If the physician should be in doubt respecting the propriety of exhibiting Aconite, he will have to resort to Belladonna, which is the next most suitable remedy after Aconite.

If Belladonna should prove useless, I give Zincum, second or third trituration, every two hours. In every case where Zincum was administered, the disease yielded in from 12 to 24 hours, except some languor, for which I continue the Zincum until every vestige of the disease has disappeared.

Beside those remedies, Hyoscyamus and Stramonium may prove useful in some cases. The former is indicated by a bright-red face, throbbing of the carotids, glistening, staring eyes, wild looks, convulsive motions of the eyes, unquenchable thirst, etc.; the latter is indicated by similar symptoms attended with wild delirium and violent congestion of the head.

If this stage should have been occasioned by eruptions, scarlatina, whooping-cough, etc., the treatment is the same, as those causes do not affect the character of the disease, and cannot be removed. If abdominal difficulties, derangement of the digestive functions, dentition, scrofula, etc., should be present, the treatment has to be combatted accordingly. Pulsatilla, Bryonia, Calcarea, Chamomilla, etc., will frequently prove of service.

§ 267. The second stage, the stage of exudation, effusion of serous and lymphatic fluid, sets in in consequence of bad treatment in the former stage, or in individuals endowed with excessive sensibility and feeble constitutions, persons who have been suffering from their infancy, and are deficient in reactive power.

This stage is characterized by a sort of insensibility, which is probably owing to the pressure on the brain. The child which was restless in the former stage, now becomes dull and stupid; the child lies quiet, is unable to be on his feet, or to keep his head erect. The eye, which was extremely sensitive to the light in the former stage, becomes insensible; the pupil dilates; the visual power is feeble; diplopia takes place; optical illusions set in; the child stares, and frequently squints. The pulse becomes slower, feebler, but remains irregular. The urine is frequently passed involuntarily, and without the patient being conscious of it; the bowels are closed. The patients sink into a state of sopor, with their eyes half open; they moan and groan on awakening, or grasp at their heads and stomachs. On raising the patient, we observe in him anguish, restlessness, a spasmodic cough, and still more frequently, vomiting, are apt to set in; the grasping at the head continues, but there are situations where the head feels relieved. All these symptoms, which denote a diminution of cerebral reaction, generally increase towards the end of this stage. In this stage the children take some nourishment, particularly in a recumbent posture. If the disease should not be arrested in this stage, it passes into the third stage in three or four days.

§ 268. Goelis proposes to exhibit Digitalis in the second stage. This does not seem to be irrational treatment, though, in our judgment, Arnica is a more powerful agent in the second stage than Digitalis. If Arnica be the most powerful remedy to absorb the extravasated fluid consequent upon contusions, swellings, and mechanical injuries, why should it not likewise prove a powerful agent in absorbing extravasated fluids occasioned by internal causes? We know now, from experience, that repeated doses of Arnica, as well as Digitalis, are eminently useful in the second stage of hydrocephalus.

Beside these remedies, the following may likewise prove useful: Belladonna, provided it has not been-employed without effect in any of the former stages; Stramonium, which is particularly useful when strabismus and other spasmodic symptoms, particularly spasms of the chest, are present; and lastly, Rhus tox.. which is considered an important remedy by some. Other distinguished remedies in this stage are Artemisia and Cina. This remedy is particularly useful when the sphincter muscles are partially paralyzed, when the child bores with the finger in his nose until blood makes its appearance. Hyoscyamus may likewise prove useful when paralytic symptoms have set in. Mercurius vivus should not be overlooked.

§ 2G9. In the last stage, that of paralysis, we observe phenomena denoting an excessive derangement of the cerebral functions and paralysis of the nervous system. Stupor and sopor increase more and more the paralytic attacks in number and intensity, the pupil is paralyzed, complete deafness and blindness, and paralysis of the extremities, set in. The tongue becomes dirty-looking, black, the breath is fetid, respiration is short, anxious, spasmodic. Symptoms of a febrile condition make their appearance; the pulse is excessively irregular, hurried, small, spasmodic, intermittent; the skin is burning-hot, and dripping with sweat, hands and feet feel alternately cold; hectic, circumscribed redness alternates with great paleness in the face. All sorts of spasms of the facial muscles, oesophagus and extremities, singultus, epileptic and tetanic spasms, make their appearance. Miliaria frequently breaks out before death.

§ 270. If the disease should have progressed so far without having been in the least influenced by the treatment, medicine will prove totally useless in this stage. Slight relief, however, may be afforded by Aconite, if the febrile svmptoms should be very violent; even the spasms may be somewhat diminished; and by Ipecacuanha or Ignatia, if the spasmodic symptoms should be the more marked. Opium is an excellent remedy if the sopor should be very obstinate, and the child, with his eyes half open, should not recover his senses. In general spasms with the head drawn backwards, the patient should smell, every five minutes, of a solution of Camphor. If the symptoms should have abated, it would be proper to put a few globules moistened with the sweet spirits of nitre on the child's tongue, or, in case of lock-jaw, to hold the open vial containing the spirits of nitre for a few seconds under the child's nose. In some cases, Moschus may prove of great service.