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Rigidity of some of the muscles remains; such as the extensors of the feet, the pronators of the wrist, and the flexors of the fingers, the adductors of the thigh, &c.; or of any or all of them.

Frequently, convulsive action does not recur; generally, however, it is repeated, and becomes, but too frequently, a habit, so to say, which, after long continuance, may not be broken through on removal of the cause. Epilepsy is then developed, to the probable ultimate destruction of the mental faculties. The experience of Bicêtre, and other similar institutions, proves that every known distortion may follow in this train.

During infancy, spasmodic action is very frequently occasioned by dental and by intestinal irritation. These forms of irritation are common during infancy, and, at this period they constitute the prominent causes of spasm and of paralysis.

The great vascular excitement of the gums and alveolar processes during the period of dentition, and the pressure upon, and irritation of, the dental branches of the trifacial nerve pending the irruption of the teeth, frequently occasion cerebral excitement and spasmodic action. Gastro-intestinal irritation, induced by disordered secretions, is also a very fertile source of infantile convulsions. The fæcal evacuations become highly offensive, and are deficient in bile; scybala and large masses of ill-coloured, or white, secretions, together with, frequently, rolls of thread-worms in surprising numbers, are removed by purgative medicines and by injections.

Many other causes of cerebral congestion and spasmodic action exist; as hooping-cough, smallpox, measles, scarlet fever, pneumonia, exposure to the sun's rays, a slight access

of fever, a renal calculus, obstinate constipation, indigestion, a flesh wound, the irritation of an insufficiently strangulated nævus, &c.

Carpo-pedal spasm may exist without cerebral disturbance, but the persistence of irritation is generally followed by convulsions.

Cerebral symptoms are generally, and probably always, preceded by spastic contractions: these often pass unnoticed, and it is then only after convulsions have been developed that attention is directed to the source of irritation.

In this carpo-pedal spasm the thumb is drawn into the palm, the fingers are flexed, the feet are extended and the toes are flexed. These spastic contractions occasionally continue for weeks and months, without convulsions being developed. This is, however, rare. The accompanying drawings were taken from an instance of this kind. (See fig. 17 and 18.)

Fig. 17.

In this case, dentition had commenced at the third month. Two months later, the child was delicate and puny, and was suffering considerable pain; the gums were swollen and tense. In consequence of the inflamed, painful con

dition of the gums, the child often refused the breast; it was irritable and anæmic. When the child cried, being in pain, the feet were forcibly extended, and the thumb and

Fig. 18.

fingers were flexed into the palm.

The fingers remained

at all times slightly flexed, and the feet were generally slightly extended; but when the child was free from pain, the feet regained their normal direction.

Rarely, the adductors and extensors of the foot are simultaneously spastically contracted, and the thumb flexed into the palm, in these infantile disorders, without convulsions. Two such cases have come under my care. In the first, the distortion had almost the appearance of congenital varus of the third degree. In the second instance, the feet were less inverted.

The following is, in few words, the history of the first case :

June, 1853.-E. S., æt. 18 months; blonde and pallid; was cutting the canine teeth; had been subject during some weeks to repeated

diarrhoea ; had lately lost flesh; lived four miles away from the metropolis. For two months the feet had been inverted; at first the toes only being turned in, but at length the anterior portion of the foot was fully inverted, and the outer edge of the foot alone was brought into contact with the ground. The child had, prior to this malposition of the feet, walked alone; but now, after some few steps, it was certain to fall. During sleep, the feet regained, in great measure, their normal direction, and distortion was not constant when the child was awake; but when standing, or if excited, the adductor muscles were powerfully contracted, inverting the foot. The tibial muscles, extensor proprius pollicis, gastrocnemius, soleus, and plantaris, were strongly contracted. The gums were painful and swollen, so I incised them; and with attention to the general health, allaying irritability, and promoting healthy secretions, this abnormal muscular action entirely subsided, and the feet regained and retained their normal direction.

Should the source of irritation not be removed, congestion and effusion will probably ensue, especially in those who may be predisposed by hereditary tendency; or rigidity may remain of the extremities of one side, or of both lower extremities, or certain muscles of a limb may alone remain affected.

The following is a case in point, and far from un

common:

When fourteen months old, during dentition, was convulsed; and when he was two years old, had a second fit. From the date of the first fit, it was observed that his heels were raised, but only occasionally, and not continuously; so frequently, however, that he was often flung to the ground. After the second fit, this action was considerably increased. I first saw him fourteen months after the first attack. He was a dark, healthy-looking child, and rather plethoric. Both feet were equally affected, the heels being raised from the ground considerably, and the anterior part of the foot, which was slightly inverted, alone supported the trunk in progression. The M. gastrocnemii and tibiales antici were the only muscles affected.

In another somewhat similar case, also occurring during dentition, and after a slight fit,—

The Achilles tendons were very tense for nearly a twelvemonth, yet the heels could be planted on the ground; in six months more the heels were raised away from the ground, and the child moved about on the anterior portions of the feet only; but to enable him to oppose the heel to the ground, though very imperfectly, the knees were bent, and the trunk inclined forward. Notwithstanding this effort to increase the plant of the foot, and preserve equilibrium, the child fell at every trial to walk, or, more strictly speaking, in every twenty or thirty paces.

Spasmodic retraction is occasionally induced by emotional causes. Menorrhagia, amenorrhoea, dysmenorrhoea, hysteria, and chlorosis, are also occasionally accompanied by these forms of muscular contraction.

An instance is related by Andral of spasmodic contraction of the lower extremities, which was induced by fright and arrest of the menstrual secretion.

Retraction of the flexor muscles of the thigh and leg, so that the heels were brought into contact with the nates, occurred periodically; the periods being those at which the catamenia should have been present. This spasmodic retraction continued at these intervals, until the catamenia were re-established.

The following instance of muscular contraction with dysmenorrhoea lately came under my care:

It occurred in a florid, stout young person, seventeen years of age, in whom there was a tendency to cerebral congestion. At each catamenial period, the extensors and adductors of the right foot were so much contracted, as to bring the outer edge of the anterior portion of the foot alone to the ground, the inner surface being raised, and the heel fully an inch from the ground.

Onanism, with or without cerebral disturbance, may induce spastic contractions. These contractions are perhaps generally accompanied by muscular debility.

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