Contribution to the morbid anatomy and pathogenesis of chronic internal hydrocephalus / by Harold J. Stiles.

  • Stiles, Harold J. (Harold Jalland), 1863-1946.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Contribution to the morbid anatomy and pathogenesis of chronic internal hydrocephalus / by Harold J. Stiles. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    29/38 (page 543)
    for a dilated aqueduct, that it is more than probable this error has actually been committed in the reports of post- mortem examinations of hydrocephalic brahis. The funnel- shaped dilatation, which is sometimes referred to as occurring at the anterior end of the aqueduct, may, in some cases, have been notliing more or less than the posterior part of the third ventricle. Pathogenesis. “ This subject,” says Hamilton 0, “ is so complicated that it would be injudicious to say much about it; there are so many possibilities, and so few facts to support them, that it would require much definite experimental evidence to arrive at any- thing like a satisfactory conclusion.” While fully appreci- ating both the difficulty and the obscurity of the subject, I think that, after a careful inquiry into the morbid anatomy of the disease, a few remarks on the pathogenesis of the condition may be permitted, even at the risk of not being able to make any important addition towards the solution of the problem. I shall confine my remarks to those cases in which no obvious lesion exists to account for the hydro- cephalus. Several more or less plausible explanations of the condi- tion have been put forward, but none of them can be said to have advanced much beyond the stage of hypothesis. That in many cases the affection is already so far advanced at birth as to give rise to difficulty in the passage of the head along the maternal passages, is of course well known. It should be remembered also, that the ventricles may be markedly dilated without giving rise to any enlargement of the head, and that this may occur in infants as well as in adults. Such cases have been described, more especially by Chiari (^). It is only fair to suppose that in those cases in which the head begins to enlarge within a few weeks or months after birth, and in which no obvious cause or lesion is discover- able post-mortem, that the condition is here also probably congenital. Admitting, then, the congenital origin of the two cases I have described, we have next to consider their causation. We