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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![91 Sequel TO THE LUMLBIAN LECTURES. ON THE TREATMENT OF DELIRIUM AND COMA, Delivered at King’s College Hospital. [Reported by Mr. Lionel S. Beale, Med. Associate, K.C.L.] LECTURE I. Recapitulation of the conclusions arrived at in the Lumleian Lectures—Delirium and Coma not inflammatory in the vast majo- rity of cases—Congestion not a cause of delirium or coma—Diagnosis of the dif- ferent forms of delirium—Assisted mate- rially by the fact of the rarity of in- flammation of the brain in the adult— The few cases in hospital practice—also in the Registrar-General’s reports—Sym- ptoms of inflammation of the brain — Diagnosis of the various forms of non- inflammatory delirium from each other. Q-entlemen,—I have lately been giving, as most of you are perhaps aware, some lectmcs at the College of Physicians, on the subject of delirium and coma. In these lectures I have endeavomed to collect and arrange the most important facts in the clinical history and morbid anatomy of these diseases; and from these premises, with due attention to certain points in the physiology of the brain and nervous sys- tem generally, it has been my object to deduce conclusions with respect to the intrinsic nature of delirium and coma; or, in other words, to frame a reasonable view of the pathology of those affections. The conclusion at which I arrived in these lectures was, that, in the vast majority of cases, delirium and coma essentially de- pended upon different degrees of derange- ment of the nutrition of those parts of the brain, which may respectively be called “the centre of intellectual action and the centre of sensation.” It may, indeed, be said that these symptoms are produced by different degrees oipoisoning of the nervous matter wliich constitutes these centres, whereby their normal action is disturbed. If the poisoning occurs only to a certain extent, delirium is produced; but if to a gi'eater extent, coma will result. Thus if you notice the effects of alcohol upon the system, as we have too many opportunities of doing, you will observe tliat when the alcohohe potations are limited to a certain point, delirium occurs, the person becomes loquacious and merrily dnmk; but if a larger dose of the poison (as it must be called) be imbibed, he becomes stupidly, or, as it is frequently termed, “ beastly drunk,” or, in more scientific phrase, comatose. You have also frequent opportunities of observing these two degrees of the opera- tion of the same poison in patients to whom chloroform is administered prior to surgical operations. After a few inliala- tions, the patient becomes delirious, talks incoh^ently, laughs very much, and offers considerable resistance when attempts are made to hold him. In a short time, how- ever, if the administration of the cliloroform be continued, all resistance ceases, the mus- cles become relaxed, and the patient lapses into a state of profound insensibihty or coma; and that coma will become more profound the more chloroform you give, so that death may be caused by its continued administration. In several constitutional affections the](https://iiif.wellcomecollection.org/image/b21955566_0041.jp2/full/800%2C/0/default.jpg)
