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