In all cases of paralysis in the child a careful examination should be made of the heart. Children, like their elders, are subject to embolisms, and if sudden hemiplegia occur in a child who suffers from valvular disease of the heart, we have reason to attribute the paralysis to this cause.
Lastly, the state of the urine must not be forgotten. Coma and con vulsions from Bright's disease are not uncommon in children. If, in such a case, oedema, however slight, be discovered, and an examination of the water reveals the presence of albumen, we can have little hesitation in attributing the nervous symptoms to a toxic cause.
To make a complete examination of a young child in whom we suspect the existence of a cerebral lesion, all these points should be taken into con sideration. In addition, it is important to study the face and expression of the patient, for by this means we may often exclude serious disease. A teething child who has just had a fit seldom looks ill—that is to say, his face has not the weary, haggard look which severe acute disease imprints upon it from the first. If the child's face looks pinched and distressed we may be sure, however apparently trifling the symptoms may be, that the case is a serious one. • In connection with this subject of nervous symptoms in children it is important to remember that in them—even in children three and four years old—we must be prepared occasionally to find the peculiar function al disorders of the nervous system which in the adult are called hys teria. These disorders are found both amongst boys and girls, and have no necessary relation to puberty or the establishment of the catamenial function. Sensitive children, if frightened by the shock of a fall or other nervous impression, may be seized with convulsions of hysterical type and have various modifications of sensibility of the skin, combined, perhaps, with impairment or disorder of motor power. Aphonia, blindness, deafness,
anaesthesia, analgesia, hyperresthesia, ria and paralyses may be all met with from this cause. It is possible that in some of these cases the child is addicted to excessive masturbation, and some instances have been published in which there can be little doubt that debility and exhaustion of nerve-power induced by this means were the cause of the nervous dis turbance. Often, however, there is no reason to suspect any such agency. The patient is a strong, healthy-looking child with firm muscles and well developed limbs. In not a few such cases the derangement can be referred to a fright or other shock to the nervous system.
Cases illustrating these various conditions are published from time to time in the medical journals, and all busy practitioners must occasionally meet with them. They are usually readily cured by the application of a moderate galvanic current.
The diagnosis is not difficult. The derangement being purely func tional, no nutritive changes can be detected. Thus the paraplegic child has full, firm limbs with no sign of muscular wasting. In the child who professes that he cannot see, and gropes his way like a blind person, the retina shows no change to the ophthalmoscope, the cornea is bright, and the pupils contract normally. Moreover, in almost all instances we may suspect the nature of the ease, partly from the character of the symptoms them selves, partly from the general appearance of the child, and partly from the absence of other signs of serious organic disease.