406 THE TREATMENT OF DISEASES. 



It may be disposed in zig-zags, or may be like a fortification. Our patient tells us 

 that before an attack comes on she often sees bright crescent moons, sometimes 

 large and apparently close to her, and at others small, as if at a distance. Sometimes 

 she sees specks "like little bits of smut" flying about; when making pie-crust she 

 " keeps picking at it," fancying there are " little black things " on it. Sometimes 

 the specks moving about seem like a cloud of flies. 



Numbness and tingling of the hands and upper extremities generally are not 

 unusual phenomena during or immediately after an attack. Sometimes it is de- 

 scribed as being like pins and needles, at others the limbs seem to have gone to sleep. 

 Exceptionally, the loss of sensation is accompanied by some impairment of movement, 

 so that the grasp is less firm than it should be, and there is a danger of dropping 

 things. It not unfrequently happens that an attack of the megrim gives rise to a 

 certain amount of mental confusion. 



In many cases drowsiness or stupor is an occasional accompaniment. It is of a 

 most uncomfortable and oppressive character, not at all like natural and grateful 

 sleep, but often verging on coma. It is a noteworthy circumstance that this pheno- 

 menon is not peculiar to megrim, but is occasionally met with in other nervous 

 diseases. Thus it may attend the progress of asthma, and is of common occurrence 

 after epileptic fits. 



The usual termination of an attack of megrim is in sleep not the lethargic 

 condition which sometimes attends the development of the seizure, but a natural 

 and refreshing sleep. This terminal sleep is probably the natural consequence of 

 the exhaustion of the brain resulting from the unnatural state of activity through 

 which it has passed, being similar to that which follows long sight-seeing or other 

 exhaustive occupation of the senses. Sometimes sleep at any period of the attack 

 will at once cut it short. Thus the case is related of a gardener, who, if seized with 

 megrim when at work, would stretch himself out under a tree, go to sleep for half 

 an hour, and then awake well. Sometimes the attacks end in vomiting, and not in 

 sleep. Many people say that if they are not sick their attacks are prolonged, and 

 hang about for days together. Guided by their experience, they often do their 

 best to assist nature, and resort to artificial means. More rarely an attack ends 

 in a copious flow of tears, a large secretion of urine, profuse perspiration, or an 

 evacuation of the bowels. Sometimes the pain and other symptoms gradually 

 subside without the occurrence of sleep, vomiting, or any other form of crisis. 



In some curious cases the attack of megrim assumes an irregular form, the 

 headache being but slightly developed, or being entirely obscured by the intensity 

 of the mental phenomena. This affords an explanation of many anomalous seizures, 

 such, for example, as the following, described by an eminent divine and literary 

 character : " I was this morning engaged," he says, " with a great number of 

 people, who followed each other quickly, and to each of whom I was obliged to give 

 my attention. I was also under the necessity of writing much, but the subjects, 

 which were various and of a trivial and uninteresting nature, had no connection 

 the one with the other. My attention, therefore, was constantly kept on the 

 stretch, and was continually shifting from one subject to another. At last it 

 became necessary that I should write a receipt for some money I had received 



