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Remarkable Resuscitations.
1005 Although, then, premature burial for all practical purposes ther be considered not to take place, nevertheless many ineliminated and that they are largely deposited in various may I are on record in which by skilful treatment the appatissues in which they may produce deleterious effects. Thestances results of the continued absorption of small quantities ofirently dead have been restored to life. The majority of such can
be
no
doubt, however, that many minerals
are
slowly
I have occurred in individuals who have been removed arsenic have been emphasised since attention was directedcases It is difficult to fix to the subject in connexion with the contamination of beerfrom the water apparently lifeless. with this substance. Antimony, mercury, and lead alsoaccurately the time in which drowning proves fatal. In afford examples of mineral drugs which may similarly pro-human beings, as a rule, asphyxia supervenes in from duce toxic symptoms of long duration. Some symptoms ofone minute to two minutes after submersion and death bromism and iodism, however, probably result from direct usually before the expiration of five or six minutes, irritation during elimination and thus do not afford examples but life may be considerably prolonged if from any cause water has been prevented from entering the lungs. of cumulative action. The importance of due appreciation of the relative rates A case was recorded in THE LANCET by Mr. CHARLES of absorption and elimination is not limited to the occa- POPE2 in 1881 in which a man was sailing in a boat when sional presence of impurities from which we should be it capsized and he fell into the water with some weights on protected by examination of the drugs employed. This top of him, so that with the exception of his left arm he knowledge should also govern the dosage and admini- was entirely and continuously submerged for from 12 to 15 stration of drugs which have the undesirable property minutes. He was resuscitated with considerable difficulty of accumulating within the system, and it affords anotherand eventually recovered. The weights probably prevented opportunity of laying stress upon the risks which may arise water from entering the lungs. Longer periods of submersion from the possession of prescriptions given without sufficient with recovery than this, however, have been recorded. In one warnings of the limits of safety or the need of caution. case submersion had lasted for 20 minutes,3 and in another, 11 Prosecutions for impurities and adulterations are interest- which is, however, doubtful," one hour is the recorded time.’ing and necessary but they would fail in their full measure Examples again have been recorded of resuscitation after two of instruction if they did not serve also to direct attention hours’ employment of SILVESTER’Smethod of artificial re5 to possible dangers which may arise during the injudicious spiration, the subjects being apparently dead. On one occasiona boatman towed the body of a man ashore and use of some most trusted remedies. I
Remarkable Resuscitations.
pronounced life to be extinct ; a medical man corroborated this opinion but two more sanguine bystanders began vigorous treatment, with the result that the apparently drowned man entirely recovered from the effects of the
buried aliveseems to be inherent submersion. Another class of case in which resuscitation in the minds of certain individuals and elaborate instrucI has occurred, although the individual was apparently dead,. tions are occasionally included iu their last testaments in is after hanging. HOFMANN reports such a case.A criminal, 1 order to prevent a fearful calamity, the occurrence of which who was sentenced to be hanged, had round his neck ’i is not denied though its frequency has been much exaggerated e enlarged glands which partly neutralised the constriction by popular report. The uncertainty of the signs of death of C the encircling slip-knot. The body remained suspended must be acknowledged but medical literature contains f for 20 minutes and death was certified to have taken. only one or two authenticated cases of a living person The body was then transported in a van at I place. having actually been buried. The first man of science or aI: rapid pace to the post-mortem room. There was some philosopher whose opinion is available as to what con- distance to go and when the van arrived the physicians stitutes a proof of death is DEMOCRITUS and he maintained were greatly surprised to see instead of a corpse an individual that there was no certain sign of the cessation of life. who raised himself up before them and looked at them CELSUS severely criticised this opinion and asserted that if with a scared expression. Three or four hours afterwards the apparent identity of certain signs deceives an unskilful tthe man died from pulmonary congestion, evidently a result physician an experienced and intelligent man cannot be (of the hanging. Obher criminals are believed to have been mistaken. ORFILA, FODERE, and MICHEL LEVY all believed 1luckier, for there are stories, which seem to have their in the possibility of premature burial. LANCISI and Louis, on in fact, of the recovery and escape of men who have ( the other hand, controverted such a doctrine. BROU ARDEL,1 origin 1 been judicially hanged. in his interesting work "Death and Sudden Death," which It is not a matter for wonder that in cases of concussion of has been translated into English by Dr. F. L. BENHAM, tthe brain mistakes have arisen. During the retreat from whilst admitting that premature burial cannot be absolutely 1Russia General ORNANO had his head grazed by a bullet denied, demonstrates that it must be extremely rare. In while in the act of charging the enemy ; he fell from hi& support of this contention he instances the mortuary cham- 1horse and his orderly ran to his assistance but found that he bers established in Germany and elsewhere in which dead Eshowed no signs of life ; he therefore buried him under a bodies are placed, a bell rope being attached to the hand of of snow. The orderly then went to announce the death each. He says"that from the time that mortuary chambers heap Two hours afterwards General ORNANO to NAPOLEON. were instituted-and that at Weimar dates from 17922 THE LANCET, Oct. 1st, 1881, p. 606. neither at Weimar nor at Munich nor anywhere else, I 3 American Journal of the Medical Sciences, April 22nd, 1853, p. 348. 4 Annales d’Hygiène, 1850-52, p. 306. believe, has anybody ever rung that bell." 5 Medical Press and Circular, Jan. 30th, 1867. 6 Dixon Mann : forensic Medicine and Toxicology, p. 242. 1 Death and Sudden Death. Translated 7 by F. L. Benham. Quoted by Brouardel, loc. cit., p. 30. THE fear of
baing
I
......
1006 and reported himself to the EMPEROR ; he lived in future medical practitioners will assist the work time a long afterwards and was actually one of the pall- of registration and the compilation of statistics by so far as practicable sundry terms now bearers to the orderly who had buried him. The after-effects abandoning deemed obsolete, such as "convulsions," "scrofula," of lightning have given rise to similar error. SESTIER, in his and"phlegmon," which are given in the list, to say work entitled, "De la Foudre,"relates seven cases in which nothing of such vague words as "consumption" or apparent death lasted for five or six hours. BROUARDEL "decline," which belong only to the popular terminology. records the case of a boy, aged 13 years, who fell from the Certain suggestions which give evidence of a commendable sixth storey of a house on to the pavement. The boy had desire to establish the statistical tables upon a foundation of been taken to a druggist who had pronounced him to be dead scientific pathology are offered, as thus: "In certifying deaths from small-pox the patient’s condition with respect to and sent him on to a hospital where admission was refused vaccination should be carefully stated."" Puerperal " fever " as he was supposed to be dead. BROUARDEL, however, saw is to be described as pyeamia, septicaemia, or septic intoxicahim and stated that the lad was alive, although the sounds tion of puerperal origin. Three forms of pneumonia are of the heart could not be heard on auscultation. The boy recognised and are included under "general diseases." received suitable treatment and recovered. Malignant disease is to be differentiated into carcinoma or Alcohol may produce a condition of apparent death. A sarcoma when possible and care is to be taken to specify the or part affected. The epidemic form of case is recorded of an old woman who was found in the particular organ is to be distinguished as cerebrocerebro-spinal meningitis street and in whom no sign of life was apparent. She was spinal fever; the exciting cause of "peritonitis" is conveyed to the hospital and the rectal temperature was to be mentioned and the nature of a "tumour"" found to be 77° F. Energetic treatment was resorted to is to be explained. If any exception is to be taken and she recovered. Prolonged narcotism brought about to these and to the other propositions set forth it can only by other substances sometimes gives rise to natural be on the ground of want of feasibility. It may not The late Sir BENJAMIN WARD RICHARDSON8 be possible always to state the cause of death with the alarm. wished-for accuracy. There is in private practice usually a mentioned the case of a medical man who took 120 grains difficulty in obtaining leave to make a post-mortem examinaof chloral. When seen he was to all common observation tion and without such examinations it is doubtful whether dead, there was no sound of respiration, it was very diffi- the objects of the new arrangement stand much chance of cult to detect the sounds of the heart, there was no pulse being realised. Nor is this the only direction in which at the wrist, and the temperature was 97° F. He had obstacles are to be found. A covering letter to the medical been in that condition for some hours. He was revived by officers of asylums asks that in certifying the deaths of persons of unsound mind particulars of the definite brain raising the temperature of the room to 84° F. and inject- disease for which the patient was under treatment in ing warm milk.and-water into the stomach. He made addition to any disease other than brain disease which a perfect recovery. Finally, we may refer to a class may have been the immediate cause of death"" shall In the present conof case more or less familiar to all members of the profes- be inserted in the certificate. of this is hardly practicable. dition cerebral pathology sion-namely, apparently stillborn infants who if left in treatment for "definite Patients are under asylums rarely simply to the care of the mother or to an ignorant midwife brain disease" in the pathological sense. The clinical
appeared
but if
surely perish
survive. children
DEPAUL
by
half, two,
and
means
even
properly
attended to in all in
probability aspects restoring newly born tion of
succeeded of pulmonary insufflation one and a three hours after the heart had ceased
to beat.
The instances that we have recorded of resuscitation of the apparently dead are, of course, of extremely rare occurrence In the vast majority of instances no difficulty is experienced by a medical practitioner in determining whether or not death has taken place but occasionally cases are met with in which some doubt may exist and it is needless to add that in such circumstances no efforts to restore animation should be relaxed until it is absolutely determined that all vital processes are extinct.
Annotations. " Ne
quid nimis."
THE NOMENCLATURE OF DEATH CERTIFICATION. The
Registrar-General has just
caused to be distributed of new list of the diseases copies causing death which is now in use in the General Register Office at Somerset House as well as in the similar offices of Scotland and Ireland. The list is based on the "Nomenclature of Diseases" authorised by the Royal College of Physicians of London. In the notes which accompany it a hope is expressed that 8
Transactions of the Medical
Society of London, 1889, vol. xii., p. 105.
of their disorders form the basis of the classificamental diseases. It is assumed with some show of reason that every mental abnormality is correlated with a structural change in the brain but the exact nature of the relation is yet obscure, for the alterations in the brain substance are not always visible and if visible may appear inconstant. Only, perhaps, in the case of general paralysis of the insane does the train of symptoms afford an index of the progression of the process of cerebral degeneration. One other point occurs to us. Alcoholism is mentioned as a cause of death but no allusion is made to it in the notes appended.
THE HOLMAN TESTIMONIAL. FOR the last 50 years the name of Constantine Holman has prominent in all the public work of the profession as treasurer and vice-president of the British Medical Association, vice-president of the British Medical Benevolent Fund, president of the Surrey Benevolent Medical Society, treasurer and vice-president of Epsom College (for which he has collected over .f.7000 by his personal efforts), and member of committee of the Royal Asylum of St. Anne’s. He has rendered signal services to his profession and the cause of charity. So great have been these services that, as we have already announced, it is thought desirable by his friends and colleagues that some record of their appreciation should be established. It is proposed to devote the proceeds of this testimonial to the erection of an art and reading room at Epsom College to be called the "Holman Art and Reading Room." Subscriptions of any amount will be received by Dr. John H. Galton, Ohunam, Sylvan-road, Norwood, S.E.
been
be
no
doubt, however, that many minerals
are
slowly
I have occurred in individuals who have been removed arsenic have been emphasised since attention was directedcases It is difficult to fix to the subject in connexion with the contamination of beerfrom the water apparently lifeless. with this substance. Antimony, mercury, and lead alsoaccurately the time in which drowning proves fatal. In afford examples of mineral drugs which may similarly pro-human beings, as a rule, asphyxia supervenes in from duce toxic symptoms of long duration. Some symptoms ofone minute to two minutes after submersion and death bromism and iodism, however, probably result from direct usually before the expiration of five or six minutes, irritation during elimination and thus do not afford examples but life may be considerably prolonged if from any cause water has been prevented from entering the lungs. of cumulative action. The importance of due appreciation of the relative rates A case was recorded in THE LANCET by Mr. CHARLES of absorption and elimination is not limited to the occa- POPE2 in 1881 in which a man was sailing in a boat when sional presence of impurities from which we should be it capsized and he fell into the water with some weights on protected by examination of the drugs employed. This top of him, so that with the exception of his left arm he knowledge should also govern the dosage and admini- was entirely and continuously submerged for from 12 to 15 stration of drugs which have the undesirable property minutes. He was resuscitated with considerable difficulty of accumulating within the system, and it affords anotherand eventually recovered. The weights probably prevented opportunity of laying stress upon the risks which may arise water from entering the lungs. Longer periods of submersion from the possession of prescriptions given without sufficient with recovery than this, however, have been recorded. In one warnings of the limits of safety or the need of caution. case submersion had lasted for 20 minutes,3 and in another, 11 Prosecutions for impurities and adulterations are interest- which is, however, doubtful," one hour is the recorded time.’ing and necessary but they would fail in their full measure Examples again have been recorded of resuscitation after two of instruction if they did not serve also to direct attention hours’ employment of SILVESTER’Smethod of artificial re5 to possible dangers which may arise during the injudicious spiration, the subjects being apparently dead. On one occasiona boatman towed the body of a man ashore and use of some most trusted remedies. I
Remarkable Resuscitations.
pronounced life to be extinct ; a medical man corroborated this opinion but two more sanguine bystanders began vigorous treatment, with the result that the apparently drowned man entirely recovered from the effects of the
buried aliveseems to be inherent submersion. Another class of case in which resuscitation in the minds of certain individuals and elaborate instrucI has occurred, although the individual was apparently dead,. tions are occasionally included iu their last testaments in is after hanging. HOFMANN reports such a case.A criminal, 1 order to prevent a fearful calamity, the occurrence of which who was sentenced to be hanged, had round his neck ’i is not denied though its frequency has been much exaggerated e enlarged glands which partly neutralised the constriction by popular report. The uncertainty of the signs of death of C the encircling slip-knot. The body remained suspended must be acknowledged but medical literature contains f for 20 minutes and death was certified to have taken. only one or two authenticated cases of a living person The body was then transported in a van at I place. having actually been buried. The first man of science or aI: rapid pace to the post-mortem room. There was some philosopher whose opinion is available as to what con- distance to go and when the van arrived the physicians stitutes a proof of death is DEMOCRITUS and he maintained were greatly surprised to see instead of a corpse an individual that there was no certain sign of the cessation of life. who raised himself up before them and looked at them CELSUS severely criticised this opinion and asserted that if with a scared expression. Three or four hours afterwards the apparent identity of certain signs deceives an unskilful tthe man died from pulmonary congestion, evidently a result physician an experienced and intelligent man cannot be (of the hanging. Obher criminals are believed to have been mistaken. ORFILA, FODERE, and MICHEL LEVY all believed 1luckier, for there are stories, which seem to have their in the possibility of premature burial. LANCISI and Louis, on in fact, of the recovery and escape of men who have ( the other hand, controverted such a doctrine. BROU ARDEL,1 origin 1 been judicially hanged. in his interesting work "Death and Sudden Death," which It is not a matter for wonder that in cases of concussion of has been translated into English by Dr. F. L. BENHAM, tthe brain mistakes have arisen. During the retreat from whilst admitting that premature burial cannot be absolutely 1Russia General ORNANO had his head grazed by a bullet denied, demonstrates that it must be extremely rare. In while in the act of charging the enemy ; he fell from hi& support of this contention he instances the mortuary cham- 1horse and his orderly ran to his assistance but found that he bers established in Germany and elsewhere in which dead Eshowed no signs of life ; he therefore buried him under a bodies are placed, a bell rope being attached to the hand of of snow. The orderly then went to announce the death each. He says"that from the time that mortuary chambers heap Two hours afterwards General ORNANO to NAPOLEON. were instituted-and that at Weimar dates from 17922 THE LANCET, Oct. 1st, 1881, p. 606. neither at Weimar nor at Munich nor anywhere else, I 3 American Journal of the Medical Sciences, April 22nd, 1853, p. 348. 4 Annales d’Hygiène, 1850-52, p. 306. believe, has anybody ever rung that bell." 5 Medical Press and Circular, Jan. 30th, 1867. 6 Dixon Mann : forensic Medicine and Toxicology, p. 242. 1 Death and Sudden Death. Translated 7 by F. L. Benham. Quoted by Brouardel, loc. cit., p. 30. THE fear of
baing
I
......
1006 and reported himself to the EMPEROR ; he lived in future medical practitioners will assist the work time a long afterwards and was actually one of the pall- of registration and the compilation of statistics by so far as practicable sundry terms now bearers to the orderly who had buried him. The after-effects abandoning deemed obsolete, such as "convulsions," "scrofula," of lightning have given rise to similar error. SESTIER, in his and"phlegmon," which are given in the list, to say work entitled, "De la Foudre,"relates seven cases in which nothing of such vague words as "consumption" or apparent death lasted for five or six hours. BROUARDEL "decline," which belong only to the popular terminology. records the case of a boy, aged 13 years, who fell from the Certain suggestions which give evidence of a commendable sixth storey of a house on to the pavement. The boy had desire to establish the statistical tables upon a foundation of been taken to a druggist who had pronounced him to be dead scientific pathology are offered, as thus: "In certifying deaths from small-pox the patient’s condition with respect to and sent him on to a hospital where admission was refused vaccination should be carefully stated."" Puerperal " fever " as he was supposed to be dead. BROUARDEL, however, saw is to be described as pyeamia, septicaemia, or septic intoxicahim and stated that the lad was alive, although the sounds tion of puerperal origin. Three forms of pneumonia are of the heart could not be heard on auscultation. The boy recognised and are included under "general diseases." received suitable treatment and recovered. Malignant disease is to be differentiated into carcinoma or Alcohol may produce a condition of apparent death. A sarcoma when possible and care is to be taken to specify the or part affected. The epidemic form of case is recorded of an old woman who was found in the particular organ is to be distinguished as cerebrocerebro-spinal meningitis street and in whom no sign of life was apparent. She was spinal fever; the exciting cause of "peritonitis" is conveyed to the hospital and the rectal temperature was to be mentioned and the nature of a "tumour"" found to be 77° F. Energetic treatment was resorted to is to be explained. If any exception is to be taken and she recovered. Prolonged narcotism brought about to these and to the other propositions set forth it can only by other substances sometimes gives rise to natural be on the ground of want of feasibility. It may not The late Sir BENJAMIN WARD RICHARDSON8 be possible always to state the cause of death with the alarm. wished-for accuracy. There is in private practice usually a mentioned the case of a medical man who took 120 grains difficulty in obtaining leave to make a post-mortem examinaof chloral. When seen he was to all common observation tion and without such examinations it is doubtful whether dead, there was no sound of respiration, it was very diffi- the objects of the new arrangement stand much chance of cult to detect the sounds of the heart, there was no pulse being realised. Nor is this the only direction in which at the wrist, and the temperature was 97° F. He had obstacles are to be found. A covering letter to the medical been in that condition for some hours. He was revived by officers of asylums asks that in certifying the deaths of persons of unsound mind particulars of the definite brain raising the temperature of the room to 84° F. and inject- disease for which the patient was under treatment in ing warm milk.and-water into the stomach. He made addition to any disease other than brain disease which a perfect recovery. Finally, we may refer to a class may have been the immediate cause of death"" shall In the present conof case more or less familiar to all members of the profes- be inserted in the certificate. of this is hardly practicable. dition cerebral pathology sion-namely, apparently stillborn infants who if left in treatment for "definite Patients are under asylums rarely simply to the care of the mother or to an ignorant midwife brain disease" in the pathological sense. The clinical
appeared
but if
surely perish
survive. children
DEPAUL
by
half, two,
and
means
even
properly
attended to in all in
probability aspects restoring newly born tion of
succeeded of pulmonary insufflation one and a three hours after the heart had ceased
to beat.
The instances that we have recorded of resuscitation of the apparently dead are, of course, of extremely rare occurrence In the vast majority of instances no difficulty is experienced by a medical practitioner in determining whether or not death has taken place but occasionally cases are met with in which some doubt may exist and it is needless to add that in such circumstances no efforts to restore animation should be relaxed until it is absolutely determined that all vital processes are extinct.
Annotations. " Ne
quid nimis."
THE NOMENCLATURE OF DEATH CERTIFICATION. The
Registrar-General has just
caused to be distributed of new list of the diseases copies causing death which is now in use in the General Register Office at Somerset House as well as in the similar offices of Scotland and Ireland. The list is based on the "Nomenclature of Diseases" authorised by the Royal College of Physicians of London. In the notes which accompany it a hope is expressed that 8
Transactions of the Medical
Society of London, 1889, vol. xii., p. 105.
of their disorders form the basis of the classificamental diseases. It is assumed with some show of reason that every mental abnormality is correlated with a structural change in the brain but the exact nature of the relation is yet obscure, for the alterations in the brain substance are not always visible and if visible may appear inconstant. Only, perhaps, in the case of general paralysis of the insane does the train of symptoms afford an index of the progression of the process of cerebral degeneration. One other point occurs to us. Alcoholism is mentioned as a cause of death but no allusion is made to it in the notes appended.
THE HOLMAN TESTIMONIAL. FOR the last 50 years the name of Constantine Holman has prominent in all the public work of the profession as treasurer and vice-president of the British Medical Association, vice-president of the British Medical Benevolent Fund, president of the Surrey Benevolent Medical Society, treasurer and vice-president of Epsom College (for which he has collected over .f.7000 by his personal efforts), and member of committee of the Royal Asylum of St. Anne’s. He has rendered signal services to his profession and the cause of charity. So great have been these services that, as we have already announced, it is thought desirable by his friends and colleagues that some record of their appreciation should be established. It is proposed to devote the proceeds of this testimonial to the erection of an art and reading room at Epsom College to be called the "Holman Art and Reading Room." Subscriptions of any amount will be received by Dr. John H. Galton, Ohunam, Sylvan-road, Norwood, S.E.
been