[From the vegetative state to unresponsive wakefulness: a historical review]. / Del estado vegetativo al estado de vigilia sin respuesta: una revisión histórica.

INTRODUCTION: Over the last few decades, the terminology, diagnostic techniques and treatment of patients with altered levels of consciousness have varied considerably. At the same time, the percentage of patients in this clinical situation has undergone a marked increase. AIMS: The purpose of this study is to present a historical review of the different terms that have been used in the medical literature to describe patients with altered states of consciousness. The article also includes the different diagnostic criteria utilised by research groups that have focused their attention on this population. DEVELOPMENT: The concept of 'vegetative state', a term coined back in the sixties, has since been transformed and replaced by other terms with a less negative connotation, such as 'unresponsive wakefulness syndrome'. In parallel, new clinical categories (minimally conscious state or minimally conscious plus) have appeared since it has been acknowledged that there are patients with a low level of consciousness but who nevertheless show signs that are consistent with interaction with the environment by means of unmistakeably voluntary behaviours in response to orders or gestures. CONCLUSIONS: The wide spectrum of signs and symptoms shown by patients with altered levels of consciousness reflects the clinical and neuropathological heterogeneity of these states. The current tendency is to describe the state clinically, adding the aetiology and the date of the event that caused the clinical picture. This article focuses on the context of an effort made by the scientific community to highlight the needs of this growing population.

The philosopher's swoon--the concussion of Michel de Montaigne: a historical vignette.

The French philosopher Michel Eyquem de Montaigne (1533-1592) sustained a transient loss of consciousness due to a head injury. Montaigne described his concussion as a "swoon," with astutely illustrative details of the symptoms he experienced, including brief loss of consciousness, with apparent (temporary) confusion, and post-traumatic amnesia. His vivid portrayal of the recovery period lends understanding of the process of conscious awakening after his near-death experience. Thanks to his power of introspection and literary talent we may gain insight into the feelings and perceptions of some patients during their recovery from concussion.

[From alcohol to liquid ecstasy (GHB)--a survey of old and modern knockout agents. Part 1: historic and classic knockout agents]. / Vom Alkohol zum Liquid Ecstasy (GHB)--ein Uberblick über alte und moderne K.-o.-Mittel. Teil 1: Historische und klassische K.-o.-Mittel.

Alcohol has been the most important knockout drug in history and literature and continues to play an essential role up to now. Blunt force to the head in the form of a knockout punch is another mechanism leading to a transient loss of consciousness. Diethyl ether and chloroform are among the classical knockout substances. Although they have meanwhile been replaced by modern sedatives and hypnotics, their use is still observed in isolated cases.

The big ideas of Edgar Alexander Pask (1912-66).

Edgar Pask worked before, during and after World War II with the anaesthetist Robert Macintosh. Both were ranking officers and engaged in work with the Royal Air Force Physiological Laboratories at Farnborough, then in the charge of Dr Bryan Matthews. Pask submitted as a Doctorate Thesis a compilation of much of the experimental work in which he was the main subject, most of the data being acquired while he was unconscious. Experiments in which the Farnborough Team were engaged form a central core to the Thesis and relate to the development of life jackets. The information is well known and has been widely publicized, along with most of the biography of Pask. However, some extreme physiological experiments, again with Pask as the test subject and which probably were not conducted at Farnborough, are less well known but in their own way even more extraordinary. The theme in common is Pask's ideas to use the anaesthetized state and the properties of anaesthetic agents as surrogates to the extreme situations Royal Air Force pilots were subject to in modern warfare. There is no purpose to detract from Pask's ideas and selfless heroism by digressions into parallel processes conducted by the opposing Oberkommando der Luftwaffe (OKL) research establishments, but it is evident these were known and had shocked the Farnborough Team (including Pask) before revelation at the Nuremberg War Crimes Trials.

Seventeenth century concepts of "apoplexy" as reflected in Bonet's "Sepulchretum".

The term "apoplexy," which has been in use since antiquity, referred to a catastrophic illness with an abrupt loss of consciousness and a frequently fatal outcome. During the sixteenth and seventeenth centuries scholastic approaches that relied on authorities were merging with an observational approach to medicine and Galen's speculation that apoplexy was due to an accumulation of phlegm or black bile in the cerebral ventricles began to be seriously challenged. The most extensive collection of case reports with autopsies published in the seventeenth century was Theophile Bonet's Sepulchretum sive Anatomia Practica. Section 2 of Book I of the Sepulchretum contains 70 case reports of patients that died with the diagnosis of apoplexy. The scholia in this section provide an idea for the modern reader of the notions physicians had of apoplexy in the seventeenth century. The Sepulchretum was an important book for physicians of the late seventeenth and eighteenth centuries. It played an important role in the development of modern medicine and it was an important foundation for Morgagni's De Sedibus et Causis Morborum. This essay reviews the pathological findings reported in victims of apoplexy and examines the views concerning the symptomatology, pathogenesis, etiology, and treatment of this condition that were prevalent at that time.

Lorenz Heister and the challenge of trepanation: a neurosurgical case study from the 18th century.

In the 18th century, medical practice was essentially based on communication. Cranial trepanation, however, was usually performed on an unconscious person. Here the dialogue ceased. It was the only operation which had to be attempted without the positive consent of the patient. Thus trepanation challenged the surgeon's skill not only with its intricate surgical practice, but also with its unusual social setting. The present paper illustrates possible ways out of the "trap of trepanation" by interweaving two points of view. On the one hand, a general account is given on the basis of surgical publications written by Lorenz Heister and his contemporaries. On the other, the unpublished sources of the Heister correspondence serve to reconstruct the case of Heinrich Wilhelm Bachmann, a German merchant who fell victim to a traffic accident and underwent trepanation in 1753. The case study shows how the physician in charge counterbalanced the patient's inability to communicate by strengthening the remaining network of professionals, and ultimately confirming his decisions by use of the post-mortem.