■ UNITED STATES OF AMERICA MB® WASHINGTON, D. C. GPO 16—67244-1 A N Inaugural Dijfertation ON THE HYDROCEPHALUS INTERNUS, OR INTERNAL DROPSY OF THE BRAIN. Submitted to the Examination of The Rev. John Ewing, S. T. P. Provoft, THE TRUSTEES AND MEDICAL FACULTY OF THE UNIVERSITY of PENNSYLVANIA. On the lyth May 1796.^/^ 'fOTKS * For the Degree of Doctor of Medicine. .,___________Si tibi vera videtur, Dede manus, et fi falfa eft, accingere contra. Lucret, By ROBERT CHISOLM, of Charleston, S. Carolina. Member of the Philadelphia Medical Society. PHILADELPHIA : Printed by ORMROD & CONRAD, FrankUn5* Head, 41, Chesnut-street, 1796. TO Alexander Chisolm, Esq; Of CHARLESTON, S.CAROLINA. Honored Sir, WITH a heart overflowing with efFu- {ions of gratitude, permit me to lay before you the firft fruits of my medical ftudies. To you I not only ow£ my life, but what is more dear to me, my education. Accept this fmall tribute, as a token of affe&ion for thofe nu- merous obligations which can never be obli- terated from the mind of your dutiful and afFe£tionate Son, ROBERT CHISOLM. TO Alexander Baron, M. D. Of CHARLESTON, S. CAROLINA. Refpefted Sir, PERMIT me likewife tq, dedicate this Inaugural Diuertation to you, as a mark of the efteem, which I entertain for your character as a Scholar, a Phyfician, and a Man. I have the Honor to be, With the greateft Refpect, Your Humble Servant, ROBERT CHISOLM. P.-R E F A C E. 'TIS hard, fays Sir Roger VEftrange, that a man cannot publifh a book, but he muft give the world a reafon for it ; when there's not one book of twenty that will bear a reafon, not one man of an hundred that is able to give one, nor one reafon of a thoujand, that was the true reafon for doing it* This obfervttion of our ingenious author, will apply better, perhaps, to almojl any per- formance, than to an Inaugural DiJJertation.— For let a man puzzle his brain ever fo long, he can find but one reafon for pub lifling a Medical The/is, and that is neceffity which obliges him to comply with the laws of the Univerfity ,from which he receives his diploma. As this is the cafe, I have only to,claim the indulgence of the reader, for attempting to write upon a difeafe, which is but little known even to the vwfl able phyficians. An Inaugural Dijfertation* m OF all the difeafes to which the human body is fubje Occafionally occur, though none of them ac- company the diforder, in an invariable manner. In confequence of this, Quin has emphatically called theDropfy of the brain, " a truly protei- form difeafe." Like the bilious remitting yellow fever, it affumes a variety of fhapes. Dr. Rufh, to whom the medical world is greatly indebted, has told us, he has hot found the dilated and infenfible pupil, the delirium or ftrabifmus to attend at all times. The fame phyfician has feen a cafe in which the appetite was entirely unimpaired, from the firft to the laft ftage of the difeafe, and met with another in which an uncommon acute- nefs in hearing took place. Upon opening the head after death, the wa- ter* is f6metimes found between the cranium and dura mater, or between the dura and pia ma- ter, but moft frequently in the ventricles of the brain. The quantity of fluid contained in thefe cavities, is fometimes fo great, as almoft to ex- ceed belief.—Whytt t has found eight ounces, Bonetus five poundsj, {Monroe three pounds, Lieutaud relates a cafe where he found thirteen pounds, and Guftavus Hume opened the cranium and found five quarts of limpid water. This laft was a moft extraordinary cafe of Hydroce- phalus. There was not the fmalleft portion of brain, or leaft trace of the membranes, except * Morgagni, Sauvages, Patterfon, Haygarth, and others, fuppofed the effufed matter was ferum, but this is not the cafe, for it will not coagulate by heat, an experiment which has been tried by Dr. Woodhoufe. + Whytt p. 735. + Bonetus Sepulch. Anat. Lib. Seft. 2d. Ob. 45, v. i, § Monroe on theDropfy, p. 154. ( s ) pppofite the orbits of the eyes, and near the meatus auditorius, where fomething like me- dulla remained. OF THE DIAGNOSIS. As it is of fome confequence to diftinguifh this difeafe, from any other refembling it, I fhall fay a few words on the Diagnofis. Whytt has in- formed us, it may be diftinguifhed from worms, by attending to what he has called the following charadteriftic marks. In the Hydrocephalus, he fays, the feverifli heat is not abated when the pulfe becomes flow and irregular, whereas, when it beats in this manner, in children who have worms, no, fever attends. Dr. Whytt has been very unfortunate in this particular, for fo feldom do worms produce a real difeafe, that it is doubt- ed by many,whether there isfuch a thing as a ge- nuine worm fever :—The diforder which is cal- led a worm fever, is now known to be a fimple remittent, which produces death, by terminate ing in a dropfy of the brain.* A flow irregular pulfe, often attends in perfons of a delicate make, when afflicted with violent nervous head-ach, faut it is attended with a cool fkin, whereas in the dropfy of the brain, the feverifh heat is ex- ceffive. By attending then to this one fymptom, if we may give credit to the ingenious author of the effay on the vital and involuntary motions, we, may eafily diftinguifh it from a nervous a <- fe£tion of the head. In fhort, it appears from the few hiftories of the Hydrocephalus, that we can depend upon no fymptom which can be con- * Vide fome valuable obfervations, on the isfantile remitting fever, by Dr. Butter. ( 6 ) fidered as characteriftic.—In confcquence of this, we fhould like faithful ccntinels, be continually upon our guard, and always fafpedt the approach of the enemy.----As two thirds of the difenfcs which inflict the human race, terminate in effu- fion in fome part of the body, I would.whenever there was a fevere head-ach, accompanied witti an affection of the ftomach,flow or irregular pulfe, always fufpect a dropfy of the brain. EXPLICATION OF SOME OF THE" SYMPTOMS. We account for the lofs of appetite and vomit-r ing, from the difeafed ftate of the brain, between which and the ftomach, there is a very great fympathy. The averfion to light, proceeds from an in- creafed fenfibility of the Retina. The flow and irregular pulfe, is not caufed as Whytt fuppofed, by the water prelfing upon the brain but by the veftels of this organ being dif- tented with blood, which impairs the fenfibility of the cardiac nerves. Now, as the action of the heart arifes from the ftimulus of the blood acting upon thefe nerves, it is evident, that the pulfe jnuft be affected, according to the degree of fenT fibility with which thefe organs are endowed. The dilatation of the pupils of the eyes, is owing to the impaired fenfibility of the optic nerves. The paralytic eyelids, ftrabifmus, and blindnefs are owing to an infenfibility of the fe- veral nerves which fupply thefe different parts. Whytt has accounted for the difficulty of ref- piration in the following manner; refpiration is a function depending partly upon the will ; he has obferved, that a coniiderable paufe generally in- tervenes after expiration, before a new infpira<- ( 1 ) t'ori fucceeds. As the fenfibility of the brafr^ which is the feat of the will, is then greatly im- paired by the accumulation of water in the ven- tricles, the uneafy fenfation, proceeding from the difficulty the blood finds in parting through the lungs will be lefs attended to than ufual. Hence, after every expiration, a long paufe in- tervenes before inspiration fucceeds, becaufe the will is not exerted to put the mufcles of refpira- tion into action, until roufed by the fenfe of fuf- focation, which is caufed by the difficulty the blood finds in palling into the lungs, from the right ventricle of the heart.-----We cannot give our affent to this explication, for the difficulty of breathing takes place, when the patient is in a found fleep, and as the ingenious author of the Botanic Garden, haselegantly and juftly obferved, " The will pre/ides not in the bowers of fleep.''' Perhaps a better method of accounting for this fymptom, would be from an accumula-' tion of blood, in the veffels of the lungs. OF THE PROGNOSIS. As in other difeafes, we are governed in our Prognofis, by the parts affected, habit of body, violence and continuance of the fymptoms, fo like wife we judge of the iffue of Hydrocephalus. If it arifes from afuppreffion of any cuftomary evacuation, or if it is the offspring of another difeafe, there is greater certainty of a cure be- ing affected, than when it arifes from a fchirrous gland, or from a violent injury done to the head. In the Prognofis, it is of the greateft confequence to attend to the habit of body, for we certainly have a greater hope of curing a perfon of a good f 8 ) tonftitution, than one who labours under the fcrophula, the confumption or the rickets. Evacuations of water^ either by the bowels or the kidneys, are a good fign, and Celius is certainly right when he fays, " Si plus humoris e.xctrnitur quam affumitur, tunc demum fecund6 ) Patterfon fuppofes, it ought not to be omitted at any tihiej). Dr. Hunter has related a cafe, which the vapour bath effectually cured||. OPIUM. Ninthly. Can Opium be adminiftered with ad- vantage ? Patterfon thinks favourably of this remedy. It has been ufed by Percival, who fays, that opiates are neceffary in large and re- peated dofes, when the pains are very acute. Dr. Dawfon alfo tried this medicine, in the form of Theriaca Andromachi. As the Hydrocephalus bears fome relation to an inflammation of the brahij and as according to the moft celebrated writers* opium is impro- per in the Phrenitis, I wrould adminifter it with the greateft caution. STERNUTATORIES. Tenthly< Are Sternutatories ever proper ? I fhould fuppofe the fhock given to the head in the act of fneezing, could in no manner leffen the accumulation of blood, in the veffels of the brain, or produce an abforption of water from the ventricles. Befides, as the leaft motion of the head, muft be detrimental to the patient, I fhould not be difpofed to make the experi- ment. § Patterfon, p. 51. || Medical Comment, vol. 8. p. toy. * Vide Sydenham, Pringle ard Culleri. 1.-7 ] COMPRESSION OF THE CAROTIDS. I ithly. This has been propofed by Patterfon, in order to obviate a morbid acceflion of blood to the veffels of the head. We have no objec- tion to a trial of this practice, Fiat Expert- mentum, DIGITALIS. I2thly. Quin was not fortunate in his trial of the digitalis. Withering gave it to fome of his patients, and Patterfon is altogether filent on the fubject. AN OPERATION. I3thly. Can a puncture be made in the brain with fafety ? When the difeafe arifes from in- flammation, the operation promifes nothing, In chronic cafes it has been tried, but the pa- tients have Uniformly died.—Le Catt and Re- met* evacuated the water of feveral Hydroce- phalic patients, at different times, but death fol- lowed in every inftance. Dr. Monroet advifes us, if ever the operation is attempted, to make the opening with a lancet, and at a part w7here * Vide Le Catt Philof. Tranf. for 1751, ant Med. Commen, Vol. 6, p. 422. + Monroe on the Dropfy, p. 161. ( »« ) there is no danger of wounding any large artery or venal finus of the head. If ever the Hydrocephalus proceeds from an original laxity of the brain, we muft place our chief dependance upon that clafs of medicines, which are ufed in difeafes proceeding from de- bility. Erratum. In page 8th, fourth Line from bottom,— for water, read urine. MecL Hist. XI0 I7U ~ )