The prominent symptom, and the first usually noticed in this disease,, is an enlargement of the head. As the face is in general not enlarged beyond the size of health, the additional size of the forehead and sides of the head becomes still more conspicuous. In some cases the face undergoes a corresponding change, and the whole head appears gigantic. The size which the head is capable of attaining in this complaint is enormous. Thus, Willan speaks of a child two years old, whose head measured twenty-nine inches in circumference; and another of fourteen months measured nearly twenty-three inches. In general, however, the size is much less.

The child walks, if it has begun to walk, with a somewhat tottering or uncertain gait, and not unfrequently falls. He either holds his head stiffly and watchfully erect, so as to prevent its falling on either side, or supports it with his hand, or upon some object in his vicinity. In bed, he usually lies upon his back. The limbs are frequently affected with tremors. There is occasionally pain in the head or limbs, which appears to be paroxysmal, and, when violent, causes the child to scream. The expression of the face is usually sad, sombre, or stupid. The acuteness of the senses is diminished. Dimness of vision occurs, which in some instances increases to blindness, while in others the patient can see to the last. The skin becomes more or less insensible; and the smell and taste are sometimes affected. Hearing is usually the last of the senses to fail. The intellect is seldom much deranged in the earlier stages; though the memory is evidently enfeebled, and not unfrequently a certain dulness of mind is evident. The appetite is sometimes keen, and, unless some other disease complicates the case, the child may even increase in flesh. But more frequently he becomes emaciated, although he may take more than the usual quantity of food. The bowels are generally costive, and the urine scanty. A disposition to copious secretion of tears and saliva have been noticed. At length the symptoms become more violent, and occasional vomiting, contractions of the limbs, muscular rigidity, squinting, grinding of the teeth, epileptic convulsions, partial palsy, and mental imbecility, with a disposition to drowsiness or stupor come on. These symptoms are soon followed by complete loss of consciousness, involuntary discharges from the bladder and bowels, a small feeble, irregular, and frequent pulse, hard breathing, and death soon follows.

The duration of the disease is uncertain. Most of those attacked die in infancy. Some few live on for some years, and occasionally one to adult age.

The quantity of liquid found in the head after death varies much; it may be a few ounces or it may be pounds. Dr. Bright mentions a case in which seven or eight pints were taken from the head of a man who had had the disease from infancy, and who died when near thirty. Water on the brain is a very dangerous complaint, and although sometimes cured, the chances are very much against the patient.

Treatment

This is one of those cases where the services of a competent professional man should be called in,if possible. Where that cannot de done, care should, in the first place, be directed to the general health of the child; its diet should be light and nourishing, with pure air and warm bathing once at least a day. The head should be kept covered with a woollen cap; the bowels should be kept regular with mild cathartics; and small doses of sweet Spirits of Nitre and Acetate of Potash may be given. Cod liver oil is also said to have been of service. Benefit is said to have been derived from putting the patient under the influence of mercury; but this should never be risked by the parents themselves. The operation of tapping has been often performed with more or less success. In some cases temporary relief had been obtained, in others the operation has appeared to aggravate the symptons and hasten death, and in others again, though comparatively few, a complete cure has been effected. But the risk is so great that the operation should never be attempted till all other measures have failed.