402 THE TREATMENT OF DISEASES. 



usually subside gradually, generally terminating at night. With some peopl( 

 limited number, unfortunately a very short sleep, say of half an hour's duration, 

 will completely dissipate an attack. Sometimes relief is afforded by vomiting, or bv 

 an unexpected action of the bowels, but this is somewhat exceptional. The abrupt 

 transition from intense suffering to perfect health in this malady is very remarkable. 

 " A young woman in the enjoyment of otherwise excellent health, well-nourished, 

 cheerful and active, the life, perhaps, of her family circle, appears in the morning, 

 once in every two or three weeks, a perfectly altered being, with a pale, inanimate 

 face, dull, lustreless eyes, and with all her usual cheerfulness departed, and so 

 remains throughout the day in a state of chronic nausea, and corresponding mental 

 and bodily dejection, to which use alone has made her resigned; and yet the 

 following morning she will be her former self again, as if nothing had occurred \ and 

 thus she may continue to live two distinct lives, as it were, perhaps for a long series 

 of years." 



The duration of the interval or period of freedom is also variable in different 

 cases, though there is some approach to regularity in the same individual. Some 

 people have an attack every fortnight, others every month or two months, and so on. 

 With many women sick headache recurs at every monthly period, with some com- 

 mencing a day or two before, and in others following it. The attack, however, 

 seldom returns with the same regularity as does, for example, a fit of ague. In 

 ague the patient can often tell almost to a certainty when the seizure will occur, but 

 in megrim all he knows is that should he exceed his usual time he is not likely to 

 remain free for many days. After an attack the patient usually feels certain that he 

 will not be troubled for some time to come. Curiously enough a sort of compensation 

 is sometimes observed between the severity of a seizure, and the degree of immunity 

 which precedes or follows it. Many people are not anxious for long intervals 

 between their attacks, for they recognise the fact that they have a certain amount 

 of suffering to go through, however it may be broken up or divided, and 

 they would as soon have it regularly as not. In the majority of cases 

 the exact time of the onset of an attack is determined by some apparently 

 trivial circumstance such, for instance, as a little indigestion or even confined 

 bowels. Some articles of food are especially likely to bring it on, and among 

 those most commonly credited with this property are butter, fat, spices, and 

 alcohol in any form. One gentleman, the subject of megrim, says that for over thirty 

 years he has not been able to take the smallest quantity of wine, not even the sacra- 

 mental wine, without suffering from an attack. A patient, a woman, now under 

 treatment, tells us that with her certain kinds of food are sure to bring it on. It is 

 positive to come on after pastry, or pork, or bacon, or veal. Even the smell of pork 

 cooking is quite enough. Mutton is almost the only kind of meat that will not bring 

 it on, and even then it must be a very nice little piece. If she cannot get mutton she 

 prefers going without anything. Eggs do not induce it, as a rule, nor does fruit. 



Mental emotion and exertion are among the most influential of the occasional 

 exciting causes of the megrim. One of our patients assures us that an attack is 

 infallibly caused by worry or excitement, or emotion of any kind. Even " doing 

 it-bout the house," she says, will bring it on. She has known it come on immediately 



