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CASES ILLUSTRATING THE TREATMENT 159
until at length the patient had barely recovered from one
attack before another began, and in this manner more than
a week would sometimes pass before he obtained complete
relief.
The headaches are preceded by a heavy dull sensation in the
head and shimmering (?) before the eyes in the morning when
the patient awakes. The dull feelmg passes away during the
forenoon, but late in the afternoon pain suddenly sets in, and
grows more and more severe towards night. The pain may
reach its height at once, or its increase may be more gradual.
It is throbbing in character, is felt most behind the eyes, and
is generally equally acute on both sides. Light intensifies the
pain. The patient dreads going to bed, because the recumbent
position makes him worse. When he does lie down, he after
some hours goes off into a heavy sleep, and wakes up the
following morning with a feeling of oppressive drowsiness, which
on more than one occasion has lasted for several days.
These attacks leave him very nervous and exhausted.
The patient never feels sick.
He has found that the headache is brought on by fatigue, by
sitting up at night, and by very strong light, as in theatres.
In the summer of 1888 he also became subject to attacks
of palpitation. The first rendered him nearly insensible ; he
felt pain down his left arm, and had considerable difiiculty
in drawing his breath.
During the attacks of palpitation, the apex beat is seen and
felt over a considerable area ; the sounds are strong ; the pulse
is between 80 and 90 beats a minute, and full. The patient is
very sensitive between the shoulders. The palpitation comes on
at any time,—sometimes it follows a meal, sometimes several
hours afterwards.
The patient smokes cigarettes.
The appetite and digestion are good.
Treatment and Progress.—On the 4th January 1890 he was
first subjected to treatment, which consisted of general move-
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