my own teeth by a headache in the temporal region. I had noticed that during these headaches there was generally tenderness over the aching part, and that there was also a tender point at some little distance, usually the eye, which was tender to pressure. On this particular occasion, however, there was no tenderness of the eye, and I felt all along the side of the cheek and under the jaw to see if I could discover a second tender spot. Under the ramus of the jaw I found a small gland painful on pressure. As glandular irritation almost always indicates something wrong in the lymphatics which pass to the gland, I at once suspected something in the mouth to be the cause of the tenderness. As there was no abrasion or tenderness of the mucous membrane of the mouth or tongue, I took a pointed instrument and tested each tooth successively. At the very back of the crown of the last molar I detected a small point which was tender upon pressure, and on going to a dentist I was informed that the point was just beginning to decay. Had it not been for the headache this would have passed unnoticed, as the tooth itself had, up to that period, given me no inconvenience whatever. Headache over the eyes, although frequently depending on gastric irritation, is not unfrequently caused by straining the eyes, and is only to be removed by lessening the work which these useful organs have to perform. One finds this headache over the eyes in men who work much with the microscope, or in women who are engaged in fine needlework. Yesterday I met a case of this sort in the surgery. This was a woman who had been accustomed to work about her house, but who began to work at dressmaking three months ago; her hours of work being from 9 a. m. to 9 p. m., with an interval of an hour for dinner in the middle of the day. About two months ago she began to suffer from headache above her eyes, which makes her sometimes feel quite giddy. It gets worse in the evening about seven or eight. The headache here, it will be observed, came on about a month after the eyes had been subjected to this unaccustomed strain; and it became worse in the evening after the darkness rendered artificial light necessary, and thus increased the visual strain.
Having said so much on reflex action as a cause of disease, we will now consider it as a method of cure; and the first instance that suggests itself to our minds is the beneficial effect of a blister. Two theories have been proposed to account for the action of a blister. One is, that it dilates the vessels of the skin in the part to which it is applied, and, by thus drawing away some of the blood from the inflamed organ below, lessens the pain and inflammation in it. The other theory is, that the blister acts reflexly upon the organ itself. The first of these suppositions is very improbable, because the amount of blood in the skin covered by a blister is exceedingly small, and, moreover, does not come from the inflamed organ, with which the blistered piece of skin may have little or no vascular action. The second theory is much the more probable one, but it is not yet certain how the vessels of the
