10 DISEASES OF CHILDREN. 



the constitutional condition of the child, this, in the vast majority of cases, is found 

 to be rickety. Search must accordingly be made for every indication of the rickety 

 constitution. (See Rickets.) Although rickets is the condition of all others in which 

 convulsions are likely to occur, we meet with them also in other weakly states of 

 the constitution, as the tubercular or scrofulous. Sometimes convulsions indicate a 

 family tendency to nervous diseases, and it may be found that other members of the 

 family have suffered in the same way, or are liable to neuralgia, or hysteria, or 

 epilepsy, or some other form of nervous disturbance. If this be the case, and if the 

 fits are repeated, they may, perhaps, be taken to indicate that the child is going to 

 become subject to epilepsy. 



Having examined into the constitutional condition of the child, we next look for 

 any local source of irritation which may be the cause of its trouble. Fits are most 

 common during the trying period of the first dentition, and some difficulty in cutting 

 the teeth will in a great number of cases account for the symptoms. Do not, how- 

 ever, rush to the conclusion that the gums want lancing. Doubtless this is very 

 often necessary, but, on the other hand, we have no doubt that gums have very fre- 

 quently been lanced when there was not the least occasion for it. Be sure, therefore, 

 before lancing the gums that they are swollen and tender. This caution is parti- 

 cularly necessary, because children who are liable to fits are very sensitive to any 

 loss of blood, however slight, and even the slight bleeding which follows the lancing 

 of the gums is a matter to be avoided. 



If the local irritation be not found in the gums, we must look elsewhere, and, 

 perhaps, the next most common cause of fits is the irritation set up by intestinal 

 worms. The motions must be carefully examined for worms, and if they are detected, 

 the proper remedies be administered. (See article on Worms.) Any irritation of 

 the intestinal canal is particularly liable to set up fits, and the diet must be strictly 

 inquired into. We well remember the deep impression made upon us many years 

 ago by seeing a heal thy 'child six years old suddenly seized with very violent con- 

 vulsions. As no cause could be discovered for the attack, except the fact that the 

 child had been indulging in a quantity of " pastry," an emetic was at once given, 

 and the child vomited up, among much food of a not very digestible character, a piece 

 of slate-pencil about half an inch long. This was the cause of the mischief, and the 

 child being relieved of it, the fits ceased, and did not return. 



Fits are occasionally the first warning of the onset of serious diseases, and the 

 child should accordingly be stripped, so that it may undergo a thorough examination. 

 The signs of scarlet fever and measles should be sought as well as other fevers. The 

 lungs also should be carefully examined with a stethoscope, so that diseases of the 

 lungs, such as inflammation or pleurisy, may be detected and treated without delay. 



Again, convulsions may indicate disease of the brain, but happily this is not often 

 the case. As a rough test, we may examine the fontanel, and if this is depressed, 

 the convulsions are certainly not due to brain disease. If it is prominent, however, 

 one must not conclude that the tits are caused by cerebral disturbance. 



Disease of the kidneys is a common cause of convulsions, even in young children, 

 and when convulsions occur during convalescence from scarlet fever, they always 

 cause one to suspect that the kidneys have suffered. A careful examination of the 



