The spasmodic movements are usually general and involve both sides of the body, although one side is often more actively convulsed than the other. Sometimes they are partial, and may be limited to one or both limbs on one side of the body, to the two arms, or even to one side of the face. The eyes are almost always involved in the convulsion. The fit lasts for a time varying from a few minutes to several hours. In the longer fits there are intervals of more or less complete remission, and some times the so-called fit consists of a series of eclamptic seizures with short intervals of quiet. In rare cases death takes place in the fit from asphyxia. As a rule, the child sleeps after the seizure has come to a close, and may wake to all appearance quite well. When the fit is repeated several times the child is drowsy for a time between the attacks, but the sleepiness passes off in a few hours. As long as any signs of abnormal excitability of the nervous system continue, and symptoms characteristic of the condition described as "inward fits "remain, we may anticipate a renewal of the con vulsive seizures. It is not until all restlessness, starlings, twitchings, etc., have disappeared that our apprehensions can be laid aside.
Some loss of motor power may be noticed after the fit is at an end. In cases of pure eclampsia this is a very temporary phenomenon, and only occurs when the seizures have been very violent and protracted. It is probably due to exhaustion of nervous power and disappears completely after a day or two. Any signs of permanent interference with nerve-force, such as local muscular weakness, contractions, or choreic movements, are usually taken to indicate some organic central cause for the convulsion. It is possible, however, that these symptoms may be the consequence of the seizure ; for severe cerebral congestion induced by intense and pro tracted eclampsia may give rise to into the brain or arachnid. CertainlyI have known cases of convulsions occurring in children as a result of some temporary irritant to be followed by paralysis with contrac tion of muscle, and have thought that in such cases the cerebral lesion might have been secondary to the eclamptic attack. There seems little rea son to doubt that sometimes congestion of brain, with serous effusion suf ficient in quantity to flatten the convolutions, may result from an eclamp tic attack, and give rise to squinting, drowsiness, and death.
A rickety little girl, aged twelve months, who had cut only two teeth, was quite well until January 7th, when she was weaned. She then became very fretful and vomited her food. At the same time an eruption of small red spots appeared on her arms and face. On January 9th the child had two fits, in which she "went stiff and worked her arms about." On Janu ary llth she had a third fit and then began to squint.
When I saw the child, on January 17th, she was lying with her eyes closed ; the right eye was turned inwards with convergent squint ; the pu pils were equally dilated, and acted well with light ; there was no discharge from either ear ; the face was pale, but flushed upon pressure of the skin ; there was no paralysis or contraction ; the thumbs were not twisted in wards, nor were the toes flexed. When the abdomen was compressed
the child made uneasy movements. She was evidently not unconscious, but seemed drowsy. The heart and lungs were healthy. The child was preparing to cut the upper incisors, and the gums were very full and tense. Pulse, 160, regular; respiration, of Cheyne-Stokes type, 40 ; tem perature, 99°.
The patient was ordered a mercurial purge, and bromide of potassium was given ; but the drowsiness deepened into stupor, and she died on January 19th. Her temperature rose every night to Half an hour before death it was 99.4°.
On examination of the body the Jura meter was noticed to be very tense, and the brain bulged through slits in the membrane. There was great venous congestion of the pia water, and the convolutions were tiat fened. On removing the brain about two ounces of sanguinolent fluid were left at the base of the skull, and on section much fluid escaped from the lateral ventricles. Nothing but congestion of the brain was noticed. There was no loss of consistence ; the membranes were not thickened, nor had they lost their pearly appearance ; there was no lymph effused, and no gray granulations could be detected. There was a mass of enlarged glands at the bifurcation of the trachea. The lungs and heart were healthy. Unfortunately the cranial sinuses were not opened.
In this case it seems clear that the post-mortem appearances were sec ondary to the convulsions. The nervous symptoms themselves seem to have been the consequence of reflex irritation from the state of the gums, combined with irritation of the stomach from unsuitable food, both oc curring in a child of rickety constitution. The red spots spoken of were strophulous, resulting from the indigestion.
Sometimes loss of speech and even imbecility have been known to follow upon an attack of convulsions. In such cases, no doubt, some profound cerebral lesion has induced the fit or been caused by it.
Diagnosis.—In every case of convulsions we should examine the patient very carefully for signs of disease of the brain or its membranes, more especially as the first question usually asked by the parents after their first excitement and alarm have subsided relates to the possibility of any affec tion of the brain. In infants of twelve or under, if the child be fat and robust, the fit is in reflex ; if he be under-nour ished, weakly, and wasted, i.e., in that condition where all reflex excitabil ity is practically in abeyance, the convulsion is no doubt the consequence of an intracranial lesion. In a weakly wasted infant by far the most com mon cause of a convulsive seizure is general tuberculosis with secondary tubercular meningitis.