A STUDY OF ONE CASE OF

HEADACHE.

BY J. M. FRENCH, M.D.,
Milford, Mass.

I AM aware that one case counts for but little in making up statistics or in settling disputed points in therapeutics. Yet all statistics are made up of the records of single cases; and when the one case is a personal experience, and extends over a period of thirty-five years, it may be worth while putting it on record, to help with others in settling disputed points.

As a boy, I suppose that I had headaches sometimes, as other boys do. But I have no recollection of their being either frequent or severe at this period of my life. In tracing their origin, however, I shall be compelled to go back several years beyond this, to my student life.

In the fall of 1875 I attended an excellent course of lectures on therapeutics at Dartmouth Medical College, given by Professor Henry M. Field, of Newton, Mass. In the course of these lectures he taught us some valuable lessons as to the nature and treatment of disease, and among others he spoke of spasmodic colic. I remember his impressing it upon our minds one day that if a person had this disease once he was especially likely to have it again and again, until he had become subject to it. "If you have the bellyache," he said to us one day, "and do not know whether it was the colic or not, you have only to wait a little. If you never have it again you may be sure it was not true colic."

I remember this remark so well on account of what followed. Up to this date I had been a stranger to colic, as I had to sick headache. But on my way home from that course of lectures I suffered from a severe attack of spasmodic colic, which, through lack of proper treatment, lasted me three days. It was brought on by the combined influence of the three factors which I have since found to be its most common exciting causes, namely, exhaustion,

errors in diet and exposure to cold. The result in my case was favorable to Professor Field's theory as to the recurrence of the disease, for from that time on for seven years I was subject to frequent irregular but periodical attacks of colic, which were quite severe, and at times interfered materially with my work as a teacher. I confess that as I look back upon them now I find some things in these attacks to remind me of what to-day we would call catarrhal appendicitis. On the whole, however, I do not think they were really of this nature, for though they were repeated at intervals of a few weeks or less for seven years I never had any considerable fever, they usually lasted only one day or a day and a night, and the attacks did not grow noticeably

worse.

At the end of about seven years the attacks of colic suddenly ceased and I began to have in their place severe attacks of headache. It was to my mind a clear case of substitution, and I have never seen any cause to doubt that the two symptoms were effects of the same cause, different manifestations of the same general condition. The headaches were not always precisely alike, yet they did all belong to the same general class. There was frontal headache, usually limited to one side, suggesting migraine. In the severer attacks there was nausea and sometimes vomiting, simulating the sccalled sick headache. Often there was pain at the base of the brain and tenderness of the cervical spine, with retraction of the head, indicating spinal congestion. The attacks would begin anywhere from morning until the middle of the afternoon, and last until dark, or sometimes until night and sleep, when they would pass away, and the next day my head would be clear. There was often a pain and aching of the eyes, made worse by reading or writing, which led to the thought of eye-strain as the cause. But my eyes were frequently inspected by a competent man, and no fault was found in them save the changes of advancing age. Sometimes I would wake up in the morning without any headache, but with a terribly

dull, heavy, oppressed feeling, as though the weight of the world was upon me. I knew that this meant a blinding headache a little later, and I was not often disappointed.

At first I did nothing for it. Then I found temporary relief from the elixir of guarana, and later from caffeine. When the coal-tar preparations came into vogue I tried acetanilid, and finally settled down to the use of a migraine pill or tablet, composed of two grains of acetanilid and onehalf grain each of caffeine alkaloid and monobromate of camphor. This gave me marked relief for years. Beginning with one, I went up to two and three at a dose, repeating hourly until relieved, sometimes taking as many as a dozen in a day. I knew that the final results of frequent doses of this nature could not be beneficial, but one will do almost anything to be relieved of a severe headache. And, after all, they never did have the direful results which are so often attributed to them. The worse thing which did happen was that the remedy gradually became worn out, and finally failed to produce its former effects. But for many years it did give me marked relief, enabling me to control my headaches. to such an extent that I was able to keep at work until night, when sleep would come and complete the cure, and the next day 1 would be all right. But during all this time I found it never safe to go away from home without the remedy in my pocket.

I tried various other remedies and plans of treatment, including the eliminating and antiseptic, and several uric acid remedies, all based on the prevalent theory of the accumulation of uric acid in the system. But none of these did me as much good as the migraine tablets.

Finally, another fact was borne in upon my mind. I found that whenever I suffered from any illness which was sufficient to confine me to the house or keep me on a light diet for a few days or a week, for the following few weeks I was invariably freer than usual from headaches. The first time I remember noticing this was when I had

a severe attack of the grip, which kept me from eating much for two weeks. After my recovery I was inclined to say that the grip was not so black as it was painted, for my headaches were missing for some time thereafter. This experience was repeated several times in different ways before it occurred to me to put two and two together and call the result four. I had long been inclined to the opinion that my headaches were caused by the accumulation of uric acid or other waste products in the system. It hardly seemed that this could be due to defective excretion on my part, however, as I am never constipated, but, on the contrary, during all these years I have had from three to six movements of the bowels a day on the average for the year round. There has never been any serious abnormality in my urine. I have never been accused of being an unusually hearty eater. I eat less meat than the average man. I do not suffer from primary indigestion, and I never had dyspepsia. I am a little under standard weight to-day, but twenty years ago was a little above it.

In spite of all this-and I do not pretend to give a satisfactory explanation of the fact -it seemed to me that my headaches were to be compared to the smoke of a lamp that is turned too high, clinkers in a furnace when the draft is poor, the ashes of imperfect combustion-in plain English, the accumulation of waste products in the tissues. And when I found that any cause which led me to live on short rations for a time would stop my headaches for a longer time, only to return as soon as the system had had time to get clogged up again, it seemed to me to confirm this theory.

I must not forget to say in this connection that for years I have been in the habit of drinking one, two, or often three cups of strong coffee with my breakfast, and sometimes for dinner also, and that I drank more or less tea. Besides this, I eat an inordinate amount of sugar with my food. I never ate much candy, as it was sure to give me a headache.

Last January my headaches became so

much worse than usual that I was twice within two weeks compelled to give up and go to bed, used up and not able to do business on account of them. This seemed rather hard to endure, especially as the migraine tablets no longer did any good, and the headaches began to hold out over night, and sometimes to last for two or three days at a time. As all the drugs warranted to carry off the uric acid and other waste from the system had failed to do the work, it occurred to me that a sensible way would be to limit the intake instead of trying to increase the outgo. So I stopped off short all at once on tea, coffee, and sugar; limited my eating to considerably less than the usual amount; especially ate still less meat than usual, and made my supper of bread and milk for a good share of the time. The tea and coffee were stopped absolutely, and I have not taken a drop of either since some time in January. The strange thing about this is, that not once have I missed either tea or coffee, not once have I been tempted to go back to them, not once have I felt that my abstinence was a hardship even. As for the sugar, I must confess that it was otherwise. I did miss it greatly, and I have not remained faithful, but have gradually returned to its use, though I do not take as much as formerly. As to the bread and milk, that is no hardship, but rather a pleasure. Nothing leaves me feeling as well as bread and milk. This does not clog up the wheels of my running gear. It seems not to smoke in the burning, but to be consumed completely.

The other important fact is, that since I made this change in my diet I have not had one hard headache, nor one that came near being hard. With the exception, that is, of one or two times when I had an attack of malaria, or fever from some other cause, and then I had a headache which was of an entirely different nature and origin from my old enemy. For some months I had an occasional dull ache, but now even these are gone, and it is but seldom that I have any reminder of the old trouble. My head is clearer, I can work better, and I do not have

to carry a bottle of migraine tablets in my pocket for fear I shall be overcome by a headache. The change is a very satisfactory one, and I propose to keep it up.

During the summer my appetite was not very good, and my weight ran down below 150 pounds, whereas a year ago it was over 190. But as the cooler weather has come on I am eating more, and my weight last night was 156. If my headaches do not return, and my appetite continues good, I propose to keep on eating heartily and gaining weight, until I have got back to 160 pounds at least. But at the first signs of the return of my old enemy I shall put on the brakes and limit my diet again.

What are my conclusions? I am satisfied that the improvement was the result of the change in my diet. How much of it was due to the lessened quantity, how much to the change in character, and abstinence from certain articles is open to question. I believe it is due to both elements combined; but, while I am now eating what is to me the normal amount of food, and in most respects the same kind of food I ate a year ago, I do not take any tea or coffee whatever, and I do not propose to do so at any time in the future.

I am not going to rush off and join the ranks of the vegetarians, or the two-mealsa-day cranks, nor enter upon a crusade against tea and coffee, or claim that everyone must do as I do. I am not even going to advocate the drugless treatment of disease. I am simply learning a lesson from experience and giving you the facts as I go along, without waiting for the final conclusions.

WITH narrow-minded persons, and those in a state of mental darkness, we find conceit; while with mental clearness and high endowments we never find it. In such cases there is generally a joyful feeling of strength, but since this strength is actual, the feeling is anything else you please, only not conceit.-GOETHE.

MAY NOT THE

EYES BE THE SOURCE OF THE TROUBLE?

BY GEORGE T. STEVENS,

New York.

I AM taking for my text for this short article a commonplace incident and I propose to base upon it some quite commonplace remarks. Yet, while these remarks will appear to the expert as ordinary truths, it is an unfortunate fact that they are truths not generally understood by those who need most to know them.

A lady who had passed her forty-fifth year consulted me respecting her eyes. She had had a number of forms of nervous trouble the past five years and had been during most of that time more or less under the care of a physician. While writing the formula for glasses, of which she was, and had been, greatly in need, I remarked upon the nervous disturbance which is almost sure to arise from the neglect to use glasses when the time for their use arrives.

A lady accompanying the patient, hearing the remarks, said to the patient, "I believe that that is all that is the matter with your husband. He is all the time under the doctor's care for his dyspepsia and his vertigo, and I think he needs glasses." To which the patient replied, "No, his eyes are all right. He has never complained of them and the doctor says it is all from his stomach."

I could hardly relate a more commonplace incident than this nor one suggesting a more important lesson. I do not know the exact state of the eyes of my patient's husband; I know only from what I overheard in the brief conversation between the two ladies that he is about forty-six years of age, that he has not used glasses and that for five or six years he has been a sufferer from dyspepsia, nervous exhaustion and vertigo. He is a merchant, an active man and personally superintends his own business. He was, previous to his first attack of "nervous prostration," a few years ago, in perfect health and in the vigor of business life.

Let us suppose that this gentleman's eyes

are just as the wife believes, without natural defect and without disease. Then we have an easy key to his nervous state during the past few years.

A pair of eyes in which there is no anomaly, that is, eyes constructed on the typical plan, begin to be presbyopic, that is "old sighted," at the age of forty. This is not the result of weakness or disease or of poor eyes; it is the natural development of the eyes and comes as regularly as the first set of teeth or any of the physical developments. It arrives, perhaps, more exactly on time than any of our normal physical modifications. It is not a loss of the power of vision, as many suppose; it is not a disease; it is not a condition which can be avoided or delayed.

The man or woman who fails to recognize this important crisis is pretty sure to pay the penalty of the neglect in the form of dyspepsia, headache, vertigo and "nervous prostration." This list does not by any means include all the reactions incident to the failure to recognize the natural course of the process of change which passes in all alike.

In this country the number of such nervous complaints is notorious. Americans are called, by themselves and by other nations, a "nervous race," and the high tension at which Americans live is supposed to be the reason for this widely prevailing condition. This is an unfortunate error; unfortunate because it diverts attention from the actual facts and thus encourages the conditions. which are so unpleasant. The peculiarity of Americans in respect to nervous troubles, if such peculiarity exists, is accounted for in the fact that of all the peoples of the earth the Americans are a reading people. They use the eyes at close range to an extent not equalled in any other quarter of the globe. When these organs, taxed beyond those of any other peoples, are worked under unfavorable circumstances it is natural that the nervous organization should suffer.

The failure to recognize presbyopia is only one of the neglects respecting the eyes, for there are many defects to which children

as we proceed.

Someone who has read these lines up to this point will smile with a complaisant curl of the lip and the remark, "this talk about presbyopia coming to all alike and at a certain age is nonsense. My mother lived to the age of ninety and never used glasses and could see as well as anyone."

This remark, my friend, shows that you are not a good observer. We shall not deny that your mother lived to the age of ninety, nor that she was able to knit or to read her bible or even her newspaper even her newspaper during her last years. That does not prove that your mother could see as well as anyone. She was myopic, that is near-sighted. She was able to see close at hand, but she could not see at a distance. She became presbyopic, but even that failed to carry the focus beyond the ordinary distance for reading.

The myopic eye may be able to see at close range but does not see clearly at some distance without the aid of glasses. In this respect it differs from the typical eye in that while the typical eye does not with age lose the faculty of seeing perfectly at the distance, it requires, after the age of about forty, a glass to aid in seeing at close range. The near-sighted eye may not have to use a glass for this purpose because whatever it sees and sees clearly is at close range. The fact that your mother could distinguish between the individuals of her family at a few feet distance did not show that she had good vision at that range.

Nothing which you could say would more positively prove that your mother did not have "good eyes" than your remark that she continued to read after the normal period for presbyopia without the aid of glasses.

Now, to return to the subject of our text. The man in the vigor of life or the woman in the height of her physical activity who, soon after the age of forty, begins to feel the weight of cares or of ordinary duties as excessive, who finds himself or herself dyspeptic or troubled with headache or in

chair without a pillow at the back of her neck, who has backache and other nervous troubles had best see an expert who can tell of the condition of the eyes, and if he or she will follow the advice of the expert it will be surprising how quickly the unpleasant symptoms may disappear. Under such circumstances the first medicine that the patient takes is often incorrectly supposed to induce a wonderful cure, and if it does not get into the newspapers as an advertisement it is sure to be extolled to all acquaintances as the most remarkable medicine which cures when everything else has failed.

I have already referred to the fact that many children have defects of the eyes which do not come under the head of diseases, but are normal peculiarities. These children and young persons may see well both at distance and at close range. The fact of ability to see does not bear upon the question of how much injury may occur to the subject of the defect as the result of the efforts to adjust the focal range or the relations of the eyes.

Thousands of children suffer from headaches, irritable temper, disinclination to study, chorea, and even most terrible forms of nervous convulsions because of some unobserved defect in the form of or the relations of the eyes.

It is absurd to say, "Oh, he has never had anything the matter with the eyes." How can one be sure that the boy or girl has never had anything the matter with the eyes until someone who is expert in detecting the defects of the eyes has reported on their condition, and why should parents and physicians neglect to the very last the investigation into the source the most potent and the most common of all the causes of nervous disturbances?

The mother who, without investigation or knowledge, exclaims, "Well, I don't want my child to put on glasses," may think that she is making an exhibition of proper regard for her child. In fact, she may be pronouncing a sentence of destruction of her