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Convulsions

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CONVULSIONS. A convulsion is a vio lent involuntary contraction or series of con tractions of the voluntary muscles. It occurs in many conditions, both functional and organic, namely, tetany, hysteria, epilepsy, tetanus (lock jaw), uremia, eclampsia and chorea (Saint Vitus dance), occurring most frequently in infants. The convulsion may be local or gen eral, tonic or clonic in character, and is due to a hypersensitive nervous system or relatively greater excitability of the brain and the un developed power of inhibitory control. In children it may be reflexly due to teething, phimosis, rachitis, eating of indigestible articles of food, intestinal worms, injuries to the body, constipation, foreign bodies in the ear and nose, and fever from any cause or toxemia of any kind. Convulsions at the time of birth may be due to cerebral hemorrhage following a forceps delivery, or brain tumor, brain abscess and hydrocephalus.

Uremia is the result of kidney disease, as is also eclampsia which occurs during the preg nant state. The convulsions are tonic and clonic in character, frequently occur without warning and in people apparently in perfect health the attack may come on at any time — the eyes become fixed at first and then roll from side to side, the convulsive movements first appear about the mouth, which begins to twitch and is drawn to one side, the entire face becoming distorted. They extend rapidly to the arms, the body, and then finally to the legs. The breathing is stertorous, the face congested and flushed, the patient foams at the mouth and often bites his tongue. During the convulsion, which may last from a few seconds to a half hour, the patient is profoundly unconscious, and after the movements cease passes into a condition of coma which lasts for a longer or shorter period. The convulsions are frequently repeated.

Chorea occurs most frequently in children, and the convulsions or twitchings are of a clonic character and affect groups of muscles. The twitchings may be slight or very severe so as to interfere with speech, eating, locomo tion and coherent voluntary bodily movements. It may affect one side of the body, as one arm and leg, when it is known as hemichorea, or it may affect both sides. The twitching move ments are greatly exaggerated when the patient endeavors to perform a voluntary act. Con

sciousness is always present.

In epilepsy (q.v.) the convulsions resemble those described under uremia. There seems to he a regular order of movements followed out, preceded by aura, the patient becomes un conscious, froths at the mouth, bites his tongue, the pupils dilate and there is an involuntary passage of urine and faces. The convulsions last a few minutes, and on recovery, the patient is left in a semi-comatose condition, complains of headache, and then falls off into a restless sleep. The attacks also frequently occur at night while asleep.

Hysteria shows a great variety of manifesta tions. The convulsions may involve only the lower extremity or the head and neck. There is a condition known as hystero-epilepsy. There is no aura, the attacks are much prolonged and purposeful and tonic in character. The bladder and rectal functions are not disturbed. There is no complete loss of consciousness The patients seldom injure themselves, in fact they seem to protect themselves from injury.

In children the convulsions usually begin suddenly, although they may be preceded by a rolling of the eyes upward and sideways and by slight twitching of the muscles of the face. Unconsciousness soon supervenes, the eyes re main fixed and staring, the head is thrown backward, and the entire body stiffens out only to be followed by clonic contractions. There is a series of contractions and relaxations. The face assumes different expressions or grimaces, the teeth become set, there is a frothing at the mouth and the color of the face becomes dusky and cyanotic. The breathing is labored and heavy, urine and faeces may be voided involun tarily. After going through several convul sions the child soon passes into a deep sleep and then awakens with an apparent interest in his surroundings. These convulsions usually indicate the approach of some disease or reflex irritation somewhere, and should be considered as a serious condition until the cause is dis covered. The convulsion in the child is analo gnus to the chill in the adult, it precedes such diseases as pneumonia, cerebrospinal menin gitis, grippe, intestinal disturbances, etc. A convulsion is a symptom and not a chsease, and therefore it is never directly the cause of death.

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