SPEC. I. GEN. VII. the entire room, and overpower the strength of six or eight attendants. In some instances it has been so violent as to break a tooth, and even fracture a bone *. When the lungs are much oppressed in the course of the contest, the convulsion. lips, cheeks, and indeed the entire surface, is dyed with a dark or purple hue. S. Convulsio infantilis. Infantile Medical treatment of The paroxysm will sometimes cease in a few minutes, but occasionally lasts for hours, and, after a short and uncertain period of rest, returns again with as much violence as before; a fact peculiarly common to puerperal and infantile convulsions. Great languor commonly succeeds; sometimes head-ache, vertigo, and vomiting, occasionally delirium but not unfrequently, and especially in infants, there are no secondary symptoms whatever. : The treatment of convulsion must apply to the paroxysm two kinds, as itself, and to the state of the constitution which gives a respecting tendency to its recurrence. the paroxysm and useful, If it proceed from a narcotic or any other poison introthe interval. duced into the stomach, much benefit may often be obVenesection tained from the stomach syringe, employed by Mr. Jukes, generally of which we have given a brief description in a preceding volumet. If the poison be in a liquid form, it may hereby be considerably pumped up in its essential state, while the remainder, or the whole, if it be a powder, may be diluted and pumped up afterwards. As there is danger from congestion in the brain, venesection is, in most cases, a good measure of caution, and, in many instances, is absolutely necessary and hence, where plethora has preceded, and has threatened to become a cause, the disease has often been prevented, and sometimes effectually cured, by a spontaneous hemorrhage but in par- from the nose, the ears, or some other organ. But we have often had occasion to observe that, in weak and relaxed habits, bleeding, if frequently repeated, increases the tendency to plethora; and, on this account, how necessary soever at the time, it should be employed with caution, and persevered in with reluctance. ticular ha bits to be employed with great caution. GEN. VII. SPEC. I. Convulsion. useful. Emetics: proved in Brisk cathartics introduced into the stomach, if possible, and where this cannot be accomplished, in the form Syspasia of an injection, lower the morbid distension almost as ef- Convulsio. fectually, and in some instances directly remove from the Treatment. system the principal fomes of the complaint. Emetics are Cathartics of more doubtful effect: they also may, occasionally, carry always off the actual cause of irritation, and by powerfully determining to the surface, make a favourable diversion of action. But in many cases of debility they have evidently have often increased the violence and prolonged the duration of the jurious. fit. The authorities, however, in their favour, are numerous and highly respectable. Le Preux * strongly recommends them in early infancy: and Hoeffner asserts that he has found them highly serviceable where the irritation proceeded from dysentery +. Schenck tells us that he employed them generally with considerable success, and preferred the preparations of copper, and particularly the verdigris, to any other emetic, from their rapidity of action. Antispasmodics are certainly entitled to our at- Antispastention, and often succeed in allaying the irregular com- often sucmotion. Those most commonly resorted to are ammonia, ceed. ether, musk, camphor, and valerian. The empyreumatic Empyreuoils, both animal and vegetable, seem to have fallen as much below their proper value in the present day as they Volatile were once prized above it. And the same may be ob- fetids. served of the volatile fetids generally, as fuligo, assafoe- Chenopotida and chenopodium Vulvaria or stinking arach: the last of which, however, under the older name of atriplex Atriplex fætida, seems to have been a favourite with Dr. Cullen. It is not very easy to explain the operation of antispasmodics of this kind. Dr. Cullen refers it to their volatility alone, and hence concludes that they are useful in proportion as they are volatile: which is, in fact, to regard them in the light of stimulants. But beyond this they seem to possess a sedative power which probably resides in their fetor. Where flatulency or some other misaffec * Diss. An. Convulsionibus recens natorum Vomitoria? Paris, 1765. + Balding. N. Mag. B. vi. 323. Lib. 1. Obs. 244. modics matic oils. dium Vul varia. fœtida. Their mode of operation. 1 GEN. VII. Convulsion. Treatment. tion of the stomach is the exciting cause, as is frequently SPEC. I. Syspasia the case in infancy, after opening the bowels, the warmer Convulsio. carminatives of anice, mint, ginger, and cardamoms will often be found sufficient; and where these fail, recourse Carmina- has been had to opium, hyoscyamus, belladonna, and sometimes St. Ignatius's bean, or M. Wedenberg's favourite medicine in this disease, the extract of stramonium *. tives. Narcotics. Cold and heat. Aetion of heat. Action of cold. : Cold and heat have also been very frequently resorted to as powerful antispasmodics, and, in many cases, with considerable success. Heat appears to act by a double power, and especially when combined with moisture, with which it is always most effectual. It both relaxes and stimulates and is hence admirably calculated to harmonize the two alternating and contending states of a morbid rigidity and a morbid mobility, on which the disease depends, and consequently to restore a healthy equipoise of action. On this account we find warm bathing, and especially in infantile convulsions, of great benefit. It ought not to be forgotten, however, that both effects, as well the stimulating as the relaxing, have a considerable tendency to exhaust and debilitate, and hence the warm-bath must not be frequently repeated. The immediate effect of a sudden application of cold, whether by a blast of air, or by an affusion of water, is a general shuddering, a spasmodic contraction of the entire skin. And hence, where cold, applied in this manner, takes off either clonic or entastic spasm, it is by a revulsive power; by a transfer of the spasmodic action from a particular organ or set of organs, to the surface of the body generally; in the same way as blistering the neighbourhood of an inflamed organ takes off the primary inflammation by a transfer of the inflammatory action to the part where the blister is applied. If the cold excite a general reaction, and the shuddering be succeeded by a glow, it becomes a direct and very powerful tonic: and on both these accounts is a remedy highly worth trying in hyste • Dissertatio Medica de Stramonii usû in Morbis Convulsivis. 4to. Upsaliæ. GEN. VII. SPEC. I. Syspasia rics, convulsions, and even those cases of epilepsy in which a suspicion of some structural cause of irritation within the cranium does not form a bar, by prohibiting every Convulsio. thing that may increase the impetus of the blood. Convulsion. in infantile convulsions. Illustrated. In the convulsion-fit of infancy, the affusion of cold- often useful water, so far as I have seen, may be much oftener resorted to with perfect safety than the fears of mothers will allow; and be found much more successful in a hot close unventilated nursery, than the more popular prescription of a warm-bath. And where I have not been able to proceed thus far, and the warm-bath has been tried repeatedly in vain, I have frequently succeeded by taking the little infant in my arms, and exposing him naked, or nearly naked, for a few moments to the air of the window, thrown open to allow it to blow upon him. The great diminution of sensibility which prevails at such a time prevents all danger of catching cold; while, on the contrary, the little patient is usually revived by the sudden rush of the external air, and the fit, in many cases, ceases instantly. tervals cold Zine how far useful and in what forms, Cold-bathing, when not prohibited by any other com- In the inplaint, will also be found a useful tonic in the intervals of bathing: the attacks, and may conveniently be employed in conjunction with internal medicines of the same character *. Of these the metallic salts and oxydes are chiefly to be metallic oxydes. depended upon, and especially those of iron, copper, arsenic, silver, and zinc. Zinc has had by far the greatest number of advocates, and is generally supposed to have succeeded best in the form of its white oxyde or flowers, ten or twelve grains of which are usually given to an adult in the course of twenty-four hours. Mr. Dugaud increased the proportion to fifteen grains † ; and Mr. Bell, at length, prescribed not less than ten grains at a time, repeated three times a-day. In the hands of the present author zinc has proved more salutary in the form of its sulphate, which has not unfrequently succeeded where the oxyde Y. W. Wedel. Liber de Morbis Infantum. Cap. xiii. + Edin. Med. Comment. v. 89. Id. 1. 120. SPEC. I. Syspasia Convulsio. Convulsion. GEN. VII. has failed; the usual proportion he has employed being a grain three times a-day given in the emulsion of bitter almonds. Where silver has been made choice of, the Treatment. usual preparation has been its nitrate, and the dose has begun with a grain given four or five times a-day in the shape of a pill, and gradually increased to eight or ten grains, or as much as the patient's stomach will bear. All improved by a combination with camphor : which is useful even alone. The virtue of all these, however, seem considerably improved by a combination with camphor, which has often been found advantageous even alone. "In spasmodic, or convulsive affections," says Dr. Cullen, "it has been of often highly service, and even in epilepsy it has been useful. I have not indeed known an epilepsy entirely cured by camphor alone; but I have had several instances of a paroxysm, which was expected in the course of a night, prevented by a dose of camphor exhibited at bed-time; and even this when the camphor was given alone; but it has been especially useful when given with a dose of cuprum ammoniacum, or white vitriol, or of the flowers of zinc."* Vegetable tonics. Cardamine pratensis. The vegetable tonics are little to be depended upon. The bark recommended by Dr. Home, Sumeire, and many other distinguished writers, is rarely of use except where the where the paroxysm is periodical: and the cardamine pratensis (lady-smock), sempervivum tectorum (houseleek), and viscus quernus (missletoe) are hardly worthy of notice in the present day, notwithstanding the specific virtues they were supposed to possess formerly. The carof Dioscori- damine, the σiouupiov Tepov of Dioscorides, is of ancient des, unduly praised by high authorities. Sempervivum tecto rum, or house-leek. celebrity, and in modern times has been warmly extolled by the commanding authorities of Mr. Ray, Sir George Baker, and Dr. Home; the second of whom, as was noticed under the head of chorea, declares himself to have succeeded in its use, not only in cases of convulsion, but of all clonic spasms whatever, and this, too, when almost every other medicine had failed +. The house-leek was employed in the form of an ex Medical Transactions. Vol. 1. Art. XIX. † Auserl. Abhandlundlung. für Pract. Aerzte. B. x. 13. |