280 DISEASES OF THE BRAIN. 



Apart from the intercurrent attacks of convulsions, which are quite 

 frequent, the course of the disease is sometimes regular and steady, so 

 that the symptoms increase gradually till death results from general 

 paralysis, or it is irregular, so that the symptoms are worse at times, 

 while at other times there is a temporary stand-still or even improve- 

 ment. Lastly, it is not rare for the disease, after attaining a certain 

 point, to remain permanent, or even for part of the existing disturbances 

 to disappear. This disappearance probably never goes on to recovery ; 

 some intellectual weakness always remains, though it may be only a 

 slight amount. 



The most frequent termination of the disease is death ; this often 

 occurs during the first years of life, partly from the disease itself with 

 convulsions and consequent coma, partly from complications. 



The increasing encroachment on the cranial cavity shows its effects 

 earlier in the mature skull than in the opposite case, and the life of 

 the child is in greater danger when the skull remains of the normal 

 size than when it is considerably dilated. In rare cases death results 

 from rupture of the distended ventricle and soft parts covering it, 

 either spontaneously or from a fall or blow. Few patients live beyond 

 puberty, and it is very rare for them to attain mature age. 



TREATMENT. In congenital hydrocephalus nothing can be accom- 

 plished by absorbent remedies, diuretics, drastics, preparations of 

 iodine, calomel, or mercurial salve. Compression of the distended 

 skull by strips of adhesive plaster is not free from danger, and in cases 

 hitherto observed has proved of little use. Nor are the results of 

 evacuating the serum by operation very encouraging. Most patients 

 died soon after the first puncture or after its repetition, so that the 

 operation should be limited to those cases where the head has attained 

 a colossal size, and where a steady progress of the enlargement is 

 observed. In the treatment of congenital hydrocephalus as in the 

 acquired form, the treatment is mostly symptomatic, and the patients 

 are to be protected as much as possible from all injurious influences. 



CHAPTER XVI. 



HYPERTROPHY OF THE BRAIN. 



ETIOLOGY. Since, in so-called hypertrophy of the brain, there is 

 jot an increase of the true tissue-elements of the brain, the nerve-fil- 

 aments, and ganglion-cells, but only a proliferation of the delicate 

 insterstitial substance which unites the nerve-elements, the name 

 hypertrophy of the brain is not exactly correct. It is sufficient, how- 

 ever, to have noticed this point, and we may preserve the old name 



