Convulsions (including epilepsy) in childhood.

Of all the upsets which can happen to the infant or child, it would be safe to say that none is as alarming to the parents as a convulsion. A good knowledge of the causes of convulsions is therefore essential, if one is to handle the situation well, and relieve the parental anxiety with authority. The diagnosis may sometimes be difficult, for even 'windy pains ' with screaming may simulate a convulsion in the parental mind. More often than not, we must base our diagnosis on the description given to us by the parents, as the attack is over before we see the child. Petit mal may be so fleeting that it can, for some time, be mistaken for a mannerism by the parents. When called to a child with a convulsion nothing can replace a very careful physical examination. The throat and ears should be viewed to exclude infection; the heart, lungs, and abdomen should also be examined, and, when possible, a specimen of urine should be analysed for sugar, acetone, albumen, blood, or pus. The eye grounds should be scrutinized for papilloedema and it should be ascertained whether there is a squint; the remainder of the central nervous system should be run over, and this examination should include testing for Kernig's sign. An examination of the nervous system of an infant or child is less informative than that of an adult, as the presence or absence of, for example, the knee jerks, is not so significant. I propose describing what is usually called epilepsy ' last of all. Since convulsions are a symptom and not a disease, it would be well to begin by enumerating the various conditions which will give rise to this symptom.