Q I am writing a murder mystery that takes place in the 1880s in America. I want a character to suffer from locked-in syndrome after a severe head injury. As I understand it, this would leave him fully conscious yet unable to move or communicate. How long could he live given the state of medicine at that time? Would the doctors be able to tell that he was still aware? He is a wealthy man and can afford the best medical care available for that time period.
J. Sharon Smith
Santa Cruz, California
A Locked-in syndrome is when the victim’s muscles are paralyzed, yet he is alive and awake. Most sufferers of this syndrome can breathe without assistance, and often eye movements are spared, which allows communication through blinks and movements. Some victims will have no eye movements, but that’s not the norm. It can be caused by trauma, as in your scenario, but also by infections, strokes, and several different types of neurological diseases.
The victim would not need life support, which was unavailable in the 1880s anyway, but he would have to be fed and cared for. The doctors, his family, or others might be able to communicate with him as described above. Or not. He might be completely unresponsive. They would of course know he was alive since he would breathe and have a pulse.
There was no specific treatment in the 1880s and little today. Most victims die from lung or kidney infections or pulmonary emboli—blood clots that form in the legs and travel to the lungs. These clots are common in immobilized individuals such as your unfortunate character.
How long could he live? Days, weeks, months, or years. In the 1880s it would depend on diligent care and luck more than anything else.
Locked-in syndrome is also called the Monte Cristo syndrome after the title character in The Count of Monte Cristo, the 1844 novel by Alexandre Dumas. Since this book would have been around by the 1880s, your doctors could use that term to describe the condition.