from hyperaemia
or anaemia, applies equally to headache; but, to embrace all the causes
of this affection we must add a third element, which, though most
commonly complicating one of the above circumstances, is not necessarily
included in them, namely a change in the constitution of the blood."
While I agree with Dr. Sieveking as regards the importance to be
ascribed to the first two factors--cerebral hyperaemia and anaemia, in the
production of the group of symptoms known as "headache,"--I fail to
perceive why especial prominence should be given to the third condition
mentioned by Dr. Sieveking. Indeed, I am quite unable to imagine how the
periodical, and more especially the intermittent form, of headache is to
be explained by what Dr. Sieveking describes rather ambiguously as a
"change in the constitution of the blood." It is quite evident,
admitting that such a change is capable of producing an amount of
cerebral irritation sufficient to develop well-marked cephalalgia, that
the latter must of necessity be within certain limits continuous. This
is not the case, as the causative factor is constant and not
fluctuating. I am, therefore, not prepared to accept this third
causative factor without question. Nevertheless I am perfectly willing
to admit that other factors besides cerebral hyperaemia and anaemia may
produce the functional variety of headache. There would seem to be ample
ground for ascribing great causative importance to excessive irritation
of the brain plasma itself. Hence those forms of headache which while,
being unaccompanied by any especial circulatory derangements, succeed,
oftentimes, with relentless regularity upon any considerable degree of
mental work. It is not my purpose to discuss the treatment of the
multifarious forms of cephalalgia on this occasion, did time permit. As
regards the so-called "neuralgic" variety I content myself by referring
to the admirable work on "Neuralgia and Kindred Diseases of the Nervous
System," by Dr. John Chapman of London, in which will be found many
interesting facts bearing on the question. Accepting the propositions,
then, that the more adjacent causes of headache are (1) cerebral
hyperaemia, (2) cerebral anaemia, and (3) irritation of the cerebral
plasma itself, let us now consider how these morbid factors are most
scientifically and speedily met at the bedside; and how, more
particularly, those distressing conditions of engorgement, which are so
baneful an item