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Show 160 ' Hydrocephalus internus. Hydrocephalus internals. suppose the fatal disorder enteritis, though he knew ithad been treated, even by cold affuu sion, as typhus. Yet it might very justly have been considered as typhus for any thing which the scalpel could distinguish. Much more nndistinguishable will be many cases, where a primary affection of the brain, terminating in effusion into the ventricles, gives rise to fever, and where fever having existed first, the disposition to effusion follows. All analogy however is in favour of the existence of such I have pretty directly proved distinction. that it takes place with regard to other modifications of‘inflammation in the brain: and in numerous instances, effusion comes on at the close of disorders, widely different during their early periods. Iam in possession of observaw tions, which prove with all the distinctness attainable in regard to any internal process, that effusion into the lateral ventricles, to the amount of five ounces at least, will supervene within afew hours, after an acute disease of the head, having the symptoms of hydro- cephalus, has subsisted for several days.----In cases denominated hydrocephalus internus, but without effusion, dilatation of vessels or Other marks of inflammation, may one not suspect that sufficient attention has not been paid to the distinction of symptoms? (Are all the symptoms, as depending on the subtle influence influence, precisely alike, whether 161 dila- tation of vessels arise or not P) Or why should I be deprived, in my hour of distress for facts, of the privilege of appealing, like those whom I oppose, to the discoveries which the future has in reserve for me P-At present, I most sensibly feel that no conclusive-mo silencing reasons against (or for) the hypothesis can be drawn from the contemplation of hydrocephalus. All the facts I could give or collect would serve for nothing better than an ill-compacted piece of argumentative mosaic work. At all stages of this disease in its acute state, I think it certain from observa- tion, that bleeding ought to be practised even to the very last. Bleeding from about the head not only removes the complaint in its early stage, but sometimes will save the patient, after general convulsions have come» on. And where it is too late to produce this happy effect, it at least prevents the horrors of the closing spectacle and most probably lessens suffering. For it is not by any means the pressure of effused liquid but that of distended vessels, that occa- Sions the convulsions and Spasmodic symptoms of the last stage, as numerous observations and not a few dissections have convinced me. But these I may state hereafter. The same treatment, ifone may believe almost universal testimony, would not answer in typhus. But at the war has |