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when the water is situ aled illiin these
a. Hydrocephalus of the cranium, Whenit is silualed etween the brain and kull. 3. Hydrocephalus of the integuments. when it is siluated totalty exterior to the That the instanc besere u is of the secondat nil can admit of no doubi Andalthough this bestes rapid in iis progressthan the firsiaind of hydrocephalus, that of the ventricles, it is perhapsio les mortal. I has even been disputed hether therei instances of recover in any casse. To his opinion, however I cannot agree; for I am persuaded thates have witne edmore than ne instance of recover evens rom hydrocephalus of the ventriciesci andis this e the case, Ι ill noti dispossedio thin that it ma no occur illi regariit hydrocephalus of the cranium. Some, o ever, are so much persuadenos the fatal tendenc' evenis the last that the adviseno meas ures tote alien during
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thes have have an effect it ill oni bet hasten the death of the patient. I must
then lookipon the caselefore us, fron thetiatur of the assiection, toleso a very an gerous tendency and there are unquestionabi but alii hopes of curea be n-tertained in cases naucli more favourablethan the present forcit is here o b observed that the diseas is no meret characterissed by the enormous increasse of the
fige of the head Though it has no givenris to ait, et it has produced severat of the ympionis arisin frona the hydrocephalus of the ventricles such, for example, a the strabismus o peculiar quinting, the dilatatio of the pupiis, and os offight. There is no doubi that in the presentinstance, as welitas in hydrocephalus of the
ventricles, these are the Tects of compression on the brain Andrio the same cause, may also refer severat ther ap- Pearances in the caseleforeis particularly
the inabilit to se the egs, and the want of thelower of articulation, although the
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child e no above two ear old. Tothesi Pthin w may add, with respect tolli intellectua faculties, a far at east asthe cante judge of at si early a periodo life that here occurs, is no absolute idiotism, at east a very considerable degre oscit. For of this, Papprehend we had sufficienti strong evidence in the wilustrieh me emitted. From at these parti
clude that the affection, in the instancebefore us, is in a very ad vanced state tandindeed it has atready subsistedior nea thes pace of two CarS. must, however, remark, that I have known instances of longe duration, and where the head ad increas exto a greater sige where the fame appearances mere notinduce l. Andes have seen a child farther advanced in life with a much large head, who ould not ni articulate, ut aseven Xtremel talkative. It would appearthen, in the instance efore us that he progress of the affection, a destroying the pomer of the system, had been great evensor
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for the time for hicli itia subsiste l.
leviation of the complaint, there is litile prospecit that he will old ut much
Besides hales have ali ead mentioned, there is nother circumstanc tote alieninto account in ivinia prognosis in alis uel cases a the present, that is the causet whicli tho affection a b referre l. And froni his, a far ascit oes I would in the present case ather dra a favola rabie judgmen than other isse. Osten the disse eas hegin without an perceptibi cause; in hicli case there is reas est drea linati has it origi in the constitution It is osten a dis eas no supervening after hirth, but born illi infanis a circumstance whicli stili farther demonstrates haesit hasit origin in the habit iis eis. But in thecas elefore us, the disea se asielther con- genia nor ithout an obvious cause atteast his affectio was attributed ora fe-ve and convulsions illi hicli me a attached abolat two ears ago. Fro that
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xime the head was observet gradu atly toenlarge It is triae indeed thes may besuspected o have been the consequences of the affection pon iis sirs attach and there is no sub that the iii st stage of the
hydrocephalus of the ventricles is marhed by a sever. But ascit is neve observet tot be a sympto of the hydrocephalus of the cranium, e ma conclude that it was not so in the present instance And asdropsica assections in generat, are osten a consequence of ever, e ma infer, that this took place in the instanc bes ore us. But allowing the dis eas noto be original, but acquired, and the cause of the a section obvious, hateve foundation thesecircumstances might ive forta favourable prognous in ther instances the can afford ut litit ground for it in the present. For after the occurrence of symptotos indicat ing the affectionis ali the more important Unctions , a recovery Would indeedi, ver extraordinary.
This, however, is, Lapprehend no susti- cient reason hy, mouid not mali atri al
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tria os disserent practices for I hold that even in the mos desperate cases patienis, while the wili submit o reaiment, areno tot deserte t. In suci desperate cases, conside a pracstitioner,s warranted evento malae a tria of doubiful remedies Andeven whereae oes no choos to employfuch, there is perhaps, no instanc in whicli meas ures may notie ahen whicli, withou dange of any preiudicia consequences have a least a prospectis afford inissem relies On these principies, then, procee to spea of the reatinent in thecas besoreis It is evident that, as in dropsica affections in generat, there arehere two great objecit tote had in view.
I. The evacuationis the water at ready collected within the cranium. et Thespreventionis future accumula
Here, as in ther cases, at the different modes of disichargin the water a bereferre 1 t two eads, naturalis artificiat Ouileis. The forme unquestionabi fur
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thymost effectual, mode of evacuation thalis by means of these, ean a least draviost the water, hateve may be the future event of the diseasse. It musti allowed, however, that in his affection ome of the artificiat modes are very doubiful Among thesees may mention what os ali modes isthe mos certain puncture into the cavitycontaining the water. Respecting the propriet of this operation, ver opposite sentiments are entertaine by the mos eminent moderns. Some represent i as a mode o cure, nolloni free froni danger, but neve to be neglected. Other conside ii as a certain means o precipitating the death of the patient. Fro my wn experience on his subjecit, I an say nothing. Pliave nevereither directed his operation to e performed, o seen it tried unde the directionis an other. I must own hoWeVer, Iciliould nolintertain rom it an sanguine hopes of successi. A the ulmost, e canloo foris farther benefit Dom it than frona tappin in ascites that is, it serves
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meret sor produc in evacuation of the water, ndio for preventing the return. Andri is stili atteris disputeio far, even in ascites, appiniis of any great ad-Vantage. Some of the most eminent prac titioners in London, indeed, ave latet y Tecommended early appin in very highternas: ut nam et assured that eventhos Who were Onc the strongest advo- Cates for it, remo much esse fond of tthan formerly hile thers, and theseto of the sirit eminerice condemn it verystrongi in almost ever instance. Is however, evacuation by an ovile of this natur beseXceptionabie in ascites, it is stili more so in hydrocephalus of the cranium. For it is ellanown that in asia cites, even the greates inconvenience illari se is the disicharge beio compensated by
due pressure Herace, before prope handage were invente i it a gi ven a a contiant direction, that in ascites, the wholewater mouid notae drawn sy tince, butat different times; and is it is orae at- . tempted in hydrocephalus, the fame in
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unction multi observed For here, romthe state of the alter forming the cavi ty, tum the bone, pres Iure cannot have an es feci or is the interval betwix the satures may ad mitis this, et it cannot have influence in an equabie manner. Ot-withluandiniat these objections hoWever, when other remedies are ineffectual, and where the diseas is evidenti on the in- creas in harid it is tote conridered a gi ving the oni possible chance of a reco very. And though, as the hance is unquestion abi a badine, it is neve tot enforced yet it ought I apprehend iniuch circum- Plances, tot propose l. Perhaps there are e cases here theevident concurrence of circumPlances require it more manifePlly than in this beforeus But to the operation, an unsui mount
able objection is the mother' dread at thethought os t. y this, heresere me erehere determine i t try What might withsas et be done by other artificiali naturalouitets. e have an artificiat utler, notoni to appearance les formidabie, but in reality
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charge is continued unde the form DanisTue Froin these, applied even to the headitself, here is les tot apprehended than in the hydrocephalus of the integuments, and more tole expected than in the hydrocephalus of the ventricies. Here, howeVer, chos to give the preferetice to the application of them in the eighbourhood of the head Ohicli, hile it is productive of nearly the fame ad vantages, might seemles alarming. It was m intention to have supportell
ment. ut although, rom the lister it self, there as a very Optous Vacuation,
yet by the issue-ointinent, the disichargemas no supported probabi from,ant ofa prope application Perhaps, hoWeVer,it is a matteris doubi, whether froni his there is any rea disseduantage forcis therebe no an equat, et, at east there is a very conriderable disicharge obtaine byrepeatedilistersci an to suci repetition Iliad