CASE OF CHRONIC HYDROCEPHALUS ; RECOVERY RY TAPPING. By Dr. L. A.

KIDD,

Civil Surgeon, Pubna. A Hindoo infant boy, six months old, was brought to the charkable dispensary, on the 2nd May, suffering with chronic Hydrocephalus. On enquiring from the parents as to the cause of the disease, I was informed that when the infant was two months old he had a severe attack of fever, with continual tossing of the head, frequent crying, and a good deal of restlessness. Tho child was placed under the treatment of one of their own nativo quacks. Alter the lapse of five or six days the fever subsided, but they observed the head larger than formerly, and the tossing of the head still continuing, with considerable drowsiness; since then it has been gradually growing, and attained the present size. I ordered the infant to he admitted as an in-door patient in hospical; this they objected to, but agreed to bring it as an outdoor patient. The shape of the head was long, and flat 011 the top ; the circumference of the head measured 20 inches, and transversely 16 inches; os frontis tilted, and the forehead as if overhanging the brow; parietal bones bulging on both sides, and the occipital bone pushed backward; fontanelles very tense, and a distinct pulpy feel the whole length of tho upper surface of the head ; strabismus and continual rolling of the eyes ; loss of appetite, and great restlessness. Treatment.?On admission, it was determined to reduce-the size, if possible, by the use of calomel with acetate of potash given three times a day; mild aperients, diraphoreties, and cold application to the head. This treatment was continued for 15 days, but no regular benefit was observed, and on measurement an increase of of an inch in the circumference appeared. I g-

July I,

CASES FROM PRACTICE."

1866.]

then strapped the whole of the head with sticking plaster, so as to cause absorption by pressure, assisted by the use of calomel with diuretics twice a day. The parents absented themselves from bringing the child to the dispensary for a period of six days ; and on their re-attending, head symptoms were observed, caused by the strapping. I removed it, and proposed to the parents the necessity of decanting the fluid with a small trocar, to which they agreed after a littls hesitation. I then introduced a small trocar from the edge cf the anterior fontanelle perpendicularly to the surface, making a slight pressure on the top and back of the head to aid the flow of water. After decanting 12 ounces, the child appeared to be faint. I withdrew the canula and closed the wound carefully. A draught, composed of spirits of lavender and spirit: amnion : aromat: was given, and the head re-strapped, to keep, in some degree at least, the pressure of the fluid removed. Calomel, with James' powder, was given twice a day, and cold application to the head. The infant has ever since been doing well, and there seems every probability of

a

recovery.

Pubna,

14th

June,

1866.

135

Case of Chronic Hydrocephalus; Recovery by Tapping.

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