CO1TVCLSIONS. 



CONVULSION'S. 



III*, as the bronchi, the stomach, the intestines, the urinary bladder, 

 the uterus, Ac., are attacked with an affection of thii kind, it U much 

 more closely allied, at has been slated, to the nature of spasm than of 

 convulsion. 



Of the voluntary muscles, whether those appropriate to locomotion, 

 or thote destined to act on foreign bodie* under the command of the 

 will, and alto of certain muscles which, though not under the direct 

 command of the will, itill belong to the animal life, having a cloae 

 relation either to actuation or motion, there U not one which may not 

 be the aeat of convulsion, singly, or conjointly with many others. 



The muscles of the eyelid*, the muscles that move the ball of the 

 eye, the muacular fibre* of the irii, the muscles of the face, and more 

 especially of the lip*, the muscles of the tongue, the muacloa of the 

 pharynx, the nmacTe* of the jaws, and particularly of the lower jaw, 

 the muaclea of the neck, the muscles of the chart, back, and abdomen, 

 and the muaclea of the upper and lower extremities, may be severally 

 attacked singly or in combination, simultaneously or in succession, 

 with every degree of convulsion, from the moat violent tonic con- 

 tractions to the slightest clonio tremor or twitching. The particular 

 muscles affected, the particular combinations of the muscles affected,, 

 the particular order in which the muacular affections succeed each 

 other, may be indicative of specific diseases of the nervous system or 

 of diseases seated in particular parts of the nervous system. The study 

 of these convulsive affections is therefore most important in a practical 

 point of view, as indicating, at one time, the near approach or the 

 actual existence of highly dangerous diseases, having their primary seat 

 in the brain or in the spinal cord ; and at another time pointing to no 

 Ins formidable diseases of the brain and spinal cord excited by diseases 

 of some distant organ. At the same time it should always be remem- 

 bered that these affections may be purely functional, and not depend- 

 ent on organic disease at all. 



When convulsions attack a single muscle, or a particular set of 

 muscles, the convulsions are called partial or local ; when they attack a 

 great number of muscles simultaneously or in rapid succession, they 

 are called general. 



The accession of an attack of general convulsion, whether local or 

 general, U commonly, though not invariably, preceded by premonitory 

 signs, which should be carefully looked for, that measures appropriate 

 to the particular nature of the ca^o may be promptly taken to prevent 

 an occurrence of the attack. 



In the actual paroxysm, the features of the face are sometimes 

 hideously distorted ; the eyeballs are prominent, staring, vacant, wild, 

 and are rolled in every direction ; the teeth gnash ; the mouth foams ; 

 the tongue protrudes ; and the action of inspiration from the passage 

 of the air through the clenched teeth, is attended with a hissing sound. 

 So violent are the contractions, that occasionally the teeth, and some* 

 times even the bones of the extremities are broken by the force. 

 When the muscles of inspiration are involved, and the respiratory 

 function is much obstructed, the face becomes tumid, bloated, and of 

 a dusky or purple colour ; and sometimes oven the entire surface of 

 the body assumes a leaden hue, from the obstructed circulation 

 through the lungs and the imperfect aeration of the blood. Such ia 

 the obstacle to the progress of the blood, that the blood-vessels some- 

 times give way, and the blood bursts from the nose, or is effused ex- 

 tensively beneath the skin, the effusion probably preventing irreparable 

 mischief to the brain. At other times the face, instead of being red, 

 ia pallid and sunk, and then the pulse is feeble, small, and contracted ; 

 as in the former case it ia full and strong, and attended with a violent 

 beating of the carotids. The violent contractions of the muscles act 

 upon the bUdder and rectum, and expel the contents involuntarily 

 and with force. In all the cases in which the current of the blood is 

 much obstructed, the functions of the brain are proportionally im- 

 paired, the general sensibility is diminished, and there is snpor, or even 

 coma ; at other times consciousness is but little affected, and the 

 violence of the contractions produces severe pain. 



The duration of the paroxysm varies from a few minutes to as many 

 hour*. The moment the convulsions subside, the patient commonly 

 falls into a long and profound sleep, from which he awakes suddenly, 

 altogether unconscious of what has happened. The attack is generally 

 1 by languor, lassitude, sickness, and a disordered state of the 



The paroxysm commonly returns at uncertain intervals, preceded by 

 the premonitory symptoms just enumerated. But sometimes it proves 

 fatal at the very first attack, by producing apoplexy or asphyxia ; and 

 not (infrequently it leaves behind it either paralysis or some definite 

 and permanent form of convulsive disease, as epilepsy, chore , and 

 o on. The fiequent recurrence of the fit* invariably impairs, and 

 sometimes wholly destroys, the mental faculties. 



In some peculiarly nervous and irritable temperaments, instead of 

 the languor and lassitude which ordinarily follow a severe convulsive 

 paroxysm, the exhaustion is so extreme that the patient falls into a 

 state of profound syncope or fainting, which continues for so long 

 period as justly to excite alarm ; and sometimes the patient actually 

 dies in tliU fainting fit, the brain never recovering iU functions. At 

 other times, the "imj life ia completely suspended, and the action 

 of the organic life appears to have ceased, but the Utter is not wholly 

 extinguished, though its functions are performed so feebly as to afford 

 no indication of their existence ; consequently, to all outward appear- 



ance the patient U dead ; yet he may be only in a state of lethargy or 

 torpor, and may ultimately revive. 



The preceding account of a paroxysm of convulsion, U the description 

 of it only as it exists in its severest form. In general even the tonic 

 seizure is a much more mild attack ; the convulsions being not violent ; 

 affecting only a few muscles at a time, and rather passing in succession 

 from one set of muscles to another, than attacking a great number 

 simultaneously. In general too the convulsions are unattended with 

 the obstruction of respiration ; are without the abolition of sensation ; 

 in short, are without tne permanent and dangerous interruption of any 

 function, organic or animal. And more especially when the paroxysm 

 is of a clonic character, the muscles are not rigid, the contractions are 

 not vehement and long-continued, the face is not swollen and livid, 

 but rather pale and sunk, the features are little distorted, the pulse is 

 feeble and rapid, and the extremities are 



Convulsions are frequently excited in the progress of other diseases, 

 towards the termination of continued fevers, for example, in which 

 they are almost always of bad, and sometimes of fatal omen ; at the 

 commencement of eruptive fevers, as small-pox, measles, scarlet fever, 

 &c , when, though generally indicative of a severe form of disease, they 

 are not so alarming as at the close of continued fever ; in inflammatory 

 affections of the brain; in hooping-cough; in cramp; in disci dered 

 states of the reproductive organs, and more especially of the uterus, 

 and in long-continued suppression or imperfect performance of the 

 catamenial function. 



The causes of convulsions are exceedingly numerous and varied. 

 There is, without doubt, a constitutional predisposition to such affec- 

 tions. They occur far more frequently in the nervous temperament 

 than in any other. The distinctive character of the nervous tempera- 

 ment is muscular mobility combined with nervous irritability. The 

 muscular fibre is relaxed, delicate, and weak ; the nervous fibre ia 

 peculiarly sensitive, while it is proportionally without energy. Other 

 powerful causes are, peculiar conformation of the body, namely, a 

 feeble frame, with a largely developed head : a relaxed and delicate 

 fibre ; a full and plethoric habit ; a constitution often manifestly pro- 

 pagated from parent to child ; all circumstances capable of producing 

 over-excitement, or in any other mode of inducing debility, ph \ sical or 

 mental ; an idle and luxurious mode of life ; too much indulgence in 

 sleep ; neglect of regular and active exercise, and, as would appear, 

 certain electrical conditions of the air, by which the nervous system is 

 rendered more susceptible of impressions, and its vital energy is more 

 rapidly exhausted. 



The exciting causes are those which act either upon the animal or 

 upon the organic portion of the nervous system. It has been stated 

 that contractility, though a property inherent in the muscular fibre, 

 con be excited only through the agency of a stimulus derived fmm the 

 nervous system. All the muscles which are under the control of the 

 will, or which depend on an act of volition for the exercise of their 

 function, derive their nervous stimulus from a particular portion of 

 the nervous system, namely, the spinal cord. Modern physiology has 

 demonstrated that the nervous fibres which supply the stimulus neces- 

 sary to voluntary muscular motion are different from the nervous 

 fibres which communicate sensation. The first, the motive nerves, 

 communicate with a particular portion of the spinal cord ; the second, 

 the sentient nerves, communicate with another portion of the spinal 

 cord. Now, it is found that whatever disturbing influences act imme- 

 diately upon the motive nerves, or upon that portion of the spinal cord 

 with which the motive nerves are in direct communication, constitute 

 most powerful exciting causes of convulsions. But there is so close a 

 sympathy between the sentient and the motive portion of the spinal 

 cord, and between the spinal cord and the brain, that any disturbing 

 influence which acts powerfully on the one is rapidly communicated to 

 the other. It is indeed seldom that it is possible to trace the aeat of 

 the irritating cause cither to the motive or to the sensitive portion of 

 the nervous system exclusively ; that would imply an accuracy and 

 completeness of knowledge which pathologists are at present far from 

 possessing. All that the present state of knowledge almost ever 

 admits of is to trace the seat of the irritating cause to some portion of 

 the spinal cord or brain ; and this, which is nearly all that can be done 

 in any other case, is sufficient to connect the morbid condition of the 

 organ with its disordered function. There are then morbid con. > 

 of the spinal cord and brain which are clearly ascertained to be imme- 

 diately connected with that disorder of their functions of which con- 

 vulsions are the result. 



Such are, 1. A disordered state of the circulation of the blood 

 through these organs. One of the conditions, the most essential to the 

 due performance of the functions of the nervous system is, that the 

 spiuol cord and brain receive a certain supply of arterial blood. If 

 the quantity of blood which flows to these organs be deficient, syncope 

 will be in. lu. .. I, with a diminution or Ions of muscular power : of this 

 state convulsions, always of a clonic character, an a constant result. 

 If the blood transmitted to the spinal cord and brain do not circulate 

 through the blood-vessels with a certain impetus and velocity, but be 

 retained either in the capillary arteries or veins, or in both, the state 

 termed congestion [CoHQBSTlON] will bo induced, of which convulsions, 

 also in general of a clonic character, are a constant result. If the 

 blood sent to the spinul cord and brain be in preternatural quantity, 

 and if it circulate with preternatural energy, the state of inflammation 



