ACUTE HYDROCEPHALUS. 245 



minute or even less. The respiration generally shows very peculiar 

 changes ; for a time the inspirations are very superficial, and it almost 

 looks as if the child forgot to breathe ; then there is a deep sighing in- 

 spiration with which it repairs the neglect, as it were. The coma 

 gradually becomes deeper ; the lucid intervals that at first interrupted 

 it grow more incomplete and shorter; the eyelids are either not 

 closed, and the eye stares into space, or else the upper lid droops, and 

 the eyeball is rolled .up, so that the pupil is half covered by the upper 

 lid. At the same time the color of the face often changes in a short 

 time, and such a child, with its blooming cheeks, widely-open eyes, 

 which have a peculiar dark and brilliant appearance from the dilata- 

 tion of the pupil, has, to an uninitiated person, the appearance of not 

 being very sick. During this stage there usually are attacks of con- 

 vulsions at intervals ; these are sometimes on one side of the body, 

 sometimes on both. We must not conclude, from the convulsions on 

 one side the body, that the opposite side of the brain is chiefly affected. 

 The tetanic contractions of the muscles on the back of the neck, and 

 I he backward curvature of the neck, usually continue in this stage. 



The stage of the disease last described occasionally continues a 

 week or more. In spite of the hopelessness of the patient's state, the 

 physician must continue his visits, and at each one he is asked anew 

 if there is no chance of averting the danger ; at last the parents are 

 utterly overcome, but even then the disease occasionally continues for 

 days, or a temporary appearance of improvement again excites deceit- 

 ful hopes. These are hard times for the physician, especially as he is 

 almost powerless against the slowly-advancing but inevitable result ; 

 and as, for days, he has but little to do except prepare the parents for 

 the child's death. We must note that death is not imminent till some 

 decided changes occur in the symptoms, to which it is well to call the 

 attention of the attendants. Almost always twelve to twenty-four 

 hours before death the pulse becomes very frequent, the skin is covered 

 with copious perspiration, the previously-sunken belly becomes puffed 

 up ; defecation and urination are involuntary, and we may hear exten- 

 sive moist and uneven rdles in the chest. 



Most cases of tuberculous basilar meningitis, and of miliary tuber- 

 culosis of the meninges in children, run their course in the above man- 

 ner and resemble each other very much. Slight differences result from 

 the predominance of certain symptoms, and from the different dura- 

 tions of certain stages or of the whole disease. But we must add that 

 in some cases the disease runs a much more rapid course, and is accom- 

 panied by symptoms so similar to those of acute meningitis, that it is 

 impossible to distinguish them. On the other hand, we must mention 

 that occasionally, on autopsy of patients who have died of consump 



