As to treatment, it is of great importance to control the convulsion before trying to find out its cause. In children this is done by placing the child in a bath of hot water with mustard and keeping it there until the skin is reddened. If the convulsions persist, the child should be put under the influence of chloroform until the convulsive tendency has disappeared. When the convulsion is controlled, search is then made for the cause. If the digestive tract is found to be at fault, the child is given a dose of castor oil, and a high rectal enema of soapsuds is given as a matter of routine to empty the lower bowel. After the bowel is cleared and the child still shows a tendency toward con vulsions, a rectal injection of 10 grains of sodium bromide and 3 grains of chloral hy drate may be given for a child five years old. In very severe cases it is justifiable to give a hypodermic of morphia in proper dose. The room should be kept noiseless and an icebag placed to the head. It is always a good plan to examine the enema stool in search for intestinal parasites, foreign bodies or undigested particles or lumps of food. A child who is very nervous and is easily excited by physical impressions should be kept very quiet. Genital abnormalities should be properly treated, a child with a tight or adherent prepuce when circumcised becomes free from convul sions. Foreign bodies should be removed from the ears and nose. A child with rachitis should be built up, kept out of doors in the sun, and given the proper kind of food and tonics. Hy. drocephalus may be treated by tapping the ventricles of the brain through the anterior fontanelle and so drain off some of the fluid or tap the spinal cord to drain it off that way and so relieve the intra-cranial pressure. Anaemia and malnutrition should . be treated if found to be the cause.
Convulsions due to tumors of the brain or brain abscess cannot be treated unless they be in a position accessible to the surgeon. Con vulsions due to uraemia are very serious and need very urgent treatment; a mouth gag should be inserted into the mouth toprevent the patient from biting his tongue, blood letting is done from one of the veins at the bend of the elbow to lower the blood pressure and rid the system of a certain amount of toxins; usually 500 c.c. is withdrawn at one time, hot
packs are given or the electric baker is placed over the patient to induce profuse perspiration, pilocarpine one-tenth grain by hypo is times used but is not safe. In eclampsia the uterus is emptied as soon and as rapidly as possible, using ether and oxygen as chloroform should never be used. Ether and oxygen are used to control the convulsions until the time for operation. A mouth gag is the first thing to be placed in the mouth. Veratrum viride, 5 minims by hypo every half hour, is given to lower the blood pressure. Magnesium sulphate, a dram to the pint, is administered usually postpartum intra-venously and frequently repeated. In epilepsy the sions usually do not last long. Prevent the patient from injuring and biting his tongue. Loosen all his clothing and see that he lies in a well-padded place and away from solid jects. Chloroform is used if the convulsion is very severe. Epileysy found to be due to depressed fracture of the skull is often cured of any future attacks when operated upon and a button of bone removed, the intra-cranial pressure being thus relieved. In chorea, the child should be kept as quiet as possible, free from all mental and physical strain. Its food should be easily digested and nourishing; senic in the form of Fowler's solution is the best remedy. If traces of rheumatism are present it is combined with the salicylates. Bromides and chloral are given to quiet and control the spasmodic movements. Iron is also given as a tonic. In hysteria the best way to check the convulsion is by dashing a glass of cold water into the patient's face. A hypo of apomorphine, one-tenth grain, causes sickness of the stomach and immediately arrests the attack. A teaspoonful of aromatic spirits of ammonia may be given. Convulsions due to meningitis, tetanus, brain abscess and tumors of the brain are treated along general principles. HENRY H. BEINFIELD, M.D.