A Letter from Mr. John Friend to Dr. Sloane, Dated Oxon. Jul. 26. Concerning an Hydrocephalus

III. A Letter from Mr. John Friend to Dr. Sloane, dated Oxon. Jul. 26. concerning an Hydrocephalus. Sir, The encouragement you give to Enquiries of this Nature, by communicating your own Observations, as well as recommending those of others, makes me trouble you with the following account: Having had the good luck to meet with an Hydrocephalus which seem'd to have somewhat extraordinary in it, I thought it might not be improper to acquaint you with it. I shall only set down the particulars, as they offer'd themselves in Dissection, and leave it to your Judgment, whether they deserve to be taken notice of or no. The outward Dimensions, taken before the Head was open'd. | Dimensions | Inches | |-------------------------------------------------|--------| | From the Eyebrows over the Crown to the Nape | 23 | | Circumference from the Nape round | 26 | | From Ear to Ear, over the Crown | 19 | | From the Eyebrows to the Chin | 4 | | From one extremity of the Eyebrows to the other | 4 and half | | From the Chin to the coronal Suture | 7 and half | | Circumference from the Chin round the Crown | 30 | | From one extremity of the Ear backward to the other | 12 | | From Temple to Temple over the Fore-head | 11 | | Circumference of the Head round the Os Frontis & Occipitis | 29 | Circumference of the Neck 9 and half Length 2 Length of the Body 33 Circumference of the Thorax 18 Length of the Foot 4 and half From the middle Fingers end to the Acromion 12 and half Arm 5 Circumference of the Calf 5 and half Thigh 8 After the integuments were remov'd the top of the Cranium appear'd soft & Membranous. The extent of the Membran from one Temple to the other was 8 Inches, between the parietal bones 3 and half, from the Os frontis to the Os Occipitis 12. In the middle just upon the Crown lay a Bone (in some places a little Cartilaginous) 5 inches long, and 1 broad, join'd to the Membran on every side; of the same thickness with the rest of the upper part of the Cranium that was bony, which was extremely thin everywhere, and the Laminae lay so close that in many places no diploe cou'd be discern'd. The Membran was as thin as the Pericranium which yet was easily divided from it. None of the Sutures were entirely clos'd, those of the upper Jaw very loose. In the Temporal and Lambdoidal was an infinite number of the Triquerra Wormiana, all which had so many distinct Sutures. Upon piercing the Dura Mater, a great quantity of Water flow'd out; it lay as well between the Dura Mater and the Pia, as in the Ventricles of the Brain. The Liquor was thin, pale, and insiped, there was taken out Five Quarts of it. The Dura Mater was firm and entire, of its usual thickness, and stuck very close as well to the Membranous as to the bony parts of the Cranium. All its Processes and Sinus's were singular, the 4th sinus somewhat larger A very large Vein of the Dura Mater enter'd the Longitudinal sinus; directly forwards towards the Crista Galli, contrary to the Course of the Blood. The Pia Mater was very much distended, and seem'd to be stretch'd as much as it cou'd bear. It lay smooth and equal upon the Surface of the Brain, there being neither any Circumvolutions in the Brain for it to go between, nor any Partition to the Corpus Callosum, tho' there was a large Falx in the Dura Mater. The lateral Ventricle were very thin: Towards the Cerebellum their upper part was quite wasted, so that nothing was left to cover the Cavity in that place, but the Pia Mater. This was so thin, that in stooping down the Head to empty the Water, it broke and hindred us from knowing exactly how much Water the Lateral Ventricle contain'd; but by their Cavity, which was very large, one might guess they held at least a Pint each. The 3d. and 4th. Ventricles had some little Water in them, but were scarce larger than usual, as Steno hath observ'd in his Hydrocephalous Case. The Brain had all its Parts plain and entire, tho' its Substance in most places was but very thin and loose: About the Corpora Striata & Thalami nervorum Opticorum it was tolerably thick, and firm enough, tho' nothing to what it is in a natural State. The Cerebrum & Cerebellum, when laid out in their right Position were 11 Inches long; the Cerebrum, cross the lateral Ventricle, 9 broad. After all the Water was taken out, both of them weigh'd, lib. 1 ff. The Corpora Striata & Thalami Nervorum Opticorum were very small in all their Dimensions; within side toward the Ventricle they were wrinkled and lay in folds, like those in the inner Coat of the Stomach. In the Corpora Striata there were no Striae discernible. The plexus choroides was very small. The Glandula pinealis was somewhat bigger, but less compact than ordinary. The Nates were very red and large; 2 inches long, broad, and thick: The Testes were not distinguished from the by any Protuberance; they seem'd rather to be a Production, into which the Nates lessen'd by degrees like a Sugar-loaf. The Cerebellum was very firm everywhere, and did not much exceed its natural Bulk. The Medullary Trunk which tends out those little Branches, like Trees, was thicker and harder than usual; the Branches were not so much dispos'd, like those of a Tree, but went rather in single oblique Lines, like so many Rays drawn from a Point. The Nerves were all regular and plain; only the Olfactory were very small, the Optick did not join before they enter'd the Orbits. The Rete Mirabile was very large, so was Dr. Ridley's Circular Sinus. On the right side were two Carotid Arteries (the intercostal Nerve lay between them) they enter'd the Skull at the same hole. The Trunk of the Vertebral (where those Arteries unite) was extremely big and full of Blood. The Veins were neither larger, nor more than usual. Upon the Brain over the Lateral Ventricles, I cou'd easily discern three or four Lymphatics; but they were too small to be trac'd. Whether this great Effusion of Water was caus'd by an Obstruction in the Capillary Arteries, (which might make the finer part of the serum ooze thro' their Coats) or by a Rupture in the Lymphatics, must be determin'd by those of a better Judgment, at least of a stronger Conjecture. The Mother brought the Child to Oxford for a Sight, the Account she gave of it was, that she was in Travel three Weeks, and that at last she was forc'd to have the Vagina rip'd for its Passage. The Child was two Years and six Weeks old, it cou'd speak a little, cou'd not go, or hold up its Head; 'twas always Merry, never subject to Drowlines, Pain in the Head, want of Appetite, or Indisposition. Its Sight was somewhat Dim, and its Smelling but dull. It never had any Illness, only two or three Days before it Dy'd, 'twas very much troubled with the Gripes, and upon opening the Abdomen, the Guts were found extremely swell'd with Wind. Every thing else in both the lower Cavities was as it shou'd be. By comparing those two Hydrocephali, which Tulpins gives an Account of; we may see how different each of them is from this. For his first was a Boy five Years old, the Skull no bigger than a Man's, and only five Pints of Water in it; the Brain had lost all its Shape, and most of its Substance, the Relicks of which stuck to the Skull. He says nothing more of the latter, than that it had a Quart of Water in one of the Lateral Ventricles. Honoured Sir, Your very humble Servant, John Freind.