Halfway through On Megrim. Liveing has gotten no less astonishing.

I am finding it difficult to plow through the book at my normal speed. He keeps sort of casually making connections that make me stop and stare into space for a while as I think through the implications -- which, since I'm reading this in 2015, probably involve a lot more math than he had in mind when he originally wrote this.

About half of his observations are connections I had not made myself yet, mainly because I am not technically a neurologist and do not have access to the same materials Liveing did, never mind a modern neurology student. The other half are things I have been saying for years, including to actual doctors, which have mostly been ignored because, again, not technically a neurologist. Most of the relevant ones have been comparisons of the course of migranous misery to things like epileptiform seizures. The boundaries between various disorders were drawn differently in the 19th century -- which I think just goes to show how arbitrary they are -- and Liveing postulates that his "megrim" is related to things like epilepsy (which in the days before EEGs encompassed pretty much anything that looked like a "fit" or the results of a weird brain-cramp), dyspneic breathing disorders like asthma and laryngismus (aka pseudocroup), angina pectoris (specifically, the variety of angina brought on by cardiac exertion, either from exercise or from emotional distress), gastralgia (an overarching term for 'pain in the digestive system', here specifically linked to the nausea and vomiting that can bring on, or resolve, an attack of migraine), chorea, and tic-douloureux (today known as trigeminal neuralgia), not to mention what he calls "paroxysmal insanity," which doesn't seem to correspond directly to anything known in psychiatry today, but which by which I gather he means some kind of pseudoseizure and/or temporary psychotic break, and may also encompass what we think of today as dissociation and panic attacks.

Basically, Liveing thinks the excruciating head-ow is related to a whole family of things that result from the "nervous sensibilities" (i.e., front-end processing of the brain, responsible for handling sensory input and conscious emotional stuff) getting overrun and setting off a brain-storm that fucks up more basic systems like the symapathetic and parasympathetic nervous systems, and in turn wrecks your homeostasis. Which is what I keep telling people when I explain to them why they really, really, really just need to give me a small handful of fucking Xanax, because this shit doesn't turn off by itself. It is very nice to know that someone else agrees with me, although I suspect that before I can make any headway on that front, I will have to find a reference with a publication date more recent than 1873.

Liveing does get into the instability of chaotic systems, although he has no idea he's doing that, inasmuch as he wrote this thing up sometime in the 1860s, when mathematicians were still hammering out how to generalize differential calculus to the complex plane. It's all in the form of anecdotal case studies, but his patients near-uniformly describe the feeling that they're "due" some amount of suffering, and the longer they orbit the point of migraine without falling into it, the harder and faster they'll fall, and the more suffering has accrued in the meantime. It is the outline of the same multi-dimensional interactions that Sacks also pulled out and eventually met enough mathematicians to recognize as catastrophe theory in the later editions of his book.

[Note to self: Come back and explain strange attractors to readers who do not feel like plowing through Gödel, Escher, Bach: An Eternal Golden Braid  or Metamagical Themas just to work out what I'm talking about.]

He also notes explicitly that migraines put you into an altered state of mind, something to which I can attest. I have been known to function through the less miserable ones, and I can do that because whatever is happening to spark the head pain also kicks me into a curious biochemical state where I'm almost incapable of giving a fuck. I can walk around like that -- insofar as the scotoma will let me; I do typically lose a good quadrant of my visual field during the aura -- but I have to be very intellectually careful about things like cars. It's difficult to describe, but essentially, 'danger' signals no longer have priority over everything else. If the list of observations about what's around me usually goes, 'bench, tree, pedestrian staring at phone, MOVING CAR, lady with stroller...' then it's an altered state where MOVING CARS no longer rate capital letters. They only register in the minuscules normally reserved for things that aren't going to mow me down. I don't know exactly what goes out of whack to cause this, but seeing as one of the few consistent triggers is when the bottom drops out of my blood pressure, I'd guess it's something broken with the feedback system for adrenaline release.

Liveing is not 100% serious all the way through this. There is an amusing and prescient eye-roll near the beginning at the idea that women are inherently physically predisposed to hysteria. There are a few other places where he lacks a precise enough handle on something to draw a proper conclusion. He has asked his patients for a better description, he notes dryly, only to find they were unable to clarify what exactly they thought they meant by, say, 'bilious attack'.

It was not as unusual to write up case studies in the first person at the time; part of a doctor's status as a clinician came from his detective-like powers of observation, and the naturalists popularized the art of personal scientific narratives. (It was particularly associated with the medical schools of Edinburgh, which was where Arthur Conan-Doyle picked it up, and later gave it to his fictional detective.) It was a wee bit more uncommon for the author to start making snarky comments about his own logorrhea. Liveing once offers up, in what appears to be good humor, a last example, "with which I must bring this already too long chapter to a close."

As is common with 19th c. academic works, Liveing likes to quote large wadges of things in other languages. He is often, but not always, nice enough to translate the relevant parts into English in the main text and leave the unaltered quotations in the footnotes. My French and German seem to be adequate, but my Latin is annoyingly spotty. My Greek is just embarrassingly bad. I can read it, in the sense that I know what noises all those letters make, but I'm pulling out possibly 20% of the words in the passage, and those only because English has absconded with them for its own use. I'm doing as well as I am mainly because it's a medical text.


  1. You are making me want to track down a copy of this and read it myself. Slightly snarky science writing is one of my favorite things ever. (She said, as though her reading list wasn't already way too long...)

    1. WorldCat entry: http://www.worldcat.org/oclc/42031688
      Amazon entry: http://amzn.to/1j8zQZ9

      Knock yourself out.


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