341 
PATHOLOGY, 
head after fuch attacks ; alarm on the gentleft touch; 
an exceffive quicknefs of hearing, fo as to be awakened 
terrified by the flighteft noife; diminiflied appetite; an 
entire abfence or excefs of thirji; aery denoting pain, on 
flight movements of the body, but fuddenly becoming 
filent by quick ones; conftant pulling the nape of the 
neck with the hand; increafed warmth of the head, par¬ 
ticularly of the forehead and nape of the neck ; are the 
chief guides for the diagnofis. 
A moil uncommon mode of approach is that, where 
the healthieft children are all at once feized with violent 
fever or convulfions, after a fudden attack of languor, 
•giddinefs, and head-ache, ftiff neck, inclination to vomit, 
full hard and flow pulfe, fenfibility to light, and iinging 
in the ears. If the practitioner is called to this mani- 
feftly inflammatory affection, and employs the neceffary 
remedies with activity, effufion may be arrefted much 
eafier than in the former cafes, and a greater number of 
fuch fufferers may be fnatched from death. But ifa clear 
view of the difeafe is not taken, and remedies are not 
applied with overwhelming power, there follows moft 
commonly in a few hours the moment of effufion, which 
may be recognized by its charafteriftie fymptoms, and is 
foon fucceeded by paralyfis and death. This firft ftage 
often lafts only for a few hours; the latter frequently 
eight, ten, fourteen, and even more, days. 
In the fecond ftage, the fymptoms of the phrenitic 
flare fhow themfelves: the patients complain of fevere 
pains in the forehead, affecting the eyes, fometimes alter¬ 
nating with colicky pains; alio pains in the limbs, and a 
fhooting fenfation in the nape of the neck. There is no 
place where they can lie ftill, and no perfon who can 
foothe them : the eye opens perfectly in the dark only, 
being very fenfible to light, and (hrinks above the upper 
eye-lid. The head is hot to the hand ; but neither it nor 
any other part of the furface of the body is red, nor 
turgid with blood. In the tumultuous acceffion of the 
inflammatory period there is, however, an exception 
in this point 5 for the tunica albuginea is ftreaked with 
blood-veffels, and the inner furface of the eye-lid is in¬ 
flamed. In fuch cafes only there are convulfive move¬ 
ments of the eyes; the pulfations of the carotids are 
ftrong; the pale countenance fhrinks, and rarely becomes 
cedematous and diftorted. 
Among the pathognomonic fymptoms of acute hydro¬ 
cephalus, Dr. Golis enumerates drynefs of the nofe, pale- 
nefs, ceffation of appetite and thirft ; furred tongue ; vo¬ 
miting, which becomes lefs frequent as patients advance 
to the ftate of effufion ; the digeftion of food is moft com¬ 
monly altogether fufpended ; the belly a!fo, before tumid, 
falls away. At this period, there is tendernefs on pref- 
fure on the region of the ftomach and liver; there is often 
obftinate conftipation ; the urine is frequently fcanty, 
paffed with pain, and has a charadieriftic white flimy de- 
pofit; the hearing now becomes acute, and even painful; 
pains in the belly, nape of the neck, and particularly the 
head, are conftantly complained of by moaning ; the deep 
is difturbed often by dreams, in which they cry out; they 
grind therr teeth alfo. Preffing queftions only obtain 
anfwers, and thofe are fhort5 their movements are languid 
and compulfatory; they cannot fit up without naufea 
and vomiting ; the pulfe is flow, unequal, and intermit¬ 
ting, .but eafily accelerated in a moment by pain : the 
latter fymptom is alfo confidered by Dr. Golis as pathog¬ 
nomonic of this ftage. The fkin becomes flaccid, dry, 
and difcoloured, and an eruption fometimes appears 
about the lips, neck, and flioulders. They are reftlefs, 
and defire to be moved from place to place. Thofe with 
a very flow pulfe, complain of as much pain as thofe with 
whom it is accelerated. 
In the third, or ftage of effufion, the above fymptoms, 
after a few hours or days, grow worfe. The patients can 
no longer fit up; the reftleffnefs ceafes; they moft com¬ 
monly lie on the back, and conftantly kick up the bed¬ 
clothes ; they carry their hands to their head, mouth, and 
noftrils, into which as well as into their ears, they often 
bore fo as to make them bleed; they half forget the 
words they would fay. All the external fenfes become 
dull or annihilated, except that of hearing, which is of¬ 
ten quick; the eyes are directed obliquely downwards; 
the pupils are dilated and ofcillating, but unaffedled by 
ftrong light; they often fee double, or falfely; and open 
and clofe their eyes repeatedly in a few minutes. A 
gloomy earneftnefs is painted in their flulhed countenance, 
with a threatening expreffion: it is a curious contraft of 
fiercenefs and patience, which often excites the aftonilh- 
ment of by-ftanders. They wafte to a fkeleton ; their 
dry flabby fkin hangs on their emaciated legs; partial 
fweats break out. The urine is paffed unconfcioufly; 
there is conftipation. The debility of the pulfe, fighing, 
offenfivenefs of the breath, and general weaknefs, in- 
creafe; coma comes on ; and, before the laft tragic feene, 
they fometimes become confcious, fo as to fit up to eat 
and drink. They fometimes even fwallow with eager- 
nefs, long for their play-things, and deceive the attend¬ 
ant with momentary hopes, which are followed by more 
fevere fuffe rings than before. 
When the patient furvives this ftate, from ten to thirty 
days after, more frightful fymptoms fucceed : convulfions, 
followed by paralyfis, moft commonly of the right fide, 
and often cramp, which draws the head backwards and 
downwards. The features are thus frightfully diftorted ; 
a violent fever follows; a perfpiration trickles from the 
head ; a hedlic rednefs alternates with a deadly palenefs on 
the disfigured countenance of the patient. The fight is 
loft ; the pupil of the convulfed eye extremely dilated, 
and infenfible to light, the tunica albuginea is blood-fliot, 
The hearing, from being quick, gradually becomes dull; 
fwallowing becomes impoffible, though there are often, 
moments in which they can take fluids 5 the urine is 
fcanty, and paffed unconfcioufly; it continues of a deep 
yellow colour, with a white fediment; the ftools are ftill 
lefs frequent, but never feetid, as in the former ftages. In 
many, the tips of the fingers become blood-red, and af¬ 
terwards, on the approach of death, pale. The pulfe is 
ftill weaker, and more intermitting than before; the 
head, however, remains warmer than the reft of the body ; 
the fpafms, which draw the head backwards, and the arms 
again ft the fides, ceafe only with life. For the above de¬ 
tail of fymptoms we are chiefly indebted to Dr. Gooch’s 
tranflation of the work of Dr. Golis on Acute Hydroce¬ 
phalus. 
Hydrocephalus is evidently inflammation of the mem¬ 
branes of the brain; and it is from the arachnoid mem¬ 
brane efpecially that the effufion is derived. The cere¬ 
bral inflammation which precedes this effufion is of courfe 
traceable in different inftances to different caufes. Among 
the children of this country, and of the large towns ei- 
pecially, it is very generally found, that irritation of the 
digeftive organs is the precurfor of Hydrops capitis ; 
while in other fituations the adlion of the fun’s rays is 
the moft common caufe of the difeafe. It is to be re¬ 
marked, however, that the adlion of the folar rays on the 
head generally induces thofe fudden and violent attacks 
in which ftupor or raving delirium precede the way to a 
fpeedy death 5 but that the more common precurlors of 
hydrocephalus caufe fymptoms of cerebral excitation to 
appear long before thofe of cerebral plethora. In the 
firft ftage, or that in which mere irritation is manifefted 
by liftleffnefs and exaltation of the mental emotions, the 
treatment confifts chiefly in improving the adlion of. the 
chylopoi'etic vifeera, which are fo generally impaired. 
The bowels may be freely opened, to a degree in fadt 
fufficient to excite counter-irritation ; the liver may be 
a died upon by dofes of calomel, and low diet ordered. 
When ftupor or much vifual deception is remarked, we 
may bleed in this ftage of the difeafe, becaufe thefe fymp¬ 
toms are figns of fulnefs of the veffels of the brain 5 but, 
