S. Comas. • rvenes • ,1 • " — • • in: • MUM= , r jagosive I r!:ni I - • cases o t e ast descriptio4 are more reit. I • reco•. • gree unconsciousness a ways.Acaompalues : this cir § 2. Stu or Unconsciousness • Corn certain de cumstance=e subsequently referred to. We have now to consider the cases in which stupor is the prominent symptom.
When coma is incomplete, but attended by hemiplegia, or con vulsive movements, the same rules of diagnosis are applicable as to complete coma. The phenomena of partial unconsciousness with paralysis are sometimes very remarkable. The attention of the patient is attracted by objects about him, which he follows in their movements with his eye; when spoken to he turns towards the speaker, and seems to make an effort to reply, and it may be conceived that paralysis alone prevents his utterance: on closer investigation, however, it will be found that, though the attention be roused, the mind receives no impression, and the patient,' thofigh not insensible, is yet unconscious.
W flea par.,5.1Thials pre.Reat, the patient seems to be asleep, • breathin aularl butIF:1s found in a very c ee,g_sleen; to is roused withiailtAi.fficulty, and, without to aw4ke, be resists any atteris to.niove him in he s r dre.ssedi he pulls up the clothes about im when he is uncovered; and even when thoroughly aroused, wits minTtqueMSZT. Though unable to answer questions. or do as he is directed, he will make very distinct combined movements in changing his position in bed, and placing himself comfortably, as if he wished again to go to sleep. Here delirium, Of the conditions in which stupor is present, we find (a.) Thata very often follows u,poiLa regular epileptic uelz,arp ; indeed, the sleep in tthiCE an elm leptiat almost always terminates may be said to be of this nature ; and, though generally very transient, it is occasionally prolonged even for days. (b.) It is also met with as the result of what has been termed transient ap_o ,plexy, or of concussion : the position the patient was found in sometimes mils in determining whether the fall was the cause of the confusion of thought, or whether it happened in consequence of loss of consciousness. Any appear ance of blood about the mouth, showing the tongue to have been bitten, would lead us to believe the attack had been one of epilepsy ; but in diagnosis, the distinction between epileptiform and apopleptic semi-coma is unimportant, and only demands consideration from the probability of recurrence in the one and the smaller chance of it in the other. (c.) Semi-coma from intoxication, or
poisoning with opium. is not accompanied by the same degree of loss of con sciousness. When the patient is thoroughly roused, he will indicate less va cuity of mind. (d.) A comatose state sometimes commences v idiousl wit.haat_ any complaint of particulax ailment : there is a tendency o seep; The patient is awaked with difficulty, and when roused and speaking rationally, he breathes deeply and slowly, and seems to fall asleep even with his eyes open, during a pause in the conversation; at first there is little confusion of thought, except momentarily, on awaking. but the coma gradually deepens, and is not unfrequently attended by convulsions. General ill health may have preceded it, but no particular derangement of any organ is traced in the his tory. Such a condition points very cerfainli .to_alliurninaus wand poi soninzof the blood by the presence of urea; the probability would be StFiffige• inasarcalitid the point may generally be determined by examination of the urine.
§ 3. Insomnia is a common attendant on most of those condi tions with which delirium is associated. The report made of want of sleep by the patient himself is never to be depended upon, as to its amount, though he can generally say whether he have been asleep at all during the night or not, unless the mental faculties be completely obscured. Starting, or waking up sud denly or in a fright, are phenomena less frequently relating to the brain than to the heart or stomach. In affections of the brain the question of most importance is whether sleeplessness preceded the delirium, or were only associated with it.
§ 4. Delirium.—The term delirium, although generally applied to that wandering of mind which accompanies certain diseased states of the body, is equally applicable to the confusion of thought which supervenes on fixed delusion, and constitutes a paroxysm of acute mania. It is not our intention here to inquire into all the perversions of judgment, eccentricities of behavior, or altera tions in the affections and moral feelings, which are met with in persons whose general health is not otherwise affected, and which give rise to the fearful apprehension that the mind is becoming unhinged; but it is necessary to allude to the phenomena attend ing an attack of acute mania, in order to contrast them with those dependent on acute disease within the cramium.