Coma

“ A horrible coma call'd living
So now in this coma call'd living
I view the bright phantons of beauty;
The false hollow phantoms of beauty
That cloak all the evils of Dzannin. ”

“ Those in a dying state are affected with coma, lethargy, and loss of muscular motion; they are difficult to rouse, or if roused by loud cries, they return a feeble answer, and again sink into a comatose state. ”

“ The skin is cold, there is great depression, and the pulse is small and weak. The respiration is affected, the breathing being slow and irregular, the breath smelling strongly of the liquid, and the odour often persisting for days. A further stage is that of loss of consciousness, and this comes on with all the suddenness of a fit of apoplexy. [186] The coma is also similar in appearance to apoplectic coma, but there have frequently been seen trismus and convulsions of the extremities. ”

“ Symptoms of Coma.—Coma is generally preceded by stupor, from which the patient may be roused to a certain extent, but only temporarily. The reflexes in this stage may be exaggerated, and the power of swallowing fluids may be retained. When coma is present there is complete abolition of consciousness, sweating, the patient is powerless, the breathing stertorous. The temperature may vary according to the cause; normal or subnormal generally, it may rise in lesions of the pons Varolii. ”

“ The patient may sometimes be partially roused, as from the coma of alcoholic intoxication, and he may finally recover complete consciousness; but very often the reverse is the fact. The coma deepens into paralysis of the respiratory centres, and death concludes existence without the slightest manifestation of sensibility or intelligence.
Lethargy is a pathological variety of sleep, in which the repose of the body is even more complete than in coma. The victim of coma often presents a countenance suffused with blood; the pulse beats vigorously, and respiration may become stertorous. ”

“ Excluding those exceptional cases in which healthy individuals, as a consequence of inordinate physical exertion, have slept for many hours beyond their ordinary limit, every extraordinary manifestation of sleep-like unconsciousness must partake of the nature of coma. Between natural sleep and this condition may be placed the distinction that the one is always the effect of natural physiological processes, while the other is always the result of injury, of disease, or of some form of intoxication. ”

“ It is evident that in the highest of psycho-motor centres, the organs of thought and of consciousness, the paresis of the lower centres assumes the form of sleep, and paralysis that of coma. Sleep, as a partial, and coma, as a complete, obliteration of thought and consciousness must, therefore, be intimately connected with motor nerve function, sleep being a reduction, coma a suppression of the function, or a suspension of thought. ”

“ What's worse, from what I knew, the horrific brain trau­mas that bring on a coma don't automatically go away when you regain consciousness. If the coma is the result of a head injury, and if it lasts more than a few days, the chances of regaining all your mental functions are up for grabs. Lou once said there's a scale of eight stages to full recovery. Peo­ple who have short comas can sometimes come out of them and go through those stages quickly—from initial eye move­ment to full mental faculties. Others, who've been under for months or longer can require years to come back. ”

“ Few diseases, therefore, exist without the possibility of coma as one of their consequences—a coma which, however, must not be confounded with the genuine sleep which sometimes occupies the larger part of certain stages of convalescence from acute illness. ”

“ At other times this transition from coma back to sleep does not take place and consciousness returns quite suddenly, the persons opening their eyes and looking around them, dazed and bewildered, but perfectly conscious at once. When coma is fully established and the largest and most powerful motor-centres have succumbed to the insidious poison, general paresis becomes general paralysis and all the motor-centres of the body are in a condition of more or less suspended functional activity. ”

“ Vice versa the deepest coma becomes sleep again, when the suspended function of the cortical centres is roused by strychnine injections. The insensible and completely paralysed patient usually announces the gradual return of consciousness by a few groans and uneasy movements and not unfrequently begins to snore, as in ordinary sleep, when a smart shake at the shoulder will rouse him into full consciousness. ”

“ He could see no change in his condition; but he set himself to make a fresh and even more careful examination, recording temperature, blood pressure, pulse, reflex action on a sort of chart which he pinned to the wall for continual reference. When he had finished he pondered a long time, unable to make up his mind whether the state of coma was the result of some injury he had not discovered, or whether it was pure shock, neurasthenic paralysis, brought about by the strain of the “third degree.” ”

“ The intelligence is generally not impaired in the course of gastric cancer.
Considerable interest belongs to coma as a symptom of cancer of the stomach, and more particularly to the occurrence of coma with the peculiar characters which have been described by Kussmaul as distinguishing diabetic coma.62 The most distinctive feature in Kussmaul's group of symptoms is the accompaniment of the coma by a peculiar [p. 555] dyspnoea in which, without evidence of disease of the lungs or air-passages, the respirations are strong and deep and often attended with a groaning sound in expiration. ”

“ Delirium and stupor or coma are associated with more severe injuries. If the cortex is lacerated, twitchings or convulsions often occur. Returning consciousness shows various reactions—headache, vomiting, amnesia, etc., and may be succeeded by convulsions, encephalitis or mental disturbances. DaCosta [147] says that some cases are followed by a complete change in the personality, forgetfulness, headache, insomnia, attacks of depression, lassitude and vertigo with increased susceptibility to alcohol, heat and physical exertion. ”

“ To her utmost sorrow, however, instead of his mind clearing a little, as so often happens after delirium and before death, he gradually fell into a state of coma, and presented every appearance of being actually dead. The doctor was sent for, and the house and grounds were speedily filled with a crowd of people, friends, tenants, fosterers, and poor relatives; one and all anxious to learn the exact condition of the sick man. ”

“ These being the effects as exercised by compression on the bulbar centres, one must not omit to consider the results produced on the higher cortical centres. Anæmia is the feature and unconsciousness is the ultimate result, preceded by headache and drowsiness progressing on to stupor and coma. Intermediate between the stages of sleepiness and coma, one observes occasionally a stage of irritation—such as is pictured in many cases of typical middle meningeal hæmorrhage. ”

“ In some instances the temporary separation was caused by accident, illness, states of coma induced by anesthetics, trance, either of spirit control or hypnosis, and sometimes a voluntary absence or activity not suspending the vital functions of the body. It is also undoubtedly true that during sleep—especially that restful, dreamless sleep that betokens a normal state of mind and body, the spirit avails itself of the opportunity of restoration by spiritual methods and activities not possible while urging the body to do its bidding. ”

“ Coma is a deep, abnormal sleep, from which the patient can not be aroused, or is aroused only with difficulty, a state of profound insensibility, perhaps with full pulse and deep, stertorous breathing, and is due to brain-oppression. ”

“ In this respect it differs from the condition of coma and of trance, in which there is entire unconsciousness. In the most profound sleep perfect unconsciousness never prevails. Impressions may be made upon the senses of the soundest sleeper that will waken him. ”

“ In the first case, that of depressed fracture of the skull, the raising of the depressed bone is often followed immediately by return of consciousness; the patient seems to wake as from a deep sleep. In medical practice there are many analogous conditions of abnormal pressure causing coma, as in meningitis, cerebral abscess, hemorrhage, embolism of cerebral vessels, etc. Long-continued or fatal coma may be caused by general morbid states, as uræmia, acetonæmia, surgical hemorrhage, intoxication by narcotics, alcohol, ether, etc., and by asphyxia. ”

“ Sleep, fainting, coma, epilepsy, and other 'unconscious' conditions are apt to break in upon and occupy large durations of what we nevertheless consider the mental history of a single man. And, the fact of interruption being admitted, is it not possible that it may exist where we do not suspect it, and even perhaps in an incessant and fine-grained form? ”

“ In studying cases of coma all the above-enumerated symptoms should be considered as of great negative or positive value: often the diagnosis is only made by exclusion. The Cheyne-Stokes respiration, pupillary variations, differences in pulse-rate and volume, are present in such varied conditions, irrespective of the nature of the lesion, as to render them of minor value in differential diagnosis.
DOUBLE CONSIOUSNESS is a rare condition, in which the subject appears to have separate forms or phases of consciousness, one normal, the other morbid. ”

“ It is the sudden shock to the delicate mechanism that produces the unconsciousness; but seeing that the coma is usually deeper and more prolonged in cerebral haemorrhage than when occasioned by vascular occlusion, and that an ingravescent apoplexy coma gradually develops and deepens as the amount of haemorrhage increases, we may presume that increase of intracranial pressure does play an important part in the degree and intensity of the coma caused by the rupture of a vessel. ”

“ A singular disorder, characterized by daily paroxysms of somnolence, tending to become more and more continuous and profound until merged in fatal coma, is encountered among the negro inhabitants of the Atlantic coast of tropical Africa. ”

“ When swallowed in large quantity, as by persons who have taken foolish wagers on their prowess in drinking, there is seldom much preliminary excitement; coma approaches in a few minutes and soon becomes profound, as in apoplexy. The face is then sometimes livid, more generally ghastly pale; the breathing stertorous, and of a spirituous odour; the pupils sometimes much contracted, more commonly dilated and insensible; and if relief is not speedily procured, death takes place,—generally in a few hours, and sometimes immediately. ”

“ By the end of the first week the delirious or stuporous condition becomes more marked with a tendency to muttering delirium, tremors and subsultus, the coma-vigil of the older writers. Terrifying hallucinations may cause the patient to jump from the window and kill himself. ”

“ Fear not, Castaly; I do not term slumber and gentle sleep disease, but signs of health. Not so, however, many a profound sleep, and its advances towards coma; those results of exhaustion from excess, or from intense and direct narcotics, as opium sleep, and the paralyzing senselessness from extreme cold, as in the story of Sir Joseph Banks and Dr. Solander in the antarctic regions.
You are aware that many remedies in medicine may be so intense as to cause fatality: inflammation, too, is the restorative process of wounds, but if in excess it is fatal. ”

“ Secondary coma may arise as a complication in the following diseases:—diabetes, uraemia, general paralysis, meningitis, cerebral tumour and acute yellow atrophy of the liver; in such diseases it is anticipated, for it is a frequent cause of the fatal termination. The depth of insensibility to stimulus is a measure of the gravity of the symptom; thus the conjunctival reflex and even the spinal reflexes may be abolished, the only sign of life being the respiration and heart-beat, the muscles of the limbs being sometimes perfectly flaccid. ”

“ Giddiness, drowsiness and stupor, followed by insensibility. Patient seems asleep; may be roused by loud noise, but quickly relapses. Breathing slow and stertorous, pulse weak, countenance livid. As coma increases, pulse becomes slower and fuller. The pupils are contracted, even to a pin's point; they are insensible to the action of light. In deep, natural sleep the eyes are turned upwards and the pupils contracted. Bowels confined, skin cold and livid or bathed in sweat. Temperature subnormal. Nausea and vomiting are sometimes present. ”

“ Without further warning, save that the pulse, which has become soft, with nearly the normal number of beats, all at once becomes low and hard; she is suddenly seized with another convulsion, in which she dies, or passes into a state of coma from which she never rallies. ”

“ The period of excitation is succeeded by the period of relaxation, and then the patient is in a deep sleep. However violent the external excitations, however painful the surgical operation, nothing can arouse the patient out of the comatose state into which he has fallen. His respiration is regular, his pulse slow and full, his pupils are motionless, and his features, paralyzed as it were, no longer wear that convulsive grimace which may be regarded as the last trace of sensibility. Intelligence is now destroyed. The coma of chloroform and that of alcohol appear to be essentially one. ”