190 DISEASES OF THE BRAIN. 



awakens fatigued, but otherwise free from threatening symptoms. In 

 a moderately extensive practice, there is occasion every year to see 

 cases of cerebral hyperaemia in children, which take the above-described 

 very regular course. Not unfrequently several children of the same 

 family will have these attacks at different times, or the same child may 

 have repeated attacks. It is rare for epilepsy to develop from them ; 

 but, as we shall hereafter show, repeated hyperaemias may induce 

 hydrocephalus. 



In a third form of cerebral hyperaemia the mental symptoms pre- 

 dominate to such a degree that the disease is often mistaken, and, to 

 the great injury of the patient, is sometimes considered as an attack 

 of melancholy ; at others, as mania. In the former case, after a few 

 days of headache, disturbance of sensibility, and sleeplessness, the 

 patients are seized with an undefined feeling of anxiety and disquiet. 

 They cannot stay long in one place, go about restlessly, are worried, 

 and are conscience-stricken about slight oversights. There is also 

 delirium, which has the same character as the above-described frame 

 of mind, and results from the attempts to explain it. At first the 

 patients struggle against this delirium, which they occasionally recog- 

 nize as such, and which they fear, as they think they are " out of their 

 minds ; " but they soon weary in this struggle, and give it up. In 

 such cases the sleeplessness is almost absolute; opiates, given by 

 ignorant physicians, have no effect, or, after the exhibition of this rem- 

 edy, which is injurious and dangerous to the patient, there is a short, 

 restless sleep, from which the patient awakes with all the symptoms 

 increased. In this form of cerebral hyperaemia, which develops chiefly 

 as a result of excessive mental labor, there is usually frequent pulse 

 and other symptoms of fever ; but in these very cases a greater amount 

 of blood in the face, etc., does not correspond to the greater amount 

 in the brain ; the patients are not high-colored, but are often even pale. 

 From the fever and sleeplessness they rapidly lose strength, emaciate, 

 and, if they do not fall into the right hands, they are in great danger 

 of dying from their disease. Finally, the excitement gives way to 

 apathy, the insomnia to deep sleep, from which the patient cannot be 

 aroused, and in which they die. Far more rarely, there is permanent 

 mental disease. 



In other persons, where the psychical disturbance is in excess, it ap- 

 pears in maniacal attacks, with corresponding delirium. This form is 

 especially seen after a long-continued excessive use of spirituous 

 liquors, in that class of topers who for a year will use very little liquor, 

 but when they have begun to drink do not know when to stop. This 

 cannot be easily mistaken for an attack of delirium tremens. The 

 patients are sleepless, run about, fight and bite if they are held, de- 



