A system of practical medicine. By American authors. Vol. 5 : $b Diseases of the nervous system
Science
A system of practical medicine. By American authors. Vol. 5 : $b Diseases of the nervous system
Medicine -- Practice
(7) Toxic narcosis, from opiates, morphia, chloral, etc., are often
difficult of diagnosis, except that from opiates and morphia, in which
extremely slow respiration and contracted pupils, with lowered
temperature, point at once to the cause.
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. This occurs in hypnotic and somnambulic states, probably
also in certain cases of insanity and epilepsy. The current of normal
consciousness is suddenly broken; the patient enters into the second
or abnormal state, in which he acts, writes, speaks, moves about with
seeming consciousness; but after a variable time a return to normal
consciousness reveals a break in the continuity of the memory: the
patient has no recollection whatever of what he did or said in the
morbid period. In the hypnotic state subjects may show increased power
of perception, and are strangely susceptible to suggestions or
guidance by the experimenter. In a second attack the patient often
refers back to the first, and does things in continuation or
repetition of what he previously did, apparently taking up the same
line of thought and action. The morbid states, long or short, are
joined together by memory, but are wholly unknown in the normally
conscious states. In other words, the patient leads two (or three,
according to a few observations) separate lives, each one forming a
chain of interrupted conscious states. In epilepsy we observe
remarkable breaks in normal consciousness: the patient goes through
certain acts or walks a distance or commits a crime in a dream-like
state, and suddenly, after the lapse of a few minutes, hours, or days,
becomes normally conscious and has no recollection of what he did with
such apparent system and purpose during the seizure. It might,
perhaps, be as well to classify these phenomena under the head of
amnesia. A case is on record where a man travelled, seeming normal to
fellow-travellers, from Paris to India, and who was immensely
astonished on coming to himself (return to common consciousness) in
Calcutta. Many murders have been committed with apparent design and
with skill by epileptics, who upon awaking from their dream-like state
were inexpressibly horrified to hear of their misdeeds.
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