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NEW YEAR HONOURS
31 MECHANISM OF HEADACHE IN FEVER
RECENT work has shown that some headaches
are
due
to dilatation of intra- and extra-cranial arteries and increased tension on the vessel wall and perivascular structures ; this mechanism has been demonstrated by Pickeringfor the headache caused by intravenous injection of histamine, for migraine, and for cases of hypertension by Sutherland and Wolff,2who also demonstrated dilatation of intracranial arteries in animals after induction of fever by protein shock.
Bodley Scott
and Warin3 have studied the mechanism
of headache in 100 patients in M.E.F. who were suffering from acute fevers of various types without evidence of meningeal involvement, The headaches occurred in three constant situations, much the commonest being frontal and temporal ; these were usually bilateral but they were predominantly unilateral in 8 patients, including a sufferer from migraine who could not distinguish his febrile headache from his accustomed hemicrania. The other two situations were at the back of the head above the occipital protuberance and in the upper cervical and lower occipital region, but pain in these areas was always accompanied by fronto-temporal headache. The character of the headache was throbbing, increasing to a constant severe pain exacerbated by each heart-beat and waning as the fever subsided ; it was
accompanied by peripheral vasodilatation,prominent and vigorous pulsation of temporal arteries, and a raised pulse-pressure. In 93 of the patients with headache there was also a constant boring ache behind the eyes, which often continued for one to two days after the headache had stopped.
.
The headaches were abolished on one side of the head when the common carotid artery was compressed, and returned on release of the artery; and actions such as straining, which raise the blood-pressure, accentuated the pain, while a fall of pressure due to inhalation of amyl nitrite temporarily relieved it. These findings suggested that the headache of fever is also due to tension on the walls of arteries, and from further tests Bodley Scott and Warin concluded that in some cases the pain is due to dilatation of extracranial arteries, in some of intracranial ones, and in a larger number of both. They based this conclusion on the difference of response to unilateral occlusion of the temporal artery and to bilateral compression of the jugular vein in three groups of cases. In one group unilateral obliteration of the temporal pulse did not alter the headache, whereas jugular compression lessened it, and in 10 of these patients lumbar puncture was done which showed a normal initial pressure. In these patients the headache was thought to originate from increased tension in the intracranial arteries, jugular compression relieving the pain because its effect is to raise first the intracranial venous pressure and secondarily the C.S.F. pressure, so lessening the difference of pressure inside and outside the arteries and reducing the distending force on the arterial walls. In a second group the headache on one side was effectively relieved by occluding the temporal artery, showing that the cause of the pain was in the extracranial vessels, and this view was supported by the finding in these cases that jugular compression increased rather than alleviated the headache, since the cushioning action of a rise in c.s.F. pressure would not affect the temporal arteries. The third group showed features common to both the other groups, and in these presumably both sets of arteries were involved. Investigations into the source of the pain behind the eyes were inconclusive. They were relieved by compression of the common carotid artery, increased by 1. Pickering, G. W. Clin. Sci. 1933, 1, 77. 2. Sutherland, A. M., Wolff, H. G. Arch. Neur. Psychiat. 1940, 44, 929. 3. Bodley Scott, R., Warin, R. P. Clin. Sci. 1946, 5, 51.
jugular compression, and unaffected by compression of the temporal artery. A raised ocular tension was sometimes found in these cases, and eserine partly or completely relieved the ache in 9 out of 16 cases in which it was tried. It seemed probable that the eyeache arose from some vascular disturbance in the orbit, but its nature remains doubtful. THE DENTISTS AND THE MINISTER THERE is no sign of agreement between the Minister of National Insurance and the dentists on the scale of payment for insured persons. The negotiations with the Minister are in the hands of the Joint Advisory Dental Council (J.A.D.C.), which represents the British Dental Association, the Incorporated Dental Society, and the Public Dental Services Association, and in November the J.A.D.C. advised the profession to accept a scale of fees proposed by the Minister. Since then, however, the British Dental Association has met and rejected this The Public Dental Services Association has scale. accepted it, and the Incorporated Dental Society is meeting shortly ; but since the B.D.A. has a membership of 700, against a total of 4500 for the other two bodies, it is unlikely that the Advisory Council will continue to support the Minister’s scale in face of B.D.A. opposition. Meanwhile most dentists are refusing to accept dental letters but are doing urgent work for panel patients on a private basis. NEW YEAR HONOURS ’
’
THE New. Year honours include three knighthoods for medical men. Mr. Eardley Holland recently concluded a notable presidency of the Royal College, of Obstetricians and Gynaecologists, whose position in the counsels of the nation he has done much to assure. Major-General H. C. Buckley, i.M.s., is the former principal of the Medical College, Agra, and Dr. C. E. Hercus. professor of bacteriology and preventive medicine at Otago, was a welcome visitor to this country last summer, Other honours conferred include : _
C.B. Rear H. R. B. HULL, M.R.C.S. Admiral Surgeon Major-General E. A.&bgr;UTTON, C.B.E., M.c., M.R.C.S.
C.M.G. Prof. P. A.
BUXTON, 3i.R.C.S., F.R.S. MELVILLE MACKENZIE, M.D. Lond. ALBERT R. SOUTHWOOD, M.D., 2.5. Adelaide. C.LE.
Major F. A. B. SHEPPARD,
o.B.E., M.B. Melb., F.R.C.S.E., i.M.sLieut.-Colonel W. J. WEBSTER, M.C., M.D. Aberd., i.M.s.
C.V.O. DANIEL T. DAVIES, M.D. Wales, F.R.C.P. F. ANDERSON JTTLER, M.B. Camb., F.R.C.S.
C.B.E. ELDRED CURWEN BRAITHWAITE, O.B.E., M.S. Durh., F.R.O.S.E. Air Commodore H. OsNIOND CLARKE, M.B. Diibl., F.R.c.s, JAMES HARDIE-NEIL, D.s.o., M.B., of Auckland. O.B.E. F. A. L’ESTRANGE BURGES, M.B.E., M.R.C.S. PERCIVAL P. COLE, M.B. Birm., F.R.C.S. P. F. J. L. R. Du VERGE, of Mauritius. Lieut..Colonel E. F. EDSON, M.B. Sheff., R.A.M.C. JOHN W. H. GRICE, M.ft.C.S. C. D. JOHNSTON, M.D. Squadron-Leader R. A. MooREHEAD, M.B. Belf., R.A.F.v.R. PATRICK W. R. PETRIE, M.B. Edin. Major E. SoYSA, Ceylon Medical Corps., JAMES GRAHAM WILLMORE, M.D. McGill, lBLR.C.P. M.B.E. LEON GILLIS, F.R.C.S. CHARLES STUART OGILVIE, L.R.C.P.E.
.
THE Society of Apothecaries of London has decided to admit medical women to its yeomanry and livery.
RECENT work has shown that some headaches
are
due
to dilatation of intra- and extra-cranial arteries and increased tension on the vessel wall and perivascular structures ; this mechanism has been demonstrated by Pickeringfor the headache caused by intravenous injection of histamine, for migraine, and for cases of hypertension by Sutherland and Wolff,2who also demonstrated dilatation of intracranial arteries in animals after induction of fever by protein shock.
Bodley Scott
and Warin3 have studied the mechanism
of headache in 100 patients in M.E.F. who were suffering from acute fevers of various types without evidence of meningeal involvement, The headaches occurred in three constant situations, much the commonest being frontal and temporal ; these were usually bilateral but they were predominantly unilateral in 8 patients, including a sufferer from migraine who could not distinguish his febrile headache from his accustomed hemicrania. The other two situations were at the back of the head above the occipital protuberance and in the upper cervical and lower occipital region, but pain in these areas was always accompanied by fronto-temporal headache. The character of the headache was throbbing, increasing to a constant severe pain exacerbated by each heart-beat and waning as the fever subsided ; it was
accompanied by peripheral vasodilatation,prominent and vigorous pulsation of temporal arteries, and a raised pulse-pressure. In 93 of the patients with headache there was also a constant boring ache behind the eyes, which often continued for one to two days after the headache had stopped.
.
The headaches were abolished on one side of the head when the common carotid artery was compressed, and returned on release of the artery; and actions such as straining, which raise the blood-pressure, accentuated the pain, while a fall of pressure due to inhalation of amyl nitrite temporarily relieved it. These findings suggested that the headache of fever is also due to tension on the walls of arteries, and from further tests Bodley Scott and Warin concluded that in some cases the pain is due to dilatation of extracranial arteries, in some of intracranial ones, and in a larger number of both. They based this conclusion on the difference of response to unilateral occlusion of the temporal artery and to bilateral compression of the jugular vein in three groups of cases. In one group unilateral obliteration of the temporal pulse did not alter the headache, whereas jugular compression lessened it, and in 10 of these patients lumbar puncture was done which showed a normal initial pressure. In these patients the headache was thought to originate from increased tension in the intracranial arteries, jugular compression relieving the pain because its effect is to raise first the intracranial venous pressure and secondarily the C.S.F. pressure, so lessening the difference of pressure inside and outside the arteries and reducing the distending force on the arterial walls. In a second group the headache on one side was effectively relieved by occluding the temporal artery, showing that the cause of the pain was in the extracranial vessels, and this view was supported by the finding in these cases that jugular compression increased rather than alleviated the headache, since the cushioning action of a rise in c.s.F. pressure would not affect the temporal arteries. The third group showed features common to both the other groups, and in these presumably both sets of arteries were involved. Investigations into the source of the pain behind the eyes were inconclusive. They were relieved by compression of the common carotid artery, increased by 1. Pickering, G. W. Clin. Sci. 1933, 1, 77. 2. Sutherland, A. M., Wolff, H. G. Arch. Neur. Psychiat. 1940, 44, 929. 3. Bodley Scott, R., Warin, R. P. Clin. Sci. 1946, 5, 51.
jugular compression, and unaffected by compression of the temporal artery. A raised ocular tension was sometimes found in these cases, and eserine partly or completely relieved the ache in 9 out of 16 cases in which it was tried. It seemed probable that the eyeache arose from some vascular disturbance in the orbit, but its nature remains doubtful. THE DENTISTS AND THE MINISTER THERE is no sign of agreement between the Minister of National Insurance and the dentists on the scale of payment for insured persons. The negotiations with the Minister are in the hands of the Joint Advisory Dental Council (J.A.D.C.), which represents the British Dental Association, the Incorporated Dental Society, and the Public Dental Services Association, and in November the J.A.D.C. advised the profession to accept a scale of fees proposed by the Minister. Since then, however, the British Dental Association has met and rejected this The Public Dental Services Association has scale. accepted it, and the Incorporated Dental Society is meeting shortly ; but since the B.D.A. has a membership of 700, against a total of 4500 for the other two bodies, it is unlikely that the Advisory Council will continue to support the Minister’s scale in face of B.D.A. opposition. Meanwhile most dentists are refusing to accept dental letters but are doing urgent work for panel patients on a private basis. NEW YEAR HONOURS ’
’
THE New. Year honours include three knighthoods for medical men. Mr. Eardley Holland recently concluded a notable presidency of the Royal College, of Obstetricians and Gynaecologists, whose position in the counsels of the nation he has done much to assure. Major-General H. C. Buckley, i.M.s., is the former principal of the Medical College, Agra, and Dr. C. E. Hercus. professor of bacteriology and preventive medicine at Otago, was a welcome visitor to this country last summer, Other honours conferred include : _
C.B. Rear H. R. B. HULL, M.R.C.S. Admiral Surgeon Major-General E. A.&bgr;UTTON, C.B.E., M.c., M.R.C.S.
C.M.G. Prof. P. A.
BUXTON, 3i.R.C.S., F.R.S. MELVILLE MACKENZIE, M.D. Lond. ALBERT R. SOUTHWOOD, M.D., 2.5. Adelaide. C.LE.
Major F. A. B. SHEPPARD,
o.B.E., M.B. Melb., F.R.C.S.E., i.M.sLieut.-Colonel W. J. WEBSTER, M.C., M.D. Aberd., i.M.s.
C.V.O. DANIEL T. DAVIES, M.D. Wales, F.R.C.P. F. ANDERSON JTTLER, M.B. Camb., F.R.C.S.
C.B.E. ELDRED CURWEN BRAITHWAITE, O.B.E., M.S. Durh., F.R.O.S.E. Air Commodore H. OsNIOND CLARKE, M.B. Diibl., F.R.c.s, JAMES HARDIE-NEIL, D.s.o., M.B., of Auckland. O.B.E. F. A. L’ESTRANGE BURGES, M.B.E., M.R.C.S. PERCIVAL P. COLE, M.B. Birm., F.R.C.S. P. F. J. L. R. Du VERGE, of Mauritius. Lieut..Colonel E. F. EDSON, M.B. Sheff., R.A.M.C. JOHN W. H. GRICE, M.ft.C.S. C. D. JOHNSTON, M.D. Squadron-Leader R. A. MooREHEAD, M.B. Belf., R.A.F.v.R. PATRICK W. R. PETRIE, M.B. Edin. Major E. SoYSA, Ceylon Medical Corps., JAMES GRAHAM WILLMORE, M.D. McGill, lBLR.C.P. M.B.E. LEON GILLIS, F.R.C.S. CHARLES STUART OGILVIE, L.R.C.P.E.
.
THE Society of Apothecaries of London has decided to admit medical women to its yeomanry and livery.