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and a glossary explaining them at the end of the book is a wonderful touch. I
expect this book to be a winner with teachers and students.”
Professor Anat Ninio, The Hebrew University of Jerusalem, Israel
8
9
This edition first published 2012 by the British Psychological Society and John
Wiley & Sons Ltd
Copyright © 2012 the British Psychological Society and John Wiley & Sons Ltd
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publisher would be glad to hear from any copyright holders whom it has not been
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please see our website at www.wiley.com.
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Library of Congress Cataloging-in-Publication Data
Brooks, Patricia (Patricia J.)
Language development / Patricia Brooks, Vera Kempe.
10
p cm
Includes bibliographical references and index.
ISBN 978-1-4443-3146-2 (pbk.)
1. Language acquisition. I. Kempe, Vera. II. Title.
P118.B687 2012
401’.93—dc23 2012000093
A catalogue record for this book is available from the British Library
Set in 11/12.5pt Dante MT by MPS Limited, Chennai, India
The British Psychological Society’s free Research Digest e-mail service rounds up
the latest research and relates it to your syllabus in a user-friendly way. To
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rd@lists.bps.org.uk.
Senior Commissioning Editor: Andrew McAleer
Assistant Editor: Katharine Earwaker
Marketing Managers: Fran Hunt and Jo Underwood
Project Editor: Juliet Booker
11
To our mentors Tatyana V. Akhutina, Martin D. S. Braine, Brian MacWhinney and
Michael Tomasello.
12
Acknowledgements
This book would not have been possible without Martyn Barrett, who encouraged
us to embark on this adventure in the first place, read multiple drafts of the entire
book, and provided extremely helpful and constructive suggestions for
improvements in structure and content. We would like to thank Michael
Almodovar for creating clear figures to our multiple (and sometime conflicting)
specifications, and Naomi Aldrich for her dedicated help with the glossary. A
number of colleagues generously read portions of the book, contributed advice,
and/or shared materials: Julia Carroll, Morten Christiansen, Ewa D browska,
Virginia Gathercole, Trevor Harley, Carmel Houston-Price, Neil Kirk, David
LaRooy, Danielle Matthews, Anat Ninio, Sonia Ragir, Harriet Tenenbaum, Robin
Thompson, Gabriella Vigliocco, Dave Vinson, as well as several anonymous
reviewers. Mid-way through the writing it was immensely helpful to receive
detailed feedback on drafts of the first six chapters from the 2011 Advanced
Cognitive Psychology class at the University of Abertay, and from the
undergraduates taking Language Development at the College of Staten Island,
CUNY. We are also grateful for the continuous encouragement provided by our
editor, Andrew McAleer. It goes without saying that all remaining errors and
inconsistencies are entirely our own.
A big warm special Thank You goes to our children Erica, Ike, Max and Marius
for the countless moments of inspiration found in their developing language, for
many often hilarious linguistic examples, for their interest and curiosity about our
work, and for growing up wonderfully despite their mothers’ preoccupations with
academic pursuits.
Last but not least, our husbands David Lobel and Ian Veltman had to bear the
brunt of responsibility for keeping domestic affairs from sliding into chaos over the
past two years. Without their continuous encouragement and support, delicious
home-cooked meals, and vacation time, we simply would not have been able to
muster the resources and persistence a project like this requires. It takes
considerably more than our own language proficiency to adequately express how
grateful we are to them.
Patty Brooks
Vera Kempe
13
Chapter 1
alloparents
artificial language
babbling
collective breeders
communicative intentions
conspecifics
constructions
coordinated interpersonal timing
discourse
Duchenne smiles
dyadic interaction
encephalisation
executive functioning
fundamental frequency
hominin
intersubjectivity
joint attention
Less-Is-More
natural pedagogy
scaffolding
social shaping
still-face effect
terrestrial bipedalism
CHAPTER OUTLINE
1.1 WHAT IS THE EVOLUTIONARY CONTEXT OF LANGUAGE
DEVELOPMENT?
1.1.1 Extended period of immaturity
1.1.2 Alloparental care
1.1.3 Reciprocal interaction between young infants and caregivers
1.1.4 Complex social environments
14
1.2 WHAT ARE THE ABILITIES OF LANGUAGE-READY
NEWBORNS?
1.2.1 Attending to others
1.2.2 Engaging others
1.2.3 Neurological and cognitive immaturity
Language is a universal human ability. Children at a young age learn to speak and
to understand others’ speech; they learn to use language to share ideas, negotiate
activities, and cooperate with others. They do this in spite of the fact that there is
extraordinary complexity and diversity in the sound patterns, word meanings, and
grammatical structures of the approximately 7000 human languages that have been
catalogued throughout the world (Gordon & Grimes, 2005; Lewis, 2009). All
human languages have a degree of complexity that surpasses by far the
communication system of any other species. Yet the process of language
development seems to be easy, effortless, and does not require specific instruction.
So how do children do it?
In this book we will try to understand what language development entails and
what lies behind this extraordinary human achievement. Humans have evolved to
learn language over an extended period of childhood. Children grow up as
members of communities in which language constitutes the primary mechanism by
which social activities are coordinated and ideas are exchanged. In this chapter, we
will examine the sociocultural context in which language development takes place
and begin to explore the social and cognitive abilities that allow human infants to
learn language so readily. Among other things, infants show precocious sensitivity
to the sound patterns of languages, and in Chapter 2 we will discuss what abilities
enable infants to crack the sound code of their native language very early in life.
Infants are also able to communicate through gesture at a stage when their ability
to use spoken language is still very rudimentary. In Chapter 3 we will show how
shared attention and non-verbal communication provide the basis for the
development of spoken language. Building on this ability, infants are able to figure
out what others mean when they produce specific speech patterns, and in Chapter 4
we will trace how the meanings of words are negotiated in the context of shared
activities with others. Once the first words are acquired, infants and toddlers start
combining and modifying them. In Chapter 5, we will describe how infants
discover the myriad ways in which speakers of their language combine and modify
words to create new meanings. Even though language development is a universal
aspect of human development, there is variation in the learning trajectories of
individual children. In Chapter 6 we will examine the nature of children’s language
input and what consequences, if any, variability in the quality and quantity of
language input has for language development.
Obviously, using language encompasses more than just knowing the meanings of
words and how to put them together to create sentences. Children learn to use
language in socially appropriate ways, to tease others and make them laugh, to
argue, lie and deceive, to tell stories, retrace the past and plan for the future, as well
as for many other purposes. These abilities take time to develop, and Chapter 7
15
traces the acquisition of pragmatic and conversational skills. Chapter 8 returns to
the phenomenon of linguistic diversity and explores how specific features of
languages and bilingualism influence cognitive development. In many cultures,
like our own, language develops further as children learn to read and write.
Chapter 9 provides an overview of literacy acquisition and its role in language
development.
Despite the fact that most children acquire language with apparent speed and
ease, language development is not always a smooth path. Some children have
impairments in language learning and processing, and Chapter 10 summarises what
is known about the possible causes of their difficulties. Chapter 11 explores sign
language development in deaf children who are not able to perceive the sound
patterns of a spoken language. Studying deaf children provides a unique
opportunity to observe what happens when exposure to a language (spoken or
signed) is delayed during development. To what extent does the brain remain
plastic enough to accommodate language learning at ages beyond early childhood?
This question is explored further in Chapter 12, which looks at the neural basis of
language development.
In describing the trajectory of human language development, this book will try to
incorporate evidence from children acquiring different languages in different
cultures. As the bulk of research on language development has been carried out
with children who are acquiring a few languages spoken in industrialised Western
societies, we acknowledge that much is still not known about language
development elsewhere. We urge readers to be cautious in their conclusions about
what is culturally and linguistically universal in language development.
16
general social and cognitive abilities, which enabled humans to adapt to a wide
variety of different environments through cultural learning (Kirby, Christiansen &
Chater, 2009; Tomasello, 2008). In other words, did changes in our genetic make-
up provide humans with an innate capacity to acquire and process language, or
alternatively, did human languages evolve under selective pressure to fit our
ancestors’ social and cognitive capabilities and ecological niche (Chater &
Christiansen, 2010; Christiansen & Chater, 2008; Levinson & Evans, 2010;
Lupyan & Dale, 2010; Nettle, 2007)? Models of gene–culture co-evolution suggest
that increased complexity in communication may have pushed genetic evolution in
a direction that enhanced the social and cognitive skills needed for language
acquisition and processing (Deacon, 1997; Richerson & Boyd, 2010). This debate
to some extent informs our understanding of how language development is
ultimately tied to children’s social and cognitive development.
In this chapter, we set the stage by briefly sketching the evolution of the
conditions under which language development takes place. These conditions
pertain to (a) the time course of language development – that is, how long it takes
for a person to master a language; (b) the nature of social and communicative
engagement between children and others; and (c) the wider social environment that
supports language development over the lifespan. We will then take a brief look at
the social and cognitive abilities of human infants that support their entry into
communities defined by their sociocultural and linguistic practices.
17
specific causes of bipedalism, an undisputed consequence is that it altered the
shape of the hominin pelvis through horizontal realignment, and thereby
effectively narrowed the birth canal (Abitbol, 1987; Rosenberg, & Trevarthan,
2002). Pelvic realignment would have generated considerable selective pressure to
delay skeletal maturation (Ragir, 2001; Ruff, 1995); that is, to allow a neonate with
a softer, less mature skeleton to pass through the constricted birth canal. Over the
subsequent course of human evolution, additional adjustments in growth
parameters may have occurred as dietary advances (e.g. hunting, cooking, and food
preservation) improved year-round access to nutrients and increased the weight of
females and the weight and size of their offspring. Increased foetal size would
become problematic if the skeleton became too big to successfully deliver through
the birth canal (Rosenberg & Trevarthan, 1996). Consequently, each dietary
advance may have triggered further maturational delays to ensure successful birth
of hominin infants. Altering the rate of skeletal maturation through adjustments to
growth parameters would also have lengthened the time course of neural
development. Such adjustments would have increased brain size, because brain
size increases proportionally as neural development is prolonged (Finlay,
Darlington, & Nicastro, 2001), which would have contributed to the
encephalisation (increased cranial volume relative to body size) characteristic of
modern humans. Crucially, a more slowly maturing brain has greater neural
plasticity and behavioural flexibility, thus leaving increased room for learning
about the physical and social environment in a rapidly changing world (Chrysikou,
Novick, Trueswell, & Thompson-Schill, 2011; Ragir, 1985; Thompson-Schill,
Ramscar, & Chrysikou, 2009).
hominin refers to humans and their ancestors, and includes all the
Homo species, all the Australopithecines, and others such as
Ardipithecus; this term is more specific and replaces the previous term
‘hominid’.
18
sarcasm, humour, literacy; see Chapters 7 and 9). In many respects, language
learning is a life-long endeavour with vocabulary, grammar, and discourse skills
continue to grow throughout adolescence and even adulthood.
19
alloparents individuals besides the parents who engage in the care and
provisioning of offspring.
20
1.1.3 Reciprocal interaction between
young infants and caregivers
To solicit care, human infants need to engage in social interactions and to monitor
the behaviours of others for signs of commitment. When interacting with their
caregivers, infants produce various types of vocalisation, such as grunting, crying,
laughter, cooing, and babbling. These vocalisations are not intentionally
communicative in the earliest stages of development; neonates obviously cannot
voluntarily control their bouts of crying. Nevertheless, even the earliest
vocalisations of infants provide information about their physical states (health,
distress) and needs (food, comfort, sleep). More mature individuals, in turn, are
predisposed to respond to infant signs of immaturity and need. This predisposition
is not only evident in mothers, but in other adults or even juveniles, who all
potentially may serve as alloparents. Indeed, it may have co-evolved with infant
immaturity to ease the burden of costly childcare.
21
behaviour (Crown, Feldstein, Jasnow, Beebe, & Jaffe, 2002). The coordination of
infant–caregiver behaviour in dyadic interaction is even more robust at 4 months of
age, as infants at this age coordinate their vocalisations with those of strangers as
well as their mothers (Jaffe, Beebe, Feldstein, Crown, & Jasnow, 2001).
Figure 1.2 In face-to-face dyadic interaction, caregivers and infants use facial
expressions, eye gaze, volcalisation, and touch to convey interest and emotion, and
to modulate arousal.
Source: © Lucian Coman. Used under licence from Shutterstock.
Infants vocalise to engage and maintain closeness with their caregivers, who
vocalise in return to reassure, soothe, elicit attention, or make infants smile. Infants
produce different qualities of vocalisation depending on whether they are alone or
engaged with others, which suggests that they can vary their prelinguistic
vocalisations for purposeful communication (Papaeliou & Trevarthan, 2006).
Adults, in turn, are highly sensitive to differences in the quality of infants’
vocalisation (Bloom & Lo, 1990). The intuitive appeal of certain types of infant
vocalisations (e.g. cooing and babbling) in contrast to the negative valence of
others (e.g. crying) leads adults to selectively reinforce specific qualities of infant
vocalisation over others. For example, when 2- to 4-month-old infants make
cooing sounds, adults intuitively perceive them as playful and friendly, and
respond favourably towards them (Locke, 2006; Snow, 1977; Watson, 1972). In
contrast, excessive crying elicits caregiver stress, frustration, and aggression. The
process whereby caregivers respond contingently and positively to their infants’
communicative bids is called social shaping, and has been shown to increase both
the quality and the quantity of babbling in infants (Goldstein, King, & West, 2003;
22
Goldstein & Schwade, 2008). Because cooing and babbling are effective in
eliciting adult attention, positive affect, social stimulation, and caretaking, infants
readily learn to use vocalisation as a means to establish and maintain positive
rapport with others (Goldstein, Schwade, & Bornstein, 2009). Recent neuro-
imaging work suggests that close social interaction between individuals leads to
the coupling of neural responses, which further reinforces the execution of
coordinated, joint behaviours (Hasson, Ghazanfar, Galantucci, Garrod, & Keysers,
2012). Thus, the interplay between infants who are primed to engage their
caregivers and caregivers who are primed to respond to their infants’ needs drives
the development of language and other social and cognitive skills.
23
transmission of knowledge.
As tool use and cooking techniques became more sophisticated, the ways in
which objects were manufactured and used became more opaque and less self-
explanatory. Humans may have adapted to this situation by evolving what Csibra
and Gergely (2009, 2011) have termed natural pedagogy; see Figure 1.3.
Although such ostensive signals may be non-linguistic (e.g. pointing or the use of
eye gaze to indicate referential intent), the process of knowledge transmission is
greatly enhanced by language, and language learning itself may benefit from the
availability of such ostensive signalling. There is controversy about the extent to
which human adults engage in direct teaching, as opposed to expecting children to
learn from observation, imitation, and overhearing: in many contemporary non-
industrial societies there is much less direct teaching and verbal instruction of
children in comparison to Western industrialised societies (Lancy, 2009; Rogoff,
1990). Still, natural pedagogy seems to be largely absent in other species, which
suggests that there is an important place for language in the transmission of
generalisable cultural knowledge.
Figure 1.3 Humans devote considerable time and effort to teaching their young
culturally significant practices. Such natural pedagogy requires the teacher and
student to achieve a mutual understanding of what they are doing together and for
what reason. Here a grandmother is teaching her grandson how to prepare meat
dumplings.
Source: © shalunishka. Used under licence from Shutterstock.
Language not only accompanies and facilitates joint activity and information
24
exchange, but is also used to cement social alliances and to share states of mind
(Carpendale & Lewis, 2004). In fact, it has been suggested that the need for
language arose when human groups became too large to engage in direct mutual
grooming (Dunbar, 1993, 1996). Mutual grooming, being both pleasurable and a
hygienic necessity, serves to cement social alliances because it implies reciprocity
– as in ‘You scratch my back and I’ll scratch yours’. As group sizes increased,
language may have taken over the social function of mutual grooming by allowing
individuals to share internal states and important social information through gossip.
Human communication, at a fundamental level, requires cooperation. Recently,
it has been suggested that the emergence of language in human evolution is a
reflection of our seemingly innate proclivity to engage cooperatively with others
(Tomasello, 2008). Coordination of point of view is necessary for any
communicative act to be mutually understood. The creation of shared meanings
between members of a group requires a mechanism for achieving
intersubjectivity. Intersubjectivity emerges early in infancy as caregivers and
infants share positive rapport through dyadic face-to-face interaction (Stern, 1985;
Trevarthen, 2001). If one views human language as a system of arbitrary
relationships between linguistic forms and their associated meanings (Bates,
Benigni, Bretherton, Camaioni, Volterra, et al. 1979), each pairing of form and
meaning had to have emerged through negotiations among community members to
achieve mutual understanding (see Chapter 11 for further discussion of the social
factors that support language emergence). Every human language reflects the
consensus of a community of speakers regarding what is to be understood in the
context of language use and community practice. All human languages comprise
complex systems of social conventions predicated upon communities of
cooperatively interacting speakers (Clark, 1996; Tomasello, 2008; Wittgenstein,
1953). For two individuals to use a human language to communicate with one
another, they must adopt the conventional ways of speaking the language, and they
must mutually appreciate when communication has been successful. If one fails to
cooperate in using the socially agreed upon constructions of the language,
communication breaks down, and shared understanding has to be re-negotiated.
For a child to break into such a system, the child must share a willingness to
engage with others in jointly constructed activities, whereby the communicative
intentions of others are made transparent and mutual understanding is achieved.
Under this view, language develops as the child grasps the myriad ways that
community members use linguistic utterances to coordinate their perspectives in
order to achieve shared goals.
25
Another random document with
no related content on Scribd:
even two or three months. I have seen a number of patients who
have attacks of migraine on Sunday with regularity, and escape
during the interval. Some of these cases ascribed the attacks to
sleeping later on this day than on others, but it is more likely that the
attacks were the result of the culminating effect of a week's hard
work. Between the attacks the patient is usually quite well as far as
headache is concerned, but he may have slight neuralgia in
branches of the trigeminal. The attacks are more or less alike. They
are often preceded by prodromal symptoms for a day or two. The
patient may feel languid or tired for a day before the attack.
Sometimes there is unusual hunger the night before a paroxysm, or
there may be violent gastralgia before each attack. The patient often
wakes in the morning after sound sleep with a pain in the head.
Should the attack come on in the day, it may be preceded by
chilliness, yawning, or sneezing and a sense of general malaise.
Ocular symptoms are frequent as a forerunner of an attack. First
muscæ volitantes are seen, then balls of fire or bright zigzags
appear before the eyes, making it impossible for the patient to read.
These symptoms last for a few minutes or a half hour, and then
cease, to be immediately followed by pain. Hemianopsia is a
precursory symptom of rather frequent occurrence. Ross mentions a
case in which the hemianopsia usually lasted about a half hour, and
was followed by severe hemicrania. The ocular symptoms are often
very alarming to patients.
Painful points (Valleix's points) are not present, but there is usually
tenderness over the supraorbital notch during an attack of migraine,
and after the paroxysm there is a general soreness of the scalp and
forehead. Sometimes there remains a tenderness of the parts
surrounding the affected nerve. This is not in the nerve itself, but in
the adjacent tissues. Anstie9 says that in his own case, after
repeated attacks of migraine, the bone had become sensibly
thickened in the neighborhood of the supraorbital notch. There is
sometimes hyperæsthesia of the skin in the affected regions of the
forehead and scalp during an attack. As well as hyperæsthesia,
there may be an abnormal acuteness of the sense of touch. Deep
pressure over the superior and middle ganglia of the sympathetic
causes pain, according to Eulenburg. This observer also states that
the spinal processes of the lower cervical and upper dorsal vertebræ
are painful on pressure.
9 Op. cit., p. 182.
During the attack there are disorders of the circulation. The pulse
may be intermittent or irregular, and the extremities are usually cold.
Disorders of cutaneous sensibility are also often present. A condition
of numbness confined to one lateral half of the body is sometimes
experienced during the early part of the paroxysm. This numbness is
noticed even in one half of the tongue.
The German writers have divided migraine into two types, and the
arrangement may be followed in some instances. The first is called
hemicrania spastica or sympathico-tonica. In this form there is
supposed to be vascular spasm and a diminished supply of blood in
the brain. The symptoms are as follows: When the attack has
reached its height the face is pale and sunken; the eye is hollow and
the pupil dilated; the arteries are tense and feel like a cord. The
external ear and the tip of the nose are cold. Eulenburg10 states that
by actual measurement he has found the temperature in the external
auditory meatus fall 0.4° to 0.6° C. The pain is increased by
stooping, straining, or anything which adds to the blood-supply in the
head. At the end of the attack the face becomes flushed and there is
a sense of heat. The conjunctiva becomes reddened, the eye is
suffused, and the pupil, which had been dilated, contracts. The
sense of warmth becomes general, the pulse is quickened, and the
heart palpitates. The crisis is reached with vomiting and a copious
flow of urine or perhaps a diarrhœic stool. There is sometimes an
abundant flow of saliva. One observer has reported that he has
estimated a flow of two pounds of saliva during an attack.
10 Op. cit.
In all forms, if the patient can be quiet, he usually falls asleep after
the crisis has been reached, and awakes free from pain, but feeling
haggard and prostrated.
The paroxysm lasts for several hours, generally the greater part of
the day. It may last for several days, with variations of severity. The
attacks are at longer or shorter intervals of time, and in women they
often appear at the menstrual period. The attack may be brought on
by over-mental or bodily exertion, imprudence in eating or drinking,
and exposure to cold draughts of air. It will often begin as a
supraorbital neuralgia from exposure to cold, and go on through all
the phenomena of a regular migraine.
We now come to the question of the origin and seat of the pain in
migraine. This question has involved a great deal of thought, and
has been answered in various ways by different writers. E. du Bois-
Raymond thought that the pain was due to tonic spasm of the
muscular coats of the vessels, and that thereby the nerves in the
sheaths of the vessels were pinched, as it were, and so caused pain.
Moellendorff was of the opinion that the pain was due to dilatation of
the vessels, and not to contraction; and this theory might explain the
pain in the angio-paralytic form. There are many cases in which
neither of these views is sufficient, for we have no reason to believe
that a condition of either anæmia or hyperæmia is present.
Romberg believed that the pain was situated in the brain itself, and
Eulenburg holds that the pain must be caused by alterations in the
blood-supply, without regard to their origin, in the vessels of one side
of the head. He thinks that the vessels may contract and dilate with
suddenness, just as is often seen in some neuralgias, and thus
intensely excite the nerves of sensation which accompany the
vessels. The increase of pain upon stooping, straining, or coughing,
and the influence upon it by compression of the carotids, seem to
give force to this view. But are we not here confusing cause with
effect? Are not these variations in the calibre of the vessels due to
the irritation of the sensory and vaso-motor nerves, which are in a
state of pain? No doubt increase in the blood-supply augments the
pain, just as it does in an inflamed part when more blood goes to the
part. Let a finger with felon hang down, or let a gouty foot rest upon
the floor, what an intensity of pain follows!
Anstie brings forward as arguments to support his view the facts that
the attacks of migraine often interchange with neuralgic seizures,
and that a person who has been migraineuse in early life may in later
years lose his hemicranial attacks, and have violent neuralgia in the
ophthalmic division of the fifth nerve.
The true seat of the lesion, if we may so call it, upon which the
exaggeration of pain-sense depends, is probably in the nerve-centre;
that is, in that part of the trigeminal nucleus back to which the fibres
go which are distributed to the painful areas. The pain is no doubt
chiefly intracranial, and in those portions of the cerebral mass and
meninges to which branches of the trigeminal are distributed. All of
the divisions of the trigeminus send branches to the dura mater.
Many nerves are found in the pia mater as plexuses around the
vessels, some of which penetrate into the centre of the brain. Most of
these nerves come from branches of the trigeminus.
Anstie has found the careful use of galvanism to the head and
sympathetic of positive advantage in keeping off attacks, and
Eulenburg has had the same experience.
In the treatment of the attack the patient should be freed from all
sources of external irritation. He should lie down in a darkened room,
and all noises should be excluded. If the attack is of the hyperæmic
variety, the patient's head should not be low, as this must favor
increase of blood to the head. In this form the patient is often more
comfortable sitting up or walking about. Occasionally an impending
attack can be warded off by the administration of caffeine, guarana,
or cannabis indica. Purgatives are of but little value in this form of
headache. The local application of menthol or of the oleate of
aconitia to the brow of the affected side will sometimes prevent an
attack. If a person can lie down quietly when he feels an attack
coming on, one or two doses of fifteen grains each of the bromide of
lithium will enable him to sleep, and wake free from pain. I have
found the lithium bromide far more valuable in migraine than any
other of the bromides. An effervescing preparation known as bromo-
caffeine is often efficacious in aborting a paroxysm or in palliating it
when it has got under way.
Once the attack has begun fully, we can only attempt to mitigate the
pain. Firm pressure on the head generally gives relief, and encircling
the head firmly with a rubber bandage is often of great comfort.
Compression of the carotids gives temporary but decided ease to the
pain. Strong counter-irritation in the shape of a mustard plaster to the
nape of the neck or a stimulating application, like Granville's lotion,
to the vertex, will afford relief. I have found in some cases that
placing a hot-water bag, as hot as could be borne, against the back
of the head alleviates the pain. In other instances cold affords more
relief, and an ice-bag resting upon the forehead is the most
efficacious way of applying cold. Hot bottles to the feet are an
accessory not to be overlooked.
It is for this reason that I prefer to use the bromides, and if a patient
is seen at the beginning of a paroxysm, given a fifteen-grain dose of
bromide of lithium, his feet put in hot mustard-water, and he then
goes to bed, he will almost always cut his attack short, and on
waking from sleep will feel refreshed and able to take food.
VERTIGO.
A few persons insist that something like a distinct aura precedes the
attacks. In other cases the brain symptoms develop gradually, from a
faint sense of dizziness up to a tumultuous feeling of confusion with
sensory illusions. In a few rare cases there is, as in that above
mentioned, an abrupt onset. Something seems to snap in the head,
and the vertigo follows; or, most rare of all, we have a sensory
discharge felt as light or sound, and followed by the ordinary
symptoms.2
2 See the author in lectures on Nerv. Diseases, Disorders of Sleep, p. 63, 2d ed.
In pigeons, injury on one side may get well, but when the canals are
cut on both sides there is permanent loss of balance. In some way,
then, these little organs appear to be needful to the preservation of
equilibrium; and of late some interesting attempts have been made
to explain the mechanism of this function. It probably depends on the
varying pressure relations of the endo-lymph to the nerve-ends
which lie in the membranous canals.
Lastly, excess in venery, or, in rare cases, every sexual act, profound
moral and emotional perturbations, and in some states of the system
mental exertion, may occasion it, while in hysteria we may have
almost any variety of vertigo well represented. Outside of the brain
grave organic diseases of the heart are apt to produce vertigo,
especially where the walls of the heart are fatty or feeble from any
cause. Suppression of habitual discharges, as of hemorrhoids or
menstrual flow, is certainly competent, but I have more doubt as to
the accepted capacity of rapidly cured cutaneous disease.