Hypertrophy of the Brain is a comparatively rare disease, and has attracted little notice in England. Laennec first drew attention to its occurrence in children, and to its similarity to chronic hydrocephalus in many of its symptoms, and the likelihood of its being mistaken for it. The cause of the disease is obscure. Brunet defines it “as an increase in the weight of the organ due to a disorder of nutrition, leading to an alteration in the nervous “substance.” The process is not one of mere increased growth, but the nutrition of the organ is modified in character as well as increased in activity. According to Rokitansky the augmented bulk is not produced by the development of new fibrils, or by the enlargement of those already existing, but by an increase in the intermediate granular matter, most probably due to an albuminoid infiltration of that structure. My own observations lead me also to the opinion that the disease, as seen in imbeciles, is due to an increase in what appears to be granular matter, for in some sections, which I have in my possession, this is seen. The change is accompanied by an increase in the number of the blood vessels, and the presence of a large number of leucocytes. Andral states that in two post-mortems made by himself, the white matter resembled the white of egg hardened by boiling. In one post-mortem only have I noticed any peculiarity in the white matter, and in that case I find I have recorded that it was of a “peculiar whiteness.” The parts affected are chiefly the white matter of the two hemispheres, sometimes the corpus striatum and optic thalamus, rarely the pons and cerebellum. MM. d'Espine and Picot consider the affection to be a congenital one, and in this opinion I concur. They hold, however, that imbecility only results when hypertrophy of the brain is accompanied by sclerosis. My experience does not lead me to this opinion, for in none of the seven post-mortems which I have made was sclerosis present. Brunet, too, describes two cases of hypertrophy of the brain without sclerosis which he has seen in idiots. Both d'Espine and Picot and Brunet describe two forms of the disease; in the one the hypertrophy is simple, in the other accompanied by sclerosis. The principal symptoms are headache, at times intensified, excitement followed by coma, blunting or arrest of development of the intelligence, difficulty in walking, and convulsions. The symptoms are said to be less marked in children than adults, because the brain is less compressed, the cranial cavity increasing in size as the brain enlarges. I proceed to relate particulars of some cases which have come under my observation.
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