chronic hydrocephalus is a perfectly distinct disease from acute hydrocephalus; while the latter is an inflammation, the former is a dropsy. In chronic hydrocephalus, a watery fluid collects within the skull, before the bones have united to form the solid brain-ease, and by pressure outwards causes the bones to separate, and increases the size of the head sometimes to an enormous extent: Thus Dr. David Moore relates the case of a girl six years old whose head measured 2 ft. 4 in. in circumference. While the skull is rapidly enlarging, the bones of the face grow no faster than usual, and the great disproportion of size between the head and the face is at once diagnostic of the disease. This disorder sometimes commences before birth, and almost always in early childhood, before the fontanelles and sutures of the skull have closed. In some rare eases, it has occurred later, as, for example, at seven or nine years old, and the closed sutures have opened under the augmenting- pressure. When the sutures will not yield, death from pressure on the'brain speedily ensues. Most children with chronic hydro cephalus either recover or die in infancy; but a few survive, bearing their complaint to adult life, or even tO old age. Blindness, d•nesS, palsy, add idiocy--one or more are commonly associated with this disease, but occasionally the intellect and senses are sufficiently perfect for the ordinary requirements of social life.
The treatment may be attempted by internal remedies or by surgical appliances. The medical treatment most worthy of trial consists in the administration of diuretics, purga tives, and especially mercury, which may be given in the form of calomel in minute doses, and applied as ointment externally. The surgical expedients arc bandaging and
puncturing the head. The former has in some cases effected a permanent cure; the latter has in many cases certainly prolonged life, although the disease has finally con quered. Neither of these means is applicable after the bones of the skull have united.
This disease occasionally occurs in adult or in advanced life, after enlargement of the head has become impossible. Stupor, paralysis, and an inability or unwillingness to speak, arc in these cases the most prominent symptoms. Dean Swift's death was due to this disease, and it is recorded that during the last three years of his life he remained in a state of silence, with few and slight exceptions.
Spurious hydrocephaloid disease of Dr. Marshall acute hydrocephalus in many of its symptoms, and has often been mistaken for it. Instead, however, of being an inflammatory disease, it is a disease of debility, and is due to a deficient supply of blood to the brain. The following are, according to Watson, the distinctive characters of this spurious hydrocephalus: the pale, cool cheek, the half shut, regardless eye; the insensible pupil; the interrupted, sighing respiration; and the state of the unclosed fontanelle. If the symptoms are those of acute hydrocephalus, the surface of the fontanelle will be convex and prominent; while if they arc due to spurious hydrocephalus, and originate in emptiness and want of support, the fontanelle will be concave and depressed. The remedies in this disease, which readily yields to treatment, are nourishing diet, small doses of wine or even of brandy in arrow-root, decoction of bark, ammonia, etc.