29 Transactions of the London Epidemiological Society, vol. i. p. 116.
30 De la Maladies du Sommeil, 1869.
31 The Medical Record, July 1, 1882, p. 23.
Lethargy.
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. But in lethargy the abolition of bodily movements is almost total. In the milder forms of this disorder the patient may be partially roused, so as to attempt an answer when addressed, appearing like a person in very profound sleep; but in the majority of cases he remains insensible, unconscious, and utterly irresponsive to ordinary forms of irritation. Respiration and circulation are reduced to a minimum, even becoming for a time imperceptible. Uncomplicated with hysteria, the disorder is rapidly fatal, but according to Rosenthal32 hysterical lethargy is never mortal.
32 Real Encyc. der ges. Heilkunde, vol. viii. p. 276.
Many examples of this disorder have been furnished by the records of apparent death.33 I am well acquainted with a lady who in early childhood was laid out for burial at the supposed termination of some infantile disease. Her mother alone insisted that the child was still alive. After some time spent in weeping and expostulation, she applied a blister to the thorax of the babe, who at length began to exhibit signs of consequent irritation, followed by a complete recovery. Still more instructive is the case related by Rosenthal34 of a young woman twenty-four years of age who in consequence of violent emotional excitement became unconscious and presented no sign of life, though tested with a mirror before the mouth and by dropping melted sealing-wax upon the skin. On raising her eyelids the pupils gave no response to light; the limbs remained perfectly placid and the radial arteries were motionless. Careful auscultation, however, detected a very feeble and intermittent sound in the cardiac region. The thorax exhibited no movement, but the lateral surfaces of the abdomen presented a slow and almost imperceptible oscillation. Gentle faradization of the muscles and nerves of the face and hand aroused definite muscular contractions. By these observations Rosenthal became satisfied that, although the patient had remained for thirty-two hours in this condition, she was only apparently dead. In fact, after continuing forty-four hours in a state of suspended animation she awoke spontaneously, made a rapid recovery, and enjoyed as tolerable health as an excitable nervous temperament would permit.
33 See article “Mort apparente,” Dic. Encyc. Sci. méd., 2d Series, vol. ix. p. 598.
34 Loc. cit., p. 272.