;',02 THE TREATMENT OF DISEASES. 



traced to an imprudent indulgence in some particular article of food. When it 

 comes on at night a heavy dinner or a hasty supper will often account for it. In 

 the case of a gentleman who was suddenly seized with giddiness whilst walking in 

 the street, the attack was attributed, probably correctly, to his having eaten very 

 heartily of sausages and Devonshire cream at breakfast. It would seem that in 

 many cases digestion progresses satisfactorily up to a certain point, when owing to 

 some temporary excitement or worry the process is suspended, the stomach is upset, 

 this causes disorder of the circulation in the brain, and the result is an attack of 

 giddiness. Even when no special exciting cause can be detected the attack is often 

 stomachal in origin. It may happen that the patient feels assured that his digestion 

 and liver are in perfect working order, and yet for all that treatment directed to 

 those organs will effect a cure. Stomach giddiness differs in several important 

 respects from giddiness resulting from brain disease. Thus it is never associated 

 with loss of consciousness, and at times the patient is perfectly free from it. It is 

 increased by excitement, by long fasting, and usually the severe attacks occur when 

 the stomach is empty. A stimulus in the form of wine or brandy affords relief, 

 and so does food taken in moderation. Sometimes, though not always, closing the 

 eyes, or gazing steadily at some fixed object, mitigates the intensity of the sensation 

 or affords temporary relief. In some cases the giddiness is slight but almost 

 constant, but more frequently it comes on in paroxysms lasting from a few minutes 

 to an hour or more. 



Another cause of giddiness is over-work. It occurs chiefly in those who, in 

 addition to being over-worked, are not too well blessed with this world's goods. Those 

 who are in comfortable circumstances and well fed may do many things with im- 

 punity which soon tell on those who are ill-clothed, badly lodged, and have not 

 enough to eat. This kind of vertigo is common enough in hospital practice, the 

 victims of it being very often poor seamstresses and others in a similar position of 

 life. The attacks are usually of short duration, they occur at intervals of some hours 

 or days, and especially after prolonged exertion, or poorer diet than usual. People 

 in a rather better social position sometimes suffer from this form of vertigo, and it is 

 then usually associated with a want of clearness of intellect, and an incapacity for 

 sustained mental exertion. Sometimes irritability of temper, restlessness, a sense of 

 impending evil, and more rarely sleeplessness are complained of. Sometimes the 

 giddiness is induced by the appearance of objects in motion, and this may occur 

 with such frequency that the patient is practically confined to the house. It is 

 probable that in many of these cases there is a general state of debility or want of 

 vitality, of which the giddiness is only one of the exponent symptoms. 



Sometimes swimming in the head depends entirely on disease of the ear. These 

 cases are comparatively rare, but we have met with two or three very striking 

 instances. There is usually an association of vertigo on movement, with singing in 

 the ears and partial deafness. This combination of symptoms is sometimes known 

 as Meniere's disease, after the French doctor who first described it. Persons in fair 

 average health, and without any stomach or other obvious disorder, usually suffer 

 most. 



Giddiness occurring in the aged often arises from the stomach, but is frequently 



