The Glasgow Coma Scale: 50-year anniversary.

In 1974, Sir Graham Teasdale and Bryan Jennett wrote the "Assessment of coma and impaired consciousness, A practical scale," which has become one of the most influential papers in the history of traumatic brain injury, with more than 10,000 citations as of January 2024. Today, it is one of the most widely used tools in emergency departments, providing a reliable general overview of the patient's consciousness status.

C. Miller Fisher and the Comatose Patient.

Neurologic examination of the comatose patient has gradually matured. Less than 50 years ago, neurological examination in coma became a regular part of textbooks with separate chapters devoted to the topic but many were deficient in detail. In 1969, C.M. Fisher published an extraordinary 56-page paper on the examination of the comatose patient. The paper-one of Fisher's gems-is not well known and infrequently cited. The many new observations collected in this comprehensive paper are reviewed in this vignette, which highlights not only how these contributions shaped our thinking on coma but also questioned shaky concepts.

Description of coma and coma arousal therapy in Caraka Samhita and its corollary in modern medicine.

The description of coma and coma arousal therapy in Caraka Samhita is described in smtra 24, verses 42-53. It describes the definition of coma, differential diagnosis of coma from other disorders of consciousness, signs of coma, etiology of coma, coma arousal therapy, and emergence from coma. The similarities and differences of these aspects of coma from the perspective of its interpretation in modern medicine are discussed in this article.

From clinical judgment to odds: a history of prognostication in anoxic-ischemic coma.

Persistent coma from a major anoxic-ischemic injury to the brain may indicate there is less chance for full recovery. The tools of prognostication to assess comatose survivors of cardiopulmonary resuscitation have developed over several decades. Physicians would initially base their judgment on experience and data on outcome in these patients in the early years were merely on awakening not on disability. In the late 1970s, a large multicenter prospective study was performed on outcome in nontraumatic coma. The impetus for this study was the result of Plum and Jennet's collaboration. In 1981--for the first time--complex statistics were used to improve the accuracy of prognosis and became known as the "Levy algorithms." These early seminal studies shaped the prediction models and implied that clinical information alone could assist physicians in making a prediction. Later, probabilistic methods became more commonplace.

[Fewer indications for sedation in mechanical ventilation therapy]. / Færre indikationer for sedation ved respiratorbehandling.

Critically ill patients undergoing mechanical ventilation have traditionally been deeply sedated. In the latest decade growing evidence supports less sedation as being beneficial for the patients. A daily interruption of sedation has been shown to reduce the length of mechanical ventilation and the length of stay in the intensive care unit. Recently it has been shown that a strategy with no sedation of critically ill patients undergoing mechanical ventilation reduced the time patients received mechanical ventilation and reduced the length of both intensive care and hospital stay.

Historical aspects of critical care and the nervous system.

The appropriate starting point for a history of neurocritical care is a matter of debate, and the organization of facts and conjectures about it must be somewhat arbitrary. Intensive care for neurosurgical patients dates back to the work of Walter Dandy at the Johns Hopkins Hospital in the 1930s; many consider his creation of a special unit for their postoperative care to be the first real ICU. The genesis of neurocritical care begins in prehistory, however. This article gives a predominantly North American history, with some brief forays into the rest of the world community of neurointensivists.

Historical study of coma: looking back through medical and neurological texts.

In the 1960s, two major works on coma by Fisher, Plum and Poser were published and ushered in the beginning of a comprehensive clinical examination in coma. How these ideas matured has been rarely investigated. In this article, we describe observations and experiments that led to a better understanding of consciousness and coma in medical texts prior to that episode. We consulted medical texts published between 1640 and 1960. Subject indexes and tables of contents of textbooks were reviewed for the words coma, (loss of) consciousness, stupor and somnolence. Chapters on apoplexy were reviewed for descriptions of impaired consciousness. We found information on terminology, classification, causes, observation and examination, pathophysiology, treatment and experimental coma. Up to the middle of the 19th century, disorders of sense, motion and breathing, and also changes in the patient's pulse, were recognized as clinical cues. The distinction between a structural and toxic (endogenous and exogenous) cause was recognized early. Observed phenomena were explained from the perspective of humoral medicine and treated likewise. After the middle of the 19th century, specialization in medicine and experimental research of intracranial pressure resulted in important insights and more accurate clinical examination. Cranial surgery and the discovery of the brainstem reticular activating system in the first half of the 20th century contributed to further increases in knowledge. The understanding, clinical examination and treatment of coma has gone through a gradual evolution over many decades. The recapitulation of clinical signs in impaired consciousness into a teachable and reproducible module marks an abrupt change in clinical approach. This transition is very recent, based on close clinical observation and interpretation of experimental and pathology studies and less on modern neuroimaging.

[The beginnings of modern biological psychiatry in Hungary: the atropine coma. A historical overview]. / A modern magyar biológiai pszichiátria kezdetei: az atropin kóma. Történeti attekintés.

In the authors' opinion modern biological psychiatry in Hungary started with the investigations into the biological mechanism of atropine coma therapy. Atropine coma was used in the period between 1950 and 1975 mainly in the treatment of various psychoses and obsessive compulsive disorder. In a previous communication the method, indications and adverse effects of atropine coma were outlined and the professional and broader social reasons for its eventual disappearance were discussed. In this paper the therapeutic effectiveness and research into the biological mode of action of atropine coma are summarized. Although thousands of patients received atropine coma therapy in the United States and in several Central-Eastern European countries including Hungary, this therapeutic modality is hardly ever features even in papers on the history of psychiatry. This is all the more surprising because initial therapeutic results with atropine coma were favourable and it seemed to be a more safe and efficient treatment than the more widely used insulin coma.

Brain death and the historical understanding of bioethics.

In a 1968 Report, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death promulgated influential criteria for the idea and practice known as "brain death." Before and since the Committee met, brain death has been a focal point of visions and nightmares of medical progress, purpose, and moral authority. Critics of the Committee felt it was deaf to apparently central moral considerations and focused on the self-serving purpose of expanding transplantation. Historical characterizations of the uses and meanings of brain death and the work of the Committee have tended to echo these themes, which means also generally repeating a widely held bioethical self-understanding of how the field appeared-that is, as a necessary antidote of moral expertise. This paper looks at the Committee and finds that historical depictions of it have been skewed by such a bioethical agenda. Entertaining different possibilities as to the motives and historical circumstances behind the Report it famously produced may point to not only different histories of the Committee, but also different perspectives on the historical legacy and role of bioethics as a discourse for addressing anxieties about medicine.

Rudolf Karl Freudenberg - from pioneer of insulin treatment to pioneering social psychiatrist.

Rudolf Karl Freudenberg was Physician Superintendent at Netherne Hospital, Couldsdon, Surrey from 1951 to 1973. In his work as superintendent and government adviser he made important contributions to mental hospital reform and to the establishment of community psychiatric services in Britain. Earlier, in Vienna and following emigration to Britain, he was one of the pioneers of insulin coma treatment with a series of publications on this topic. The paper gives an account of published papers of both phases, and it highlights the background to Freudenberg's shift in professional interest from physical to social intervention. It argues that the change of emphasis reflects important general trends, i.e. profound change due to new forms of physical treatment on the one hand and similarly convincing evidence of the impact of social factors on clinical course and outcome on the other hand.

Landmark article Aug 5, 1968: A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to examine the definition of brain death.

KIE: The report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Death, originally published in the 5 August 1968 issue of JAMA, is reprinted as a landmark article. The report defines "irreversible coma" as a new criterion for death, lists steps to be taken by physicians to diagnose this condition, and mentions two early instances of the concept's appearance in judicial rulings.^ieng

Landmark perspective: A new look at death.

KIE: The author comments on an accompanying reprint of a landmark article, "A definition of irreversible coma," the 1968 report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Death. Joynt briefly describes the gradual acceptance of brain death as a medical and legal concept in the U.S. and examines the four criteria recommended by the Ad Hoc Committee for diagnosis of irreversible coma--unreceptivity and unresponsivity, no movements or breathing, no reflexes, and a flat EEG--in the light of current thinking. He notes that, while "irreversible coma" was an unfortunate choice of words for the definition, the term "brain death" is also inexact and confusing.^ieng