Coma

Coma (Gr. κῶμα, from κοιμᾶν, to put to sleep), a deep sleep; the term is, however, used in medicine to imply something more than its Greek origin denotes, namely, a complete and prolonged loss of consciousness from which a patient cannot be roused. There are various degrees of coma: in the slighter forms the patient can be partially roused only to relapse again into a state of insensibility; in the deeper states, the patient cannot be roused at all, and such are met with in apoplexy, already described. Coma may arise abruptly in a patient who has presented no pre-existent indication of such a state occurring. Such a condition is called primary coma, and may result from the following causes:—(1) concussion, compression or laceration of the brain from head injuries, especially fracture of the skull; (2) from alcoholic and narcotic poisoning; (3) from cerebral haemorrhage, embolism and thrombosis, such being the causes of apoplexy. 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. A characteristic change in the respiration, known as Cheyne-Stokes breathing occurs prior to death in some cases; it indicates that the respiratory centre in the medulla is becoming exhausted, and is stimulated to action only when the venosity of the blood has increased sufficiently to excite it. The breathing consequently loses its natural rhythm, and each successive breath becomes deeper until a maximum is reached; it then diminishes in depth by successive steps until it dies away completely. The condition of apnoea, or cessation of breathing, follows, and as soon as the venosity of the blood again affords sufficient stimulus, the signs of air-hunger commence; this altered rhythm continues until the respiratory centre becomes exhausted and death ensues.

Coma Vigil is a state of unconsciousness met with in the algide stage of cholera and some other exhausting diseases. The patient’s eyes remain open, and he may be in a state of low muttering delirium; he is entirely insensible to his surroundings, and neither knows nor can indicate his wants.

There is a distinct word “coma” (Gr. κόμη, hair), which is used in astronomy for the envelope of a comet, and in botany for a tuft.

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