7G9 



HYDROCEPHALUS. 



HYDROCYAN-HARMALINE. 



770 



HYDROCE'PHALUS (from SSap, water, and KefaXh, head), water 

 in the head, is a name applied to two diseases nearly peculiar to 

 infancy and childhood, which are distinguished as the acute and the 

 chronic. These diseases differ entirely in their nature. Acute hydro- 

 cephalus is a disease rapid in its course and essentially inflammatory in 

 its nature, and of which the effusion of fluid in the head is but one, 

 and that not a constant effect or concomitant. To constitute chronic 

 hydrocephalus (an affection which may last many years), the only 

 essential condition is the accumulation of a watery fluid within the 

 skull, which may or may not be caused by or attended with inflamma- 

 tory action. 



1. Acute hydrocephalus is a most frequent and fatal disease of the 

 early stages of life. It occurs most commonly between the first and 

 the eighth year, and corresponds in. a great measure to the inflamma- 

 tion of the brain (phrenitis and arachnitis) of later years. 



The rapidity of the disease when once formed, and its frequently 

 fatal termination, render it a matter of the greatest importance to 

 detect its first or premonitory symptoms. But these, which it fre- 

 quently falls to the lot of the parents and friends only to observe, are 

 unfortunately seldom so marked as to be thought to demand medical 

 aid, and are indeed with great difficulty distinguished from the 

 symptoms of other affections of far less formidable nature. 



The child is perhaps liable to momentary giddiness while moving 

 quickly, is fretful and nervous, and its rest is disturbed ; it loses its 

 appetite, its bowels are costive, and the motions offensive. The eyes 

 become heavy and very sensible to light, the face is pale, and the fea- 

 tures devoid of animation. There is more and more indisposition to 

 motion ; the little patient complains of heaviness of the head, and loses 

 its strength ; its gait is unsteady. Of the above symptoms, those 

 referrible to the bowels are frequently most prominent : purgative 

 medicine is given, and sometimes relieves the symptoms for a time. 

 The child may remain in this state for several days or weeks without 

 anything more than heaviness or slight pain in the head being com- 

 plained of, and without any fever ; but when the symptoms persist 

 after purgative medicine has acted, they should be looked upon with 

 apprehension ; and if there be no known cause, such as the presence of 

 worms in the intestines or the eruption of a tooth, to account for them, 

 they should be closely attended to from the commencement* 



The symptoms more surely indicative of the disease are more in- 

 tense pain in the head, to which the child constantly carries its hand ; 

 intolerance of light, sound, and motion ; squinting ; heat of the head ; 

 knitting of the brows ; disturbed sleep, with grinding of the teeth, the 

 child frequently waking with a scream ; the pulse being at the same 

 time slow and irregular, and not quick as in fever from worms or 

 teething. The appetite is lost, the evacuations from the bowels are 

 unhealthy, and vomiting ensues. The abdomen, if previously dis- 

 tended, now falls in and becomes quite flat. Stupor, interrupted by 

 screams, follows. After these symptoms have continued for some 

 hours or days, there will sometimes be a temporary recovery of sense ; 

 the child will see, hear, and know its friends, and will take its food ; 

 but this promising state is soon interrupted by convulsions of the 

 whole body, or of one side, paralysis of one side, return of the squinting, 

 complete loss of sight and hearing, and inability to swallow; still 

 greater emaciation ensues, the breathing becomes irregular, the ex- 

 tremities cold, and death follows. 



This is the more usual course of the disease ; it then generally lasts 

 several days or even weeks. But it in some instances comes on sud- 

 denly, and proves fatal in a few hours. In other cases the symptoms 

 are less severe and more prolonged ; and chronic hydrocephalus gradu- 

 ally developes itself. 



The appearances which are found in the brain after death are con- 

 gestion of the blood-vessels, effusion of serum mixed with lymph in 

 very variable quantity between the membranes at the base of the brain 

 or in its cavities, and softening of the substance of the brain itself, 

 particularly of those parts of it .which form the floor of its cavities or 

 ventricles. Sometimes there is merely effusion of clear serum, some- 

 times no effusion, but merely softening of the cerebral substance. 



Cautes. Children of scrofulous diathesis, or of irritable tempera- 

 ment, and those of precocious intellect, with a large head, are most 

 subject to this disease. It may in fact be essentially regarded as a 

 disease of scrofulous origin. Scrofulous children should be as much as 

 possible guarded from agencies likely to excite increased flow of blood 

 to the brain, such as cold or external violence to the head, the influence 

 of the sun, the suppression of eruptions of the skin, and particularly 

 of the scalp, the use of narcotic remedies, as opium, too great excite- 

 ment of the mind, and the early exercise of the intellectual powers. 



The treatment must vary in the different stages of the disease, but 

 will generally consist in endeavouring to subdue inflammatory action, 

 in Amoving any causes which may, directly or indirectly by sympathy, 

 keep up irritation of the brain ; and lastly, in the latter stages, in 

 supporting the strength of the system. 



In order to subdue the disease in the inflammatory stage leeches 

 should be applied to the temples, and some have even recommended 

 the abstraction of blood from the jugular vein. Active purgatives 

 should be administered, and the circulation should be controlled. 

 Mercurials were formerly recommended, but the fact of the origin of 

 this disease in a scrofulous habit has led to a considerable modification 

 of this practice. When the active symptoms have been subdued, an 



iltTS ASD SCI. DFV. VOL. IV. 



alterative course, consisting of iodide of potassium with slight tonics 

 have been found most beneficial. 



Spurious hydrocephalus. There is a form of disease to which child- 

 ren are liable, and which has been called spurious hydrocephalus, which, 

 with symptoms closely resembling the above disease, comes on, never- 

 theless, in an opposite state of the system. It arises from depletion, 

 loss of blood, or active medicines. In these cases active remedies 

 speedily destroy the life of the child. Dr. Watson states that as these 

 cases are very difficult to distinguish from those of acute hydro- 

 cephalus, he is guided by the state of the unclosed fontanelle. If the 

 unclosed fontanelle be convex and prominent, he regards it as indicative 

 of the acute form of the disease ; but if it be depressed and concave, 

 he prescribes a better diet, ammonia, brandy, and arrow-root, instead 

 of depletants. 



2. Chrmtic hydrocephalus. The disease to which this name is applied 

 is correctly denominated water in the head, being always accompanied 

 with a considerable collection of watery fluid in the cavity of the head, 

 sometimes within the membranes of the brain only and exterior to the 

 organ itself, but more frequently in the ventricles or cavities of the 

 cerebral hemispheres, which are then distended to the form of a sac. 

 The quantity of fluid is sometimes so great as to cause an increased 

 size of the skull, amounting to great deformity ; the face, remaining of 

 its natural size, appears disproportionately small. The disease gene- 

 rally arises before or very soon after birth ; and the cranial bones not 

 being completely ossified at the time of its commencement, they 

 become separated to a distance from each other, and the sutures re- 

 main open for a long period. When the disease comes on after birth 

 its early progress is very insidious. 



fympttmu. The intellectual faculties are always deranged, and the 

 senses generally more or less disordered; there is usually impaired 

 vision or blindness, with squinting ; speech is imperfect ; the voluntary 

 power over the limbs is partially lost, giving rise to an unsteady gait, 

 as a frequent symptom. The digestive functions, respiration, and 

 circulation, are in most cases unaffected until near the termination of 

 the disease. The unfortunate patient is sometimes the subject of, 

 occasional epileptic fits. In the latter stages of the disease the loss of 

 intellect and of the power of motion increases, till at last complete 

 coma and paralysis ensue. 



The duration of the disease is extremely various. It may terminate 

 fatally even before birth, or the child may live for many months or 

 years. A man named Cardinal, the subject of water in the head, died 

 a few years since at Guy's Hospital, aged thirty-two years : and a 

 woman is mentioned by Gall and Spurzheim as having lived to the age 

 of fifty-four years, though after death four pints of fluid were found in 

 her head. > 



The amount of fluid accumulated in the brain or its membranes is 

 as various as the duration of the affection. It may not exceed half a 

 pint or a pint, or it may reach the quantity of several pints. In the 

 patient Cardinal, ten pints of fluid were contained in the head. Cases 

 are recorded in which as many quarts have been found. 



Causa. The children of scrofulous parents, and those of a rickety 

 diathesis, are most prone to chronic hydrocephalus. Any causes acting 

 on the mother so as to interfere with the proper nutrition of the fetus 

 may produce it. Sometimes several children of the same parent are 

 similarly affected from birth. Chronic hydrocephalus may be left as a 

 consequence of the acute disease. 



Treatment. In the majority of cases medical treatment is quite 

 useless, except in the early stage of the disease, and when it has come 

 on subsequently to birth. If there are symptoms of subacute inflam- 

 mation existing, the means calculated to subdue this are used with 

 benefit. The next great object to be effected is to remove the accu- 

 mulated fluid. This may be attempted by internal remedies supposed 

 to accelerate absorption, or it may be effected by puncturing the head. 

 The latter operation has been performed at different times by many 

 Burgeons, and in numerous instances with success. 



HYDROCHLORIC ACID. [CHLORIXK ; Hydrochloric acid.] 



HYDROCHRYSAMIDE. [CHRYSAMMIO ACID.] 



HYDROCYANALDIN (C^H^N.). A product of the action of 

 hydrocyanic and hydrochloric acids upon aldehyde-ammonia. When 

 these bodies are gently heated together they form alanin [ALANIN], but 

 without heat the reaction produces hyclrocyanaldin : 



3 ^'NB* J + SC.NII + 2HC1 = C, 8 H,,N 4 + 2NH 4 C1 + 6HO 

 Vldch <! Hydrocyanic Hj drocyanaldin. 



.minium. i. 



acid. 



Hydrocyanaldin is a neutral, insipid, and colourless crystalline sub- 

 stance. Heated with potash, it disengages ammonia, whilst the solution 

 becomes brown from the separation of resin of aldehyde. 



HYDROCYAN-HARMALINE (C^H^N^O.,, C 2 NH). An organic 

 base composed of harmaline and hydrocyanic acid. It is best obtained 

 by dissolving harmaline in a weak boiling solution of hydrocyanic acid, 

 and then filtering whilst hot. As the liquor cools, the base crystallises 

 out in thin rhomboidal tables, soluble in water and alcohol. It forms 

 very instable salts with acids, which readily decompose into salts of 

 harmaline and free hydrocyanic acid. 



When nitroharmalinc is treated in the same way, it yields another 



3 D 



