In the great majority of cases the symptoms of congestion of the brain come on slowly; and for the most part, general uneasiness, or disordered state of the bowels, which are usually, though not invariably constipated, and feverishness precede for a few days the more serious attack. The head by degrees becomes hot, the child grows restless and fretful, and seems distressed by light, or noise, or sudden motion, and children who are old enough sometimes complain of their head. Usually too, vomiting occurs repeatedly; a symptom of the greatest importance, since it may exist before there is any well-marked sign of head affection. Causeless frequently repeated vomiting in a child not ill but ailing, is nine times out of ten a sign of mischief in the head. The degree of fever which attends this condition varies much, and its returns are irregular; but any one who knows how to feel the pulse will find it permanently quickened, and if the head is unclosed the pulsations of the brain may be seen and felt distinctly. The sleep is disturbed, the child often waking with a start, while there is occasional twitching of the muscles of its face, or of the tendons of its wrist.
The child may continue in this condition for many days and then recover its health without any medical interference. This is especially likely to be the case with children while teething, the fever subsiding, the head growing cool, and the little one appearing quite well so soon as the tooth has cut through the gum, but the approach of each tooth to the surface being attended by the recurrence of the same symptoms.
The fortunate issue of these cases though frequent, is by no means invariable, for sometimes they are but the precursors of that formidable, I might indeed say, all but hopeless disease, water on the brain. But even of itself congestion of the brain is by no means a trivial ailment, for it may pass into a stage in which the smaller discomforts of the child lead to the sad mistake that the condition of the child is improving, instead of which it is really the dulling of sensibility from approaching death. The head, indeed, becomes less hot, the flush of the face grows slighter and less constant; but the countenance is heavy and anxious, the indifference to surrounding objects increases, and the child lies in a state of torpor or drowsiness, from which indeed it can at first be roused to complete consciousness The manner on being roused is always fretful, but, if old enough to talk, the child's answers are natural, though generally very short; and murmuring, 'I am so sleepy, so sleepy,' it subsides into its former drowsiness. The bowels generally continue constipated, and the vomiting seldom ceases, though it is sometimes less frequent than before. In this state, without any apparent cause, the child sometimes has an attack of convulsions, which subsiding, leaves the torpor deeper than before. The fits return, and death may take place in one of them, or the torpor growing more profound after each convulsive seizure, the child at length dies insensible.
Now and then, especially in infants of only five or six months old, recovery takes place even where there seemed almost no ground for hope. The overfull vessels have at length relieved themselves, fluid has been poured out into the cavities of the brain, the yielding skull has given way under the pressure from within, and should the child after all survive, its large head, due to chronic water on the brain, tells to all who know how to interpret the signs, the tale of its past illness, and the manner of its imperfect recovery.
Cases such as these are obviously beyond the reach of domestic management, and call for all the resources of medical skill. The mistake commonly made is that of calling in the doctor too late, because it is not realised how grave may be the import of symptoms which at first appear so little alarming; and the so-called experienced nurse having said, 'Oh! it's nothing but the baby's teeth,' time is lost and danger not anticipated till too late for remedy.
The application of two, three, or four leeches at the very outset of these cases is often of great service, and sometimes cuts short symptoms which had seemed very threatening. The doctor, of course, must be the judge of its expediency, but I refer to it because I have known parents raise objections to it, and beg to have milder means tried first. It must be borne in mind then, that whenever leeches are of use it is at the beginning of an attack, and that the opportunity once let slip does not return. Purgatives, cold to the head, saline medicines, and perhaps some carefully selected sedative, are the measures which will probably be employed in most cases, but success will in great measure depend on the minute care with which all the details which I dwelt on in the introduction, are carried out.
It is not always, indeed, that active treatment is desirable, and gentle measures then suffice; but nothing except close and frequent watching can enable the doctor to steer safely between the two opposite dangers of too little and too much.
When I come to speak of the eruptive fevers, I shall have to mention the convulsions and other signs of most serious brain disturbance, which sometimes occur at their outset, and which are due to the condition of the blood charged with the fever poison.
A somewhat similar set of symptoms, attributed with reason to the overheated state of the blood, occurs in cases of sunstroke. It is true that sunstroke, with the formidable characters that it presents in hot countries, is not seen in England, but even here the mere exposure of an infant or young child to an overheated atmosphere, is by no means unattended with risk, and I refer to it here, because mothers are by no means aware of the danger, and believe that it suffices to guard the child from the direct rays of the sun.
Alarm, restlessness, and fretfulness, alternating with drowsiness, hurried, irregular breathing, intense heat of skin, violent beating of the open part of the head, twitching of the limbs, and starting of the tendons of the wrists, with a pulse too rapid to be counted, are the symptoms when the attack is severe. Convulsions are rare, though they sometimes occur. Sickness is almost invariable, the stomach rejecting everything, and the bowels are almost invariably relaxed, severe diarrhœa or dysentery sometimes coming on, as the brain disturbance abates. The first shock may kill the child in a few hours, or it may sink under the subsequent diarrhœa, but as a rule recovery eventually takes place.