Sec. 17. This disease, which has of late so much attracted the attention
of the medical world, I believe, originates in inflammation; and that
the water found in the ventricles of the brain after death, is the
consequence, and not the cause of the illness.
It has seldom happened to me to be called upon in the earlier stages
of this complaint, and the symptoms are at first so similar to those
usually attendant upon dentition and worms, that it is very difficult
to pronounce decidedly upon the real nature of the disease; and it is
rather from the failure of the usual modes of relief, than from any
other more decided observation, that we at length dare to give it a
name.
At first, the febrile symptoms are sometimes so unsteady, that I have
known them mistaken for the symptoms of an intermittent, and the cure
attempted by the bark.
In the more advanced stages, the diagnostics obtrude themselves upon
our notice, and put the situation of the patient beyond a doubt. But
this does not always happen. The variations of the pulse, so
accurately described by the late Dr. Whytt, do not always ensue. The
dilatation of the pupils, the squinting, and the aversion to light, do
not universally exist. The screaming upon raising the head from the
pillow or the lap, and the flushing of the cheeks, I once considered
as affording indubitable marks of the disease; but in a child which I
sometime since attended with Dr. Ash, the pulse was uniformly about
85, (except during the first week, before we had the care of the
patient.) The child never shewed any aversion to the light; never had
dilated pupils, never squinted, never screamed when raised from the
lap or taken out of the bed, nor did we observe any remarkable
flushing of the cheeks; and the sleep was quiet, but sometimes
moaning.
Frequent vomiting existed from the first, but ceased for several days
towards the conclusion. One or two worms came away during the illness,
and it was all along difficult to purge the child. Three days before
death, the right side became slightly paralytic, and the pupil of that
eye somewhat dilated.
After death, about two ounces and a half of water were found in the
ventricles of the brain, and the vessels of the dura mater were turgid
with blood.
If I am right as to the nature of hydrocephalus, that it is at first
dependant upon inflammation, or congestion; and that the water in the
ventricles is a consequence, and not a cause of the disease; the
curative intentions ought to be extremely different in the first and
the last stages.
It happens very rarely that I am called to patients at the beginning,
but in two instances wherein I was called at first, the patients were
cured by repeated topical bleedings, vomits, and purges.
Some years ago I mentioned these opinions, and the success of the
practice resulting from them, to Dr. Quin, now physician at Dublin.
That gentleman had lately taken his degree, and had chosen
hydrocephalus for the subject of his thesis in the year 1779. In this
very ingenious essay, which he gave me the same morning, I was much
pleased to find that the author had not only held the same ideas
relative to the nature of the disease, but had also confirmed them by
dissections.
In the year 1781, another case in the first stage demanded my
attention. The reader is referred back to Case LXIX for the
particulars.
I have not yet been able to determine whether the Digitalis can or
cannot be used with advantage in the second stage of the
hydrocephalus. In Case XXXIII. the symptoms of death were at hand; in
Case LXIX. the practice, though successful, was too complicated, and
in Case CLI. the medicine was certainly stopped too soon.
When we consider what enormous quantities of mercury may be used in
this complaint, without affecting the salivary glands, it seems
probable that other parts may be equally insensible to the action of
their peculiar stimuli, and therefore that the Digitalis ought to be
given in much larger doses in this, than in other diseases.