POST-ICTAL TODD'S PARALYSIS
THE MAN BEHIND THE SYNDROME
Practicing neurologists love to see patients with epilepsy, not least because it requires a certain amount of wit for correct diagnosis. Treating epilepsy improves the life of the patient, a worthwhile endeavor for the thoughtful physician. Periodically, the neurologist sees a patient with post-ictal paralysis and knows, roughly, where the focal discharge originated. The accidental historian who sees the same patient ponders the amazing Robert Bentley Todd.
A scion of the Irish Ascendancy and a graduate of Trinity College Dublin and of Oxford, Todd arrived in London in 1831, penniless but intent on making his fortune in the metropolis. He quickly established a large and lucrative practice. His rapid rise to prominence enabled him to become one of the founders of King's College Hospital. He indulged his literary bent and wrote texts of physiology and anatomy, which became widely known in the London medical world. Neurology as a distinct scientific or medical discipline did not exist in 1850.
Like Robert Graves and other noted London physicians interested in the nervous system, Todd made his living as a general physician. He advanced his academic interests by giving lectures open to the medical public, sometimes supplementing his income by charging an admission fee.
In the exciting milieu of 1853 London, Todd commenced a series of lectures at the King's College Hospital on the topic of paralysis and other diseases of the nervous system. His 20 lectures revolved around cases that he had seen, and a devoted student transcribed them as he spoke. He then revised the transcripts and published them as Clinical Lectures on Paralysis, Disease of the Brain and other Affections of the Nervous System (London, 1855).
In his 14th lecture, he said that the symptoms of epilepsy were due to a disturbed state of the nervous force, a morbidly excited polarity. This undue exaltation of nervous tissue led to exhaustion of nervous force. Like an exhausted person, exhausted tissue cannot function, and temporary paralysis ensued until the tissue could regain its force. Todd did not define the nature of the nervous force; his conception of excitation and depression of nervous tissue is not the same as modern views, and the physiological demonstration of the nature of inhibition came much later. Nevertheless, the patient with post-ictal paralysis is unable to energize his or her nervous tissue in something like the way that Todd explained it.
Todd's Clinical Lectures became a standard text of clinical neurology for medical students, providing the conventional view of clinical neurophysiology to such luminaries as Gowers and Hughlings Jackson. He might have been a candidate for appointment to the National Hospital at Queen Square, had he not been a prodigious consumer of alcohol. He died in 1860 at the age of 50, the victim of a massive gastric hemorrhage and hepatic cirrhosis. He was taken ill in his consulting rooms in Brook Street, Grosvenor Square, just around the corner from Claridge's Hotel.