TREATMENT OF SPASMOPHILE DISEASES As a rule, the acute convulsive paroxysm requires no treatment because it usually terminates before any remedy can be applied. If there is high fever, a tepid bath may be useful: otherwise baths of every kind are useless and only disturb the rest which is so imperative. A narcotic is indicated only when the convulsions are protracted or recur in great numbers, separated by short remissions. For this pur pose, we recommend chloral hydrate, at least 0.5 gram (8 minims) of a 2 per cent. solution at a dose, per rectum, the injection being allowed to remain for some time. The drug always acts in from five to ten minutes, and the effect usually lasts from six to eight hours. We have hacl no personal experience with inhalations of ehloroform, which have been recommended by Henoch and others. When the breathing threatens to stop, artificial respiration must be instituted as soon as the muscles relax.
Immediately after the attack is over, measures must be adopted to combat the excessive overexeitability of the nervous system. Among these may be mentioned: Evacuation of the bowels with a purgative (I prefer castor oil, two teaspoonfuls at a dose, to calomel, which is so generally popular), and a tea diet; or, in older infants, oatmeal porridge without any milk, for one of two clays. On this diet the spasmophilia usually disappears. When this has been accomplished breast-feeding should, if possible, be instituted at once (at least in younger infants). If this is not feasible, a farinaceous diet offers the best protection against a return of the overexcitability; but owing to the danger of injurious effects from farinaceous feeding (Czerny) this regime cannot be kept up longer than about a week, and must then be cautiously replaced by a milk diet. In a general way it is advisable to cut clown the food to a minimum for some time, and rather to forego an increase of weight for several weeks than run tile risk of a relapse.
In older infants the restricted cliet may be supplemented by milks and soups, and finely divided soft vegetables.
While the overexcitability, after it has once been removed by initial evacuations of the gastro-enteric tract, does not as a rule return if the child is fed on breast-milk, there is no form of artificial feeding that will permanently guard tlie child against overexcitability. It is pos
sible, however, to keep the overexcitability of the nervous system within bouncls and to prevent the occurrence of further manifest symptoms.
The prophylactic importance of this observation is obvious.
In the case of ill-nourished children with chronic gastro-enterie disease the dietetic treatment of spasrnophilia presents considerable difficulty. In such cases, which are fortunately comparatively rare, the most important indication is to improve the general condition, ignoring the spasmophilia altogether. Such a policy is quite justified since in these children spasrnophilia very rarely, brings on any severe accidents that \youId threaten the infant's life.
In every case the medicinal treatment is of very little importance compared to the dietetic management, since the continuous adminis tration of narcotics is hardly justifiable.
A few words must be devoted to phosphorus, which was first reconi mended by Kassow-itz, both for the treatment of rachitic bone changes and for the rapid removal of the "nervous complications" of rachitis, and since his time has been extensively used and recommended by other observers. The adherents {Finkelstein, for example) of phos phorus themselves acknowledge that the drug is effective only in the form of phosphorus-codliver oil which is customarily given. In any other form it is useless, and it must therefore always be prescribed as phosphorus-codliver oil.
How much of the effect is to be ascribed to the phosphorus and how much to the codliver oil is difficult to determine. Finkelstein found that cociliver oil alone exerted but a "questionable influence, and that only in exceptional cases." Personally. however, I am inclined to think that codliN-er oil without phosphorus Is more efficacious than Finkelstein believes. With regard to the combination of raw milk and codliver oil, recently- recommended by Finkelstein, I have not as yet had sufficient experience to express an opinion. In one severe case of eclarnpsia and laryngospasm the combination failed to have any effect.
For the present we believe that, aside from regulating the diet, the best thing that can be done is to order phosphorus-coclliver oil, which also enjoys a good reputation among the general public.