Wednesday, September 13, 2017

Dr. West's letter to the Lancet

(My apologies for the underlining.)


In a poignant letter to the Lancet in 1841 Dr. W. J. West clearly described infantile spasms and the accompanying mental subnor­mality. The patient was his own son and the letter below is an anguished appeal for possible help for West's son from readers of the Lancet.

To the Editor of THE LANCET:—
Sir:—I beg, through your valuable and extensively circulating Journal, to call the attention of the medical profession to a very rare and singular species of convulsion pecu­liar to young children.

As the only case I have witnessed is in my own child, I shall be very grateful to any member of the profession who can give me any information on the subject, either privately or through your excel­lent Publication.

The child is now near a year old; was a remark­ably fine, healthy child when born, and continued to thrive till he was four months old. It was at this time that I first observed slight bobbings of the head forward, which I then regarded as a trick, but were, in fact, the first indications of disease; for these bobbings increased in frequency, and at length because so frequent and powerful, as to cause a complete heaving of the head forward to­wards his knees, and then immediately relaxing into the upright position, something similar to the attacks of emprosthotonos: these bowings and re-laxings would be repeated alternately at intervals of a few seconds, and repeated from ten to twenty or more times at each attack, which attack would not continue more than two or three minutes; he sometimes has two, three, or more attacks in the day; they come on whether sitting or lying; just before they come on he is all alive and in motion, making a strange noise, and then all of a sudden down goes his head and upwards his knees; he then appears frightened and screams out: at one time he lost flesh, looked pale and exhausted, but latterly he has regained his good looks, and, inde­pendent of this affection, is a fine grown child, but he neither possesses the intellectual vivacity or the power of moving his limbs, of a child of his age; he never cries at the time of the attacks, or smiles or takes any notice, but looks placid and pitiful, yet his hearing and vision are good; he has no power of holding himself upright or using his limbs, and his head falls without support.

   Although I have had an extensive practice among women and children, and a large circle of medical friends, I have never heard or witnessed a similar complaint before. The view I took of it was that, most probably, it depended on some irritation of the nervous system from teething; and, as the child was strong and vigorous, I commenced an ac­tive treatment of leeches and cold applications to the head, repeated calomel purgatives, and the usual antiphologistic treatment; the gums were lanced, and the child frequently put into warm baths. Notwithstanding a steady perseverance in this plan for three or four weeks, he got worse, the attacks being more numerous, to the amount of fifty or sixty in the course of a day. I then had re­course to sedatives, syrup of poppies, conium, and opium, without any relief: at seven months old he cut four teeth nearly altogether without any abate­ment of the symptoms, and up to this period, he was supported solely at the breast; but now, at the eighth month, I had him weaned, as he had lost flesh and appeared worse; I then only gave him alternatives, and occasionally castor-oil. Finding no benefit from all that had been done, I took the child to London, and had a consultation with Sir Charles Clarke and Dr. Locock, both of whom rec­ognized the complaint. . . .

 Although this may be a very rare and singular affection, and only noticed by two of our most emi­nent physicians, I am, from all I have learnt, con­vinced that it is a disease (sui generis) which, from its infrequency, has escaped the attention of the profession. I therefore hope you will give it the fullest publicity, as this paper might rather be ex­tended than curtailed....

W. J. West.
Tunbridge, Jan. 26, 1841.

P.S.—In my own child's case, the bowing convul­sions continued every day, without intermission, for seven months; he had then an interval of three days free; but, on the fourth day, the convulsions returned, with this difference, instead of bowing, he stretched out his arms, looked wild, seem to lose all animation, and appeared quite exhausted.'

1. West, W. J.: Letter to the Editor: On a peculiar form of infantile convulsions. Lancet, 1:724, 1841. 

Cone TE Jr. On a peculiar form of infantile convulsions  (hypsarrhythmia) as described in his own infant son by Dr. W.J. West in 1841. Pediatrics. 1970 Oct;46(4):603. 

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