Volume 2

An American text-book of the diseases of children ... / edited by Louis Starr ; assisted by Thompson S. Westcott.

Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: An American text-book of the diseases of children ... / edited by Louis Starr ; assisted by Thompson S. Westcott. Source: Wellcome Collection.

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    the face will recover, and that the leg will become sufficiently useful for loco- motion. In the bilateral palsies the prognosis as regards walking cannot be quite so favorable. Except in the severest forms speech will be recovered more or less perfectly. After the lapse of a few months an idea can be obtained as to the mental state, and as to whether imbecility or idiocy is to be appre- hended. The probability of epilepsy is the feature in prognosis requiring the greatest exercise of judgment. Epilepsy may not appear for a year or two after the onset of the paralysis, and the statistics already given as to the enormous percentage of these cases thus affected must be borne in mind. Treatment.—In cases seen shortly after birth, showing symptoms of cere- bral lesion, quiet and careful handling are the chief indications. Minimal doses of bromide of potassium or chloral, or chloroform inhalation may be employed if convulsions occur. In the initial stages of the acute acquired palsies we treat the infantile apoplexy in much the same manner as we would apoplexy in the adult. Absolute quiet, cold applications to the head, and emptying of the bowel are the first steps in treatment. In a few days the bromides may be used to ensure greater rest to the brain, and subsequently, combined with an iodide, continued for some time, though not so long as to interfere with nutrition. In the chronic stages relief is generally sought for secondary conditions, such as deformities from contractures, and idiocy and epilepsy. Excellent results are achieved by tenotomy and orthopaedic apparatus properly applied for the cor- rection of the various deformities, particularly of the lower extremities. In one case in this city athetosis in the right arm was so extreme that the limb was amputated at the shoulder, to the great relief of the patient. Electricity (especially the faradic current) may be used to exercise the paralyzed muscles, and, combined with massage, may go far to prevent and remedy contractures. The epilepsy is treated with the usual agents, the bromides, chloral, and the like, though, it must be confessed, without much success. To remedy the mental defects very much can be done by careful manual and intellectual training. In fact, surprising results are often achieved in the development of the mind, speech, capabilities, and character of these cases when placed in schools especially adapted for such purpose, as is evidenced by the experience at Bicetre and some of the private schools in this country. As regards surgical procedures in any of these cases, either for relief of epilepsy or for the improvement of the mental condition, the most that can he said at the present time is that, upon the whole, little or nothing is to be ex- pected from trephining, craniectomy, and the like. Possibly future experience may justify operative interference in a small percentage; but the great majority of infantile cerebral palsies are better left to the treatment of the family phy- sician, to the orthopaedic surgeon, and to the developmental influences of special schools. M. Allen Starr states, in a very recent paper, that he has collected some fifty cases of operations in these and allied conditions (like mierocephalus). Many of these he publishes in a list, and an examination of his table showing the results obtained is certainly not very encouraging. In addition to these, Sachs gives notes of three of his own cases operated upon, all hemiplegics with epilepsy, in two of which the seizures returned after operation in three and six months respectively, and the other was not seen after three months, up to which time no attacks had supervened. Wildermuth, however, reports two cases of hemiplegia with epilepsy, in which the seizures seemed to have ceased, one having not been observed for three years and the other ten months subsequent to operation. Besides the apparent futility of cerebral surgery in most of such cases, children do not undergo these operations with as little danger as adults, and the proportion of deaths in the cases thus far published is rather large. 42