is a symptom which may be serious or not ac cording to circumstances. In estimating the importance of the symptom we must consider the age of the child, the nature and severity of the at tack, and the probable cause which has induced it. Infants of a few weeks old often die even from purely reflex convulsions if the seizures are vio lent. Older children have a better chance of recovery. After the first few weeks of life much depends upon the cause of the attack. Purely reflex fits and the initial convulsions of acute disease rarely end otherwise than favourably. Again, the convulsions which arise from imperfect aera tion of the blood, such as may occur in pertussis, are often recovered from ; but when the cause is collapse of the lung they are generally fatal. In pertussis, however, convulsions may be of several kinds, of which some are more serious than others. Those clue to cerebral congestion and throm bosis are invariably fatal. Eclampsia arising from congestion and antenna of the brain are especially serious, because they usually take place when the patient is already in a state of great exhaustion. When convulsions occur towards the close of the eruptive stage of measles or scarlatina, they must be looked upon as a very dangerous symptom. thveinic fits often pass away without producing serious consequences. Whatever be the cause of the attack, stertorous breathing, great lividity of the face with blueness of the nails, or a very rapid pulse should excite the gravest ap prehensions. As a rule, the prospect becomes more unfavourable in pro portion to the rapid succession of the eclamptic seizures and the severity of the attacks. The occurrence of a large flow of urine, according to M. Simon, is a sign of good omen, indicating that the convulsive movements are about to cease.
In convulsions from cerebral disease it need not be said that prognosis is most unfavourable ; and if the fits are followed by stupor, squinting, or irregularity and sluggishness of the pupils, we can have little hope of the patient's recovery.
The influence which the attack is likely to have upon future brain-de velopment is a point of importance, and much anxiety is usually manifested on the subject by the child's relatives. In the commonest case, that in which a rickety child has a fit as a result of some trifling irritant, I be lieve the attack to be usually unimportant ; and familiar as is the experi ence, have rarely known the patient to suffer from any after ill-conse quences. So in the case of the other forms of purely reflex convulsions, the eclamptic seizure is due to some temporary condition, or set of conditions, which may pass oft if the child survives, leaving the brain unharmed. If, however, the patient belong to a family in which nervous disorders are com mon, convulsive seizures assume greater significance. If the attacks are often repeated, the prospect as regards the mental development of the child is unfavourable, for such cases may end in epilepsy or even idiocy. In all cases, too, where the convulsions are connected, either as cause or effect, with some intracranial lesion, and where they are followed by signs, more than merely, temporary, of muscular weakness, there is no doubt that for the time the brain is injured by the illness. In cases of recovery especial care would then have to be exercised in the child's education so as not to put too great a strain upon his faculties.
Treatment.—When called to a case of convulsions the practitioner should lose no time in questioning the attendants, but should at once have the child placed in a warm bath of the temperature of 90° Fah., and apply sponges dipped in cold water to his head. This is the time-honoured remedy : it is certainly an innocent one : it may tend to quiet the nervous system, and it is one the efficacy of which is so generally recognised amongst the public, that it would be unwise to court unfavourable criti cism by neglecting to employ it. The bath must not be continued too long. In ordinary cases the child should be allowed to remain in it for ten or twenty minutes, according to his age. If, however, the patient be an infant who has lately been reduced by an exhausting diarrhoea, he should not be allowed to remain more than two or three minutes in the warm water, and cold applications to the head may be dispensed with. If the convulsions have ceased when the case is first seen, the bath need not•be used ; but we should not omit to have the child completely undressed, and then to see that he is placed, lightly covered, in a large cot, and that the room in which he lies is well ventilated and not too light. Care should be taken to unload the bowels by a large enema of soap and water ; and if the child be noticed to retch, his stomach may be relieved by a teaspoon ful of ipecacuanha wine. In the case of a teething infant opinions differ as to the propriety of lancing the gums. There is no doubt that this op eration is a useless one if employed with any hope of hastening the evolu tion of the teeth ; but if the object be to relieve pain and tension, I con sider the practice judicious, and never hesitate in such circumstances to have recourse to it. If it be desirable to remove all sources of irritation, surely such a source of irritation as a swollen and inflamed gum should not be disregarded. Lastly, if it can be discovered that the child has had pain in the ear, or if the tympanic membrane can be seen to be red, the ear should be fomented with hot water ; and if thought desirable a leech may be applied within the concha, the meatus being first plugged with cotton wool.
If in spite of these measures the convulsions return, or signs are no ticed of continued irritability of the nervous system, it is best to adminis ter a dose of chloral. Two grains can be given to a child between six and twelve months old ; and if the patient be unable to swallow, half as much again may be administered by the rectum, dissolved in a few teaspoonfuls of water. If necessary the dose can be repeated several times a day. Bro mide of ammonium, and belladonna, are also largely employed in these cases. The former may be given in three or four grain doses every two hours to a child between six and twelve months old ; the second in ten, fifteen, or twenty drop doses two or three times a day. In the convulsions of pertussis, where the spasm of the glottis is extreme, treatment by bro mide of ammonium or potassium and belladonna is especially indicated. The bromides are well borne by quite young children, and we should not fear ill consequences from what may seem a very large dose. Chloroform also is often employed, but is decidedly inferior to chloral and much more troublesome.