HYDROCEPHALUS CONGENITUS. 279 



bral functions at this age, partly to the yielding nature and gradual 

 distention of the skull. If an equal amount of transudation occurred 

 in the mature skull, the severest symptoms would arise. 



Even during the first years of life, the increasing size of the skull 

 and the growing difficulty that the child finds in holding its head up- 

 right are the most prominent and only characteristic symptoms. If 

 the head be not enlarged, or so slightly so as not to be noticed, the 

 disease is generally overlooked in the first year also. It is true the 

 mother wonders that, when the child is nine months old or over, it still 

 remains uncleanly, makes no attempts to walk, and does not even try 

 to speak ; she hardly asks the physician's advice, and, when she does 

 finally consult him, he also reassures her. But gradually the child 

 appears more strange. First of all, there is an idiotic manner with 

 outbursts of pleasure or fear, in which the child often shrieks out, dis- 

 torts the face into horrible grimaces, and drums with the extremities. 

 The first year passes, and the child continues to stick all toys, for 

 which other children of the same age seem to understand the use, into 

 its mouth, because it does not know what else to do with them. The 

 eye does not regard any object held in front of it, but rolls about un- 

 steadily. The face has no expression, but is empty and silly ; often 

 saliva flows constantly from the half-open mouth. And gradually 

 comes the sorrowful conclusion that the child does not develop intel- 

 lectually, or even loses ground. Many such children do not learn to 

 walk. If we attempt to teach them to walk, they often cross the legs 

 instead of setting them forward. Others, who do learn to walk, have 

 such an uncertain and helpless gait that they readily fall, and fre- 

 quently cannot step over any elevation. There are usually no anom- 

 alies in the organs of special sense. On more careful observation, 

 apparent deafness generally turns out to be deficient attention. It is 

 difficult to come to any decision regarding the senses of smell and 

 taste ; the sense of sight usually remains intact, though there is often 

 strabismus or dilatation of the pupil. 



In those cases where the head quickly becomes very large, the dis- 

 ease is recognized sooner and more easily, although in them the above 

 symptoms are usually less developed than where the head is mod- 

 erately or not at all enlarged. The little old face, which does not 

 agree with the large skull, and forms with it a triangle pointing toward 

 the chin, the distended veins traversing the skin, especially in the 

 frontal and parietal regions, the thin hair covering the broad skull, the 

 often rachitic bones or a general dwarfy appearance, the vain attempts 

 of the child to hold up the heavy head, which sinks again every time 

 it is raised, give the disease an appearance as melancholy as it is 

 characteristic. 



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