Eclamptic attacks are common in the child at the onset of acute illness, and correspond to the rigor which usually introduces the febrile move ment in older persons. These seizures must not be attributed directly to the pyrexia, for it is improbable that the mere elevation of temperature is sufficient to produce them. The more severe the attack and the younger and more impressible the patient, the more likely are convulsions to be seen. These attacks are seldom dangerous, but the eclamptic fits which occur at a later stage of the same diseases arise from a different cause and have a far graver meaning.
Another class consists of the convulsions which are induced by fect aeration of blood. These constitute the less serious attacks which sometimes arise in the course of pertussis after a prolonged paroxysm of cough, and often precede death in cases of extensive collapse of the Congestion of the brain is often quoted as one of the causes of sions, and no doubt fatal fits of eclampsia are frequently associated with a hyperaemic state of the cerebral vessels. The chief factor in such cases, both of the congestion and the fits, may, as Dr. Bastian has suggested, be minute embolisms or thromboses in the small arteries and capillaries of the brain. In the fatal convulsions which sometimes abruptly terminate an attack of whooping-cough congestion of the brain is generally present, and is often dependent in such cases upon thrombosis of the cranial sinuses. An exactly opposite state of the cerebral vessels may induce the same symptom. The anmmis, of brain which results from profuse haemorrhage or exhausting discharges, such as an attack of acute diarrhea, is often dicated by a convulsive seizure. It is, however, worthy of note that an equal degree of prostration slowly established by a chronic intestinal de rangement is not followed by the same consequences, the excitability of the nervous centres being then diminished instead of exalted.
Lastly, toxic causes may induce convulsive seizures. Urmmic convul sions belong to this class, and also the eclamptic attacks which are com mon in children who live in malarious districts. Lead in the system may produce the same result. Infants seem to be very susceptible to the influ ence of lead given medicinally. I have long ceased to make use of this remedy in the treatment of the diarrhceas of young children, as I have several times seen convulsions follow its employment, and the attack has ap peared to me in some cases to be directly excited by the use of this agent.
Convulsions arising from cerebral disease have been omitted from the above classification, as partaking more of the nature of epileptic attacks than of true eclampsia. Reference must, however, be frequently made to
them in discussing the subject of convulsive seizures, for it is of the ut most importance in every case where a child is taken with a fit to be able to exclude centric causes from consideration.
Symptoms.—The convulsive seizures may come on suddenly or be pre ceded by symptoms of nervous excitability which are more or less obvious. Such phenomena are often called by nurses "inward fits." They are not invariably followed by a convulsion. Indeed, as a rule perhaps, they pass_ off after a time, especially if they are the consequence of digestive trouble, and the infant's placidity of manner returns. In other cases they become more and more pronounced, and culminate in an attack of eclamptic spasms. Thus the child is unusually disturbed in his sleep. He often starts and twitches. His eyelids may only partially close, and he wakes easily, starting up at the slightest touch. When awake he is restless and fretful. His senses seem unusually acute, so that loud noises frighten him. He changes colour frequently. His face has a curious expression, the eyeballs are often directed upwards, and his thumbs may be twisted inwards across the palms.. After these symptoms have continued for a variable time—often for several days—the child is all at once noticed to be unusually quiet. He stares with a peculiar fixed look, and his attention cannot be diverted to his toys. Then, suddenly, the fit begins. The child gets quite stiff, his head is retracted, his arms and legs are rigidly extended, his eyes are turned upwards, and he ceases entirely to breathe. In a few seconds the tonic rigidity is replaced by clonic spasms. The face becomes intensely congested, the eyelids are widely open, and the eyeballs are drawn upwards and to one side, and are twitched rapidly in different direc tions. The muscles of the face work, the tongue may be seized and bit ten by the teeth, and froth, perhaps tinged with blood, may appear upon the lips. The muscles of the limbs are thrown into the same spasmodic action, and more or less pronounced twitching affects the arms and legs, sometimes even down to the fingers and toes. Consciousness is completely lost. The skin is often covered with a profuse sweat, and in many cases the sphincters are relaxed, so that there is involuntary passage of urine and faeces. During the clothe spasms the breathing is not suspended, but there are jerking movements of the respiratory muscles. After some time the spasms become less violent. The face then changes from dusky red to a deathly pallor, the muscles relax, the child often gives a long sigh, and the attack is at an end.