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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![brain suffers in its nutrition, or its healthy functions are interfered with by the influ- ence of various morbid poisons : of this wo have examples in the frequent occurrence of delh’iuin and coma in typhus fever and the exanthemata, in erysipelas, rhoumatic fever, and gout, in epilopsy. Hence I was led to describe the various forms of delirium and coma under the respective names of ty])hoid, of rhemnatic, of gouty, of erysipe- latous, of epileptic delirium and coma, &c. These various foims of delirium and coma resemble in all essential points those which may be brought on by the introduction into the system of such poisons as alcohol, opium, and the whole class of narcotic poi- sons, &e. From this we may infer, that a morbid matter, generated in the human body, or communicated from one person to another, as the poison of typhus, of the ex- anthemata, of erysipelas, &c. may disturb the eentres of intelleetual action and of sensation; these poisons having a special afiinity for those centres; as Flourens sug- gested that some of the narcotie poisons exereise primarily a speeial influence on particular parts of the brain; as belladonna, which causes blindness and dilatation of the pupil, by acting primarily on the centre of implantation of the optic nerves; alcohol, which impairs the power of the co-ordina- tion of movements, by affecting the cere- bellum; or opium, which eauses contraction of the pxipil, by exerting its particiilar in- fluence on the centre in which the third pair of nerves is impheated. Again, Dr. Percy has shown by chemical analysis, that, in eases of poisoning by alcohol, the brain oontains more of this stimulant than any other texture in the body; so that it woidd appear that the nervous matter exercises a partieular at- traction for this substance, and has a greater power of separating it from the blood, than any of the other tissues. Whatever theories we may adopt with respect to the causes of delirium and coma, chnical examination clearly shows that, in the vast majority of cases, there is no evi- dence that they arise from any inflamma- tory state of the brain. I should say, speaking very roughly, that, of twenty cases of delirium or coma, one might depend upon inflammation; for one ease depend- ing upon inflammation, you have nineteen others arising from causes of a non-inflam- matory charEicter; in other words, for every hundred cases of dehrium and coma, which you meet with, not more than five wfll be inflammatory m their nature. And it may be fruther deduced from the facts of the clinical history which I have coUectod, that congestion takes no part in the production of delirium or coma—congestion, that state to which many are so prone to ascribe the most various, and even opposite affections of tlie brain. If a man be giddy, the giddi- i ness is said to depend upon congestion; if ho has a headache, the pain is referred to I the same cause; if ho be delirious, conges- j tion is the cause; if he be comatose, it is j because the brain is congested. Nor has • any advocate of this view, so far as I am | aware, ever attempted to explain, what seems 1 an obvious contradiction, namely, how a i raving dehrium may be caused by the same j pathological condition (congestion) which | would produce an apojflectic coma. j Undoubtedly, as I have before observed, | in the vast majority of cases we sliall find j that delirium and coma are not produced j by an inflammatory or by a congested state j of the brain; it must, however, be borne I in mind, that now and then we do find J that inflammation of the brain or its en- j velopes does cause delirium or coma, j though these cases are indeed few when compared with the nvunber of cases which cannot be ascribed to such a cause. When the practitioner is called upon to treat a case of delirium or coma, he must first solve the problem, whether, in this particular case, the symptoms are dependent upon in- flammation of the membranes or substance of the brain, or whether it is produced by a peculiar condition of the system not in any way connected with inflammation. At the College of Physicians I was ima- f ble, from the great extent of the subject, to 1 enter at length on the consideration of the J treatment of these diseases, and I therefore I propose to discuss that part of tlie subject • here in the present smd two or three other I lectures, and to illustrate my remarks by I reference to such cases as may occur to us. | Before, however, I speak of the treat- ^ ment of the various forms of delirium and ^ coma, it wfll be necessary that I should occupy a Httle tune with some remarks 1 upon the subject of the diagnosis,—not only of each form of delirium or coma from the others,—but especially of the in- flammatoiy from the non-inflammatory forms of delirium and coma. In this latter diagnosis, it is plain that we derive great aid from the clinical fact to which I have already alluded; namely, that the vast majox’ity of cases of dehrixun and coma are clearly not dependent upon any inflammatory process in the brain—upon any process which leads to the formation of lymph or pus, or to tJxe idtimate disor- ganixatioii or total destx’uction of the tissues affected. Anri we derive fiuther help, in the diag- nosis, fi’om the fact (which, 1 think, cannot be doubted), that inflammation of the brain (whether of tlie membranes or of the cere- hral pvilp) is a rare disease, excepting iu](https://iiif.wellcomecollection.org/image/b21955566_0042.jp2/full/800%2C/0/default.jpg)
