132 PRACTICE OF MEDICINE. 



an enormous size. The accumulation of fluid within the skull not 

 only distends the bony cavity and impedes its ossification, but sepa- 

 rates the bones from each other, leaving spaces at the fontanelles, 

 and in divers other places, which are now merely protected by mem- 

 branous expansions. The cerebral substance is also more or less 

 injured. In some cases, a great portion of the nervous matter seems 

 to have disappeared ; while in others it is spread out in thin layers, 

 which embrace the fluid, as it were, in a sac. The gradual aug- 

 mentation of the head is the chief sign of chronic hydrocephalus ; 

 in addition to this symptom, we find that the infant gradually loses 

 flesh, and becomes dull ; manifests signs of suffering in the head; 

 sympathetic vomiting is also frequently observed ; and the intellec- 

 tual faculties and senses gradually become more obtuse. The child 

 is unable to carry the head erect, and the muscles of the face be- 

 come the seat of convulsive movements. As the disease progresses, 

 the well-known symptoms of compression manifest themselves more 

 and more, and the patient dies either in a state of idiotcy or in con- 

 vulsions. 



Treatment. — There are only two modes of treatment worth men- 

 tioning, viz., gradual compression of the head, and puncture. The 

 former method, which was well known to the physicians of the 

 seventeenth and eighteenth centuries, has been recently revived by 

 Sir Gilbert Blane ; while the happy results of puncture, through the 

 anterior fontanelle, in the hands of Dr. Conquest, sufficiently justify 

 us in having recourse to this operation as a probable means of cure. 

 Compression should be well kept up after the operations. 



ENCEPHALITIS. 



{Inflammation of the Brain.) 



Causes. — Long exposure to a vertical sun, anxiety of mind, the 

 inordinate use of ardent spirits, cold, fright, external injury, the 

 sudden disappearance of an old discharge, &c., may produce this 

 disease ; it sometimes occurs as consequent on small-pox, or erysi- 

 pelas of^ the face and scalp, and fevers, especially those of typhoid 

 character, &c. 



Symptoms. — Violent inflammatory fever, hot and dry skin, 

 flushed countenance, suffused eyes, quick and hard pulse, throbbing 

 of the carotids, and delirium. The senses are morbidly acute, there 

 being intolerance of light and sound. The person is extremely rest- 

 less ; there is jactitation of the limbs, and rigidity of the muscles ; 

 the head is remarkably hot, the pupils contracted, and the excretions 

 and secretions are suppressed. Occasionally, the muscles of the 

 face are spasmodically affected, the upper eyelid hangs down, and 

 the commissures of the lips seem to be drawn to one side. The 

 tongue is white, loaded, red at its edges, and the papillcE elevated ; 



