24 THE TONER LECTURES 



One form of occipito-cervical pain is indicative of serious dis- 

 ease of the kidneys, Seguin^ has reported two cases of occipito- 

 cervical pain of a severe type. Both patients were adults and had 

 suffered from chronic headache more or less of the migraine type. 

 At a certain period this headache became transformed into a local- 

 ized occipital pain, very different from that of the former attacks. 

 The pain in one case extended down tlie cervical spine, and Avas 

 much aggravated by movement. The peculiar headache was dis- 

 tinctly i^aroxysmal and accompanied by. nausea. In both cases 

 evidences of chronic Bright's disease, in the form of urine of low sj^e- 

 cific gravity, and containing albumen and hyaline and granular 

 casts. Convulsions were present in one case. One of the patients 

 died, and the autopsy showed extensive disease of the kidney l)ut 

 none of the brain. 



That disorders of digestion are sometimes early results of brain 

 strain and over-work needs only to be recalled. A true nervous 

 dyspepsia, associated with heart palpitations and coming and going 

 diarrhoea, is often one of the first and most annoying evidences of 

 nervous strain. A distinguished physician, when financially embar- 

 rassed and working with great energy for recognition, suffered so 

 severely with dyspeptic symptoms that cancer of the stomach was 

 suspected by himself and by some of his i^rofessional friends. With 

 professional success came relief to his gastric symptoms. 



Digestive disorders come early and late in the history of nervous 

 break-down, but their true significance is often overlooked, and 

 treatment is directed to the stomach when the over-worked brain is 

 the organ really at fault. 



In not a few cases Avhich are supposed to be the result of over- 

 work, and which are at first conveniently labelled as neurasthenia, 

 the l)reak-down in health is really due to some special physical 

 conditions which may or may not be serious. Headache, vertigo, 

 and mental distress may arise from the eye-strain which is caused 

 by optical defect ; and tinnitus and vertigo, which are regarded 



L\rchives of Medicine, August, 1880. 



