproduce Headach, that Cause being always present in such as are subject to it, Headach alsoshould be always present in them . The otherCause of a disease which accedes to the predisponent, is called its procatarctic, evident, oroccasional Cause, or simply the occasion of it:so that the predisponent Cause is as a latentspark, big with the flame of some disease, butwhich may exist when it is not suspected; andwhich, when it is known to exist, may not always be kindled.I shall first speak of the Predisposition toHeadach, of which some seem to entertain a veryerroneous notion, and others no definite notionat all. For one hears every day the Causes ofthe Predisponent Cause confounded with thePredisponent Cause itself, whereas there can beonly one Predisponent Cause of any disease, although the Causes of it may be innumerable.The actual presence of Headach is not alwaysnecessary to convince us of the existence of itsPredisponent Cause: but there are two signs, by103either of which we may sometimes, and by bothofwhich we may always be convinced of its existence the one is an imbecility in the head;the other is a mis-shapen head.Celsus takes it for granted that scarcely anyone is born without an imbecility of some part:he devotes a whole Chapter to those, who havenaturally an imbecility in the head: * and he expressly says, treating of Headachs, that there issometimes an imbecility of the head, which isneither intolerable, nor dangerous, lasting a lifetime, and not requiring the remedies of Headach. I suppose he alludes to such as often complain of a sensation in their head, which they donot allow to be a pain, but carefully distinguishfrom a pain: for I have known such. But noperson, whose animal functions are rightly andeasily performed, feels even that he has one partmore than another, or that he has any part; sothat, if he do feel it, the predisposition to somedisease must be in it, because it must be influenced on occasions, on which others are not conscious of any sensation. I have heard personsremark, that they had momentary and quicklyevanescent disorders of sight, of hearing, ofsmelling, and of tasting; and these, I conclude,are signs of an imbecility in the head. If a person cannot bear vivid light, nor sudden, loud,shrill, or peculiar noises, nor certain odours,without some disagreeable feeling in his head, ofhowever short duration, he has the predisposition

  • Raro quisquam non aliquam Partem Corporis imbecillam

habet Lib. i. cap. 3 and 4.Hunter's Treatise on the Blood, Inflammation, &c . p .221, &c.104to Headach. If any one of his senses be permanently increased, diminished , or depraved in anyway, he is generally liable to Headach on slightoccasions, and therefore has the predisposition tothis disease. Ifhe can neither retain his urine,when it should no longer be retained, nor have adejection requiring ever so little the concurrentaction of the abdominal muscles, without experiencing pain in his head, or giddiness, or a confusion of ideas, or an absence of consciousness,together with a sensation of sinking in the regionof his stomach, he has the Predisposition toHeadach.Whether there be in the system a certainquantity of energy, so that while one organ ismore excited than usual, the rest suffer a diminution of their power, although many facts seemto prove it, I am not able to decide: * but it hasoften been remarked, that some men, whose understanding is sound and efficient, and whosereasoning always commands attention, have theirseasons for study. Several such, whom I haveknown, were troubled with a Headach. Accipimus eum, qui Rem cum aliqua habeat, etsi aduratur vel incidatur, tamen ne minimum quidemDoloris Sensum capere posse.A mis-shapen head is acknowledged by Morgagni to be a sign of the Predisposition to Headach; and he adduces many instances of it . †

  • Bichât, Recherches Physiologiques sur la Vie et la Mort.

Edit. 3d. p. 127 and 128. But see how the ingenious Frenchman is anticipated by our countryman Sydenham, treating ofthe Hysteric Disease.+ De Sedibus et Causis Morborum, &c. Epist. i. §. 14,15. lxii. §. 15. 16.105Homer, like a true Craniologist, representsthe head of Thersytes, as pyramidical (poos, )and as proclaiming his malevolent affections,more especially his hatred of superiors, even ofKings.Of the configuration ofthe head, as connectedwith the intellectual and moral character of individuals, and of Gall's four-fold division of thebrain, I shall say nothing; but of the comparisonof the brain in different classes of animals, andof the relation between the faculties of animals,and the proportions of those parts of the brain,which are common to them all , Mons. Cuvierhas treated so strictly in the way of induction, thattoo much attention cannot be paid to him. Heconcludes, that the hemispheres of the brain arethicker in every direction in man, than in otheranimals; that the convolutions of the brain aredeeper; and that the inequalities at the base ofthe brain are more numerous. *1When the cranium is mis-shapen, there canbe no doubt, that a corresponding condition ofthe brain exists: those who have one hemisphereof the brain less than the other, must have itsblood vessels less developed . And if the hemispheres do not match, they cannot act harmoniously. Those who have odd eyes, do not seewell; and their eyes are often in pain.I do not mean to assert that, when an irregular form ofthe cranium is hereditary, then only

  • Cuvier Leçons d'Anatomie comparée. Tome i.

See also, Elemens d'Anatomie Générale, ou Description detous Genres d' Organes qui composent le Corps Humain,par P. A. Beelard, &c.106some peculiarity of structure, some lusus naturæis within it . There may, for ought I know, beas often peculiarities within the cranium, whenit is well-formed: for the brain and the cerebellum are liable to great varieties of originallymonstrous formation; the convolutions on theupper, the lateral, and the posterior surface ofthe brain have been found to differ in number,and in distribution: the hemispheres of the brainhave been found to be wanting, or to be incomplete the middle or the posterior lobes havebeen found without furrows and circumvolutions;the corpus callosum has been found to be wanting; one ventricle of the brain has been foundlonger than usual, and another shorter; one ofthe anterior lobes of the brain, where they areboth contiguous, has been found bulging out, andreceived into a depression of the other; some ofthe arteries at the base of the brain have beenfound larger than usual; a peculiar distributionof the arteries has been found at the base ofthebrain; the left lateral sinus of the dura materhas been found to be wanting: holes have beenfound in the falciform process of the dura mater;the falciform process of the dura mater has beenfound to be entirely wanting, the two hemispheresof the brain being united, &c, and similar defectsand deviations have been found in the cerebellum.Headachs occurring at an early age generallydepend upon a predisposition congenite with persons, and connatural to them; and it is not uncommon for persons to have such a Headach, astheir fathers, or their mothers had, They maybe expected to have it, ifthe figure of their heads107be peculiar, but be like their fathers, or theirmothers; more especially if they have beside, animbecility of their heads. But a Headach hasoften been traced bythe mere figure of the headto a grandfather, to a grandmother, and even tosome more remote progenitor, the predispositionperhaps not having existed, or not having beenexcited in every succeeding generation.Such impressions as the imitations of paintersand poets make on us, differ in degree principally from the impressions, which the objectsimitated make. These imitations have hithertobeen intended to stir up the passions only; buttheir effect in this way cannot be durable: * whyshould not the imitations of the painter be addressed to the reason, and so made subservientto the practice of physic? I have seen a familyportraiture, which I, as a Physician, consideredfar more valuable to that family, than Le Brun'sPicture of the Massacre of the Innocents couldhave been. I could wish, then, that the portraitures of patients who die of diseases, which aresaid to run in their families, were kept for thebenefit of their posterity. How many a portraiture is georgeously suspended as an ornament,which speaks a volume to those who can understand it.Morgagni complains, that the head of infantsis often disfigured by unskilful midwives, whoneglect, or who do not know how, to restore itsshape, after a difficult birth . And how muchthe form of the cranium is liable to be altered in

  • Namque iis, quae in Exemplum assumimus, subest natura,

et vera Vis: contra, omnis imitatio ficta est. Quinct. Instit.Orat. Lib. x. cap. ii.10813birth, and how it may then be reduced withoutinjury to of its volume, * are facts totally unknown to them, But whoever reflects on thedifferent degrees of ossification of the cranium atbirth; on the very acute angle sometimes formedby the bones of the cranium passing through adistorted pelvis; on the head of a male being generally or larger than that of a female; † on 49 out of 84 still - born children beingmales; on one-half more males than femalesbeing born dead; on the greater proportion ofmales than of females dying soon after birth, &c.will probably be inclined to believe that thefoundation of the predisposition to Headach issometimes laid in the very act of parturition.It is the custom of some barbarous nations toalter the form of the head immediately afterbirth: § and some suppose, that the faculties ofthe mind are not injured by the alteration: butwho can tell , how many infants may be killed byit; whether the foundation of some of the benevolent affections may not sometimes be destroyedby it, and the foundation of some of the malevolent affections laid; whether the predispositionto Headach, to convulsions, to epilepsy, to insanity, &c. may not sometimes originate in it?

  • Denman's Introduction to the Practice of Midwifery.

Edit. 2d. vol. ii , p. 49.+ Philosophical Transactions, vol. lxxvi.Philosophical Transactions, vol. lxxi.§ Adair's History of the North American Indians, p. 9.Marsden's History of Sumatra. p. 38.Mears's Voyages, p. 249.Lawson's History of Carolina, p. 33.Portal. Anatomie Medicale. Tome i. p. 92.109Galen maintains, that a head either too large,or too small , is accompanied with a limited powerof thinking: and it seems to be the general opinion, that a head smaller than usual is neverfound in one distinguished by his mental acquirements. However, what Galen says of asmall head, relates rather to a mis-shapen head . *But, in determining whether the head of anyindividual be large, it should not be forgotten,how much the magnitude of the head may depend upon the thickness of the bones of the cranium, upon the greater projection of the frontalsinuses, &c.Now, it is a very natural supposition, thatthe predisposition to a Headach maydepend upona tenuity and delicacy of texture, an exility offibre in some part of the brain; for weak partsare easily thrown into action: and as their actionis weak and soon exhausted, especially underunusual circ*mstances, so it is very apt to become diseased action.On the other hand, " the only well esta-"blished difference in the general anatomy of"the arterial system, previously to the period" of maturity, is, says Dr. Gordon, the much 66 greater absolute size of the capillary branches." This is always the more remarkable, theyounger the subject. " I presume, it will not 66

Scribit Galenus 6 Epid. Comment. 2. Aph. 3. acuta Capita, in quibus Dentium Positus immutatus videtur, ut inferiores e regione superiorum non sunt, sed veluti revulsum acdistortum Os videatur, Doloribus assiduis Capitis conflictari.Sennert. Pract. Lib. I. Pars. III . Sect. 1. cap. iii.† A System of Human Anatomy, by John Gordon, M. D.&c. Edinb. 1815. p. lxi.110be denied, that an unusual size ofthe capillary arteries may exist in the brain only, or in some portion only of it. All must acknowledge, that partsmerely weak by nature may be made strong byskilfully regulating their action. What is morecommon than to hear of those, who at an earlyage were unable to exert some ofthe faculties ofthe mind, having by a gradual intension of thosefaculties raised them to a surprising degree ofperfection? What is more common than to hearof those, who at an early age incurred a Headach on every extraordinary occasion, having atlength outlived it?Again, suppose the Cause ofthe predisposition to Headach to be a peculiarity in the figureofsome part within the cranium, or in its relativemagnitude, or in its total absence. Any peculiarity within the cranium may limit the cerebralfunctions, and cause the predisposition to Headach. Nature often accomplishes her ends inliving bodies by different means: and althoughnot so well, perhaps, as by such means as arecommon to the species, yet well enough for thepreservation of the individual, and for all his ordinary concerns. I have no doubt, that partsunusually formed within the cranium may bycarefully extended exertion have the sphere oftheir activity enlarged, so that the predisposition,depending upon them, to any disease may be sofar lessened, that the disease shall arise on feweroccasions, because not on such slight ones.The temperament most apt to be affectedwith Headach is generally said to be the sanguineo- melanchotic . I think it occurs equally inall temperaments; but that it is connected with111a less frequent systole of the heart: for childrenare not very liable to Headach, although itmay occur at any age: and the experienced andsagacious Dr. Heberden who fixes the limits ofthe pulse for the third, fourth, fifth , and sixthyears, at 80 and 108, says, that, if " the pulse" of a child be 15, or 20, below the lowest limit" of the natural standard, and there be at the" same time, signs of considerable illness, it is a" certain indication , that the brain is affected . "*It seems to me, assuming the average number of the pulse of men to be 73-75, or 75, in aminute , and of women, between thirty and fortyyears of age, to be 84, that Headach is most frequent from about forty-five years of age, whenthe pulse becomes gradually slower, to about 60,after which the pulse begins again to be morefrequent. Ofcourse the natural pulse of the patient in health should be known: for in hisHeadach, and, perhaps, for some time before it,his pulse is slower than natural .So much for that predisposition, which is hereditary; and for that, of which the Cause maybe acquired in early infancy. But the Predisposition to Headach may be acquired at any periodof life , and may not be known to exist afterwards for years, and never, perhaps, because itrequires an occasion, and, it may be, a veryparticular occasion to affect it, so as to producea Headach. There are some, who may everyday be heard to say, that they knew not what aHeadach is , till they had had a certain disease,or had suffered a certain injury.

  • Medical Transactions of the College of Physicians in

London. Vol. II .112The diseases which are said most frequentlyto leave behind them the Predisposition to Headach, are fevers attended with congestion, or inflammation in the head, and the specific diseases,scrophula, syphilis, &c.Fevers often give rise to an irregular distribution of blood in the head, and even to inflammation: but fevers maygive rise to them in any otherpart: and, if I am not mistaken, fevers give riseto them oftener in the lungs, in the stomach, inthe intestines , or in the liver, To fevers I wouldrefer drunkenness, the habit of which, as rendering persons liable to Headach, has long sincebeen noticed by Willis, Morgagni, Ramazini,and others. There can be no doubt that, in a fitof drunkenness, the action of the heart is increased; and that when the fit is over, the actionof it is diminished: some say, so diminished, asto be unable to unload the venous system. Morgagni says, that the habit of drunkenness produces a weakness and enlargement of the bloodvessels within the cranium; and therefore pressure on the brain, the cerebellum, and the medulla oblongata: and I am inclined to believeopium, when taken as a dram, does the same.Certain it is, that opium, like spirituous liquors,intoxicates a man, and then lays him asleep . †

  • APassione vehementi, a Crapula, Ebrietate, insuper a

Capitis Ictu, Vulnere, aut Contusione. Dispositio Cephalalgica non facile delebilis crebro inducitur. Willis de AnimaBrutorum. Pars Pathologica.Morgagni, de Sedibus et Causis Morborum, &c. Epist .lx. §. 13.Ramazini, de Morbis Artificum. Cap. xxi .† See Haller's Parallel of Wine and Opium. ElamentaPhys. Vol. v. p. 610, &c.113On the assumption, that more females havethe Predisposition to Scrophula than males, thegreater frequency and violence of Headach inthem might, perhaps, be accounted for. * ButI am not convinced, that more females have thescrophulous predisposition, or that females aremore subject to Headach than males, althoughthis is generally asserted. A smooth, transparent, white, and delicate skin, with rosy cheeks,light blue or grey eyes, light- coloured and weakhair, and a somewhat thick upper lip, I have sooften seen in those who had never had, in theiryouth, any swelling of the lympathetic glandsin the neck, or in the mesentery, any swellingofthe upper lip, or any affection of the eyes, orin their advanced life, any disease of the headsof the cylindrical bones, the bones of the carpus,the tarsus, or the vertebrae, and tumours containing a shining, flaky, and coagulated matter,although they had for twenty years, or more, carelessly exposed themselves to cold and dampth,&c. which might have occasioned inflammationin the most healthy and robust, that I agree withthose, who maintain that they are not really thesigns ofthe Predisposition to Scrophula. I haveseen many cases of scrophula in persons, whosehair was dark- coloured, and whose skin was notremarkable for the fineness of its texture: nay,

  • Sed vehementius Feminas tenet ob Diligentiam Capillorum, says Caelius Aurelianus, Morbor. Chronicor. Lib. 1.

cap. i. And Almeloveen adds, by way of explanation, quos(sc. Capillos) cum pectunt, comunt, tingunt, summittunt,Caput saepius lavant.I114I have known whole families of children, whosehair was almost black, to be affected with scrophula, although they had not one of the signsusually supposed to proclaim the Predispositionto this disease.The Predisposition to Scrophula is , I believe, always hereditary: but it does not follow,that a person must have scrophula, because heinherits the Predisposition to it . For it seemsto be fully proved, that scrophula may be prevented, ifnot, that the Predisposition to it maybe removed, by fortifying the body. Where,however, there is the Predisposition to Scrophula, in any part, for this may exist in onepart only, it may be excited in that part, by aconstitutional disease, or by an injury . If theconstitutional disease be a fever, when the febrileaction ends, it ends not in the healthy action ofevery part, but in the scrophulous action of thatpart: therefore the Predisposition to Scrophulacannot consist in mere weakness, local or general.The women, whom I have found to be mostfrequently the subjects of Headach, and of insanity, were the irascible, the arrogant, and thosesubject to effusions of spleen: such as had darkcoloured hair, dark eyes, a brown and coarse skin,a sallow complexion , a rather slender habit, smalland firm muscles, a slow and full pulse, vigour ofintellect, gravity of deportment, incapability ofdisguise, and awkwardness in attempting it;zeal and constancy in friendship, implacabilityin enmity, a predisposition to disease of the liver,a proneness to depression of spirits, and a frequently returning groundless apprehension ofhumiliation. And it tends, I think, to showthat115such women as these are the most liable to Headach, that women in general are so often afflictedwith it, after the final cessation of menstruation ,when some of the signs characteristic of sex disappear, and others rendering them more likemales appear. *The Predisposition to Scrophula in the brainmay, I think, be the Predisposition to Headach;and a Headach may sometimes be traced to it;oftenest, perhaps, after the age of 35 or 40: forif a person have had the glands of his neck swollen before puberty, or any other demonstrationof Scrophula, and complain after puberty offrequent attacks of Headach, he may have anexostosis ofhis cranium , or tubercles in his brain,resembling exactly such as are found in the mesentery.I am decidedly of Dr. Baron's opinion, thattubercles in the lungs are not produced by anykind of inflammation; and I have reason to believe they sometimes exist in the brain, as wellas in the lungs, at birth, and long afterwards,without producing any symptoms.If a scrophulous caries of the cranium extendto the dura mater, it must disturb the functionsof the brain.

  • Blumenbach refers to a Treatise in 4to. De Feminis ex

Suppressione Mensium barbatis, printed at Altorf 1664,and he says, that a change perfectly analogous is frequentlyseen in female birds, which, when they cease to lay eggs,lose the feathers peculiar to their sex, and acquire such ascharacterise the males. Instit. Physiol. §. 660.See also John Hunter's account of an extraordinary Pheasant, re-published from the Philosophical Transactions, in hisObservations on certain Parts of the Animal Economy.I 2116Whether Hyperostosis of the cranium evergive the Predisposition to Headach, as exostosisdoes, I know not: but I suppose it does, as ithas been found in those who had suffered fits ofepilepsy.Whether syphilis or mercury be the moresevere scourge of the votaries to Venus, is not aquestion to be here decided . But I am one ofthose who cannot see why mercury should produce affections in syphilis, which it does notproduce in the diseases, for which it is used sofreely in the East Indies; and who, at the sametime are persuaded, that mercury has not alwaysbeen employed in so moderate and gentle a manner as it should have been, for the cure of primary venereal sores, more particularly in irritable and scrophulous habits .

Not only Syphilis, but also those diseases resembling it, which depending upon secretions andsores, are propagated by promiscuous intercourse, may leave behind them the Predisposisition to Headach. Nocturnal pains of the headbeginning six weeks, or even much later afterthe removal of the primary symptoms of Syphilis,may be the mere precursor of some of the eruptive diseases attendant on Syphilis; but they mayalso be the consequence of some disease in theexternal, or the internal, table of the cranium,as node, caries, &c. to which Syphilis disposes.A syphilitic caries has destroyed the greater partof the cranium, and of the brain itself, even to itsventricles .A pregnant woman, affected with the venereal disease, may contaminate her foetus in ut-117tero and a child at its birth may bring Syphiliswith it, although neither its father, nor its mother have for many years had any symptom ofthis disease. * I have often seen infants notmore than two months old , with copper - colouredspots on the skin, and eruptions papular, tubercular, or pustular, with hoarseness, ulcers in themouth and throat, and upon the face, hands, andlabia pudendi, which I cured with mercury, because I thought them to be venereal; but whichI do not positively assert to have been so .I do not suppose, that the bones of infants areever affected with Syphilis, which generally attacks the hardest and most compact bones, andthe hardest and most compact parts of bones:but I suspect that they may be affected by itearly in life; for I know, that a Headach occurssometimes about the time of puberty, rages mostduring the night, the pains being as if the bonesof the cranium were being torn asunder, and extending down the cervical vertebrae; and thatmercury has seemed to cure it . I do not, however, ground my suspicion, that this Headach isvenereal, entirely upon its raging most in thenight; for I am aware that there are other painsas well as venereal, which rage most in thenight:† and also, that venereal pains do not always rage most then. My suspicion rests moreon such pains being often followed by eruptions.Hypertrophy of the brain, or enlargement of

  • Medico- ch . Transact. Vol. vII. p. 541.

See the Life of William Hey, Esq. by J. Pearson , F. R. S.+ Triller, Exercitatio de vespertina Morborum Exacerbatione, Opuscul. Medic. Tom. ii .Stoll, Ratio Medendi. Pars. II . p. 163.118this organ, is said to give rise to all the symptoms of Hydrocephalus. It is conjectured thatthis disease may arise from the sutures of thecranium closing too soon, so that the brain continuing to be developed, suffers compression.The injuries which are said most frequentlyto leave behind them a Predisposition to Headach, are blows or falls on the head and theymay have been received very early in life, andbeen forgotten or concealed by those, to whosecarelessness, if they had been known, theywould probably have been attributed . I shallnot enter here into a detail of all the possibleconsequences of a blow on the head: some ofthem I have already noticed; another of them,however, I take to be an irregular tumour, consisting of ossific matter, and projecting beyond .the level of the internal table of the cranium,perhaps, the effect of Nature's endeavour to repair an injury in a constitution, altogether freefrom the tendency to any specific disease.Tumours, the consequence of external injury,or of internal disease, arising from the internaltable of the cranium, and tumours, tubercles,hydatids, &c. in the membranes of the brain, orin the brain itself, whatever may have occasionedthem, may have produced no pain during theirgrowth, or after it had ceased, because in proportion as they grew, and compressed the brain,the brain in some way or other made room forthem. * Even a tumour on the tuberculum annulare, sunk into it , and extending to the corpus

  • See Sir Everard Home's Paper in the Philosophical Transactions for 1814. p. 474.

119pyramidale ofthe same side did not of itself produce pain; for the patient, Dr. Yellowly says,had been subject occasionally only to severe attacks of pain in the head .Abscesses and ulcers have been detected inthe brain of those, who had never complained ofpain and one whole hemisphere has been destroyed by chronic inflammation, without anypain or fever. I have already noticed, thatencysted abscesses in the brain have been unattended with pain in the head, or any disorder ofthe cerebral functions; and that, where personshave died with them, either active inflammationaround them, or hemorrhage had supervened.I think, however, that the abscesses may asjustly be placed among the Causes of the Predisposition to Headach, as to active inflammation,or hemorrhage. Whether tubercles in the brainever become hardened , and then lie in a dormantstate. or whether they ever become softened ,excavated, and covered with a semicartilaginousmembrane, as a curative effort of Nature, I cannot decide.It happens seldom, but it happens sometimes,says Celsus, that the whole of the cranium remains entire after a blow on the head, but thata blood-vessel, ruptured by it in the membraneof the brain, pours out some blood . * A caseof rupture of the middle artery of the dura materfrom the shock of a false step, in which the quantity of blood effused was prodigious, and thepatient died on the second day, with slight pain ofthe head, and slight giddiness, is given by Bell . †

  • Celsus. Lib. VIII. cap. 4.

+ Anatomy ofthe Human Body. Edit. II . p. 290.120But effusions of blood, in cases of apoplexy,from which patients have recovered, are noticedby many authors; and Sir Astley Cooper says,that his dissections have led him to believe, that" extravasated blood upon the brain, from apo66-plexy, and accidents, never becomes absorbed," but that the brain gradually acquires the power" of bearing its pressure; and that thus thesymptoms which are produced at the first mo-" ments of general extravasation gradually di-" minish. "*66And the brain may be lacerated in different parts, where no vessels carrying red bloodare to be seen; and, by consequence, wherethere is no effusion of blood; but the sides of thelacerated part remaining in contact, they maybe cemented together by coagulated lymph,and the laceration may be healed by the adhesive process.Morgagni mentions thickened membranes,and membranes joined to each other by coagulated and organised lymph, as Causes of thePredisposition to intolerable pains in the head.And he adds, that these pains return daily at thesame hour; and that they are the more dangerous, the more they are exactly periodical, so thatthey are seldom cured. Surely the reason thatthese pains return every day at the same hour canbe no other than that the circulation of the blood

  • See Sir Astley Cooper's Account of his Dissections of

Cases of Apoplexy. and Extravasations of Blood upon theBrain, in page 275 ofthe First Volume of Dr. Cooke's Treatise on Nervous Diseases.121in the head is every day disturbed at the samehour. *Are not new-formed parts in the brain, asweak parts are every where in the body, moreliable to ulceration from irregular modes of living, from violent exercise, from great depravations of habit, &c. under which, as they havelittle power, so they are unable to support themselves. I allude to cicatrices, &c.tI may here add, that fungoid affections arevery apt to exist at the same time, or in succession in different parts: thus the medullary sarcoma, or fungus haematodes has taken placefirst in a testicl*, and then in the brain.Dissections have shewn, in the medullaryportion of the brain, the cerebellum, and thespinal marrow, induration apparently withoutblood- vessels, altogether inorganic, and resembling the white of an egg boiled hard; also a softening, sometimes almost to fluidity, which isoftener of the thalami nervorum opticorum, andof the corpora striata . Ofthis softened part thecolour varies: it is sometimes as white as milk,or rosy, or red, or brown, or yellow. A violentpain in the head more or less frequently attends it; as do, according to its seat, differentchanges in sensation and voluntary motion, andin all the other functions of the nervous system.‡

Morgagni de Sedibus et Causis Morborum, &c. Epist.I. §. II . &c.+ Ansons Voyages.↑ Baillie's Morbid Anatomy. Edition 5th. p. 452.Rostan, Recherches sur le Ramollissem*nt du Cerveau.Oilivier de la Moelle Epiniere et de ses Maladies.122The intelligent reader is, no doubt, awarethat several appearances within the cranium,which some refer to injuries, others refer to diseases; and that several appearances, whichsome take to be morbid, others consider as natural, or as the consequence of death? Certainly,it must be acknowledged, that the same appearances have sometimes been detected in such ashad been subject to Headach, to convulsions, toepilepsy, to palsy, or to insanity: so that it isdifficult to tell why they should have caused thePredisposition to any one of these diseases ratherthan to any other. Perhaps, they maynot alwayshave caused the Predisposition to any of thesediseases, although when they were detected,they were supposed to have done it: for no morbid appearance is sometimes to be detected afterthe most distressing Headach, after Epilepsy,after Insanity, &c.It is generally a very difficult task to ascertain where the Cause of the Predispositionto Headach has its seat: for when symptomsare to all appearance the same, the Cause of thePredisposition is often very different. It is certain, however, that the seat ofthe Cause of thePredisposition may, in some cases, be ascertained: thus, in a case related by Du Verney, inwhich, first blindness (amaurosis), and nextdeafness, took place, it might have been inferred,that the cause was in the thalami nervorum opticorum , or in the course of the optic nerves withinthe cranium, although it could not have beenknownwhat the causewas: and in Dr. Yellowly'scase, in which the abductor muscle of the eye123was paralytic, it might have been concludedfrom the strabismus, together with the pain having for twelve months before shot occasionallyfrom the hind part to the fore part of the head,that the cause was at the point of union betweenthe nodus cerebri and the spinal marrow, or inits course to the foramen lacerum. But from theseat of the pain alone, in a Headach, we cannotvery confidently reason to the seat of its Cause,even although the pain should always have returned to the same place; for Morgagni relatesa case, where pain had always been referred tothe brain, but where a tumour was found in thecerebellum; and he thinks the pain in this casehad depended upon more blood being sent to thebrain in proportion as less was admitted into thecerebellum: * and in like manner, Dr. Lallemandattributes the symptoms of Mary Gabriel's case,communicated to him by Mons. Breschet, to thecompression of the sound hemisphere of herbrain, by the gradual enlargement of the inflamed hemisphere. †Thus, I think, I have in some manner advanced enough to show, that the perfunctory examination ofa patient labouring under a Headach,is inexcusable. I do not mean that questionsshould be put to a patient, till he is tired of answering them, which in most diseases is never,although in Headach it is very soon; but thatquestions, the answers to which have no ten-

Morgagni de Sedibus et Causis Morborum, &c. Epist.LXII. §. 16.Recherches Anatomico-pathologiques sur l' Encéphaleet ses Dependances.124dency to elicit a knowledge of the patient's case,should not be put at all . John Hunter says, thathe has heard such questions asked a patient asconvinced him that the surgeon had mistaken onedisease for another; or one stage of a disease foranother. Therefore, that a patient with a Headach, the severity of which is augmented by theexercise of attention, may not be harrassed byunnecessary questions, as he is too often, for noother reason that I can imagine, than that he andhis friends may be deluded, it is to be wished thatthe medical man, in whom he confides, may bewell versed in the appropriate studies of his profession; that he may more especially be acquainted with the minute structure of the humanbody, the properties of its different textures, thechanges which they may undergo, and the symptoms corresponding with those changes in everystage of their progress; that he may know inevery respect the habits and the idiosyncracy ofhis patient, if he have any, the disease that runsin his family, if there be any; and the diseasesand injuries which he may, even from his birth,have suffered; * then that he may be possessed of a talent for minute, comprehensive, andrapid observation, a memory at once retentiveand ready, and such a presence of mind as notto be disconcerted, and restrained in his exer-

  • Celsus says, cum par Scientia sit, utilior Medicus est

amicus, quam extraneus (Praef. Lib. 1 ); which is thus paraphrastically translated by M. M. Vitet: un Medecin Ami duMalade connoit mieux son Temperament, son Charactere saConduit, et les Remedes, qui lui conviennent, qu' un étranger. Mat. Med. Disc. Prelim.125tions, either by the rank and splendour of hispatient, or by the silly suggestions of ignorantintruders; and lastly, that he may be able toascertain of what kind a Headach is, and whether it be to be cured, or into what disease it islikely to be converted . Medicine is a conjecturalart: and they, who have seen many patients, aresometimes apt to conceive themselves duly qualified to judge of a case of anydisease; not awarethat, in medicine, if conjecture be not foundedon anatomical, physiological, and pathologicalknowledge, it is no better than blind palpation.And now, to return to the division of Headachs, as I promised. I presume that the readerhas clearly seen, that there are two kinds ofHeadach, essentially different from each other;one, in which every succeeding paroxysm is notmore violent than the preceding, but is generally less so; and another, in which every succeeding paroxysm is more violent than the preceding; that the former Headach is not excitedon all extraordinary occasions, but on some only;but that the latter is, more or less , excited onall extraordinary occasion; and, therefore, thatin the former, there is a disposition to discontinuea morbid action; but that in the latter, the vismedicatrix naturae is surpassed by the Predisposition, which increases even in the intervals ofthe paroxysms. * The former Headach, I shallcall Cephalalgia, the latter Cephalaea.φιλυπόςροφον γὰρ κακὸν, και ἐν ἐδρη ίζον τὰ πολλὰpwλEVEL. Aretaeus.126CHAPTER IV.SECTION II.OCCASIONAL CAUSES OF HEADACH.THE Occasions, on which a Headach mayarise, are so many, that I cannot pretend toenumerate them all. But all persons are notliable to Cephalalgia on the same Occasions,which probably depends upon the diversity ofthe Causes of the Predisposition to it in differentindividuals. This, however, seems to be certain, that whatever may be the Occasion of Cephalalgia in one, may be the Occasion of Cephalaea in all, provided that they have the Predisposition to it. I shall, therefore, take notice ofsome of the more common Occasions, whichthey who are liable to Cephalalgia may avoid;and of others, which they who are liable to Cephalaea, cannot avoid.The reason that some confound predisponentwith occasional Causes is, that many things,which produce the Predisposition to any disease,produce the disease itself in such as already havethe Predisposition. I have noticed the necessity127ofdistinguishing the Predisposition to a disease,from the Causes of that Predisposition.We know, that impressions made on our organs of sense are the occasion of sensations: butin what manner, or by what means, sensationsare produced, we shall probably never know.Every organ of sense is susceptible of itsproper impression only: the eye cannot receivethat impression, which excites the perception ofsound; nor the ear that, which excites the perception of light. All impressions on the eye excite sensations of vision only: nor does fire givethe sensation of heat to any nerve, except tothat which is appropriated to the surface.All our knowledge of the qualities of externalobjects is obtained by means of our organs ofsense; and we know nothing of them, excepttheir qualities. •We reckon five senses: seeing, hearing,smelling, tasting, and touching: but some resolve all these five into one; * and others add tothem a sixth.†All sensations are the more distinct, in proportion to the vivacity of impression: and vivacity of impression is increased by novelty andcontrast; by novelty, because it raises the curiosity and confines the attention; by contrast,because it changes the very nature of the sensation. The light of the sun, and the light of acandle, if viewed apart, are both white; but ifviewed together, the former is blue, and thelatter yellow.

  • Elemens d' Idéologie par A. L. C. Destutt- Tracy. Edit. II .

+ Buffon. Histoire Naturelle.128Two sensations affecting us at the same time,the one of them strong, and the other weak, thelatter is sometimes not felt at all. The starsdisappear before the sun.Two sensations may so agree in their naturethat neither of them is distinguishable in theircompound impression . The fragrance of a nosegay does not lead us to a knowledge of all theodoriferous flowers composing it.Two sensations, with a very short intervalbetween them, are apt to be confounded: twosounds at a less distance from each other, thanof a second, give the idea of a continuedsound. An ignited stick, quickly whirled round,gives the idea of a ribbon.Such are the general remarks, which I wouldpremise, to avoid repetition.First, then, as to Vision, which is the mostactive of all our senses. This depends upon thesecond pair ofnerves, the optic: and the impressions upon the retina, which is an expansion ofthe optic nerve, at the bottom of the eye, aremade singly and instantly.Some have their Vision naturally too acute,so that they contract a Headach on the slightestoccasion.Galen says, that they who have a Headach,cannot bear the light: but they who have thePredisposition only to Headach, may have thisdisease excited by too vivid a light; and, therefore, by coming too suddenly out of darkness intoordinary day-light. For although our organs ofsense are never in pain from the absence of theirappropriate objects, as parts used to perpetual129stimulus are, when this stimulus has for a timebeen withholden, yet their excitability shouldseem to be accumulated during their inaction.A person who has lost his eye-brows, or hiseye-lashes, is more liable to Headach, if he havethe Predisposition to it: for they are shades, andlessen the number of the pencils of the rays proceeding from the different points of a visible object. They serve also to exclude dust, and allsmall particles floating in the atmosphere. Butwhen the eye-lids are closed, light may be seenthrough them, which is, perhaps, the reasonthat they who have a Headach prefer utter darkness. * No organ of sense shows the energy ofthe brain so plainly as the eye.They, whose occupation requires the continual exercise of their eyes on minute objects ,and they who fatigue their eyes by poring over abook, printed in a small type, more especiallyin a dim light, are frequently affected with Headach. Mr. Travers, treating of amaurosis, observes that tailors and shoe-makers never see sowell as on a Monday morning, after the reposeof the eyes on the preceding day.It is a curious fact, that they who have losttheir sight, often dream that they are surveyingobjects; as they who have lost a leg, often complain of a pain in their toes. It is a proof, however, that the mind, and not the eye, sees; and

  • Ou cite des Exemples oú la seule Impression d'une Lumière vive sur les Paupières entièrement fermées, avoit donné

Lieu à l'Eternuement. Bichât, Traité d' Anat. Descript.Tome 11. p. 420.K130also that vision may be revived without light, insuch as have once seen. From frequent inquiries, made of persons who had lost their sight,by consequence of ophthalmia, it should seem,that, if one dream of viewing objects with attention, he always awakes with a Headach, provided that he have the Predisposition to it. And,indeed, if he, who sees , dream that he is surveying the paintings of great artists, and admiring thebeautiful masses of light, and shade, the grouping ofthe figures, the expression of the passions,&c. his sight is as much fatigued, when he wakesin the morning, as if he had been surveying themin his waking hours.Hearing. Persons who have long been insilence, hear for a time the more acutely for it:hence slight noises are quickly and acutely heardin the dead of the night. In all Headachs thehearing is more acute, unless the patient wasdeaf before their occurrence. In that Headach,which produces a collection of water in the brain,Dr. Rush knew two patients, whose hearing wasso acute, that they could not bear the noise ofthe sparks from a hiccory fire without starting.They, who have had their tympanum perforated, although deaf before, are said to hearpainfully for some time afterwards.The impression of sound should seem to besometimes conveyed to the portio mollis bytheportio dura of the seventh pair of nerves: aswhen the meatus auditorius externus is stopped,or the tympanum is imperfect, so that impressions are not conveyed in the usual way to theportio mollis: but when sounds are heard with131the face, it is not likely that they should occasion Headach. *Sounds may, perhaps, so affect the abdominal viscera as to occasion Headach. †Smelling. Mons. Magendie endeavoured toshow, that the first pair of nerves are not thenerves of smelling; but he seems to have forgotten that the healthy state of the portio dura,which controuls the action of the muscles on thecartilages of the nostrils, is necessary to the complete act of smelling: for if the portio dura bedivided, effluvia cannot be forcibly drawn to theseat of the sense of smelling. The common sensibility of the schneiderian membrane dependsupon the fifth pair of nerves.†Every one knows, that Headach is often occasioned by perfumes: Hippocrates says, thatthey occasion a heaviness of the head, (carebaria) . Many contract a Headach by smellingflowers in the open air, especially in the morning, while the dew is disappearing, and also ina fog, when the odorant particles are suspendedby the aqueous. I have heard of those, who

  • Medico- chirurgical Trans. Vol. ix . p. 422.

+ Les Sensations des Sons e' etendent sur les Nerfs detous nos Organes. La Musique peut produire en nous desEffets etonnans. Des Bruits violens peuvent affecter les Entrailles et determiner des Evacuations subites , produire delegeres Contractions des Muscles et meme de Convulsions, ou ,par une action differente, occasion la Stupeur des Membres,&c. Portal, Anat. Medic. Tome iv. pages 140, 191, 480.An Exposition ofthe Natural System ofthe Nerves oftheHuman Body, &c. by Charles Bell.§ Aph. 28 of Sect. V.K 2132could not bear the smell of pinks and honeysuckles, and who were ready to" die of a Rose in aromatie Pain."The hydrocyanic acid, of which the odourproduces almost instantly a pain in the headwith deafness, exists naturally in bitter almonds,kernels of apricots , of peaches, of cherries, inleaves of laurel, in peach blossoms, &c. Thisexcites no inflammation. It is a most virulentpoison, and as it exists in flowers, leaves, kernels , &c. the odour of it seems to affect thenerves of the blood-vessels, and to occasion àdilatation of them, which dilitation is passive,and lays the foundation of a local congestion,and of a disproportionate circulation throughthe brain. No antidote is yet discovered forthe hydrocyanic poison: but for the Headach itoccasions, we employ stimulants, as carbonateof ammonia, brandy, &c.Orfila says, that a person was killed bysleeping in a room with rose-bay and Dolaeus, that sleeping under a walnut-tree oċċasions Headach.They who are suffering from the aroma offlowers are advised, by Orfila, to go as quicklyas possible into the open air, to inspire the vapour of vinegar, and to drink a draught of sugaredwater.Animals that do not smell, are said to tastethe emanations of odorant bodies; emanationswhich in a manner become visible, when thosebodies are floated on water.Humboldt says, that the smell of a dogawakes a crocodile from the sleep ofhybernation.133It is impossible to overlook the analogy between different diseases of the head, althoughone may not agree with Dr. Mead, that suchdiseases generally proceed from too much bloodin the head. I shall only remark here, in addition to what is elsewhere said, that most insanepersons have a pain in the head, or have had it;and that light is equally disagreeable to an insane person at day-break, and to a patient labouring under Headach . *Attention. Perceptions are soon forgotten,if the objects, which occasion them, he not attended to, Attention requires an effort, and thata voluntary effort: it is the state of one, whowishes to overcome a difficulty. There are some,who cannot exert this faculty at any time, theleast unseasonable, without feeling a pain in theirhead. And the famous Boerhaave, by unremitting attention to a single subject, for awhole day,was prevented from sleeping for six weeks.Attention is more likely to occasion a Headach, when obstacles are in its way; as when onelooks upwards stedfastly at objects in the Heayens, or, downwards from the battlements of atower, since it is more difficult for him to judgeof things which are either much above, or muchbelow his level; also when one inquisitivelyturns his eyes to fixed objects, while he is ridingin a carriage, sailing in a boat, or whirled aboutin a swing; and also where one directs his sightto objects in rotary motion, himself being still.Divided attention is powerful in occasioning

  • Dictionnaire des Sciences Medicales. Art. FOLIE.

134Headach; as when one surveys an extensivelandscape from a window, either embracing thewhole of it at once, or even regarding one partof it after another, beginning with the moststriking parts, then passing to the less striking,and so on, marking the respective situation of allthe parts in succession. Cæsar is said to havedictated to seven Secretaries at once. *Remembrance or Reminiscence may occasiona Headach. A lady, whom I know, always feelsa pain in her head, when she thinks of a favoritechild who died. I once saw her faint at a concert, as soon as a tune was begun, which herchild had been accustomed to play and on herrecovery, she told me, that the mere Reminiscence of her child always made her Head ache.Some persons shudder at the remembrance ofwhat they have suffered , or of what they haveescaped; and others become sick at the veryname of ipecacuanha, or of antimonial wine. †Recollection, or active Memory, or readyMemory, which depends upon the will of theindividual, is so common an occasion of Headach, that every school-boy, and every adult,Ssribere et legere simul, dictare et audire accepimus:Epistolas vero tantarum Rerum quaternas pariter Librariisdictare, aut, si nihil aliud ageret, septenas. Plin. Hist. Nat.Lib. viii. cap. 25.+ Who, if he have had a classical education, does not remember these admirable and very beautiful lines:Stetit acer in ArmisAeneas, volvens Oculos, dextramque repressit:Et jam jamque magis cunctantem flectere SermoCoeperat infelix Humero cum adparuit altoBalteus, et notis fulserunt cingula bullis135who is in the habit of looking beyond the surface of things, may have experienced it. Whena person is describing his Headach, althoughhe may not have had a paroxysm of it for years,he may occasion its return.As Headach is a very common effect of theendeavour to retrace the evanescent processesof Thought, as when one is obliged to stateto others the grounds on which he proceededin forming some decision, so it is common whenone follows a series of judgments in a book onany science, of which he scarcely knows thefirst principles. Every one finds Study the lesshurtful, the more his intellectual faculties havebeen improved; the more he is acquainted withthe principal divisions and ramifications of science; and the more the objects of his reasoningare connected with the particular details, withwhich his senses are conversant. For thus prepared, his mind is directed , and prevented fromdigression. I believe, a Headach is never theconsequence of the formation of general principles; the characteristic properties of things,when once the things have been fairly examined,arising spontaneously in the mind, by a kind ofReminiscence, which, Themistius says, is always most perfect in the most ingenious minds.Pallantis Pueri; victum, quem volnere TurnusStraverat, atque humeris inimicum insigne gerebat.Ille, Oculis postquam saevi monumenta DolorisExuviasque hausit, Furiìs adcensus, et IraTerribilis: Tune hine Spoliìs indute meorumEripiare mihi? Pallas te hoe Volnere. PallasImmolat, et poenam scelerato ex sanguine sumit,Hoc dicens, Ferrum adverso sub Pectore conditFervidus.136Night Study, which is always protracted,and prevents sleep, and also Study immediatelyafter meals, which prevents digestion, frequentlyoccasion Headach.Are not some portions of the brain expanded,or erected, in sensation, perception, attention,recollection, &c.? If this be the case, theremust be an irregular distribution of the blood inthe brain. I would not, then, be considered asone, who denies, that the brain is actually theinstrument of sensation, perception, memory, &c.so that a Cause almost physical may, perhaps,be assigned for the Headach of those, who applythemselves, late in life, to Study: for thestrength of the perceptive, as well as of the physical faculties, is elicited with the developmentof organization, is confirmed by the pursuit ofknowledge, and continues through life with increasing vigour, till the decay of the body begins.Dr. Fothergill, writing on Hydrocephalus,remarks, that " several of the children who came" under his care in this disease, were either the" favourites of the family, or the sole hopes of" their parents."* Their quickness of perception, their ready memory, their uncommon docility, and their playfulness, are often, I suspect,the motives for sending them to school soonerthan others, that they may have the full advantages oftheir premature endowments. But theirprecocity is generally connected with the Predisposition to scrophula; and this with largearterial capillaries..

  • Medical Obs. and Inq. Vol. iv. p. 42.

137What then can be more absurd than to forceorgans to act immoderately, before they are socompletely formed as to act firmly? I am anadvocate for early education; and from the organization of the eye, and of the ear being almostas perfect at the full term of gestation as it is inthe adult, I would infer that education is ordained to be early. Indeed the first age seemsto be intended for the education of the senses;the second for the improvement of the memory, and the third for the exercise ofjudgment;and this derives confirmation from the quickergrowth of the brain in the foetus, of the limbsin childhood, and of the genitals at puberty.I have heard it stated, and I believe it, thatwe never acquire so much knowledge, as in thethree first years of our life . These are yearsof observation and discovery: and as observationand discovery are almost the sole pleasure ofyoung children, this pleasure should be encouraged. It is Nature who then teaches; and wecannot teach so well as she does. It is the habitof exercising the organs of Sense that rendersthem perfect. How admirably does Dr. Reidremark, that if children, from the time they begin to employ their hands, had all the Reasonof a Philosopher, they could not be more properly engaged! In Roger Ascham's SchoolMaster, and in Dr. Watts's Essay on the Improvement of the mind, I have found some excellent observations on the instruction of children, which those, who have the care of them,may, I think, read with advantage. As boys,

  • Bichat, Anat. Descriptive. Tome v. p. 406.

138however, are often sent to school at a very earlyage, to learn Latin and Greek, I might hereproduce what a most accomplished Physician,the Baron Van Swieten, says of certain pedagogues, who, by their rigid discipline, sometimesrender their scholars epileptic, or dull and silly,all the rest of their lives: but it is unnecessary:my firm belief is, that the school-masters inEngland show more discretion in teaching, andin correcting; and that they never punish theweakness of nature, rather than the fault of thescholar.We often hear of the Mind of Man being disordered, deranged, and sometimes of its beingfatigued and wanting repose; but when I speakof the Mind of Man, I allude to nothing like sensation, perception, and memory, which are ofnecessity connected with a particular organization, which are improved as the organizationbecomes developed and strengthened , and which,on the contrary, are impaired as the organizationbecomes weakened and decayed. When I speakof the Mind of Man, I mean nothing that is ofnecessity disturbed, when his brain is in any partdisorganised. When I speak ofthe Mind of Man,I mean nothing common to him and to the loweranimals '; but that higher order of intellectual faculties, by which man contemplates the qualitiesof objects apart from the actual assemblages ofnature; by which he connects the objects of histhoughts according to various relations, essential'or not essential; and by which he performs general reasoning; faculties, with which bruteshave never been supposed to be endowed.་It may be objected, that the operations of139the mind are manifested through the medium ofthe brain but granting, that we could not betaught, that wisdom, which " maketh wise untosalvation" without the brain, yet it does not follow, that the brain should not be the medium bywhich inferior qualities, as seeing, hearing, &c.are also manifested. The male urethra serves toconvey sem*n, as well as " the water of thefeet;" the former, then only, when the sensibility of the urethra is at a high degree: the latter,then only, when the sensibility of the urethra isnot higher than usual. Ifthe " Breath of Life,"" the Breath of the Almighty," " the Spiritwhich returns unto God who gave it,"immaterial Soul" could not exist without beingunited to a particular organization ofmatter, whyshould its immaterialty, its separate existence,its surviving the putrefaction of the body, andits returning unto God who gave it, have beenso much insisted on by the inspired writers? Iprofess, that I believe in the life of the blood, notso much from the arguments of John Hunter, although they seem to me to be conclusive, as fromthe explicit assertions of Holy Writ. * 795 *..the

Dr. Spurzheim's assertion, that " the Cause " of every Derangement of the Manifestations of " the Mind belongs to organic Parts, " is in direct opposition to the experience of Pinel, Esquirol, Georget, and others.

Indeed, there is the evidence of the mind

  • Genesis ix. 4. Levit. xvii. II. 4.

Sallust puts Sanguis for Life (ne illis Sanguinem nostrumlargiantur. Bel. Catal. § . lvii . ) and other heathen writers have done the same.140itself to show, that it is never fatigued, never disordered, but always active, vivid in the decrepitness of age, and so transcendent in the veryact of dying, that some of the wisest and best ofmen have been led to the belief, that it manifestsits independence on matter, nay, its immortality,by divination, while it effects its escape from themouldering prison of the body, to return to Him,who placed it there.* We are often told of thereason of apes, and how they like warmth, andassemble around the embers which the centinelsat Gibraltar leave, after having boiled their kettles: but we have never heard, that they are ledby reasoning to apply the chips, which are leftnear the fire, to prevent its extinction,66Of the qualities bearing a resemblance tovirtue in man, which dogs, lions, and horsespossess, there are well authenticated and wonderful examples, and we do not deny that somebrutes possess aliquid simile virtutis . † And asMr. Langstaff says, " domesticated animals areliable to most of the morbid ulcerations ofstruc-" ture to which mankind are prone, with thisdifference, that they are capable of sustaining" for a greater length of time pain, and destruction of parts, than the human being; " but, heasks, " can this be accounted for from their want" of a reasoning faculty?"66The reasoning of brutes, such as it is, is

  • Genesis, chap. xlix. in D'Oyly's and Mant's Bible.

Petri Petiti Comment. et Animad. in secund. AretaeiCappad. Lib. p. 160+ Cic. Fin. 5. 38.

Medico-ch. Transact. Vol. ix . p. 348.141confined to particular facts and circ*mstances,connected with their own preservation: but man,even in what is called his mental derangement,abstracts, generalises, and exercises generalreasoning, to the use ofwhich, language, as aninstrument of thought, is indispensably requisite.' 'After a most impartial and patient consideration of the opinions, arguments, and authoritiesof Physicians of the greatest celebrity, concerning madness, insanity, or whatever it should becalled, and after all that I have seen of it, I aminclined to agree with the learned Dr. Mead, thatboth species, Melancholia and Mania, consist inthe strength of imagination; for as this samePhysician afterwards remarks, " there is nothinghow incredibly silly soever, and contrary togood sense, but may affect à depraved imagination. " Now imagination is not a simplefaculty for it consists in so combining the partsof different objects as to form new wholes, whichhave no real existence. And if a person modifyand combine the parts of different objects in soextraordinary a manner, that the new whole ofhis own creation gives no pleasure to any one,except to himself, and if he believe in the actualexistence ofthat whole, then we say, that he hasá depraved imagination, or that he is insane.*66

  • There is much truth, but much vague and unsupported

assumption too, in what Richerand asserts: Le Traitementmoral est de beaucoup preferable: il faut eloigner l'aliénédes Causes de son Délire, entrer dans l'Ordre de ses Idées ,et l'amener peu à peu à en sentir la Fausseté. Les Ideesfixes sout la Cause la plus frequente de la Manie. Se complaire et s' arreter trop long Temps à une même Idée est le142He assumes false premises;reason incorrectly from thembut he does notIt is the depressing passions, which give rise to insanity: thesedisorder the functions of some of the distant organs ofthe body, and these organs re-act on theintellectual functions, and give rise to insanity.66I shall take this opportunity of recommending a careful perusal of Dr. Burrows's " Inquiryinto certain Errors relative to Insanity; " awork embracing subjects which may in vain belooked for elsewhere, and ofwhich it may be trulysaid, plus habet Operis quam Ostentationis.Passions. These, like the affections, are bysome aptly enough divided into benevolent andmalevolent, being nothing more than the affections increased beyond the bounds ofmoderation.Although affections ofthe brain, they are most feltplus sûr Moyen de perdre là Raison: et lorsque Newton parle Force d'une Attention constante et soutenue, découvroitle Lois de la Gravitation, et atteignoit ces verites sublimes, iln'etait pas loin de l'alienation: nullum magnum Ingeniumsine Mistura Dementiæ. Erreurs Populaires, &c. p. 197.But his countryman, Pinel, would not have spoken thus ofNewton. On the contrary, he affirms, that " in consulting"the Registers of Bicetre, we find many Priests and Monks,66 as well as country people, terrified into this Condition by" the anticipation of Hell Torments, many Artists, Painters," Sculptors, and Musicians, some Poets extatised by their" own productions, a great number of Advocates and Attor-" nies: but there are no instances of Persons whose Profes-" sions require the habitual Exercise of the judging Faculty;" not one Naturalist, not a Physician, nor a Chemist, and" for the best Reason in the World, not one Geometrician."Davis's Translation of Pinel's Traité sur l' Alien. Mentale,&c. p. 114.143in the breast; and every Passion has a corresponding expression of the features, which is modified by sex, age, the state of the individual'shealth, his education, &c.* Haller divides thepassions, not metaphysically, but physiologically,into exhilarating and depressing; the former distinguished by increased strength and frequencyof the pulse, the latter by debility and retardation ofthe pulse. † Anger belongs to the former;grief, fear, shame, aversion and disgust to thelatter. And during anger, the force of the loco-

  • According to Lord Bacon, " Shame causeth Blushing.

Blushing is the Resort of the Blood to the Face, althoughBlushing will be seen in the whole Breast, yet that is but" in Passage to the Face." This is by far the best account of Blushing that I have seen: for as Mr. C. Bell says,66 a review of the human frame in a state of high activity, or" under the influence of passion, will convince us that the" motions dependant on respiration extend almost over the" whole body, while they more directly affect the trunk," neck, and face. " An Exposition of the Natural Systemof the Nerves of the Human Body, &c. p. 48. Again, " TheLanguage and Sentiments of every People have pointed to" the Heart as the Seat of Passion . "—" Although the Heart" be not in the proper sense the Seat of Passion, it is influ66enced by the Conditions of the Mind, and from thence its" influence is extended, so as to mountto the Throat, Lips," and Cheeks, &c. Ibid. p. 280.The Cynic Diogenes, is said to have called a Blush, theColour of Virtue. Aug. Buckner. Epist. Plinii Lib. iv.Epist. 17.The word Virtus, is often put ironically for Vitium, Flagitium; as in Terent. Adelph. Act. ii . Sec. I. And Manutius says, 66 potest esse Virtus. sine Innocentia." M. T.Ciceronis Epist. ad Fam. Pauli Manutii Arg. et Annot, illust.Lib. xv. Epist. 5.+ Elementa Physiologiae. Vol v. p. 589.Nisholls, de Anima Medica.144motive organs is increased, as well as the contractions ofthe heart. How both the exhilerating and the depressing Passions may produceHeadach, how they may both not only cause,but also cure diseases, how they may both killsuddenly, &c. these are questions, into whichI cannot enter.It is remarkable, that both Anger and Jealousy, which consists of Anger and Fear, produce such effects, that they have often beendenominated by the symptoms, or by the supposed causes ofjaundice and of insanity. * Butthat mental affections often disorder the stomach,alter the sensibility of its nerves, produce a turgescence ofthe blood- vessels in its villous coat,and occasionally give rise to dyspepsia, haematemesis, scirrhus, and headach, are facts generally known. Anger and grief are, perhaps, thePassions that most frequently occasion Headach;at least I have observed them to be so.Appetites. Hunger, thirst, &c . which areattended with a painful sensation, and are notconstant, but return at intervals, being satisfiedwith the attainment of their object. Hunger isa frequent occasion of Faintness and of Headach,

  • Cum tu, Lydia, Telephi

Cervicem roseam, cerea TelephiLaudas Brachia, Vae, meumFervens difficili Bile tumet Jecur. HOR.quo deinde, iusane, ruis? Quo?Quid tibi vis? calido sub Pectoré mascula BilisIntumuit, quam non extinxerit Urna Cicutae, PERS.See the Notes of Ruperti on the 45th and 165th Lines ofJuvenal's First Satire.145and sometimes of epilepsy, and sometimes of atemporary blindness *Celsus asserts, that a person between twentyfive and thirty-five years old bears hunger moreeasily than boys and old persons: more easily ina dense than in a light atmosphere: more easilyin winter than in summer: more easily, if accustomed to one meal a day than to a supper also. †It were easy to produce instances of hunger;but I shall refer to one only, Mrs. Woodco*ck's:buried under the snow for eight days, near Cambridge, she is said to have preserved her life byoccasionally sucking the snow. And the reason,that hunger is more easily borne in a dense, moistatmosphere, than in a thin and dry one, is nodoubt, that in the former, the skin inhales moisture from the atmosphere. It is easily conceivedhow the excitability of the system is augmentedby a total abstraction of nutriment: persons whohave eat nothing for several days together, havebeen intoxicated by a bason of broth.Desires. Desires are constant: they neitheroperate periodically, nor cease entirely with the

  • See Dr. Park's Paper on Hunger and Thirst in the Journal ofScience, &c. No. x1 .

† Lib. 1. Praefatio; and also Lib. 1. cap. 3. where hesays, Quod ad Aetates vero pertinet, Inediam facillime sustinent mediae Aetates, minus Juvenes, minimè Pueri et Senectute confecti.Morgagni de Sedibus et Causis Morbor. Ep. xxviii.Haller, Elementa Physiologiae. Vol. vi.Miscellaneous Works of the late Robert Willan, M. D.edited by Ashby Smith, M. D. p. 440.L146attainment of their objects. Headach is occasioned by the desire for some object, ofthe attainment of which there is sometimes a prospect,sometimes no prospect: when there has been aprospect, it has excited the circulation, andcured a palsy. But when very intense, it hasoccasioned epilepsy, and even an aneurism ofthe aorta. *Sensibility fostered preposterously, whetherin females, or in males; as when one cannot seea person in hysterics, without falling into hysterics one's self, or having a Headach: and is,therefore, not inured to the common occurrencesof life. But I must touch lightly on so tender asubject as the modern sceptical system of politelife.Sleep. As to the cause, and even the phenomena of Sleep, authors differ greatly: † butno doubt can be entertained, that he, who sleeps,has his volition suspended; and that sleep isfavoured by the abstraction of external stimuli,as light, sound, &c. A state resembling sleepmay be occasioned by pressure on the brain, asis seen in cases of spina bifida, and by whirlinga person extended across a mill- stone, so thatmore blood may, by the centrifugal force, bedriven towards his head; but it does not appearthat natural sleep depends upon compression ofthe brain. When sleep is occasioned by cold,

  • Haller, Elementa Physiologiae. Vol. v. p. 582.

+ See Dr. Park on the Cause of Sleep, in the Journal ofScience. &c. Vol. vii. p. 238.↑ Cullens Institutions of Medicine. Part I. Physiology. §.cxxvi.147or by narcotics, it, perhaps, and the torpor arethe consequence of a diminished faculty of producing heat.Every one knows, that when a person isasleep, he is pale; and that, if not covered morethan usual, he is cold, because his power of producing heat is lessened.All do not agree, as to the state ofthe pulse.Galen, and many of the earlier writers , and,indeed, some later writers, state the pulse to beslower; but others, and among them, Dr. BrowneLangrish, maintain the contrary. He says, that" the pulses of grown persons are observed to" beat faster during sleep, than at other times," the ordinary number of pulsations in a minute 66 being from 70 to 80, under a state of waking" and moderate heat, and from 80 to 96 during"the time of sleep. "* It should seem nowto be admitted that, in ordinary sleep, thenervous and muscular powers are increasedby the suspension of voluntary motion; and,therefore, that the action of the heart is fuller,and slower but that in sleep after a full meal,the action of the heart is not only stronger,but also more frequent, by consequence of theheat disengaged during digestion, and of thestimulus of fresh chyle poured into the blood.There can be no doubt, that the longer volition is suspended, the more the nervous and themuscular powers are increased; for all our sensations are more vivid in sleep; and our morningdreams are more various and vivacious than those

  • The Modern Theory and Practice of Physic. p. 273.

148soon after lying down. Digestion, secretion,and nutrition are more vigorous in sleep: andeven plants grow more in their sleep . - Nobodydenies, that perspiration is more active in sleep:and they who think, that the kidneys secrete lessin sleep, have taken a very partial and superficialview of the subject. The truth is, we nevermake water, without wishing to do it: therefore,we do not make water in our sleep, when volition is totally suspended. Because little wateris made in the morning, it does not follow thatlittle has been secreted in the night. Thedeepercolour and the greater specific gravity of morning urine show plainly, that a large quantity hasbeen secreted, the thinner and more aqueouspart of which has been absorbed. *Children sometimes wet their beds, whenthey sleep upon their backs, and feel such anuneasiness from the pressure of the urine uponthe most sensible and vascular part ofthe membrane lining the bladder, that volition is in somedegree excited, but not in a degree sufficient toawaken them. The ecstacy of infants in theircradles consists in an exertion to get rid of somepainful sensation: and we turn in bed, withoutwaking, to remove the uneasiness of a continuedposture. In incubus, or night-mare, we imagineand believe ourselves to be oppressed by someprodigious weight, and to be almost suffocated:and we should awake, instead of having thenight-mare, if our sleep were not so profound.The night-mare sometimes attacks persons inthe

  • Darwin's Zoonomia. Vol. i . p. 198. Vol. ii . p. 397.

149night, when they are not asleep. * Headach,like epilepsy, makes its attack oftener duringsleep than waking; which is, I suppose, owingto the increase of sensibility. I have knownpersons subject to Headach, who dreaded a protracted sleep; and who very seldom awoke fromany sleep, without a Headach, unless they hadfreely perspired during it.Sleep not in a recumbent posture, and at unseasonable hours, at noon especially, is noticedbyvery manyauthors, as an occasion of Headach.Whoever would sleep comfortably, and awakerefreshed by it, should go to bed betimes, withan unloaded stomach, and be more attentivethan usual to the position in which he is to lie:but night-mare seldom, if ever, seizes him, wholies on either side . He should lie horizontally,to favour the passage ofthe chyle into the blood:but he should lie on his right side; for then theheart neither strikes the ribs, which may occasion dreaming, nor is it compressed by the lungs;neither are the contents of the stomach, whichare powerfully digested during sleep, preventedfrom easily passing through the pylorus.Heat ofthe Atmosphere. The heat of the drysurface of a man's body in health to vary from86° to 981° of Far. but it is one degree less in themorning than in the evening; and it may be varied by external applications and by diseases.Under the influence of some diseases, the power

  • Deterius est, ubi per Noctem etiam vigilantibus incumbit.

Lommius, Obs. Medicinal. Lib. ii.Vix unquam Incubus accidit in Latus cubantibus. Lommius, Loco citato.150of producing heat is often much increased . In aboy, twelve years old, afflicted with tetinus, Dr.Prevost, of Geneva, found it 11030; but theEditor of the Edinb. Med. and Surg. Journalrarely found it in continued fever, scarlatina,measles, and small-pox, above 105° , in, perhaps,half a dozen instances 107°, and once only 10740.This is more remarkable, since Dr. Currie foundit in scarlatina as high as 112°.It has been supposed, that man, and themore perfect animals in health, preserve theirtemperature in all the varieties of season andclimate but the contrary seems nowto be fullyproved the greatest variation observed betweenSummer and Winter, by Dr. Edward's, was inthe case of the Sparrow; the mean of severalexperiments gave 105° . 33. for February, 107°. 5.for April, and 110°. 75. for July. † Nevertheless, during health, a room heated to 200° . doesnot raise the temperature of our bodies three degrees, although an animal dies sooner in a warmatmosphere than in a cold one, perhaps, becausethe blood then passes through the capillaries notsufficiently decarbonated . Man certainly couldnot long sustain a heat of 210°, 224° , 240°, andeven 260°, although there are instances of hishaving endured it for some time . But a close,crowded, and heated room occasions langour andlassitude, giddiness, a mist before the eyes,sometimes a bleeding at the nose, or if these

  • Edinb. Med. and Surg. Journal. Oct. 1824. p. 363.

↑ Seethe Edinb. Med. and Surg. Journal of Oct. 1824. p.332. for an account of Dr. Edward's Experiments on the Influence des Agens Physiques sur la Vie, &c.151effects do not occur, a Headach, or a fit of apoplexy. The atmosphere of such a room, besidesbeing rarefied, and containing less oxygene ina given volume, is loaded with moisture, sothat although the matter of perspiration is condensed into drops upon the skin, yet perspirationis diminished, and the power of resisting heat isdiminished.66The power which the body possesses of supporting changes of climate, is rather a change inthe power of producing heat, which is greater ongoing into a cold climate, and less on going intoa hot climate, than the difference of evaporationin different temperatures. Dr. Currie supposesthe remarks of Dr. M'c Kittrick Adair, " that the"heat ofthe European on his arrival in the West" Indies has been observed to be three or fourdegrees higher than that ofthe natives, or ofthose accustomed to the climate, to which,however, it gradually sinks in the course oftime," to be one of those inconsiderate observations by which medical science is so often corrupted. Dr. Currie was led to this suppositionby the experiments of Dr. Chisholm, in Demerary, which contradict Dr. M'c Kittrick's remark:* but the more accurate experiments ofDr. Davy, at Ceylon, confirm Dr. M'c Kittrick'sremark. †6666The Sun. Solar Heat was very early found

  • Medical Reports of the Effects of Water, cold and warm,

&c. Vol. i . p. 279.+An Account of the Interior of Ceylon, &c. by John Davy,M.D. F. R. S. Part iii.152to be sometimes an occasion of Headach. * Sauvages is uncertain whether the Headach frominsolation should be placed among his species ofCephalalgia. He says that, on opening the headof such as had died of it, he found nothing amiss.Secto Capite, nihil laesi inveni . † It should , Ithink, be treated by prompt and large depletion,and by cold applied to the head. I restored aneighbour of mine from Coup de Soleil by suchmeans, applying the same mixture of muriate ofammonia, nitrate of potass, and water, in a bladder to his head, as Sir Astley Cooper uses atGuy's Hospital, in cases of strangulated hernia.Cold. Persons are said, by Mons. de l'Isle,to have lived at Kirenga, in Siberia, in an atmosphere, when the thermometer stood at 118° below o of Farenheit. We know, however, thatpersons die, ifthey fall asleep in an atmosphereeven 12° above 0. Extreme parts, as the toes,fingers, ears , nose, &c. in winter, are many degrees colder than our arms and legs: but our internal parts are seldom below 96º.Headach is more frequent in winter and during cold weather, and damp, when the skin ispale, the perspiration is diminished , and the

  • The Bible. Judith. chap. viii.

Morgagni de Sedibus et Causis Morborum, &c . Epist. v.§. 13. vi. §. 5.Hunter on the Diseases ofthe Armyin Jamaica, &c. p. 100.Selle, Rudimenta Pyretologiae Methodicae. p. 141 .Bichât, Anatomie Generale. Tome i . p. 34.+ See his Species Cephalalgia Anemotropa, and Carus abInsolatione.Martine's Essay towards a Natural and ExperimentalHistory ofthe various Degrees of Heat in Bodies.153whole body occupies less space, as is shown byrings then dropping off the fingers. And then,while less blood flows to the surface of the body,more must by consequence be circulating withinit; and circulating irregularly. It is in the beginning of winter principally that Headach, vertigo, and apoplexy, are more frequent, or whenthe weather becomes suddenly hot, after havingbeen long cold and damp, as Morgagni remarks,speaking of Anthony Tita. He thinks too, that,in hot weather, the blood is greatly expanded. *I have seen several cases of mortified feet fromextreme cold; and I could never learn from thepatients that they had felt a pain in the head.They could recollect the sleepiness only, whichthey described as a sort of Coma: and we aretold that those who have died of cold have hadthe vessels of their dura mater turgid with blood,and its ventricles containing a collection oflymph.Extreme cold certainly diminishes the nervousand muscular powers: as is clear from the peculiar lassitude felt on very high mountains, whichis, I believe, rather a degree of Asphyxia; forthe atmosphere there being rarefied, contains verylittle oxygene to support animal heat; and theywho suddenly die, fatigued by climbing thosemountains die with all the signs of suffocation, †and, perhaps, with their sensible cold greaterthan their thermometrical. But if their nervousand muscular powers be diminished by any othercause than cold, the skin turns pale, and the body

  • Morgagni de Sedibus et Causis Morborum. &c. Epist. iii.

+ Saussure. Journal de Physique. Sept. 1788. p. 209.154shrinks. Dr. Martine was pale, all-shivering, andsuffering a great degree of cold in the beginningof an ague fit; and yet his skin was 2° or 3ºwarmer than in a natural and healthy state.Mr. Brodie thinks, that cold " causes contrac-"tion ofthe capillaries, and thus lessens the su-" perficial circulation, and stops the cutaneous" secretion:" but I would account for the diminution ofthe superficial circulation, and the suspension of perspiration in another way. For itdoes not appear to me, that the capillaries arecontracted or collapsed, if this word be taken inan active sense, or that the skin is contracted,condensed, and hardened, as inanimate matteris, bythe most intense cold of this climate, or bysuch evaporating lotions as we occasionally applyto it; but that it is rendered flaccid , loose, andwrinkled. Nay, and I suspect that the sum ofthe areas of the capillaries on the surface of thebody, instead of being diminished, is rather increased by extremely cold weather. The truthseems to be this, that the heart sends the bloodas far in cold weather as in hot; that is, as faras the capillaries, but no farther; and that thecirculation in the capillaries of the skin is lessened, or suspended, in cold weather, in partbecause the arteries supplying them with blood,send it to them with diminished power; and inpart, because those capillaries themselves havetheir action suppressed: so that the blood, whichthey may have contained, is absorbed from themby the beginnings of the veins.It must follow, however, the quantity ofblood in the body remaining the same, not only155that when the capillaries of its surface contain less blood, more must be circulating withinit, but also, as a diminution of the heat of theskin is attended with a diminution of heat to agreater or less depth within it, that the weak internal parts, whether belonging to the originalcomposition of the body, or superadded to it, byconsequence of injuries or diseases, must containso much more blood than the strong internalparts, as gives rise to pain and disease: so that,I would thus account for Headach being occasioned by cold: its effects on the skin extendinginwards, and diminishing the tonic power oftheblood- vessels of a weak part, these blood-vesselsbecome dilated, and subject to an enormous distension, by which the parts contiguous with themare compressed. The pain is, perhaps, not feltduring the benumbing influence of the cold, butafterwards for those who are exposed to cold,feel no pain, but sleepiness; and if they fallasleep in the cold, they sleep to death.Coldness of the feet, from standing upon adamp pavement, is often noticed as an occasionof Headach: but I believe a Headach is as oftenincurred by the exposure of any part, which isusually covered, to a damp cold wind. Coldness of the face, and even of the hands, althoughthey are more exposed to vicissitudes oftemperature, is often followed by indigestion and headach in winter; because, as I suppose, of thegreat sympathy between them and the stomach.The skin of the face sympathises more than thatofany other part with the stomach, as is no lessevident from the eruption on it after a draught of156cold water, when one is heated, than from thegutta rosea of drunkards.But I cannot help remarking, that acuterheumatism, cough, quinsy, pleurisy, and otherdiseases most prevalent in winter should seem,from the experience of those most able to makecorrect observation, to be occasioned not by mereexposure to cold, but by the sudden exposure toheat of parts, the temperature of which is lowered. I would appeal, however, to common observation: for who does not remember persons flying to the fire, scorching their faces and theirshins, and calling impatiently for hot, perhapsfor spiritous drinks, after having been exposed tobitter cold, and cutting wind, who were not thenseized with a hoarseness, or in the night with apleurisy, or the next morning with a quinsy, anacute rheumatism, or some other inflammatorydisease.I am not obliged to speak here of cold as astimulant, curing Headach, convulsions, asphyxia, from opium, from the fumes of charcoal,&c. but it is common to hear persons, talking ofcold applied to the surface of the body producinga determination of blood and of heat to internalparts, so that if the internal part be a vital partand inflamed, its inflammation must be increased,and danger must be the consequence. This reasoning would be correct, if a living, healthy bodycould be compared to a dead, dried sponge.But allowing that cold applied to the surface ofthe body is in course followed by an increasedquantity ofblood in the internal organs, is it alsofollowed by an increased heat in the internal or-157gans? I know no fact to prove that the blood isdetermined or driven inwards, when its surfaceis exposed to cold; but believe that it flows inwards by consequence ofthe diminution oftonicity, and the enlargement ofthe internal bloodvessels. Nay, and I am convinced, that whenthe heat ofthe surface of the body is diminished,that of its inside is diminished likewise. Thus itis that folds of linen soaked in cold water or insolution of muriate of ammonia laid on the skin,which render it cold by their evaporation, abstract heat, and diminish the sensibility of internal pars, so as to check inflammatory action, andthe growth and increase of tumours. Inflammation of the brain, of the pleura, of the intestines,of the kidneys, &c. have all, if I am not mistaken,been checked by cold applied to the skin.I am not ignorant that in cases of costiveness ,the removal of it , when following the effusion ofcold water to the lower extremities and the abdomen is by some attributed to a relaxation ofthe intestines, and an increase of their secretions,depending upon the sudden contraction, as theysay, of the skin from cold . But not in ileus only,but also in enteritis, nephritis, &c. I have knowncold water, and in one case of arachnitis a mixture of nitrate ofpotass and muriate of ammoniawith water, applied to the skin, a most successful remedy, acting, I have no doubt, by producing a sympathy through the brain, of the diseasedpart with the skin: in ileus perhaps by stimulating the skin and the bowels, and occasioning agreater secretion into the latter; but in enteritis ,and other internal inflammations, by diminishing158the sensibility and heat of the skin and of theinflamed parts. I do not say all this from theory:for I have many years relied more on the application of cold water and on blood - letting in enteritis than on any other remedies, and it is nowmore than thirty years ago since I ordered theapplication of cold water to the abdomen of ayouth, who is now a distinguished officer in hisMajesty's Service, and so saved his life, after ithad been asserted, that the whole College ofPhysicians could not save it.The Weight of the Atmosphere has great influence on us, when it is either suddenly increased, or suddenly diminished: and it may be assumedas a fact, that the more the vital powers are diminished, the more we are affected by mechanical and chemical powers. Thus, when there isa low state ofthe barometer, or a very light stateof the atmosphere, we hear those, who werewell before, complaining of dullness and inactivity. Caelius Aurelianus says, that patientswith Cephalaea, when they sit down, are seizedwith giddiness, dimness of sight, nausea, andvomiting of bile; and Dr. Wollaston, ' that seasickness depends upon the subsidence ofthe vessel upon the wave that supports it, during whichthe blood presses suddenly and with unusualforce upon the brain. On the other hand, Dr.Wollaston remarks, that rising suddenly fromone's seat, is sometimes followed by a giddiness,and a diminution of muscular power, amounting almost to fainting, because then the pressure of the blood is too quickly withdrawn fromthe head. Sea-sickness is certainly owing to the159stomach sympathising with the brain. Eversince I read Dr. Wollaston's Croonian Lecture,I have occasionally desired my patients, whenlabouring under a Headach, to make deep inspirations; and I have frequently known them tobe relieved by it.ItWind is often accused of occasioning Headach and I have known it to be justly accused,when the patient had walked, or had riddenagainst it. But I am not certain, that I havenot known a Headach from a want of wind; fromwhat Hoffman calls diuturna humidaque austrinaAeris Intemperies, praesertim Ventis vacua.has been repeated from very early ages, that amoist warm wind from the south is an occasionof Headach. Ofthe peculiar qualities of different winds, our knowledge is at present, I believe, not very correct. Sauvages says that,where he lives, as often as the south wind blows,the electricity of the atmosphere vanishes; andthat the Headachs depending upon it are immediately cured by electricity. †Celsus says, pains of the head and foreheadfrom wind, or cold, or heat, are put a stop to bya gravedo and sneezing.Hair ofthe Head. This has more uses thanone. It diminishes the effect of blows and fallson the head, by its mass and density: from itsoiliness preventing moisture from adhering to it,·See some valuable Remarks on the Sciroc Wind, by SirBrooke Faulkner, M. D. &c. in the Topographical Sketch ofthe Island of Malta, prefixed to his Treatise on the Plague.+ See his Species Cephalalgia anemotropa.160and from its being a bad conductor ofheat, it preserves the head of an uniform temperature: andfrom its being a bad conductor of electricity, itpreserves the head in an insulated state. I haveknown several instances of Headach in persons,who had become bald, although they had neverhad a Headach before; and I have known several instances of Headach, which were cured,even in young persons, by shaving the head, andwhich returned as soon as the hair had againgrown the length of an inch.Bichat speaks of the danger of cutting thehair after acute diseases, of which he had seenone example, and Lanoix more. Nay, he says,it is often dangerous in desperate diseases to clearchildrens heads all at once of vermin. *Compositions are frequently advertised forchanging the colour of the hair, which they burnor char: but they sometimes occasion dreadfulHeadachs, and even epilepsy, in which cases,the head, some say, should be shaved, blistered, &c.Skin andmucous Membrane contain the wholebody; the former covering its outside, and thelatter lining all those cavities which have a natural opening. The skin and the mucous membrane have a great sympathy with each other;and most cutaneous eruptions , as small- pox,measles, miliaria, usually considered as primaryaffections are now thought by most to be merelysympathetic of an affection of the mucous membrane of the lungs, or ofthe alimentary canal.

  • Anatomie Generale. Tome iv. p. 816 .

161The nerves of the skin are from the brain andspinal marrow, and of the mucous membraneprincipally from the ganglions.The extent ofthe skin may be judged offromthis, that Hales computes the surface of a man'sbody at a medium to be equal to 15 square feet. *Perspiration, and the obstruction of it, of whichDe Gorter has found in Sanctorius no fewer thanthirty-two causes, to which we are every dayexposed, I shall purposely pass over; althoughdysentery may be traced to an over-loaded stateof the mesenteric vessels, and of the vena portarum, consequent to the natural excretion fromthe skin being interrupted. But I cannot passover absorption from the skin and mucous membrane for as painters, plumbers, glaziers, potters, smelters, printers, gilders , silverers ofmirrors, enamellers, workers in certain manufactories, mines, caverns, wells, &c . are more orless afflicted with Headach, cholic, palsy, & c .it is not improbable that their skin and their mucous membrane may absorb the substances towhich they are exposed. † Mr. Abernethy hasfully proved that the skin has the power ofoccasionally absorbing and of exhaling certain gases;and Mons. Magendie asserts, that an animal maybe poisoned by poisonous substances applied to

  • Statical Essays, containing Vegetable Staticks. Edit.

p. 242.3rd.+ See Dr. Fothergill on Disorders to which Painters inWater Colours are exposed , in Med. Obs. and Inquiries . Vol.v. p. 394.Surgical and Physiological Essays, Part ii . Edit. 1793.M162its tunica conjunctiva. * Perhaps, all effluviaand gases are more deleterious during the night;for a horizontal position, fatigue , ebriety, as wellas fear, hunger, a vegetable diet, venesection,purging, &c. are all said to favour absorption.Carbonic acidgas cannot be respired , becauseit occasions a spasm of the epiglottis, which shutsup the glottis. † The atmosphere, near the surface ofthe earth, contains about robo of carbonicacid gas; but on the summit ofthe Peak ofTeneriffe, the chemists who accompanied La Perouse,in his last voyage, could detect none.All agree that the atmosphere contains, in100 volumes of it,21 of oxigen gas, weighing 23}, and72 of azotic gas, weighing 763;that no other proportions can be substituted forthese, and that they are in a state of mixture,not of chemical union. It is astonishing, thatthe atmosphere on the highest mountains doesnot contain a greater proportion of oxygen thanthat in our manufactories and hospitals: but,perhaps, no stronger proof, that these are thefittest for respiration, can be given.An animal cannot live in an atmosphere deprived of oxygen: neither can a fire burn in it:but an animal lives too fast, if the proportion ofoxygen in the atmosphere be increased and bodiesburn too fast there, and are sooner consumed.In recovering persons out of the asphyxia from

  • Précis elementaire de Physiologie. Tome i . p. 42.

+ Morgagni de Sedibus et Causis Morbor. Ep. xix. §. 39.Thomson's System of Chemistry.163submersion, it should seem that oxygen gas istoo powerful a stimulus for the inflation of thelungs. Low and damp situations, those in particular where agues are endemial, are the bestfor consumptive patients . *The Vapour of burning Charcoal is destructive of animal life , because it consists of carbonicacid gas, which prevents inspiration, with a portion of carburated hydrogen gas, which can beinspired, but is a deadly poison. Dr. Babington,with whom, in the early part of my life, I hadthe good fortune to be an inmate, and to whom Iam indebted for much that I know, succeeded inrestoring from an almost lifeless state, a waiter,who had slept in the Vapour of Charcoal; andhis history ofthe case, and his reflections annexed to it, are admirable, alike for their practicalimportance, and for the unaffected simplicity oftheir language.†Bichât says, that the first effect of the Vapour of Charcoal is a more or less violent pain inthe head and this he attributes to the merecontact ofblood not decarbonated with the brain.But granting that the Vapour of Charcoal doesproduce a pain in the head, I would attribute this,not to mere black blood, as Bichât calls it, coming in contact with the brain, but to blood im-

  • Dr. Wells, in " Transactions of a Society for the Im-

"provement of Medical and Chirurgical Knowledge." Vol. iii.+ Medico- chirurgical Transactions. Vol. i.That the first bad effect of the Fumes of Charcoal is tobe referred to the Head, and not to the Lungs, was known toVan Helmont. Van Swieten, Comment. in Boerhaavii Aph.§. 1010.M 2164pregnated with carburated hydrogen . However,it can scarcely become so impregnated, if one beeither on the same level as the burning charcoal,or below that level, for then the vapour containing of carbonic acid, the glottis must be closedby it . The thermometer standing at 60° , and thebarometer at 30 inches, the specific gravity ofcarbonic acid is to 1.000 as 1.527 , and of carburated hydrogen as 0.555; so that it should seemas if the Vapour of Charcoal kills those who arerecumbent in it, by excluding oxygen from thelungs, and those who are not recumbent in it,by its carburated hydrogen being inspired, andpassed into the blood.When a person is insensible and motionless,and his respiration is suspended, by consequenceof the Vapour of burning Charcoal, he may beconsidered, like one who has been under water,as having but a few minutes to live . If his respiration be not restored during these few minutes, his heart ceases to beat, and then his lifeis irrecoverably gone. * He should, therefore,Presque tous les Malades qui ont servécu à cet Accident,surtout lorsqu'il est determiné par la Vapeur du Charbon,disent avoir ressenti d'abord une Douleur plus ou moins violente à la Tête, Effet probable du premier Contact du Sangnoir sur le Cerveau. Ce Fait a été noté par la plupart desAuteurs qui ont traité cette Matiere. Recherches Physiologiques sur la Vie et la Mort. p. 232.Burns also places a Pain in the Head among the symptomsdenoting a mixture of venous with arterial blood . Observations on some of the most important and frequent Diseases ofthe Heart, &c. p. 5.

  • Mr. Brodie thinks " that it is extremely doubtful whether

" the heart ever continues to pulsate for so long a period as165be carried into the open air. or into a spaciousroom, where the air is pure; and attemptsshould be made to revive his respiration by inflating his lungs, by dashing cold water in his face.and against his breast, by the application of ammonia to his nostrils, and by warmth, conveyed both by glysters, and bythe warm bath,or hot flannels, and as the bladder is said, byPortal, to be distended in persons dead of asphyxia, it may not be amiss to have the catheterintroduced as soon as possible.Hunch-backed Persons are often the subjectsof Headach. Morgagni relates the case of ayoung man at Venice, in whom all the vertebrae,from the lower part of the neck to the os sacrumwere so bent to the left side, that the middle ofthe curvature was more than seven inches distantfrom a right line drawn from one of those pointsto the other and the descending aorta was bentas the spine was. On dissection, for he hadfallen down and died in the street, perhaps, because he had been indulging in inebriating liquors, his heart was found to be enlarged, itsright auricle to contain a polypus, its ventriclescoagulated blood: the longitudinal sinus of hisdura mater a polypus concretion, and the lateralsinus of the right side grumous and coagulatedblood, &c. It is not said, that he had been--16 ·" five minutes after the lungs have ceased to perform their" office, and very questionable whether in most instances," the interval is not considerably shorter than this. " ButDr. Roesler has succeeded in resuscitating animals completelyasphyxiated by immersion in water for 51, 91, and 113 minutes, and deprived of the access of air to the lungs for sixminutes longer. Edin. Med. &Sur. Jour. Jan. 1825, p. 209, &c.166affected with Headach: but considering the inflections of the aorta, and the consequent impeded motion of the blood in it, as he was adrunkard, Morgagni would not have wondered,if he had found some of the blood-vessels withinhis cranium ruptured. *Shoe-makers, Tailors, and all sedentary Artificers, whose trade obliges them to lean theirbody forwards, and to compress the abdominalviscera, are very liable to Headach, because inthem more blood is sent towards the head always, and on some occasions more than onothers.+Stays rendered stiff with rods of whalebone,and all tight ligatures around the thorax, or theabdomen, may occasion a Headach, by interrupting the return of blood from the head:‡ buton this subject, I shall not dilate here, having done it elsewhere. If, however, a determination of blood to the head be an occasion ofHeadach in adults, may it not be the same ininfants, whom I have often seen bound up verytightly; may not Hydrocephalus be occasionedin some by it? other diseases may. ||Metastasis is a word, which was once usedto express the removal of morbific matter from

  • De Sedibus et Causis Morborum, &c. Epist. iv. §. 16. 17 .

+ Ibid. Epist. xviii . §. 4.Ibid . Epist. xxvi. § . 23. Epist. xxxviii. §. 55.§ An Essay, Philosophical and Medical, on ModernClothing, sold by the Robinsons, Paternoster Row, in 1792.|| Boerhaave pluries vidit Haematuriam in Infantibus àFasciis et Vestibus arctioribus oriundam. Sauvages Noso .Method.167the place it occupied to another: it is now usedto signify the sudden disappearance of a diseasein one part, and the sudden appearance of a disease in another; and no reference to a morbificmatter is implied, but to a morbid action. This,however, is incorrect: for when a disease leavesone part, and another part is suddenly affectedwith a disease, it is not because the action in theformer part is transferred to the latter; for everypart has its own sensibility, and its own mode ofaction, whether it be in a healthy, or in a diseasedstate. I said, that I should speak of a goutyHeadach. When the gout suddenly quits thefirst joint of the great toe, or any other joint,and a Headach arises, the Headach is called agouty Headach. But the gout is a constitutional disease giving rise to local and externalinflammation, or to inflammation of the ligaments, ofthe bursae mucosae, of the sheaths oftendons, and of the aponeuroses of the smallerjoints and the stomach is perhaps always disordered, when the gout quits another part, before it is said to affect the head. Does it thereforefollow, that the disorder of the stomach, and ofthe brain, is gouty; that the same action existsin the stomach, and afterwards in the head ashad existed in the joint of the great toe? thereis nothing like ligament, in the stomach and inthe brain. But the gouty Headach is said tohave killed by apoplexy, which, if it were true,would always lead us to attempt the cure of theHeadach, called gouty, by blood-letting.Ibelieve this Headach generally depends upon thestomach, and is to be cured by stimulants and168antispasmodics . Such means I have known tosucceed and I have never seen a case of Headach, attributed to retrocedent Gout, in which Icould consider myself as authorised to order venesection, cold applications to the head, &c.Headach often arises from the sudden healing of ulcers, the sudden recession of exanthemata, the sudden suppression of the haemorrhoidal discharge, or of any other that is becomehabitual. Even a suppression of the dischargefrom the feet, which is so offensive, has beenfollowed by a violent Headach✶ and vomiting,premonitory of apoplexy. A sudden suppressionof acrid, watery, bilious, and green, or bloodyand slimy discharges from the bowels of children,by opium and astringents, has been followed bythat Headach, which produces a fluid in the ventricles of the brain. It was long ago ascertainedby Dr. Clarke, of Dublin, that the best remedyfor these discharges from the bowels, is hydrargyrisubmurias, in small doses. The sudden suppression ofthe Catamenia, I shall speak ofhereafter; but it, and the sudden suppression ofmilk, during lactation, are universally known tobe occasions of Headach. †Convalescents. Persons recovering from diseases, whose appetite is keener than usual, whoare crammed with delicacies, and whose bloodis, perhaps, made too fast, have often a Headach, convulsions, or a fatal coma, occasioned not

  • Medico chir. Rev. Sept. 1822. p. 401 .

† Hemicrania in Feminis lactantibus ub ipsis Mammis, ubiLac aut retineatur, aut putrescat. Nic, Piso, de cognoscend.et curand. Morbis. Lib. i. cap. 8.169only by the quantity and the quality oftheir food,but also by the premature administration ofstimulant medicines.All have not the sense to see, that in proportion as the weakness of a patient is greater, thestimulus of his food and of his medicine shouldbe weaker and yet examples of the sudden extinction of vitality, after extreme cold, by theapplication of heat, after long fasting by the exhibition of wine, and nourishment, &c. must beknown to every one.Beer, ale, wine, brandy, &c. often occasion aHeadach, not from their containing alkohol only,but also other poisonous substances . *The Amputation ofa Limb has been followedby better health: but it has also been soonfollowed by a Headach, which yielded to bloodletting and a spare diet; and Boerhaave and hisCommentator, Van Swieten, talk of the toogreat chylification and sanguification of those,

  • Wine is said to occasion Headach in those more especially, quibus Caput est parvum, et quibus angusta est Pars

ipsius anterior. Nic. Piso, de cognoscend. et curand. Morbis.Lib. I. cap. vi.Port, Madéira, and Sherry contain, according to Mr.Brande, from to their bulk of Alkohol: so that he whodrinks daily a bottle of Port, drinks daily almost half a pintofpure alkohol, which is equivalent to a pint of Brandy.Journal of Science, &c. Vol. iv. art. xiii. and PhilosophicalTransactions for 1811 and 1813. Alkohol acts on the brainthrough the pneumo-gastric nerves, and occasions comaand insensibility; as opium does: they both destroy thefunctions ofthe brain, so that they kill by bringing on suffocation.170who have lost a large limb. * Mr. Foot, according to John Hunter, was relieved of a Headach of long standing, by the loss of a leg, butdied afterwards of a complaint in his head, verysimilar to apoplexy, † And in all such cases, ifapoplexy occur and terminate fatally, there is aprevious disposition; for stumps are very liableto pain and spasm, which by nervous communication affect the brain more especially.If a person have the Predisposition , not toHeadach, but to Haemoptoe, the loss of a limbmay occasion Haemoptoe. Pulmonary consumption is, I believe, not uncommon after theamputation of a limb.I shall next speak of affections of the thoracic, the abdominal, and the pelvic viscera,which may occasion a Headach: and I shall begin with the Heart and the Lungs, because theyare contiguous organs.Not only the Heart and Lungs, but also thestomach, the larynx and the pharynx have theirnerves from the eighth pair, the par vagum, orpneumo-gastric nerve, and are by this nerve connected with one another. Nothing is betterknown than that diseases of the lungs affect theheart. The lungs, the heart, the stomach, thelarynx and the pharynx, which are associated bythe par vagum, have nerves from other sources.A division of the par vagum on each sideat the height of the thyroid gland destroys the

  • Commentar. in Aphorismum 474.

A Treatise on the Blood, &c. p. 332 .↑ Nosographie Philosophique, ou la Methode de l ' Analyse appliquée à la Médicine, par Ph. Pinel. Tome ii . p. 519.171voice, excludes air from the larynx, causes acollection of phlegm in the bronchia and air- cellsand prevents the passage of the blood from thepulmonary artery into the pulmonary veins; sothat, after death, the venous system is found tobe distended, with blood, and the arterial tocontain very little..A division of the par vagum only does notdestroy the functions ofthe heart: neither does adestruction ofthe spinal marrow only: therefore,the power of the heart is independent ofboth, asis also the action of all the muscles of involuntary motion; but the heart may be influencedby stimuli applied to either, and by affections ofthe mind. The proper stimulus of the heart, isthe blood.A division of the par vagum in the neck, orof the stomachic plexus immediately above thecardiac orifice of the stomach suspends the secretion of that fluid, upon which the digestion offood depends.But it is not a mere division of the par vagumthat intercepts the nervous influences, and pro,duces these effects on the lungs, the heart, thestomach, &c. for if the cut ends be not morethan of an inch asunder, those effects are notproduced.daSuch however is the consequence of thelungs, the heart, and the stomach, receiving theirnerves from a common source, that if one of thembe irritated, they may all be disordered, or oneonly ofthem may be disordered, and not theone that is irritated . Thus the stomach beingirritated, every part receiving nerves from the172par vagum may be disordered; or the lungsonly may be disordered . Persons have beendeemed consumptive, when the stomach onlywas irritated . Coughing, hickuping, &c. oftendépend upon irritation of the stomach Such isthe connection between the functions of thelungs, the heart, and the stomach, that it is sometimes impossible to tell which of the three isprimarily affected: extensive and close adhesionof the pleura costalis and pleura pulmonalis, andpressure onthe bronchial cells by fluids effused,or by tumours formed in the thorax, and by enlargements of the abdominal viscera, or collections of fluid in the peritoneum, produce thesame symptoms as an affection of the heart does,although the heart may be altogether free fromdisease. And it may not be amiss to remarkhere, that inflammation, induration, wounds,abscess, ulceration of the heart have all existed,without betraying themselves by pain or anydiagnostic sign.

It may be necessary, in inquiring after thecause of diseases ofthe chest, to remember that inperfect health, when respiration is not at all disturbed, the middle of the diaphragm extends oneach side as high into the thorax as the fourthrib; and by consequence that a part of the cavity of the abdomen is in the thorax for whenthe stomach, or the intestines are distended withflatus, or the liver is enlarged, or the panereas isgrown out into tumours, like apples as Morgagnisays, or there is an ascites , both the ascent and

  • De Sedibus et Causis Morbor. Epist. xv. §. II.

173descent of the diaphragm must be more or lessimpeded.Mr. Abernethy has shown how the degree ofobstruction in the lungs maybe easily ascertained,assuming that in a state of health from six toeight quarts of air may be expired at once.The Lungs. I shall consider affections ofthe Lungs before those of the Heart because inspiration is essentially necessary to the commencement of animal life, and to the restorationof it when suspended, as from drowning; forwhen a person is dying, his inspiration is alwayslaborious, and becomes more and more so till hismuscles of respiration cease entirely to be actuated by the nerves belonging to them. Expiration, in which death takes place, is the naturalconsequence of the inability of the respiratorymuscles to continue their action. In short, deathnever takes place, without a disordered state ofrespiration.The Lungs themselves are absolutely passive;respiration, as far as regards , the office of theLungs, being performed when undisturbed, bythe intercostal muscles only.As often as a person is obliged by exercise,or by passion, or by violent efforts, to make sudden, deep, and quickly repeated inspirations, sooften are his shoulders raised at every inspiration ,and we see that in running, declaiming, singing,playing on wind-instruments, laughing, crying,coughing, sneezing, &c. , his glottis , larynx, pharynx, nostrils, and lips are in action; while thereis not only an accumulation of venous blood onthe right side of his heart, in his pulmonary arte-174ry, in his internal jugular veins, and in the sinuses, of which those veins are continuations, butalso a passage of blood too little decarbonatedinto his pulmonary veins, the left side ofhis heart,and his aorta. Hence the Headach, the giddiness, and the degree of insensibility occasionallyfelt in disturbed respiration from any cause.I knew one who died, while he was in adance, as suddenly as if both his phrenic nerves,and his spinal marrow at the lower part of hisneck had been divided . * But, after violent andlong continued exercise, the heart palpitates, thechest feels constricted, the eyes are prominent,the lips, ears, nose, tongue, and the parts beneath the nails, are all of a very dark and lividcolour, the cause of which is, no doubt, the mixture of venous with arterial blood.iCoughing is a quick succession of expirationsmore or less violent and more or less sonorous;depending upon an irritation of the extremity ofone of the respiratory nerves, by consequence ofwhich irritation all the muscles influenced bythese nerves are thrown into violent action. Itis not generally known, how great a velocity inthe current of air is required, in the simple actof expiration, when the glottis is irritated, to dislodge any thing attached to the membrane liningthe bronchia, and of the manner in which thisdegree of velocity is obtained. It should seem,however, that this degree of velocity is obtainedby closing the glottis, till the air within the

  • Ramazini de Morbis Artificum. Cap. xxxv.

Morgagni de Sedibus et Causis Morborum, &c. Epist . Ix.§. 8. 9.175lungs is a little condensed, and then by suddenlyopening it. Dr. Young says " it is demonstra-"ble, that the velocity produced by the expan-" sion of the air thus condensed, may easily be<< very considerable; a force, for instance, sufficient to support a column of a quarter of an"inch of mercury only, being capable of causinga velocity of about 120 feet in a second, which" is greater than that of a violent gale of wind . "Coughing is a frequent occasion of Headach;and has occasioned apoplexy. Two ounces ofthe brain of a girl about thirteen years old wereforced through a cicatrix in the integuments,after the loss of about four inches of the cranium,by a violent fit of coughing; * so great was thepressure of the brain against the bones of thecranium .But although coughing often depends uponthe irritation of some extraneous body lodged ateither edge of the rima glottidis, and is no morethan an effort of nature to shake it off, whichrequires the simultaneous action of all the muscles of incited respiration, yet it is sometimes tobe traced to the irritations of some part very distant from the glottis, and even from the thorax.Thus, it is no weak proof, of a cough being occasioned by something in the lungs, that thepharynx is hot and painful, when the cardia isirritated by an acid in the stomach; that theopening of the ductus communis cholidochus isin pain, when a stone is in the hepatic duct;that the glans penis of men, and the cl*tor*s ofwomen are in pain, when there is irritation at

  • Edinb. Medical Essays and Observations, vol . ii. p. 245 .

176the vesical end of the urethra, &c. And that acough may be traced to the brain, the wholepulmonary system being perfectly free from disease, we may believe on the authority of Vesaliusand Lehelius, * to the frontal sinuses, on that ofLieutaud; to the vagin*, on that of De Haen;&c. since nobody hesitates to admit that thereis a cough from worms in the bowels, from affections ofthe liver, of the stomach, of the kidneys,of the bladder, of the uterus, &c . All coughs,that are sympathetic, are without expectoration,at least in the beginning.Laughter is not, as some assert, peculiar tothe human species. Dogs laugh, although theirlaughter is not like that of man. Be this as itmay, ifthe laughter of persons be violent andlong continued, it very often leaves behind it apain in the head; and has been known to occasion apoplexy, epilepsy, &e. The stoic chrysippus, we are told, died of laughter at seeing anass eat figs from a silver platter, when some winewas brought for it to drink; and one ofthe Popesat seeing a monkey adorn itself with the holytiara.爨The Heart. I cannot persuade myself, thata pain in the head is ever occasioned by the increased action of the heart, unless the brain bepredisposed to it: for how often do we see thetemporal arteries beating violently from exercise,and how often may we have heard the complaintof a sensation of fulness at the temples, in the

Morgagni de Sedibus et Causis Morbor. Epist. xix. §.54. &c .177parotid gland, at the foramen caroticum of thetemporal bone, and at the foramen spinale of theSphenoïdal bone, where the meningea mediaenters the cranium to be distributed in the duramater, as the superficial temporal artery is inthe skin, all without any pain in the head?What can we know for certain of the forceof the left ventricle in health, when Borelli compares it to that necessary to raise a weight of180,000 pounds; Hales a weight of 51 pounds,5 ounces; and Keil a' weight of only from 5 to 8ounces?When an aneurism of the heart is active, thatis, when the sides of its ventricles are augmentedin thickness, and contract with greater force,their cavities being at the same time enlarged,it is not to be wondered at, some say, that itshould sometimes be an occasion of apoplexy.It is the left ventricle, that is oftener the subjectofactive aneurism: and it is naturally the stronger of the two. But when there is any obstacleto the course of the blood from the left ventricle,it redoubles its efforts to overcome that obstacle;and its nutrition is by consequence increased.Corvisart asserts without hesitation, that themost frequent organic diseases, those ofthe lungsexcepted, are those of the heart; and Bichâtsays that diseases of the heart, and aneurismsof the aorta were remarked by Desault to bemultiplied during the French Revolution , inproportion to the enormities it gave rise to.But if Hypertrophy of the left ventricle ofthe heart may be the occasion of Headach, andof apoplexy, can it be the occasion of either, ifN178there be not the predisposition to either? Can itfirst produce the predisposition to Headach or toapoplexy, and afterwards be the occasion ofit?I know no proof, that it ever produces the predisposition. In the case of Baglivi, and of Cabanis, the former sixty- six or seventy years old,and the latter having already had a fit of apoplexy, they might both, I believe, have been cutoff by this disease, if they had had no enlargement of the left ventricle of their heart. Richerand, therefore, has not, in my opinion, tracedapoplexy to an aneurism of the heart: and asfor the extravasations produced in the corpus striatum, and the thalami nervorum opticorum byforcible injections through the carotid arteries,all they prove is, what we did not wish to beproved, that a healthy brain may be destroyedby mechanical violence. But when Mons. Bricheteau employed his metallic syringe, can it besupposed that the matter he injected, was sentthrough the carotids by anembolus like the heart?I shall dwell no longer on the subject; but wouldask, if aneurism of the heart be so common acause of apoplexy, as Richerand suggests, howcan Corvisart say, ma Pratique ne m'a présentéaucum Fait de cette Nature, ce qui mérite d'êtreremarqné, vu les Observations assez nombreusesquej'ai été à portée de faire sur la maladie dontil s'agit?*The Liver. Nobody can wonder, that adisease ofthe liver is sometimes the occasion of

  • Sur les Maladies et les Lesions organiques du Cœur, &c.

p. 178.179a Headach, who knows, on the one hand, thatthe Ancients attributed madness to it; thatbleeding at the nose is very often a consequenceof it; that hydrocephalus is so frequently connected with a scrophulous state of it, and of themesenteric glands; and on the other hand, thatthe passions disorder it oftener, perhaps, than anyother of the viscera. But the intimate connection of the liver with the brain is shown by numerous histories: Bianchi relates one, in whichthe region of the liver being pressed, the painthere was exasperated, and a pain was also sympathetically excited at the same time in thebrain, together with a confusion of ideas: Grenlich relates another case, in which the fingerbeing applied to the region of the liver, a suddenacute pain was felt in it, and the patient wasimmediately attacked with a convulsive diseaseresembling epilepsy. †To ascertain whether the liver be enlarged,the patient's abdominal muscles should be asmuch as possible relaxed, the recti muscles moreespecially, and the examination should be madeduring an expiration, the patient having previously had a dejection.An abscess ofthe liver is then only to be felt,when it is in its external, inferior, and thin part,or at the end ofthe horizontal lobe.

  • See Hippocrates' two Letters, the one to Damagetus, the

other to Democritus.+ Traité sur la Structure, des Fonctions, et des Maladiesdu Foie, &c. par G. Saunders, &c. traduit de l'Anglais dela troisieme Edition et augmenté de plusieurs notes, par P.Thomas, D. M. M. p. 272.N 2180Great eaters have large livers , and smallspleens, because an overloaded stomach compresses the spleen, which is attached to thestomach and when the spleen is compressed,the blood which should pass into it, must go tothe liver by the hepatic artery.The liver, the lungs, and the spleen are peculiarly subject to a congestion of blood. Thesplenic artery is much larger than is necessaryfor the nourishment of the spleen, and it terminates in cells, out of which its vein of immensesize arises, and goes to the vena portarum.Butwe do not know the use of the spleen. It hasno excretory duct.Whenthe right side of the heart is distendedwith blood, the liver is so too; because the cavainferior cannot receive all the blood brought to itby the hepatic veins.When the liver is gorged with blood, there isgenerally pain or tenderness in the epigastricregion, redness of the face, which is often studded with inflamed pimples, a full , hard, and forthe most part intermitting pulse, and sometimesas the patient says, an audible noise in the epigastrium, or a fluttering there, as ifthe blood ofthe vena portarum were regurgitating. A Headach or some other disorder of the head generallyattends it, which is sometimes relieved, in youngpersons, by a bleeding at the nose, and in oldpersons, by a bleeding from the haemorrhoidalveins, or from the mucous membrane of the stomach or of the intestines , when there are dejections consisting of a mixture of blood and mucous, which is ropy, black, and fuliginous. The181Ancients called this mixture Atrabilis, and thedisease Μέλαινα,But there is often a congestion of bile in theliver; and it is generally connected with a painin the head. There is then a pain felt at thatmost sensible part, the ductus communis choledochus, where it opens into the duodenum, andsometimes, but not always, jaundice. Thesesymptoms with dyspepsia, which is never absent, may exist without scirrhus or steatoma,although ofthe latter disease the liver is oftenerperhaps the seat than any other gland .A pain in the head is not very commonlynoticed in the histories of dysentery: but Sydenham notices it, * and so does Selle. † and twospecies of dysentery have been observed betweenthe tropics; one idiopathic, from an overchargeof the vessels of the large intestines, and consequent inflammation of their coats; and anothersymptomatic, having its seat in the liver andsmall intestines . The symptomatic, maismal,or hepatic dysentery is distinguishable at its verycommencement by a fixed pain at the pit ofthestomach and constant Headach. These twosymptoms accompanied with a disposition tofrequent alvine dejection should, according toDr. Chisholm, be considered, as indicating hepatic dysentery. He found the liver inflamed,enlarged, partially suppurated, or in some portions, sphacelated . The whole intestinal canal,Opera Universa. p. 190.Rudimenta Pyretologiae Methodicae, p. 152. EditBerolini, 1789.豐182the small intestines especially more or less inflamed. *Diseases of the liver are generally attendedwith emaciation. Perhaps one principal use ofthe liver is to assist the lungs in decarbonatingthe blood.The Stomach. Every one knows, that aHeadach is often dependent on the state of thestomach, the brain being intimately connectedwith it; that passions, as grief, fear, &c. mayremove hunger, and suspend digestion for manydays together; and that some are unable toexert their intellectual powers during the digestive process. I shall, however, consider thestomach as the organ of digestion, which Ishall briefly describe, as I proceed , because itis impossible for any one, who is entirely ignorant of the different stages of digestion, to understand why a Headach should accompany thelodgement of alimentary matter, and of its residue in one part of the intestinal canal rather thanin another; although it must have been knownto many, that some substances, which passthrough the stomach without occasioning anyparticular effect on it, disorder the bowels; thata purgative may be traced through the bowels bythe kind of pain to which it gives rise; and thatfood of difficult digestion, although abounding innutritive matter, may for days lie in the stomach,occasioning Headach and other disorders, whilefood of easy digestion is quickly acted on by thegastric liquor.

  • A Manual of the Climate and Diseases of Tropical

Countries, &c. by Colin Chisholm , M. D. &c.183By digestion is meant the conversion of foodinto chyme. This conversion is effected bymeans of a liquor, commonly called the gastricjuice, which is secreted from the mucous membrane of the stomach.There can be no doubt, that the conversionoffood into chyme is the effect of the gastricjuice, first, because, if food be enclosed in tubes,so as to be kept out of contact with the stomach,when they are conveyed into it, the food, undergoes no other change than it would have doneout of the stomach; whereas, if the tubes containing the food be perforated, the food is digested: secondly, because, if the secretion ofgastric juice be suspended, food is not digestedin the stomach. It is therefore, not digested,after a division of the eighth pair of nerves oneach side of the neck: for as already observed,the secreting power ofthe stomach is under theinfluence of those nerves which arise from thatcolumn ofthe spinal marrow, which is destinedto respiration.Numerous experiments were made by Spallanzani, Gosse, Brugnatelli, Carminati, andothers to collect the gastric juice, that it mightbe analysed but in all their experiments, it isthought, that not gastric juice in a pure state,and fit for analysis, was obtained, but gastricjuice blended with other fluids, saliva, mucus, &c.Indeed, it is thought by some to be very uncertain whether what was procured by them, contained any gastric juice; because none can beseparated by filtration from the chyme, although •fresh food imbibes some of it by lying in contact184with digested food, or near it. * The gastric juiceseems to act on the surface only of food; for itscentre may often be not at all affected by it:and the food that is last swallowed, is neverfound mixed with that, which had been takenlong before, but is enclosed in it: so that digestion is the more rapid, the more the food is divided by mastication, and perhaps the more it isblended with saliva, this affording it oxygen.Nay, Boyle and Ray both observed that fishwhich swallow animals too large to be containedin their stomach, have that part only of the animals converted into chyme, which is containedin their stomach.Is gastric juice secreted, when no food is inthe stomach? I think it is not; but that freshfood, and that perhaps moistened with saliva, isthe proper stimulus of the gastric glands.Th formation of chyle takes place exactly atthat part of the duodenum, where the bile flowsinto it; †for neither chyle, nor albumen, which isthe principal part of chyle, is ever found in thestomach. How chyle is formed out of chymeis, I believe, as yet unknown: but, if a ligaturebe made on the ductus communis cholydochus,so as to prevent any bile from flowing into theduodenum, chyle is no longer to be found either

  • Mons, Montegre is thought by some to have ascertained

that what has been conceived to be the gastric juice is nomore than a mixture of saliva and mucus, the chyme becoming acid during digestion, but not food in the stomach, whenundigested.+ Journal of Science, Literature, and the Arts. No. xxviii.page 341.185in the intestines, or in the lacteals; but, in theintestines, chyme differing from that in the stomach in this respect only, that it is of a thickerconsistence in proportion as it is nearer the termination of the ileum , where it is solid, but notofthe same appearance as the ordinary faeces;and in the lacteals, a transparent fluid, consistingperhaps of lymph and the more fluid part of thechyme, which, being noxious to the body, whatever portion of it is conveyed into the blood isthrown out by urine, by perspiration, and probably by pulmonary exhalation. *The bile is, therefore, indispensably necessaryto the formation of chyle, although it neither becomes incorporated with the chyle, nor imparts ayellow colour, or a bitter taste to it.When the residue of the alimentary matter,and the bile adhering to it, have passed into thelarge intestines, it instantly acquires the smellcharacteristic of the faeces; but not sooner.This is not yet accounted for.

The reader is aware, that the natural colourof the gastro-enteric mucous membrane is white;but that it is red in the stomach during chymification; in the Duodenum and in the other inOn présume depuis long-temps que la vapeur pulmonairen'est pas de l'Eau pure. L'Haleine febrile de quelques Personnes, l'Haleine contagieuse des Malades atteints de Fievrespestilentielles, l'Haleine cadavereuse des agonizans, semblentappuyer cette opinion. Une experience du professeur Chaussier, citée par M. Majendie dans un mémoire lu á l'Institut,prouve que, dans l'Etat de Santé, la vapeur pulmonaire contient une petite proportion de matière animale. Séméiotique, on Traite des Signes des Maladies, par A. I. LandreBeauvais. §. 157.1186testines, during the passage of chyle, or of excrement through them.The Headachs referred to the stomach,which I shall notice, are independent of any organic disease, as scirrhus, cancer, stricture, &c.Indeed I am not certain, that organic diseasesof the stomach ever excite a Headach,The first Headach is that from over- distensionofthe stomach, in a person in good health. Evena sort of apoplexy is sometimes incurred at avenison or a turtle feast. The stomach has beenfound extending into the left iliac region andfilling almost the whole ofthe cavity ofthe abdomen: and from the pressure of the stomach onthe aorta in the epigastric region, more bloodmust have been sent towards the head, and lessinto the extremities. In the Headach howeverand in the apoplexy from a distended stomach,the blood is decarbonated in the lungs to keepup the action of the heart; but the lungs cannotbe duly expanded, because the descent of thediaphragm is prevented: hence there is an accumulation of blood on the right side of the heart.I have already remarked, that irritation ofthe stomach may disorder respiration as if thelungs themselves were injured: and if the lungsbe already disordered, their disorder may beaggravated by the state of the stomach.聪If one exert himself by running, or even bywalking after a meal, he feels his breathing oppressed, because his digestion is interrupted, andthe capacity of his chest is diminished.The second Headach is occasioned by hunger in a healthy person, as when he abstainsfrom food beyond his usual hour of dining. This187Headach may almost instantly be removed by amorsel of meat, for this, as soon as swallowed,communicates a vigour to the whole system;and does it by its mere contact with the stomach;therefore before chyle can be formed of it, beforechyme can be formed of it; nay, and before anyadditional quantity of blood can be determinedto the stomach. A glass of wine does the sameas a morsel of meat; so does tea, coffee, andopium, which diminish the accumulated excitability ofthe stomach,The third Headach is that which is traced toa naturally weak stomach, when empty. It isnoticed by Celsus, who says that a weak stomach is indicated by paleness, emaciation, pain atthe praecordia, nausea, involuntary vomiting,and pain in the head, when the stomach is empty.He mentions also as indicating weakness ofthestomach, a distension of it by flatus, with frequent discharges ofit upwards and downwards,acidity of the mouth, and thirst at bedtime fromsome heat. * It is plain, that these symptomsdenote morbid secretions in the stomach, forthe acid and the air are both such.inet.1 To the removal of that state of the stomachwhich is productive of this Headach, I havefound nothing more conducive than warm clothing, and keeping the bowels soluble. Warmthis best kept up by a covering of flannel, andactivity of the bowels by dejections at regularhours every day. As however the bowels aregenerally costive, when there is acidity in the

  • Lib. 1. Cap, 8.

188mouth; sulphate of magnesia, together withmagnesia in simple mint-water, taken everymorning, I have found most beneficial. Mercurials I have never tried. Spontaneous vomitingis always followed by relief, but vomiting procured by emetics never: nor is the relief in theformer case of long duration. * The best diet isthe simplest and plainest, taken often, but insmall quantities.There is a fourth Headach, to which the chlorotic and the hypochondriac are peculiarly liable, which comes on with a pain of the stomach not immediately after taking food, but, asit should seem, as soon as digestion begins: forthe pain is not felt till the food has been swallowed for some time, but is increased till the food,which is little altered, is brought up. If no foodbe taken, no pain is felt in the stomach, and noHeadach: which leads some to abstain too longfrom eating, so that, when they are obliged toeat, the pain in the stomach and in the head seemto be the greater, the longer they may havefasted.As pain may be communicated from branchesof nerves to their trunk, as well as from thetrunk to its branches; and as palsy from irritation may take place as well above it as below it,I suspect that this Headach, and perhaps allresembling it, arise from irritation ofthe stomach communicating an impression to the brainby the eighth pair ofnerves.Small doses of opium taken a little before

  • Vomitus inutilis est gracilibus, et imbecillum stomachum

habentibus. Celsus, Lib. 1. Cap. 3.189dinner render the pain of the stomach more tolerable, if they do not prevent it.་།The bowels should be kept soluble by gentlelaxatives, hydrargyri submurias may be givenat bedtime, and a saline purgative the nextmorning twice a week. And, during the pain;carbonate of ammonia, spiritus aetheris aromaticus, spiritus aetheris sulphurici compositus, opium, camphor, castor, assafoetida, ormosch, may be occasionally given; but thedisease of the stomach and of the constitutionare best removed by the mixtura ferri composita.And a blister should be applied to the epigastricregion or to the back.The best diet is meat, with less vegetablesthan usual: but less of every thing should betaken at a time.I have never found meat broths agree with aweak stomach; although I have sometimes foundit difficult to convince a patient. that a fluid stateoffood is unfavourable to its digestion . * I thinkthat broiled meat is better than either roastedor boiled.66As for a beverage at meals, for the patient

  • John Hunter says, " a fluid is difficult of digestion. We

' may observe, that nature has given us very few fluids as"articles 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." Obs. on certainparts of the An Oec. page 175.It is remarkable, that Cicero, in a Letter to Tiro, shouldhave condemned his Physician for ordering him soup: DeMedico et tu bene existimari scribis, et ego sic audio: sedplanè curationem ejus non probo; Jus enim dandum tibi nonfuit, cùm Kakoçóμaxoc esses. Epist. Fam. Lib. xvi.6.190should not distend his stomach with fluids, purewater is the best, and fermented liquors arethe worst. *The patient should sometimes, before dinner,walk abroad, and sometimes ride on horse-back,or, if it rain, in a carriage; and his exercise inthe open air should not be omitted for a day, butshould never be such as to bring on fatigue. †Analogous to this Headach is that of personsof what is called a nervous habit, subject to flatulency, making large quantities of pale urine, andoccasionally distressed by feelings of sinking anddying. When these persons are recovering fromany constitutional, or from any local disease,have suffered any accident, as a compoundfracture, or have undergone any surgical operation, they are for some time afterwards liable tobe seized with a cold shivering, attended with asense of dying, and followed by a cold sweat.The Headach is best subdued by camphor,valerian, opium, &c. the irritable state of thestomach and of the constitution by peruvian barkand preparations of iron; and the feelings ofsinking and dying by brandy.A fifth Headach is that from which the veryyoung are always, and the very old would al-

  • Mr. Accum's little Book, called " Death in the Pot,"

contains much valuable information: but there is no noveltyin its very significant title. Schultze's Mors in Olla, Altdorf,1732, is referred to by Gmelin, in his Apparatus Medicaminum, &c. vol. i . p. 336.+ Exercitationis plerumque Finis esse debet sudor, aut certe Lassitudo, quae citra Fatigationem sit. Celsus Lib. ii.Hunter on the Blood, Inflammation, &c. page 412.191ways be exempt, if they had not habitually loaded their stomach with improper food, and fromtime to time suspended its functions by large andrepeated draughts of alkohol in some mannerdiluted, as in brandy, rum, wine, &c. all whichact on the brain, as well as on the stomach, andbring on disorder of the chylopoietic organs. Patients labouring under this Headach have noappetite for ordinary food, and therefore seekfor condiments; and often from taking ginger ina morning, they fly to tinctures from the apothecaries, and then to drams; not aware that everything, which suspends, the action of the stomach,and the digestion of food, gives rise to flatulence,they flatter themselves, that the escape of it,which they cannot prevent, is the salutary effectof spices and spirits, and therefore take themoftener, and in larger quantity, till their tonguebecomes foul, their urine turbid, their bowelscostive, their faeces of an unnatural colour, consistence, and odour, their epigastrium tender onpressure, and their complexion totally changed.These dyspeptic symptoms, which are often keptup by local irritation of some part, are largelytreated of by Mr. Abernethy, whose observations are in every one's hands.Headach does not always attend these symptoms of indigestion; when it does, the cure ofthe Headach is the cure of the symptoms. Indeed, the sick Headach of Dr. Fothergill, as itis commonly called, seems to me to be no otherthan this, arising from the incipient state of thesymptoms which I have mentioned.In this Headach the pain generally extends192to one of the eye-balls; heart-burn attends it,and what is thrown up is the food last swallowed, together with an acid so sharp that it seemsto the patient as if it excoriated his gullet all theway from his cardia. A prodigious quantity ofby vomitings and eructations, the smell of which, is so nidorous, so likethat of putrid meat, as to be no less distressingto the patient than to those next him.air is also brought upMorgagni knew a Knight, forty- six years old,given to errors of diet, exercise, attention ofmind, &c. who threw up veal, as he had swallowed it, five days before.When once the habit offorming an acid, † andof setting loose vast quantities of air from theblood, by a sort of secretion in the stomach, isestablished; when things which turn sour, turnsour almost as soon as they are swallowed, andmeat is brought up undigested, or in a putre-

  • De Sedibus et Causis Morborum, &c . Epist. xlii. §. 2.

+ The acid of the stomach appears to Dr. Prout to befree, or at least unsaturated muriatic acid. PhilosophicalTransactions for 1824. Part 1. But this, or any other acidin the primae viac, has been found to occasion a depositionof lithie acid from the urine, probably before this leaves thepelvis of the kidney: and a lithic nucleus from the kidney isconsidered by Dr. Henry as by far the most common originof all species of urinary calculi. An Essay on the chemicalHistory and medical Treatment of calculous Disorders, byAlexander Marcet. M. D. p. 51. But of the value of Dr.Prout's discovery of muriatic acid in the digestive organs, ajudgment may be formed from Dr. Bostock's Paper in theEdinburgh Medical and Surgical Journal. Jan. 1825, p. 65,where it is shewn that ʊʊʊ of a grain of bichloride of mercury dissolved in 100 grains of water, may be detected byone drop of protomuriate of tin.193scent state, which ought to have been digested;when the secretions of the stomach, the skin, theliver, and the intestines, are checked, or aredisordered; there can be no difficulty in accounting for the symptoms of this Headach.66I cannot agree, then, with Dr. Parry, that" Headach, whether affecting the external, or" internal part of the head, is owing to corresponding conditions of circulation in the exter-" nal, or internal carotid artery; " and that theHeadach so well described by Dr. Fothergill,and usually called the Sick Headach, dependsnot upon the stomach. Dr. Parry asserts,6666•that the state of the stomach is the Effect" and not the Cause of the Malady of the"Head, which it never precedes; just as sick-"ness and vomiting are the consequences, and" not the cause, of the affection of the head,produced by a blow on the cranium:" and"he goes on, Accordingly the Sick Head-"ach may be cured, or relieved, by spontaneous bleeding from the nose, or other simi-" lar remedies applied to the head; but is not"alleviated by purging, and is always aggra-" vated by the stimulants which relieve dys-"pepsia. "*I must say, that if I have seen a fit of thisHeadach with an increased action of the carotidarteries, yet I have never known it to precede animmoderate indulgence in food, and an abuse ofcondiments; never known it to be cured by a

  • Elements of Pathology and Therapeutics, pages 302, 303.

194spontaneous bleeding from the nose; neverknown it to follow a blow on the head; nevercould fancy any analogy between the sicknessand faintness, and vomiting from indigestion, andthat sickness and vomiting which immediatelyfollow a blow on the cranium; * never knownblood- letting either to cure, or to relieve , theHeadach from indigestion; but have often knowna fit of it to be relieved by magnesia, and byalkalies, carbonate of ammonia more especially,and to be cured by vomiting, whether spontaneous, or excited by emetics.The state ofthe stomach is to be relieved, asHippocrates says, by an emetic: † but supposing the stomach to be loaded, I would previouslyabstract blood, which is, I think, a cautious procedure and I would then administer daily suchan eccoprotic as should at once correct the superabundant acid of the stomach, and prevent itspassing to the kidneys, to precipitate lithic acidin their pelves. I know nothing better for thispurpose than magnesia, together with sulphat ofmagnesia in peppermint water.The cure of this Headach, is not, however,the cure of the disorder in the digestive organs;for in proportion as this becomes established andincreased, the Headach ceases, or is convertedHippocrates Aph. Sect. vi . §. 50.Saunders's Treatise on the Structure. Economy, and Diseases of the Liver, &c . Edit. iii . p. 213, &c.Also Mr. Abernethy on the loose and fallacious analogybetween the insensibility in fainting, and that which occursin concussion. Surg. and Phys. Essays. Part iii . p. 61.† Aph. Sect. iv. §. 17.195into some disorder of the intellect. To cure thedisorder ofthe digestive organs, the peristalticaction should be kept up. The patient shouldnot be purged. His bowels should not be irritated . Till there is healthy bile secreted, andthat in a sufficient quantity, the pilula hydrargyri, or submurate of mercury should be givenin small quantities every night; and its action,if insufficient, should be assisted with gentlelaxatives. But at the same time, cinchona,columba, rhubarb, &c . should be administeredto keep up the strength. Mercury should notbe so used as to affect the constitution.+What I said of the diet, and exercise of chlorotic and hypochondriac patients, is applicableto those who are dyspeptic; except that with thelatter, although wine does not generally agreewith the stomach, spirit diluted is a necessary beverage. I speak here of spirits, as if the patienthad been accustomed to them: I do not recommend them to such as have not accustomedthemselves to them.A sixth Headach, depending upon the stomach, is that occasioned by worms irritating it . *The more common signs of worms in the stomach, or in the intestines, are a gnawing painthere; sometimes a voracious appetite; a tumidand hard abdomen; a fetid breath; emaciation ,paleness of the face; faeces of an earthly smell,and containing, what some suppose to be, the3

  • Nullum tam peregrinum est Symptoma, quod Vermes

excitare non possint . Klein. Interpres Clinicus.o 2· 196remains of dead worms; urine, soon after it ismade, turning milky, the precipitate being oxalate of lime; tumour with lividity around theeyes; dilatation of the pupils; the eye-lids during sleep half-open, grinding of the teeth in sleep,starting, and calling out in sleep, the mouthmoved in a peculiar manner; oedema ofthe upper lip and of the alae nasi; itching of the tip ofthe nose, &c.All these symptoms, I believe, often dependupon foulness in the bowels, when there are noworms and so do Dr. Armstrong and Dr. Marshall Hall: but that vertigo and Headach shouldbe excited by worms in the stomach and smallintestines is not more wonderful, than that cough,pleurisy, haemoptoë, and consumption, shouldbe excited, not only by them, but also by disorders of the digestive organs . * The Headachas well as the cough, the pleurisy, the haemoptoë, and the consumption, are all sympatheticaffections, and the heart and arteries are not excited, because they are sympathetic affections.If, from being sympathetic affections they arechanging, or changed, into the diseases theyimitate, the action of the heart and arteriesis excited. Hence the sympathetic Headach, cough, pleurisy, haemoptoë, and consumption, but not the real Headach, cough, pleurisy,haemoptoë, and consumption, are often cured bythe expulsion of lumbrici. It is not true, thatin haemoptoë any of the pulmonary vessels areruptured: the bronchial membrane undergoes

  • Medico-chirurg. Trans. vol. vii . p. 499. vol. ix. p. 389.

197a functional derangement, by consequence ofwhich blood is exhaled, instead of mucus, asBichat and Laennec remark.66Alexander, who was born at Tralles, a famous city of Lydia, was the first, according toDr. Friend, who observed that immoderate hunger (Bovios) is sometimes caused by worms. " He" mentions the case of a woman who laboured" under this ravenous appetite, and had a perpetual gnawing at her stomach, and pain in her" head, after taking Hiera, she voided a worm" above a dozen cubits long, and was entirely"eased of her complaints. "* I suspect thatlumbrici, which often exist in the bowels ofchildren, without occasioning any symptoms, aresometimes a cause of Headach in adults; andnot only of Headach, but also of the symptomswhich I have mentioned. The taenia is generally accompanied with giddiness and Headach,and spasmodic affections: and so is the trichuriswhich is larger than the ascaris, and has a hornon its head, which it can project and retract:but whether ascarides, however numerous, everproduce any effect, except irritation where theyare, I know not.The Duodenum, called sometimes Ventriculus succenturiutus . The food digested in thestomach, and converted into chyme, is graduallyprotruded through the pylorus into the Duodenum; and chyle is immediately formed out ofthe chyme. The food which passes undigested,

  • The History of Physic from the time of Galen, &c. by

J. Friend, M. D. 4th Edit. vol. i . p. 112.198with the chyme, into the Duodenum, is probablycarried undigested into the iejunum; and thereis reason to believe, that a portion of chyme,from which chyle has not been separated, byconsequence of deficient bile and pancreaticjuice, or of some other cause, is carried on withthe undigested food . It is not likely that digestion, when it is imperfectly performed in the stomach, is perfectly performed in the Duodenum:neither is it likely, that digestion and chylification go on at once in the same place.We are not much acquainted with either thenature, or the purpose, of the pancreatic juice.Chemists have not examined it: but from fatalbilious vomitings occurring to dogs, when theirpancreas had been taken out, some have supposed, that it serves to dilute the bile, whenmore acrid than usual: and also that it is purgative, because dogs, when their pancreas hadbeen removed, were afterwards exceedingly costive. The common belief is, that the pancreasis a salivary gland.The Duodenum, the colon, and the rectumare intestines fixed in their places; and accumulations are very apt to take place in them . TheDuodenum is fixed in its situation, by its attachment to the liver, to the capsule of the right kidney, to the colon, and to the back: and Dr.Yeats, in his observations on the Duodenum, adisease of which he has often known to be mistaken for a disease of the liver, after having enumerated the symptoms of a disease of that intestine, says " such patients, as have it , will trace" with most anatomical accuracy a considerable1199uneasiness in the course of the Duodenum withtheir finger, from the stomach to the loins onthe right side, and back again across the abdo-" men to the umbilicus."

Dr. A. P. W. Philip speaking of the secondstage of indigestion, which is characterised byepigastric tenderness and hardness of pulse, attributes the epigastric tenderness to inflammation, or a state approaching to it, of the pylorus,and the subsequent extension downwards on theright side of the tenderness with some degree offulness to the communication of the affection ofthe pylorus to the thin edge of the liver. †I have no doubt, that the Duodenum mayexcite a Headach by nervous communicationbut I think a Headach may depend upon undigested, or merely digested, and irritating matters taken up with extreme rapidity, not by thelacteals, along with the chyle, but by the veins,and carried into the blood of the vena portarum,and thence bythe hepatic veins into the vena cava .If neither the stomach, nor the liver, havebeen disordered, I have found a fluid- ounce ofdeooctum aloës compositum, taken once ortwice a day, or pills consisting of equal parts ofrhubarband Terebinthina Chia taken every night,so as to keep the bowels soluble, of more availthan any other remedy in this Headach: butI generally premise an emetic.In obstinate cases, I have thought that aMedical Transactions of the College of Physicians , inLondou, Vol. vi. p. 325.A Treatise on Indigestion, &c . p. 105, &c .Sed Medicamenta Stomachum fere laedunt, ideoque omnibus Catharticis aloe miscenda est. Celsus, Lib. ii . cap. 12.200pill consisting of two or three grains of the pilula hydrargyri, and one grain of ipecacuanha,given every night for a fortnight, was of verygreat advantage in this Headach: but if thebowels were active enough without it, and thecolour and the consistence of the faeces proper,I have omitted it.I pass over the colon, so subject to enormousdistensions, from flatus, and from solid matterscoacervated in its cells, where they may remain,although softer matters may pass by them, orthrough them: for I never knew a pain in thehead from a distension of the colon only, although I have dyspepsia and emaciation.I also pass over the Jejunum and the Ileum,which, like the stomach, are not fixed in theirsituation, as the duodenum, the colon, and therectum are. For the Jejunum and the Ileum haveadhered to each other, and been heaped up in aball, whichfell to either side, as the patient turnedto it. But I never heard of a pain in the headfrom an affection of the Jejunum or of the Ileum.The Rectum. This intestine begins at theinferior and left lateral part of the body of theMagna, eaque diuturna Intestinorum Evacuatio contingere potest per medium canalis; dum interea contractae cellulae cum compacta Foecum Mole fermiter unitae maneant.Evidenter id evinc*nt Ossa animalium, Nuclei Cerasorum etPrunorum, Nummi, aliaque indigestibilia Corpora, quae perSeptimanas et Menses Intestina Sinu gerunt, et interim quotidie Foecum Copiase exonerant: imò interea dum eo TemporePurgantibus et Enematibus sollicitata fuerint. Mira talia inPraxi vidi, videre Practici omnes. De Haen. Ratio Medendi.Pars. iii. cap. 2.+ Morgagni de Sedibus et Causis Morborum, &c. Epist.xxxix. §. 21, &c. Portal Anat. Medicale. Tome v. p. 210,201fifth lumbar vertebra, descends obliquely fromleft to right, as low as the inferior third ofthe os sacrum, and then runs down, fixed andimmovable, on the median line, to the os coccygis. The faeces are commonly collected init, till by their bulk, their weight, or their acrimony they excite the circular and the longitudinal fibres of its muscular coat to expel them. Itis astonishing how much the rectum may contain, more especially when it is weakened: andhow much it may occupy of the pelvis, displacing its proper viscera.Concerning the diseases of the rectum muchmight be here noticed: but I must not dwell onthem.""66Mr. White says, " pain in the head, especially towards the occiput, is another very common symptom attendant on the stricture ofthe66 rectum. I was not aware of this until an emi-“ nent Physician, who laboured under strictures,“consulted me, and being afflicted with severe66Headachs himself, inquired if I had noticedthat symptom in persons labouring under this"disease. Recollecting two cases, in which thepatients had occasionally complained of theirheads, I informed him ofthe circ*mstance, at" the same time observing, that I did not consi-"der that symptom as at all depending upon the" state of the intestine. I have, however, so6666frequently met with it since, that I have no"doubt ofthis being the fact. "* I am happy in

  • Observations on Strictures of the Rectum, &c. by W.

White, &c. p. 38.202the opportunity ofadducing the experience of thisintelligent Surgeon; and whether the Predisposition to Headach be more frequently rousedbythe presence of a stricture of the rectum, thanby simple distention of this intestine from a coacervation of faeces, I leave for him to determine:but although I have known, in females especially, enormous distentions of the colon withoutHeadach, yet I have never met with a considerable distention of the rectum without it. AndI suspect that a pain in the head may be occasioned by pressure externally on the rectum; asit was in that case related by Morgagni, of awoman who had a tumour in the parietes of theUterus, which so compressed the rectum that itwas not without difficulty that she could expelits contents. * The remark of Morgagni, thatthe pain ofthis tumour was rendered excruciating, by uneasiness of mind, may bring to theremembrance of the reader of Bichât, his comparison of the rectum to the pharynx, in participating of the characters of organs of both lives.As Headach is my subject, I have endeavoured to confine myself to it: but among thesympathetic affections arising from irritation ofthe mucous membrane of the digestive organs,there is not one, perhaps, more frequent thaninsanity nor do I know any disorder, to thecure of which a removal of morbid secretionsfrom the mucous membrane of the alimentarycanal is more indispensably necessary.TI have mentioned a Headach from an affec-

  • De Sedibus et Causis Morborum, &c. Epist. xxxix . §. 12.

203tion of the similunar ganglion: but the readermay consult Professor Lobstein on the structure,use, and diseases ofthe great sympathetic nerve.The Kidneys, &c. Passing over the spleen,the pancreas, the mesentery, and the omentum,because I have not learned that affections ofthemever occasion a Headach, I now come to theKidneys.1f1I shall say nothing here of their acidifyingpower: but it may not be amiss to remark, thatin Headachs, as in all diseases of irritation anddebility, the urine is generally pale-coloured andin large quantity.Baglivi, according to Sauvages, observed aHemicrania during a nephritic paroxysm, on thesame side as the stone had produced the pain,with a small and depressed pulse of the sameside; and supposed the Hemicrania to arise froma painful oscillation and contraction of the pericranium communicated to it by the Kidney. Buthow the pericranium, which is a fibrous membrane, should have sympathised with the mucous membrane lining the pelvis of the Kidney,I cannot conceive . It is not likely, that the external capsule of the Kidney, which is a fibrousmembrane, should have been affected by a stonein its pelvis. Inflammation of the capsule oftheKidney is a rare morbid appearance. *Without the influence of the nerves, no urineis secreted; as after a division of the spinal marrow, between the cranium and the first vertebra. † But Mr. Krimer found, that when the

  • Baillie's Morbid Anatomy. p. 287.

+ Journal Complementaire. Sept. 1823.204renal nerves only are divided, the urine yieldsmuch less urea, uric acid, phosphates, or hydrochlorates, and no rhubarb, if rhubarb havebeen previously taken, but a much larger quantity of albumen.Ischuria vesicalis is often attended with painin the head, which I have always found to be ofshort duration, subsiding with the sense of fulness and distention in the pelvis. The urine wasactually removed from the bladder; for afterhaving, in my professional occupation, beenoften obliged to retain it, I have found, that whenthe sense of distention had ceased, I could makelittle or none.That urine, secreted in the bladder, has, asurine, been translated to the axillae, the stomach, the brain, or any other part, I do not believe. Dr. Darwin refers to Dr. Senter's case,in the Transactions ofthe College of Physicians,at Philadelphia, Vol. I. p. 96, of a girl who laboured under an ischuria, and vomited her urinefor many months, which could not be distinguished from that which at other times wasdrawn off by the catheter; and who, after having taken much opium, frequently brought upsome gravel. * But I could as soon believe , thathearinghad been performed bythe eye, and visionby the nose, as that urine was ever secreted bythe stomach, and that gravel was formed in it.Ischuria renalis, in which no urine is secreted bythe Kidneys, or in which urine is accumulated in the Kidneys by an enlarged prostategland, is attended with Headach, and in about

  • Zoonomia. vol. i. p. 164.

205eight or nine days, with coma, which ends inapoplexy. It is a rare disease, because theKidneys, and the ureters are double. ProfessorWhytt says, that “grown people who die ofischuria, have often water collected in the ven→"tricles of the brain, and become comatous be-"fore death; " and Ferrier, that in fatal66""66 cases of ischuria, when the patient dies comatous, it is well known, that the ventricles of"the brain are filled with a fluid , which has thesensible qualities of urine . This is a real con-"version to apoplexy. "* I have attended several patients with ischuria, in whom there was noswelling ofthe hypo-gastric region, and in whomno urine was detected inthe bladder by the catheter. They all died lethargic; but none of themhad perspiration of an urinous odour; I couldnot be permitted to have the brain examined.Portal supposes, that urine is formed in therenal arteries: † but this is very unlikely.The Ovaria, Uterus, and Mammae. Itshould seem to follow from facts connected withthe want of Ovaria, as that without them, thereis no menstruation, ‡ no sexual appetite, no venereal sensation; with the want of an Uterus, asthat the sexual sensations remain, although itmay have been removed; and with extra-uterinegestation, as that the same symptoms attend it

  • Medical Histories and Reflections. Vol. ii. p. 78.

+ Anatome Medicale. Tome v. p. 369.↑ When both her Ovaria had passed through the tendinousopenings of the oblique muscles, and had been extirpated, awoman recovered, but her breasts wasted, and she nevermenstruated afterwards. Perc. Pott's Works. vol. iii . p. 352.206as uterine gestation, that many things, whichthe Ancients attributed to the Uterus, are notowing to it, but to the Ovaria.Democritus, in his letter to Hippocrates, pronounces the Uterus to be the cause of six hundred diseases: but I shall consider not it, butthe Ovaria, as the cause of Headach; andthis, as connected with menstruation, a functionvery little understood, but of the phaenomena ofwhich it may not be unnecessary to say a fewwords...At the age of puberty, in this climate, therecommonly ooses from the mucous membrane ofUterus, for the space of three or four, or sevenor eight days, a fluid, resembling blood, calledthe menstrua, the menses, or the catamenia,because, during health, it observes its periodsvery regularly from about the second Septinarytill the seventh. As to the quantity of the fluiddischarged, it differs in different women. DeHaen concludes, " nonnullas foeminas menstruoTempore tres Uncias Sanguinis demittere;" alias quatuor, quinque; pauciores esse, se-" milibram; raras admodum quae uncias decemevacuarent, nisi Uteri quopiam Defectu labora-" rent. "* Smellie, Dobson, Young, and Haller,agree with De Haen.6666Some women never menstruate: but, if theynever menstruate, they never conceive. I shallnot enter into a disquisition on the causes of sterility but as some would have it believed, thata woman cannot conceive, let her ever so regularly menstruate, provided that the fimbriated

  • Ratio Medendi, Pars. iv. cap. vi.

2071extremities of the fallopian tubes be preventedby adhesions from grasping the Ovaria, I wouldobserve, that I do not see how conception isthus prevented. Perhaps the impregnated ovum,not being conveyed by one of the fallopiantubes into the Uterus, may drop into the cavityof the abdomen, and form a placenta there;so that an extra-uterine fœtus is generally theconsequence ofthe fallopian tube receding fromthe Ovarium, before the ovum has entered it. *I can easily conceive, that the fallopian tube may.recede too soon, if the female be surprised, interUsum Veneris.Women are more irritable and more subjectto hysterical affections at the menstrual periods;but some menstruate without any disorder. Suchare, I believe, those who have not been broughtup in indolence and luxury, and in whomthemind has not been debilitated by premature andextravagant excitement of the passions. Mostwomen, however, in this climate, when theyhave arrived at puberty, do not menstruate without pain in the loins, about the Kidneys, extending to the pudenda, weakness of the lower extremities, langour, pandiculation, and pain in the誓

  • Certum est Ovulum non protinus a Coitu ex Ovario separari, neque intra perbreve Tempus per Tubas ad uterum

deferri. —Concludere debebis, in Fœmina etiam plus quamtriduum requiri, donec ovulum ad Uterum pertingat. Marherr Praelect. in H. Boerhaave's Instit. Med. §. DCLXXIV.+ Uterus nullum sibi praeter Animi Pathemata Hostemnovit. Van Helmont. Fear, grief, fright, and anger, &c.sometimes stop menstruation, and sometimes render itimmoderate.208head, all of which cease as soon as menstruationhas begun. These symptoms are generally moreviolent at the first period: Headach and epilepsy are then most frequent, and are sometimesbrought on by attempts to accelerate menstruation.The growth of the body is never more rapidthan after the first menstruation. *All this is , I believe, universally admitted astrue: but it is also stated by some, that the menstrual flux is not always from the Uterus, butsometimes from the eyes, the ears, the nostrils,the gums, the lungs, the stomach, the anus, theurinary passages, the mammae, the umbilicus,the little finger, or some other part, when it iscalled vicarious menstruation.Dr. Friend's explanation ofthe phenomena ofmenstruation on mechanical laws is both elegantand perspicuous; † but is not, perhaps, agreeable to the laws of Nature: nor is it necessarythat I should examine it in this place. I shall,1644<6

  • As to that position of the plethorists, that women have

come to the aкμn, or pitch of their growth before the phœnomenon takes place, I have been at pains to inquire intothis, and find the fact every where contradicted, the growth<6 never being more remarkable than after this time, at which"the body becomes every way more healthful." The System of the Womb, &c. by Tho. Simson, Chandos- Professorof Medicine and Anatomy in the University of St. Andrew's,p. 10.Van Swieten agrees with Simson: see the learned Baron'sComment. in Boerhaave Aphorismum, 1284.+ Emmenologia; in qua Fluxus Muliebris Menstrui Phœnomena, Periodi, Vitia, cum medendi Methodo ad Rationesmechanicas exiguntur.209however, offer some remarks on such ofthe phenomena of menstruation as are most common;and shall first speak of their occurrence at puberty. This is attributed, by such as would assign a reason for every thing, to the firmness ofthe solids, which admit of no further expansion,and therefore to the escape of the blood by theUterus, where it is most loosely confined . Thisreasoning presupposes, among other things, thatwomen come to the pitch of their growth, beforethey begin to menstruate, which is an error. Itpresupposes besides, that the blood is sent witha force greater in proportion to the resistance.given to it by the Uterus, than by other parts,in which the branches of the arteries are neitherso numerous, nor so small. Ofthe number andsize ofthe branches, ofthe hypogastric and spermatic arteries, in proportion to their trunks, itis impossible to form any estimate: but it is certain that the capillary arteries, which furnish theblood, from which the menstrual fluid is separated, are infinitely small as well as numerous;and that the sum of their capacities being greaterthan that of their trunks, the motion of the bloodin them must be vastly slower than in theirtrunks. Indeed, it is demonstrated by Dr. Keil,.that the velocity of the blood in the thirtiethbranch from any arterial trunk, is to the velocityof the blood in the trunk, as unite is to 615, thecapacities being as the squares of the diameters,and the velocity reciprocally as the capacities.It should seem, therefore, that the very slow motion of the blood in the arteries of the Uterus isР210not at all favourable to either a dilatation of theirramifications, or to a rupture of them.Others have supposed, not a general, but alocal plethora to be the cause of menstruation;but they have not told how it takes place, nor,indeed, given any proofs that it does take place.They have assigned an unnatural cause for a natural effect, which is not very philosophical.The pain in the back and loins has been verygenerally attributed to the distention of the hypogastric and spermatic arteries; but who eversaw them distended? The Uterus is, no doubt,more vascular at the time of menstruation, andat the time of uterine gestation, because menstruation and growth are operations beyond thesimple support of the part; but who ever sawthe hypogastric and, spermatic arteries so distended as to give rise to pain in the back andloins? They become larger and longer: but theydo not become distended . *Ifthese arteries in women contain more bloodafter death, than other arteries do, it does notfollow that such an accumulation as Dr. Friendsupposes, is necessary for menstruation: Dr.Monro says, that the spermatic arteries in males• Alteram verò Opinionem, menstruae Purgationis motumà solo exuberante Sanguine, qui in uteri vasa perlabitur,eaque Copia et Calore distendit ac aperit, derivantem, nonRatio tantum, sed et frequens Cadaverum Dissectio prorsusrefellendam esse demonstrat: siquidem nulla Probabilitatenititur, quod Sanguis (qui perenni Circulationis Lege continuòper omnes Corporis Partes movetur) tanto Temporis Spatioin Uteri Vasis stagnaret: quibus addendum, Uteri Vasahaudquaquam tantam Sanguinis Copiam continere posse,quanta una Periodo evacuari solet: praeterea in Muliebribus211after death, contain more blood than any otherarteries in the body. * Ifthe menstrual fluid hasbeen seen issuing from a prolapsed Uterus, or ifit has been pressed out of it, is this a proof, thatthere is a collection of blood in the uterine arteries before menstruation takes place? Supposing that the menstrual fluid is not blood, but afluid separated from it, should there then be acollection of blood in the uterine arteries beforeits separation from that blood?t I think not.The languor, the debility of the lower extremities, &c. are attributed to the plethora, to aredundance of blood. But is it not granted,that a plethora may exist, when there is no reinstante Menstruorum Fluxu subitanea Morte extinctis acdissectis, Uteri Vasa, mirum in modum distenta inveniri deberent: at illud nunquam invenire potuimus, nec ab eliis inventum legimus: et licet aliquantulum magis quandoqueturgerent, illud profecto parum facere posset ad Quantitatemsingulis Mensibus expurgari solitam. De Graaf de MulierumOrganis Generationi enservientibus. Cap. ix. De FluxuMenstruo.• Rarus sane et insignis hujus Arteriae Decursus inQuadrupedibus praesertim, fluidorum Impetum eo usque minuit, ut in ea port Mortem, Sanguinis Copiam majorem quamin aliis arteriis invenerim. Dissertat. Medica inauguralis deTestibus et de Semine in Variis animalibus. p. 11.+ A la Suite des longues et abondantes Secretions ou Exhalations je n'ai point observé que les Arteres fufsent plusdilatées dans les Glandes ou antour les Organes exhalans.Bichât, Anat. Gen. Tome ii . p. 373.↑ Languor verò invadit, quia in Plethora et nimio Ponderelaborat Corpns, et tenera Cerebri Vascula ita turgesc*nt, utCompressu suo omnes pene in nervos aditus praecludant;hinc in Membra minor derivatur Spirituum Copia. Friend,Emmenologia. cap. viii.P 2212dundance of blood, from the diminished powerof the heart and arteries; as in consumptivepatients?As to the origin, course, and distribution ofthe nerves, which are in the substance of theUterus, I shall refer to Professor Tiedemann. *""66Now the menstrual fluid is not blood, thepurest and most fragrant, as Dr. Friend asserts:† and if it were blood, the heart could notsend it into one part more than into any other.For, as Professor Simson remarks, 66 the mass" ofblood which is distributed through the diffe-"rent parts of the body by the impartial heart," must convince us that the variety, which wefind in the form, velocity, and exit of the liquors, after their protrusion from the heart,is owing to the circ*mstances of the parts ,through which they afterwards pass. Andthat the menstrual fluid is not blood, is plain fromthese facts, that it does not coagulate and separate, as blood does, into crassamentum and serum; that it does not become putrid in a summer heat, as blood does; and that it contains neither fibrine nor globules, as blood does. Nay,it is plain, that it is a fluid secreted from theblood and that, like all other fluids, secretedor excreted, its suppression should be the66• Tabulae Nervorum Uteri.+ Neque enin iu sanis Sanguis ille, qui ejicitur impurusest, aut vitiosus , sed optimus et fragrantissimus. Friend—Sanguis ille qui ejicitur , ex Capillaribus Arteriis erumpit:ideoque naturam arterioi h. e. purissimi Sanguinis retinet.Id. Emmenologia.System ofthe Womb. chap. i .213cause of disorder, is a conclusion, which is , Ithink, fairly countenanced by analogy . It seemsto me, however, that the composition of the menstrual fluid is not fully ascertained. It certainlyconsists of more than the colouring matter of theblood floating in serum . *The menstrual fluid can no more be formedwithout an uterus, or a vagin*, than bile canwithout a liver: and, therefore, if the discharge.ofthe menstrual fluid being stopped, a haemorrhage take place from any other part, it cannotbe vicarious of the menstrual flux. Every Physician knows, that the most scanty menstruationaffords more benefit, in many cases, than theloss oftwenty ounces of blood; and that the lossof a greater quantity of blood, than there ever isofmenstrual fluid, never prevents menstruation.When a girl does not menstruate at the usualtime, she is said to have a retention of themenses: but how that can be retained, whichnever existed, I am at a loss to tell. The menstrua do not exist in the blood, quia menstruasint, more than bile does. And till a girl hasmenstruated, who can tell, that she will ever doit? I know three women, who are now advancedBichát, speaking of the singular connection which exists,in mucous haemorrhages, between the mucous membrane ofthe Uterus and that of the Bronchiac, says Si le Sang cesseaccidentellement de couler de l' une pendant la Menstruation,l'autre l'exhale fréquemment et supplée pour ainsi dire àses Functions. Anat. Gen. Tome iv. p. 419. But menstruation is not a haemorrhage: the menstrual fluid is not blood:nor do I believe that a haemorrhage from the mucous membrane ofthe lungs, or of any other part is ever vicarious ofthe discharge of the menstrual fluid.214in life, who never menstruated. Many do notmenstruate at the usual time, and are not theworse for it, unless it have led their officiousmothers to torment them with emmenagogues.It is a rule laid down by very great authority,that, if a girl who does not menstruate be wellin all respects, no , medicines should be givenher * But I have known those, who were endeavouring to bring on menstruation, when therewas no sign of puberty, not even a swelling ofthe eye-lids, and certainly no dingy rednessround the eyes.When, however, the menstrua do not appearat the usual time, and yet there are all the signsof their being about to flow; when they havebegun to flow, but suddenly cease to flow; whenthey have flowed at one period, but do not flowat the next period, then vertigo, tinnitus aurium,flushed face, headach, furred tongue, loss of appetite, pain in the epigastrium, nausea, colic,constipation, quick pulse, and great lassitude,are sometimes the consequences. But sometimes paralysis of the inferior and superior extremities, sometimes death from apoplexy follows.Blood-letting, the warm bath from 97° to 100° ,purging with magnesiae sulphas and vinum antimonii tartarisati together in aqua menthae viridis, and the antiphlogistic regimen, should behad recourse to in all these cases.

  • Hae, si ceteroquin recte valeant, neque ulla Pectoris

oppressio, aut Tensio molesta in Lumbris, Epigastrio et adOs sacrum percipiatur, haud vexandae sunt Medicamentis,sed totum id negotium naturae permittendum. Quarin, Obs.Medicae Pract. p. 52.215Perhaps the blood is best taken from the pudenda by ten or fifteen leeches: but it shouldbe taken from the head also, if there be signs ofvascular pressure on the brain.Chlorosis, when fully formed, is generallyattended with suppression of the menstrua, aswell as with a disorder of the stomach andHeadach; but I have nothing to add concerning this Headach, to what I have already said,of that produced by a diseased state of thestomach. When there is a strong Predisposition to consumption, this disease will certainly occur, unless the weak, and irritable stateof the system be quickly removed. All meansof restoring the vigour of the system, and offavouring menstruation should , therefore, behad recourse to. But the means of favouringmenstruation, in such a case, are also themeans of imparting vigour to the system: exercise in the open air, nourishing diet, and coldbath, chalybeate waters, preparations of iron. Ihave, therefore, been long in the habit of adopting, in such cases, a practice like that which isrecommended in consumptions, by Dr. Stewart,and is detailed by him, in some letters, whichwere lent me by my lamented friend, Dr. Saunders, * and in others , which were sent me bythe late Dean of Rochester, Dr. Busby, whosedaughter, supposed by some to be soon to die ofconsumption, I was then attending.

  • These Letters were also lent to Dr. Sutton, and are published in his Tracts on Delirium Tremens, &c. p. 180.

216It would be absurd to bring about menstruation, and to neglect the general system: emmenagogues are, therefore, improper, unless marriage be an emmenagogue. Even cough, hectic,and violent Haemoptoë have been removed insome, who had never menstruated, by restoringthe strength of the system. *All Authors seem to agree, that the suppression of menstruation, by consequence of fever,or of any other disease, is not to be removedtill the fever, or the other disease is cured; andthat all attempts to restore menstruation soonerdo but aggravate the disease, upon which theamenorrhoea depends. +Pregnancy. The state of Pregnancy is oftenattended with pain in the head: but if this painoccur before the end of the third month, whilethe uterus is within the pelvis, and the ovum isnot larger than a goose's egg, there is no morereason for attributing it to the foetus in utero,than the sickness and other symptoms of earlyPregnancy, which occasionally happen, even ifthe foetus be in one of the ovaria, or of the fallopian tubes, or in the abdomen.Pain in the head, with sickness, heartburn,&c. is often felt about the beginning ofthe fourthmonthofPregnancy, when the uterus suddenly ascends out of the pelvis into the abdomen. This isnot the first movement of the foetus; but when awoman has felt it, she is said to have quickened.•ATreatise on the Origin, Progress, Prevention, and CureofConsumption, by John Reid, M. D. &c. p. 252.+ Cullen's First Lines of the Practice of Physic.Gulielmi Heberden Commentarii, &c. cap. 62 and cap, 72.217All women do not feel such symptoms in theirPregnancies; but when they do, they are bestquieted by venesection.Pain in the head, with giddiness and sleepiness, especially after having been long in a horizontal posture, as in sleep, sometimes comes onafter the beginning of the sixth month of Pregnancy, rarely earlier; and is attributed to thepressure of the gravid uterus upon the lower partof the aorta descendens; so that less blood beingsent below the point of pressure, more is detained above it. * And as more blood is detainedabove this point for some time after child-birth,if there be then the Predisposition to Headach,affections of the stomach, produced by eatingany ofthe fungi, or shell-fish of the bivalve class,muscles, oysters, &c. may be followed by Headach, apoplexy, convulsions, and death. † Ourreliance should be on venesection, purging, &cA pain in the middle of the forehead, of apregnant woman, as if a nail were driven inthere, is almost a certain prelude to convulsions:and Dr. Dewes, who makes this observation, recommends immediate recourse to the lancet, In

  • L' Artere Aorte parvenue au-dessous du Corps ligamentocartilagineux , qui unit la troisieme à la quatrieme Vertèbre

lombaire se divise en deux grosses Branches: il est rare qu'cette Division de l' Aorte soit plus elevee, et encore plus quelle soit plus basse. Si elle etoit placée sur la cinquiemeVertebre, comme Lieutaud l'a dit, la matrice, pendant laGrossesse, ainsi que Camper l' a remarquè, ne pourroit manquer de la comprimer, d'ou resulteroient des Accidens graves.Portal, Anat. Medic. Tome iii . p. 297.+ Medical Trans. of the College of Physicians, in London,vol. v.p. 109.218all cases of convulsions during Pregnancy, hehas observed the attack to be preceded by Headach, ringing in the ears, vertigo, and often atemporary loss of vision . *Cessation of Menstruation. Women ceaseto menstruate about their fiftieth year, sometimesat about their forty- eighth; and this is generallyand very emphatically called by them, the Turnof Life, for it is that turn of a female's life, inwhich she loses the grand characteristic of hersex. Various diseases are then apt to takeplace,t of which cancer is one. Perhaps, theshrinking of the Ovaria and their change of structure, may concur to produce the pain in thehead, after the final Cessation of MenstruationBlood-letting and purging are then to be employed.Ovaria, or Female Testes. It is remarked,by Morgagni, that diseases of the Ovaria occurso much more frequently to women, than to thefemales of other animals, that it is natural tosuppose those diseases depend, in some measure,upon the passions. When one of the Ovaria is• American Medical Recorder. No. iii .+ Post Menstruorum Cessationem, Plethora oborta, accedere solent Cephalalgia, Rubor et Inflatio Faciei, Vertigo,Dentium Dolor, artuum Titillationes, ardores fugaces, Ephelides seu maculae Faciei, Pustulae in Facie et Collo, imonasus quasi flava vernice obductus; non aliam ob Rationemnisi quod Sanguis versus Caput congeritur. J. G. RoedereriElem. Artis Obstetriciae, &c. §. 144.In provoctioribus ac decrepitis minores, duriores, et magisexhausti sensim magis et magis emarcesc*nt, numquam tamenevanesc*nt: minimos namque Vetularum Testiculos adhucScrupulum ponderasse notavimus. De Graaf, Loco citato.§ De Sedibus et Causis Morborum, &c. Epist. xxxix. §. 38.219diseased, a pain is said to be frequently felt veryearly in the mamma ofthe same side, and in somecases there is a secretion of milk. I have metwith two cases of dropsy of an Ovarium, in bothof which there was a fixed pain in the head ofthesame side, and in one of which there was also apain in the mamma, and milk secreted by it.One ofthese women was tapped at Guy's Hospital, and a considerable quantity of water wasdischarged; but peritoneal inflammation ensuing, she died; and Sir Astley Cooper favouredme with the following account of the appearances on dissection:66" The left Ovarium was the seat of theDropsy, and it occupied all the abdomen on" the left side, thrusting the viscera to the right." The right Ovarium and Fallopian Tube" formed a considerable Tumour, apparently of"the cancerous kind, sending forth a number offungous shoots from its surface.66" The abdomen contained about four quarts" of water, independently of what was found in" the Ovarian Cyst.66" The Peritoneum was much inflamed, bothupon the surface of the intestines, and where" it lines the abdominal muscles." The Cyst adhered partially to the parietes" ofthe abdomen." I shall hope to have an opportunity of" showing you the parts at some future time, asthey are preserved in the Museum of Guy's" Hospital."66⚫ Haller, Disp. Med. Tom. iv. p. 401.220Male Testes. Headach, epilepsy, convulsions, tetanus, apoplexy, hemiplegia, &c. havebeen traced to a swelling of one of the Testes, toan injury of it, as compression, &c.In inflammation of a Testis, the pain is likethat in inflammation of the stomach and smallintestines, heavy oppressive sickly and thepulse at the wrist is alike in both, small, low, orcontracted, and quick, but becoming fuller andstronger after venesection . John Hunter says,that " the Testis receiving its nerves from theplexuses of the intercostal, accounts for the" stomach and intestines sympathising so readily with it, and its particular sensation, with"the effects arising in the constitution upon its"being injured. "*66Such are the principal occasions of Headach,which now come into my mind: and although itwould be easy, bya little exercise of recollection,to increase the number, I think it unnecessary,because all Headachs occur by paroxysms, andno patient is so indifferent concerning his Headach, when it interrupts his pursuits, as not to bediligent in his inquiry as to the occasions of itsreturn, that he may avoid them . Utile est scireunumquemque, quid, et quando, maxime caveat.+• Observations on certain Parts of the Animal Economy.p. 3. 4.+ Celsus.221CHAPTER V.CURE OF HEADACHS.As every case which may occur of any Disease is a new case, so the cure of it presupposesa knowledge of the circ*mstances in which itdiffers from other cases that have occurred, andby consequence requires some sort of theoreticaldeliberation . This theoretical deliberation preceding prescription must differ in different Physicians, not only as they have seen a greaternumber of cases, but also in proportion as theyare qualified to appropriate to themselves moreof the general truths of past ages, and to seizemore of those new analogies, which are from dayto day offered by discoveries in the physicalSciences. Indeed, common sense dictates noless forcibly that vague experiment is dangerous, * than that he, who shall have investigated

  • Ο βίος βραχὺς, nἡ δὲ τεχνη μακρὴ, ὁ δὲ καιρός οξύς , ἡ δὲ

πειρα σφαλερὴ, κ . τ. λ. Hippocrates, Aph.Vaga Experientia et se tantum sequens mera Palpatio est,et Homines potius stupefacit, quam informat. Bacon, NovuniOrg. Lib. i. Aph. C.222the proximate Cause of a Disease, and attendedto the greater number of circ*mstances, distinguishing different cases of it, is most likely tohave Reason for his Guide, and to cure safely,quickly, and pleasantly.'Assuming, therefore, that a Headach is whatI have defined it (see p. 31); and also that thereare two kinds of Headach, Cephalalgia andCephalaea, in which either the whole head, oronly one-half of it is in pain; the first inquiry iswhether the disease be sympathetic, or, as Iwish we could say, ideopathic (see p . 96.) Itis not always easy, when the pain is referred tothe whole head, to distinguish a sympatheticfrom an idiopathic Headach, as it is called; butit is in general easy enough, when the pain isreferred to one side only of the head: for weshould then search after the part with which thebrain sympathises on the same side of the bodyas the Hemicrania is. And in addition to whatI stated, in speaking of the more common casesof Hemicrania (see p. 46,) I might, at the sametime, have reminded the reader, of the dura mater becoming inflamed, and of the cheek becoming flushed on the same side as the lungs areinflamed; of the tongue becoming white andrough on one side only, if the lung of the sameside only be inflamed, or on both sides, if bothlungs be inflamed; † of digestion being accompaIs erit recte curaturus, quem prima Origo Causae nonfefellerit. Celsus, Praef. ad Lib. i .Asclepiades officium esse Medici dicit, ut tuto, ut celeriter,utjucuude curet. Celsus, Lib. iii . cap. iv.+ Morgagni de Sedibus et Causis Morbor. Ep. vii . §. 12.223nied with languor of the left side, because thestomach is situated there;* and of disorders ofvision, which may always be thought to originate in a disease ofthe retina, by those who arenot aware that this nerve sometimes sympathiseswith the liver, the stomach, the intestines, &c.but minds accustomed to reflection and to association, and capable of estimating the degree ofevidence which numerous analogies afford, require no recommendation from me of analogicalevidence. I promise not a complete Treatise onHeadachs, but only an Essay.Whena pain in the head is sympathetic, it iscured by removing the disease of the part, withwhich the head sympathises. A periodicalamaurosis is often cured by removing a diseaseof the stomach. In all such cases, the Headachis preceded by flatulence, distention of the stomach, and oily, or nidorous eructations, followedby changes in the colour, odour, and consistenceof the alvine discharge, whiteness of the tongue,clamminess of the mouth, languor, despondency,and alarm: and when once the Headach supervenes, all the gastric symptoms are increased;and other symptoms arise from contiguity ofposition, association of function, and connexionof nerves. It is the property, however, of asympathetic Headach to occasion either a partial, or a general distention of blood-vessels inthe head: but in a partial distention of the bloodvessels of the brain, when some of the bloodvessels contain less blood than usual, in proportion as others contain more, when there is an

  • Bichat sur la Vie, &c. p. 27.

224undue circulation and distribution ofthe blood , asin the slighter cases of compression of the brain,the sensibility is increased; whereas in a generaldistention of the blood- vessels of the brain, thesensibility is nearly destroyed, so that the pupilsare dilated, the limbs are relaxed, &c. therefore,if together with the distention ofsome only ofthevessels ofthe head, the Headach increase, andthe sensibility of the body be also increased, theHeadach is no longer to be considered as sympathetic it is become an idiopathic disease, andnew symptoms may be traced to it .Now, no person can have a disease , unlesshe be predisposed to it: so that whether the disease be Cephalalgia, or Cephalaea, there mustbe a distinct predisposition to it . As I have already expatiated on this subject, I shall only sayhere, thatthe Predisposition to Cephalalgia seemsto me to consist in a peculiarity of structure insome part within the cranium, which peculiarityis either original and congenital, or acquired byconsequence of diseases, or of injuries, fromwhich the patients are said to have recovered.Having enumerated several of these peculiarities,I shall now direct the reader's attention to thatwhich is common to them all; such a distribution of the blood as differs from that in the generality. Perhaps, the blood-vessels take a different course to their destination; or the diameterof some ofthem is larger, and of others smaller.Be this as it may, let the circulation be ever sopeculiar in any part within the cranium of an individual who is liable to Cephalalgia, it is compatible with the exercise of all his faculties. Allmust acknowledge, however, that a circulation225which is peculiar in any part of an individual, ismore easily disturbed than a circulation which iscommon to that part in the species .I suppose my reader to know how solutionsofcontinuity, as we say, are repaired in differentstructures; how new and adventitious parts differfrom original parts, and from themselves, whengrowing, and when their growth is finished, &c.Whenever then that circulation within thehead, which is the Cause of the Predispositionto Cephalalgia, is somewhat permanently disordered, I suppose Cephalalgia arises.Cephalalgia cannot arise from the mere Predisposition to it. There must be an occasionacceding and this occasion must be an unusualone, for Cephalalgia arises neither on commonoccasions; nor, indeed, always on unusual ones;because the arteries have a power of accommodating themselves to the column of blood theycontain.It is not improbable, I think, that the occasions of Cephalalgia are all such as act by producing a debility and dilatation of some of thoseblood- vessels within the cranium, in which thePredisposition to Cephalalgia consists. It is notdifficult to suppose, that blood -vessels, having apeculiar course to their destination, if suddenlydebilitated, are by consequence enlarged morethan the extent of their elastic power allows.John Hunter supposes a dilatation of theblood-vessels to exist in inflammation: but thedilatation of the blood- vessels in inflammation ispreceded by a dilatation of the capillaries;Q226whereas the dilatation of the blood-vessels inHeadach is without a previous distention of thecapillaries, so that in the latter, there is no fever,no greater frequency ofthe pulse.It is an unfounded opinion of some, that allpains depend upon excess of stimuli: for painsdepend as often upon defect of stimuli as uponexcess. Pain attends defect ofstimuli in the Headach preceding fevers, in the Headach after considerable loss of blood, as in that of women afteruterine haemorrhage, whenthe pupilis dilated andimmoveable, when there is occasionally vertigo ,&c. in the Headach of feeble persons, and in theHeadach of all, when the head and the extremities are cold, when the pulse is slow and weak,&c. Nor is it ascertained, that an acceleratedaction of the heart and arteries ever occasions aHeadach; for although a Headach often followsit, yet, as far as I know, a Headach never accompanies it. I appeal to every man, whetherhe ever felt a Headach, when in violent exercise,or by consequence of it, till the acceleration ofhis pulse had ceased, and till a sense of exhaustion and fatigue had taken place . On the otherhand, when the odour of hydrocyanic acid occasions a Headach, no acceleration of the pulseintervenes between the impression on the firstpair of nerves and the Headach: no excited action attends this Headach, and it is removed bystimuli ofthe strongest kind, as subcarbonate ofammonia, brandy, ether, &c.A partial dilatation of the blood-vessels, andCephalalgia, may, therefore, be induced by occasions of diminished action, as well as by occa-227sions of increased action, directly by the former,but indirectly by the latter; and the action ineither case, is through the nerves of the arteries.Perhaps, the blood itself, as well as the arteriescontaining it, is under nervous influence. *This is the outline of a hypothesis of Cephalalgia: and it may, I think, mutatis mutandis,explain all the phenomena of Cephalaea, considering by what a number of facts generalised byinduction, it is proved, that in the seat of thePredisposition to this Headach there is a tendency to disorganization, or an adventitious partof a malignant tendency deriving its nourishment,parasitically as it were, from some original partnext it, but living and increasing by its ownpeculiar powers.As to the Cure of Headach, I can easily conceive not only howa Cephalalgia resembling a Cephalaea, or this resembling that, the same meanswhich relieve the one, may increase the other; butalso how similar cases ofCephalalgia, or ofCephalaea, may be diminished , or exasperated, by thesame means: for he who directs all his attentionto one prominent symptom, and neglects the cirહું

  • John Hunter speaks of contiguous sympathy between the

blood and the blood- vessels: and Dr. Baillie, discoursing onthe natural Cure of Aneurism, says, " the State of the Blood," or rather of the coagulable lymph may arise from someconnexion or sympathy it may have with the diseased struc-" ture of the artery. " Trans. of a Society for the Improvement of Medical and Chirurgical Knowledge. Vol. i . p. 124.See also Beclard's Elemens d' Anatomie Generale. chap . x .§. 755. where this Professor refers to G. A. Treviranus Biologia, a work which I have not yet seen.Q 2228c*mstances peculiar to a case, is more likely toexasperate than to relieve it. Even in differentcases of Cephalalgia, I am persuaded, that a degree and kind of stimulus may cure one, whichincrease another; and that I shall not err much,if I lay it down as a fact, that in every case ofCephalalgia, debilitated and distended bloodvessels are to be made to contract by stimulantsproportioned to their debility; and that in everycase of Cephalaea, a specific action is to be diminished, and the means of restoring the naturalaction are to be employed,OF BLOOD-LETTING.The most common remedy in all pains ofthehead is Blood- letting; as if the head containeda quantity of blood greater than usual, and thatquantity in addition to the other contents ofthecranium. And certain it is, that the quantity ofblood in the body, or in any organ of it, shouldbe in a due proportion to its solid parts. Butthat the head ever contains an unusual quantityof blood, while the brain, its membranes, andtheir blood-vessels are in a healthy state, is verydoubtful and considering how incompressiblethe brain is, if either water or other matter beeffused or secreted from the blood-vessels, theremust, as Monro says, be a quantity of blood,equal in bulk to the effused matter, pressed outof the cranium. *A pain in the head is often attended with aplethoric state ofthe body: but it does not followthat there is then an accumulation ofblood in the

  • Three Treatises. On the Brain, the Eye, and the Ear.

229head. Yet, if the body be plethoric, as it mayoccasion pressure on the brain, Blood- letting isnecessary. But a person may be thought plethoric, when he is really not so, and when hisconstitution does not easily bear a loss of blood.Therefore, Blood- letting, which has a tendencyto increase the disposition to plethora, and torender its own repetition necessary, should notbe had recourse to without the utmost caution:for a person may have a deep- seated pain in thehead with a suffused countenance, dilated andimmovable pupils, a noise in his ears, and occasional giddiness, and yet no plethora of eitherhis body or his head; and experience shows,that Blood- letting, whether local or general, increases his Headach. Indeed, it should seem,that it is as irrational to think of lessening thequantity of blood in the head, or in the body, inthis Headach, as in that at the beginning of fevers, before any re-action has taken place. Ihold such a Headach to be nervous or sympathetic, and to give rise to an irregular circulationof blood in the brain, and to end sometimes inCephalalgea or Cephalaea. But as long as it issympathetic, I have ever known it increased bytaking blood from the head, or from the arm.Thus, I have ever known, that the Headach froma retention, or from a suppression of the menses,as long as it was sympathetic, was increased byleeches applied to the temples, or by drawingblood from the arm, although it was relieved byleeches applied to the loins, to the lower part ofthe abdomen, or to the pudenda. The sameholds of the Headach from a suppression of the230haemorrhois, which, even when being convertedinto another disease, I have seen quickly curedby leeches applied around the anus.66

John Hunter, according to his new theory ofthe action of the vessels in inflammation, supposes that " besides the loss of any quantity of" blood being universally felt, an universal alarm" is excited, and a greater contraction ofthe ves-" sels ensues than simply in proportion to this' quantity, in consequence, as it would appear," of a sympathetic affection with the part bleeding. " But the enlargement of the bloodvessels in inflammation, John Hunter considers ,as active, and compares to the increase of size inthe Uterus during Pregnancy, and in the OsTincae during parturition; whereas I conceivethat, in Headach, there is a dilatation of theblood-vessels beyond the extent of their elasticpower, and of their vital , which does not dependon an " Action of Dilatation . " For very littleblood drawn by leeches, from the scalp, oftencures a Headach, and much blood taken from thehead, or from the arm, often aggravates a Headach. In this latter case, I believe, the blood isalways slow in coagulating, and when coagulated, loose in its texture. In short, where thereis too much blood in circulation, the quantity ofit should, no doubt, be diminished; but whenthere is merely an irregular distribution of theblood in some part of the head, which exists,perhaps, in every Headach, there I am convincedthe Headach is aggravated and prolonged by that

1A Treatise on the Blood, Inflammation, &c. p. 336, 338.231weakness which all the modes of depletion produce, but none more than Blood- letting. AsBlood- letting is, however, one of the most powerful modes of exciting a contraction of the vessels, a medical man should consider, in the cureof every Headach, whether it be sympathetic, oridiopathic, how much blood should be taken away,and from what part it should be taken.ARTERIOTOMY.To lessen the column of blood going to thebrain by the internal carotid artery, some recommend the temporal artery be opened, forthe cure of Headach; others for the cure ofHeadach and of other disorders, the arteries behindthe ears; others recommend other arteries to beopened for the cure of Headach, as the coronaryof the lips, the inferior thyroid, the collateral ofthe fingers and of the toes, and the radial: * but Ihave never known any advantage from Arteriotomy and, as I have witnessed from it a suddenand alarming increase ofthat weakness, which isso evident in all Headachs, and by consequencea sudden increase of the susceptibility of impression from slight causes, after great losses ofblood, I never recommend it.PHLEBOTOMY.If a pain in the Head occur in a plethoricperson, he should lose blood from his arm.

    • Martin, de la Phlebotomie et de l' Arteriotomie. Paris,

1741, in 12mo. p. 481 , et Suiv.232

If a pain in the Head occur in a person, who

is not plethoric, he should not lose blood eitherfrom his arm or his head.If a pain in the Head be sympathetic, whether the Patient be plethoric or not, he shouldbe bled from the part with which the Head sympathises, or from as near this part as possible.Thus, at the period of the first menstruation,there is often a dreadful Headach which the lossofa few ounces of blood from the neighbourhoodof the Uterus will remove, but which the loss oftwice that quantity from the Head will not remove. The reason I take to be this: that whilethe Headach is incipient, or merely sympathetic,there is no such disproportionate circulation,as is unnatural, in the Brain: but a change istaking place in its vessels for a disproportionatecirculation. This is a most momentous time forfemales for if the state of the Uterus, uponwhich the Headach depends, be not removed in aday or two at farthest, Epilepsy, Apoplexy, orInsanity may ensue. The same may be said ofthat Headach, which supervenes to a suppressionof the Menses. Perhaps, in all such cases, afterhaving drawn blood from the neighbourhood ofthe Uterus, leeches should be applied to thetemples, or cupping glasses to the occiput, withdeep scarifications there; it being generally uncertain when the brain may begin to be compressed and irritated. Indeed in all chronicaffections of the Head, in low obscure inflammations or congestions, and in all cases in whichEpilepsy, Apoplexy, or Palsy is to be dreaded,many are of opinion that the jugular vein should233be opened. I cannot speak from experience onthis subject but if a jugular vein be to be opened, I would rather that blood were taken fromthe internal than the external. Morgagni says,we cannot come at these veins in order to openthem:* but their inferior part being covered bythe Sterno-cleido- mastoid muscle, the platysmamyoides, and integuments only, if these be divided on either side the internal jugular may beseen, and may certainly be opened with a lancet,without wounding either the carotid artery, whichruns close to it, or the eighth pair of nerves.As to the quantity of blood taken away byleeches, or by cupping glasses, it should never beso great as to induce fainting. Fainting is neverto be induced in Headach. It is not to diminishthe quantity of blood in the Head that we applyleeches, but to produce a contraction ofdistendedvessels, and so to restore the natural distributionand circulation of the blood through the brain.An ounce of blood, and sometimes less , from thescalp often removes a Headach, as from the nearest skin it does a pain in the thorax, or abdomen.Some are afraid to bleed in Headach, duringmenstruation, or the flow of the lochia: but Ihave often known both these discharges promoted by it, and the Headach cease in proportionas the pulse became more developed, and thepatient freer from weariness and oppression.Whether there be any advantage in takingblood from the opposite side of the Head to thatin pain, I know not. Hippocrates seems to have

  • De Sedibus et Causis Morbor, &c . Epist. xi. § 10.

234thought so, * as does also Coelius Aurelianus:but, perhaps, if leeches to the temples do notanswer, cupping of the occiput with deep scarifications may answer: and when the pain extendsdown the spine, leeches should be applied to it.Many are of opinion that, if the cause ofthepredisposition to a Headach be in the membranesof the brain, it is better to apply leeches, cupping, and wounding the blood- vessels in themucous membrane of the nostrils; and that ifthe cause of the predisposition be in the brain,it is better to open the temporal artery .PURGING.Purging is another mode of bringing about acontraction of the dilated vessels, and of removing the disproportionate circulation of bloodthrough the brain. It is in vain that the attemptis made to cure a Headach, if the bowels beloaded with indurated faeces, and ifthe secretionsinto them be suspended, diminished , or vitiated.Purging always gives strength to those, who livetoo fast, if I may say so. But, I think, I haveknown a Headach cured by restoring the secretions into the bowels, by Hydrargyri Submurias,and brought back by a continuance of it. †...In a protracted Headach, more especiallyduring pregnancy, I am not satisfied with mereblood- letting and purging: for having ascertained,that purging may be continued a long time, and

  • Aph. Sect. v. Aph. 68.

+ Morgagni de Sedibus et Causis Morbor, &c. Epist. xxxi.§ 9.235yet a coacervation of faeces be retained in therectum, whenever I suspect it, however a patientmay have been purged, I prescribe accordingly.I cannot recollect, that I have either heard orread ofthe manner in which a coacervation in therectum is formed: and yet, it appears to me that,if this were generally known, the presence of acoacervation would be more frequently suspect+ed. I had long remarked, that women are moresubject to costiveness than men; the PeruvianBark generally rendered them costive; that theyrequire stronger purgatives than men; that theleast Diarrhoea is instantly checked by them withabsorbents, astringents, or opium, after whichthey almost always become obstinately costive;that for a variety of reasons, which I purposelypass over, they do not retire to the gardé robe asoften as they feel the inclination to do it; &c. Ispeak of this coacervation of faeces in women especially, because in them, it is on many occasions, of more consequence than in men: butmen also are subject to it. I had, however, remarked the facts I have mentioned, as to women;and had made many inquiries suggested by thosefacts, before it came into my mind how the coacervation takes place thus I learned beside,that if faeces be not evacuated on going to bed;when there is an inclination, they are not eva→cuated the next morning, or they are evacuatedin an indurated state, and not without the assist+ance ofthe abdominal muscles, or that fluid faecesonly are evacuated, without the rectum seemingto be emptied, a sensation of weight and irritation approaching to tenesmus remaining for a236

longer or shorter time afterwards, and sometimesreturning after short remissions. Well: remembering the relative capacity ofthe rectum, as wellas the degree of distention, of which it is susceptible, and reflecting on the appearances of suchportions of indurated faeces as I had seen takenfrom the rectum, after long purging, and whichhad no resemblance to scybala, I reasoned inthis manner if the faeces, which should be discharged to night, be retained till to morrow, andthen only fluid faeces be discharged, the formermust be still retained: but it can be retained byconsequence only of an absorption of its fluidpart, which must have left it indurated, firmlyattached, and even moulded, as it were, to theinternal surface of the rectum, somewhat as thecoagulum is to the inside of an aneurismal sac;and the latter or fluid faeces must have passedthrough it. But the mucous follicles , glandulæsolitariæ, must be obstructed by the layer of indurated faeces so attached to the intestines: andevery subsequent omission to evacuate the rectum, may be followed by another layer of indurated faeces; so that although fluid faecesmay afterwards flow at times from the rectum,yet this intestine, so defended by the layer ofindurated faeces, and perhaps by many layers,can no longer feel any other stimulus than thatof distention, every evacuation of it dependingupon a vis á tergo in its axis only.With this notion of the formation of a coacervation of faeces in the rectum, I could no longerrely on pills and purging draughts for its removal:and I became awakened to the danger of neg-237lecting it. I now, as soon as I suspect it, orderan ounce of soft soap dissolved in a pint only ofwater, to be slowly injected into the rectum, andam not at all anxious, if it remain there an hour.When it comes away, it generally brings with itportions of faeces, whichhave long been retained.This is the manner in which I begin to remove acoacervation of faeces in the rectum.Theintroduction ofthe finger above the sphincter muscle, or of a candle, may afterwards benecessary.VOMITING.Vomiting I have known to remove a Headach,a Cephalalgia, not a Cephalaea; and perhapsthere is no more certain way of equalizing thebalance of the circulation, of promoting perspiration, and of awaking all torpid secretions. Butin the Headachs of old persons, vomiting is certainly dangerous, because of the brittleness ofthe blood vessels; so that I would never orderan emetic for them, unless blood- letting hadbeen premised; nor then, unless I thought thestomach to be overloaded.I have already spoken of vomiting in concussion of the brain. Sauvages supposes that anemetic cures a Headach, by dispersing blood inspissated, and stuffing up the vessels in the membranes of the brain. Perhaps sneezing cures itin the same way: for subcarbonate of ammonia,

  • Medical Observations and Inquiries, &c. Vol. iv.

Page 123.238snuff, &c. are generally tried by those, who havea Headach. *i . Sickness lowers the pulse, brings on a sweatofdebility, and often aggravates a Headach.PEDILUVIUM.The pediluvium is most efficacious after bleeding; it should be hot enough to redden the skin;and it should be employed for half or three quarters of an hour. After leeches to the part in pain,a pediluvium in hemicrania is an excellent remedy. The circulation in the veins is accelerated,if the temperature of the pediluvium be above100° of Far.; and I have never known a pediluvium of the temperature of 96° produce anyrelief in a Headach, unless it were sympatheticof some inflammatory affection . If the temperature of a pediluvium do not exceed 60º, it doesnot accelerate the circulation, according to Dr.F. Home.DRINKING OF HOT WATER.A Lady once assured Dr. Darwin, that whenher Headach was coming on, she drank threepints of hot water as hastily as she could, whichprevented the progress of the disease:† and I donot question the Lady's veracity; for warm water, when taken into the stomach of a healthyperson, produces giddiness, and when applied to

  • But see Morgagni de Sedibus et Causis Morbor, &c.

Epist. xiv. § . 26. &c.Zoonomia. Vol . ii . page 497.239the lower extremities, increases the action of thecerebral arteries. But of Dr. Sangrado'sBoissons copieuses de l'eau chaud, as a remedyfor Headach, I have no experience ..1998HOT OR COLD WATER ON THE HEAD.**.Cold water poured upon the Head by ashower bath, or applied to it by means of a concave sponge, must constringe the vessels of theHead; and I have often known it efficacious:but I cannot say, that hot water, used so, has inmy practice been so successful .I have often seen the Head, during a Headach, in a profuse sweat; and haveas often thoughtofthat aphorism of Hippocrates, inwhich a sweatupon any part of the body, is said to be the sign ofa disease within.+ The Headach, according to myobservation, was always relieved by it, and theparoxysm was sometimes entirely removed by it .Morgagni gave the decoction of the woods to aperson who had a violent Hemierania, which wascertainly hereditary; and when a sweat brokeout, the Hemicrania abated. Ballonius, Morgagni says, had found the same method successful . In Monsieur Robson's case of Headach, asweat of the Head broke out, as soon as themoxa began to burn the skin, and then theHeadach abated. Whether the sweat break

  • Saunders's Treatise on the Structure, Economy, and

Diseases of the Liver. Edit. iii, page 173.† Aphor. Sect. iv. 38.De Sedibus et Causis Morbor. Epist. i .§ Journal de Med. Tome xxx . page 107, &.240success.out oftener in Cephalalgia or in Cephalaea, Ihave not been able to ascertain: but I have excited it by means of Decoct. Sarsap. Comp. inHeadachs of long standing, which were traced toan accident, a blow on the Head; and with greatI considered these Headachs as casesof Cephalalgia; and that inflammation, perhapsof the vasa vasorum of organized lymph, wassupervening, so that I ordered a dozen or moreleeches to be laid on the scalp, and the punctures to be fomented with warm water, as longasany blood flowed from them, before the decoctionwas given. In a child that had the measlesin my neighbourhood, a prodigious sweat brokeout, and continued on its chest, and large quantities of nitrate of potass were given it; but itdied. In a man, who had a prodigious sweat onhis chest and head, and whose respiration seemedto be carried on by his diaphragm only, althoughhe was permitted to drink wine and water, because he had no cough and no pain in his side,Iconcluded that his lungs were inflamed, and ordered venesection, which immediately relievedhim, and he is now alive and well. * Where therethere is a perspiration greater than natural oftheHead, there a suppression of it has been foundtoexcite insanity: the affusion of cold water on theHead, must, therefore, be dangerous, if there bea sweat of it; and more especially if the sweatbe an accedent to Headach.

  • Une Sueur partielle chaude fait souvent connoitre la suffrance de la partie sur laquelle elle se trouve: elle se remarque

dans quelques Inflammations latentes de Poitrine: c'est unmauvais Signe. Semeiotique, &c . par A. I. Landré- Beanvais . §. 1083 .241COMPRESSION.Quidam etiam id (sc. Caput) devinciunt, saysCelsus and nothing is more common than tosee a handkerchief bound tightly round the Headof one who has a Headach. When it relieves aHeadach, it must be, I should think, by determining more blood to the inside of the cranium,and by so increasing the momentum of the bloodin the internal carotid artery, as to bring about acontraction of dilated vessels.C. OF THE CAROTID ARTERIES.་ ་This is sometimes effectual in relieving aHeadach but then only, I suspect, when theHeadach occurs in a plethoric habit, in whichthe general plethora seems to keep it up, I donot believe it relieves a Headach by preventingthe rush of blood into the head, but by preventing the pressure of the brain.CUCUPHABonnet odoriferant, ou Cephalique. Anodoriferous cap for the head. I have known asilk cap, containing lavender, rosemary, &c .in powder, applied to the head, but I have neverknown the head freed from a pain by it.CUTTING OFF THE HAIR.This too is mentioned by Celsus; but seewhat I have already said of it.R242BLISTERS.Blisters, Issues, Setons, and Tartar emeticOintment rubbed into the scalp, bring bloodto the surface, and lessen the irritation within:but, I do not think they cure a Headach in thisway; but by exciting the dilated vessels tocontract. As a remedy for the Headach offevers, a blister to each temple, behind each ear,to the nape of the neck, to the head, between theshoulders, or down the back, is known to personseven out of the profession.OLEUM SUCCINI.Friction of the spine with this oil is said tohave cured a Headach.TREPAN.Willis tells us, that Harvey once proposedthis to a Lady, who had an inveterate Headach;but that nobody could be found, who would applyit, although the Lady was promised a cure by it.INUSTION, MOXA.The same may perhaps be said of Inustionand of Moxa, as of Blisters; but I never knewInustion employed in Headach; and am not encouraged to prescribe it by what Willis and DeHaen have said of it.243INTERNAL REMEDIES TONICS.Cinchona, Sulphate of Quinina. These arecertainly powerful remedies for Headachs, especially for such as are periodical.ANTISPASMODICS.Opium, Aether, Assafoetida, Valerian, Camphor, and Camphor with Extractum Hyoscyami.These quiet nervous irritations attending Headach, and sometimes Headach itself.TIGLII OLEUM.A drop or two of this oil on the tongue is saidto have cured Tic douloureux .Such are the means commonly had recourseto for the cure of Headach; and I have notthought it necessary to point out such of them asare exclusively applicable to either Cephalalgiaor to Cephalaea. I proceed, however, to consider, briefly, what is to be done in cases of Cephalaea.66Dr. Home says, " in the cure of this disease" (Headach) we have little or no power overossifications, effusions, or ulcerations; ' hemeans in Cephalaea: but " in congestions ornervous affections, we may be of some assistance, ” he means in Cephalalgia. *6666

  • Clinical Experiments, Histories, and Dissections, by

Francis Home, M.D. one of His Majesty's Physicians, andProfessor of Materia Medica in the University of Edinburgh.Edit. iii . page 155.R 2244Now, it appears to me, that the frequent disappointment in the cure of Headachs, does notdepend so much upon our having little or nopower over ossifications, effusions , or ulcerations ,as upon the neglect to distinguish the early signsof Cephalaea from those of Cephalalgia, beforethe cure is begun . For he, who has ascertainedthat a Headach is a Cephalaea, cannot entertainmuch hope of curing it, and will be cautious ingiving any. Perhaps he will say no more thanthat such a Headach has been cured (whetherby nature rather than by art, is of no moment),and that he will endeavour to cure it. But whoever looks over that enumeration, which I havemade, of the remedies employed in Cephalalgia,must see that some of them cannot prevent thecause of the predisposition to Cephalaea fromincreasing, and that others may hasten its increase. And it may, I think, be laid down asa maxim, that such powerful means as are oftenproper and effectual in Cephalalgia, are improper and dangerous in Cephalaea, because in theformer there is mere morbid action, but in thelatter disorganization from a specific action .have more than once suggested, that Cephalaea,and cerebral apoplexy have some symptoms incommonIAs to ossifications within the cranium, itdoes not follow that, when they are the causeof the predisposition to a Headach, that Headachis a Cephalaea. True it is , that a long-continued pain in the Head , sometimes delirium, sometimes convulsions, and sometimes coma or apoplexy have been known in those, in whose brain245or in the membranes of whose brain solid orencysted tumours were forming: but when suchtumours have ceased to increase, it is probable,they no longer predispose to pain, the pain having depended upon their growth and increasebeing faster than room was made for them withinthe cranium, so that then by compressing thebrain directly, they compress indirectly the tuberculum annulare or the medulla oblongata.But ossifications have been found within theskull of those, who never had a pain in the Head.And again, when tumours are deep in the brain,and have excited the adhesive inflammation, bywhich they have become enclosed in a cyst, theyhave predisposed to no pain, but have lain quietand innocuous, as the leaden bullet did for thirtyyears in a Nobleman's thigh. * It should neverbe forgotten, therefore, that the cause of thepredisposition to Cephalaea, increases in theintervals of the paroxysms, so that every succeeding paroxysm exceeds in violence the preceding paroxysm.As to blood or water effused within the cranium, the former from apoplexies or from accidents, Sir Astley Cooper thinks, is neverabsorbed; but the brain gradually acquiring thepower of bearing its pressure, the symptomsproduced at the first moments of general extravasation gradually diminish . Nor have I yetlearnt, that effusions or extravasations, when

  • Morgagni de Sedibus et Causis Morbor, &c . Epist. xxvii.

§. 28.Hunter on the Blood, &c. page 238.246the symptoms of compression and irritation hadonce ceased, ever left behind them the predisposition to Headach.Lacerations of the brain, healed by the adhesive process, cannot be supposed to give alwaysthe predisposition to Headach: and if they andthickened membranes ever do it, I am not certain, that it is in our power to put a stop to theirdoing so; much, I know, may be done by avoiding the occasions of Headach, and by diminishing their effects by bloodletting, purging, &c.but if coagulated lymph have become organized,which it does very quickly, mercury can, I conceive, have no other power over it than that ofloosening its texture. This is, I conceive, whatit does in curing mesenteric obstructions: it removes solid matter deposited in the mesentericglands, and so renders them permeable to thechyle. Perhaps the obstruction in the mesenteric glands, and the enlargement of them dependon inflammation communicated to them from themucous membrane of the intestines. But canmercury given internally have any power overscrophulous tumours in the brain? can it removea scrophulous Exostosis from the cranium? Iknow itcan remove a venereal Exostosis or node,and also venereal Excresences, Fici, Mori, &c.but in all cases, scrophulous or venereal, wherethere is great weakness, and the restorativepowers of the constitution are impaired, I wouldnot excite the action of the extreme arteries bymercury. That a Headach has depended upona predisposition induced , by the venereal disease,and which predisposition was removed by the247use of mercury, I have no doubt: but I have nodoubt, that depositions under the pariosteum,resembling nodes, and morbid affections of membranes are sometimes induced by mercury, anddispose to Headach.As to an effusion ofwater within the cranium,if there have been the signs of acute Hydrocephalus, it is probably the consequence of Headach: but if there have been neither the signs ofHydrocephalus, or of Arachnitis, nor distendedsutures, the effusion of water is probably not amorbid phaenomenon. I believe, that less thantwo or three ounces of water in the ventricles ofthe brain, (and more is seldom found after theacute Hydrocephalus) , are not a morbid phaenomenon, unless the signs of acute Hydrocephalushave preceded death. *As to ulcerations within the cranium, I suspect that they are generally connected with thedisposition to some specific disease, which is of

  • March 31 , 1825, p.m. I was sent for to one of the

most exquisitely formed Infants I ever saw, who, I was told,had for several days laboured under that difficulty of breathing, which I then saw, and from which I could not hesitate topredict, that he had a few hours only to live. For as thesymptoms were those, which are produced by an inflammationof the lungs, during which a large quantity of coagulablelymph is extravasated, so I could not doubt that such inflammation had preceded it.His breathing was extremely short, rapid, and painful,performed not by his intercostal muscles, but by his diaphragm and abdominal muscles; so that, when heendeavouredto inspire, he stretched out his arms, raised his shoulders, &c.His pulsewas small, weak, and scarcely perceptible, becausehe could not make a full inspiration; so that the right side ofhis heart, and his whole venous system, were being overloaded248very difficult cure, even when it attacks an external part of the body. If a person have hadScrophula, when young, a Headach with affecwith blood, while the left side of his heart, and his wholearterial system, were being emptied of it.His breath was cold, because less blood was conveyed tohis brain by the internal carotid and vertebral arteries: andbecause the mucous membrane of his lungs no longer servedfor the decarbonization of his blood. Cold breath is universally known to be a fatal sign in inflammation of the lungs.His skin was cold , which it has long been noticed to be,when there is venous congestion in the head.66 The child had not been bled: but Huxham says, ifany" thing can be done in inflammation of the lungs, it is by" early and immediate bleeding, or it becomes, in very few"hours, utterly irrecoverable"; because, ashe states in anotherplace, the lungs become " stuffed up with concreted blood,66 red, hard, and as it were fleshy, or rather of the colour and" consistence of liver." Cullen says, this is the common termination of pneumonic inflammation, when it ends fatally: andBaillie and Laennec are also of opinion, that carnification orhepatisation of the lungs depends upon inflammation.April 2. The child died in the morning between 9 and 10o'clock, breathing, as he had done throughout, as if hislarynx were clogged with phlegm .But I was asked in the morning of April 1. whether suchrespiration might not be occasioned by water collected in thehead? To which question, as the person who put it to mehad no pretensions to medical literature, I thought it sufficientto reply, that such a disorder of respiration could arise fromno other cause than an obstruction to the passage ofthe bloodthrough the lungs, which obstruction was the consequence ofinflammation. I was, however, requested to attend the dissection of the child, between 8 and 9 o'clock of the day onwhich he had died, no doubt, that I might see the collectionofwater, as little diminished as possible by absorption.Iattended the dissection , and resolved not to interfere withit, but to be a mere spectator.249tions of particular nerves, every paroxysm increasing in violence, may suggest scrophulousaction going on in the brain, or in its membranes:The thorax as it happened was first opened.Healthy lungs subside as soon as the knife has penetratedthe thorax; as a bladder half filled with air, but distended byit in a vacuum, does on the admission ofthe atmosphere; butthe child's lungs did not subside when fully exposed.There was no sign of inflammation, either present, or past,in the pleura pulmonalis or the pleura costalis; nor had anybeen suspected to be there.The superior lobes of the lungs were severally grasped inthe hand and compressed, but were not diminished by thecompression; no blood was pressed out ofthem; neither wasany crackling noise produced bythe compression: but after themost complete expiration, the quantity of air remaining in anadult's lungs, if they be healthy, is equal to perhaps 109 cubicinches.The superior lobes of the lungs, viewed through thediaphanous pleura, were of the colour of muscle, or ratherof liver: and when an incision was made into them, therewas no appearance of cells .The inferior lobe of the left lung, on its surface in contact with the diaphragm, was inflamed; which was probably the reason that, when, April 1 , I pressed upwardsfrom under the child's ribs, he coughed tremendously, hisface was deeply suffused, and his larynx seemed to be cloggedwith a tenacious mucous. The lobe of the lungs was certainlyinflamed, for it was of a florid colour, and of a firmer consistence than in health. It was not of a dark colour, as bloodsunk into it by gravitation after death would have rendered it.Besides, had its colour depended upon blood accumulatedthere by gravitation after death, it should have been on theposterior part only of the lobe, and also on the posterior partof all the lobes, as the child had for several hours been placedupon its back.The trunk of the Trachea was repeatedly and forciblycompressed between the finger and thumb, from the division250and if a person have fungus haematodes in anypart of his body, as a testis, a constant pain inhis Head, &c. may suggest, that fungus haemotodes is also going on within his cranium. Butof the bronchia upwards to the thyroid gland; as I have oftenseen a leech plena cruoris freed from its blood.The larynx was not opened: but as soon as the head wasraised, so that it fell forwards, a portion of tenacious mucous,which had been squeezed up from the trachea through theglottis, ran out of the mouth, which was full of it.Bythis examination, I thought my diagnosis confirmed,that the child had died, because he could no longer inspire;his lungs no longer serving for the transmission of blood fromthe right to the left side of his heart.But the head was to be opened, and as it should seem,more water than usual was to be detected in it; as if sucha disorder of respiration , as the child had had, could havedepended upon a collection of water in his head.Now it must occur to every one, that, if a collection ofwater in the head produces, at all times, a difficulty of breathing, a difficulty of breathing must always be a symptom ofserous apoplexy, and of hydrocephalus, whether acute or,chronic. But of serous apoplexy, according to Tissot, it isnot a symptom; and in perhaps the best book ever written onthe acute hydrocephalus, we are told that " respiration is" natural in the third stage or period of effusion; " and inthe chronic hydrocephalus, when the head was enormouslyenlarged, as it may well be supposed to have been, for it contained nearly nine pints of water, the little girl two years old,who was the subject of it, is said by Vesalius, to have had nodifficulty of respiration, except when her head was raised;nor then such a difficulty of respiration as the child in questionhad. Vesalius says only " difficilis respiratio:" but, ifthelittle girl's respiration had in any respect resembled that frominflammation of the lungs, would Vesalius not have noticedit? Besides, the little girl's respiration was only then difficult, when her head was raised: but the little boy's respiration was disordered as much when he was lying horizontally,as when he was sitting up in his mother's lap.251in every case of Cephalaea, it is, I believe, a goodrule to diminish the specific action, if this bepossible; at least not to increase it. By strictlyThe little boy's head however was to be opened; and before it was opened, the anterior fontanel, which in his lifetime had been level with the bones forming it, was now foundto be sunk inwards; a proof that the bones of the skull hadnot been forced assunder by a collection of water within it.The anfractuosities (anfractus, sulci) of his brain were notat all diminished; neither were the circumvolutions (gyri);a proofthat his brain had not been distended by a redundanceof water in its ventricles.There was no sign of present or of past inflammation inthe membranes of the brain, but there was great congestion inthe vessels ofthe pia mater. There was a certain quantity ofwater in the cells of the pia mater, which was visible throughthe tunica anachnoides, and appeared like a jelly, upon thesurface of the brain, and the ventricles contained more.There was no sign of increased vascularity in any portionofthe brain, or cerebellum, or medulla oblongata, or nervesoriginating in this. No bloody points appeared in them ,when they were cut.Now, having shown, that an unusual quantity of water inthe head does not much disorder respiration , it may be inquired whether the quantity discovered in the little boy'shead, (as he had had no Sopor, no fits of vomiting, no convulsions, no dilitation ofthe pupils, no paralysis, no wasting ofthe body,) was really a morbid phaenomenon? In one ofthelatest books on anatomy, perhaps in the very latest (Shaw'sManuel of Anatomy) , a certain proportion of water in theventricles of the brain, at its base, and in the theca vertebralis, is said to be not a morbid phaenomenon; so true it is,that appearances, which some, who are searching for morbidappearances, boldly pronounce morbid, others more versed inmorbid anatomy, and having no opinion to support, consideras healthy.I might have noticed sooner, that, although the child hadnot been bled, yet that Emplastrum Ladani had been applied252observing this rule, if we do not cure the disease,we favour the return of the natural action of thepart which is its seat.to his chest; and that it remained there, when I was calledto it. But, supposing water in the head to have been thecause of the child's disordered breathing, what could thenhave been expected from Emplastrum Ladani applied to hischest?THE END.ROCHESTER:PRINTED BY W. WILDASH, 196, HIGH- STREET.CORRIGENDA.Page.5, line 2 after occasions, put a colon.12, --13,16,-- -17, --29,31,41,42,46,----the last of the notes, for p. 3, put 53.4 ofthe notes, begin the article the with a capital.16 for? put:17 for but, read and.3 of the note for continentur, read continenter.3 of the notes for plusieres , read plusieurs.4from the bottom, for internal read external.25 delefrom.6 from the bottom for Lomminus, read Lommius.4for medium read median.54, 24 for Exostisis read Exostosis.66,67,68,71,88,89,93,98,---

110,112,113,134, --139,144,---2 ofthe note, for Le panser, read de penser.5 omitthe m, in contramhitur.5 of the note, for vowd read vowp 6 ofthe notes, for vide, read vitae.3 ofthe notes, for Gemitus read Gemitu.12 for Hysterica, read Hysteria.29 for Tulpins, read Tulpius.2 of the note, for dependant, read dependent.9 ofthe note, for Perniciam, read Perniciem.34 for melanchotic, read melancholic.2 ofthe notes, from the bottom, for Elamenta, read Elementa.13 for lympathetic, read lymphatic.1 ofthe notes, for Ssribere, read Scribere.4 ofthe notes, for viii, read vii.17 for immaterialty, read immateriality.5 ofthe notes, for iusane, read insane.149, 26 after in Health, read is said.150, 2 for tetinus, read Tetanus.--- 15 put the article a, before bitter.19 for Effusion, read Affusion.20 for to, put on.156,157,169, -- 2 ofthe notes, for ub, read ab.176,194,218,19 for chrysippus, read Chrysippus.24 after the word Cure, add of a Fit.9 of the notes, for provoctioribus, read provectioribus.232, 26 after Uterus, add if the Headach continue and increase. --235, -- 10 for the, read that.}244Now, it appears to me, that the frequent disappointment in the cure of Headachs, does notdepend so much upon our having little or nopower over ossifications, effusions , or ulcerations,as upon the neglect to distinguish the early signsof Cephalaea from those of Cephalalgia, beforethe cure is begun. For he, who has ascertainedthat a Headach is a Cephalaea, cannot entertainmuch hope of curing it, and will be cautious ingiving any. Perhaps he will say no more thanthat such a Headach has been cured (whetherby nature rather than by art, is of no moment),and that he will endeavour to cure it. But whoever looks over that enumeration, which I havemade, of the remedies employed in Cephalalgia,must see that some of them cannot prevent thecause of the predisposition to Cephalaea fromincreasing, and that others may hasten its increase. And it may, I think, be laid down asa maxim, that such powerful means as are oftenproper and effectual in Cephalalgia, are improper and dangerous in Cephalaea, because in theformer there is mere morbid action, but in thelatter disorganization from a specific action.have more than once suggested, that Cephalaea,and cerebral apoplexy have some symptoms incommonIAs to ossifications within the cranium, itdoes not follow that, when they are the causeof the predisposition to a Headach , that Headachis a Cephalaea. True it is, that a long- continued pain in the Head, sometimes delirium, sometimes convulsions, and sometimes coma or apoplexy have been known in those, in whose brain245匦or in the membranes of whose brain solid orencysted tumours were forming: butwhen suchtumours have ceased to increase, it is probable,they no longer predispose to pain, the pain having depended upon their growth and increasebeing faster than room was made for them withinthe cranium, so that then by compressing thebrain directly, they compress indirectly the tuberculum annulare or the medulla oblongata.But ossifications have been found within theskull of those, who never had a pain in the Head.And again, when tumours are deep in the brain,and have excited the adhesive inflammation, bywhich they have become enclosed in a cyst, theyhave predisposed to no pain, but have lain quietand innocuous, as the leaden bullet did for thirtyyears in a Nobleman's thigh. * It should neverbe forgotten, therefore, that the cause of thepredisposition to Cephalaea, increases in theintervals of the paroxysms, so that every succeeding paroxysm exceeds in violence the preceding paroxysm.1As to blood or water effused within the cranium, the former from apoplexies or from accidents, Sir Astley Cooper thinks, is neverabsorbed; but the brain gradually acquiring thepower of bearing its pressure, the symptomsproduced at the first moments of general extravasation gradually diminish. Nor have I yetlearnt, that effusions or extravasations, when

§. 28.Morgagni. de Sedibus et Causis Morbor, &c. Epist. xxvii.Hunter on the Blood, &c. page 238.246the symptoms ofcompression and irritation hadonce ceased, ever left behind them the predisposition to Headach.Lacerations of the brain, healed by the adhesive process, cannot be supposed to give alwaysthe predisposition to Headach: and if they andthickened membranes ever do it, I am not certain, that it is in our power to put a stop to theirdoing so; much, I know, may be done by avoiding the occasions of Headach, and by diminishing their effects by bloodletting, purging, &c.but if coagulated lymph have become organized,which it does very quickly, mercury can, I conceive, have no other power over it than that ofloosening its texture. This is, I conceive, whatit does in curing mesenteric obstructions: it removes solid matter deposited in the mesentericglands, and so renders them permeable to thechyle. Perhaps the obstruction in the mesenteric glands, and the enlargement of them dependon inflammation communicated to them from themucous membrane of the intestines. But canmercury given internally have any power overscrophulous tumours in the brain? can it removea scrophulous Exostosis from the cranium? Iknow it can remove a venereal Exostosis or node,and also venereal Excresences, Fici, Mori, &c.but in all cases, scrophulous or venereal, wherethere is great weakness, and the restorativepowers ofthe constitution are impaired, I wouldnot excite the action of the extreme arteries bymercury. That a Headach has depended upona predisposition induced , by the venereal disease,and which predisposition was removed by the247use of mercury, I have no doubt: but I have nodoubt, that depositions under the pariosteum,resembling nodes, and morbid affections of membranes are sometimes induced by mercury, anddispose to Headach.As to an effusion ofwater within the cranium,if there have been the signs of acute Hydrocephalus, it is probably the consequence of Headach: but if there have been neither the signs ofHydrocephalus, or of Arachnitis , nor distendedsutures, the effusion of water is probably not amorbid phaenomenon. I believe, that less thantwo or three ounces of water in the ventricles ofthe brain, (and more is seldom found after theacute Hydrocephalus) , are not a morbid phaenomenon, unless the signs of acute Hydrocephalushave preceded death. *As to ulcerations within the cranium, I suspect that they are generally connected with thedisposition to some specific disease, which is of

  • March 31, 1825, p. m. I was sent for to one of the

most exquisitely formed Infants I ever saw, who, I was told,had for several days laboured under that difficulty of breathing, which I then saw, and from which I could not hesitate topredict, that he had a few hours only to live. For as thesymptoms were those, which are produced by an inflammationof the lungs, during which a large quantity of coagulablelymph is extravasated, so I could not doubt that such inflammation had preceded it.His breathing was extremely short, rapid, and painful,performed not by his intercostal muscles, but by his diaphragm and abdominal muscles; so that, when he endeavouredto inspire, he stretched out his arms, raised his shoulders, &c.His pulse was small, weak, and scarcelyperceptible, becausehe could not make a full inspiration; so that the right side ofhis heart, and his whole venous system, were being overloaded2481very difficult cure, even when it attacks an external part of the body. If a person have hadScrophula, when young, a Headach with affecwith blood, while the left side of his heart, and his wholearterial system, were being emptied of it.His breath was cold, because less blood was conveyed tohis brain by the internal carotid and vertebral arteries: andbecause the mucous membrane of his lungs no longer servedfor the decarbonization of his blood . Cold breath is universally known to be a fatal sign in inflammation of the lungs.His skin was cold, which it has long been noticed to be,when there is venous congestion in the head.મંદThe child had not been bled: but Huxham says, ifanything can be done in inflammation of the lungs, it is by" early and immediate bleeding, or it becomes, in very few"hours, utterly irrecoverable"; because, ashe states in anotherplace, the lungs become " stuffed up with concreted blood," red, hard, and as it were fleshy, or rather of the colour and" consistence of liver." Cullen says, this is the common termination of pneumonic inflammation, when it ends fatally: andBaillie and Laennec are also of opinion, that carnification orhepatisation of the lungs depends upon inflammation.April 2. The child died in the morning between 9 and 10o'clock, breathing, as he had done throughout, as if hislarynx were clogged with phlegm.But I was asked in the morning of April 1. whether suchrespiration might not be occasioned by water collected in thehead? To which question, as the person who put it to mehad no pretensions to medical literature, I thought it sufficientto reply, that such a disorder of respiration could arise fromno other cause than an obstruction to the passage ofthe bloodthrough the lungs, which obstruction was the consequence ofinflammation. I was, however, requested to attend the dissection of the child, between 8 and 9 o'clock of the day onwhich he had died, no doubt, that I might see the collectionof water, as little diminished as possible by absorption.Iattended the dissection, and resolved not to interfere withit, but to be a mere spectator.249tions of particular nerves, every paroxysm increasing in violence, may suggest scrophulousaction going on in the brain, or in its membranes:The thorax as it happened was first opened.Healthy lungs subside as soon as the knife has penetratedthe thorax; as a bladder half filled with air, but distended byit in a vacuum, does on the admission of the atmosphere; butthe child's lungs did not subside when fully exposed.There was no sign ofinflammation, either present, or past,in the pleura pulmonalis or the pleura costalis; nor had anybeen suspected to be there.The superior lobes of the lungs were severally grasped inthe hand and compressed, but were not diminished by thecompression; no blood was pressed out ofthem; neither wasany crackling noise produced bythe compression: butafter themost complete expiration, the quantity of air remaining in anadult's lungs, if they be healthy, is equal to perhaps 109 cubicinches.The superior lobes of the lungs, viewed through thediaphanous pleura, were of the colour of muscle, or ratherof liver: and when an incision was made into them, therewas no appearance of cells.The inferior lobe of the left lung, on its surface in contact with the diaphragm, was inflamed; which was probably the reason that, when, April 1 , I pressed upwardsfrom under the child's ribs, he coughed tremendously, hisface was deeply suffused , and his larynx seemed to be cloggedwith a tenacious mucous. The lobe of the lungs was certainlyinflamed, for it was of a florid colour, and of a firmer consistence than in health. It was not of a dark colour, as bloodsunk into it by gravitation after death would have rendered it.Besides, had its colour depended upon blood accumulatedthere by gravitation after death, it should have been on theposterior part only of the lobe, and also on the posterior partof all the lobes, as the child had for several hours been placedupon its back.The trunk of the Trachea was repeatedly and forciblycompressed between the finger and thumb, from the division.250and if a person have fungus haematodes in anypart of his body, as a testis, a constant pain inhis Head, &c. may suggest, that fungus haemotodes is also going on within his cranium . Butof the bronchia upwards to the thyroid gland; as I have oftenseen a leech plena cruoris freed from its blood.The larynx was not opened: but as soon as the head wasraised, so that it fell forwards, a portion of tenacious mucous,which had been squeezed up from the trachea through theglottis, ran out of the mouth, which was full of it.By this examination, I thought my diagnosis confirmed,that the child had died, because he could no longer inspire;his lungs no longer serving for the transmission of blood fromthe right to the left side of his heart.But the head was to be opened, and as it should seem,more water than usual was to be detected in it; as if sucha disorder of respiration, as the child had had, could havedepended upon a collection of water in his head.Now it must occur to every one, that, if a collection ofwater in the head produces, at all times, a difficulty of breathing, a difficulty of breathing must always be a symptom ofserous apoplexy, and of hydrocephalus, whether acute or,chronic. But of serous apoplexy, according to Tissot, it isnot a symptom; and in perhaps the best book ever written onthe acute hydrocephalus, we are told that " respiration is" natural in the third stage or period of effusion; " and inthe chronic hydrocephalus, when the head was enormouslyenlarged, as it may well be supposed to have been, for it contained nearly nine pints of water, the little girl two years old,who was the subject of it , is said by Vesalius, to have had nodifficulty of respiration, except when her head was raised;nor then such a difficulty of respiration as the child in questionhad. Vesalius says only " difficilis respiratio:" but, if thelittle girl's respiration had in any respect resembled that frominflammation of the lungs, would Vesalius not have noticedit? Besides, the little girl's respiration was only then difficult, when her head was raised: but the little boy's respiration was disordered as much when he was lying horizontally,as when he was sitting up in his mother's lap.251in every case of Cephalaea, it is, I believe, a goodrule to diminish the specific action, if this bepossible; at least not to increase it. By strictlyThe little boy's head however was to be opened; and before it was opened, the anterior fontanel, which in his lifetime had been level with the bones forming it, was now foundto be sunk inwards; a proofthat the bones of the skull hadnot been forced assunder by a collection of water within it.The anfractuosities ( anfractus, sulci) of his brain were notat all diminished; neither were the circumvolutions (gyri);a proofthat his brain had not been distended by a redundanceof water in its ventricles.There was no sign of present or of past inflammation inthe membranes of the brain, but there was great congestion inthe vessels of the pia mater. There was a certain quantity ofwater in the cells of the pia mater, which was visible throughthe tunica anachnoides, and appeared like a jelly, upon thesurface of the brain, and the ventricles contained more.There was no sign of increased vascularity in any portionofthe brain, or cerebellum, or medulla oblongata, or nervesoriginating in this . No bloody points appeared in them,when they were cut.Now, having shown, that an unusual quantity of water inthe head does not much disorder respiration, it may be inquired whether the quantity discovered in the little boy'shead, (as he had had no Sopor, no fits of vomiting, no convulsions, no dilitation of the pupils, no paralysis , no wasting ofthe body, ) was really a morbid phaenomenon? In one of thelatest books on anatomy, perhaps in the very latest (Shaw'sManuel of Anatomy) , a certain proportion of water in theventricles of the brain, at its base, and in the theca vertebralis, is said to be not a morbid phaenomenon; so true it is ,that appearances, which some, who are searching for morbidappearances, boldly pronounce morbid, others more versed inmorbid anatomy, and having no opinion to support, consideras healthy.I might have noticed sooner, that, although the child hadnot been bled, yet that Emplastrum Ladani had been applied252observing this rule , if we do not cure the disease,we favour the return of the natural action ofthepart which is its seat.to his chest; and that it remained there, when I was calledto it . But, supposing water in the head to have been thecause of the child's disordered breathing, what could thenhave been expected from Emplastrum Ladani applied to hischest?THE END.ROCHESTER:PRINTED BY W. WILDASH, 196, HIGH- STREET.CORRIGENDA.Page.5, line 2 after occasions, put a colon.12, the last of the notes, for p. 3, put 53.13,16,17,29,------4 ofthe notes, begin the article the with a capital.16 for? put:17 for but, read and.3 ofthe note for continentur, read continenter.3 ofthe notes for plusieres, read plusieurs.31, 4from the bottom, for internal read external. --41 , 25 dele from.42,46,54,66,67,68,71,88,89,93,98,110,112,113,134,139,144,-------

------

"--6 from the bottom for Lomminus, read Lommius.4for medium read median.24 for Exostisis read Exostosis.2 ofthe note, for Le panser, read de penser.5 omitthe m, in contramhitur.5 of the note, for vowd read vowp 6 ofthe notes, for vide, read vitae.3 ofthe notes, for Gemitus read Gemitu.12 for Hysterica, read Hysteria.29 for Tulpins, read Tulpius.2 ofthe note, for dependant, read dependent.9 of the note, for Perniciam, read Perniciem.34 for melanchotic, read melancholic.2 ofthe notes, from the bottom, for Elamenta, read Elementa.13 for lympathetic, read lymphatic.1 ofthe notes, for Ssribere, read Scribere.4 ofthe notes, for viii, read vii.17 for immaterialty, read immateriality.5 ofthe notes, for iusane, read insane.149, 26 after in Health, read is said.150,156,157,------2 for tetinus, read Tetanus.15 putthe article a, before bitter.19 for Effusion, read Affusion.20 for to, put on.168, 2 ofthe notes, for ub, read ab.176,

19 for chrysippus, read Chrysippus.

194, 24 after the word Cure, add of a Fit.218,232,235,-3- 9 of the notes, for provoctioribus, read provectioribus.26 after Uterus, add if the Headach continue and increase.10 for the, read that.


D

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