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Headache owing to germ poisons is also one of the most distressing accompaniments of grippe, measles, and smallpox, and sometimes of pneumonia.

The headache caused by the poison of the malarial parasite in the blood is very violent, and the pain is situated usually just over the eye, and occurring often in the place of the paroxysm of the chill and fever at a regular hour daily, every other day, or every fourth day. If the headache is due to malaria, quinine will cure it (Malaria, Vol. I, p. 258). The headache of rheumatism is owing also to a special poison in the blood, and is often associated with soreness of the scalp. If there are symptoms of rheumatism elsewhere in the body, existing headache may be logically attributed to the same disease (see Rheumatism, p. 169).

The poison of gout circulating in the blood is sometimes a source of intense headache.

The headache of Bright's disease of the kidneys and of diabetes is dull and commonly associated with nausea or vomiting, swelling of the feet or ankles, pallor and shortness of breath in the former; with thirst and the passage of a large amount of urine (normal quantity is three pints in twenty-four hours) in the case of diabetes.

The headaches of indigestion are also of poisonous origin, the products of imperfectly digested food being absorbed into the blood and acting as poisons.

Another variety of headache due to poisoning is seen in children crowded together in ill-ventilated

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schoolrooms and overworked. Still another kind is due to inhalation of illuminating gas escaping from leaky fixtures.

Headache from Heat Stroke.-Persons who have been exposed to excessive heat or have actually had a heat stroke (Vol. I, p. 40) are very prone to headache, which is made worse by movements of the head. Sodium bromide, twenty grains dissolved in water, may be given to advantage three times daily between meals in these cases for not more than two days. Phenacetin in eight-grain doses may also afford relief, but should not be used more often than once or twice a day.

Constant Headache. This, afflicting the patient all day and every day, and increasing in severity at night, is suggestive of some disease of the brain, as congestion, brain tumor, or meningitis, and urgently demands skillful medical attention.

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Part II









Growths and Enlargements

Benign and Malignant Tumors-Treatment of Rupture-Hernia in Children-Varicocele-Causes of Varicose Veins-External and Internal Piles.

TUMORS.-A tumor-in its original meaningsignifies a swelling. As commonly used it means a new growth or enlargement of a part, which is not due to injury or inflammation. Tumors occur at all ages, in both sexes, and may attack any part of the body. Tumors are usually divided into benign and malignant growths. In a general way the malignant tumors are painful; they do not move about freely but become fixed to the adjacent parts; their growth is more rapid; they often have no well-defined borders; frequently they return after removal; the skin covering them is often attached and cannot be moved readily without also moving the tumor. Malignant tumors are divided into cancers (carcinomata) and sarcomas (sarcomata). Cancer is much more frequent than sarcoma. Cancer occurs more often in persons over thirty; there appears to be a hereditary tendency to it in some families, and a number of individuals in the same house or locality sometimes develop cancer as if

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