The headache does not always occur in the early morning. Sometimes the patient wakes up in his usual health, and it is not until several hours afterwards that the pain begins. The cephalalgia is then often preceded by curious disorders of vision. Some children will say that objects look small to them, others that everything appears to be larger than natural. Sometimes stationary objects seem to be in movement, or there is partial insensibility of the retina, so that the patient cannot see the whole of an object at once. Thus in looking at his mother's face he may see only the right or the left side, not the whole. In addition to the sight, other senses may be affected. There may be noises in the head or impairment of hearing, or the taste or smell may be deficient. The child complains of unpleasant odours, or if offered milk remarks upon the peculiarity of its flavour.
These earlier symptoms usually subside when the pain comes on. The headache lasts a variable time, from three or four to eight or ten hours, and then gradually subsides. As his suffering becomes relieved the child usually falls asleep and wakes well, but wearied and weak. The frequency with which the attacks come on varies in different subjects. Often they are periodical and return with remarkable regularity every week or fort night. Sometimes a child after one attack has no return of the, com plaint for months. If boys at school suffer, the attacks are often very frequent.
Some time ago I saw a school-boy, twelve or thirteen years of age, who was subject to daily headaches to such a degree as to be almost incapaci tated from pursuing his education. The pain began in the morning on risingrisin from bed and lasted all day, only subsiding towards the evening. It pervaded the whole of the head, and although not at first very severe, was made worse by exercise, by head-work, and by a bright light. It was not attended by sickness. If, as sometimes happened, the boy awoke free from pain, the cephalalgia came on in the middle of the day, and in this case did not subside as usual in the evening. The boy was subject about once a month to bilious headaches, but these he described as different to his ordinary pain. In the latter, objects always looked large to him.
There was no doubt about the truth of the boy's statements. They were corroborated by his mother, who assured me that the severity of her son's suffering during his attacks was perfectly visible in his face. The boy himself was fond of his studies and seemed very anxious to be cured. He first took ten-grain guarana powders, but without relief. He was then ordered to take twice a day a dose of liq. strychnie Cal iij.) and liquid extract of ergot (il, x.), and in a few days the headaches had entirely
ceased.
In some cases, in addition to the cephalalgia pains apparently of a neu ralgic character are complained of in the limbs.
A well-grown boy, nine years old, was sent to me from the Isle of Wight by Dr. Gibson, with the history that for six months he had been suffering from frequent attacks of pain in the head and often in the legs. The boy used frequently to cry with pain which attacked him at night in the right hip and knee. He was noticed to drag the affected leg slightly in walking, and seemed to have a difficulty in placing the foot fairly by the side of the other. It was thought, too, that the leg was a little shortened. His temperature at that time was between 99° and 100°. The pain was not, however, confined to that limb. Sometimes it shifted to the other extremity, and sometimes was complained of in the back and shoulder. The temperature for a month was about 100°, but the boy seemed well except for the pains, and strongly objected to any restriction in his diet.
When the patient came under my own notice he was in good condition and had a healthy appearance. The lungs and heart were normal, and the organs generally gave no sign of disease. The urine was acid, of specific gravity 1.014, and contained no albumen. No petechim or signs of bruis ing were seen about the body. There was no swelling of any of the joints, nor any excess of fluid in the knees. The attacks of pain were said to come on at variable intervals. Often he woke in the morning with a se vere frontal headache, but sometimes the cephalalgia came on during the day. It always lasted many hours. He rarely vomited. When the pain first began in the course of the day, he was noticed for some time before hand to look white, with eyes " drawn," and his sight would be affected. He would see only half an object, or objects would look unnaturally small to him. In the limbs the pains were chiefly at this time behind the knees, but sometimes they affected the thighs and calves of the legs. They were increased by exercise, and he could not walk long without fatigue. His appetite was good and his bowels were regular. The boy was ordered to take two minims of liq. strychnin and fifteen of the liquid extract of ergot three times a day, and the nurse was directed to employ vigorous frictions to his limbs before he went to bed. Under this treatment the distressing symptoms began to moderate, and as long as the boy remained in London—a period of several weeks—he had no return of the headache or pains in the limbs. Before his return home he was said to have greatly improved in his power of walking.