The same vasomotor instability which shows itself in the tendency to
syncopal attacks is apparent in many other ways. Sudden sensations of
heat and of flushing, equally sudden attacks of pallor, coldness of
the extremities, abundant perspiration,--raising in the mind of the
anxious mother the fear of consumption,--and excessive diuresis are
common accompaniments. A further group of symptoms is provided by the
extreme sensibility of the digestive apparatus. Dyspepsia,
hyperaesthesia of the intestinal tract, viscero-motor atonies and
spasms, and anomalies of the secretions, whether specific like that of
the gastric juice or indifferent like that of the nasal, pharyngeal,
gastric, and intestinal mucus, are all of common occurrence. Whenever
the nervous child is subjected to any exhausting experience, any
excitement, pleasurable or the reverse, or any undue exertion, whether
mental or physical, one may note the subsequent gastro-intestinal
derangement, including even a coating of the tongue. The slightest
deviation from the usual diet, the most trivial fatigue, a chill of
the body, even a change in the temperature of the food may set loose
the most extreme reactions in the gastro-intestinal tract--motor,
sensory, or secretory. It is not an accident that so often the mucous
diarrhoea, which may have afflicted an excitable child in London for
many months, and which a visit to the seaside, with all its healthy
activities, may seem to have completely cured, relapses within a day
or two of the return to the restricted environment and uninteresting
routine of life in London. The child who was happy and busy and at
peace with himself, at play in the open air, resents the sudden
cessation of all this, and the nervous unrest returns. To attempt
treatment by dietetic restrictions alone is to deal only with a
symptom. The gastro-intestinal reactions are so violent that the
parents are generally voluble on the subject of the many foods which
cannot be taken and the few which are not suspect. To prescribe rigid
tables of diet is to add to the alarm of the mother, and to sustain
her in the belief that the child is in daily danger of being poisoned
by a variety of common articles of diet. Only by lowering the
excitability of the nervous system, by occupying the mind and giving
strength to the child's powers of control can we effectively combat
the hyperaesthesia. If necessary the personnel of the management of
the child will have to be altered. There may be no other way to
achieve certain and rapid improvement in a condition which is causing
grave danger to the child and very genuine distress and suffering to
the parents. A violent reaction to intoxications of all sorts is a
further stigma of nervous instability. Sudden and even inexplicable
rises of temperature are frequent complaints, and the constitutional
effects of even trivial local infections are apt to be
disproportionately great.
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