UNITED STATES  OF AMERICA
v  .  .
FOUNDED 1836
WASHINGTON, D.C,
B19574 
 
 
~ <p^v^t
A  CASE
^DROCEPHALUS,

             RE^D BEFORE THE
Metrical  j>otietp  of  £outB-Carolma,


      ON THE FIRST OF  JULY, 1818,

         AND PUBLISHED AT THEIR REQUEST J

     By JOSEPH GLOVER, M. D.

 Surgeon-General of the State of South-Carolina, Sfc.
u IN APRICUM PROFERET .ETAS,"
                  Hor.
        CHARLESTON:
Printed by A. E. Miller, No. 99, Queen-street.
             amon
            1818. 
Lrv/




  /
sr
u
/
/"
-?•-
^
6^
dd

2/v
-^ 
A CASE, &c.
    Mr. President and Gentlemen,

JlUMAN  knowledge  is so limited, that he who
observes, must each day add something to his stock
of experience ; and although theory has been said to
be to the Physician and Surgeon what the compass is
to the mariner; yet, experience is  the best  test of
theory, for it teaches us to embrace the one, which will
explain to us the greater number of the  phenomena
which occur.  How necessary therefore, is it for each
of us  to  throw  his mite  into the  scale of science,
for in no  profession, be assured, is it more necessary
than in the  one which we have embraced. Impressed
with the correctness of these ideas,  I submit  to your
consideration the following case:
  On the 13th of December, 1817, I was requested
to visit the child of Mr. H. on South-Bay; I  was in-
formed on my arrival, that Mrs. H. had been delivered
of a female  child, on the 21st of the preceding month ;
that the birth  was not premature; that she had been
in good health during her pregnancy; that she had
previously borne five healthful children,  and that the 
                        4
 child to which I had been called, was in every respect
 perfect, except  that she had a watery head, which
 was discovered  shortly after her birth;  that various
 remedies  had been tried without effect,  and that her
 head had increased in size so much as to give great
 uneasiness to her  parents,  and was evidently  very
 distressing to the child  herself.
   On  examination, I  found the head of the child
 much enlarged,  being IPjinches in  circumference,
 measuring over  the frontal and occipital bones ; and
 19i. inches measuring  from under  the chin over the
 ossa parietalia.   I discovered all the proper bones of
 the cranium  to be considerably separated at  their
 sutures, and  found an  evident fluctuation of water
 within them.
   The child was to appearance, (in every other
 respect,) healthful: had no symptom of fever, that I
 could discover,  and was reported  to me as nursing
 well.  There was  however an  evident  distortion of
 her eyes,  and moreover she had a countenance from
 which nothing   favorable could be drawn.   I there-
 fore  deemed it my duty to inform  her parents, that
 from my own experience, as well as from the cases
 of which I had read, little more than hope remained
 of the recovery  of their child;  suggested a  plan of
 treatment  and retired.
   I repeated  my visits  at interrupted periods, until
 the second of March  following, during which  time,
 I attempted every plan of treatment for the relief of
my patient, which  either my judgment dictated, or
that I could collect from the authors on the  subject,
which were within my reach ;  but,  they were of no 
                        5
avail,  The  d'«nr>se contin ,:d to increase with great
rapidity, and  nothing  but a  prolonged existence  of
mtacvy, and an untimely death appeared to await my
patient, her head having now  increased in size to two
feet in circumference, measuring over the frontal and
occipital bones, and one inch  more measuring from
under the chin over the ossa parietalia.   Under these
circumstances, I thought proper to advise the opera-
tion  of tapping the head, as the only means left within
my power, which appeared to  afford the least prospect
of relief to my patient.  To  this her parents readily
consented. I therefore invited several  of my  medical
friends, and performed the operation on  the  day fol-
lowing, being the  3d of March,  1818, in  the pre-
senceofDr. Jos. Johnson, Dr. Whitridge, Dr. War-
ing,  Dr. Frost, Dr. Hume, and my brother Dr. H.  C.
Glover.
   It was done in the following manner:—Perceiving
that the fluctuation was most distinctly felt, on the
right side of the childs head, between the parietal and
temporal bones in the course  of the squamose suture,
I punctured the head in that part, with  a common lan-
cet,  and by introducing a grooved director into the in-
cision,  was enabled to let off the water as freely as 1
wished. A person who was not present, would perhaps
suppose, that the danger of wounding a branch of the
temporal artery, would  render  this a  very improper
place at which to puncture the head, but, I can assure
you, that I could discover its course so readily in this
case, that it was not at all difficult  to avoid it.
   There was scarcely any discharge  of blood  from
the puncture; but when we had drawn off a pint oi 
                        6
 Water, it was perceived that the bones of the cranium
 were so slightly attached to each other at their sutures,
 and the collapse of the integuments was so great, that it
 Was judged advisable to  withdraw the director, and
 take away no more  water at that time.  The water
 drawn off was such as We generally see in ascites, and
 in dropsical depositions in other parts of the body.
   In attempting to bandage the head, the bones yield-
 ed so much, after the water had been thus evacuated,
 that there appeared to be great danger of injuring
 the parts within the cranium, oh lifting the head With
 our hands.  I was therefore obliged to slip a wide
 bandage  under the head, (with which to make the
 pressure more equal  when the head was elevated,)
 before I was enabled to apply the necessary bandages
 for completing the dressing.  I made no other appli-
 cation to the wound made by my lancet, than a plas-
 ter of oil  and wax,  over  which I placed a compress
 arid two  circular  bandages; (for the purpose of sup-
 porting the bones and bringing them in contact' at
 their sutures) the  one around the head over  the fron-
 tal and occipital bones;  the  other, from  und<?r the
 chin and over the ossa parietalia The child appeared
 to suffer very little pain from the operation, and when
 I visited her on the evening of that day, nothing had
 occured worthy of being noted  down.
   On the  morning of the fourth of March, I found my
patient as well as usual.   She  had been  somewhat
restless, during the  first part'of the preceding night,
but was soon relieved by an anodyne, which (I have
omitted to mention) her mother had been obliged to
give her repeatedly before, to procure sleep.  I was 
                        7
informed that she had passed an unusual quantity of
water by urine since the operation.
   It was my intention to have introduced  my direc-
tor at this visit, and to have let off a further quantity
of water, before  the  lips of the wound had  healed;
but, the day being cold and rainy, I thought it most
advisable to defer it.
   On the morning of the fifth of  March, the weather
being favorable, and my patient being as well as usual,
(jn the presence  of several of my medical friends,) I
 separated the lips of  the wound  with a probe, intro-
 duced my director and let off another pint (by mea-
 sure) of water.   The child appeared to suffer as little
 pain as before, from the operation ; the  bones of the
 head were  more firmly attached to each other, and I
 was enabled to  apply the necessary bandages  with
 much less  difficulty.
    I found  my patient, on the morning of the sixth of
 March, very languid and to appearance much worse.
 I discovered, that there had been a very considerable
 discharge of water from the incision during the nigh^
 and that  the child was  much  exhausted in conse-
  quence of it.  The lips of the wound had not united,
  by the first intention, as after the first tapping, and
  the water  had continued to ooze through the orifice,
  from the time my director  had  been withdrawn.  I
   immediately applied a small dossil of lint to the part,
   and when I visited the child in the evening,  I was
   happy to find her somewhat recovered.
    On the  morning of the seventh of March, I found
   my patient as free from pain, as before the operation,
   and much revived,  having sucked heartily, and hav- 
8
 ing had a good nights rest.  I discovered however,
 that the discharge of water from  the orifice having
 ceased, its accumulation  had  evidently increased,
 and the fluctuation had become more distinct.
   It became necessary On the morning of the eighth
 of  March,  to repeat the  operation  of tapping the
 head, for the third time, which was done in the pre-
sence of several medical gentlemen, in  the manner
 last  mentioned, and another pint  (by measure) of
 water was drawn off.  The child did not appear to
 suffer more pain than from the previous operations.
   When I visited  the child on the  morning  of the
 ninth of March, she  was  ?>s well as usual ; but, on
 examining her head, I discovered that the water was
 again accumulating.
   On the morning of the tenth  of March, the  child
 being still as well  as usual,  and finding  the  water
 had  increased considerably in  quantity, I resolved
 again to let it off, before the incision had healed, in
 order to supercede the necessity  of making a new ori-
 fice.  This  I accordingly did. in the  presence  of se-
 veral of my medical friends, and let off three gills
 (by  measure) of water,  making three pints and three
 gills, which  were  drawn off in the four several ope-
rations  of tapping  the  head, from the third to  the
tenth of March ;«ad all of  which were borne by my
patient  with very  little apparent suffering, and evi-
dently with the happiest result, for the child had be-
come more  flleshy;  and if the water did not cease to
collect, its accumulation was now slow.
   From the tenth to the  twentieth of March, my
patient  continued to improve in health.  The  bones 
                        9
of the  cranium  had  approximated considerably,
and  were uniting at their sutures.  The deposition
of water  was inconsiderable and  its accumulation
slow.  Her eyes were very little distorted.   She was
able to move her  head  ; knew  her  mother; sucked
heartily ;  passed  a considerable quantity  of water
daily by urine; and in fact every favorable  symptom
presenting itself  to our view,  we had every thing to
hope.
  On the  morning of the twenty-first of March, the
child's head measured only 19 inches over the frontal
and  occipital bones, and an inch more  from under
the chin and over the ossa parietalia ; after an interval
therefore of ten days from the last operation, it was
very  little larger than  when  I first saw the child,
which was on the 13th  of December, 1817, and her
health had  now  much improved.
  On the  twenty-second of March, I found the child
very sick, she had been distressed through  the  night
(from taking  improper food) with cholera morbus ;
was much reduced and very languid, being scarcely
able  to suck  without  her chin being supported by
her  nurse ;  she had likewise had two or  three con-
vulsions through the night.  I ordered her  an absor-
bent anodyne mixture.
  On the twenty-third of March, my patient was still
very ill, having had nineteen convulsions within the
last twenty-four hours.
  On the  twenty-fourth of March she was still very ill,
but had had only  two convulsions during the  preced-
twenty-four hours.
                        B 
                      10
  On the twenty-fifth of March, she was still ill, she
had had only two convulsions during the preceding
Wenty-four hours.
  On the twenty-sixth of March, I found  my patient
somewhat better, she had been free from convulsions
and continued so until the night of tne twenty-ninth,
when she had another.   We finally succeeded in re-
lieving  her  bowel   complaint,  and  with  it her
convulsions ceased.   The plan of treatment which I
pursued in the  cure of this unwelcome  and unex-
pected innovation of another and  distinct disease, it
is unnecessary that I  should mention here. I am sure
it would not be new to you.

  No sooner was my patient relieved from her attack
of cholera morbus, than I perceived, that  the water
was again  accumulating within  the cranium.  She
notwithstanding continued  to acquire strength, and
improved  in her general health,  until the  14th  of
April, 1818, when, the quantity of water effused, in-
dicated the necessity of another operation.  I deter-
mined to repeat it for the fifth time (her head  mea-
suring 18 and 20 inches in the two several directions
hitherto mentioned) but, here, a difficulty arose ; lit-
tle or no fluctuation of water could be discovered at
the  part where I  had previously operated  so  often
with safety and success.   The parietal and temporal
bones had united at the sq' amose suture,  and it be^
came necessary to make the incision in another place.
The fluctuation being most  distinct in  the course of
the  coronal suture, I made the incision on the right
side of the  childs head, at an equal distance between
the  frontal and parietal bones (these bones being se- 
                        11
parated at their sutures) and at about an equal distance
from the  sagittal and squamose sutures  and finished
the operation as before.  I  succeeded in  drawing off
another pint (by measure) of  water, in the presence
of Drs. Porcher and Waring and several of my pupils.
Only a few drops  of blood escaped  from  the inci-
sion, and  nothing  unfavorable  occurred during the
operation ; but, when it was over, I perceived, that the
 head had  been more completely evacuated of water
 than from any previous  tapping ;  tl.;o the collapse
of the integuments was greater, and that the caviiy
at the anterior fontanelle was large enough to receive a
hens egg  ; the child too  became pale, her pulse was
languid, she was likewise threathened with vomiting,
and  shewed evident symptoms of a disposition to
faint.  She however revived in a few moments, after
the dressings were applied and sucked tolerably well.
I have since thought that we drew off more  water at
this  tapping  than the  child  bore with  conveni-
ence, or than was proper.  The  medical gentlemen
present were  of opinion, that the  childs eyes were
much less  distorted  after, than previous  to  the ope-
ration.
  In the evening on visiting  my patient, I  was inform-
ed by her mother, that she very soon recovered from
the effects of the operation ; that she  was then very
easy, and had slept several hours.
  On the  fifteenth of April,  my patient  was much
better. She had passed a more  tranquil night than she
had done for a fortnight, and without taking an ano-
dyne ; she sucked well, and squinted less than I had
ever  before observed. Some water however, was again
discovered to  be effused within the craniuin, and the 
                        n
head had in some degree recovered its fullness.  No
oozing had taken place from the incision of the day
before.
   My patient was as well  as usual on the  sixteenth
of April. Her mother then informed me she had ob-
served,  that when her child had been recently  tapped
and  there  was  little water present in her head, she
was enabled to direct her eyes to any object; but, that
when the collection of water  was considerable, the
reverse  was the case ; that, then strabismus and  an
involuntary motion  of the eyes was always present.
Some water having now collected, and the last in-
cision having  not yet healed, I resolved to introduce
my director for the purpose of letting it off  the sixth
time. I did so, and discharged a gill  (by  measure)
which I believe to have been  all which had collected,
as the  subsequent  collapse was considerable.  She
bore the operation extremely well, and appeared to
suffer very  little pain from it.
   From the sixteenth of April to the eleventh of May,
my patient continued to improve in health, and noth-
ing occurred worthy of notice.
   On the twelfth of May, business of an imperious
nature,  obliging  me  to leave the city, I  committed
the  care of my patient to Dr.  H. Waring, who in-
formed  me on  my return, that the child had several
convulsions on the  nineteenth and twentieth, and
that on  the twenty-first, the accumulation of water
made it necessary for him to repeat  the operation,
(being the seventh time) which he accordingly per-
formed in the presence of Dr. Whitridge,  when three
giils of water were drawn off.   He likewise observed 
                       13
to me that the childhad tWo convulsions a short time
previous to his operating, but that they ceased to re-
turn after  the head had been tapped.
  The child soon recovered  from  the  effects  of the
operation, and when I returned to the city on the twen-
ty-third of May, I found my patient as well  as usual.
The water however, I shortly after perceived to be
still accumulating,  and on the thirteenth of June it
became  necessary  to tap her head, the eighth time.
I performed the operation as before, in the  presence
of several of my pupils, and  a pint of water  (by mea-
sure) was again drawn off.  Her  head  measured in
circumference, previous to  the operation, 20 inches
over the frontal and occipital bones, and VA  inches
from  under  the chin  and over  the ossa parietalia.
The child suffered as little from this, as  from  any of
the previous  operations, and I at length began to flat-
ter myself that  my  endeavours to relieve my little
patient would ultimately prove successful.

    In this, however, I was disappointed.  A few days
 only had elapsed when I discovered my patient to be
 much worse.  I found her gums much  swollen and
 occasioning  her  considerable distres s ;  she likewise
 had  thrush, and  evident  symptoms of  whooping
 cough.

    On the  morning of the  Seventee nth of June, she
 had  very  high  fever, and  1  was itnformed  by her
 mother that  she had had no sleep  during the night,
 having been excessively distressed with paroxysms of
 convulsive coughing.  Her  fever continued  without
  intermission^ attended with  coiif-rh  and  occasional 
                         14
  convulsions, until the morning of the twenty-first of
  June, when all my efforts to relieve her proving inef-
  fectual, she died.
    It is perhaps worthy  of notice, that, so soon as the
  febrile action commenced  in  the  system, the ac-
  cumulation of water in the head became much  more
  rapid, than was discovered at any previous period of
 Jhe disease.  It was likewise uniformly observed, that
  after  each tapping the kidnies did their duty more
  freely  for several  days,  and there was much  more
 water discharged, by urine, than at any other  time,
  even when they were stimulated by diuretics.

   The head, after death,  measured 20 inches in cir-
 cumference over the frontal and occipital bones,  and
 24 inches from under the chin and over the ossa pa-
 rietalia.
   On  tapping the head  three pints of water (by mea-
 sure) were taken away (in the presence of Dr.H. War-
 ing, my brother Dr. H. C. Glover, and several others)
 making in the whole 9|- pints which were  drawn  off
 in this case in the short period of little  more  than
 three months, from a child who was only seven months
 old.
   The head being opened, I found that the opinion
 which  I had  given of  the case was correct.   The
 water  had  been contained between the dura and pia-
 mater.  The dura-mater was much  thickened, but
 shewed no  marks of acute inflammation.

  The brain was nearly all absorbed, but  what  re-
 mained of it, rested with its pia-materon the base  of
the cranium.   It had lost much  of its  consistence ;
indeed, 1 found it impossible to distinguish the seve- 
                        15
ml parts of which it was composed, and on appealing
to the  gentlemen  present, they, as well as myself,
were ol opinion,  that it was not larger than a henS
egg ; and yei, astonishing to relate, this  child retain-
ed  her senses to the last,  and  appeared to possess
many of the faculties of the mind.
  I cannot conclude the statement of this case, with-
out recommending to you  the  operation of tapping
the  head  in  this  species of hydrocephalus, in the
strongest terms.  I believe it to be the surest,  safest,
and most speedy method of relieving,  if not of cur-
ing this very formidable disease, and I  have  now to
 regret that I did  not have recourse to  it earlier in the
 case which I have just  related.
   It will be recollected, that from the 13th of Decem-
 ber 1817, (the day on which I first visited  this pati-
 ent) to  the 3d of March 1818, (the day of the first
 operation) the disease had increased with great rapi-
 dity, under various plans of treatment.  No  sooner
 however, did we have recourse to the operation of
 tapping the head than the disease (to  say the least of
 it) was arrested.   Had we therefore commenced with
 it earlier, it is evident the chances of success would
 have been greater.
    The operation of itself, is as safe and easy as blood-
 letting.   Perhaps at this assertion some of you  may
 smile, and think me too sanguine ; to such of you, I
 would answer in the language of the immortal Rush,
  " dies doceat."
    To use our best endeavours to improve the healing
  art, and learn to relieve the  sufferings of humanity, is 
                        16
at least a pleasant, if not an honorable employment.
Let us therefore, I beseeeh you, stimulate each other
to exertion; let us humbly imitate the bright  exam-
ples of Shippen,  of Rush,  of Barton, of Wistar, and
the American Archimides, in surgery, Physick ; let us
discuss this case  freely; let us not forget, that  one of
the first objects of our Society is  mutual improve-
ment ; let us always remember the motto, " ex col-
lisions SCINTILLA.'" 
 
 
Mei.Hist.
  xno