Vertigo

“ Sometimes the vertigo from internal causes, as from intoxication, or at the beginning of some fevers, becomes so universal, that the irritative motions which belong to other organs of sense are succeeded by sensation or attention, as well as those of the eye. ”

“ But in riding over a broad and fluctuating stream, though we are well experienced in the motions of our horse, we are liable to become dizzy from our inexperience in that of the water. And when first we go on ship-board, where the movements of ourselves, and the movements of the large waves are both new to us, the vertigo is almost unavoidable with the terrible sickness, which attends it. ”

“ DIAGNOSIS.—Vertigo is of course, as a rule, only a complex symptom of one or more numerous conditions. Acute isolated fits of vertigo are sometimes puzzling, because epilepsy may be preceded by brief vertigo and exist without notable spasms. Time may bring to us a frankly expressive epilepsy to explain former and less distinct fits. But usually it is the attacks of vertigo which are the causes of doubt. A man has sudden giddiness, and falls unconscious for a moment. These attacks persist. How shall we know them as vertigo? how be secure that they be not some form of the lesser epilepsy? ”

“ So that in this vertigo the motions of the associated organs are decreased by direct sympathy with their primary link of irritation; as in the preceding case of sea-sickness they are decreased by reverse sympathy.
When vertigo affects people about fifty years of age, their sight has generally been suddenly impaired; and from their less accurate vision they do not soon enough perceive the apparent motions of objects ”

“ The vertigo attack is frequently accompanied by the worst kind of anxiety and is often combined with cardiac and respiratory disturbances. Vertigo of elevations, mountains and precipices, can also be frequently observed in anxiety neurosis ”

“ The vertigo visualis is owing to less perfect vision, and is not accompanied with pleasurable sensation. This frequently occurs in strokes of the palsy, and is then succeeded by vomiting; it sometimes precedes epileptic fits, and often attends those, whose sight begins to be impaired by age. ”

“ And there is the true brain vertigo—a common symptom of disease of the nervous system. In anæmia, and one or two diseases of the heart, giddiness is common—due to the brain not being sufficiently supplied with blood. Here you have the cause of vertigo in a nutshell. To tell which of them is causing your giddiness, with nothing whatever to guide us to a conclusion, is quite impossible.
Foolish.—The pseudonym you have chosen is very appropriate. You are exceedingly foolish to take drugs of which you know nothing; but it is worse than foolish, it is criminal. ”

“ For the vertigo from failure of sight, spectacles may be used. For the auditory vertigo, æther may be dropt into the ear to stimulate the part, or to dissolve ear-wax, if such be a part of the cause. For the vertigo arising from indigestion, the peruvian bark and a blister are recommended. And for that owing to a stone in the ureter, venesection, cathartics, opiates, sal soda aerated.
12. Definition of vertigo. 1. Some of the irritative sensual, or muscular motions, which were usually not succeeded by sensation, are in this disease succeeded by sensation ”

“ In this vertigo the irritative ideas of the apparent motions of objects are less distinct, and on that account are not succeeded by their usual irritative associations of motion; but excite our attention. Whence the objects appear to librate or circulate according to the motions of our heads, which is called dizziness; and we lose the means of balancing ourselves, or preserving our perpendicularity, by vision. ”

“ The cure of vertigo will frequently depend on our previously investigating the cause of it, which from what has been delivered above may originate from the disorder of any part of the great tribes of irritative motions, and of the associate motions catenated with them.
Many people, when they arrive at fifty or sixty years of age, are affected with slight vertigo ”

“ A fit of giddiness, with sickness and ear-disease, is not this labyrinthine vertigo?
On different days in January, 1711, he writes:
"I had an ugly fit in my chamber last night. . . . My head is not in order, and yet is not absolutely ill; but giddyish, and makes me listless. . . . One fit shakes me a long time." ”

“ Fits of vertigo are often as distinct clinically as epileptic attacks. The patient has for a few moments, in an acute form, all of the phenomena of vertigo, and may then recover promptly, or it may chance that he has a vertiginous status and a series of fits, or remains for long periods in a state of chronic disorder of head, with now and then an acute onset. ”

“ From these two considerations it appears, that the dizziness felt in the head, after seeing objects in unusual motion, is no other than a continuation of the motions of the optic nerve excited by those objects and which engage our attention. Thus on turning round on one foot, the vertigo continues for some seconds of time after the person is fallen on the ground ”

“ Many of the hysterical palsies are really due to dreads, consequent upon some incident, motor or sensory, which produced a profound effect upon the patient's mind. A patient who has been surprised by a digestive vertigo while descending a stairs, even though nothing more happened than the dizziness which required him to grasp the balustrade, will sometimes develop a fear of vertigo that will actually make it difficult for him to go down stairs without such an effort of will as is very exhausting. ”

“ If more severe, there is disturbed equilibrium, an effort is needed to stand erect, or there is, as in most vertigo, a fear of falling. The brain seems to be moving round or upward. This type is found in insanity, in hysteria, and in the vertigo of mental effort observed in extreme cerebral exhaustion.
In a second clinical species of vertigo the patient appears to himself to be in motion, while outside objects maintain for him their places. This may or may not be accompanied with sensory disturbance or an approach to mental confusion. It is really a delirium of movement. ”

“ Whenever vertigo recurs frequently, and at an advanced period of life; and more particularly when it is accompanied with drowsiness; weakness of the voluntary muscles; impaired memory, or judgment; or, in short, any other disturbance or imperfection in the state of the sensorial functions; an unfavourable result is to be expected; because all these afford decisive evidence of a considerable degree and extent of disease in the brain—Dr. ”

“ Others regard the vertigo as a climacteric neurosis, since it occasionally occurs before the menstrual irregularities begin, and in such cases a reflex disturbance of the cerebral circulation cannot be supposed to have arisen. ”

“ The cure. Those affected with vertigo are to be roused at the onset, by using strong-scented things of a suitable nature, by frictions, and such like; and, during the remission, for the recovery of the complaint, they ought first to be bled, and then purged with hiera. And after an interval we must use an acrid clyster of centaury, or the decoction of colocynth. After such evacuations, we are to apply to the back part of the head cupping-instruments with scarifications, and afterwards use masticatories and sternutatories. ”

“ One is certainly justified, when a man of your age complains of vertigo, in suspecting calcification of the arteries to be the cause of the trouble, since it constitutes the common senile change, and vertigo forms one of its most frequent symptoms. ”

“ In the vertigo of brain lesions, the acute forms are attended by fever and marked signs of delirium or disordered nervous functions, while in the chronic forms there may be permanent hyperæsthesia or anæsthesia, general or with rather diffuse limits, and the vertiginous attacks repeat themselves frequently irrespective of weather, though they may be precipitated by faults of feeding, indigestion, severe exertion, or some of the other exciting causes above mentioned. ”

“ Hence a violent vertigo, from whatever cause it happens, is generally attended with undulating noise in the head, perversions of the motions of the stomach and duodenum, unusual excretion of bile and gastric juice, with much pale urine, sometimes with yellowness of the skin, and a disordered secretion of almost every gland of the body, till at length the arterial system is affected, and fever succeeds. ”

“ Nothing can induce some persons to venture into the steaming shaft after they have taken one good look at it, while proper explanations speedily cure others of their vertigo, apoplectic symptoms, palpitation of the heart, or whatever disease it may be their fancy to affect. ”

“ A quick pace will induce rapid circulation, and the blood, checked at the waist, will, like a stream which has met with an obstacle in its course, turn into other channels, rushing either to the heart, causing faintness, or to the head, producing headache and vertigo. ”

“ The most frequent cause is, accumulation and congestion of blood in the brain: but sometimes, on dissection, no disease is discernible; and effusions in the brain do not always inflict apoplexy.
Of vertigo, the causes are several of those just enumerated: the principal, plethora, suppressed hemorrhages; suppressed perspiration; luxurious diet, gluttony, somnolency; foul or disordered stomach; costiveness; intoxication; narcotick and tobacco fumes; unremitting attention of mind to study or business; restlessness, mental distress; hunger, inanition, debility ”

“ Vertigo.—Besides, there are pathological conditions that cause dizziness yet have no connection at all with the dizziness that is a premonitory symptom of apoplexy. Menière's disease, for instance, even in its milder forms, causes at times a vertigo that is extremely annoying and that frequently gives rise to the fear that a serious brain lesion is either actually occurring or is impending. I have seen even comparatively young patients suffer so much from this dread that life became miserable to them and they were unable to do their work properly. ”

“ ADOLPH. Yes, I have had attacks of vertigo now and then, but my physician says it's only anaemia.
GUSTAV. Well, that's the beginning of it, you know. But, believe me, it will end in epilepsy if you don't take care of yourself. ”

“ Vertigo, or giddiness, though unattended with pain, is, in general, of a more dangerous nature than the severest headach. Vertigo consists in a disturbance of the voluntary power, and in some degree of sensation, especially of vision; and thus it shows itself to be an affection of the brain itself; while mere pain in the head does not necessarily imply this, it being for the most part an affection of the membranes only. In vertigo, objects that are fixed appear to be in motion, or to turn round, as the name implies. The patient loses his balance, and is inclined to fall down. ”

“ When subjectively excited, this sensation is known as dizziness or vertigo, and rapidly engenders the farther feeling of nausea. Irritative disease of the inner ear causes intense vertigo (Ménière's disease) . Traumatic irritation of the canals in birds and mammals makes the animals tumble and throw themselves about in a way best explained by supposing them to suffer from false sensations of falling, etc., which they compensate by reflex muscular acts that throw them the other way. ”

“ The apparent movement of objects in vertigo, or giddiness, is probably due to the loss, through a physical cause, of the impressions made by the pressure of the fluid contents of the ear on the auditory fibres, by which the sense of equilibrium and of rotation is usually received. ”

“ There is however a slighter vertigo attending all people, who have been long confined in bed, on their first rising; owing to their having been so long unused to the apparent motions of objects in their erect posture, or as they pass by them, that they have lost in part the habit of balancing themselves by them. ”

“ And hence, when a patient is inclined to vomit from other causes, as in some fevers, any motions of the attendants in his room, or of himself when he is raised or turned in his bed, presently induces the vomiting by superadding a degree of vertigo. ”

“ Although the symptoms are a little more marked, vertigo also is of brief duration. To the pallor and the loss of consciousness of the preceding condition there is added a little muscular relaxation. The child totters, supports himself by anything in his neighbourhood, slips down in his seat, or drops his pen. Sometimes there is a slight spasm of the muscles of the face, the mouth is drawn to one side by slight jerks, or performs some movements of mastication or deglutition. ”

“ These signs are recurring dizziness, or vertigo, not clearly associated with gastric disturbance; tendency of the limbs, and especially the fingers and toes, to go to sleep easily, and when there is no external cause for this condition; tendency to faintness and to dizziness when the patient rises in the morning, especially if he assumes the erect position suddenly; tendency to vertigo when the patient stoops, as to tie a shoe, or pick up something from the floor, and the like ”

“ PROGNOSIS.—In true vertigo, if we exclude the organic causes, and especially intracranial neoplasms, there is very little to be feared. Deaths have been seen in Menière's disease, but are most rare. Even in grave examples of labyrinthine vertigo there is a probability that the worst which can occur will be deafness, and that vertigo will gradually cease as the delicate neural tissues become so degenerated as to cease to respond to irritations. ”

“ At all times, your prognosis should be guarded; because vertigo seldom occurs under favourable circumstances of age and general health; unless when produced by so slight a cause as bloodletting, or a trifling blow upon the head. ”