GENERAL RECAPITULATION, PATHOLOGICAL APPLICATIONS. 841 



body. We have another illustration of it in the Coma of mere exhaustion, 

 which is frequently preceded by delirium that is clearly attributable to nothing 

 else than a deficient supply of blood. Still we must not regard Coma as always 

 indicating a more advanced state of morbid change than that which occasions 

 Delirium ; for it stands to some forms of delirium in the same light in which 

 ordinary sleep stands to the waking state, being the repose which is required 

 for reparation after a state of excessive mental activity. In fact, the profound 

 sleep which succeeds a protracted period of severe bodily or mental exertion, is 

 often almost comatose, as regards the degree in which the subject of it is insen- 

 sible to external stimuli. The same may be stated with great probability of 

 the coma which is consequent upon " concussion' 7 of the brain ; for this may be 

 regarded as a period of slow regeneration, during which the effects of the injury 

 are being repaired by the nutritive processes j and any attempt to arouse the 

 patient prematurely is far more likely to be injurious than beneficial, tending 

 especially to increase the violence of the subsequent reaction. 



xin. It is, as we have seen, in the Sensorial centres, that those lesions are 

 most commonly found, which give rise to hemiplegic Paralysis. There can be 

 little doubt that this form of paralysis is usually attributable to some structural 

 disorganization of the nervous substance, produced by hemorrhage, softening, 

 &c. Still this, like other forms of partial paralysis, may be toxic, depending 

 rather upon the condition of the blood than upon that of the nervous tissue. 

 Of such toxic influence, we have a remarkable example in the peculiar local 

 paralysis induced by the presence of Lead in the system ; and there seems much 

 reason to believe that some of the Hysterical forms of paralysis (as well as of 

 convulsive disorders) are of toxic origin. There are many instances, too, in 

 which paralysis, like convulsion, seems to depend upon some injurious influence 

 propagated from the nerves of some other part. Although it is in Hemiplegia 

 that we have the most distinct evidence of disorder of the Encephalic centres, 

 yet paralysis of any one part of the body may proceed from Encephalic lesion ; 

 and even some forms of Paraplegia seem traceable to disorders of the Cerebrum 

 and Sensory Ganglia. 1 



xiv. We seem entitled to consider the Sensory Ganglia as the primary seat 

 of that combination of loss of sensibility, with spasmodic movements, which 

 essentially constitutes Epilepsy. This is marked by the peculiar sensorial phe- ; 

 nomena which usually precede the paroxysm ; by the obliteration of consciousness, 

 which is its prominent symptom; and by the peculiarity of the spasmodic contrac- 

 tions, which are donic (or alternating with relaxation) instead of being tonic (or 

 persistent), and which correspond with those that may be induced by artificial 

 stimulation of this portion of the Encephalic centres ( 738). The disordered 

 action, however, manifestly extends itself to the Cerebrum ; for a maniacal 

 paroxysm frequently occurs in connection with the epileptic attacks ; the attacks 

 themselves are sometimes preceded, and very commonly followed, by consider- 

 able confusion of the intellect; the disease is seldom long persistent without im- 

 pairing the memory and the control of the will over the mental operations; and 

 in cases of long standing, the power of the Cerebrum appears to be almost 

 entirely destroyed. There is very considerable diversity, on the other hand, in 

 regard to the nature and intensity of the muscular convulsion ; and there seems 

 reason to think that when the morbid influence is determined downwards into 

 the Motor apparatus, the Cerebrum escapes with a less serious impairment of 

 its powers, since the destruction of the intellectual power occurs more surely 

 where the fits are accompanied by much mental disturbance or stupor, than 

 where the convulsive character predominates. One of the most remarkable 



1 For much valuable information on the different forms of Paralysis, see Dr. Gull's 

 Gulstonian Lectures "On the Nervous System" in the "Medical Times," 1849. 



