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Spasmodic and Nervous Diseases

attack, irritation, fever, causes, convulsions and convulsion

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Convulsions.—Referenee may be made to p. 180 for a general description of convulsions. In children the causes that excite an attack may be put into three classes: (1) The onset of a febrile disease, such as scarlet fever, pneumonia, &c.

(2) Reflex nervous irritation. Thus the irritation of worms in the bowel may cause them; or the irritation of the bowel by some undigested or in digestible article of food.

(3) Disease of the nervous system.

(1) Under the first class comes a group of muses that are extremely common in children. A grown person, at the commencement of any fever, is usually seized with a shivering-fit, a rigor, as it is called; in children this is usually replaced by a convulsion. If the convulsion be merely the ushering in of an attack of measles, scarlet fever, pneumonia, inflammation of the kidney, &c., the temperature will be found to be raised. The presence of fever should con sequently lead to a careful examination of the skin, throat, eyes, &c., for further evidence as to the nature of the commencing fever.

(2) On the other hand, the convulsion may be merely one outward sign of something going on somewhere that is acting as an irritant to the child's nervous system. Now in a child what are the localities where such irritation is most likely to have its seat? The stomach and bowels are first and fore most among the places from which irritation of the nervous system is liable to be produced. The irritant may be merely ordinary food that has not been properly digested, large pieces of curd, for instance, in the case of the bottle-fed infant. It may be improper food that the child has eaten unknown to parent or nurse, if it is old enough to get about by itself, and is at the stage when it thrusts everything into its mouth that its hands can lay hold of. Thus I have seen pieces of boiled pork with the rind on come away from an infant's bowels, and with their washing away the immediate cessation of fits that had been going on for an hour or two. Similarly, pieces of raw carrot I have seen, and so on. Included also in such causes are worms,

and foreign bodies of all kinds. Hard masses of motion retained in the bowel in constipated children act in this respect like foreign bodies.

The teeth is another possible source of irri tation that must be mentioned, though teeth cutting their way through the gums are not nearly so common a cause of convulsions as people imagine. When teething seems to be related to the attack, it will usually be found that the child is not otherwise in a very healthy condition, and that its diet is badly managed, and its bowels ill regulated.

The nose and ears, as likely sources of irri tation leading to convulsions, must not be over looked. A pea or bead in nose or ear, or a boil in the ear, may quite easily be the cause of attack after attack, till something directs attention to the place concerned.

From the throat also the irritation may arise.

A partially descended testicle in boys, or a long and adherent foreskin, must not be overlooked in the search for causes.

Inflammation about the urinary passage in girls should be borne in mind.

An attack of convulsions, then, should lead to a careful search, so far a4 that is possible, to find any indications of any of these regions being the source of the disturbance.

(3) The third class of cases includes such diseases as tubercular meningitis—tumour of the brain, &c.

The above division of causes is rather of practical value than of logical completeness, for its mere statement will indicate to every intelligent person the kind of line on which treatment is likely to be useful.

It will be pretty obvious, for instance, that the attack is not likely to be an extremely serious thing in itself in the first two kinds of cases, but that convulsions due to causes of the third class are of really grave omen. It will also be clear that in the first class of cases any special treatment for the convulsion is scarcely necessary, and that the treatment resolves itself into that of the fever which it is ushering in.

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