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or Megrim

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MEGRIM, or migraine, is a functional nervous disorder which gives rise to severe headache and other nervous phenomena, and often to nausea and bilious vomiting. The derangement is a not uncommon one in child hood, eopecially amongst growing boys. Treatment is of peculiar impor tance at this age, for if the complaint be allowed to continue and the attacks become frequent, the patient may be almost entirely incapacitated from pursuing his studies, and his education may suffer greatly in con sequence.

Causation.—In many cases megrim appears to be hereditary. We often find on inquiry that one or the other parent suffers or has suffered from the derangement, or that there is a tendency in the family to some form of nervous disease. Sometimes, however, this is not the case. The dis order then appears to be acquired. In excitable children it may be in duced by continued mental effort in crowded, ill-ventilated school-rooms, and the common practice of pressing forward the education at a very early age no doubt helps to engender the disposition to suffer from this com plaint.

Anemia and debility, from which children often suffer soon after the second crop of teeth begin to make their appearance, probably also aid in the production of megrim, and an exhausting illness, such as typhoid fever, sometimes seems to predispose towards it. One of the most powerful of the exciting causes appears to be confinement in-doors combined with over feeding in a weakly child. The complaint is much more common amongst the children of well-to-do parents than amongst the children of the poor, who pass so much of their time playing in the streets.

Megrim is not seen in early childhood. It rarely begins to show itself before the beginning of the second dentition, at about the sixth year. I have, however, known it to occur in a little boy five years old.

Pathology.—The view formerly held that the head symptoms were the consequence of gastric disturbance is now practically abandoned. Dr. Latham refers the source of the affection to the sympathetic nervous sys tem. He believes that if by anxiety, fatigue, or other depressing cause,

the regulating influence of the cerebrospinal system of nerves is im paired, the sympathetic system, no longer controlled, rims riot, causing contraction of the vessels and consequent anemia of the brain. It is to this anremia that he attributes the disorders of sensation which precede the cephalalgia. Afterwards the excitement of the sympathetic subsides and is followed by exhaustion, and the vessels becoming dilated produce the headache.

Dr. Edward Living differs from this view. This authority ascribes all the phenomena to the irregular accumulation and discharge of nerve-force. He believes that a " nerve-storm traverses more or less of the sensory tract from the optic thalami to the ganglia of the vague, or else radiates in the same tract from a focus in the neighbourhood of the quadrigeminal bodies." Symptonts.—The chief symptom of megrim is headache. Sometimes it appears to be the sole source of discomfort, but it is often preceded by a general feeling of illness and certain disorders of sensation. In many cases we are told that the child wakes up with a severe headache, and that this continues for several hours, during which he lies groaning and incapa ble of any exertion either of mind or body. The pain in young subjects is more often bilateral than it is in older persons, and is comparatively seldom limited to one spot or one side of the head. It may extend across the forehead or over the top of the head or the occiput. It is of a very severe throbbing character, and is increased by light, by noise, or by movement. The child feels and looks excessively depressed. His face is pale and haggard. He cannot eat, and usually prefers to lie quietly on a sofa in a darkened room. His head is often hot, but his feet and hands feel cold to the touch, and he complains of feeling chilly and may shiver. The pulse is small and weak and may fall to 60 or 70. In exceptional cases the child feels sick and may vomit.

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