mation of the arachnoid, and especially of that lining the ventricles. Treatment.—The plan of Gölis is perhaps the one that has been most frequently adopted. It consists in the administration of calomel in quarter to half-grain doses twice a day, together with the inunction of one or two drachms of mercurial ointment into the shaven scalp once in the day; at the same time a flannel cap is to be worn to prevent chill. If no improvement take place at the end of six or eight weeks, diuretics are to be given, and an issue inserted in the neck or shoulders. Of course it is necessary to remember that some cases, especially congenital ones, and cases depending on malformation, are not susceptible of cure. Another plan is that of bandaging the head with flannel bands or strips of diachylon plaster; releasing it of course if symptoms of compression arise, which they sometimes do. A third plan is that of puncturing and evacuating the fluid. This is performed at the coronal suture with a small trocar and canula about an inch and a half from the anterior fontanelle, care being taken to avoid the longitudinal sinus-a portion of the fluid only is removed at a time, and pressure carefully maintained between the tappings. It is, however, evident that this method is not applicable to the ventricular form of the disease, but only to those of the so-called external hydrocephalus. Legendre gives a sign by which external hydrocephalus can be diagnosed" that it is never congenital, but begins usually about the tenth month, or about the period of the first dentition. The head enlarges gradually and does not attain the size it does in the ventricular disease, and it is, moreover, preceded by repeated convulsions and other forms of cerebral disturbance." There are also other points against the operation, as, for example, whether the fluid will not collect again, as in other dropsies; whether even if it did not, the state of the brain is such as to allow of reasonable hope of its recovering its functions. There is also danger of wounding some vessel of the brain, and, moreover, inflammation may be set up as a consequence of its performance. Dr Churchill gives a long list of unsuccessful cases, and also points out how frequently unsuccessful cases are not recorded. Still the fact remains that the operation has been occasionally successful, perhaps one case in fourteen has been thus cured. At any rate it shonld not be tried till other methods have failed, and then only in carefully selected cases. After tapping, injections of iodine, strong and weak, have been employed as it would appear without exciting inflammatory mischief. Then Dr Tournesko of Bucharest injected ziij of tincture of iodine in 3v of distilled water after tapping and drawing off 24 ounces of serum. After 15 days the child seemed in excellent health, the girth of the head being diminished from 56 to 43 centimetres. My own practice consists in the employment of blistering fluid, applied sometimes behind the ears, sometimes on the scalp, or upper portion of the spine. With these I administer the iodide of potassium in large doses, and very frequently I combine it with the Syr. Ferri Phosphat. Co. Several patients of mine at the Victoria Hospital have improved remarkably under this treatment. Iodide of iron is also very efficacious. The expediency of employing mercury is much disputed. No doubt its use is occasionally attended with excellent results, but probably, in the majority of cases, it is better avoided. Sir Thomas Watson records ten cases in which ten grains of crude mercury were rubbed down with 9j of manna and five grains of fresh squills, and given every eight hours, and this treatment proved successful in both instances when other means had failed. It was continued for three or four weeks and caused copious diuresis, emaciation, and debility, but no ptyalism. When the hydrocephalus disappeared, the strength was restored under the use of Griffiths' mixture. 13. TUBERCLE IN THE BRAIN Very rare in adults, is not a very rare affection in children. MM Rilliet and Barthez found tubercle in the brains of 37 out of 312 children between the ages of 1 and 15, in some organ or other of whose body tubercle was also deposited. The tubercular masses vary in size from a millet seed to a large walnut; in number, from a single mass to 40 or 50; the tubercle is sometimes crude; sometimes softened in the centre; generally globular; often very firm and less friable than in the lungs or lymphatic glands. The brain substance around crude tubercle is usually unchanged. It is common for the tumours to be attached to the pia mater; but they may be found quite unconnected with the membranes. The hemispheres, the cerebellum, and the pons varolii, are all frequent sites of their occurrence. These tubercular deposits are often associated with evidences of meningitis, as, for example, a granular condition of the membranes, an effusion of hyaline matter into the pia mater at the base of the skull, and the ventricles are also often distended with serum. It has been suggested that mechanical obstructions offered to the circulation by the pressure of the tubercular masses, is the explanation of this. It is rare for tubercle to be confined to the brain, it almost always coexists in other viscera, all the depositions being equally evidences of the diathesis, i. e. the tubercular. Symptoms. Unfortunately, these are very obscure, sometimes there are none at all, and tubercle in the brain is only discovered after death. At other times, headache is the only symptom, it may be expressed in the young child by drowsiness and listlessness, it is not uncommon for the headache to be of acute, intense, lancinating character, at times, or at others to be completely absent, such attacks combined with vomiting are exceedingly suspicious. Deafness, and discharges from the ears are very common. Amaurosis is not rare. Convulsions occur especially when the tubercles are in the central portion of the cerebral mass. Rigidity, or contraction of one or other extremity, is not uncommon. Dr West points out that convulsions may occur on one side only and yet the tubercle be found on both sides of the brain; or the convulsions may be general, and the tubercle only on one side. In a word, no disease presents symptoms more variable, because of the many secondary affections excited, e. g. encephalitis, tubercular meningitis, &c., and also because of the variety produced by the different position and condition of the tubercular matter, which may be crude, softening, or cretaceous. The following summary will afford the best clue to diagnosis. 1. The age: the disease being commonest before three years. 2. The general history, if tubercular or otherwise. 3. Headache, irregularity of the pulse, and coincident otorrhoea. 4. Tubercular infiltration of other organs. 5. The chronic course of the disease as contrasted with the acute course of other cerebral affections in childhood. The prognosis is grave, but not wholly hopeless, remembering the cretaceous state in which the tubercle is sometimes found after death. Treatment.-Improving the general health and treating symptoms as they arise, are the two chief indications, for instance, gastro-intestinal irritation must be checked by gentle aperients, regulated diet, &c. ; and attacks of cerebral congestion call for purgation, cold to the head, and moderate counter-irritation. These cases are, in fact, more susceptible of improvement by treatment than might be supposed, but it would be impossible in a disease of such protean manifestations to lay down exact rules. Setons and issues are highly spoken of so also is tartar-emetic ointment. Cod-liver oil and steel are of course valuable. Iodide of iron with an occasional aperient, moderate counterirritation, and well-regulated diet, is the proper treatment of many cases. Bromide of potassium is valuable when there are convulsions or general irritability. Cocoa, chocolate, and Iceland moss are highly nutritious substances, of much value in the diet of these difficult and trying cases, in which a change often seems so beneficial to the child when sickened of its ordinary food. 14. CHOREA, OR ST VITUS'S DANCE This disease is not absolutely limited to childhood, but it is commonest between the ages of seven and fifteen years. The disease may either set in suddenly, or with some gastro-intestinal disorder and irritability of temper. This is followed by slight twitching, convulsive movements of the face or one of the lower extremities; these gradually increase in severity, extending to the other limbs and even to the tongue. This condition of course |