mentioned, characteristic of the acute species. 
I This lirst kind of hydrocephalus is succinctly 
j described by Dr. ileberden, in the following 
words: “ Capitis dolores, manus ad caput 
crebro admotae, claniores subiti, distensio 
nervorum, stupor, mentis perturbatio, motus 
venarum lentus, postremo ciecitas.” He 
adds, “ Justam hujus morbi suspicionem in- 
jiejunt hsc symptomata etiamsi capitis moles 
non fuerit aucta.” 
Chronic external . — The head of an infant 
at, or soon after, the period of birth exhibits 
a preternatural size and form ; the regular 
process of ossification does not take place; 
but the principal part of the external surface 
of the cranium continues soft and yielding, 
while not unfrequently, in the progress of the 
complaint, an undulation of a fluid may be 
perceived by applying the hand to the su- 
tures of the skull. As the disease continues 
to advance, the signs' of its existence be- 
come shortly obvious to the most superficial 
observation ; not only does the head increase 
to an enormous size, but the growth of other 
parts is in a proportionate ratio defective ; 
the limbs do not often acquire a much greater 
bulk than at birth ; at the ordinary period of 
teething no teeth present themselves ; the 
percipient faculty is not gradually unfolded, 
as in other infants ; and, indeed, although vi- 
tauty is preserved, it appears to be a vitality 
almost entirely unconnected with feeling. In 
this state of torpid existence life however is, 
in some instances, prolonged for four, six, or 
even a greater number of years. . In the 
Commentaries of Van Svvieten, we have the 
relation of life being maintained under this 
malady for thirty years: this, however, is an 
anomaly ; and indeed the hydrocephalic pa- 
tient seldom survives the second year. 
Acute hydrocephalus . — The acute, pliro- 
nitic, inflammatory, or, as it has been termed 
by some writers, apoplectic hydrocephalus, 
is not, like the other species, entirely confined 
to any constitution. Although most frequent 
in children under twelve years, it is sometimes 
observed in adults. It has been divided by 
Dr. VVhytt, and others who have followed 
him, into three distinct stages : the first of 
which is invariably characterised by a pulse 
of much celerity and comparative strenglh ; 
in the second the pulsations become slower, 
and more feeble; in the third and last period 
their rapidity is increased even beyond that 
of the primary stage; but this increased ac- 
tion is now connected with extreme debilitv. 
These different changes in the circulation are 
not, however, always to be traced even in the 
acute species of hydrocephalus, in that or- 
der which the observations of Dr. "VVhytt 
would lead us to suppose. 
Obscure affections of the stomach, a ge- 
neral feeling of lassitude, with sometimes a 
kind of palsy of the limbs, or an affection of 
them, in some measure similar to that ob- 
served in St. Vitus’s dance, if the child 
lias previously been able to walk, some- 
times present themselves as precursors of the 
first, or the inflammatory stage; at other 
times the feverish state, intolerance of light, 
violent pains in the head, and vomiting, are 
. the first signs of disorder that are noticed, 
f These symptoms are in some cases connect- 
led, according to the observations of Dr. 
Kush, with an impatience of sound ; the pain 
of the head is often confined to one side. 
Voj.. II. ’ 
Infancy. 
and in proportion to its intensity the nausea 
and vomiting become less urgent, while with 
the remission of the pain these affections of 
the stomach are disposed to recur. Respira- 
tion at this time is spasmodic and irregular ; 
the bowels are generally so costive as to re- 
quire very drastic purgatives, in order to pro- 
duce evacuations. This stage of the com- 
plaint continues sometimes for several days, 
but is more usually in a shelter period suc- 
ceeded by the second, which commences by 
a sudden reduction of the pulse, and other 
symptoms of irritation. The pain of the 
head now becomes less urgent, torpor suc- 
ceeds to watchfulness, the infant lilts his 
hands to his head, and frequently utters 
piercing screams (claniores subiti) ; a degree 
of strabismus takes place of the previously 
morbid susceptibility of light ; the little pa- 
tient lies in an horizontal posture, with the 
head low, and shows an indisposition to be 
taken up ; the bowels still continue torpid ; 
the urine not unfrequently deposits a thick 
sediment ; and after these symptoms have 
lasted from seven to fourteen days, tiie com- 
plaint sometimes appears suddenly to de- 
cline. This semblance of returning health 
is, however, deceitful, and is hut a prelude to 
the final period of the complaint: it is now 
that the pulse increases in frequency, and 
oftentimes so quick as not to be counted. 
Dr. VVhytt informs us that in some children 
he has been able to number 210 pulsations 
in the space of a minute ; this extraordinary 
rapidity, however, does not last through the 
whole ef the day ; it comes on and declines 
with the accessions and remissions of the 
hectic flush in the cheek. The eyes at 
length become insensible to the strongest 
light, convulsions come on, and life is ter- 
minated. The duration of tills last period, 
like that of the others, is irregular. Some- 
times the patient is carried off in less than a 
week from its commencement; at other times 
the child lingers in a hectic state for three, 
four, or six weeks ; and Dr. Monro has in- 
formed us, that the last stage has been known 
to be protracted even to the fourth month. 
Causes. — The two first species of the com- 
plaint arc decidedly of ascrophulous nature. 
They generally come on without any evident J 
exciting cause, and, like other asthenic affec- : 
tions, in the early periods of life, originate' 
from lymphatic debility," without previous 
excitement in the vessels of the brain to pro- 
duce the effusion : the last species is perhaps j 
always preceded by an inflammation in the) 
internal vessels of the brain. The immediate 
cause of this irritation is not, however, in 
every instance to be detected ; it may arise 
in subjects predisposed, in common with all 
other inflammations, from the sudden alterna- 
tions of cold and heat. It has been observed 
to supervene upon the contagious eruptive I 
affections, especially when these have been 
unusually violent ; and Dr. Beddoes, in a 
letter to Dr. Darwin, enquires “ whether it 
may not happen more frequently than lias 
been suspected from external injury ?” Zoo- 
nomia. 
Treatment. — Evacuations of every kind, 
viz. cathartics, sudorilics, emetics, general 
and local blood-letting, as well as the exter- 
nal application of cold, and of blisters to the 
scalp, with due attention to the erect position 
of the head, had all, in conjunction or sepa- 
rately, been tried in the acute species of by- 
C. 
17 
drocephalus, but, according to the general 
report of physicians, without effect. 
In consequence, therefore, of the ill suc- 
I cess that had attended the common routine 
of treatment in hydrocephalus. Dr. Dobson, 
of Liverpool, was induced to make trial of 
mercurials, with an intention of exciting the 
absorbents of the brain, and in this manner 
removing the extravasated fluid. The event 
appeared to justify his theory; and we have 
several cases recorded by this physician and 
by others, in which mercury, carried to the 
extent of salivation, accomplished a speedy and 
effectual cure. The following case is from 
Dr. Percival: “One of my own children, 
a girl, aged three years and three months, 
has lately been a severe sufferer under this 
alarming malady. As soon as the charac- 
teristic symptoms of the disease clearly mani- 
fested themselves, I laid aside all other re- 
medies, convinced by repealed observation 
of their insufficiency, and trusted solely, 
though with much solicitude, to the internal 
and external use of mercury. In forty-eight 
hours, signs of amendment appeared, and 
her recovery was perfected in six days. 
During this space of time, thirteen grains of 
calomel were administered, and seven 
scruples of unguentum mercuriale fortius 
carefully rubbed into the legs.” 
With the same design of exciting the ab- 
sorbents, digitalis has recently been employ- 
ed. “ In one child,” says Dr. Darwin, “ I 
tried the foxglove in tincture, but it was 
given witii too timid a hand and too late in 
the disease to determine its effects.” In the 
work of Dr. Reid, to which we referred in a 
former part of this article, we meet with the 
following observations: “ The universality of 
lymphatic absorbents is rather conceived than 
actually demonstrated. Dissection has hi- 
therto not been able to detect these vessels 
in the brain; analogy, however, favours the 
supposition of their existence. If that fre- 
quent and too fatal disease of young persons, 
water in the brain, admits of cure, the reme- 
dies which effect it, must necessarily operate 
by producing an absorption of the effused 
fluid. The author imagines he has witnessed 
the. cure of hydrocephalus by means of fox- 
glove. The symptoms, however, of worms 
and other infantile afl'ections, so otten resem- 
ble those indicative of water in the ventricles 
of the brain, that it is scarcely possible to de- 
cide with absolute certainty on the interesting 
question of the inevitable fatality or reme- 
diable nature of hydrocephalus.” 
Il foxglove should lie proved by future expe- 
rience to succeed as a remedy for this alarmin g 
malady, its modus operandi must be referred 
to the extraordinary faculty which it pos- 
sesses of repressing the arterial, while it sti- 
mulates the absorbent system. Both in the 
acute and chronic hydrocephalus, it appears 
to be deserving of a more extensive trial*. 
To the earlier.stages of the former we should, 
a priori, be disposed to conceive it more 
applicable than even mercury. 
Sect. Ill .—TCorms. (Vermes.) 
The marks by which the presence of worm*? 
is indicated are confessedly at times, both in 
the infant and adult, obscure and equivocal. 
In the majority of cases, however, the pheno- 
mena which they present require only for 
their detection a careful and discerning scru- 
tiny. 
