Medical Inquiries and Observations, Vol. 2 / The Second Edition, Revised and Enlarged by the Author

by Benjamin Rush

1. The internal dropsy of the brain is a disease confined chiefly to children.

2. In children the brain is larger in proportion to other parts of the body, than it is in adults; and of course a greater proportion of blood is sent to it in childhood, than in the subsequent periods of life. The effects of this determination of blood to the brain appear in the mucous discharge from the nose, and in the sores on the head and behind the ears, which are so common in childhood.

3. In all febrile diseases, there is a preternatural determination of blood to the brain. This occurs in a more especial manner in children: hence the reason why they are so apt to be affected by convulsions in the eruptive fever of the small-pox, in dentition, in the diseases from worms, and in the first paroxysm of intermitting fevers.

4. In fevers of every kind, and in every stage of life, there is a disposition to effusion in that part to which there is the greatest determination. Thus, in inflammatory fever, effusions take place in the lungs and in the joints. In the bilious fever they occur in the liver, and in the gout in every part of the body. The matter effused is always influenced by the structure of the part in which it takes place.

These propositions being premised, I should have proceeded to mention the remote causes of this disease; but as this inquiry may possibly fall into the hands of some gentlemen who may not have access to the description of it as given by Dr. Whytt, Dr. Fothergill, and Dr. Quin, I shall introduce a history of its symptoms taken from the last of those authors. I prefer it to the histories by Dr. Whytt and Dr. Fothergill, as it accords most with the ordinary phenomena of this disease in the United States.

“In general, the patient is at first languid and inactive, often drowsy and peevish, but at intervals cheerful and apparently free from complaint. The appetite is weak, a nausea, and, in many cases, a vomiting, occurs once or twice in the day, and the skin is observed to be hot and dry towards the evenings: soon after these symptoms have appeared, the patient is affected with a sharp head-ach, chiefly in the fore-part, or, if not there, generally in the crown of the head: it is sometimes, however, confined to one side of the head, and, in that case, when the posture of the body is erect, the head often inclines to the side affected. We frequently find, also, that the head-ach alternates with the affection of the stomach; the vomiting being less troublesome when the pain is most violent, and vice versâ; other parts of the body are likewise subject to temporary attacks of pain, viz. the extremities, or the bowels, but more constantly the back of the neck, and between the scapulæ; in all such cases the head is more free from uneasiness.

“The patient dislikes the light at this period; cries much, sleeps little, and when he does sleep, he grinds his teeth, picks his nose, appears to be uneasy, and starts often, screaming as if he were terrified; the bowels are in the majority of cases very much confined, though it sometimes happens that they are in an opposite state: the pulse in this early stage of the disorder, does not usually indicate any material derangement.

“When the symptoms above-mentioned have continued for a few days, subject as they always are in this disease to great fluctuation, the axis of one eye is generally found to be turned in towards the nose; the pupil on this side is rather more dilated than the other; and when both eyes have the axes directed inwards (which sometimes happens), both pupils are larger than they are observed to be in the eyes of healthy persons: the vomiting becomes more constant, and the head-ach more excruciating; every symptom of fever then makes its appearance, the pulse is frequent, and the breathing quick; exacerbations of the fever take place towards the evening, and the face is occasionally flushed; usually one cheek is much more affected than the other; temporary perspirations likewise break forth, which are not followed by any alleviation of distress; a discharge of blood from the nose, which sometimes appears about this period, is equally inefficacious.