The Mother's Manual of Children's Diseases

by Charles West

There is, however, a very real paralysis which occurs sometimes in infants and young children. It comes on for the most part quite suddenly, often unaccompanied by any sign of brain disorder, but tending nevertheless to issue in great permanent impairment of the power over the affected limb or limbs, and eventually to interfere with their growth and thus to produce serious deformity.

It is in general impossible to assign any distinct exciting cause for the affection, though the fact that in two-thirds of the cases it occurs between the ages of six months and three years, proves it to be in some way intimately associated with teething. The oldest child in whom I have ever seen it was aged between seven and eight years, and the youngest a little under six months. It is of excessive rarity for the arm alone to be affected, but it is by no means unusual for the legs alone to be paralysed; though in the majority of instances power is lost on one side only, the leg and arm being both involved.

A child goes to bed quite well, or at the worst having seemed slightly ailing and feverish for a day or two, and on waking in the morning it is suddenly discovered that power is lost over one leg or both, or over both arm and leg of one side. The loss of power is at first seldom complete, though neither arm nor leg can be used to any good purpose, and during the ensuing twenty-four hours the palsy often grows worse, and sometimes affects one or both limbs of the opposite side. After that time recovery in general begins. It is now and then speedy, so that in three or four days all trace of the paralysis may have disappeared. This, however, is a fortunate exception to the general rule, which is that amendment is very tardy, showing itself first in the arm, afterwards in the leg, and, if both sides have been affected, more on one side than on the other. Unless the improvement is very rapid, it is almost always only partial, and the palsied limb, though it does not lose sensation, regains but little power; it grows much more slowly than the other, is always colder and wastes considerably, while, some muscles still retaining more power than others, it becomes twisted out of shape, and requires all the skill of the orthopædic surgeon to remedy or at least to lessen the consequent deformity.

It has been ascertained that this form of palsy depends on a state of congestion, or overfilling of the minute blood-vessels of the spinal marrow. When the child gets well the congestion has passed away; but it does this speedily, and recovery is then rapid as well as complete. If it does not soon pass away, other changes take place in the spinal marrow, and recovery is then slow, incomplete, or even does not take place at all.

Remedies are unfortunately of little avail here, but it is evident that when the palsy is quite recent all movement of the limb must be mischievous, and that the congestion of the spinal marrow to which it is due will be most likely to abate under the influence of perfect quiet, rest in bed, and soothing or fever medicines, or of such as are calculated to overcome constipation, or to correct any fault of digestion, while the importance of teething, and the possible expediency of lancing the gums must not be forgotten.

Afterwards comes the time for exercise of the paralysed limb, for friction, for shampooing, for galvanism; all continued perhaps for months or years with unwearied patience, and I must add with reasonable expectations as to the result. The only additional remark which I have to make is this, that to gain any real good from galvanism, a battery must be procured under the direction of some medical man specially skilled in the use of electricity, and the mode of employing it must be learned thoroughly from him. It is merely idle to purchase a toy machine, and, giving it to the nurse to turn the handle for ten minutes twice a day, to fancy that you are making a serious trial of the effects of galvanism. As a mere money question, a costly machine, and several fees paid in order to be thoroughly instructed in the way to use it, is much cheaper than a cripple child.

A few words may not be out of place with reference to cases in which paralysis is mistakenly supposed to exist. Much anxiety is sometimes expressed by parents concerning children who have long passed the usual age without making any attempt to walk; or who having once walked seem to have lost that power. Now it often happens that after any weakening illness a child ceases for some weeks to walk, just as it ceases to talk. The power in both cases was newly acquired, it called for effort which, when strength is regained, will be put forth once more. The same applies to other instances in which children are late in learning to walk; or who, having once walked, leave off walking when a back tooth, or when one of the eye teeth is coming near the surface of the gum, and regaining the power lose it again, or lose at least the desire to exert it more than once during the active progress of teething. But, holding the child under its arms, you have but to put its feet to the ground, and at once it will draw up its legs though it will make no other movement; or take it on your lap and tickle the soles of its feet, and laughing or crying, as the mood takes it, it will move its legs about as freely as you could wish and show that the power is still there, though for the present the child will not take the trouble to exert it.

Gradual loss of power over one or other leg, especially if attended with pain either in the back or in the knee or hip, should always call for attention, and induce you to seek at once for medical advice. Such cases generally occur later in childhood than the conditions of which I spoke in the former paragraph, and may depend on disease of the spine or of the hip-joint, two serious conditions which it needs the medical expert to discover and to treat.

Neuralgia and Headache.—In the grown person neuralgia, as many of us know to our cost, is by no means infrequent; in the child it is very rare, and when a child complains of severe pain in the head, or of severe pain to the knee or hip apart from rheumatism, it is almost invariably the sign of disease of the brain in the one case, of the hip-joint in the other. To this rule there are indeed exceptions, but it will always be well to leave it to the doctor to determine—no easy matter by the bye—whether any given case is one of the rare exceptions or not.

There is, however, one form of real neuralgic headache which is by no means rare in children after the commencement of the second dentition, and which sometimes goes on into early manhood or womanhood, when it becomes what is commonly known as sick headache. It is essentially an ailment of development, incidental to the time when the brain is first called on for the performance of its higher functions.