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ON THE TREATMENT OF CONGESTIVE HEADACHE.

By J. LEONARD CORNING, M.D., New York.

If we examine the literature of our theme, we are astounded by the apparently hopeless confusion in which the whole is involved.  Everywhere attempts at ill-founded generalization are encountered.  We are compelled to admit, after perusing long debates in regard to the relative merits of various therapeutic measures, that those who were foremost to disparage the treatment pursued by others were totally ignorant of the fact that those same symptomatic manifestations which they were considering might be owing to entirely different causes from similar conditions described by others.  Hence a commensurate modification in therapy might not only be admissible, but eminently desirable.  It is more especially of recent years that a laudable attempt to differentiate the various etiological factors involved in different forms of headache has been made.  In 1832 Dr. James Mease, of Philadelphia published a monograph on “The Cause, Cure, and Prevention of the Sick Headache,” which is substantially a treatise on the dietetics of this particular form of headache.  The work, however, is conspicuously lacking in those philosophical qualities which are so necessary to a true understanding of the questions involved.  Dr. E.H.  Sieveking published in 1854[1] a most interesting paper on “Chronic and Periodical Headache.”  The views therein expressed are remarkable for their succinct and thoroughly scientific elucidation of the two great physiological principles involved in the consideration of by far the greater majority of instances of cephalalgia.  I refer namely to the importance ascribed by this eminent physician to the fluctuations of the blood-stream within the cranial vault.  In speaking of this subject Dr. Sieveking says:  “Nothing is of more importance in reference to the pathology and therapeutics of the head than clear and well-defined notions on the physiological subject of the circulation within the cranium; for, among the various sources of medical skepticism, no one is more puzzling or more destructive of logical practice than a contradiction between the doctrine of physiology and the daily practice of medicine.”

[Footnote 1:  On Chronic and Periodical Headache, by E.H.  Sieveking, M.D., Medical Times and Gazette London, August 12, 1854.]

What Dr. Sieveking said in 1854 holds equally good to-day; and, indeed, the position then taken has received substantial indorsement through the positive results of more recent experimental physiology.  Conspicuous in this connection are the inductive researches of Durham, Fleming, and Hammond, touching the modifications in the cerebral circulation during sleep and wakefulness.  By these experiments it has been conclusively proved that the amount of blood in the brain is decreased during sleep and increased during wakefulness.