Casebooks

The extracts from Robert Bentley Todd’s casebooks shown here date from 1840. They are listed as cases of hemiplegia, and show some of the symptoms of the epileptic disease which was to become known as ‘Todd’s paralysis’. The symptoms which are mentioned here include paralysis of one side of the body.

Robert Bentley Todd first developed his theory concerning the causation of this disease in his Lumleian lectures of 1849, On the pathology and treatment of convulsive diseases, delivered at the Royal College of Physicians. Todd’s far-reaching theory of the nervous system has already been explained, and EH Reynolds has argued that this is crucial to understanding his view of the causation of Todd’s paralysis. Scholars, such as Owsei Temkin, who claim that Todd’s theory was ‘humoural’, have overlooked the fact that his preferred treatment for the disease was anything but humoural. He was sceptical of phlebotomy as a cure, because he did not believe that excess of blood in the affected part of the brain was the cause of the illness. He doubted the conventional view that the disease was cerebro-vascular in origin.

Todd thought that epilepsy arose from the periodic discharge of a nervous force or polarity in the hemispheres or mid-brain, which spread by a rapid polarisation to other parts of the brain and to the spinal cord. Accumulation of morbid material in the brain or blood would cause a polar state and disruptive discharge, leaving the brain free from disturbance until a new seizure was excited by more accumulation of morbid matter. This meant that patients could recover quickly from the symptoms. As Todd asserted:

I would lay it down that epilepsy denotes a state of abnormal nutrition of the brain. This abnormal nutrition shows itself in the unnatural development of the nervous force at particular times, in such a manner as to disturb the functions of the whole cerebro-spinal centres but of the brain in particular… the periodic evolutions of the nervous force which give rise to the epileptic paroxysm may be compared to the epileptic phenomenon described by Faraday under the name of disruptive discharge.

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