(ECLAMPSIA)
=Infantile convulsions= may be due to various causes. A neurotic
inheritance is an important predisposing factor. They may precede the
development of many diseases of the nervous system, and also occur as
the result of peripheral irritation. Dentition in association with
rickets, and intestinal parasites are common causes. They may be the
early symptoms of acute, infectious diseases. Scarlet fever, measles,
pneumonia and smallpox are very frequently preceded by convulsions.
They may be due to debility, resulting from gastro-intestinal
disorders. Malnutrition is a predisposing cause. Disease of the bones,
especially rickets, may be associated with convulsions. Lesions of the
brain are other causes. A protracted instrumental delivery may cause a
hemorrhage of the meninges.
=Symptoms.=—In severe cases the fit may be identical with epilepsy.
It is more often not so complete as true epilepsy. Convulsions vary
considerably, but there will be no difficulty in diagnosis. It may
come on suddenly, or be preceded by restlessness, twitching, sometimes
grinding of the teeth and fever. The spasms may be either of a tonic
or clonic type preceded by a cry and loss of consciousness. The attack
may be single, but the fits may follow each other with great rapidity
and terminate fatally. It is rare for the child to die during a
convulsion. Exhaustion and asphyxiation may cause a fatal termination.
As in epilepsy the temperature often rises during the fit. A transient
paresis sometimes follows, if the convulsions have been chiefly limited
to one side.
=Diagnosis.=—The diagnosis is generally easy. The attack is usually
due to the ingestion of some indigestible food or to some peripheral
irritation, or an acute disease. Convulsions, appearing immediately
after birth or injury, are probably due to meningeal hemorrhages or
serious injuries to the cortex; although a few of these cases will
present grave lesions of the cervical vertebræ, probably often due to
protracted instrumental delivery. Infantile convulsions usually occur
between the fifth and twentieth months. Convulsions occurring after
the second year are more likely to be true epilepsy. The =prognosis=
depends almost wholly upon the cause, severity and duration.
=Treatment.=—The =first step= in the treatment is to determine the
cause if possible. Treatment in the region of the sixth and seventh
dorsals will often give relief; thorough work along the lumbar region
and the sacrum will many times be sufficient, if the convulsion is due
to intestinal disorder. C. M. Proctor reports that in male infants he
has relieved convulsions quickly, in several cases, by pushing back
the foreskin and has always found, in such cases, either a phimosis
or an adherent prepuce. In female infants it might be well to examine
the clitoris. Dilatation of the rectal sphincter may be of aid. It may
be necessary to vomit the patient, when it is due to undigested food
in the stomach; and in some cases an enema should be used, when the
irritation is in the intestines. In a few cases, when the convulsions
are due to dentition, a lancet applied to the gums will be all that
is required. A thorough treatment to the cervical region, to control
the circulation, should always be given; at the same time apply ice to
the head. The patient should be put in a bath of 95 to 98 degrees F.,
should the preceding treatment not have the desired effect, or, better
still, use the bath at once and treat at the same time.
Owing to the neurotic tendency and the ofttimes trivial causes that
precipitate an attack everything possible should be done to build up
the general condition—adjustment of all lesions, regulated diet and
disciplined habits.