RESUSCITATION OF STILL-BORN AND OTHER INFANTS.

The danger of premature burial of still-born (apparently dead) infants is clearly shown by the following quotation from Tidy’s “Legal Medicine,” part ii., page 253, from tables given on the authority of the British and Foreign Medical Review, No. ii., p. 235, based on eight millions of births. “It would appear that from one in eighteen to one in twenty births are still-born. Dr. Lever found that the proportion in his three thousand cases was one in eighteen. So notorious is it that a large number of these deaths could be averted, that some legislation is urgently needed, requiring that still-borns, whose bodies weigh, say, not less than two pounds (the average weight about the sixth and seventh months at which children are viable), should not be buried without registration and a medical examination.”

Many instances can be found in current medical literature of still-born infants that have been revived by artificial respiration. Such cases not infrequently revive without any means being employed for their resuscitation; but among the poor, who dispose of the new-born apparently dead in a hasty manner, they might be buried alive through carelessness. The use of mortuaries, where the seeming dead would be kept under observation until decomposition appears, would of course prevent such disasters.

Struve, in the Essay cited in the Bibliography (1802), says:—

“All still-born children should be considered as only apparently dead, and the resuscitative process ought never to be neglected. Sometimes two hours or more will elapse before reanimation can be effected. An ingenious man-midwife, says Bruhier, was employed for several hours in the revival of an apparently still-born child, and as his endeavours proved unavailing, he considered the subject really dead. Being, however, accidentally detained, he again turned his attention to the child, and by continuing the resuscitative method for some time it was unexpectedly restored to life” (p. 150).

The following is one of Struve’s most striking cases:—

A Mr. E.—— called in 18—— to obtain a certificate of death for a still-born child of seven months’ gestation. Arriving at the house, the doctor found the child laid upon a little straw and covered with a slight black shawl; this was one p.m., and the child had been there since five a.m. It was icy cold, and there was no heart sound nor respiration, but there was a slight muscular twitching over the region of the heart. The child was immersed in a hot bath and artificial respiration employed, but for twenty minutes the case seemed hopeless; then the eyes opened and after continued effort the respirations began, laborious and interrupted at first, then normal by degrees. The child was saved, and became an accomplished violinist.

The mortality and waste of infant life, particularly in large cities like Paris, London, Berlin, Vienna, and New York, is admitted by all investigators to be enormous. In France medical writers, in view of the small percentage of births to population, are waking up to the realisation that the State cannot afford the loss, and that, among other things, steps should be taken to resuscitate the still-born, so that none should be buried before unequivocal signs of death are manifested.[21] The premature abandonment of the still-born among the poorer classes in crowded cities is only too probable. There are also cases recorded which show a corresponding risk to infants who have survived their birth:—

The British Medical Journal, January 21, 1871, p. 71, gives the following case, under the heading, “Alive in a Coffin”:—“Stories of this kind are generally very apocryphal; but the following reaches us from an authentic source. A child narrowly escaped being buried alive last week in Manchester. The infant’s father had died, and was to be buried in Ardwick Cemetery. The day before the burial the infant was taken ill, and apparently died. A certificate of death was procured from a surgeon’s assistant who had seen the child, and, to save expense, it was decided to place it in the same coffin with the father. This was done, and the next morning the bearers set off to the cemetery with their double burden; but before reaching the grave-yard a cry was heard to issue from the coffin. The lid being removed, the infant was discovered alive and kicking. It was at once removed to a neighbour’s house, but died eight hours afterwards.

The British Medical Journal, 1885, ii., p. 841, gives the following case, under the heading, “Death or Coma?”

“The close similarity which is occasionally seen to connect the appearance of death with that of exhaustion following disease, was lately illustrated in a somewhat striking manner. An infant seized with convulsions was supposed to have died about three weeks ago at Stamford Hill. After five days’ interval, preparations were being made for its interment, when, at the grave’s mouth, a cry was heard to come from the coffin. The lid was taken off, and the child was found to be alive; it was taken home, and is recovering.”

The following is from Tidy’s “Legal Medicine,” pt. i., p. 29:—

“In a communication to the French Academy, Professor Fort mentions a child (Ætat. three) having been resuscitated by artificial respiration continued for four hours, and not commenced until three and a half hours after its apparent decease.

“Ogston records one case of a child alive for seven hours, and a second case of a young woman alive for four hours, after they had been left as dead.”

From the Lancet, April 22, 1882, p. 675:—

The following letter to the editor of the Lancet, March 31, 1866, p. 360, illustrates the danger to which infants supposed to be dead are exposed, under one of our traditional customs:—

It is recorded that Dr. Doddridge showed so little signs of life at his birth that he was laid aside as dead, but one of the attendants observing some signs of life, took the baby under her charge, and by her judicious treatment perfectly restored it.

Mr. Highmore, Secretary of the London Lying-in Hospital, confirmed (by a communication to the Royal Humane Society, April, 1816,) the statement of Mrs. Catherine Widgen, the matron of that excellent establishment, that, by a zealous perseverance in the means recommended by that Society, she had been the happy instrument of restoring from a state of apparent death in the space of three years no less than forty-five infants, who, but for her humane attention and indefatigable exertions, must have been consigned to the grave. Later on, Mrs. Widgen restored in one year twenty-seven apparently dead-born children—a striking instance of the truth of the remark of a celebrated writer (Osiander) that “the generality of infants, considered as still-born, are only apparently so; if, therefore, persons would persevere in their exertions to revive them, most of them might be restored.”—Report of the Royal Humane Society, 1816-17, pp. 52-54.

“For these exertions the General Court adjudged the Honorary Medallion to Mrs. Widgen, and it was accordingly presented to her by His Royal Highness the Duke of Kent.”—Ibid., p. 52.

[The question naturally suggests itself in this place: If the matron of such a noble institution as the above was able to save seventy-two apparently dead children from the grave in four years, how many of these poor little beings are consigned to the grave all over the world for lack of the “humane attention and indefatigable exertions,” such as this skilful matron gave to those that came under her intelligent care?]

“RECURRENCE OF SUSPENDED ANIMATION.

“A child, who had a cough for some time, was suddenly attacked with difficulty of breathing, and to all appearances died. A medical gentleman immediately inflated the lungs, and by persisting in this for a considerable time, recovered the child. A similar state of suspended animation took place three or four times, and inflation was as often had recourse to with the same success; but the attack, happening, unfortunately, to recur whilst the medical gentleman in whose family the case happened was from home, the proper measures were not taken, and the child was lost.”—Ibid., p. 140.

“SHOCK FROM LIGHTNING.

“A boy was struck down by a flash of lightning near Hoxton (in the suburbs of London), and lay exposed to the rain at least an hour, until his companions carried him home on some boards, apparently dead—the body being stiff and universally cold, the fingers and toes contracted, and the countenance livid. He was stripped of his wet clothes, put in hot blankets, and bled twenty ounces. In half an hour, interrupted respiration commenced, without inflating the lungs; in an hour more, regular pulsation and breathing were established, together with power of swallowing; and in a week he was quite well.”—Ibid., p. 147.

In the Lancet, 1884, vol. i., p. 922, W. Arnold Thompson, F.R.C.S.I., reports a case of resuscitation of a child delivered by the forceps, which was “apparently to myself [he says] and the nurse and relatives, a perfectly dead child, and with no signs of respiration or life about it.... My opinion was that the death was real and positive, but that, there being no actual disease present, and the blood still warm, the machinery of life was set going, and resuscitation followed as a consequence of suitable means being taken and persevered in without undue delay. In the future I do not intend to allow any still-born children to be put away without making strenuous efforts to restore vitality.”

The Lancet, 1880, vol. ii., p. 582:—In a discussion at the Royal Medical and Chirurgical Society upon Artificial Respiration in New-born Children, Dr. Roper related three cases in which the child was left for dead. “One of these occurred in the practice of Mr. Brown, of St. Mary Axe. The child was still-born in the absence of a medical man. It was taken to the surgery, and thence to the late Mr. Solly, who next day, in dissecting the body, found that the heart was still beating. A second instance was of a foetus of five months and a half, which was set aside as dead, Dr. Roper attending the mother, who was suffering from hÆmorrhage. He was astonished next day to find that this immature child, which had lain on the floor for eleven hours through a cold night, was breathing and its heart beating....” Such examples show that the new-born have greater tenacity of life than is supposed.

The Lancet, 1881, vol. ii., p. 430, under the heading of “The Burial of Still-born Infants,” states that “Greater security for the due observance of these necessary regulations (the Births and Deaths Registration Act of 1874), for the burial of infants said to be still-born, is urgently called for. It is constantly patent that the burial of deceased infants as still-born, if checked, is by no means prevented; and that the authorities of burial grounds, by their laxity in carrying out the provisions of the Act, afford dangerous facilities for the concealment of crime, or negligence, and for a practice which threatens to impair the value of our birth and death registration statistics; for, if a live-born infant be buried as still-born, neither its birth nor its death is registered.”

A case of forceps-delivery occurred in the hands of the writer (E.P.V.), in which the child, when extracted, was quite purple in colour, and absolutely dead to all appearances—there was no breathing nor impulse to be found anywhere. After some efforts at resuscitation in the way of artificial respiration—not very thoroughly done, nor much prolonged (for the child was believed to be dead)—with a warm bath and frictions, it was laid aside and covered up. At a subsequent visit some hours later, the child was found in the nurse’s lap, completely recovered, and changed in colour to a bright pink. The nurse said she did not like to give the little fellow up, and by breathing into his mouth for some time he showed returning life, and by keeping it up he soon began to breathe himself.

Cases like this are believed to be not infrequent, because physicians and nurses are not, as a general rule, aware of the great tenacity of life possessed by the new-born infant.

“Still-births are not registered in England; but, under the new Registration Act, no still-born child can be buried without a certificate from a registered practitioner in attendance, or a declaration from a midwife, to the effect that the child was still-born. The proportion of still-births in this country is supposed to be about four per cent., but this is uncertain.”—A. Newsholme, Vital Statistics, 1889, p. 61.

“The proportion of deaths from premature births, compared with the total number of births, in 1861-65 was 11·19 to 1,000 births; since which time it has steadily increased, reaching the ratio of 15·89 per births in 1,000 in 1887.”—Ibid., p. 216.

The same author, p. 17, states that “a certain proportion of the births remain unregistered(a). There is strong reason for thinking that a certain number of children born alive are buried as still-born.”