332 DISEASES OF THE PERIPHERAL NERVES. 



trigeminus to the dura mater, in the sympathetic filaments accompa- 

 nying the vessels, or in the brain itself! According to a fanciful hy- 

 pothesis of Du Bois-Meymond, which Dr. Mollendorf has carried still 

 further, the attack of migraine depends on a dilatation of the branches 

 of the internal carotid, the result of abnormal innervation of the vessels 

 from the ganglion supremum of the sympathetic. According to this 

 view, the brain would, during an attack, be in the same condition as 

 the ear of a rabbit that has had the cervical portion of the sympathetic 

 divided. 



Migraine is a very common disease, so that, in a moderately-exten- 

 sive practice, we may usually observe a series of cases for years, and 

 be again and again reminded by them of the impotence of our art. 

 The disease occurs in both sexes, but is far more frequent among 

 women than men. Like gout, migraine is considered a fashionable 

 disease, but it also occurs among the lower classes, and is for them a 

 peculiarly-distressing disease, as they cannot lie by for it. In most 

 cases its commencement dates from the time of going to school, if not 

 from early childhood. Probably in half of the women affected with 

 migraine, the attacks occur at the menstrual period, or immediately 

 before it. In other cases the attacks are unmistakably due to mental 

 excitement. I treated one lady, who never had a party without suf- 

 fering from migraine next day ; another was affected in the same way 

 after each visit to the theatre. In some cases a severe attack, particu- 

 larly if it end with sick stomach, results in a certain immunity to re- 

 lapses. The first lady above mentioned had her guests invited the 

 day she had migraine, so that she might be certain of being able to 

 receive them the following day. In the cases that I have seen, the 

 attack could rarely be referred to an error of diet ; but, on the other 

 hand, the pain and general disturbance were almost always increased 

 if the patient took any food, no matter how digestible, during the 

 attack. 



After feeling perfectly well the day before an attack of migraine, 

 the patients perceive the first symptoms as soon as they awake, or im- 

 mediately afterward. They feel heavy and depressed, are uneasy and 

 irritated, complain of slight chilliness, are inclined to gape, usually 

 have no appetite, and have a slimy taste in the mouth. Besides the 

 above, there is headache, which is almost always limited to one side, 

 increases rapidly, and becomes almost unbearable. The relaxatior 

 and pain drive the patients to bed ; they are very sensitive to light 

 and noise ; hence they seek the darkest and most retired chambers. 

 They dislike all visits, even that of the physician, during the attack 

 The pulse is usually slower. In many cases, at the height of the at- 

 tack (in some patients at every attack), there is nausea, and, after great 



