Abstract
For many centuries following Galen's views and dogma medical notions of migraine were stifled. Johann Jakob Wepfer (1620–1695) had set the stage for advancement of medical thought. He wrote a set of Observations (1669) that include basilar migraine localized to the brainstem; migraine in a child; classic visual aura; and trigeminal neuralgia.
The famous Swiss physician (1) of the eighteenth century, Samuel Auguste André David Tissot (2) devoted an 83-page chapter to migraine in his Traité des nerfs et de leurs maladies (3) (Treatise on the nerves and nervous disorders). Tissot of Lausanne followed Wepfer in providing a thorough clinical description of migraine. (There may be some confusion about his name. Morton's medical bibliography, citing ‘Avis au peuple sur sa sante’ (4) refers to Simon André Tissot but gives the exact dates of birth and death. Garrison's History of Neurology refers to him as S.A.A.D. Tissot.) He recognized that migraine (4) affected the nervous system, and reported hemianopia, hemiplegia and typical visual prodromata. An extensive account is found in his 1790 monograph (5). He noted that gastric symptoms might precede or initiate attacks, and that vomiting might herald the termination of the headache. Though a supporter of the gastric theory, Tissot observed (3): ‘…if the vomiting are violent the bole flows back from the duodenum; but this, is often a proof of the violence of the malady, and not its cause’. ‘…A focus of irritation is formed little by little in the stomach, and that when it has reached a certain point the irritation is sufficient to give rise to acute pains in all the ramifications of the supraorbital nerve’. He described clearly the periodicity and the pattern of migrainous attacks (3): ‘Migraine is distinguished by the severity of the pain, by a kind of periodical return, by the similarity of different attacks, by its recurrence independently of those accidental causes which determine other kinds of headache. We may say of every seizure that its onset is spontaneous and somewhat sudden, sometimes with a slight sense of chilliness, and then the paroxysm is often more violent; the pain, however, does not set in at first in its full severity, which it does not usually attain for an hour and a half, and then remains at the same intensity for some hours… After the headache vomiting frequently sets in, which is attended by relief; the pain diminishes, and the patient sometimes falls into a tranquil sleep for some hours, and awakes feeling quite well’.
He had also reported in Traité des Nerfs, the full gamut of visual, sensory and dysphasic phenomena during the aura, in a serving Austrian officer's history: ‘sight becomes disordered but more on one side than the other, like a person who has looked at the sun. This lasts about 10 minutes; afterwards an arm and a leg of the same side, one time one side and one another, go to sleep. I feel a tingling as if ants were on them; I have the same feeling in the mouth and tongue, and further, during this period, I have the greatest difficulty in speaking. This lasts about half an hour; afterwards the pain in the head commences, but only in the temples, where they persist with great severity during seven or eight hours. When I can be sick, I get relief’.
Willis had recognized the cerebral nature of the vomiting in De cephalalgia. Tissot had noticed trigger factors which could ‘excite’ or precipitate migraine attacks. Liveing acknowledged his contribution when he remarked on ‘The often slight intensity of the stimulus needed to evoke an attack. Other illustrations of the insignificance of the exciting causes: the medical man who told me that the smallest particle of burnt pastry, or a spoonful of wine, would occasion an attack of megrim…This disposition, which Tissot terms proëgumenal, deserves the greatest attention in connexion with preventive treatment, but is just as hard to explain as the periodicity of epilepsy. Van Swieten has expressed a very similar view…. “This diathesis” he says, “appears in fact inherent in the sensorium commune, where such a disposition of the parts is established that they are afterwards liable to irritation and disturbance by such occasional causes as before would have no such effect”.
Interestingly, these fine physicians of the 17th and 18th centuries—who included Heberden, Whytt, Cheyne, Sydenham and Willis—made no distinction between physical and mental symptoms. They recognized both, but regarded them as manifestations of disorders of the nervous system. The 19th century saw the introduction of the terms ‘organic’ and ‘functional’, the latter implying literally a disordered function or altered physiological reaction. The current misuse of ‘functional’ implies psychogenesis, thus creating much misunderstanding.
Tissot practised in Lausanne. He was one of the prominent and influential physicians of the Age of Enlightenment, an advocate of rational medicine as opposed to the prevailing widespread charlatanism. The small Duchy of Anhalt-Dessau was ahead of its times in its public health policies. The influence of Tissot on both Prince Leopold Friedrich Franz and his court physician, Samuel Friedrich Kretzschmar (1730–1793) was considerable. He was able to promote the early introduction of smallpox vaccination.
Samuel-Auguste Tissot (1728–1797). By courtesy of Medizinhistorisches Institut, Zurich, Switzerland.
He was perhaps most renowned for his popular book (6), a tract on medicine for the layman that ran through several editions and was translated into English. It provided an explanation and understanding of the principles of hygiene, diet, and prevention of disease for the public and gave advice on self-treatment for those who lived in remote areas. His best known scientific work was the ‘Traité de l’épilepsie' (1770), in which he described the symptoms and natural history of many types of epileptic seizures that created a foundation for future research.
Tissot was appointed Professor of Medicine at the Academy of Lausanne. He gave his inaugural lecture (7) on De Morbis Litteratorum on 9 April 1766 and published it 15 days later under the title Sermo inauguralis de valetudine litteratorum. Some of his biographers incorrectly claimed that this publication was dedicated to the King of Poland. In reality, this dedication starts with the inscription: ‘Inclytae Reipublicae Bernensis Consulibus …’ (to the excellencies and senators of the Republic of Berne).
The medical distinction he achieved was passed on; his relation, Clément Joseph Tissot (1750–1826) wrote the fist book on therapeutic exercise, Gymnastique médicinale et chirugicale, ou essai sur l'utilité du mouvement (8).