origin of this disease, and its predisposing causes, are obscure : it affords a remarkable instance of the exist ence of a peculiar train of symptoms, indicating an af fection of a part remote from that whence they might naturally be supposed to proceed, and of the sympathy between two parts, not related to each other by their local situation, or by any obvious action of their func tions. The disease, wilco it exists under its usual form, commences with fever, violent pain of the head, characterized by an acute darting sensation, which is generally felt in the temples or across the forehead ; great sensibility to light and noise, extreme agitation and restlessness, with the expression of sudden parox ysms of severe suffering ; along with these symptoms there is great derangement of the digestive organs, vomiting and obstinate constipation, with a peculiar morbid appearance of the evacuations. After these symptoms have continued, the state of excitement ap pears to be succeeded by one of oppression ; there is a considerable degree of coma and stupor, while the pulse becomes preternaturally slow, the pupils dilated, and the bowels still more torpid. The indications of severe suffering are exchanged fur those of insensibili ty, and at length a complete state of Paralysis super venes, and announces the near approaches of death. The acute disease is seldom, if ever, found after the age of puberty : it has been supposed, although, as we think, without sufficient foundation, to be connected with a tendency to Scrofula or Rickets; it is, however, hereditary, and therefore may be conceived to attach to some original peculiarity in the structure of the body. Its exciting causes are not well ascertained ; for although it may occasionally appear to follow an injury of the head, in most cases we are unable to trace it to any thing of the kind. With respect to its proxi mate cause, we apprehend it must be regarded as ori ginating in an inflammatory action of the capillaries of the brain, although probably of some specific kind, and that the effusion of the fluid is the consequence of the increased action of the vessels. In what consists the es sential difference between Hydrocephalus and Phreni tis is not well ascertained, whether upon a different set of vessels, or upon a different action of the same ves sels ; the diseases are, however, in all respects very different from each other, both with respect to their symptoms and their treatment. The connexion which we observe between the state of the alimentary canal and the head is difficult to explain ; and what increases the difficulty is, that symptoms which very nearly re semble those of Hydrocephalus not unfrequently exist, where it would appear that the head is not actually the seat of disease, and which are referred to the effect of worms. But every thing that respects the existence of worms, or the symptoms which they produce, is very obscure, and is so much involved in empiricism, that we are always at a loss to determine what de gree of credit is to be attached to the statements that are made on this subject. Upon the whole, we are disposed to consider the peculiar state of the as partly the cause and partly the effect of the condi tion of the brain, and, as far as regards the point of practice, whichever is actually the primary disease, the plan of treatment is not materially different.
The cure of Hydrocephalus is to be attempted by di minishing the over-excitement of the vessels of the brain, and by restoring the action of the alimentary canal. The first is to be attempted by blood-letting, which is generally local, and which must be perseveret1 in as far as the strength of the patient, or the other circumstances connected with the case, will admit, but which is seldom effectual, unless it be carried to an ex tent which would not be justified under less urgent circumstances. Purgatives are to be also administered with steadiness and perseverance, until the evacuations assume a more natural aspect, and it is generally agreed, that they are more effectual when calomel en ters into their composition. Along with these, which are our principal means of relief, we apply blisters to the head and neck, with external cold, and likewise give such remedies as may be indicated by the general state of fever, or by any other peculiarly urgent symp toms. These remedies are to be used in the first stage of the complaint : should this be passed by, and the symptoms of effusion manifest themselves, we believe that every means will be unavailing, but still it is our duty to attempt what offers the most probable chance of relief, and among the remedies which have been re commended at this period is mercury, given so as to produce its specific effect upon the system. How far
we are still to use blood-letting is a question which must be decided by the symptoms of each individual case, but the assiduous use of purgatives will still be proper; we must, however, be careful, lest, in our eagerness to administer medicines, we aggravate the sufferings of the patient, and, by an ill-directed solici tude, disturb the short remaining period of his exist ence.
Besides the disease which we have now been de scribing, which is altogether of a very acute kind, there is a chronic Hydrocephalus, where the disease comes on so slowly as scarcely to produce any general affec tion of the system. The bones of the skull in these cases gradually give way to the pressure of the fluid effused in the interior parts of the brain, and the head becomes enlarged to a degree which would have been supposed incompatible with the exercise of any of the functions, or indeed with the actual continuance of life. This complaint is irremediable, or, if any relief can be obtained, it must be by hazarding an operation which promises so little advantage, that nothing but the mise rable state of existence in which the patient is reduced by the disease could sanction the experiment.' After the two first orders of the Neuroses, including the diseases that arc characterized respectively by an increase, and by a diminution of the nervous power, we come to the third order, where it is exercised in an ir regular manner ; to these we give thc name of Spasmi. We derive the genera of the Spasmi from the relation which the part affected bears to the exercise of volition, into diseases of the voluntary muscles, the involuntary muscles, and those which possess a middle rank be tween the two. One of the most important of thc spe cies belonging to the first genus is Epilepsy. This disease may be shortly defined a sudden accession of violent convulsions of the whole body, with a loss of sensation and voluntary motion. Each attack continues for comparatively a short period only, when the patient recovers his usual state of body and mind, and experi ences a degree of stupor and drowsiness, but without any recollection of what has passed. Although, how ever, the effect of a single fit is not productive of any visible change upon the animal economy, yet, when the disease recurs frequently, and the attacks are violent, the functions that depend upon the nervous system gra dually become weakened, and ultimately much deranged, so as to bring on imbecility of the mental faculties, and an imperfect power over the voluntary muscles. It has been usual to divide Epilepsy into idiopathic and sym pathetic; the latter being supposed to depend upon some obvious exciting cause ; but we do not apprehend that there is any real foundation for this division; it in fact amounts to no more than that in some cases we are able to detect the exciting cause, while in others we are ignorant of it. The exciting causes appear to be very various, originating from a great number of different circumstances, that bear different relations to each other, and all produce neatly the same symptoms. Those that generally fall under our observations arc, 1st, Injury and malconformation of the skull, or the parts included in it ; 2d, Certain states of the alimentary canal, parti cularly worms, or that morbid condition of their con tents which is supposed to be favourable to thc produc tion of these parasitical animals; 3d, The peculiar irri tation caused by teething ; Violent mental emotions, especially surprise and terror; 5th, Repeated intoxica tion ; and, lastly, an hereditary tendency in the consti tution, which we are not able to describe or define, although we can have little doubt of its existence. The invasion of Epilepsy is sometimes so sudden, that the patient has not the least warning of its approach, but falls down at once in a state of complete insensibility ; at other times there is a feeling of oppression in the head, with vertigo, dimness of sight, and confusion of thought, and occasionally there is a peculiar sensation of cold, which has been named the aura epileptica, passing up from some part of the body to the head, when the complete paroxysm comes on.