GEN. IV. SPEC. IV. Hemicrania phænomenon of the throbbing or beating of the heart, or of a particular artery, or part of an artery, which frequently takes place without any connexion with the re- pulsatilis. gular systole of the circulation, often, indeed, discordantly head-ache Throbbing with it both in time and force: and we endeavoured to show that these anomalies, for the most part, depend upon a peculiarly nervous irritability, and spastic tendency of the muscular fibres of the arterial fabric, sometimes limited to the artery, or portion of an artery, in which the palpitation occurs, and sometimes common to the whole arterial system. ner. Pulsation often inac cordant with that of the heart. Sometimes Whenever any of the preceding species of the present Origin. genus are grafted upon a constitution of this kind, or at least upon an idiosyncrasy in which one or both the temporal arteries are possessed of this spastic tendency, and are consequently disposed to run into this anomalous contraction and relaxation, we shall have an instance of the species before us which commonly originates in this manThe consequence of which is, that a regular arterial stroke, as though influenced by the systole and diastole of the heart, is often feigned, which has no existence; and a pulsation is produced which is in no respect synchronous with the movements of the heart, and is often accordant, half as rapid again. It occurs, not unfrequently, how ever, that the morbid beat is in perfect accordance with that of the heart; but it is not less a spasmodic action on this account, for in the discussion already adverted to, as well as in the Proem to the third class, we have observed that the arteries, when in a state of health, suffer no alteration in their diameter during the passage of the blood through them, and that their ordinary pulsation is only produced by the pressure of the finger or of some other hard substance against their sides. The species of head-ache before us, therefore, is to be regarded as something of a more compound kind than the rest, in consequence of the peculiarity of the constitution in which it occurs: with the exception of which its causes, and history, and, as we shall presently show, mode of treatment do not essentially differ. but still a diseased action. Disease more com plicated than any of the rest. GEN. IV. Spasmodic SPEC. V. SPECIES V. CEPHALEA NAUSEOSA. Sick-Head-ache. THIS is the spasmodic affection of Dr. Fothergill, who has described it at great length and with much accuracy. head-ache of As the last species consists of almost any of the precedFothergill. Pathology, ing set down upon a constitution peculiarly predisposed Description. variable. to irregularity of arterial action, the present consists of the same set down upon a constitution peculiarly predisposed to irregular action of the intestinal canal. In its general symptoms, however, it is chiefly related to the stupid head-ache, and the hemicrania, particularly to the last; only that, while proper hemicrania most frequently makes its attack in the afternoon, sick-head-ache usually shows itself in the morning; though the latter, like the former, occasionally varies its hour, as it does also its length of intermission. The patient, observes Dr. Fothergill *, commonly Seat of pain awakes early in the morning with a head-ache that rarely affects the whole head, but only some particular part of it, most frequently the forehead, extending over one or both eyes. Sometimes it is fixed about the upper part of the parietal bone of one side only; sometimes the occiput is the part affected; or it darts from one place to another; and equally varies during its continuance in its degree of intensity. There is some degree of sickness usually connected with it, mostly limited to nausea, but occasionally amounting to vomiting. If the pain commence in the morning before any meal is taken, phlegm only is thrown up, unless the straining be severe, in which case bile is in * Fothergill's Works, p. 597, 4to. Medical Observ. and Inquir. Vol. VI. p. 103. GEN. IV. SPEC. V. Sick-head variable. termixed with it. After this the pain soon begins to abate, leaving a soreness about the head, a squeamishness Cephala at the stomach, and a general uneasiness which induces nauseosa. the patient to wish for repose. Perhaps after a short sleep ache. he recovers perfectly, only a little weakened by his sufferings. The duration of this species of head-ache dif- Duration of the pain fers, however, in different persons: in some it subsides in two or three hours; in others it extends to twenty-four hours or longer, and with a violence scarcely to be endured, the smallest light or noise rendering the pain intolerable. In young persons the paroxysm goes off soon; but, after the disease has been a companion for years, it is of longer duration, and the system becomes extremely debilitated. Its returns are very irregular: some per- Returns often irregusons suffer from it every two or three days; some every lar. two or three weeks; and others have still longer intervals. Those who use but little exercise, and are inattentive to their diet, are afflicted most severely: costiveness, when habitual, is a frequent predisposing cause; and hence a protracted laxity of the bowels, supervening on habitual constipation, has removed the complaint altogether. Dr. P. Warren, in a very valuable paper on this subject, seems to think that a line of distinction may be drawn between the disease as produced by a morbid state of the stomach, and of the collatitious viscera, or, in other words, as it makes an approach to the first, or to the third species before us. "Upon the whole", says Dr. Warren, "that form of head-ache, which is attended more with confusion than pain, and in which there is a temporary dimness of sight, appears to depend chiefly upon a defective action or secretion of the STOMACH; the other (that in which the pain is acute or exceeds the confusion) which is the most prevalent form, more particularly upon inactivity of the upper bowels, from whatever cause it may be produced, and an imperfection of that part of digestion in which the bile is concerned.”* * On Head-aches which arise from a Defective Action of the Digestive Organs. Med. Trans. iv. Art. xvIII. How distinguished from the first species. GEN. IV. SPEC. V. Cephalæa nauseosa. Sick-headache. General mode of treatment. Leading signs and principles. A diseased action of the stomach most com monly implicated, and requiring attention. Hence eme tics so often with an anodyne afterwards: as also the advantage of aperients. The connexion between all these species of head-ache is so close, and several of them are so apt to run into the others, that the author has reserved the few remarks he will have to make upon the remedial treatment till the whole have, as now, passed under review, and have furnished us with an opportunity of concluding how far any thing like a common plan of treatment may be advantageous, and upon what points it ought to vary. A very slight recurrence to the preceding history will show us that the chief causes of head-ache are local irritations, suddenly checked perspiration, or exposure to cold and damp; a peculiar irritability of the nervous system, and particularly a spastic idiosyncrasy of the temporal arteries, and a morbid condition of the chylopoetic viscera. The last is, perhaps, the most common cause; and hence, wherever there is any doubt as to the specific character of the disease, we can never do better than treat it as chiefly appertaining to the fifth species, and implicated with a diseased action of the stomach or its collatitious organs. It is on this account that emetics, with an anodyne serviceable given afterwards, have been so generally found serviceable, and have often effected a cure in a few hours. And hence also the great advantage of keeping the bowels not only free from costiveness, but with some kind of warm irritant slightly, though constantly, acting upon them, of which one of the best is aloes, where there is no tendency to piles, and copaiba, or the extracts of rhubarb and coloPiles occa- cynth where there is. Piles, however, are not an affection to be much regarded in cephalæa, for it is probable that they may often become a useful revellent: and Dr. Arbuthnot was so firmly of this opinion that he was in the constant habit of employing suppositories of aloes, rock-salt, and honey, and asserted that nothing relieves the head so much as piles. sionally remedia). When of a rheumatic character how to be managed. When the disease is evidently of a rheumatic character, an open state of the bowels should be combined with mild sudorifics, and, if necessary, narcotics. And hence the SPEC. V. Sick-head benefit that is so often found from adding four or five grains of antimonial powder to an aloetic pill given at Cephalaa night, which rarely disturbs the patient before the morn- nauseosa. ing and, where this does not answer alone, or we have ache. reason to fear, from a constitutional debility of the bowels, Treatment. that the aperient may act in the night, we should unite a grain of opium with the other ingredients, or employ Dover's powder instead. crania. Such a plan will, indeed, often be found to succeed Treatment even in the pulsatory head-ache or hemicrania; though head-ache of pulsatory here we may frequently employ such sedatives as hyoscy- and hemiamus, conium, aconite, and flammula Jovis, or the antispasmodics of musk, camphor, valerian, especially its essential oil, and ammonia, with somewhat more benefit during the paroxysm; and epithems of cold salt water, or a diluted solution of acetate of ammonia, applied round the head every morning. I cannot, however, avoid think- Prussic acid: ing, that in many cases of this disease, and especially where we have a clear proof of great irritability of the nervous system, that the prussic or hydrocyanic acid may be had recourse to with considerable advantage in moderate doses of a drop or two three times a day, in a little cinnamon water, gradually increasing the power, and uniting the acid with full doses of subcarbonate of iron, as in with iron. the case of neuralgia. the hair sometimes indiscriminately may produce but if used mischief. In some instances thinning the hair, where it is pro- Thinning fuse, has also been found serviceable; but in others it has failed, and the following remarks of the author's late useful; valued friend, Dr. Parr, upon the subject of shaving, are well entitled to attention." This practice", says he, "has not the sanction of long experience, nor is it supported by reason. Each hair is a vegetable, nourished Exemplified. by a bulbous root, supplied by numerous blood-vessels. These, though small from their number, convey no inconsiderable quantity of fluids; and as the external and internal carotids arise from a common trunk, and anastomose in some of their branches, whatever cause increases the circulation in the former, must lessen it in the latter." He adds, that he himself was for many years a sufferer |