INFANTS EMERGENCY CASES


INFANTS EMERGENCY CASES. Goswami B K

INFANTILE CONVULSION.

 

Convulsion of little childre…


INFANTILE CONVULSION.

Convulsion of little children, termed as infantile convulsion, is one of the common complaints of children for which a physician is called for with all hurriedness. Involuntary paroxysmal movements of certain muscles (local) or a group of muscles (general) is called convulsion. This ailment is due to some disorder of the nervous system. The nervous system of children is said to be more sensitive than that of adults.

Moreover, it has been found that children with a tendency to convulsion are generally born of neurotic parents. In the majority of these cases it has been found again that they are either rachitic or have an inclination to that direction. The immediate exciting cause may be numerous, the most common one being some disturbance in the alimentary canal.

Children with worms are more nervous and consequently have a greater possibility to become its victims. Besides, convulsions of children very often precede an attack of some acute infectious disease.

Immediately before an attack the face of the child becomes pale and he is found heedless to his nearest surroundings; unconsciousness follows soon and convulsions start next. During a fit the jaws remain tightly locked and the fingers tightly clenched with the thumbs inside the fists. This state passes away soon when the child becomes very drowsy.

auxiliary Treatment.– Sprinkling of cold water on the face and head, and fanning should be the first measures. Stuffiness should be avoided and the clothes of the child should be loosened. He should be protected safely on a bed, Warm bath in this condition has a soothing effect but if the water is very hot the result will be the reverse.

Wrapping up the child in a blanket wring out of hot water, an ice-bag may be put over his his head, this will cut short the fit. The old-school advises an enema with soap-water but it is not necessary if the child remains under homoeopathic treatment. Inhalation of camphor to is said to be very efficacious in infantile convulsions.

MEDICINAL TREATMENT:

Medicines in general:— (1) Bell., Cham., Cina., Cupr-m., Op. Verat., Zinc. (2) Acon., Aeth., Ambr., Apis., Calc-c., Camph., Cic., Coff., Gels. Helleb., Hep., Hyosc., Ign., Ip., Lach., Lyco., Mag-p., Nux-v., Sil., Sulph.

In the treatment of infantile convulsions it is more important to find the cause and to conduct the treatment accordingly than to treat the convulsion itself basing on a few the then appearing transitory symptoms. If a permanent cure is desired it is to be ascertained whether the child has any evidence of worms, nervousness or rachitis.

Therapeutic Hints: In the majority of these cases Belladonna alone will be sufficient. It is useful in convulsions during dentition and in convulsions with fever (Acon. The more violent are the spasms the quicker will be the benefits under this medicine. Congestion especially of face and head, and sudden appearance of ailments are keynotes of this medicines. When Belladonna is indicated we find the head hot and the feet cold. Another characteristic of this medicine is aggravation from jerks; even the slightest jerk will bring on a new attack.

When Bell. fails or the symptoms do not agree we have to fall on Cina, which is suitable in convulsions of teething children and in those of nervous origin, or with worms. Some of its leaders are the reverse of Belladonna, e.g. under Cina pallor is marked on the childs face whereas Bell., is red; jerks and movements create new attacks in Bell. but in Cina they relieve. A Cina kid remains alright as long as he is carried about and will get a fresh attack if he is put on bed to remain quiet. Ignatia rivals with Cina in frequency of application.

Both of these medicines have pale face and worms and are equally useful in convulsion during dentition. But ignatia is more suitable for puny children. It has neither fever nor any cerebral congestion. It will be certainly our first choice if the condition occurs after a punishment, chagrin or some other violent emotion. It has twitching of single muscles, particularly those of eyelids and mouth, and stiffness of body or limbs, Chamomilla is another drug having close resemblance with Cina, and is a valuable remedy in infantile convulsions, especially during dentition.

The child moans and cries too much, and is very peevish and irritable. One cheek red and hot while the other is pale and cold. Head and face hot, and hot perspiration over the head. It is our sheet anchor when convulsion follows a fit of anger. The next in common use is Calcarea carb. Dr. E.A. Farrington says “In cases in which the convulsions persist, Calcarea is superior to Belladonna.

As the Calcarea child grows older it is slow in teething and may even have fever or convulsions attending the tardy eruption of the teeth.” Profuse perspiration, particularly on the back of the head during sleep, is one of its determining symptom. Sulphur will deserve a consideration every time you give the decision in favour of Calcarea, more particularly during dentition. It precedes Calcarea well. Dr. Jahr advises its application if, after such spasm, the child inclines to bore his head into the pillow. If Sulphur does not relieve this condition in two or three days Calcarea will do.

LEADING INDICATIONS:–.

Aconite: Convulsions of teething children with high temperature, dry skin and twitching of single muscles. The child gnaws his fists, frets and screams.

Aethusa: Convulsions from reflex irritation of gum which is swollen and red. The child vomits big lumps or curdled milk.

Cicuta: Violent convulsions. The child is thrown to all sorts of shapes and violent contortions. Opisthotonus condition with total absence of consciousness. Particularly efficacious if there is a history of concussion of brain or injury to spine.

Colchicum: Convulsions attending gastric troubles changing colors of stools.

Cuprum-met: During the convulsions the childs face turns blue and the thumbs are tightly clenched. It is of unrivalled importance in convulsions from retarded eruptions of small-pox, measles or any other exanthema.

Dolichos: Convulsions attending gastric troubles and changing colors of stools.

Cuprum met: During the convulsions the childs face turns blue and the thumbs are tightly clenched. It is of unrivalled importance in convulsions from retarded eruptions of small-pox, measles or any other exanthema.

Dolichos; Convulsions during dentition from cerebral congestion or from emotion (Ign., Op.). The fingers are spread asunder.

Helleborus: During the fit the whole body becomes icy-cold with the only exception of head which may be hot (Arn.).

Hyoscyamus: Convulsions of children from fright or worms (Cina, Ind.). The child vomits first, then shrieks suddenly and becomes unconscious with twitching and jerking of all muscles, more prominently of those about the face and the eyes. Wild look and foaming from mouth.

N. B. Twitching of muscles is most predominant under this drug and next come Nux-v. and Ign. Dr. Allen says in spasms of Hyos. every muscle in the body twitches, from the eyes to the toes.

Indigo: In convulsions some authors prefer this medicine to Cina if there is evidence of worms.

Ipecacuanha: Convulsion from indulgence in rich food. The spasms are generally of rigid, tetanic form, though, sometimes, the rigidity alternates with flexing of the arms. Much nausea and vomiting with a clean tongue. It is also useful in convulsions during dentition or from suppression of eruptions or cold.

Lycopodium: When this polychrest is indicated we find the spasms are of a clonic form. In the body we find alternating contraction and expansion; in the mouth, the tongue coming out and withdrawn; on the face, corners of the mouth draw up and relaxed, and fan- like movements of alae nasi. Constipation, incarcerated wind in the intestine and 4 to 8 P.M. aggravation are some of its accompanying features.

Opium: Convulsions from emotions, fright or cerebral congestion. Face red and bloated; the child screams loudly before and sometimes during the fit (Cic.) with total loss of consciousness, and stertorous sleep afterwards. Trembling of the whole body; eyes half-closed and up-turned (eyes turned downward–AEth.).

Stramonium: Suitable in convulsions from retarded, delayed or undeveloped eruptions. The child wakes up frightened as if from the first object seen and screams holding the mother with fear; unable to recognise anybody; face bright red. Urine and stool escape involuntarily.

Zincum-met.: This is of importance in convulsions from repelled eruptions (Cupr.-m. Stram.). Getting up frightened from a sleep the child rolls his head from side to side (Bell.) Frequent micturition.

SPECIAL FEATURES.

For convulsions of nervous origin think of –Bell., Ign., AEth., and Cupr. first and then Cic., Colch., Helleb., Hyosc. and Zinc-m. For convulsions with signs of rickets give Calc-c., Calc-p., Ign., Sil. and Sulph. For convulsions with worm complication consider Cina, Ign., and Ind. first, and next Hyosc. and Stram. When convulsions are in association with whooping cough think of Cupr-m., first and then Bell., Cina and Ip. For convulsions during sleep give Cupr-m., Hyosc., Ign., Op., Sil. and Stram.

Convulsions originated from fright– Calc-c., Hyosc., Ign., Op.; from indigestion Ipecac; from chagrins (after punishments) (i) Ign. (ii) Cham. (iii) Cina: from vexation (i) Cupr-m., (ii) Calc-c., Ign., Ip; from repelled exanthemata or when they do not appear — (i) Zinc-m. (ii) Bry., Cupr-m., Ip., Stram., Sulph.; from bad effects of vaccination–Sil.; from nursing the child when the mother was in fright –Op.; and when mother was in a fit of anger– Cham.; from suppression of discharges–Cupr-m.; of eruptions– Calc-c., Cupr-m., Sulph., Zinc.; of foot-sweat–Sil.

For convulsions when eruptions fail to break out — (i) Cupr-m., Zinc. (ii) Ant-t.; when small-pox fail to break out–Ant-t.

For convulsions with tetanic rigidity–(i) Cic., Nux-v. (ii) Bell., Cham., Cupr-m., Gels., Helleb., Hyosc., Ign., Ip., Lyco., Mag-p., Op., Stram.

For convulsions followed by deep sleep think of Op. first and Zinc-m. next; by restlessness–Cupr-m.

REMEMBER:

If you find the childs face flushed and hot at the time of convulsions remember Belladonna. But if the blush and the heat are not over the whole face of the child and are only one sided, perhaps circumscribed on one cheek while the other cheek is pale and cold your patient requires Chamomilla. When pallor prevails over the whole face instead of red you are dealing with, most likely, a Cina patient. You may come across still another type of discolouration of face; in such a case pallor and red appear in alternation but still, you have no reason to be confused, remember Ignatia (Sulph).

In our country it is a general practice to apply cold water during an attack of convulsion. This is what the mothers do and the grandmas advise. If this cold application ameliorates the condition appreciably or if you find a cold drink to avert an attack you can, with confidence, anticipate benefit from Cuprum- met.

CAUTION:

Before we close we would like to quote the following warning from Dr. J. T. Kents lectures– It is taught in the old school text-books so much that the old women and nurses know that a hot bath is good for fits and before you get there just as like as not you will have a dead baby. If the baby needs Opium or Apis in congestion of the brain the fits become worse by bathing in hot water; consequently warm bathing is not always good for fits.

B K Goswami