130 PRACTICE OF MEDICINE. 



and the division employed by Dr. Cheyne, is, 1st, the stage 

 of increased sensibility; 2d, that of diminished sensibility; and, 

 3d, that with palsy or convulsions. 



Symptoms : First stage. — After the existence of precursory 

 signs, tor a variable period, the child is attacked with head-ache, 

 confined to the forehead or temples; the pulse becomes quick 

 and hard ; the skin hot and dry ; and the bowels obstinately 

 constipated. The tongue is loaded or furred ; the stomach is 

 exceedingly irritable, vomiting being frequently produced on the 

 child changing its position ; and the urine is scanty and thick. 

 The temperature of the head is much increased ; the pupils are 

 contracted ; the brows are knit ; there is an inability to sit up, 

 and a whining or moaning noise when the child is lying down. 

 The sleep is short and disturbe(^ the patient rolls its head on 

 the pillow, or often wakens with a scream, or crying, and raises its 

 hands to its head. Sometimes the attack begins by convulsions. 



Second stage. — The sensibility is now remarkably impaired ; the 

 drowsiness increases in degree ; the pupils are dilated, and there is 

 strabismus, and imperfect or double vision ; the eyes are dull, heavy, 

 vacant, or staring; the eyelids drooping or half closed. The pulse, 

 from being frequent, now becomes slow, and sometimes even more 

 so than natural, when the patient is in the horizontal position ; but 

 if he attempts to sit up, it immediately acquires its former rapidity. 

 Slight convulsions show themselves in momentary attacks in 

 the eyes, mouth, or upper extremities, which are tremulous. The 

 hands either are raised to the head, or the child picks its nose 

 or mouth. The stupor is occasionally interrupted by loud and 

 shrill screams from the child ; and partial contractions of some of 

 the limbs begin to manifest themselves. 



Third stage. — The last stage now comes on ; the pulse is quick, 

 thready, and weak ; there are partial or general convulsions ; and 

 paralysis of one side or limb occurs. The pupils become more and 

 more dilated, the eyes suffused, and the cornea dull and filmy. The 

 patient is either comatose or delirious, rolls its head about on the 

 pillow, grinds his teeth, and moans or breathes heavily and quickly. 

 The skin becomes cold and covered with perspiration, or the sweat- 

 ing may be partial ; the respiration is irregular, or stertorous. The 

 excretions are passed involuntarily, and the patient generally dies 

 in a brief convulsive fit. 



Morbid appearances. — Inflammation of the pia matter, most 

 commonly observable at the base of the brain, around and in the 

 fissures of Sylvius. The cerebral substance is generally engorged, 

 and the central white parts of the brain are more or less softened. 

 The lateral ventricles frequently contain from four to six ounces of 

 fluid. The most common complication of hydrocephalus is, tubercle 

 of the nervous substance, which, amongst the poorer classes, occurs 



