Part 38

Symptoms.--There are two distinct types. The major attacks--or "grand mal"--in which there are severe convulsions with complete loss of consciousness, etc.; and the minor attacks or "petit mal," in which the convulsive movements are slight and may be absent, and in which the loss of consciousness is often but momentary or practically absent. In some the attacks occur during the day; in others during the night, and they may not be noticed for a long time.

Characteristic paroxysm of the Major attacks.--This may be ushered in by a localized sensation, known as the Aura, in some part of the body; but it may come without any warning and suddenly. The convulsions begin suddenly and at first are tonic, that is, it does not change but holds on. Thc patient falls unconscious regardless of the surroundings, and the unconsciousness may be preceded by an involuntary piercing cry. The head is drawn back and often turned to the right. The jaws are fixed (tonic spasm). The fingers are clenched over the thumb and the extremities are stiff. The breathing is affected and the face looks blue. The urine and bowel contents may escape; but this occurs oftener in the next stage. This tonic spasm usually lasts from a few seconds to a half minute when it is succeeded by the clonic spasm stage.

[NERVOUS SYSTEM 289]

Clonic spasm stage.--In this the contraction of the muscles is intermittent. (Tonic spasm is the opposite condition.) At first there is trembling, but it gradually becomes more rapid and the limbs are jerked and patient tosses violently about. The muscles of the face are in intermittent motion, the eyes roll, the eyelids are opened and closed convulsively. The jaws move forcibly and strongly, and the tongue is apt to be caught between the teeth and bitten. The blue look now gradually decreases. A frothy saliva, which may be bloodstained from the bitten tongue, escapes from the mouth. The urine and bowel contents may escape involuntarily. The length of time of this stage is variable. It may last two minutes. The contraction becomes less violent and the patient gradually sinks into the condition of deep sleep, when the breathing is noisy and stertorous, the face looks red and swollen, but no longer bluish. The limbs loose their stiffness and unconsciousness is profound. The patient, if left alone, will sleep for some hours and then awakes and complains only of a dull headache. His mind is apt to be confused. He remembers nothing or little of what has occurred. Afterwards the patient may be irrational for some time and even dangerous.

The minor attack or "petit mal."--There is a convulsion; a short period of unconsciousness, and this may come at any time, and may be accompanied by a feeling of faintness or vertigo. Suddenly, for example, at dinner time the person stops talking and eating, the eyes are fixed and staring and the face is slightly pale. The patient usually drops anything he may be holding. The consciousness returns in a moment or two and the patient resumes conversation as if nothing had happened. In other instances there is a slight incoherency or the patient performs some almost automatic action. He may begin to undress himself, and on returning to consciousness find that he has partially disrobed. He may rub his beard or face, or may spit about in a careless way. An eminent physician states: "One of my patients, after an attack, was in the habit of tearing anything he could lay his hands on, particularly books; violent actions have been committed and assaults made, frequently giving rise to questions which come before court. In the majority of cases of "petit mal" (light attacks) convulsions finally occur, at first slight, but ultimately the grand mal (major attacks) becomes well developed, and the attacks may then alternate."

Recovery.--The authority above goes on to say: "This may be given today in the words of Hippocrates: 'The prognosis in epilepsy is unfavorable when the disease is congenital (that is, existing at birth), when it endures to manhood, and when it occurs in a grown person without any previous cause. The cure may be attempted in young persons but not in old.' '' Death rarely occurs during the fit, but it may happen if the patient is eating. If the attacks are frequent and the patient has marked mental disturbance the conditions are unfavorable. Males have a better outlook than females.

[290 MOTHERS' REMEDIES ]

PHYSICIANS' TREATMENT.--What to do during the Attack of Epilepsy.--Keep the patient from injuring himself, loosen the clothing, take off the collar or anything tight about the neck. Place a cork or spool or tooth-brush handle between the teeth to keep the patient from biting his tongue, but attach a stout cord to the object and hold it in that way.

Preventive and general treatment.--In the case of children the parents should be made to understand that in the great majority of cases epilepsy is incurable. The patients need firm but kind treatment. It does not render a person incapable of following some occupations. "Julius Caesar and Napoleon were subjects of epilepsy." The disease causes gradual impairment of the mind, and if such patients become extremely irritable or show signs of violence, they should be placed under supervision in an asylum. A person with this disease should not marry.

Diet.--Give the patient a light diet at regular hours, and the stomach should never be overloaded. There are cases in which meat is injurious, and it should not be eaten more than once a day and at noon time. A vegetable diet seems best. The patient should not go to sleep until the digestion is completed in the stomach.

Causes.--Should be removed if possible. Circumcision should be done, especially in the young. In case of a female child the "hood of the clitoris" should be kept free. Undue mental and physical excitement should be avoided. Systematic exercise should be taken. Baths in cold water in the morning, if possible, as the skin should be in good working condition.

Medicines.--The bromides are the best, and should always be given under proper supervision of a physician or nurse.

Caution.--I wish to add that parents should always attend to the seemingly harmless "fits" in their young children. It will not do to say they are due to teething or worms. If they are, the worms at least can be treated and that cause removed. They may be due to too tight opening in the penis. If that opening is small, or if the foreskin is tight it will make the child irritable and cause restless sleep. Attend to that immediately. The same advice applies to female children. The "cover" of the "clitoris" may be tight, making the little one nervous; loosen it. If your child keeps its fingers rubbing its private organs there is reason for you to have the parts examined and the cause removed as masturbation often starts in that way. The parts itch and the child tries to stop the itching. These little things often cause "big things" and I am sure "fits" can be stopped very often by looking after the private organs in both sexes.

[NERVOUS SYSTEM 291]

SHAKING PALSY. (Paralysis Agitans).--This is a chronic affection of the nervous system, characterized by muscular weakness, trembling and rigidity.

Causes.--It usually occurs after the fortieth year, and is more common in men than in women. The exciting causes are exposure to cold and wet, business worries, anxieties, violent emotional excitement and specific fevers.

Symptoms.--The four prominent symptoms are trembling, weakness, rigidity, and a peculiar attitude. It generally develops gradually, usually in one or the other hand. There is at first a fine trembling, beginning in the hands or feet, gradually extending to the arms, the legs and sometimes the whole body. The head is not involved so frequently. This trembling (tremor) consists of rapid, uniform "shakings." At first it may come in spells, but as the disease advances it is continuous. Any excitement makes it worse. It is very marked in the hands. The trembling generally ceases during sleep. The muscles become rigid and shortened; the head is bent and the body is bent forward; the arms are flexed (bent) and the thumbs are turned into the palms and grasped by the fingers; the legs are bent, movement soon becomes impaired and the extremities show some stiffness in motion. There is great weakness of the muscles and it is most marked, where the trembling is most developed. There is no expression on the face, and the person has a slow and measured speech. The walk is very peculiar, and in attempting to walk the steps are short and hurried. The steps gradually become faster and faster, while the body is bent forward and the patient must keep on going faster to keep from falling. It is difficult to go around in a short circle. The patient cannot change his position in bed easily. The mind is rarely affected.

Recovery.--It is an incurable disease. It may run on for twenty years or more. There may be times of improvement, but the tendency is to grow, gradually worse.

PHYSICIANS' TREATMENT for Shaking Palsy.--This is simply to make the patient as comfortable as possible. Regulate the diet. The patient should not worry or have much exercise. Frequent warm baths are sometimes beneficial with gentle massage of the muscles.

APHASIA.--A partial or total inability to express thoughts in words or to interpret perceptions.

Varieties.--Motor and sensory aphasia.

Causes.--Softening of the brain, tumors of the brain, lesions in syphilis especially, hemorrhage in the brain, blows on the head, and inflammation of the brain and its covering.

Symptoms of Motor Aphasia.--The patient cannot make the muscles of the larynx, tongue, palate and lips perform their functions and produce speech. The patient knows what he wishes to say, but cannot pronounce it. This may be complete or partial. Complete, when the patient can only utter separate sounds. Partial, when the words are only slightly mispronounced and when some certain words cannot be pronounced at all. In some cases, nouns only or verbs cannot be pronounced. Agraphia, means inability to write down the thoughts. Sensory aphasia: word deafness. This is an inability to interpret spoken language. The sound of the word is not recognized and cannot be recalled; but sounds such as that of an engine whistle, or an alarm clock, are heard and recognized. Word-blindness: the person cannot interpret written language. Pharaphrasia: cannot use the right word in continued speech; the patient uses words but misplaces them.

[292 MOTHERS' REMEDIES]

Recovery depends a great deal upon the cause.

Treatment.--Treat the cause. If from syphilis, iodide of potash and mercury. If from an injury or tumors, operate if possible. Teach the patient how to speak, read and write. The result of this often gives you a pleasant surprise.

WRITERS' CRAMP. Causes.--This occurs much oftener in men than in women, and usually between the ages of twenty-five and forty. The predisposing causes are a nervous constitution, heredity, alcoholism, worry, etc. The chief exciting cause,--excessive writing, especially when it is done under a strain.

Symptoms.--It usually begins with fatigue, weight, or actual pain in the affected muscles. In the spasm form the fingers are seized with a constant or intermittent spasm whenever the person grasps the pen. The neuralgic form is similar in symptoms but severe pain and fatigue comes with writing. The tremulous form: In this the hand when used becomes the seat of the decided tremor. The paralytic form: The chief symptoms are excessive weakness and fatigue of the part and these disappear when the pen is laid aside.

Recovery.--If taken in time and if the hand is allowed perfect rest, the condition may improve rapidly. There is, however, a tendency to recur.

PHYSICIANS' TREATMENT for Writers' Cramps.--There must be absolute rest of the hand. General tonics, such as iron, strychnine, arsenic, and cod-liver oil may be needed to tone up the system.

APOPLEXY. (Cerebral Hemorrhage). (Brain Hemorrhage). Causes.--Bleeding (hemorrhage) into the brain substance is almost always due to an affection of the walls of the large or small arteries of the brain, producing rupture and subsequent bleeding. Persons of fifty or over are more subject to it, and it is more common in men than in women. Any disease that will cause degeneration of the arteries, helps to cause it, such as nephritis, rheumatism, syphilis, gout and alcoholism. Nephritis is one of the most certain causes, because arterio-sclerosis (hardening and decaying of the walls of the arteries) and hypertrophy of the heart are associated with nephritis, etc.

[NERVOUS SYSTEM 293]

Direct Causes.--Straining at stool, heavy lifting, anger, rage, fright, etc.; paroxysm of whooping-cough or convulsions may cause it in children.

Symptoms.--Sometimes the patient experiences headache, dizziness, paleness or flushing of the face, fullness in the head, ringing in the ears, etc., temporary attacks of numbness or peculiar tingling in one-half of the body. When the bleeding takes place there is usually loss of consciousness. In the attack:--If the bleeding is extensive the patient falls suddenly into coma, and this may soon prove fatal. If the bleeding is slight at first and gradually increases, the patient is delirious at first, then one arm, then one side, and finally the whole body may become paralyzed, and unconsciousness, and even death may come from the paralysis of the heart and breathing nerve centers. In many cases the patient falls unconscious without previous warning. The face is red, the eyes injected, the lips are blue, the pulse is full and slow, and the breathing is slow and deep. The head and eyes may be strongly turned to the injured side. The pupils may be unequal. The paralysis may not be noticed while the patient is unconscious and is quiet. The urine and the bowels contents may pass involuntarily or the urine may be retained. Sometimes when the case is very grave the patient does not awake from his deep sleep (coma); the pulse becomes very feeble, respiration becomes changed, mucus collects in the throat, and death may occur in a few hours or days. In other cases the clot in the brain is gradually absorbed, and the patient slowly returns to consciousness. Sometimes relapses occur. In mild cases instead of deep coma, there may be only headache, faintness, nausea and vomiting.

Subsequent Symptoms.--When the patient improves, consciousness returns, but there remains a half-side paralysis, hemiplegia, on the side and opposite to that of the seat of the injury in the brain. It may not take in the whole side, only a part. The gait is peculiar. In walking the patient supports the paralyzed arm. In many cases the paralyzed parts gradually regain their functions in a few weeks, but not always complete. The leg improves more than the arm. There is danger of other attacks. When the sleep (coma) is very deep, the breathing is embarrassed, with vomiting and prolonged half-consciousness and extension and complete paralysis, the danger to life is great.

What can I do at once? Loosen the clothing around the neck and waist. Raise the head and shoulders and put cold to the head (ice bag if you have it) and warmth to the feet, legs and hands. Watch the bladder closely. The urine must be drawn frequently in this disease, especially if there is much paralysis. It may dribble away, but that is not enough. Look out for bed sores, especially if the sickness is a long one.

[294 MOTHERS' REMEDIES]

APOPLEXY. 1. Mothers' Remedies, Simple yet Effective Remedy for.--"Place the feet of the patient in hot water and mustard," This is a very simple treatment for such a serious disease, but very often will relieve as the hot bath will cause a reaction, take the pressure of blood from the brain and by this means has been known to save many lives.

2. Apoplexy, Simple Injection for.-"Place dry salt on the tongue and give an injection as follows:

Warm water 1 quart Common salt 2 teaspoonfuls Brandy 1/2 ounce

This injection is recommended for any kind of a shock which affects the circulation."

The injection of the bowels will relieve the congestion by drawing the blood away from the brain.

Medical treatment must be to regulate the diet, bowels, kidneys, and stomach. Restore the general health.

Caution.--A person who has had an attack of this kind may have another. The mode of life must be changed in most cases. The patient must take things easy. The bowels, kidneys, stomach, and liver must work naturally and the stomach must not be overloaded. Too much meat must not be eaten; alcohol must be let alone; rich foods are prohibited. Hurry, worry, anger, fright, excitement, etc., are bad. Be lazy, take life easy, do not get over-heated, and sleep, sleep, SLEEP,--in a room where there is plenty of good air. Do not lift or strain to have a passage of the bowels. Stooping is injurious. The blood must be kept from the head. Take proper care and you are likely to live years longer. And now you may wonder why I give such cautions. Apoplexy is directly due to a breaking of the wall of a blood vessel, large or small; due to a weakening, or decay, or degeneration of the wall. This lets the blood into the substance of the brain and presses upon the nerve centers, causing the trouble and paralysis. Any wrong action tends to fill the blood vessels very full and the weakened wall bursts.

PALSY. Paralysis.--A loss of movement, entire or partial, in the voluntary muscles of the body. When this loss of power is complete it is called paralysis; when it is not complete, paresis.

Causes.--Inflammation of the brain and spinal cord, tumors in these parts, accidents and injuries, poisons, apoplexy, etc.

Symptoms.--The patient cannot make all the usual motions of the part. The affected muscles may waste after a time.

Different Varieties.--

(a) Paralysis of the ocular (eye) muscles.--The vision becomes double, the eyelids do not act normally, may droop. The eye may not move in every direction as it should.

(b) Paralysis of the muscles of mastication (eating). Symptoms.--If paralysis is only on one side, it is difficult to chew; if on both sides, chewing is impossible. The jaw hangs down.

[NERVOUS SYSTEM 295]

(c) Paralysis of the facial (face) muscle.--This is a rather common occurrence, and is due to exposure to wet, and cold, diseases of the middle ear, tumors, etc. Symptoms:--The eyelids do not close tightly, and tears are continually trickling over the cheek; the corner of the mouth droops and the saliva runs out, etc. The mild cases last two or three weeks; the severe form from four to six weeks; the worst cases usually recover in a long time.

(d) Paralysis of the muscles of the upper extremity.--There are various and many symptoms, but with all there is the same loss of the usual motion. That particular muscle does not do its special work; for instance, if the paralysis is of the deltoid muscle of the arm and shoulder, it is not possible to raise the arm, usually pain in the shoulder. The muscle soon wastes and the head of the arm bone (humerus) falls away from the shoulder, etc.

(e) Paralysis of the muscles of the lower extremities.--Paralysis of the "Gluteus Maximus and Minimus." (Hip muscles). Lifting up of the thigh is difficult and so is walking up hill or rising from sitting position. The toes are turned out. The other muscles may be paralyzed and simply cannot do their usual duty.

(f) Toxic (poison) paralysis. Lead paralysis.--It is hard to extend the fingers. The lead line is shown on the gums.

PHYSICIANS' TREATMENT for Palsy.--Remove the cause. Give salts and iodide of potash. Paralysis from arsenic, mercury, zinc or copper:--The symptoms are those of neuritis and are greatly similar in each kind. The spongy gums show mercury; the puffy face and diarrhea show arsenic poison. Remove the cause.

CONGESTION OF THE BRAIN. (Diseases of the Cerebral (Brain) Circulation). (Hyperaemia).--The brain is too full of blood.

Causes. For Active Congestion.--Over-exertion in study, etc.; chronic pletbora (too much blood in the blood vessels); from constant use of alcohol, tobacco, amyl nitrite, and from the stomach.

For passive congestion.--Local obstruction to the return of blood from the brain. Prolonged mental and physical exertion with excesses and irregular living may cause it.

Symptoms of active kind.--Head feels warm, face is red, the arteries in the neck beat hard, violent headache, ears ringing, very restless and does not sleep well.

Symptoms of the passive form.--The headache is not so great; there may be stupor, drowsiness and dull intellect and very sleepy.

Recovery.--Favorable if the cause is removed.

Treatment for active congestion.--Keep the patient absolutely quiet in a dark, well aired room, with the head and shoulders raised, an ice bag or cold cloths to the head and warm applications to the hands and feet. A warm foot bath will aid in drawing the blood away from the head. Give salts (salines) to move the bowels. These take away a great deal of water from the blood and aid in relieving the congestion of the head.

[296 MOTHERS' REMEDIES]

Treatment for passive congestion.--Remove the cause if possible. Give a light nutritious diet; prohibit alcohol in any form; keep the bowels regular.

CEREBRAL ANEMIA. (Too little blood in the brain). Causes.--Heart disease, general anemia, and mental excitement.

Symptoms.--"Fainting spells," dizziness, the ears ring and there are spots before the eyes; nausea and vomiting may go ahead of the fainting spells. The face is pale, the pupils are dilated, the pulse is small and feeble, and there may be cold sweating on the body. If you can remove the cause the result is favorable.

Treatment.--For the fainting fits:--Place the patient in the "lying down" position and this frequently restores consciousness; loosen any tight clothes, corset, waist, collar, etc. Give plenty of fresh air and do not crowd. Keep quiet yourself; do not get excited. In mild cases, mild stimulants may be necessary. Let the patient smell of camphor, put a cloth with camphor or ammonia near the nose. In other cases amylnitrite and strychnine may be necessary. Small doses of whisky or brandy frequently help. Remove the cause. Give tonics for general anemia.

TUMORS OF THE BRAIN AND INFLAMMATION, Abscess, etc. Abscess.

Causes.--This is always secondary and comes from some other part of the body. It comes often in young and middle life and is more common in males than in females. The most frequent cause is inflammation of the ear and the next is from fracture of the skull bones. It may be large or small.

Symptoms.--May come slowly or quickly. After an injury to the head the symptoms may come on suddenly such as intense headache, delirium, vomiting, chills, high fever, and sometimes convulsions, and a very deep seeming sleep (coma). In chronic cases the symptoms are not so severe.

Treatment.--An operation if the abscess can be reached. If not, an ice bag should be applied to the head; quiet the distress with narcotics.

TUMORS OF THE BRAIN.--Varieties in order of their frequency. Gumma, tuberculous tumors, glioma, sarcoma, cancer, etc.

Causes. Predisposing.--Men are about twice as often affected as women until fifty and then it is about equal. It is more frequent in early adult life. The exciting causes are blows and severe emotional shock.

Gumma (in third stage of Syphilis) appear as a round, yellow, cheesy mass, usually beginning in the membranes and are usually seen between thirty and fifty. They come from syphilis.

[NERVOUS SYSTEM 297]

Tuberculous tumors. These appear as hard masses and vary in size. They may be single or many, and are situated in any part of the brain. More than half of the tumors appearing in children are of this variety.