On the pathology and treatment of delirium and coma : the Lumleian lectures for 1850 / by R.B. Todd.
- Date:
- 1850
Licence: Public Domain Mark
Credit: On the pathology and treatment of delirium and coma : the Lumleian lectures for 1850 / by R.B. Todd. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![niorism. By this gonllemnn he was mcs* nicriscd daily for one liour for the space of four weeks. After one of tlicse mesmeric sittings ho recovered his liearing, and in tlu-ce-quarters of an hour after that his speech. I cannot help, however, express- ing my belief, that, as his health had greatly improved under the discipline and treat- ment to wliich he was subject in the hos- pital, ho would have recovered both lus hearing and his speech in less time than under the mesmeric processes, which, in- deed, I cannot doubt, had the effect of re- tarding recovery ; for I can no more be- lieve that the hysterical disposition is to bo removed by the frequent repetition of the hysterical paroxysms, than I can suppose that the tendency to epilepsy is to be cured by the daily repetition of an epileptic fit. I am confirmed in my belief that this pa- tient wo\dd have perfectly recovered with- out the aid of the mesmeric mysteries, by the favourable result of another case, which we succeeded in keeping out of the hands of the mesmerists. The patient, in this case, was a girl of 19 years of age, of a nervous temperament. She accidentally fell into a river, and w'as inunersed in deep water for many minutes: she was taken up in a state of suspended animation. Six hom-s elapsed before she recovered her senses ; and she continued unwell and depressed with headache for several days after the accident. Ten days after it, she had an hysterical paroxysm, and lay for nearly four hours in a state of stupor, out of which she came, deprived of the power of speech and of hearing, as well as of taste and smell, and her mental facul- ties quite benumbed or paralysed, as she gave no indication that she recognized any of her friends about her. An admh'able account of this case has been given in the Lancet for 1845, by my friend Mr. Robert Dunn, to whose kindness I am indebted for the opport miity of seeing it. The patient recovered perfectly under a treatment directed to the improvement of her physical health and strength, and is now in a perfectly healthy state. Whatever be the natui’e of these coma- tose hysterical affections,—whether they occur in men or hi women, and whether they are compheated with ecstatic or cata- leptic phenomena,—the general tendency is for them to get well. Nor have we any evidence of the existence of any inflamma- tory or other organic lesion in the brain or other part of the nei-vous system in these cases. There cannot, indeed, be any doubt that they are never accompanied by an in- flammatory state of the brain or its mem- branes. Traumatic coma.—I shall next refer to a fonn of coma wliich accompanies injuries and severe oiierations, which is well known by the name of concussion, when occurring in consequence of injuries to the head. The phenomena of concussion are these: —A man gets a violent blow on his head, without any fracture or injury of the bone: he is stunned; in other words, he is ren- dered comatose from the moment of the injury. If the blow be not severe, he re- mains insensible for a httle time, and then recovers perfectly; or, if tlie shock be great, he becomes cold, his pulse intermit- tent, and he dies apparently from the shock, the insensibility remaining to the last; or he remains insensible for some time, then becomes delirious, and ulti- mately recovers. Such is the history of concussion of the brain, or traumatic coma fi’om shock to the brain. When you exa- mine the bram in fatal cases, you find it in an apparently healthy state. “ From such examination,” says Sir Benjamin Brodie, in his valuable paper on Injuries of the Brain, in vol. xiv. of the Med.-Cliir. Trans- actions, “ we learn that the symptoms which are ascribed to concussion do not depend on any such derangement of the organization as admits of being disclosed to us by dissection. The brain appears to retain its natural structure unimpaired.” And not only does this state of coma occur in cases of injury of the head, but also from the shock produced by severe surgical operations or other mjuries. Many years ago I was present at the operation of lithotomy on a boy nine years old. The operation was done in the ordi- nary way, without any untoward accident which could endanger the favoiu-able re- sult. The evening after the operation the child began to be comatose, with cold ex- tremities and small pulse, and without the least indication of peritonitis. The patient continued in this comatose state for three days, and died. I examined the body with great care, but could not detect any mor- bid ap]iearance except a general pallor of all the uitemal organs. Severe and extensive burns and scalds create at the moment of the accident, or very shortly after, a state of more or less complete coma. This state of coma may be due partly to the physical effect of the shock, and partly to the mental trouble of the severe fright. Such was probably the mode of death in the case of the young woman known as the Lion Queen, who formed part of the com- pany attending Wombwell’s menagerie. The case was reported m the newspapera some months ago. The ghl, while playing with the tiger, vexed him, whereupon he seized her neck in his mouth, and inflicted a severe wound in the neck, which exposed](https://iiif.wellcomecollection.org/image/b21955566_0024.jp2/full/800%2C/0/default.jpg)
