In injuries of the brain, there occasionally exist some remarkable peculiarities in the symptoms, ' those in the pulse are related in Latta's Surgery and Hennen's Military Surgery; those of the mem ory in the latter work, and in Larrey's Memoirs of Military Surgery and Sir A. Cooper's Lectures; those of the stomach and liver, by Bertrandi, in Me moirs of the French .Rcademy of Surgery, vol. iii. in Pouteau's Works, Desault's Works, J. Bell's Prin ciples of Surgery, Richerand's Nosographie China gicale, Ilennen's Military Surgery, and Rose's Ob servations upon Depositions of Pus and Lymph; but it is doubtful if these visceral sequences are not the result of confinement.—See Edinburgh .annztal Reg ister for 1822.
Acute inflammation of the brain generally soon ends fatally, either by general effusion between the arachnoid membrane and pia mater, and also into the ventricles; or by effusion of coagulable lympth; or by suppuration of the arachnoides and pia mater. Gangrene and blood are said by Bursarius, Rive rius, J. Bell and others, to be also terminations. The first of these constitutes acute hydrocephalus, which prevails both in the child and in the adult, and originates from many causes; and when it is evident that effusion has taken place, there is no hopes of relief hut by an operation, however faint that hope may be; for no medicine as yet discov ered can remove the effused fluid. The operation must be performed early if at all, and ought to be re peated on any appearance of re-accumulation of the fluid. In all cases where the symptoms have crept on gradually and insidiously, the water is found ef fused solely in the ventricles; while, where the symptoms have been rapid, the effusion has taken place, both within the cavities and on the surface of the brain; because in the latter it produces com pression more suddenly, for it is only when the whole brain is acted on by the general pressure of' the fluid, that its functions are paralyzed or de stroyed. Chronic hydrocephalus, from being gen erally congenital, and from the cavity in which the fluid is contained being invested with an epithe lium, resembling coagulable lymph, there is less chance of success. In infancy the operation is per formed with a small troear and canula, which is carefully plunged into one of the lateral ventricles, at one of the lateral corners of the anterior fonta nelle. After the closure of this fontanelle, espe cially when the bone has become ossified, a small trephine is required to remove a circular portion of the bone, before having recourse to the trocar and canula. In those cases however, where the fluid is effused between the arachnoid membrane and pia mater, and at the same time into the ventricles, the mere puncturing of the arachnoid membrane with a lancet will evacuate the fluid, in consequence of the free communication inferior or basilad to the ve lum interpositum Halleri. For an account of hydro
cephalus, the reader is referred to the article NIEni ci NE, to Edin. Med. and Surg. Journal, vols. xv. and xvi; and Medico-Chirur. Review, vol. vii. No. 21.
Chronic Hydrocephalus occurs also between the dura mater and arachnoid membrane, as lately proved by the dissection of a patient in Guy's Hospital. The fluid sometimes appears through a foramen of the cranium from a deficiency in the bone, and forms a tumour, whose sac consists of the dura mater and integuments. This has been termed spina bifida; although spina bifida or hydro-rachitis literally applies to a disease of the spine, and consists of a malformation of the os seous canal, the spinal cord and its membranes; the bone being deficient in few or more of its spinous processes and arches, the membranes with the integuments forming a pouch, which contains either the cord itself or the nerves, together with serous effusion. The fluid only occasionally com municates with the ventricles of the brain, and is precisely analogous to congenital hydrocephalus. Children seldom live for many years under this affection, but there is on record a person who survived until twenty years of age. This disease generally occurs in the lumbar or sacral region, but has been observed also in the dorsal and cer vical, and in one instance the spinous processes were deficient the whole length of the column. Sometimes there is a double cyst. In consequence of the effused fluid pressing upon the nerves, there is involuntary passage of the feces and urine, and this is instantaneously produced, together with occasional convulsions, b) external pressure on the tumour; and in the worst cases paralysis of the lower extremities is present. The treatment is by puncturing the tumour with a fine needle, previously drawing upwards the skin that it may act as a valve; and whenever the water collects, removing the fluid, but never the whole quantity at once, as it is liable by producing a collapse to prove fatal. Between the intervals gentle pres sure should be applied. Caustic and ligature have proved fatal. Apoplexy has been already treated of under MEDICINE, Vol. XIII. 1). 11. The reader is also referred to Abernethy's Surgical Works, to J. Bell's Principles of Surgery, and to Dr. Arm strong's Lectures, for further information on this in teresting disease. Paralysis or palsy has been also described under MEDICINE.