GENUS IV. CEPHALE A. Head-ache. ACHING PAIN IN THE HEAD; INTOLERANCE OF LIGHT 66 CEPHALEA (Epaλaía from xepaλn," caput") is employed GEN. IV. Origin of by Galen, chiefly, in the sense of chronic head-ache; whence the generic the term cephalalgia has been invented in later times to term. express affections of shorter duration. Head-aches of all Synonyms. kinds, however, form a natural group, and should be described under a common genus, which is here named after the oldest and most authorized term. Sauvages has particularly remarked the symptom of disability of the mental powers in the first species we are about to notice, and the remark may be applied to all the others: "difficultas cogitandi, distinctè ratiocinandi, reminiscendi." The species which may be enumerated under this genus are the following: GEN. IV. SPEC. I. Remote causes of head-ache generally. Repelled discharges and other fluids. SPECIES I. CEPHALEEA GRAVANS. Stupid Head-ache. PAIN OBTUSE; WITH A SENSE OF HEAVINESS EXTENDING THE remote causes of head-ache are so numerous and so complicated that it is difficult to catch or arrange them; and many of them are so completely concealed from view, by a confinement to the brain itself, that we vainly endeavour to discover and analyse them. Repelled discharges from the hemorrhoidal vessels, repelled or retarded catamenia, repelled fluids from the surface, are very frequent causes of one or other of the species of cephalaa now enumerated. Whatever retards the current of the blood in the sinuses of the brain, or the veins which convey the blood from the head, will produce it. Of this kind are Obstructions various tumours, particularly of the conglobate glands, polypi, exostoses, or bony fragments separated by some violence from the internal table of the skull, not producing irritation, perhaps, till the accident that gave rise to them has long passed by and been forgotten. Hence some part of the brain has often, on dissection, been found diseased in its structure, producing, occasionally, an abscess with a considerable lodgement of pus. And, in some cases, the discase has been cured by the pus making its way through the frontal sinuses*, or through the ears †, and escaping externally. It has, in every age, within the cranium. Decayed teeth. Nicolai, Decad. Observationum Illustr. Anat. Schrader. Observ. Anat. Med. Lentilius. Miscel. 1. 599. + Gockell, Gallicin. Med. Pract. Trecourt, Mem. et Observ. de Chirurgie, N. 5. GEN. IV. Cephalaa catarrh. Acrimony mach. been produced by a decayed tooth, and has ceased on its removal; a profusion of hair on the head has been also an occasional cause, in which case it has yielded to shaving gravans. Stupid or merely thinning the hair. It has often followed upon head-ache. a neglected catarrh or neglected rheumatism, and still Profusion oftener has resulted from some morbid irritation of the of hair. stomach, and especially from worms*. So again, what- Neglected ever prevents a free evacuation of the right auricle and ventricle of the heart, and contributes to retard the mo- in the stotion of the blood in the veins which discharge their con- Obstructents on this side of the heart, has a tendency to lay a tions in the foundation for this complaint. Under these circumstances nothing is more difficult often to disthan to determine, in many instances, whether a head- tinguish ache of any kind be an idiopathic or a symptomatic af idiopathic fection, and on this account Dr. Cullen, deviating from and a symthe general opinion of the nosologists who preceded him, head-ache: ptomatic has regarded it as a symptom in every instance. This, and hence however, is to suppose that the encephalon which, from regarded by its magnitude and complexity, seems to open a theatre always symfor more intrinsic disquietudes than all other organs ptomatic. whatever, is exempted beyond any of them. heart. Difficult between an Cullen as of the pre sent species. The species immediately before us, emphatically distin- Pathology guished by the name of STUPID HEAD-ACHE, seems, when idiopathic, to be strictly a nervous affection of the organ, originating from nervous debility or exhaustion; or, in other words, from the want of a proper supply of that kind of sensorial fluid on which the organic feeling of comfort and refreshment depends. It is hence peculiarly Diagnostics. marked by a general disquiet and confusion, rather than by acute pain; by a general hebetude of sensorial power which disqualifies the person labouring under it for a continuance of mental labour; and in which the sight is dim, and the hearing dull, and the memory vacant. On which account it is frequently experienced by hard students, who have sat up through the whole of the night in pursuit of some abstruse and difficult subject, or who * Walther, Thes. Obs. 17. Blumenbach, Med. Bibl. B. 1. p. 434, GEN. IV. SPEC. I. Cephalaa gravans. Stupid head-ache. In certain cases whence derived, and how best relieved. In other cases rived. have laboured upon the same from week to week with too small an allowance of time for sleep or exercise. In all which cases it is often relieved by surrounding the temples with a bandage steeped in cold water, which acts as a tonic upon the spent and enfeebled brain, and once more excites it to a little temporary energy. A sudden blow of severe grief often produces the same kind of exhaustion, and is accompanied with the same symptoms, during which the sufferer is equally incapable of thinking, sleeping, or attending to external objects. A similar effect is produced by whatever else has a whence de- tendency to induce debility and torpitude in the nervous structure of the brain, as a profuse diarrhoea, repeated and immoderate venesections, and particularly any sudden faintness, or debility of the stomach. The last acts, indeed, in a double way; directly, as withholding the means of sensorial recruit; and, indirectly, from the close sympathy that, on all occasions, exists between the two organs. And hence, wherever we meet with cephalæa gravans as a sympathetic affection, and are doubtful to what particular organ to ascribe it, we shall, in most cases, find the stomach affected, and may venture to treat it accordingly. General remedial process. As much of the remedial process, however, which may be serviceable in any one of the species of head-ache before us, may be useful in the rest, it will be most expedient to reserve this subject for the close of the entire genus. SPECIES II. CEPHALEA INTENSA. Chronic Head-ache. PAIN VEHEMENT, WITH A SENSE OF TENSION OVER THE pre GEN. IV. internal causes, and defies all medical aid, and why. THIS species is, perhaps, always dependent upon some local irritation; and may be produced by many, probably Often from most, of the irritants noticed at the opening of the ceding species and as not a few of these have a seat in the brain itself, and must remain concealed till disclosed to us by dissection, and would be still beyond our reach if we could ascertain them from the first attack, there is no difficulty in conceiving why this form of head-ache should often defy all medical aid whatever, and run parallel with the life itself. causes. Among the external causes, those productive of rheu- External matism are, perhaps, the most frequent, as exposing the feet for a long time to cold and damp, or lying in a damp bed with a small quantity of covering. And as all rheumatic affections, when they become chronic, have a tendency to intermit, and return periodically, we may easily see why the disease before us should do so in many instances. This species may therefore be distinguished by its being rather limited to some particular part of the head than extending over the whole organ; by its remissions or intermissions; by the acuteness of the pain during the return of the paroxysm; by an intolerance of all motion of the head, far more than of light or sound, both of which, however, are sometimes highly irksome; and by a peculiar feeling of tenseness or constriction over the ence Present species how distinguishable from others. |