HYDROCEPHALUS. Under this term, which literally means water in the head, are included three distinct diseases—viz., acute hydrocephalus, chronic hydrocephalus, and spurious hydrocephalus, or, as Dr. Marshall Hall termed it, hydroeephaloid disease.
By acute hydrocephalus is signified inflammation of the brain as it usually occurs in scrofulous children. The name is not a good one, because it merely refers to a frequent effect of the disease, and not to its cause or essence; and because, further, a similar effect may result from other morbid conditions; it is. however, so universally adopted, that it would be inexpedient to change it. The disease is one of so dangerous a nature, that it is of the greatest importance to detect it in its earliest stage, and even to look out for indications of its approach. The premonitory symptoms (which, however, do not occur in all cases) consist chiefly in a morbid state of the nutritive functions. The appe tite is capricious, the tongue foul, the breath offensive, the belly enlarged, and sometimes tender, and the evacuations unnatural; and the child is heavy, languid, and dejected, and becomes either fretful and irritable, or drowsy and listless. Restless sleep attended by grinding of the teeth or moaning, a frequent sudden scream, clenching of the fists, and a turning in of the thumb towards the palm of the hand, are also important premonitory warnings.
After these symptoms have lasted for. some days, severe pain in the head comes on, it is generally of a sharp shooting character, recurring at intervals, and often during sleep, and causing the child to shriek in a very characteristic manner. ' Coma or morbid drowsiness now supervenes, and the shrieking is replaced by moaning. Vomiting is a frequent concomitant of this stage of the disease. In this first stage of hydrocephalus, which most commonly lasts two or three days, the pulse is rapid, and the symptoms gen erally are those of excitement. In the second stage, the pulse becomes irregular, vari able, and often slow. General heaviness and stupor come on. The light,which annoyed
the child in the first stage, is no longer a source of annoyance; the pupils become dilated, the power of sight becomes imperfect or lost, and squinting is almost always to be observed. The little patient now lies on his back in a drowsy condition; and at this period spasmodic twitchings, convulsions, or paralysis may come on. The excretions are passed unconsciously. This second stage may last a week or two, and is often attended by deceptive appearances of amendment, the child not 'infrequently regaining the use of its senses for a day or two, but then relapsing into a deeper stupor than before. The symptoms in the third or last stage, which may last only a few hours, or may extend, to a fortnight, are very similar to those in the second, except that the pulse again becomes very rapid, beating sometimes so quickly that it can scarcely be counted, and gradually gets more and more weak, till the patient expires. The characteristic appearances after death are softening of the central part of the brain, with the effusion of serous fluid, usually to the extent of several ounces, into the ventricles; and a tubercular deposit, in the shape of small granules, upon or between the membranes of the brain.
The only disorder with which acute hydrocephalus can easily be confounded is infantile remittent fever; but we have not space to notice the various points which enable us to discriminate between these two complaints. Acute hydrocephalus is essen tially a disease of childhood; it scarcely ever occurs after the twelfth year. Half the cases that occur are in children between three and six years of age.
As the treatment should he left entirely to the physician, it is unnecessary to notice it further than to state that strong antipldogistie remedies—such as cold to the head, leeching. and active purging—applied in the first stage of the disease, yield the most satisfactory results; yet under this treatment, three cases out of four are lost.