vii THE SICK HEADACHE 61 



twisted, its diameter is lessened in proportion as the tube is 

 short. It is in this way that the jugular veins are contracted 

 when a short-necked person turns his head, causing at first 

 giddiness and then even apoplexy ; a tight collar aggravates 

 the effect. 



The practice of bleeding in apoplexies was too deeply 

 rooted in the medical mind to give way to FothergilTs caution. 

 It was not till some generations later that venaesection was 

 restricted to a certain type of cases. After this, in the latter 

 half of last century, bleeding was almost disused in England, 

 although still mentioned in the text-books. Of late years 

 more accurate knowledge of arterial and venous tension has 

 led to bleeding being again resorted to with advantage, 

 especially as a prophylactic, but also in some cases after the 

 onset of cerebral haemorrhage. 1 



THE SICK HEADACHE 



An essay of FothergilTs written in 1778 contains one of 

 the earliest clinical accounts of the Sick Headache (Megrim), 

 a disorder which had not yet attained a place in systematic 

 medicine, and of which he knew something in his own person. 

 Whilst incident to both sexes and at all seasons, it is found, 

 he says, mostly in persons of early and middle age, belonging 

 to the middle and upper ranks, who are of sedentary and 

 relaxed habits, and eat incautiously. The onset occurs on 

 first waking in the morning or later ; there is " a singular 

 kind of glimmering in the sight, objects swiftly changing 

 their apparent position, and surrounded with luminous angles, 

 like those of a fortification." Giddiness comes on ; then 

 headache of varying severity over one eye, or over both, 

 sometimes on one parietal bone, or on the occiput. Sickness 

 succeeds, in some cases only nausea, or a thin phlegm is 

 vomited, or in others bile. Abatement of the pain follows, 

 leaving soreness, uneasiness, and a wish for repose. After a 

 short sleep the patient awakes well, only debilitated. Such 

 an attack in a young person may last two or three hours ; as 

 the years pass, it is apt to continue longer, twenty-four hours 

 or more, and the patients suffer " with a violence scarcely to 

 be endured ; the least light or noise seems to throw them on 

 *the rack." The fits recur in some cases once in two or three 



1 Considerations on the Practice of Bleeding in Apoplexies, read 1776. Med, 

 Obs. & Inq. vi. 80 ; Works, iii. 208. Heberden had expressed similar if less 

 decided views in 1767, Med. Trans, i. 472 ; Cyclop, of Pract. Med. 1833, i. 130. 



