The Lumleian lectures for 1850 ... On the pathology and treatment of delirium and coma / [Robert Bentley Todd].

  • Robert Bentley Todd
Date:
[1850]
Catalogue details

Licence: Public Domain Mark

Credit: The Lumleian lectures for 1850 ... On the pathology and treatment of delirium and coma / [Robert Bentley Todd]. Source: Wellcome Collection.

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    I must call hysterical coma, or, to connect it with phenomena otherwise produced, mesmeric coma. The only history we could obtain of him was that he had, about two o’clock in the morning, walked into a coffee-shop in Drury Lane, where he was found sitting in one of the boxes, speech¬ less and insensible. He was handed over to the police, by whom he was brought to the hospital. The house-physician found him sitting erect on a chan, his eyes widely open and motionless, pupils dilated, and presenting an undulating motion when the candle was placed near them; conjunctiva) rather injected ; countenance expressive of astonishment; respiration easy, although a little quicker than it ought to be; power of deglutition perfect; no spasm or twitch¬ ing of any single muscle. The most re¬ markable feature was his utter insensibility to every external impression; even the roughest treatment produced no effect upon him ; the splashing of cold water, shaking, pinching, shouting in his ears, seemed to make no impression. He had walked into the hospital between two policemen : whilst in the surgery of the hospital he never altered his position m the slightest degree; and after having been examined in the surgery, he walked up stairs to his ward without dragging his feet, but aided by the policemen. After he was placed in bed he continued in the same state of insensibility to external impressions, but appeared to resist any attempt to alter the position of his limbs, and exhibited a disposition to retain the limb in any position in which it was placed. He kept for some time continually opening and shutting his mouth at regular intervals, and winked his eyes naturally, and moved his eye-balls from side to side. At 10 A.M., eight hours after his admis¬ sion, he was still insensible; his bladder became much distended, and three pints of urine were drawn off, which exhibited no morbid character, but was of low spe¬ cific gravity,—1010. He remained in this state the whole of the 2d, and on the 3d he was still found insensible, having not uttered a sound since his admission. He was taken out of bed, and an attempt made to place him in the erect posture, but his whole body became rigid, all the muscles being thrown into powerful tonic contractions: he was re¬ turned to his bed, where he lay in the same insensible state : the urine accumulated in his bladder, and had again to be drawn off. To-day various expedients were resorted to, to test the reality of his insensibility, which ended in confirming our belief, from the appearance of t he patient, that he really was insensible. Among other means em¬ ployed, the soles of his feet were filliped with a wet towel, without exciting the least indication of sensibility. A bottle of strong ammonia was held under his nostrils, but the fumes produced no effect beyond watering of the eyes ; and after some time he turned away his head. He continued to lie in bed apparently unconscious, but oc¬ casionally snapping with his teeth. On the second day after his admission (the 4th) he made signs for paper, and wrote an account of himself, stating that he had been subject to fits, and giving the address of his father, and also giving a his¬ tory of himself during the day previous to his admission to the hospital. But it was very remarkable that in writing he seemed to trust entirely to the guidance of his sense of touch, for during the whole time he was writing he kept his eyes averted from the paper, with a fixed gaze directed towards the ceiling, and when a handker- c hief was applied round his eyes it did not interfere with his ability to write. But we could not obtain any satisfactory evidence that he could see, or hear, or smell. After this he began to ask for food, and ate with the most extraordinary eagerness, snapping at everything that came in con¬ tact with his lips,—even pieces of paper, which he chewed and swallowed. In the afternoon of this day he began to see, and amused himself reading and writing, in both of which he showed him¬ self a proficient. He was still defective in hearing and in the power of speech ; he seemed quite in¬ sensible to the loudest noises ; shouting into the ear, which generally produces so disa¬ greeable a sensation in the meatus, seemed to produce no effect upon him, either npon the common sensibility or upon the hearing. We could only converse with him on paper, and he showed great readiness in keeping up the conversation. He continued in this state in the hospital nearly three weeks from his admission: various means and devices were tried to ascertain whether he could hear; but all who saw him, both nurses, patients, stu¬ dents, and visitors to the hospital, agreed in opinion that he could not or did not hear, or that if he did hear he carried on his deception in the most remarkable manner. Nor could he be induced to speak: on one occasion I ordered him to be kept without food until he spoke, but the effect of this was merely to cause a paroxysm of hysterical crying. Unfortunately this patient was inveigled from the hospital by some devotee of mes¬ merism ; and he was placed under the care of a physician who unhappily misap¬ plies his great talents to what I can regard no otherwise than as the conjurings ofmes-
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