Treatment.

extremely probable that animalculæ have a considerable share in its production. The same remedies which prove so efficacious for the cure of psora, are equally so in this malady.

Sulphur in combination with tar seldom fails to remove it; when however it has been allowed to acquire a considerable degree of malignity, it will be necessary to vary the applications as well as the mode of applying them. If the head be very scaly, or covered with thick and indurated crusts, the practice pursued at this hospital, is to invest the whole scalp with a poultice of linseed meal. Some tar ointment with sulphur may be advantageously combined with the poultice. After this plan has been put in force, the hair is to be completely removed with a razor and the parts anointed with the ointment night and morning. Previously to rubbing on the ointment it will be extremely proper to wash the head with soft soap and water.

There is a species of Tinea or Porrigo much more difficult of removal, although less disgusting to the eye. It is in the highest degree contagious, and whenever it gets admission into a seminary of education, or other large establishment, it is not easily eradicated. The hair falls from the head either partially or entirely. The denuded places look as if they had been stripped of their covering by a razor or a pair of scissors. Whitish furfuraceous scales, which sometimes adhere with great pertinacity, form upon the bared parts.

Treatment.

With this species of the complaint mercurial preparations succeed more speedily than sulphurous.

If the scalp be not entirely free from hair, what remains should be removed with a razor. A blister should

then be applied, and dressed with mercurial ointment. Should a morbid skin be reproduced, anoint the scalp with an ointment composed of equal parts of tar and mercurial ointment. For this preparation diluted nitrated ointment of quicksilver may sometimes be advantageously substituted. Frequent washing is in this species of the disease highly desirable.

CHAPTER III.

Hydrocephalus Externus.

Capitis intumescentia mollis, inelastica, Hiantibus cranii suturis.~~
Cl. iii. O. ii. G. Ixxii. CULLENI.

THIS disease uniformly and inevitably proves sooner or later fatal. Its appearances are so universally known, that it would be superfluous in me to dwell upon them. It probably is the consequence of original defective organization in the brain.* Before it manifests itself by any enlargement or other symptom, its existence may be sometimes recognized by the veins of the scalp becoming varicose. The most beautiful appearance I ever saw those vessels assume was upon the integuments investing the head of a hydrocephalic patient. The cranium was large, but had not acquired an immoderate size. In the cases I have witnessed there has been but a scanty growth of hair.

* Dr. Spurzheim has, I think, very satisfactorily shewn, that the deposition of fluid takes place within the ventricles, and not between the membranes of the brain as generally supposed. If it be so, the disease must no longer be designated-external.

+ The superficial veins upon the abdomen often present the same appearance before any great accumulation of water has taken place within its cavity.

CHAPTER IV.

Hydrocephalus Internus.

Ir is perhaps to be lamented, that professional men sacrifice so much of their time in searching after specifics for diseases which have been proved by the experience of ages, utterly incurable. Would they but employ it in devising measures for their prevention; and zealously insist upon the necessity of their being rigorously adopted; from what a series of sufferings and miseries would they deliver mankind !

When once Hydrocephalus Internus is fully developed, medicine can achieve but little. I will relate several cases of this formidable disease; detail the appearances which presented themselves upon dissection; investigate its nature; point out that which I conceive to be the most judicious mode of treating it; and finally give such directions as will, I hope, if steadily pursued, preserve many from becoming its victims.

CASE I.

On the 21st of January. 1811, a Boy, aged 15, by the name of Jesse Clissold, applied for relief as an out-patient to the Bristol Infirmary.

His mother stated, "that he had been in an indifferent state of health for a considerable length of time; that three or four days previous to his application he had been unmercifully beaten by some boys, and that he had scarcely held his head up since."

His appearance was by no means unhealthy. His countenance was florid, his complexion clear. He complained of slight headach and a sore throat. His pulse was full and rather frequent, the tongue white, the tonsils slightly inflamed, the parotid glands were very * More properly, Hýdrencephalus.

much enlarged, the bowels were confined, and there was a little oppression about the chest. The enlargement of the glands principally attracted attention, and the disease was considered to be Cynanche Parotidœa, attended with a more than usual degree of inflammatory diathesis. An emetic was ordered to be taken in the evening, a purgative on the following morning, and afterwards four grains of the antimonial powder every six hours. On the 24th, he appeared to be nearly in the same state. A blister was ordered to the chest, and a saline mixture to be taken in lieu of the powders.

On the 31st, he was admitted into the Infirmary. Ten ounces of blood was drawn from the arm and fifteen grains of the cathartic powder of the House,* were taken on the following morning.

February 1st. Pulse soft and rather frequent, throat sore, tongue white, parotids not much enlarged, skin rather dry.

2nd. Delirium with loud and frequent moaning came on during the night, pulse strong and frequent, bowels costive. Ordered a stimulating enema. Eight ounces of blood were abstracted from the external jugular vein. A blister was applied between the shoulders. Three grains of calomel were taken at ten o'clock at night, and repeated on the following morning at four o'clock.

3rd. Has some lucid intervals. Pulse full, tongue moist. The bleeding was ordered to be repeated, and three grains of calomel to be administered every three hours till copious evacuations should be procured. The blood exhibited no inflammatory appearance.

4th. Bowels open, pulse 100 in the minute and soft, tongue clean and moist. Passed a more comfortable night, delirium continues, stools fetid and black, picks his nose and lips. Ordered three grains of calomel to be taken every six hours.

*This powder is formed of five grains of calomel, and fifteen of jalap.

5th. Delirium unabated, picking of the bed clothes, involuntary discharge of fæces, pupils dilated; Strabis

mus.

6th. Continued in the same state till seven o'clock this morning, at which hour he expired.

Examination.

The vessels of the pia mater were very much distended with blood, and a large quantity of the same fluid escaped from the lateral sinuses through an accidental opening made into it, while sawing the occipital bone. The texture of the hemispheres appeared to be natural.

Upon making an incision by the side of the raphe into the lateral ventricle, a large quantity of water was discharged; the right lateral ventricle was very much distended and appeared to have contained more than two ounces of the fluid, the left ventricle was filled with about an ounce and a half; the choroid plexuses were remarkably pale. They in all probability were rendered so by the water in which they floated, having after death deprived them of the red particles of the blood; in other words, they had a sodden appearance. The foramen of Monro was remarkably distinct, a small quantity of water was situated between the folds of the septum lucidum, the third ventricle contained nearly half an ounce of the serous fluid, the pineal gland was destitute of gritty particles, the fourth ventricle was in a healthy state, the prominences of the basis of the brain were remarkably distinct.

Appearances in the thoracic cavity.

The surfaces of the lungs had a tuberculated appearance, but no tubercles existed within the substance of those organs; there were slight adhesions between the pleura and its reflected portion; a mass of coagulable lymph was found in the right ventricle of the heart.