The character of the fit itself will give some indication valuable in diag nosis. Cerebral convulsions are often partial. Therefore, if the spasms are limited to one side of the body or one limb, we should search carefully for signs of cerebral disease. Paralysis of the face remaining after the end of an attack is indicative of a cerebral lesion. Thus, drawing of the mouth to one side, ptosis, or inequality of pupils are symptoms never seen in true uncomplicated eclampsia. squint persisting after the convulsion. has passed off must be regarded with anxiety ; for although not necessarily a grave symptom, it is often indicative of a serious lesion ; and if accompanied by signs of heaviness, or tendency to stupor, must be looked upon as an unfavourable omen. Again, convulsions, general or partial, without loss of consciousness, shmild lead us to suspect disease of the brain. Another im portant symptom is the condition of the child after the attack. In true eclampsia consciousness is recovered quickly after the seizure ; and if any drowsiness remain, it is over in a few hours. Signs of persistent stupor or dulness of the senses would point to a cerebral lesion. Mere temporary loss of power in a limb is no proof of centric origin ; but if the paralysis continue longer than a few hours or a day or two, especially if contraction of muscle occur, we may conclude that some centric lesion, either primary or secondary, is present. Even if unmistakable evidence of a cerebral lesion is seen when the convulsion is at an end, it does not follow that the lesion was the cause of the fit. One consequence of eclamptic seizures is conges tion of the brain ; and if the nervous attack be prolonged, serous effusions, and perhaps minute capillary haemorrhages, may occur and lead to alarming consequences. A case in which death took place from this cause has already been narrated.
It has been said that convulsions taking place at the end of the exan themata and other febrile diseases are commonly attributed to cerebral congestion, although it seems probable from the observations of Dr. Bas tian that embolic plugging of minute cerebral arteries takes a large share in their production. These attacks never come on except at an advanced period of the illness, when the state of the patient is evidently very serious ; and they quickly put an end to his sufferings. It is right here to mention that a fit may be the first sign of secondary tuberculosis. Tubercular meningitis, when it occurs in the course of an acute illness, has its own early symptoms masked by those proper to the primary disease, and only reveals its presence by the more violent phenomena which are character istic of the third stage of the intracranial lesion. Appearing in this form —as a part of a general formation of the gray granulation all over the body—tubercular meningitis is not uncommon in babies of only a few months old. If, then, in a child of any age suffering from an acute in flammatory disease, such as an attack of acute catarrhal pneumonia, con vulsions come on, we should strongly suspect tuberculosis ; and if the fit is followed by squinting and irregularity of pupils, with or without rigidity of joints, we can speak confidently of the existence of tubercular inflammation in the skull cavity.
In cases where no serious cerebral lesion is suspected, it is important to distinguish an eclamptic attack from an epileptic seizure. At the time this
is impossible, for the state of the patient requires all our attention, and if only to quiet the alarm of the relatives, it is urgent that something should be done. When, however, the subsidence of the spasms gives us leisure to make inquiries, we should try to discover some source of irritation to which the convulsion may be attributed. We should look for signs of rickets— the condition which especially predisposes to eclamptic seizures—and in quire for any convulsive tendency in the family.
The age is of importance. Up to the time of completion of the first den tition the disturbance is probably not epileptic ; and if the gums are tense or hot, or the child has lately swallowed some unsuitable food, we may feel satisfied that the case is one of pure eclampsia. Again, high fever is not a characteristic of epilepsy ; therefore, if there be pyrexia, the fit is probably reflex, or is a nervous disturbance announcing the onset of one of the exanthemata or of an acute disease. But irrespective of these considerations, under the age of two years epilepsy is rare, while reflex convulsions and the other forms of pure eclampsia are very com mon.
In older children it is more difficult, often it is quite impossible, to ex clude epilepsy. If, however, the fit is a prolonged one, and lasts for an hour or more without intermission, we may conclude that the attack is eclamptic, for the duration of an epileptic seizure rarely exceeds ten min utes, or at the most a quarter of an hour. When the urine can be obtained it should be examined for albumen, as urcemic convulsions in chil dren are not uncommon. For the same reason the whole body should be carefully inspected for signs of peeling of the skin, as ummic convulsions towards the end of the desquamative stage of scarlatina are far from rare. The attack of scarlatina is sometimes so mild as to be overlooked by inat tentive or unobservant parents ; and even if it be known to have occurred, the past illness may be looked upon as immaterial to the present disturb ance, and may not be referred to. In all cases we must remember that after the age of three, or at the most four years, eclamptic attacks from reflex irritation are rare. Convulsions occurring in a child of this age, if not due to epilepsy or cerebral disease, are generally either urwmic or are premonitory of some acute febrile disease.
As long as any cause can be discovered for the attack the fit is prob ably eclamptic. It is the convulsion occurring without evident reason that is so suspicious of true epilepsy ; and if a child of four or five years old, or upwards, be visited while in apparent health by such a seizure, we are justified in fearing the beginning of epilepsy. It must be remembered, however, that convulsive seizures, at first eclamptic, may pass into true epilepsy. There is no doubt that this does happen in cases where there is a strong neurotic inheritance. Where there is no such predisposition I believe that epilepsy only follows in cases where the eclamptic attack has induced a secondary cerebral lesion. In such a case, although the first attack, or series of attacks, may have occurred as a result of some apprecia ble cause, the after convulsions may arise without anything being discov ered to serve as an explanation of the morbid phenomenon.