Of the remaining theories in regard to the pathogenesis of func tional convulsions in childhood we shall briefly mention the three which, in our opinion, are the most itnportant and for the present shall not indulge in any critical comment, which will develop naturally in the course of our exposition of the subject.
The first may be briefly designated the autointoxication hypothesis. Bacterial toxines, on the one hand, and poisonous substances resulting from bacterial decomposition of the intestinal contents such as the diarnins, on the other, have been mentioned in this connection. Later acetone, ammonia, carbaminic acid and similar substances, which enter the blood when the antitoxic function of the liver is insufficient, were credited with the power of producing the COHN ulsions. Under certain conditions the sudden access of fever, overloading of the blood with carbon dioxide, and disturbance of the osmotic relations between the blood and the tissues were also believed to play an etiologic part in the production of convulsions.
The second theory is the one advocated by Kassowitz. Accord ing to this theory convulsions—and a few other nervous diseases—in infancy, represent the concomitant symptoms or sequelx of rachitis. They are supposed to be due to circulatory disturbances in the cere bral cortex, which in turn depend in some way on the hypermmia of the cranial bones in rachitis.
The third and last of the theories that we shall mention here was advanced by Baume as early as 1S05, and in our own times chiefly de fended by Fere. According to this theory infantile convulsions are merely a special farm of epilepsy peculiar to the age of the affected indi viduals and characterized by a more favorable prognosis.
It appears from the foregoing that Soltmann made the best attempt to explain the undeniable fact that functional convulsions are much more frequent during early childhood than at any other period of life.
But. by this time we have outgrown his ingenious theory. Its downfall is not due to the fact that later investigations by Tarchanoff, Lemoine, Paneth and others have shaken its experimental foundations; nor to any change in our views with regard to the relations existing between functional power and electrical irritability in a nerve organ; nor to this or that secondary objection. His theory was shipwrecked
on the contradiction which is found to exist between his assumptions and the results of clinical observation. Fleischmann was one of the earliest to object that his theories could not be brought into harmony with clinical experience, because in reality even the most intense stim uli, such as burns, the actual cautery, intestinal ulcers, peritonitis, etc. by no means often elicit convulsions.
Soltinann himself was quite aware of this weak point and later assumed, in addition to tile causa physioiogica interna, i.e., the increased susceptibility to reflex irritation, and the causa pathologica externa, i.e., the irritation which produces the convulsions, a mum pathologica interna, without howiever associating CVell a hypothetical conception with this term, although such an internal pathologic cause would alone explain the individual spasmophilia of certain children.
Not until quite recently have any additional facts or possible theories been brought forward in explanation of this point. Individual pathologic spasmophilia, which Thiemich in 1Sflit mentioned in his literary review on Convulsions in Childhood, is no longer a vague ex pression intended to hide our ignorance, hut. has come to signify an exact clinical finding. It is characterized by exaggerated mechanical and electrical irritability of the peripheral nervous system before and after the convulsions, and in the interval of freedom between the. at tacks. Children of this type are peculiar in the behavior of their pe ripheral nerves, so that we are justified in speaking of a special nervous state, which hitherto has usually been termed a tetanoid condition. Historically the latter term owes its origin to the fact, that. the anomaly which is a peculiar feature of the condition was first discovered in tetany; but it is too narrow, and has already led to misunderstandings (Hochsinger). We shall therefore make use of the more comprehensive term "spasmophilie condition" (Fleubner) "or spasmophile diathesis" (Finkelstein).