A succession of grimaces due to con traction of the facial muscles may be the only early change seen; or later the hands may be clenched, the thumbs being buried in the palms; the great toe extended downward—"carpo-pedal spasms"—or these phenomena again may be followed by a general commotion; frothing at the mouth; disturbed respi ration and pulse, slow or rapid, usually irregular; sweating of the forehead, and blueness of the lips and face. The sphincters may become relaxed, urine and feces being passed involuntary. After the fit there is usually evidence of prostration, and temporary palsies not infrequently follow, due to exhaustion of the nerve-centres. One attack of con vulsions is commonly followed by others, exhibiting an increasing susceptibility. Convulsions coming on in a child pre viously well point to some acute disease of exceptional severity, or possibly acute meningitis. Convulsions occurring in most forms of brain disease are not usu ally accompanied by marked tempera ture-rises, but are liable to exhibit pupil lary changes, strabismus, rigidity, or lo calized palsies.
Etiology.—Convulsions, local or gen eral, arise in excessive and irregular dis charges of nerve-centres in the cortex or base of the brain. Nothnagel suggests a convulsive centre in the pons.
Experiments by Suschtschinski and Wyrubow (von Bechterew in Neurol. Centralb., No. 4, '97) have shown that the convulsions caused by irritation of the pons are not the effects upon a con vulsion centre, but due to the transmis sion of irritation to the cerebral hemi spheres and especially the motor cortex.
The seat of discharge in convulsions is presumably in the ganglion-cells of the brain, and molecular disturbances in these cells necessary to the morbid dis charge are determined either by direct irritation of those centres or reflexly through peripheral irritation. The phe nomena have to do with exaltation of the lower centres or loss of inhibition in the higher centres, or both.
In infants the nervous system is struct urally immature, hut in process of rapid development. Even after structural completion time is required to attain functional stability.
At birth the lower centres only are developed; hence control is limited until the higher centres become competent to exert inhibition. In the earlier months of life convulsions are common, progress ively less so after birth to the first year of life (Nassowitz), and are more rare after the second year.
It is unusual, perhaps impossible, for a healthy child to suffer from convul sions, unless the exciting cause be over whelming, such as trauma, an intense irritant, or poison. Convulsions readily
occur in children of unstable equi librium. This dangerous condition may arise from inheritance or become ac quired, and is of very varying degree. One convulsion predisposes to another, and the habit may become fixed.
Some families are especially prone to suffer ill effects from motor excitements, or their infants offer but feeble resist ance to excitants, be these physical or psychical. Again, individuals vary from time to time, and are rendered suscepti ble by depressing causes, nutritional and emotional, as well as by the onset of definite disease.
Exciting causes are chiefly reflex from peripheral irritations, inducing overactiv ity in convulsive centres. The history of many of these must be received with cau tion. since deeper causes can usually be found where careful search is made, more probably several causes acting to gether: vasomotor instability, temporary or prolonged; states of anaemia, varia tions in blood-supply and quality, along with states of certain special nerve irri tation, as that of the fifth or gastroin testinal supply and rickets, the extremes of heat and cold, produce conditions which react in convulsions readily to relatively slight exciting causes.
What part is actually played by dis ordered dentition is not determined, but the weight of modern evidence is against this being of great significance. Some go so far as to assert that it is absolutely nil, others admit that it exerts some posi tive influence. Certainly it is not shown to be a large factor. The lancing of the gum over an approaching tooth often re lieves the spasm. In the same category of doubtful causes may be mentioned the presence of intestinal parasites, where re moval is, however, of practical value.
Convulsions in male children are so often dependent upon an adherent pre puce that one should make it a rule, in such cases, to look for this condition and relieve it. Ewing (Phila. Med. Jour., July 1, '99).
Of the determining causes, by far the most important is the use of improper food, unsuited in amount, kind, or con dition to the needs of the young child. This acts often as both fundamental and exciting cause. Milk from a mother or wet-nurse may be vitiated by various causes,—fatigue, emotional,—or it may act as a medium of poisons,—such as alcohol.—and has been known to cause convulsions.
A nursing infant is often most seriously disturbed, and sometimes even thrown into violent convulsions, by changes in the lacteal secretion brought about by unusual or excessive coitus. A. C. Cot ton (Phila. Med. Jour., July 1, '99).