520 PEDIATRICS 



solation, however, to know that the victims of surgical zeal are 

 getting less in number since operators have consented to fear death 

 on the operating-table and thoughtful surgeons have come to the 

 conclusion to leave bad enough alone. In the very young the frag- 

 ility of the blood-vessels, the lack of coagulability of the blood, 

 the large size of the carotid and vertebral arteries, the frequency 

 of trauma during labor and after birth, the vulnerability of the 

 ear and scalp, contribute to the frequency of nervous diseases, 

 which before the fifth year amounts to 87 % of all the cases of sick- 

 ness. Rapid exhaustion leads to intracranial emaciation and throm- 

 bosis, the so-called hydroencephaloid of gastro-enteritis. The large 

 size and number of the lymph-vessels of the nasal and pharyngeal 

 cavities facilitate the invasion into the nerve centres of infections 

 which show themselves as tubercular meningitis, cerebro-spinal 

 meningitis, and polio-encephalitis, or more so, poliomyelitis, and 

 as chorea of so-called rheumatic mostly streptococcic - - origin. 

 Nose and throat specialists, as well as anatomists, have contri- 

 buted to our knowledge on these points --another proof of the 

 intimate dependency of all parts of medicine upon one another. 

 Now all these conditions are not limited to early life, but their 

 numerical preponderance at that time is so great that it is easy 

 to understand that general nosology could not advance without 

 the overwhelming number of well-marked cases amongst children. 

 Amongst them are the very numerous cases of epilepsy. They es- 

 cape statistical accuracy, for many an epileptic infant or child 

 dies before his condition is observed, or diagnosticated; a great 

 many cases of petit mal, vertigo, dreamlike states and somnambul- 

 ism, fainting, habit-chorea, truancy, imbecility, incompetency, 

 or occasionally wild attacks of mania, or the perversity of incen- 

 diarism, or in older children religious delirium, even hysteric spells, 

 are overlooked or perhaps noticed or suspected by nobody but the 

 family physician; or, in the cases of the million poor, by nobody. 

 They are cared for or neglected at home, and the seizure is taken 

 to be an eclamptic attack due to bowels, worms, colds, and teeth, 

 exactly like three hundred years ago. 



Of equal importance in this disease to the podiatrist, the peda- 

 gogue, the psychiatrist, the judge, the statesman, no matter whether 

 in office or a thoughtful citizen, is the influence of heredity. The 

 old figures of Echeverria, which have been substantiated by a great 

 many observers, tell the whole story. One hundred and thirty- 

 six epileptics had 553 children. Of these, 309 remained alive; 78 

 (25%) were epileptic; how many of the 231 that died had some 

 form of epilepsy or would have exhibited it, nobody can tell. He 

 observed a dozen cases in one family. While in his opinion 29.72 % 

 showed a direct inheritance from epileptic parents, Gowers has 



