How long could someone with locked in syndrome survive in 1915 [closed]

Question

Let's assume a modern for its day, 1915, hospital gets a patient with locked in syndrome: how would he fare?

We will think of someone who is just locked in. This means they don't have any problem breathing or any other lack of vital processes. They can't thought communicate in any way, or move including swallowing food. Wikipedia article describing the condition

I realize that by this point IVs are invented, but I don't know if proper nutrition could be fed to the person. This is also an age before antibiotics, and I am guessing infection would be a major threat to the patient.

Would this person make it days, weeks months, years?

Answer 1

You seem to take a big leap from 'can't swallow' to 'needs IV nutrition'.

Tube feeding is a viable option that is used a lot in modern medicine as well; in fact, it is preferred to IV nutrition if at all possible (i.e. when the bowel works as it should). This preference is because of the risk of infection inherent in using long-term IV access, and also because providing adequate nutrition that can be passed directly into the bloodstream is difficult and therefore costly. (While you can pass any sort of pureed meal through a feeding tube, any IV nutrition needs to be the pure nutrients (glucose, fatty acids, etc.) and absolutely free of any microbes and irritants.)

In using a feeding tube there are two main ways:

• using an existing opening to reach the stomach (most commonly the nose)

  This is more commonly used for short term tube feeding, since the mucous membranes of the existing opening will get irritated and damaged by the tube after a while, leading to increased risk of infection (and also pain for the patient). This link suggests a maximum counted in weeks.

• surgically creating an opening through which the feeding tube should pass

  This carries all the 'usual' risks of any surgical procedure (anesthesiologic risk, risk of infection), plus the risk of infection in the surgically created opening that is open to the outside world long term. However, since such an opening does not directly communicate with a main blood vessel, the risk of complications from infection are slightly lower than with long-term IV access.

As to the availability of these options to a patient in 1915: R. Skeeter provided a link to an article about surgically placed feeding tubes that mentions the practice appearing in mid to late 1800 - implying that non-surgical feeding tubes were available before that already. Another link provided by R. Skeeter illustrates a modern-day patient with a surgically placed feeding tube surviving for several years at least.

Without antibiotics I would expect some infection to set in within a few months, maybe a lucky patient with an otherwise strong constitution would be able to survive longer. However, once the immediate concern of nutrition has been taken care of, a patient that is bedridden long term will develop other problems - bedsores being one of them - and overall the body's health will deteriorate due to the inactivity.

Taking it all together, my expectation would be that several months is the maximum.

Answer 2

I have the feeling he won't last long, few months at best.

IV's were developed, yes, but Teflon needles weren't. This means lack of flexible needles and therefore higher chances of long term complications while taking IV's. Add to this the lack of antibiotics, and you see that infections are highly likely.

From that to the grave the step is short.

Answer 3

One aspect of this answer is the purely medical one which L.Dutch has already answered to. Even under the best of circumstances, survival would be hung on a very thin thread as IV needles of that time would leave arms and legs so bruised and swollen within weeks that setting up a new IV would become more critical with each treatment. Any infection which is not unlikely to occur in spite of increasing hygiene standards, would most likely lead to the person's death.

Another aspect is a social one. Why would you treat such a patient, unless the hospital is provided with immense funding to make up for such experimental treatment of a person without any hope of recovery from the point of view of doctor's and people of that day alike?

An additional complication to think of is that 1915 is after the start of WWI. Therefore, the chance of treating such a patient in a country/area where hundreds, even thousands of wounded soldiers require immediate treatment and ressources are getting more and more scarce with the progress of the war is definitely decreasing inspite of all funding. Sooner or later they will lack even the basic IV needles and medications and then the beds.

Answer 4

A few weeks seems likely, but a lot of artistic license can be allowed

If the person can breathe, she will not need an "iron lung", which did not come into widespread use until after 1928. However, if the person cannot swallow food, she cannot swallow saliva either, nor cough, which is another voluntary movement that locked-in people lose. Gradually, fluid and bits of food would fill the lungs and the patient develops pneumonia if she does not drown first.

Pneumonia can develop rapidly for some patients and our locked-in person may also suffer from complications related to blood-cloths and urinary tract infection, which are two conditions that may develop from the prolonged immobilization of locked-in persons.

Even today, locked-in syndrome is deadly. Acute LIS of a "vascular origin" has an almost 90% mortality in the first 4 months [2], although those who remain alive and learn to communicate has an 80% survival rate over the next 10 years. [3]

[1] As an aside, Pneumonia may also occur in a similar way in normal people who are taking cough-suppressant medicine, or where brain surgery has damaged the cough reflex.

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4506615/

[3] http://www.medicinenet.com/locked-in_syndrome/article.htm#what_is_the_prognosis_with_locked-in_syndrome

Answer 5

Ugh, that's a bleak outlook. Days.

Another 50-70 years earlier, someone with locked-in syndrome would likely have benefitted from an awesome treatment called trepanation, in the early 20th century they might as well have enjoyed the benefits of electrocution electrostimulation in one of its forms (at that time likely alternating-current cranial electrotherapy, two decades later electroconvulsive therapy would be en vogue).
Which, given the state of technology, was not much better than trepanation. Neither treatment precisely increases the subject's lifetime (or does anything beneficial for that matter), so... that's that.

On a more serious note, pressure ulcer is a frequent complication, and a cause of infection and death even today. In the early 20th century, neither was there any understanding of the problem or its causes, nor were there any applicable preventive measures or cures (clinitron bed, vacuum-assisted closure). Antibiotics? Well, come back in three decades. Someone being paralyzed/atonic in an early-20th-century style of bed... I'd expect Bad Things™ happening within days.

Parenteral nutrition with the goal of mid-term to long-term survival (that is, more than a few days) is only possible since the 1960s with Steramin and Lipofundin being among the earliest, and rather insufficient, products available. It really only "works well" since the mid-1980s. In the early 20th century, expect more-or-less isotonic saline infusions so you don't die from dehydration right away, if you're lucky. But surely, not much more.

Surgically-placed feeding tubes have been available since the late 19th century, so there's that possibility. Rates of success (in particular long-term) were, on the other hand side, not so great, as indicated by the word "desastrous" in [Minard G 2006] for... rather obvious reasons. Trans-esophageal feeding tubes have been used for two thousand or so years, but the lack of understanding in nutrient requirements made sustaining a person for more than a few weeks a "challenge". For example, the notion of essential amino acids only became known in the mid-1930s at all.

Then of course, you may have read the stories of Edgar Allan Poe. Although not likely in case vertical eye movement ability is retained, nevertheless possibly, someone suffering from locked-in syndrome might just get buried!