408 THE TREATMENT OF DISEASES. 



life at which they are manifested. We have already seen that angina pectoris 

 rarely occurs in young people, whilst megrim is seldom met with after the age of 

 forty-five or fifty. In all these paroxysmal diseases it should be noticed that 

 during each attack the symptoms gradually increase in severity, reach a culminating 

 point, and then decline. Another feature common to the paroxysms of these 

 several nervous affections is their periodical return ; not an exact periodicity, it is 

 true, but a rough approximation to regular recurrence, as if the result of a gradually 

 accumulating tension. 



Intimately connected with this periodicity is a kind of compensation, observable 

 in many of these affections. There is obviously some relation between the time 

 of exemption and the violence of the succeeding attack, a longer interval being 

 followed by a more severe seizure, or an unusually severe seizure by a longer exemp- 

 tion. The exciting causes of many of these nervous outbreaks are strikingly similar. 

 We have already seen that muscular exertion will determine the occurrence of 

 megrim with many patients, and the same is the case with epilepsy, and especially 

 with angina pectoris. Indigestion is a very frequent exciting cause of a fit of asthma 

 in fact, one of the commonest varieties of asthma is called " peptic " asthma, the 

 attacks being controlled entirely by the state of the digestive organs. We have 

 already referred at some length to the influence of certain kinds of food in inducing 

 sick-headache/ The transition from sleeping to waking is singularly influential in 

 determining the occurrence of many of these seizures. Passion and mental emotion 

 are especially efficacious in determining attacks of asthma and angina pectoris, as 

 they are in exciting megrim. The influence of prolonged fasting or exhaustion is 

 also worth bearing in mind. We think the evidence we have adduced will be regarded 

 as affording a conclusive proof that megrim belongs to the same family group of 

 diseases as do asthma, angina pectoris, epilepsy, and neuralgia. If further evidence 

 were wanted it would be found in the fact that in the same individual one form of 

 seizure is often replaced temporarily, or it may be permanently, by another. For 

 example, epilepsy and asthma are occasionally observed to be interchangeable affec- 

 tions, and in illustration of this the following case is related : " The patient was a 

 man about fifty years of age, subject to epilepsy. His fits had certain well-known 

 premonitory symptoms, and occurred with tolerable regularity about once a fortnight. 

 On one occasion his medical attendant was sent for in haste, and found him suffering 

 from violent asthma. The account given by his friends was that at the usual time 

 at which he had expected the fit he had experienced the accustomed premonitory 

 symptoms, but instead of these being followed as usual by convulsions., the shortness of 

 breath had come on. Within a few hours this passed off, and left him as well as usual. 

 At the expiration of the accustomed interval .after this attack the ordinary premoni- 

 tory symptoms and the usual epileptic fit occurred. On several occasions this was 

 repeated, the epileptic seizure being, as it were, supplanted by the asthmatic." 



And what, it may be said, is the real cause of megrim 1 ? What is it due to 1 ? Is 

 it an affection of the liver, ov the spleen, or the stomach, or what 1 This is a question 

 by no means easy to answer, although it is a subject that has occupied the best 

 energies of some of the foremost physiologists and pathologists, not only of this, but 

 we may say of almost every age. It would be wearisome even to enumerate the 



