§ 263. Acute hydrocephalus.

Acute hydrocephalus runs a regular course, like all other acute diseases, particularly encephalitis; it is, in fact, nothing else than an inflammation of the brain with effusion.

Formerly, the phenomena and course of the disease were very little understood. Thanks to the discoveries of Formey and Gaelis, it is much easier now to diagnose this disease, and to trace it through its various stages. Among children, those from two to six years old are most liable to it. It attacks even children of the best constitution. In some families there prevails a natural disposition for that disease. A dangerous symptom is, if death by hydrocephalus did occur in a family. Other dangerous indications for the probable development of hydrocephalus are: Globular shape of the head, prominence of the anterior and posterior portions of the head, with sunken eyes, and the fontanels remaining open, much vivacity, premature mental development, disposition to nose-bleed; the new-born infant looks feeble, sickly, without strength or intellectual expression, sleeps a good deal, has a vacant and staring look on waking; want of sensibility; retarded and imperfect development of body and mind.

(1.) The precursory stage. This is not always present, or at any rate, not distinctly perceptible; in infants, particularly, it is sometimes overlooked, or is supposed to indicate a different disease. This stage sometimes lasts only a few hours, at other times a few days, and does not offer any of the characteristic symptoms of acute hydrocephalus. It is recognised by the following symptoms: The child, which was previously able to run about with ease, has an unsteady, vacillating gait; he raises his feet high from the floor, and is liable to fall on a level floor, even in the room. This unsteadiness communicates itself to the whole body. We observe, moreover, a sudden change of disposition; in the place of the former cheerfulness and lightness of heart, the children become morose, peevish. On moving the head suddenly, for instance, or raising it in a recumbent posture, vertigo, or a sudden stupefaction is experienced. In some cases, the secretion of urine is scanty, in others the urine is turbid, flocculent, opalescent. Some authors number a fine, dry, colourless eruption on the outer side of the upper arm, on the cheeks and lips, among the precursory symptoms of hydrocephalus.

Beside these characteristic symptoms, there are some that are less characteristic, such as loss of the blooming appearance, sudden change of complexion, diminished appetite, restless sleep, during which the children moan, groan, start up as in affright, alternation of creeping chills and flushes of heat; a pulse of the ordinary rapidity, but intermitting at times, or beating more feebly. If these less characteristic symptoms should co-exist with the above-mentioned characteristic ones, the physician will be led to suspect the approach of hydrocephalus, and will watch the development of the symptoms with redoubled attention. § 264. The most suitable remedy for the above-described symptoms of the precursory stage is Pulsatilla. It corresponds more especially to the tottering gait, the vertigo, and the deranged secretion of urine. The moral condition of the patient in this stage of hydrocephalus is likewise one of the best indications for Pulsatilla. Belladonna is preferable to Pulsatilla, when the gait of the patient is not so much unsteady and tottering as vacillating, when the urine is scanty but of a natural colour, and when the above-mentioned eruption is distinctly perceptible. Cases may likewise occur where Ipec, Chamom., Ignat., and Bryon., are indicated. In some cases, the above-mentioned precursory symptoms exist without any further development; the children are very backward in learning to walk, and the continuance of the aforementioned symptoms points to the existence of a more deep-seated affection. No other symptoms are seen except a want of power to walk. For this difficulty, I have frequently administered Causticum with benefit.

§ 265. First stage, irritative stage. This stage is characterized by the following symptoms: Violent headache, particularly in the forehead and temporal region, with pressure in the eyes. Infants express this pain by moaning and grasping at the forehead; disposition to vomit, and actual vomiting, which is less apt to occur in a quiet position, and is excited by raising the child, carrying it about, moving it to and fro, or by any other motion; liquids are more readily vomited up than solid food. The more the disease develops itself towards the following stage, the less vomiting there is. A characteristic symptom is the increased sensibility of the eye to the light; the patients do not open their eyes except in the dark, or by a feeble light. The little patients are likewise very sensitive to noise, and are tormented by internal anguish and restlessness in consequence of it. The alvine evacuations are generally suppressed, and when they occur they are viscid, tenacious, brown. The face is generally pale, the features are altered, distorted, the nose is always dry, the lips are pale or of a faint dark-red, cracked in consequence of the heat. According to Goelis, a pathognomonic symptom is the collapsed state of the bowels, without any increase of the alvine evacuations. There is scarcely ever any characteristic fever present. The pulse is small, irregular, very changeable, frequent, now and then intermitting, or beating more feebly. There is a disposition to sleep, but the sleep is restless, attended with grating of teeth, fancies, starting as if in affright.

§ 266. This stage is characterized by a number of definite symptoms, and it would seem as though it were possible to adopt a definite course of treatment in regard to it. But this is not so. Different constitutions require a different treatment, and the other morbid phenomena are frequently present, which complicate the original disease. Be that, however, as it may, it is absolutely necessary to commence the treatment with Aconite, which frequently changes the disease to a milder form.