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.
28/72 page 28
![answers to these queries ;—1. Wlmtpart— what organ—is aUcetcd in cleliriuin and eonia ? 2. Wliat is the nat nre of tlio nHeclion, and is tliat allbction the same for eaeli and all those various forms of deli- rium and of coma wliich clinical study tea 'hos us are apt to occur ? With regard to the first question, it is quite clear that wo cannot assign any other scat for these remarkable states than the neiwous system: nor can wo locate them in any other part of the nervous system than in that part which is connected with the actions of the’ intellect, and with that reciprocal inlluence between mind and body which constitutes consciousness. Can we assign them their seat in the spinal cord ? Certainly not; for we know that mental phenomena are completely independent of the spinal cord. Tlie mind may act even when the connection between the cord and the brain is cut off, of which we have many proofs both in chnical observation and in physiological experiment. The removal of the hemispheres of the brain will destroy the phenomena of thought and of con- sciousness ; but the spinal cord may be taken away piece by piece, leaving intact the centre of respiration, and mental phe- nomena will continue unaffected, save so far as concerns the partial affection of con- sciousness which necessarily must residt from severing the connection between the encephalon and those parts of the body whose nerves are implanted in the separated portions of the spmal cord. We are con- scious of the existence of our limbs tlnough the connection of them with the spinal cord, and the connection of the spinal cord with the brain. So long as the trmiks of the nerves of a limb ai-e implanted in a state of integrity in the spinal cord, and so Jong as the connection between the cord and the brain is intact, so long will the consciousness of the connection of tliat limb with the body remain,—so long wdl the mmd conthiue to have the feeling of the connection of that limb • and it is re- markable that that feeling may be falla- cious ; for it will exist even after the limb has been amputated, if only the conditions which I have mentioned are present— namely, the mtegrity of the trunks of the neiwes. and of tlieir implanted roots. Nor can it be got rid of even after a long in- terval of years has elapsed from the time of tlie amputation. The neiwcs of the limb are the media of connection between the organ of consciousness, or, in other words, the centre of sensation and the lunb ; and the trunks of the neiwes contain in them every llbril which is destined for every point of the limb,—for every fibre of its muscidar system. So long, then, ns these fibres arc intact as regards their nutrition and their central implantation, so long arc those conditions sufficient to uphold the feeling or consciousness (fallacious though it be) of the presence of the limb, and of every part of which those fibres form an integral and most important portion. l?arly last winter a girl was admitted into Jiuig’s College Hospital, in whom I had the opportunity of observing the effects of the gradual separation of the spinal cord from the brain. Wlien she was admitted she was suffer- ing from a paralytic state of the left arm and leg, which in many respects resembled that form of paralysis which we often see in hysterical women, so that I was led at first to regard it as a case of hysterical paralysis. I soon, however, discovered a swelling at the upper part of the cervical region of the spine, and a distorted state of the neck, owing to a paralysed state of the muscles of one side, and the consequent disturbance of the eqiuhbriiun between the antagonising muscles of the opposite side. It was then fomid that aU the muscles of one side were paralysed which are supphed with nerves below the level of the second vertebra of the neck —the cervical muscles, the mtercostals, tlie abdominal muscles, and the muscles of the extremities. After a httle while the paralysis began to affect the muscles of the right side of the body ; the right arm first, then the leg, then the intercostal and abdominal muscles; the breathing became extremely feeble, and in parts of the lungs the most attentive aus- cultation could not detect any respfratory murmur. At length the breathing fell considerably in frequency, and it took place by gasps, at intervals of twenty seconds, the oidy muscles which seemed to retain any power being the stemo-mastoid and the trapezius, which are supplied by the spinal accessoiy nen-e. During aU this time the mind remained clear and fi'ce from any delirium, although during the greatest part of it fully three-fom*ths of the body was withdrawn from the controUhig power of the wiU. In this case the medulla oblongata was severed from the spinal cord by the gradual compression of an enlarged odontoid pro- cess, over wluch there was a considerable growtli of cartilage, which no doiibt, by a rapid development, contributed to the ulti- mate ra])id extension of the separation. It is impossible to conceive a more re- markable instance of “dying by mehes” than was aflbrded by tins case. The severance of the spinal cord from the mc- didla oblongata took place in the most gradual manner, and thci’cfoi’o without any of that shock to the nervous centres whicli is so aj)t to conqilicate the results of phy- siological cx)Derunents. It was most hi-](https://iiif.wellcomecollection.org/image/b21955566_0030.jp2/full/800%2C/0/default.jpg)
