CASE I.

Wherein the action of the heart fails before that of the respiratory organs.

In no case of this description can artificial inflation of the lungs afford the least assistance, for the left side of the heart always contains florid blood at the moment of its cessation; and since this fact proves that it failed in its action, while under the full influence of duly oxygenized blood, how can we expect that the stimulus, which was unable to preserve the heart’s action while yet in motion, shall be able to re-excite it after it has ceased? Such a practice can only have been suggested by that erroneous physiology which maintained that the motion of the lungs excited that of the blood.

The preservation of the body from the influence of external cold is always important, for it is only within a certain range of temperature that the vital functions can be performed; and during a state of asphyxia, the body is necessarily incapable of generating any portion of animal heat; where the heat is lost it should be gradually restored, and for such a purpose the introduction of wine, the volatile alkali, and other stimulants, into the stomach, by means of a flexible tube, would probably, in certain states of syncope, prove serviceable; although in cases of suffocation it can never occasion the least benefit. We have been also directed to employ frictions on the surface of the body, for the purpose of assisting the circulation of the blood; as if, says Mr. Brodie, (Manuscript Notes) this could answer any useful purpose where the action of the heart has ceased, or as if it could be necessary where it still continues.

Under the head ‘death from cold,’ we have stated that the left cavities of the heart contain florid blood; it therefore follows that the directions of the Humane Society, to inflate the lungs in such cases, are founded in error.

It has been stated that in cases of suffocation the heart continues to contract for a short period, after the cessation of breathing; that this interval is extremely short, but liable to vary from several causes; and that it is uniformly shorter in cases of death by drowning, than in those by strangulation. To the physician this is an interval of anxiety and importance; let him beware how he trifles with the fleeting moments, in which alone the resources of his art can be of any avail. If artificial respiration be established at this period, the blood will become once more oxygenised, the action of the heart will be continued, the scarlet blood will be transmitted to the brain, and sensibility will therefore return; the nervous energy will be once more transmitted to the respiratory organs, and the animal will at length make a voluntary effort to inspire air. Here then is the interval of time, during which artificial breathing may be employed so as to effect a restoration to life, where death must otherwise have been inevitable. Mr. Brodie has made a great variety of interesting experiments upon this subject, from which may be deduced the following important corollaries.

1. If the lungs be inflated, the action of the heart will continue.

2. If the action of the heart has become feeble, but the circulation is nevertheless not entirely suspended, the inflation of the lungs will cause the feeble actions to become again frequent and vigorous.

3. If the action of the heart has entirely ceased, it is impossible to restore it by the inflation of the lungs.

4. If the action of the heart has not entirely ceased, but is so feeble as no longer to maintain the circulation, the artificial respiration will prove as useless, as if the heart were perfectly motionless.

There is still, however, another period at which artificial respiration may be employed with the greatest advantage; we have stated that after the natural respiration has been re-established, and the animal would appear to be advancing towards recovery, it not unfrequently relapses into a state of insensibility, becomes convulsed, and dies. As this depends upon the black blood which is circulating through the brain, so paralysing that organ as to prevent a necessary transmission of its influence to the muscles of respiration, life may be preserved if artificial respiration be established until the brain is again supplied with duly oxygenized blood; after which the animal will be enabled to perform its own functions without any assistance from art.

The same treatment will, of course, apply in every case where the natural respiration ceases in consequence of being deprived of a due supply of nervous energy, from the insensibility of the brain; as from a blow on the head—the action of a narcotic poison—from lightning?

It has been proposed, in cases of suffocation, to take away blood from some of the larger veins; as far as relates to the asphyxia, no advantage can accrue from such a practice, but incidental benefit may arise where congestion has taken place in the brain, as happens in hanging: in such cases the jugular veins are those from which the blood can be taken with the greatest chance of success.

Advantage is also said to accrue from the application of volatile alkali, or other pungent bodies to the inside of the nostrils; whatever promotes sneezing or coughing is supposed to give a succussion to the diaphragm and its antagonist muscles, and thereby to promote the re-establishment of respiration.

Cordials, moderate warmth, and quiet, are the resources upon which we are to rely for the ultimate recovery of the vital powers, after the complete establishment of the function of respiration.

For a long period, injections of tobacco enjoyed a high, but unmerited reputation amongst the medicinal agents that were supposed capable of rousing the latent energies of life, in cases of suspended animation; and strange as it may appear, this most powerful narcotic poison, until within a few years, was annually recommended for such purposes by those who professed to instruct the profession and the public upon these important topics; this may be considered as one of the most stupendous errors that ever occurred in the exercise of the medical art.

Where the asphyxia has arisen from the inhalation of noxious vapours, as those emitted by burning charcoal, the exposure of the body to cold has been strongly recommended. In Russia, where from the mode of heating the dwellings, accidents of this kind very frequently occur, the general practice is to rub the body with snow, and it is said with the happiest effect; this plan, says Dr. Babington, is probably of use, from the strong impression which is made upon the skin as a sentient organ. It is also a well known fact, that the recovery of the dogs which are made the subjects of experiment in the Grotto del Cane, is much favoured by their being plunged into a neighbouring lake.

Is it necessary to repeat, that the idea respecting the presence of any considerable portion of water in the lungs of a drowned person, has no foundation in truth? we should have scarcely deemed the notice of such a fallacy, and that of the practice founded upon it, of hanging by the heels, called for in this place, had not an opinion been lately delivered, by a medical witness, that a person drowned in the Thames might possibly have been recovered, but for the impurity of the water, arising from the gas-works. We have only to observe upon this occasion, that had the individual in question recovered in the hands of a practitioner who could have delivered so absurd an opinion, he would have been more indebted to good fortune than to skilful attention.

A drowned animal will, in general, be recovered more slowly and with greater difficulty than one which has fallen into a state of asphyxia from strangulation. It is probable that, in the former case, the sudden reduction of temperature will contribute to the more rapid extinction of vitality.

Having thus examined the pretensions to which the several modes of restoring animation are entitled, we may conveniently introduce in this place some observations upon the different methods which have been adopted to secure condemned criminals against the fatal effects of their execution. There can be no doubt but that by making an opening in the trachea, below the ligature, death might in some cases be prevented, provided the neck were not dislocated, nor the weight of the body very considerable. Richerand says, that a surgeon of the imperial armies, whose veracity cannot be questioned, assured him that he had saved the life of a soldier by performing the operation of laryngotomy some hours before he was executed.

Dr. Male^[71] states that it was tried on one Gordon, a butcher, who was executed at the Old Bailey in the early part of the last century; the body having hung the usual time, was removed to a neighbouring house, where a surgeon waited to receive it, and enforce every means calculated to restore animation: he opened his eyes, and sighed, but soon expired: the want of success was attributed to his great weight, but we apprehend that, if the statement be correct as to his opening his eyes and sighing, the failure must have depended upon want of skill in the operators. We have yet to notice those cases of spontaneous recovery which have taken place after execution, and which are too well authenticated to admit of doubt; upon this point we would observe, that such results by no means militate against the accuracy of the physiological views which have been already presented to our readers. Whenever such a recovery occurs, the strangulation has never been complete, and feeble motions of the heart have been preserved by imperfect and occasional respirations, during the interval of suspension; this may depend, in a great measure, upon the situation of the noose; if placed at the side of the neck, it would be pulled tight by the weight of the body; but if at the back of the neck, it would be far otherwise. John Smith, who was executed at Tyburn on the 24th of December 1705, was cut down in consequence of the arrival of a reprieve, nearly fifteen minutes after he had been turned off, but is said to have been recovered by venesection and other means^[72]; Governor Wall was a long time in the act of dying, and it was subsequently discovered that this was owing to an ossified portion of the trachea resisting the pressure of the rope; but the most extraordinary instance of this kind, and one well authenticated, is that of Margaret Dickson, of Musselburgh, who was tried and convicted in Edinburgh in the year 1728, for the murder of her child; her conviction was accomplished by the evidence of a medical person, who deposed that the lungs of the child swam in water; there were, however, strong reasons to suspect the justness of the verdict, and the sequel of the story was well calculated to cherish a superstitious belief on the occasion. After execution, her body was cut down, and delivered to her friends for the rites of interment; it was accordingly placed in a coffin, and sent in a cart to be buried at her native place, but the weather being sultry, the persons who had the body in charge stopped to drink, at a village called Peppermill, about two miles from Edinburgh; while they were refreshing themselves, one of them perceived the lid of the coffin move, and uncovering it, the woman immediately sat up, and most of the spectators ran away with every sign of trepidation; a person, however, who was in the public house immediately bled her, and in about an hour she was put to bed, and by the following morning, was so far recovered as to be able to walk to her own house^[73], after which she lived twenty-five years and had several children.^[74]