SUDDEN DEATH.

The idea commonly entertained is that with animal bodies there are only two possible conditions—either life or death; that the presence of one of these conditions implies the absence of the other; that when the body has assumed the appearance of death, as during the sudden suspension of all the functional activities, it must be dead. This last is far from being true; for all the appearances of death are fallacious, especially those that accompany so-called sudden death. All such cases should be challenged as of doubtful character, and held so till recovery or putrefaction of the tissues proves the presence of life or of death. This subject is too often treated by medical writers with indifference. Technically, it is regarded as a failure of the brain, or lungs, or heart, to perform their functions; popularly, we say that “the thread of life is snapped asunder;” or it is “the going out of life,” like the sudden extinguishing of a candle. The author’s experience, however, at the sick bedside, and in the death-chamber, has taught him that life leaves the body in a gradual manner, and that death approaches, and takes the place of life, in one part or organ after another, thus creeping through the tissues, and sometimes defying all tests to prove its presence, leaving putrefaction to be its only sign. There can be no such thing as veritable sudden death, unless the body is crushed into a shapeless mass, like an insect under foot.

The late Dr. Farr, of the Registrar-General’s Department, London, says:—“No definition of the sense in which sudden death is practically understood by coroners has been given.” Dr. Granville says: “The writers on medical jurisprudence do not state with any strictness what they mean by sudden death, whether it be death in ten minutes, ten hours, or ten days.”[9] And he asks in the same vein, “Does sudden death mean death in three minutes, three hours, or three days?”[10] Still further he remarks regarding the customary definitions, “They lead one to infer that a certain mysterious principle, called LIFE, has been instantaneously withdrawn from a healthy and well-constituted individual, who was at the very moment, as heretofore, exercising his proper animal functions with a regularity that promised to endure for a long continuance of years.... No such phenomena occur in Nature, unless through violence or from accident. Under Nature’s laws there is no such thing as sudden death.... In every case where death has abruptly cut short the thread of life, there has been a preparation, more or less antecedent to the occurrence, which must inevitably have led to it.... The victim may seem to have been struck down, as if by lightning. But in reality the event was only the natural termination of an inward state of things which insidiously and unexpectedly was preparing the blow.”[11]

Dr. Tidy, in “Legal Medicine,” p. 29, says:—“As a rule, the action required to bring about complete molecular death—i.e., the suspension of vital activity in every part—is progressive. In a given case, therefore, we are unable to state any definite time as the period of its occurrence. The popular idea of death is that the entire body dies at once. Somatic death is an impossibility.” Thus, it is clear that the process of death, or the departure of life, may require days or weeks for its completion; and it may even be delayed to a time when putrefaction has set in quite generally, as when the hair and nails grow after the body has been buried some weeks, as has been credibly reported. Writers upon so-called sudden death recite a number of diseases and conditions which quickly destroy the machinery that carries on the vital functions, thus rendering resuscitation quite impossible. Tidy[12] names some twelve of such causes: prominent among them are diseases of the heart, rupture of the heart, clots in the blood vessels, aneurisms, effusions of blood in the brain, bursting of visceral abscesses, ulcers of the stomach, extra-uterine pregnancy, rupture of the uterus or bladder, large draughts of cold water taken when the body is heated, cholera, alcoholic poisoning, mental emotions, etc. But he remarks upon these causes—“Because a person dies suddenly, there being no evidence of violence or poison, the action adopted by many coroners in not requiring a post-mortem examination leaves the most important witness—the dead body itself—unheard, and the inquest so far valueless.” Which may mean that, without the risk of an autopsy, it is impossible in such cases to determine whether they are beyond resuscitation or not, unless putrefaction settles the question. Unfortunately there is nothing in the external appearance of those cases of so-called sudden death in which the vital machinery may be totally wrecked, to distinguish them from those of apparent death, in which all the organism is in a state of perfect integrity, and in which resuscitation is possible, provided the vital principle has not entirely left the body. Consequently, the only safe rule to observe in all cases in which death has not followed poisoning, or injuries which kill outright, or some known disease of sufficient duration and severity to bring on dissolution, is to wait for unmistakable evidences of decomposition before autopsy, embalming, cremation, or burial is allowed.

In former times precipitate interments of persons who died suddenly were specially guarded against.

Nothing is more common, on opening a newspaper, than to see one or more announcements of sudden death. These occurrences are so frequent that the great London dailies, except when an inquest is held, or when the deceased is a person of note, omit to record them. The narratives are much alike: the person, described to be in his usual health, is seized with faintness in the midst of his daily-avocation, and he falls down apparently dead; or he retires for the night, and is found dead in his bed. In many instances post-mortems are made, and an inquest held; but in other cases the opinion of the attendant doctor, that the death is due to heart-disease, syncope, asphyxia, coma, apoplexy, or “natural causes,” is deemed sufficient. The friends who are called in to look at the body will remark, “how natural and how life-like,” “how flexible the limbs,” “how placid the face;” and, without the faintest attempt at resuscitation, arrangements are made for an early burial.

Dr. Alexander Wilder, Professor of Physiology and Psychology, in a letter to the author, says:—“There are a variety of causes for sudden death. The use of tobacco is one. Another is overtaxed nervous system. Men of business keep on the strain till they drop from sheer exhaustion. At the base of the brain is a little nerve-ganglion, the medulla oblongata, which, once impaired, sends death everywhere. Overtaxing the strength by study and mental stress will do this. The solar ganglion below the diaphragm is the real vital focus of the body. It is first to begin, last to die. A blow on it often kills. An emotion will paralyse it. Even undue excess at a meal, or the use of overmuch alcohol, may produce the effect.

“Tobacco impairs the action of the heart. An overfull stomach paralyses the ganglionic store, and breathing is likely to stop. It is dangerous in such cases to lie on the back. All these deaths are by heart-failure.” It is syncope where the heart fails first; asphyxia where the lungs are first to cease; coma when the brain is first at fault. “Natural causes” and “heart-failure” usually mean, like “congestion,” that the doctor’s ideas are vague.

Dr. Wilder continues:—“I would choose such a death if I could be sure it was death. But most of those things which I have enumerated may cause a death which is only apparent.”

The following briefly extracted cases from English papers are typical of thousands of others, and can be duplicated, with slight variation in terms, throughout the United States. The absolute proof of the reality of such deaths is not found in hasty diagnosis or in medical certificates, but in the presence of putrefaction:—

Amongst other sudden deaths more recently reported are:—R. F——, of RECENT CASES OF SUDDEN DEATH.Torquay, described as “a man of exceptional physique, who had every appearance of possessing a very robust constitution.”—F. P. C—— “looked more than usually robust of late, had never been known to complain of his head, and appeared in the best of health and spirits.”—W. W——“had always appeared to enjoy good health, with the exception of a cough.”—O. P——, “beyond failing appetite, had given no indication of ill health.”—W. M——“was in his usual health, and went to bed all right.”—Mrs. T. B—— “was in the best of health, and was attending to her household duties.”—L. T——, “a powerfully-built fisherman, and most unlikely to come to such a sudden termination of life.”—M. J. M——, at East Garston. “A post-mortem was made by Dr. K. and his assistant, but they were unable to find any evidence as to the cause of death. Verdict: ‘Natural causes.’”—The sudden death, while playing the pianoforte, of a girl, aged twelve, “who had never had a day’s illness in her life.”—S. G——“was quite well, and in excellent spirits.”—T. B. B—— was “a robust man, and had not been ailing.”—G. R—— was “in excellent health and spirits, and attended to his duties as usual.”—A little girl, M. B——, who appeared to be in her usual health, died very suddenly while sleeping in a cot by the side of her parents. Verdict at the inquest: “Death from natural causes.”—A. S——, aged twenty-three, a strong young fellow, who went to rest before eleven o’clock. About one o’clock the following morning he was seized with pain, became unconscious, from which he succumbed.—R. J. C——, labourer, “a fine, robust-looking man,” suddenly expired before medical aid could be procured. Verdict at inquest: “Died suddenly from natural causes.”—Mrs. R——, “who was quite well when her daughter left the room, was found dead on her return a few minutes later.”—T. H——, blacksmith, “went to bed in his usual health and spirits” in company with a comrade, who on attempting to wake him in the morning found life extinct.

The above are given simply as typical examples of a class of cases of which thousands might be cited, but it has not been thought necessary to weary the reader with the details of further instances.

While it is not suggested that the foregoing are cases of premature burial, yet it is absolutely certain that they belong to the category of persons of whom a considerable percentage are liable to such misadventures unless precautions very different from those in vogue are taken to prevent them. All medical practitioners allow that a man may be half drowned or half dead, and that cases of suspended animation occur where the most experienced physician is unable to detect the faintest indication of breathing or cardiac movement. They are, however, quite sceptical as to absolute suspensions of life where all the ordinary methods to test its existence fail; and, owing to this scepticism, and the readiness to give certificates of death in cases of alleged sudden death, have unwittingly promoted premature burials, as will appear by the facts quoted in these pages.

Mr. M. Cooper, in the “Uncertainty of the Signs of Death,” p. 49, cites from a letter by one William Fabri, a surgeon, the opinion that we “... have just reason to condemn the too precipitate interment of persons overpowered by lethargies, apoplexies, or suffocation of the matrix; for I know there have been some, supposed to be irretrievably cut off by these disorders, who, resuming strength and returning to life, have raised the boards of their own coffins, because in such disorders the soul only retires, as it were, to her most secret and concealed residence, in order to make the body afterwards sensible that she had not entirely forsaken it.” These wise counsels were written two hundred and sixty-eight years ago, since which time thousands of our fellow-creatures have, it is feared, been the victims of premature interment, and yet the danger then pointed out remains. The Undertakers’ and Funeral Directors’ Journal, the conductors of which are laudably anxious to keep their profession from the odium of burying people alive, referring to sudden deaths and this danger, says, in its issue of January 24, 1894, under the head of “A Burning Question”:—“Sufferers from such chronic ailments as are reputed to end suddenly are in constant danger from the present state of the law, if they are in the hands of people interested in their death.” And continues: “Even where a medical certificate is obtained, such general laxity has entered into proceedings that but little protection is thereby afforded to the public. While the medical man is bound to state what he believes to be the cause of death, he is under no obligation to make sure either that the patient is dead at all, or that, if dead, he died from a particular disease for which he was attending him.”

VIVISECTION.

The Medical Times and Gazette, 1859, vol. xviii., p. 256, has the following:—

SYNCOPE.

The deaths attributed to syncope in the Registrar-General’s reports for England and Wales during the last six years are:—

Syncope, however, is not a disease, though often certified as such, but is merely a symptom of certain maladies, or a manifestation of suspended animation from unascertained cause. In Hoblyn’s “Dictionary of Medical Terms,” p. 632, syncope is described as—“Fainting or swoon; a sudden suspension of the heart’s action, accompanied by cessation of the functions of the organs of respiration, internal and external sensation, and voluntary motion.” DEATHS ATTRIBUTED TO SYNCOPE.There appears, therefore, every probability that, with careless or ignorant medical practitioners, syncope is not seldom mistaken for trance, and a certificate of death may be given where there is merely a suspension and not a termination of life; and this probability is reduced to a certainty when we learn the number of premature burials and narrow escapes reported by Winslow, Bruhier, KÖppen, E. Bouchut, LÉnormand, F. Kempner, Moore Russell Fletcher, Gannal, Gaubert, Hartmann, and other recognised authorities. Dr. James Curry, Senior Physician to Guy’s Hospital, and Lecturer on the Theory and Practice of Medicine, in the introduction to his “Observations on Apparent Death,” London, 1815, 2 ed., p. 1, says—“The time is still within the recollection of many now living when it was almost universally believed that life quitted the body in a very few minutes after the person had ceased to breathe. Remarkable examples to the contrary were, indeed, upon record; but these, besides being extremely rare, were generally cases wherein the suspension, as well as the recovery of life, had occurred spontaneously; they were, therefore, beheld with astonishment, as particular instances of Divine Interposition.” It is believed that the majority of the members of the medical profession still entertain the idea that a human being is dead when breathing can no longer be detected, as in the cases of reported sudden deaths; and, except in those which occur from drowning, or suffocation through noxious gases, attempts are very rarely made to promote restoration, and, unless they return to life spontaneously while above ground, there are good reasons to fear that an appreciable number do so under ground. The prevailing belief in the existence of sudden deaths is one of the chief causes of the terrible mistakes that lead to live burials. If this delusive idea were removed, those concerned, such as physicians, undertakers, relatives, and friends, would treat a person who unexpectedly took on the appearance of death as one needing careful attention by physician and nurse to bring him round to health again, as is usually done in cases of fainting. If trance were understood, doctors would be on the lookout for it; but, as it is not understood, it is called death, and we bury our mistakes under ground.

Dr. Hilton Fagge, while doubting whether there is any foundation for the strong fear which many persons entertain of being buried alive after supposed death, allows that there is danger in cases of sudden death. In his “Principles and Practice of Medicine,” Dr. Fagge says: “The cases really requiring caution are some very few instances of persons found in the streets, or losing consciousness unexpectedly and in unusual circumstances.”[13]

Dr. LÉonce LÉnormand, in “Des Inhumations PrÉcipitÉes,” p. 86, says that medical archives record details of a great number of apoplectic cases revived after one, two, and three days’ apparent death; and observes that the most celebrated physicians, both ancient and modern, agree in recommending delay in the burial of persons who succumb to this affliction.

Dr. Franz Hartmann, in his “Premature Burial,” p. 11, quotes the following:—

In “Les Signes de la Mort,” by Dr. E. Bouchut, p. 51, Dr. J. Schmid is cited for the case of a girl, seven years of age, who, while playing with her companions, fell suddenly down (as if struck by lightning), and died. There was paleness, absence of pulse, insensibility to all stimulus. Nevertheless, owing to the requests of the distressed parents, the apparently hopeless attempts at resuscitation were continued. After three quarters of an hour the girl gave a sigh and recovered.

The Medical Record, New York, 1883, vol. xxiii., p. 236, contains a paper on “Revivification” (in cases of sudden apparent death from heart-disease, and in the still-born), by S. Waterman, M.D., New York Case 1, February, 1880.—Mr. B——, aged 84, suffered from valvular disease of the heart, and likewise from Bright’s disease. “One morning, while I was sitting at his bedside and in friendly conversation with him, he being to all appearance in a very happy mood of mind, he suddenly fell back, his eyes became fixed and glassy, a deadly pallor crept over his countenance, respiration and the heart’s action ceased simultaneously, and death seemed to have carried him off suddenly and unexpectedly. It was this suddenness of the event that impelled me to make efforts at revivification. Two nephews of Mrs. B——, who were fortunately in the house, were brought under requisition, and, under my direction, systematic artificial movements were carried on for nearly thirty minutes, when one deep inspiratory effort was made by the patient himself. Thus encouraged, we redoubled our efforts for ten minutes more; other inspiratory efforts followed in quicker succession; the heart began to respond. Hardly audible at first, it acquired force and momentum; it could now be felt at the wrist; the deadly pallor passed away, the eyes lost their glassy, fixed aspect, sighs and groans could be heard, twitchings of the muscles of the arm and fingers could be distinctly felt, and the appearances of death made way for reanimated conditions. He lay unconscious for more than ten hours, respiration being hurried, and breathing stertorous, the heart’s action wild and irregular. During the night he was delirious and restless; toward morning all untoward symptoms subsided, and a quiet sleep followed the extreme restlessness.... He died six weeks afterwards, under symptoms of urÆmic toxication. During these six weeks he had several other attacks—one very prolonged and almost fatal—in which artificial respiration was resorted to with the same success.”

The editor of the Manchester Criterion, December 11, 1895, says:—“Many cases of sudden death have been entombed who were really alive, so far as the union of the body and soul is concerned. Sudden disappearance of life is very common, due to excessive weakness or a partial cessation of the heart’s action; and doctors should be very chary in giving death-certificates until it has been ascertained that decomposition has ensued. Many object to this delay, and on the approach of an indication of death, or apparent death, often hurry the body to the grave. We know of a young lady, for whom the shroud was bought, and the crape fastened on the door, who was restored to life.”

SUDDEN DEATH.

Professor Alexander Wilder, M.D., in “Perils of Premature Burial,” p. 16, says:—“In this country (America), however, the peril of interment before death has actually taken place is very great. For years past it has been a very common occurrence for persons in supposed good health to fall down suddenly, with every appearance of having died. We do not regard sudden death with terror, as it is so often painless, and exempts the individual from the anxiety and other unpleasant experiences which so often accompany a lingering dissolution. But there is a terrible liability of being prostrated by catalepsy, the counterpart of death, under such circumstances that those who have the body in charge will not hesitate about a prompt interment.”

“The difficulty of distinguishing a person apparently dead from one who is really so has, in all countries where bodies are interred precipitately, rendered it necessary for the law to assist humanity. Of several regulations made on this subject, a few of the most recent may suffice—such as those of Arras in 1772; of Mantua in 1774; of the Grand Duke of Tuscany in 1775; of the SenechaussÉe of Sivrai in Poitou in 1777; and of the Parliament of Metz in the same year.... These edicts forbid the precipitate interment of persons who die suddenly. Magistrates of health are to be informed, that physicians may examine the body; that they may use every endeavour to recall life, if possible, or to discover the cause of death.”—EncyclopÆdia Britannica, quoted by John Snart in Apparent Death, 1824, pp. 81-82.