Other determining causes besides the visceral sensory distribution (gastro-in testinal) are such as disordered dentition (fifth nerve); the various infections, espe cially whooping-cough, syphilis, scarla tina, and the other exanthemata; pto maines and leucomaines, unemia, mala ria, heat, cold, febrile states, burns, fatigue and depressing influences, blood loss, shock, emotions, fright, anger, etc. Of poisons, some are the toxins generated within the organism alluded to, and others are swallowed, among which should be borne in mind lead, alcohol, etc.
Interesting cases were reported by D. D. Stewart among a series of children poisoned by lead used as coloring matter in cakes. Meunier reports cases of con vulsions caused in nursing where the nurse took large amounts of alcohol. Many of these causes are aggravated by meteorological conditions, especially of hot weather in summer. It has long been believed that convulsions frequently oc curred as a prodrome in pneumonia, but Gossage and Coutts show a series of 166 cases with this symptom in only 8, or 4.7 per cent.
Convulsions—and these the more seri ous ones—are also due to various forms of cerebral disease: haemorrhage, internal pressure as from rapidly increasing hy drocephalus or abscess, and emboli and thrombosis, and, above all, rickets. Only a small proportion of cases of convulsions, however, are demonstrated to occur in children who have evidences of rickets.. In them motor disorders are more likely to be tetany and laryngospasm. The. brain presumably suffers from malnutri tion in all these disorders, and to this the instability is clue.
Prognosis.—In estimating the dangers resulting from convulsions it is necessary to consider the nature and extent of the cause. In children of a markedly un stable nervous equilibrium a convulsion may mean little or nothing. Moreover, moderate convulsions occurring in young infants are of small import. Fits appear ing as prodromes of acute febrile diseases are rarely serious and may not even indi cate an unusually severe attack of the disease. When they occur after the estab lishment of the characteristic features of the disease they are of deeper significance, and may indicate the oncoming of ne phritis, meningitis, or other grave com plications. Those points on which one is likely to base a serious prognosis are ex treme prolongation or frequent recur rence of the convulsions; also profound disturbances of the circulation, stupor, or subsequent prostration.
Gossage and Courts lay great stress on the facts that the danger of future neu rotic manifestations has been underesti mated; predisposing causes are of more importance than the exciting causes; and that the slighter exciting causes will not produce convulsions except in children so predisposed. Statistics were produced at the 1S99 meeting of the British Med ical Association, showing that over one half of the patients who had exhibited convulsions in infancy suffered from some form of neurosis. And they were not so much to be ascribed to the mal nutrition of the nervous system in in fancy or to damage during the convulsive stage as to congenital faulty development.
This particularly in children of gouty, nervous, rheumatic, or diabetic parents, and it is in whom such a family diathesis is known to exist that any extreme of reflex irritation must be repressed or it will result in a nervous explosion.
Treatment. — The treatment of con vulsions divides itself in two very un equal halves: to overcome the symptom and to master the underlying condition. The indications, for the first, are to hasten to the case with all speed, to promptly secure various items of equip ment, which may, any or all. be needed, but the absence of any one of which may cause serious embarrassment, possibly danger of life.
A severe or continued condition of con vulsions may produce serious damage to remote organs and tissues. The ex plosion may be overcome by the inhala tion of chloroform, which, in the condi tion of such a state of nervous exaltation, is quite safe. To this may be added, with advantage, nitrite of amyl and sulphuric ether. The mixture I have used for years most successfully in the paroxysm of per tussis is equally applicable here: amyl nitrite, 1 drachm; spt. of chloroform, 3 drachms; ether. sulph., 5 drachms. It is well to loosen the clothing, or, better, to promptly remove them. Thus, many important points may be revealed. Often the child will be found in a bath of hot water, perhaps mustard is added. In the excitement this may have been so hot or irritating as to cause damage, and it is best to remove the child at once, and it may be necessary to investigate the condition of the skin and apply emol lients. If not in a bath, it is often use ful to apply mustard pack—which con sists of 1 teaspoonful of dry mustard rubbed up with 1 ounce of water and added to a quart of hot water, and into this a sheet, or bath-towel is dipped and wrapped around the child. After this has been applied for a suitable time, or during the continuance of it, a careful search should be made for various sources of reflex irritation. The chief of these may be found in the digestive tract, and the next routine procedure to be recom mended is to apply a cleansing enema. This enema serves several valuable ends in removing knees or undigested food. and, if hot, aids in stimulating capillary relaxation. If the temperature be found high, this can be followed, with advan tage. by a cool enema. If subnormal, as is the case frequently in the convulsions following summer diarrhceas, a salt enema supplies fluid by imbibition, or hypodermoclysis may be even better. I have seen lives saved by this. In hyper pyrexia cold to the head is in most cases a useful measure. If congestive states are pronounced, local blood-letting by leeches is of much use, and is recom mended by Baginsky and others. Lum bar puncture is a safe measure too, and this I have done with great satisfaction many times. If the convulsions be un duly prolonged, the use of morphine hypodermically is both safe and gratify ing. If the first dose (of, say, grain to a six-month-old baby) is not sufficient, a second may be given in an hour, of double the first dose, and again, in an hour, double of this, if needed.