HEADACH. 555 



of cure here, adapted to the nature of different species of head- 

 ach. 



" In the simple plethoric headach immediate relief may be given 

 by bleeding ; but its effects are only transitory ; and if often re- 

 peated, it may be hurtful, as frequent bleeding is equally apt to 

 bring on a return of the plethora, as the most plentiful diet is. 

 It should, therefore, be used with caution, and along with it 

 may be employed abstinence and moderate exercise, to prevent 

 any accumulation for the future, by supporting the usual dis- 

 charges. But it seldom happens that headach which subsists 

 for a long time, is purely plethorical ; it should, therefore, be treat- 

 ed as a topical fever, but variously, according to the various 

 circumstances causing it. These, whether exactly periodical or 

 not, have their intervals and returns, and to prevent these returns 

 is the chief business of the physician. The disease is often ow- 

 ing to a plethoric state in the vessels of the head, either in con- 

 sequence of an universal plethora, or a particular determination 

 to that part. Where this is very evident, and the fever pro- 

 duces a hot fit, attended with an increase of heat, a frequent 

 pulse, or only a full one with throbbings, there the cure is to 

 be found only in blood-letting. 



" When there are only presumptions of a plethora, regard 

 must be paid to circumstances, as, if it occurs in young persons, 

 in the spring season, &c. In general, bleeding should only be 

 used where the plethora is evident. Topical bleeding is most 

 proper, as by leeches, or cupping-glasses. If it is thought pro- 

 per to open a vein, it will be more proper to open the jugular 

 than that of the arm ; but here too, we must observe that the 

 effects of bleeding are only temporary. A more effectual re- 

 medy is the use of purgatives ; these have not such an imme- 

 diate effect in taking off the pletho-ra and diminishing the heat, 

 though they do this too ; but they may be more safely repeated, 

 and so are more permanent, and have a peculiar advantage in 

 causing a derivation from the head. The headach has, accord- 

 ingly, been frequently cured by moderate, but habitual laxa- 

 tives. If valerian ever cured this disorder, as has been assert- 

 ed, it was by acting as a laxative, of which we have several 

 proofs now in the Royal Infirmary. Accordingly, there are two 

 instances mentioned by Dr. Fordyce and Dr, Whytt, in which 



