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Epidural blood patch (EBP) was performed for the treatment of severe postlumbar puncture cephalalgia in 118 young patients. Following the first EBP, 105 patients had relief of headache. Eleven of the 13 in whom it failed had a second EBP, with adequate relief in 10, giving an overall success of 97.5 percent. Lumbar epidural, caudal, and spinal procedures were successful in 3 patients 105 to 380 days after EBP. Soon after EBP, one patient developed facial paralysis and one complained of episodes of vertigo, dizziness, tinnitus, and ataxia without headaches. Residual complications included backache and/or back stiffness in 22 patients and paresthesia in two. Two-year follow-up revealed 95 percent patient acceptance of the procedure. EBP was found to be a safe, effective method for treating severe postlumbar puncture cephalalgia, provided a proper diagnosis is made and there is no contraindication.

• The etiology and management of headaches is still a cause of concern to the physician and a great worry and annoyance to the patient. In fact, the patient with a transient headache is to be considered "for­ tunate"-otherwise he may eventually consult an allergist, dentist, internist, neurologist, ophthalmologist, orthopedist, otolaryngologist, psychiatrist and in many instances, a chiro­ practor. In his desire to seek relief, he may indeed sec all these. Opinions vary as to the existence and fre­ quency of spontaneous headaches due to his­ tamine. During the course of this research, a headache was reproduced in the six reported patients by a rapid intravenous injection of 0.1 mg. of histamine acid phosphate. The re­ produced headache hegan in the clocked time of one minute to one minute 20 seconds. The headache in each patient was preceded by a visible facial flush or a suhjectively reported sensation of heat in the face and a moderate fall in the systolic and diastolic blood pressure in the recumbent position. As the facial flush or heat sensation faded, the headache became maximal in intensity in the clocked time of two minutes to two minutes 12 seconds after the injection. The headache disappeared com­ pletely in seven minutes 25 seconds to eight minutes 22 seconds. The induced headache in five of the six patients was reported to throb with each beat of the temporal pulse, first on the side of the head where the headache was felt, then on both sides of the forehead and when it be­ came maximal, extended to the vertex and occiput.

^aGraphico n. 1 - A. s. C., Reg. 169 A., 22 annos, branco, portuguez. Inicio com cephalalgia, mal estar e vomitos. Ao ser internado sentia grande abatimento, olhos injectados, ictericia bem nitida da esclerotica. Baco crescido. Dor epigastrica. Bulhas cardiacas abafadas. Exame da urina: grande quantidade de albumina, cylindros granulosos, urobilina. Ate o 13o dia continuou com grande adynamia. Ate o 8o dia de molestia tinha cylindros na urina, persistindo depois tracos de albumina. Graphico n. 2 - S. I. Reg. 829, 10 annos, branco, brasileiro. Adoeceu com dores musculares, fraqueza nos membros inferiores e peso na cabeca. Ao internar-se apresentava olhos brilhantes e injectados, e vaso dilatacao peripherica. Baco augmentado. Durante 3 dias teve cylindros na urina e tracos de albumina. Graphico n. 3 - I. D., Reg. 853, 14 annos, branco, russo. Inicio com cephalalgia, dores lombares e temperatura elevada. Ansiedade e dores epigastricas. Vomitos de "borra de cafe" desde o 2o dia de molestia. Grande prostracao, olhos brilhantes, sub-ictericia. Exame da urina, ao entrar: Grande quantidade de albumina, cylindros granulosos e epitheliaes e cellulas renaes. O estado do doente aggravou-se ate o 7o dia de molestia, tendo dias de delirio. A ictericia augmentou progressivamente. Os signaes urinarios melhoraram depois do 16o dia. Graphico n. 4 - F. W., Reg. 165 A., 12 annos, branco, hungaro. Cephalalgia, fortes dores lombares, mau estar, vomitos e oppresao epigastrica. Grande prostracao, rubor da face, vaso-dilatacao peripherica. Face vultuosa. Depois de internado teve vomitos pretos. Os cylindros desappareceram depois do 8o dia e a albumina no 10o. Graphico n. 5 - A. H. M., 824, 22 annos, brancos, portuguez. Adoeceu com cephalalgia, dores lombares, calafrio e elevacao thermica. Face vultuosa, olhos injectados. Albumina e cylindros na urina por muitos dias. Ictericia desde o 4o dia. Graphico n. 6 - Y. P., Reg. 824, 15 annos, branca, brasileira. Calafrios e elevacao thermica. Cephalalgia e grande mal estar. Vomitos de "borra de cafe" desde o 4o dia. Nos primeiros dias o symptomas se aggravaram. Cylindruria ate o 6o dia de molestia, restando tracos de albumina. Graphico n. 7 - M. M., Reg. 829, 28 annos, branco, portuguez. Inicio com calafrios, febre, cephalalgia e dores lombares. Ao internar-se apresentava grande prostracao, ruboe da face, olhos brilhantes e injectados. Lingua humida com muita saburra. A urina revelou grande quantidade de albumina e cylindros granulosos. Os signaes renaes duraram ate o 16o dia. Nao teve vomitos. Icterica intensa. Graphico n. 8 - A. S. S., Reg. 868, 18 annos, pardo, brasileiro. Internado em estado de confusao mental. Adynamia com grande apathia. Mucosas labiaes sangrando a pressao. Leve ictericia. Pequeno edema das palpebras. Baco palpavel. Oliguria. Grande quantidade de albumina e abundancia de cylindros granulosos e epitheliaes e cellulas renaes. Somente depois de 10o dia de hospitalizacao foi que as melhoras se accentuaram e nesse dia desappareceram os cylindros. Tracos de albumina. Graphico n. 9 - A. A. F., Reg. 821, 19 annos, branco, portuguez. Cephalalgia, rachialgia, adynamia. Face vultuosa. Suffusoes sanguineas nos labios. As mucosas do nariz, gengivas e labios sangraram por muitos dias. Urina: grande quantidade de albumina, cylindros granulosos e epitheliaes e cellulas renaes, tendo este signaes desapparecido depois de 10o dia. Icterica muito accentuada.^lpt^aGraphic n. 1 - A. S. G., Reg. 169. A., 22 years, white, Portuguese. Begins with headache, ill feeling and vomiting. On being interned, great faintness, bloodshot eyes, clear jaundiced sclerotic. Spleen enlarged. - Epigastric pain, stifled heart breaths. Urine examination: big quantity of albumin, granulous casts, urobilin. Up to the 13th day, goes on with a great adynamy. Until the 8th day of the illness, there were casts in urine, persisting further traces of albumina. Graphic n. 2-S. I., Reg. 829, 20 years, while, Brazilian. Felt at first muscular pain, weakness of inferior limbs and a weight in the head. When interned glistening and bloodshot eyes, peripheric vaso-dilatation. Spleen enlarged. During three days, there were casts in urine and also traces of albumina. Graphic n. 3-I. D., Reg. 853, 14 years, Russian. Begins with headache, lumbar pain and high temperature. Anxiety and epigastric pain "coffee grounds" vomiting from the second day of the illness. Great prostration, glistening eyes, sub-ictericia. Urine examination on his admission: Great quantity of albumina, granulous and apithelial casts and renal cells. The condition of the patient grew worse until the 7th day of the illness, occurring some days delirium. Ictericia gradually increasing. Signs in urine improving from the 16th day. Graphic n. 4- F. W. Reg. 165 A., 12 years, Hungarian. Headache, great pain in the back, ill feeling, vomiting and epigastric oppression. Serious prostration, red face, peripheric vaso-dilatation, tnrgid face. After being interned, had dark vomiting. Casts disappeared after the 8th day, albumina after 10. Graphic n. 5 - A. H. M., Reg. 824, 22 years, white, Portuguese. Began with headache, lumbar pain, shivering and temperature rise.Turgid face, bloodshot eyes. Albumina and casts in urine for many days. Jaundice from the 4 th day. Graphic n. 6 - Y. P . Reg. 824, 15 years, white, Brazilian woman. Shivering and thermic rise. Headache and serious ill feeling. Vomiting of "coffee grounds type" from the 4th day. During the first days, symptoms grew worse. Cylindruria until the 6th day of the illness, remaining traces of albumina. Graphic n. 7 - M. M., Reg. 289, 28 years, white, Portuguese. Begins with shivering, fever, headache and lumbar pain. When interned, great prostration, red face, glistening and bloodshot eyes. Tongue wet and very saburrhal. Urine reveals great quantity of albumina and granulous casts. Renal signs persisting up to the 16th day. There is no vomiting. Intense jaundice. Graphic n. 8- A. S. S., Reg. 868, 18 years, myxed, Brazilian. Interned in complete state of mental confusion. Adynamy and great apathy. Labial mucosae bleeding under pressure. Slight jaundice. Slight oedema of the eyelids. Spleen palpable.-Oliguria.-Great quantity of albumina and of granulous and epithelial casts and renal cells. Only after 10 days of the internment, the improvement became patent, in which day the casts disappeared. Traces of albumina. Graphic n. 9- A. A. F., Reg. 821, 19 years, white, Portuguese. Headache, rachialgia, adynamia. Turgid face. Bleeding lips. The nasal, gums and labial mucosae bleeding for many days. Urine: big quantity of albumina, granulous and epithelial casts and renal cells, which signs disappear after the 10th day. Highly accentuated jaundice. ^len.

SUMMARY A four-year research study in which several M.D.s helped by contributing their worst migraine cases. A complete survey of all credited types of migraine has been presented, showing that the term migraine is more inclusive than merely the classic pain syndrome of migraine simplex. To this group of accepted migraines I have added the new designation “ocular migraine.” Most writers in referring to chronic severe cephalalgia have ruled out the ocular mechanism and have stated that headaches of ocular origin are merely of the mild to average intensity. There has been presented herein substantial evidence that the most severe head pain syndrome known to medicine has been completely eradicated by proper vision therapy. Also, in a cephalalgia of multiple etiology, it is shown that success has not been complete with medical therapy because the latent visual problem has not been found. When both are treated together, complete success ensues. As the key that unlocks the door to these latent visual problems is a prolonged monocular occlusion test, the previous evidence of its impractical value is presented. This is greatly overshadowed, however, by the overwhelming evidence of practical value, provided the technique is standardised. The balance of the article goes into a step-by-step analysis of a standardised technique for prolonged monocular occlusion. It is felt that the role of the optometrist in the field of headache therapy and related neurasthenia problems is just beginning. The proper technique and interpretation of prolonged occlusion opens a whole new field of research for the specialist in vision. There are countless thousands who suffer with chronic cephalalgia merely because their problem is hidden to all diagnosis and, hence, incurable. Surely, the day is not far distant when great inroads into this “lost battalion” of sufferers will be made by men of vision.

T HE concept that pain in the head and/or face might arise from disease in the neck is not new.’ Many writers have referred to this ~~~~~~~~~~~~12~13~16~19~21~23~26~28~33 Similar symptoms, however, have been thought by others to arise from lesions of the autonomic nervous system, for example, the sphenopalatine ganglion, 3Fr38 the geniculate gangIion,20 the vidian39JO and greater superficial petrosal nerves,” the cervical sympathetics, etc.4-7,10B 1~26.27 Vasodilatation due to histamine sensitization of the vascular tree has received wide attention.17,18 ru’evertheless, the etiology of hemicranial pain, migraine, atypical facial neuralgia, histamine cephalalgia, the postconcussion syndrome, etc., has remained obscure and the results of therapy disappointing. The recent clinical investigations of Raney and his associates2g-33 have shown that disorder of the cervical discs may give rise to pain in the head and face. Their attention has been directed to the middle and lower cervical spinal roots. We have been interested in the upper cervical spine and in particular the sensory root of the second cervical nerve. This artrcle is based on the data of eleven patients who suffered with recurring attacks of severe hemicranial pain in the head and/or face and who have been treated either by (I) avulsion of the greater occipital nerve; (2) intraspinal section of the sensory root of C-2 or (3) section of the sensory roots of C-2 and c-3. These cases may be divided roughly into two groups, nameIy, those cases in which symptoms followed definite trauma to the neck and cases in which symptoms of the same character were present without a definite history of initiating trauma. The eight patients whose symptoms folIowed trauma have been relieved or greatly benefitted by interruption of the upper cervical nerves. Those in which almost identical symptoms were present but without trauma have not been relieved. It is our purpose in this article to describe the anatomic basis upon which rests the concept that upper cervical root disease might initiate this syndrome, to present the clinical data of these cases and also to present certain data concerning the dermatomes of the upper cervical roots as they have been elicited following operation.

Ever since Donders pointed out the close connection of optical defects of the eye with cranial pain, innumerable papers and statistics have been published tending to estimate the influence of ocular pathologic processes and of refractive and muscular anomalies on the production of cephalalgia. In other branches of medicine, headache as a diagnostic aid is of limited value. Its presence in the majority of ailments precludes consideration of it as a symptom of a particular disease ; hence, most textbooks on general medicine make slight reference to headache. In ocular conditions, however, it is different ; cranial pain, as a rule, is stimulated by the use of the eye and subsides when the eye is at rest or when the defect is corrected; consequently, it becomes to the laity and even to some members of the medical profession a symptom pathognomonic of eyestrain. There is, however, no subject in the

N A PREVIOUS communication we described a method for isolating a diabetogenic polypeptide from the urine of patients with lipoatrophic diabetes.l This substance, designated as fraction 1, was shown to provoke insulin antagonism and loss of glucose tolerance when administered to dogs and men. Isolation of the compound and demonstration of its diabetogenic activities have now been confirmed.* However, interpretation of the results was somewhat clouded by the occurrance in man of mild toxic effects which included myalgia, cephalalgia and pyrexia. Further purification of the material was initially achieved by somewhat drastic treatment of the material with O.lN hydrochloric acid at a temperature of 100” C. From this solution an

IT is a generally recognized fact that there are many causes of headache. It will occasion no surprise, therefore, that the roentgen-ray findings in cases of headache present usually a wide range of variation. It happens not infrequently, however, that a roentgenogram, even in cases of very severe and obstinate headache, gives a negative result. That is particularly true of the various types of nervous cephalalgia (in neurasthenics), and likewise of headache associated with vasomotor disturbances, which are caused by anemia, by venous stasis in heart and lung diseases, or by congestions. The conditions are similar in toxic headaches resulting from intoxicating poisons; in auto-intoxications of gastro-intestinal, uremic and diabetic origin, and in infectious diseases. Finally, there should be mentioned, in this connection, the traumatic headache. If the positive roentgen-ray findings in cases of headache are classified according to the anatomic changes visible in the roentgenogram, one may distinguish dest...

(1950). Treatment of Hereditary Cephalalgia. Postgraduate Medicine: Vol. 7, No. 1, pp. 33-35.

Two of seven cases of migraine out of a series slightly in excess of 100 are reported in detail, because the episodic attacks in these seven cases have been replaced in the fourth or fifth decade by a continuous, low grade cephalalgia. The pathophysiological origin is not clear; but it is possible that a functional, long-lasting vasoconstrictor neurosis slowly effects organic changes in the vessels or in the adjacent brain tissue.

Five patients developed posttraumatic vascular headaches associated with autonomic dysfunction. The precipitating injury affected the anterior triangle of the neck, presumably involving the region of the carotid artery sheath. Disturbance of sympathetic function, characterized by excessive sweating and pupillary dilation associated with headache, was noted. Appropriate pharmacologic studies revealed evidence of partial sympathetic devervation. While headache was resistant to ergotamine preparations, prompt relief was obtained with propranolol hydrochloride, and adrenergic beta-receptor blocking agent.

REPORTS OF CASES Case 1. —On August 19, 1905, three months after my arrival at Iquitos, I was called to attend Mr. G. S., a German, aged 34 and robust, who had recently arrived from Brazil, where he had passed a few days in Manaos on his journey from Europe. He lived in Iquitos above a store. A violent shivering, with intense rachialgia, cephalalgia and fever, had been the first symptoms of the patient's illness. Examining his abdomen, there was noticeable only a wellmarked sensation of pain at the epigastrium. He had fits of vomiting and a temperature of 39 C. (102.2 F.). His eyes were red. I ordered him a saline purge. On the following day I observed that the patient's liver was enlarged and the other symptoms continued. As the purge had caused a good evacuation, I ordered him quinin as a draught and salicylate enemas.

Histaminic cephalalgia is a syndrome characterized by a unilateral headache, facial pain, inflammation of the eye, rhinorrhea, or blocking of the nose on the affected side. The attack of facial pain lasts from 15 minutes to several hours and usually occurs during the night when the patient is asleep. Emotional stress probably is an important etiologic factor. Treatment consists of injections of histamine to desensitize the patient, and the administration of ergotamine and caffeine to allay the attacks.

I have been using sodium cacodylate in three cases of secondary and one case of tertiary syphilis. Each dose contained 3 grains of the drug. The cases are as follows: CASE 1. —A. M., male, aged 31, married, had been under mercurials and tonics for eight months. The only lesions present were two small mucous patches on the side of the tongue. Mercury was discontinued. On April 26, April 30 and May 10 the patient received 3-grain doses of sodium cacodylate. May 12 the patient was attacked by very severe cephalalgia, requiring opiate by hypodermic method to relieve. Mercury by inunction soon controlled the trouble. CASE 2. —Mrs. A., aged 28, had just recovered from secondary skin lesion under mercury. On April 26 and April 30 she received hypodermic injections, each containing 3 grains of the drug, into pectoral muscle. May 15 brown patches appeared on the arms and chest.

HISTAMINE for the treatment of vertigo was first reported by Alfoldy in 1938 and for the treatment of headache by Horton, MacLean and Craig in 1939. Horton described a distinct clinical syndrome that he named histaminic cephalalgia, or vascular headache, that could be elicited by a subcutaneous dose of histamine and relieved by repeated injections of graduated doses of histamine given subcutaneously twice daily. Hansel also used histamine in the treatment of cases of typical histaminic cephalalgia, but in contrast to the relatively large frequent subcutaneous injections advised by Horton, Hansel used an extremely minute dose of histamine given less frequently, once or twice a week, and usually supplemented by drops of very dilute histamine solution under the tongue twice daily. My associates and I have followed the plan of treatment suggested by Hansel, and in typical cases of histaminic cephalalgia the results have been satisfactory in the majority of

The influenza, or "grippe," as it is generally called, Protean in its forms and chameleon-like in its aspects, has made a flying trip through our country, and left its multiform impression upon our population. This strange disease enjoys as many titles as a European nobleman: influenza, because it exercises such a decided influence upon all the tissues and functions of the human body; la grippe , because, when it once takes hold, it rarely lets go its grip; rheuma epidemicum , be cause, under its dire influence, the universal nose and throat becomes a perennial fountain; cephalalgia contagiosa , because of the infernally Plu tonian headache it induces; failette, because, when attacked by it, we are driven almost to madness; coquette , because it plays with our feelings as a cat does with a mouse or a young lady with her devoted admirers; petit courier , because it runs from organ to organ, suffering none

The conquest of headache can be accomplished only by separation into various clinical entities and the application to each entity of specific drugs or surgical therapy. The vascular element contributing to the propagation of migraine has been frequently demonstrated. Harris 1 in 1936 pointed out the association of vasomotor changes in the cerebral vessels as demonstrated by scotomas, transient paresis, mental depression and visual field disturbances. Clark, Hough and Wolff 2 found that headache was due to excessive pulsation and stretching of the walls of the dural and temporal arteries. Penfield, 3 Harris and Penfield and McNaughton 4 caused relief from a migrainous headache by selective section of the upper fibers of the trigeminal root which interrupted the sensory fibers to the dura and scalp traveling beside the blood vessels. However, in Penfield's operation to expose the trigeminal root, he must have severed the middle meningeal and temporal arteries as

Publisher Summary An acute headache, sometimes accompanied by sickness and psychomotor disturbance, suggests that circulatory disturbances resulting from phaeochromocytoma or the release of histamine play a part in the headache. In all patients with acute headaches, apart from a thorough pain analysis, an examination must be carried out during the attack. This also applies to migraine, which is usually diagnosed far too quickly and examined too hesitantly. Migraine seems to be a clearly defined reaction of the body. Once the pain is localized, migraine cannot be confused with neuralgia. The migraine attack also lacks the vegetative syndrome of sympathalgia. With most headache sufferers, neither transferred pains nor neuralgia nor sympathalgia nor cephalalgia occur, but they suffer from a diffuse headache that frequently changes its site but in any case occurs over a long period. Headache and facial pain are frequent illnesses with no physical findings. Frequent complaints only relatively rarely indicate a dangerous illness.

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A patient is presented with alternating unilateral exophthalmos associated with severe cephalalgia and ophthalmoplegia. Over a seven-year period, six episodes were equally distributed between right and left. He is being presented with such a combination of clinical findings to emphasize the possibility that an alternating unilateral cephalalgia of vascular origin may cause orbital swelling sufficient to produce exophthalmos. Report of Case The patient, a 24-year-old seminary student, was referred to the author by Dr. Fred Laschever of Princeton, NJ. Seven years prior to his present illness he began to experience episodes of unilateral cephalalgia involving alternately the right and left side accompanied by ptosis and double vision. The initial three attacks were less severe than the last three, but each one would last from 10 to 12 days. With one of the initial episodes, the patient was investigated as to neurological examination, lumbar puncture, and x-rays of the skull, all

Indurative headache is of organic origin, chronic and usually paroxysmal, occurring in various parts of the head, and due to infiltrations or thickenings at various points, chiefly in the muscles of the head and neck. From the so-called cases cephalalgia, cephalodynia, migraine, hemicrania, cranial neuralgia and neuritis, many can be separated as belonging to this class. A search made through works of neurology and monographs on headache by American physicians found little or no mention of headache due to these indurations. The subject seems neglected, except for the statement that headache is sometimes rheumatic, lithemic, or gouty in origin. The condition is ably treated, however, by Professor Edinger 1 and by Professor Norstrom, 2 of Stockholm, who spent some time in New York and while there wrote on this subject. The significance of this condition has been recognized for years by physicians abroad, notably by the Swedes and Germans. 3

The interest aroused by the publications of Tonin, 1 Moon 2 and Harris 3 in the finding of a drug that would act as a specific for rabies warrants the publication of a report of this case, which was treated with both neosalvarsan and quinin. C. M., Mexican, aged 10, was bitten, July 18, 1913, by a rabid dog, the left forearm and throat being badly lacerated; the wounds were cauterized and dressed daily at the charity clinic. Pasteur treatment was persistently urged but refused. About August 2 the boy became depressed and anxious and told the office girl at the clinic that he knew he was going mad. There were cephalalgia, loss of appetite accompanied by gastric uneasiness and nausea; the patient's mental condition gradually grew worse and at times he was intermittently delirious. I saw him on the morning of August 6; the wounds were healed, but the

IT WOULD TAKE one into too controversial a field to attempt to cover all the allergic manifestations of the central nervous system which might be attributed to the hypersensitive state. I shall, therefore, omit from consideration migraine, histamine cephalalgia, Meniere's syndrome, epilepsy and certain convulsions of infancy, which have all been charged to allergy by one or another investigator. My remarks will be confined to an analysis of the cerebrospinal effects occurring in serum sickness and from serum allergy1. The allergic manifestations resulting from the parenteral injection of foreign serum lend themselves to accurate appraisal. The time of entrance of the otherwise innocuous substance can always be ascertained; the material is not complicated, nor does it possess primary toxicity when properly prepared. Consideration of allergic encephalopathies from smallpox or rabies vaccines, drugs and antibiotic substances is somewhat complicated because of the primary toxicity of drug and antibiotic substances on

While a study was being made of headaches which had been treated in the past six years with the roentgen rays and glandular extracts, the similarities of the visual field were strikingly alike and seemed of enough importance to report. Headache as a symptom is probably the most common complaint which brings the patient to the ophthalmologist. In a few cases in which correction of the refractive error did not relieve the cephalalgia, a study made with the aid of the internist, the roentgenologist and visual fields led to the belief that these headaches are of pituitary origin. Pituitary headaches as described by Engelbach and Tierney1is a term "not to be used to apply to the type of headache caused by neoplasms of the pituitary or other brain tumors." It has been established by these authors that the pituitary gland, almost equally with the thyroid, is concerned in

Both in the preclinical and clinical training of physicians, little emphasis is placed on understanding the mechanism, diagnosis, and treatment of cephalalgia. Clinicians interested in acquiring expertise or simple understanding of these patients are limited to diminutive, frequently biased, unorganized texts that do not comprehensively or realistically represent the subject. In this fourth edition of the classic treatise, originally written by the great researcher Harold G. Wolff, the editor has successfully integrated contemporary advancements with the detailed and valued observations of the original author. The initial chapter of this 473-page volume sets a pattern of clarity by giving a simple and realistic classification of headache rather than the disjointed one that was used in the third edition. I heartily commend the editor for encouraging the reader to think of head pain in a logical diagnostic sequence, rather than grouping all cephalalgias together or classifying them according to treatment. The

ALTHOUGH the complications of rabies vaccine therapy are rare, the physician always keeps them in mind, owing to their danger. These complications are of two main types: (1) the local reaction, 1 which is of no importance, and (2) the systemic reaction, which Grinker 2 classifies as myelitic and neuritic. Remlinger 3 describes three clinical types of systemic reaction: (1) acute ascending paralysis of the Landry type, with sudden onset, fever, cephalalgia, restlessness, and paralysis, usually fatal in one-third of the cases; (2) dorsolumbar myelitis, with gradual onset, paralysis, and weakness, and (3) neuritic form, with symptoms of peripheral nerve involvement. The last two types terminate in complete recovery in 100% of cases. The incidence of systemic reaction is low. Remlinger, 4 in 1905, reported 40 cases of paralysis after 107,712 treatments, and the same author, in 1927, reported 529 cases among 1,164,264 patients treated. Simon 5 gave an average

Chicago, Ill., May 12, 1894. To the Editor: —I always find it interesting reading the report of the proceedings of the American Electro-Therapeutic Association, and in theJournalof April 7 an article appeared read before that body by Dr. W. B. Sprague, of Detroit, on "A Contribution to the Electro-Therapeusis of Salpingitis." As this subject is of great interest, and as I have found it especially interesting, you will pardon me if I review his article. The pathology of tubal troubles has been so recently evolved that the therapeusis is still in the embryonic stage. Many of our leading lights declare that there can be no rational therapeusis—that there can be no remedy but extirpation—as if decapitation were a cure for cephalalgia! Yet many men have a firmer faith in nature's economy, and are seeking to aid her efforts at repair by, at least so far as possible, removing

Histaminic cephalalgia is a distinct clinical entity that usually begins in the later decades of life.1It is characterized by a unilateral headache of short duration generally lasting less than an hour; it commences and often terminates suddenly. It tends to awaken the patient at night one to two hours after he has gone to sleep, and the severity of the pain makes the patient get out of bed and pace the floor. At its height the pain is associated with watering and congestion of the eye, rhinorrhea or stuffiness of the nostril, sweating, and, often, visible dilatation of the temporal vessels of the involved side of the head. Once observed in its full-blown form, the clinical picture will never be forgotten. Constant, excruciating, burning, and boring pain is the outstanding complaint. It involves the orbital area and the temple and may extend to the upper jaw, occipital region

The Herxheimer reaction may be defined as an aggravation of pathologic processes in syphilis following the use of antisyphilitic therapy. The reaction manifests itself in various ways. There may be an increase in the intensity of the lesions of the skin and mucous membranes. Gummas may become swollen and ulcerate before improvement is shown. Visceral lesions may react in a similar manner, manifesting themselves by fever, severe nephritis and obstructive jaundice lasting for a week or more. In syphilis of the nervous system, the symptoms may range from a mild cephalalgia to intensely aggravated focal symptoms and paralysis. As to the nature of the Herxheimer reaction, much difference of opinion exists among different workers. Many believe it is produced by the liberation of endotoxins fromSpirochaeta pallida, thereby accentuating the local and general syphilitic manifestations. Ehrlich suggested that the reaction is due to insufficient dosage of arsphenamine, and that instead

Introduction The diagnosis and treatment of cyclical facial pain is difficult for a number of reasons. The complex cranial- and cervical-root innervation, lack of correlation between the findings of the neurophysiologist and those of the clinician, and the psychological aspects, all add to the intricacy of the physician's problem. The present report deals with our experiences with the typical and atypical neuralgias at the Headache Unit the Divisions of Neurology and Neurosurgery of Montefiore Hospital during the past 11 years; classic migraine is not considered in our study. The material includes 206 ambulatory and 88 inpatients and is selective in that most of the patients are chronic sufferers from facial cephalalgia and have been treated previously with a variety of therapeutic procedures. This clinical group presents a common and important type of facial pain, of interest to all branches of medicine. The term "cyclical" is used to indicate recurrent attacks

From many quarters there arise diverse voices intimating that in this day and time the clinical neurologist is destined to become merely, an anachronism, whose former functions might now better be relegated to other colleagues, especially the psychiatrist and the neurosurgeon. The internist proclaims that to him, rightfully, belong the infections and deficiency, toxic and vascular disorders of the nervous system; the syphilologist requisitions the cases of syphilis of the central nervous system; the pediatrician deems only himself competent to manage the neurologic disorders of childhood, and the allergist disputes for the paroxysmal dysfunctions such as migraine, Meniere's syndrome and cephalalgia. The orthopedist treats both spastic and flaccid paralyses and the neurosurgeon seeks the traumatisms and neoplasms of the nervous system, while the psychiatrists consider only themselves competent to manage the case in which there is the slightest psychogenic component. For the clinical neurologist there remain only the leavings of

The Eye and Migraine. —Forseveral thousand years the observation has been unconsciously persisted in that the cephalalgia is not a head-pain, but an eye-pain. Few or none in any definite way noticed that it was produced by near-use of the eyes, and none that the various extensions to other parts and organs, the intensifications of the pain, and the masking under a hundred other protean disguises, were also products of continued and increased eyestrain. But there was never any failure of the necessity to notice the implication of the ocular factor. The most noteworthy after the eye-pain was, of course, scintillating scotoma. The seat of this strange disorder has been placed in every part of the visual apparatus from the retina to the ultimate of the visual center.1Piorry's theories of "monophthalmalgia" or "iralgia," or of an affection of peripheral nerves of the eye, was followed by Brewster's thought that the