sion on the nerve. The painful points are located (1) above the hip-joint, near the posterior iliac spine, (2) at the sciatic notch, (3) about the middle of the thigh, (4) behind the knee, (5) below the head of the fibula, (6) behind the external malleolus, and (7) on the back of the foot. Tenderness is usually also elicited by pressure along the course of the nerve. Muscular wasting and fibrillary twitchings complicate the severe cases.

Sciatica is most common in those with a gouty or rheumatic tendency. The nerve may be compressed by intrapelvic growths or may be involved by spinal caries.

The prognosis must be made with caution, as many cases of neuralgia prove intractable to treatment.

Treatment.--All causes for reflex irritation must be discovered and removed if possible. A tonic and supporting treatment is of the greatest importance. The patient should be built up in every possible way. Iron and arsenic are required for anæmic conditions; gouty and rheumatic taints are to be treated; quinine is to be given to malarial patients. The diet should be generous. Fats are indicated in nearly all of the cases, and a liberal amount of meat is to be allowed to all except those subject to gout. Many obstinate cases are benefited by residence in a dry inland climate. Strychnine, phosphorus, and cod-liver oil are of great service.

For the pain, antipyrine, phenacetine, lactophenin, chloral, croton-chloral, the bromides, and cannabis indica may be given. Aconite and gelsemium are recommended for trifacial neuralgia. Morphine, codeia, and hypodermic injections of cocaine are to be withheld, because of the danger of forming the habit. Local applications are frequently of service. Heat, stimulating liniments, freezing of the skin by ether or methyl-chloride sprays, blisters, or application of the actual cautery may be employed. Surgical treatment may be required for obstinate cases. Nerve-stretching is

not likely to be followed by permanent results. Neurectomy, or the excision of a portion of the affected nerve, is frequently followed by good results, but the pain may return in time.

7. GENERAL NERVOUS DISEASES.

INFANTILE CONVULSIONS; INFANTILE
ECLAMPSIA.

Etiology.-Convulsions are so frequent in children that a special mention is justifiable. Owing to the lack of development of the higher cerebral centres of children, the lower centres are but improperly controlled, so that increased reaction to direct or reflex stimulation is permitted. The most important causes for convulsive seizures in children are the following:

1. Rickets. Convulsions, usually without marked febrile disturbance, occur from slight causes, and are apt to be repeated at intervals for months.

2. Gastro-intestinal Irritation.-This most common cause arises from dietetic errors, indigestion, or worms. The convulsions are usually accompanied by fever.

3. General exhaustion, especially if due to diarrhœal disease. Convulsions may be part of a hydro-encephaloid condition.

4. Mechanical congestion of the brain, as with violent attacks of coughing.

5. Deficient aëration of blood, as with croup, diphtheria, or vitiated air in incubators.

6. During the first few days of life, from severe braininjury during birth. If the convulsions be severe and persistent, meningeal hemorrhage should be suspected.

7. Peripheral irritation, as teething, phimosis, or otitis.

8. Acute febrile conditions, especially at the onset of measles, scarlet fever, and pneumonia.

9. Convulsions may usher in or accompany any serious disease of the nervous system in children.

10. Convulsions in infancy are not infrequently epileptic. The symptoms may be preceded by signs of irritation of the nervous system-restlessness, irritability, and twitchings. The attack begins with a fixation of the eyeballs; the face becomes pale, the limbs and trunk become rigid and stiff. The fingers and toes are inverted (carpopedal spasm). Respiratory movement is impaired, so that the face becomes cyanotic. The spasm may relax, or may become clonic as in epilepsy. In some cases clonic spasms are marked from the start, and usually begin in the hands and face.

The spasm may be followed by muscular rigidity for some little time. In convulsions due to indigestion the attack may be single; in other cases attacks follow each other with great rapidity. Attacks coming irregularly and without assignable cause in children over two years of age are likely to prove to be true epilepsy. Convulsions may be followed by slight paresis or may lead to meningeal hemorrhage with hemiplegia.

The prognosis is usually good. A dubious prognosis should be given, however, in the case of weakly subjects, as fatal exhaustion may be induced.

Treatment. The first and most important measure is to search for the cause of the seizure, and to remove it if possible. If indigestion be the cause, a prompt emetic should at once be given, or the stomach may be washed out. For the attack itself, if severe, whiffs of chloroform should be given, and an enema containing chloral (gr. ij) and sodium bromide (gr. v-x) should be administered, these doses being suitable for a child of from six to twelve

months. No time should be lost in immersing the child in a bath at 95° F.; baths of a higher temperature are not suitable. After the bath an ice-cap should be employed or cold applications should be made to the head. Morphine may be necessary in case of recurring convulsions, but the drug should be administered with extreme caution, and should never be ordered for infants under six months of age. For a child of one year, gr. 16 to hypodermically will be a sufficient dose.

EPILEPSY.

Etiology. Among the remote causes which induce this disease, heredity is the most important, a neurotic family history being obtained in about one-quarter of all cases. A direct inheritance of epilepsy is rare, but the parents are apt to suffer from nervous diseases or to be the victims of the alcohol habit. Any vicious influence deteriorating the parent stock predisposes to the development of epilepsy in the offspring. Consanguineous marriages exert a distinct influence upon the causation of the disease. Epilepsy may interchange with insanity in different gen

erations.

An immediate exciting cause is determined in but onethird of all cases. There may be blows on the head, dissipation, fright, or continued reflex irritation. Many cases in children date from teething or from acute infectious diseases. Although in many cases the exciting cause may be removed, the nerve-centres may have formed the habit of discharging nerve-force, so that the seizures continue through life.

Males are more frequently affected than females. The disease appears before the thirteenth year in one-third of the cases, between the thirteenth and nineteenth years in one-third, and between the nineteenth and thirtieth years in one-third of the cases. After the thirtieth year idiopathic

epilepsy is rare. "An epilepsy which develops after the thirty-fifth year of age is not idiopathic, but is due to some organic brain disease, to the abuse of alcohol, to reflex irritation, or other causes, which in some cases may be so hidden as to be exceedingly difficult of recognition" (H. C. Wood). In the great majority of cases, recurring epileptic seizures in those over the age of thirty are due to brain syphilis.

The pathology of epilepsy is obscure. A degeneration of the neuroglia in the brain has been described by some observers. The generally accepted theory is that the seizures are due to a discharging lesion of the brain-cortex, so that an overflow of nerve-force occurs.

Symptoms.-Loss of consciousness with general convulsions is known as grand mal; loss of consciousness without convulsions, as petit mal. Localized convulsions, usually without loss of consciousness, are described as Jacksonian or cortical epilepsy.

GRAND MAL.-The attack may be preceded by peculiar sensations, described as auræ, which give warning to the patient that an attack is impending. Sensory auræ are the most common; they differ in character in different patients, but are constant in the one subject. An aura consists of a peculiar sensation, felt in some part of the body, mounting upward to the head. Auræ of special senses are occasionally observed. An ocular aura consists of visual sensations-flashes of light or of color, bizarre forms, double vision, or even blindness. In auditory auræ abnormal sounds or voices may be heard. An olfactory aura, which takes the form of a bad smell, is rather infrequent. Psychical auræ are not uncommon; the patient may feel alarmed or may be in terror, or there may be a vague sense of strangeness or a dreamy sensation. In some cases the attack is preceded by forced movements; the patient may run forward with great speed ("procursive epilepsy"), or