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been developed insensibly. The forehead was high, but not prominent, and the occipital protuberances had acquired a · great magnitude. For a long time he did not complain of pain, and was only annoyed by the weight of the head, which, in running, was suddenly projected forwards, and caused him to fall. This inconvenience gradually increased, and in the last year of his life occurred very often. The intelligence of the young patient presented nothing remarkable ; he understood and retained very well whatever was said to him, but surpassed in nothing other children of his own age. When he sat down and remained quiet, it very often happened that he fell into a profound sleep, but with no unusual appearance.
All the functions of young Peisset were performed with regularity, and no apparent cause had yet occurred to disturb them, when on a sudden, on the 1st day of September, 1823, the appetite disappeared, thirst became urgent, and dull pain was felt in the epigastrium. The abdomen remained soft; the pulse was hard, full, and frequent ; in regard to the encephalon there was little alteration in the intellectual functions; but there was a considerable drowsiness which ceased when spoken to. The alvine evacuations were rather scanty, but were promoted by castor oil and other means, which caused the expulsion of several worms without any amendment.
During fifteen days the morbid phenomena offered no perceptible change, and nothing was ordered but emollients and light soups.
On the sixteenth day an increase of all the symptoms suddenly occurred; the intellectual functions were completely abolished; the pupil of the eye was dilated, but the iris retained its contractility ; respiration became difficult ; the pulse became slower and softer; and at four in the afternoon the young patient expired without any unusual nervous symptom.
VOL. IV.No XIII.
Head very voluminous, evidently larger than that of an adult of great stature. The posterior ovale is especially very much enlarged ; the eyes do not project beyond the sockets; the abdomen is not large; and the inferior extremities are rather slender.
On opening the skull, the latter is found to be from one and a half to two lines in thickness; the dura-mater is strongly adherent to the skull, and its vessels distended, but without alteration of structure; the pia-mater, very red in all its points, presents in several places very visible sanguinolent exudations, as well as several white laminæ, formed by its thickening, and all its folds and the choroid plexus are strongly injected. The very voluminous brain presents in all its parts a consistence greater than that generally observed in a child of five years. Its substance, of a rosy hue, offered no appearance of degeneration. The unusual development of the brain had taken place chiefly at the upper and posterior part of the hemispheres; and this is demonstrated by my having to make a perpendicular incision of nearly three inches before arriving at the ventricles, while below these there was only one inch of substance. The ventricles contained a very small quantity of reddish serosity.
M. Scoutetten gives this case of hypertrophy of the brain as a specimen of an exceedingly rare and curious affection never before observed ; and he takes occasion to express his astonishment, that the intellectual faculties did not present any extraordinary degree either of precocity or activity; and he adds, that if a few more such cases shall occur, it will be necessary for physiologists to admit, that the great development of the cerebral masses is not always attended with a great degree of intelligence. In both of these respects, however, M. Scoutetten is wrong. Other cases of a similar morbid growth are on record, and living instances not unfrequently present themselves, though to a less extent, in
rickety and scrofulous children, the size of many of whose heads strikes every one as out of all proportion to their feeble bodies. In many of these cases, where considerable activity or irritability exists, there is a corresponding precocity of mental power, which often excites the fondest hopes and the warmest admiration of the parents, but which, under injudicious management, ends in bitter disappointment. Urged on by the brilliant maturity of the youthful mind, and not aware how much of the effect is dependent on an irritability bordering on active disease, the parents, by way of encouraging and fostering talent and genius, too often defeat their object, and either altogether exhaust the little real energy existing, or, by exciting too much and too long, pave the way for a train of convulsive and nervous symptoms which put a period to life itself; where, by a more judicious training, and by exercise proportioned to the state of the constitution, talent and health might ultimately have been secured on a more solid basis. Many little prodigies thus sink into an untimely grave,'or, by pure exhaustion, become unfit for any even ordinary mental exertion, and pass through life, not like beings moved by their own internal resources, but constantly requiring the aid of others to help them on their way.
Others again of these large-headed children, who, like that mentioned by Scoutetten, show no superiority during their earlier years, occasionally shine forth at the age of maturity as beings of a higher order than their earlier manifestations gave any reason to expect. This happens when, by the lapse of time, favourable circumstances and restored constitution, the development, which originally sprang from disease, becomes animated with the full vigour of health. It is absurd, then, in M. Scoutetten to say, that if several such cases as that of young Peisset should occur, we shall then be forced to admit, that size is not the only condition of superior power; for, without waiting any longer, we have already facts more numerous than a man's small brain can hold to prove, that other conditions as well as size must be attended to; and if the Phrenologists become tiresome by constantly
calling attention to the ceteris paribus, their excuse is, that still it is overlooked, not by the vulgar only, but by men of professional and philosophical eminence ; and although they are themselves almost sick with the repetition, and would gladly have it understood rather than expressed, yet, while the public remains deaf to the sound, they, disagreeable as it is to themselves, and to those who do listen, must only cry the longer and the louder, till they succeed in forcing general attention.
Thus, in the case more immediately under consideration, it was solely from M. Scoutetten not attending to the signs of diseases which he had previously enumerated, both as regarding the increased vascularity and consistency of the brain, and the sanguinolent exudations, and white lamina and thickening of the pia-mater, and from not attending to the fact which he himself had stated of the unusual development having taken place chiefly at the upper and posterior parts of the hemispheres, or region of the sentiments and propensities, not in the anterior part, or where the organs of the intellect are situated, that he was led to wonder that the same effect does not always follow from causes essentially different; whereas, if he had considered for a moment, that a large head, remarkable for intellectual power, differs from the one described in the very important conditions of health, and of great development of the anterior part of the brain, he would at once have recognised, that, although size was a principal condition of power, yet it was not so much so as to supersede all other circumstances. In other words, he would have expected similar effects to present themselves only where the causes producing them were also similar.
As the growth and decrease of the brain are involved in considerable obscurity, it may be worth while to lay before our readers rather a singular case which came under the notiu of the celebrated Baron Larrey, and which is narrated at p. 41 of that author's Memoires de Chirurgie, &c. It is remarkable as an instance of an increased size of the head from disease being followed by a diminished power in all the
sensitive and intellectual functions, and by the decrease consequent upon recovery being attended with the restoration of these functions to their usual state of activity.
A young trumpeter of the chasseurs de Tergarde, after a fall from his horse, on the head, was tormented for two years with epileptic attacks so close upon each other, that they often came on twice in one day. The skull was deformed, and had acquired such a size in a short time, that his uniform-hat, received at entering the regiment, was now five or six lines too strait for him. The eyes were very prominent and almost immoveable, the face discoloured, the pulse slow and caudal, the respiration laborious; the contractions of the heart were distant and scarcely sensible. The extremities almost always cold. Standing and walking were accomplished with difficulty, and all the sensitive functions, and sight in particular, as well as the mental faculties, were very much weakened ; lastly, every thing remained une gêne et une compression sans doute concentrique du cerveau, the effects of which augmented in proportion to the variations of the atmosphere and other determinate causes. After a large bleeding from the jugular, the application of several cupping-glasses to the nape and temples, that of ice to the head, and mustard-baths to the feet, and the internal use of calomel, 15 moxas were applied round the head, and especially in the course of the original lateral and posterior fontanels. The symptoms diminished gradually and progressively, so as to render the attacks slighter and rarer, till at last they disappeared entirely, and the patient was perfectly cured before the end of ten months. All the animal and sensitive functions were soon re-established ; and a remarkable thing is, that the voute du crane was reduced in its circumference, the primitive conformation of these bones was gradually reproduced, and, when the trumpeter left the hospital, his hat, at first too tight, was now four or five lines too wide; so that a reduction of eight or ten lines had taken place in the circumference of the head.