Preventable Diseases

by Woods Hutchinson

Greatness always has its penalties. Other ills besides death love a shining mark. Pain is one of them, and headache its best exemplar. If there be one thing about our bodies of which we are peculiarly and inordinately proud it is that expanded brain-bulb which we call the head. Yet it aches oftener than all the rest of us put together. Headache is the commonest of all pains, which fact gives the slight consolation that everybody can sympathize with you when you have it. One touch of headache makes the whole world kin, and the man or woman who has never had it would be looked upon as a creature abnormal and "a thing apart." It has even become incorporated into our social fabric as one of the sacred institutions of the game of polite society. How could we possibly protect ourselves against our instructors in youth and our would-be friends in later life if there were no such words as "a severe headache"?

What is a headache, and why does it ache the head? This is a wide and hotly disputed problem. But one fact, which is obvious at the first intelligent glance, becomes clearer and more important with deeper study, and that is that it is not the fault of the head. When the head aches, it is, nine times out of ten, simply doing a combination of scapegoat and fire-alarm duty for the rest of the body. Just as the brain is the servant of the body, rather than its master, so the devoted head meekly offers itself as a sort of vicarious atonement for the sins of the entire body. It is the eloquent spokesman of such "mute, inglorious Miltons" as the stomach, the liver, the muscles, and the heart. The humblest and least distinguished of all the organs of the body can order the lordly head to ache for it, and the head has no alternative but to obey.

To discuss the cause of headaches is like discussing the cause of the human species. It is one of the commonest facts of every-day observation, and can be demonstrated almost at will, that any one of a hundred different causes,—a stuffy room, a broken night's sleep, a troublesome letter, a few extra hours of work, eating something that disagrees, a cold, a glare of light in the eyes,—any and all of these may bring on a headache. The problem of avoiding headaches is the problem of the whole conduct of life.

Two or three broad generalizations, however, can be made from the confused and enormous mass of data at our disposal, which are of both philosophic interest and practical value. One of these is that, while headache is felt in the head, and particularly in those regions that lie over the brain, the brain has comparatively little to do with the pain. Headache is neither a mark of intellectuality, nor, with rare exceptions, a sign of cerebral disturbance. Indeed, it is far more a matter of the digestion, the muscles, and the ductless glands, than it is of the brain, or even of the nervous system. It is, therefore, idle to endeavor either to treat or try to prevent it by measures directed to the head, the brain, or even the nervous system as such.

Secondly, it is coming to be more and more clearly recognized that, while its causes are legion, a very large percentage of these practically and eventually operate by producing a toxic, or poisoned, condition of the blood, which, circulating through certain delicate and sensitive nerve-strands in the head and face, give rise to the sensation of pain.

Thirdly, the tissues which give out this pain-cry under the torture of the toxins in the blood are, in a large majority of cases, neither the brain, nor the nerves of the eye, nor other special senses, but the nerves of common sensation which supply the face, the scalp, and the structures of the head generally, most of them derived from one great pair of nerve-trunks, the so-called Trigeminus, or fifth pair of cranial nerves. Strange as it may seem, the brain substance is comparatively insensitive to pain, and the acutest pain of an operation upon it, such as for the removal of a tumor, is over when the skin and scalp have been cut through. These poisons, of course, go all over the body, wherever the circulation goes, but they produce their promptest and loudest pain outcry, so to speak, in the region where the nerves are most exquisitely sensitive. When your head aches, nine times out of ten your whole body is suffering, but other regions of it are not able to express themselves so promptly and so clearly.

These newer and clearer views of the nature of headache dispose at once of some of the most time-honored controversies in regard to its nature. In my student-days one of the most hotly debated problems in medicine was as to whether headaches were due to lack of blood (anæmia) or excess of blood (hyperæmia) in the brain. Few things could have been more natural for both the sufferer in, and the observer of, a case of throbbing, bursting headache, where every pulse-beat is registered as a thrill of agony, than to draw the conclusion that the pain was due to a huge engorgement and swelling of the brain with blood, resulting in agonizing pressure against its rigid, bony skull-walls.

One of the most naïve and vivid illustrations of this conception of headache is the remedy adopted for generations past, in this all too familiar and distressing condition, by the Irish peasantry. It consists of a band or strip of tough cloth, or better, of twisted or plaited straw, which is tied around the head and then tightened vigorously by means of a stick inserted tourniquet fashion. This is believed to prevent the head, which is aching "fit to split," from actually bursting open, and is considered a cure of wondrous merit through many a countryside. Ludicrous as is the reason which is gravely assigned for its use, it does, in some cases, greatly relieve the pain, a fact which we were entirely at a loss to account for until our later knowledge showed us that the pain, instead of being inside the skull, was outside of it in the sensitive nerves supplying the scalp. By steady pressure of this sort upon the trunks of these nerves, pressing them against the bone, they can be gradually numbed into a condition of anæsthesia, when naturally the pain would diminish.

In politer circles a similar misapprehension has also given rise to a favorite form of treatment. That is the application of cold in the form of the classic wet cloth sprinkled with eau de Cologne. The mere mention of headache calls up in the minds of most of us memories of a darkened room, a pale face on the pillow with a ghastly bandage over the eyes, and a pervading smell of eau de Cologne. It was a perfectly natural conclusion that, because the head throbbed and felt hot and bursting, there must be some inflammation, or at least congestion, present, and that the application of cold would relieve this. The results seemed to justify this belief, for in many cases the sense of coolness to the aching head gives great relief; but this is apt to be only temporary, and in really severe cases makes the situation worse by adding another depressing influence—cold—to the toxin-burdens that are weighing upon the tortured nerves. The chief virtue in these cold cloths and handkerchiefs soaked in cologne was that you were compelled to lie down and keep perfectly still in order to keep them on, while at the same time they mechanically blindfolded you. Few better devices for automatically insuring that absolute rest, which is the best and only rational cure for a headache, have ever been invented.

We were not long in discovering that headaches, both of the mildest and the severest types, might be accompanied either by a rush of blood to the head, with flushing of the skin, reddening of the eyes, and a bursting sense of oppression in the head, or, on the other hand, by an absolute draining of the whole floating surplus of the blood into the so-called "abdominal pool," the huge network of vessels supplying the digestive organs, which, when distended, will contain nearly two-thirds of the entire blood of the body, leaving the face blanched, the eyes white and staring, and the brain so nearly emptied of blood as to cause loss of consciousness or swooning. Other headaches, again, will be accompanied by a fresh, natural color and a perfectly normal and healthy distribution of the blood-supply. In short, the amount of blood in the head, whether plus or minus, has practically nothing to do with the pain, but depends solely upon the effect of the poisons producing it upon the heart and great blood-vessels.