322 THE TREATMENT OF DISEASES. 



the exciting causes probably fatigue in some form or other is the most common. Too 

 long a walk, sitting up beyond the usual hour for retiring to rest, compulsory mental 

 effort, whether in the course of conversation, or in study or business, the exhaustion 

 following the excitement of a long journey, or of an evening party, may all act as 

 exciting causes, especially if the fatigue and debility are from any cause associated 

 with circumstances producing perturbing or depressing emotions. Excessive 

 muscular exercise will often act in the same way. In delicate women subject to 

 this headache, it often comes on before, and lasts during the whole of each menstrual 

 period, although there may be nothing abnormal or unhealthy in the function. 



In addition to the varieties we have described there are many other forms of 

 headache of more or less frequent occurrence. In what is known as " sympathetic " 

 headache, irritation proceeds at a distance from the nervous centre, as in decayed 

 teeth, arrested digestion, or some disorder of the womb. The case is related of a 

 gentleman who had suffered from pain in the right side of his head for three or four 

 months. It was sometimes acute, at others dull, and it had come on without any 

 assignable reason. A great variety of remedial measures had been tried, including 

 blisters, tonics, regulation of diet, change of air and scene, and so on, but without 

 success. As a last resource he had been advised to seek relief at one of the German 

 spas, but, fortunately for him, before setting out he had his teeth examined. They 

 were all in wonderfully fine condition except the wisdom-tooth in the upper jaw on 

 the right side, which was decayed. This was extracted, and from that moment the 

 patient was cured. This is an exceptional case, but it is a remarkable instance of 

 sympathetic headache. A more familiar example is the pain in the head which, 

 with many people, supervenes on taking ice into the stomach. Headache is some- 

 times produced by the presence of some special poison in the blood. The headache 

 occuring in typhoid fever is probably the most decided instance of this variety ; the 

 poison in this case being the poison of the fever, In the same category must be 

 placed the headache of rheumatism, gout, ague, and some other affections. 



Megrim, sick-headache, blind-headache, or bilious-headache, as it is called, is ot 

 such importance that it merits a separate consideration (see MEGRIM). 



Speaking of headaches generally, it may be said that in the large majority of 

 cases they are induced by excessive brain-work, combined with a deficiency of bodily 

 exercise, short restless nights, and insufficient sleep. Excessive brain-work does not 

 mean exclusively work of an intellectual kind, as in close application to study or 

 literary composition, or to the business of chambers or the counting-house, but it 

 also includes that strain of the affective or emotional part of our nature which is the 

 result of prolonged mental anxiety, vexation, and disappointment, and is far more 

 rapidly exhaustive of nervous power than any intellectual efforts that are free from 

 such emotional complications. Headaches occur more frequently in persons of adult 

 life than in youth or advanced old age, and a predisposition to them is undoubtedly 

 in many cases hereditary. 



Habitual dwellers in town suffer more than residents in the country ; women 

 more than men ; the nervous and delicate more than the robust, and the middle 

 and upper classes of society more than the lower. All pains in the head especially 

 affect those who neglect the many little attentions and cares that our civilised, and 



