  SUGGESTIONS FOR PREVENTION. The learned Dr. VignÉ, of Rouen, who won the respect of his fellow-citizens during a long and honourable career, was for many years engaged in the study of this question, and published the result of his researches shortly before his death. Convinced that the resources of science were insufficient to distinguish real from apparent death, he left testamentary instructions to provide against his own premature burial. (“Des Inhumations PrÉcipitÉes, p. 83,” by LÉnormand.) Dr. Winslow, a French physician, who had on two different occasions very nearly fallen a victim to premature burial, having been laid out for dead, chose for the subject of his thesis before the Paris Faculty of Medicine, “Les moyens les plus propres À reconnaÎtre la rÉalitÉ de la mort.” Dr. Winslow may be said to have been the pioneer of a movement in France for exposing the danger of, and educating the public into the necessity of reforms in, the mode of treating the apparent dead; and, although his efforts and warnings were as of one crying in the wilderness or amongst an apathetic people, with a legislature apparently uninfluenced either by facts or by reason, they were never relaxed. Numerous writers have since confirmed the truth of Dr. Winslow’s contention by facts within their own experience, and it is believed that legislation in France cannot be much longer delayed. That the risk of premature burial is not an imaginary one, as recently declared by a leading London medical journal, has been shown by the citation in this volume of cases of death-like trance which have baffled the ablest of medical experts; also the instances of numerous narrow escapes from this terrible occurrence, and of others where the victims were suffocated before timely aid could be obtained, most of which are drawn from medical sources, and some from the columns of the said sceptical journal. The painful reality is also shown by the multitude of preventive measures suggested by medical authorities, and by the ingenious contrivances of those who have made this distressing subject one of patient and laborious research. Several of the remedies suggested for adoption in cataleptic cases are really homicidal, or seriously mutilative; many of them are impracticable, and have been shown by Hufeland, LÉnormand, Richardson, Hartmann, Bouchut, Fletcher, and Gannal to be delusive. The merits and demerits of some of these methods might be inquired into by the appointment of a Parliamentary Committee, or a Royal Commission, as a supplement to that appointed in 1893, by Mr. Asquith, on Death-Certification. CUTANEOUS EXCITATION. Dr. James Curry, F.R.S., in his “Observations on Apparent Death,” pp. 56, 57, says, concerning the application of stimulants to the skin:— “To assist in rousing the activity of the vital principle, it has been customary to apply various stimulating matters to different parts of the body. But, as some of these applications are in themselves positively hurtful, and the others serviceable only according to the time and manner of their employment, it will be proper to consider them particularly. “The application of all such matters in cases of apparent death is founded upon the supposition that the skin still retains sensibility enough to be affected by them. It is well known, however, that even during life the skin loses sensibility in proportion as it is deprived of heat, and does not recover it again until the natural degree of warmth be restored. Previous to the restoration of heat, therefore, to a drowned body, all stimulating applications are useless, and, so far as they interfere with the other measures, are also prejudicial.” Several writers, besides Dr. Winslow, whose views on premature burial are cited in this volume, have themselves been the victims of hasty and erroneous medical diagnosis; and, having had narrow escapes of premature burial, their experience has prompted them to take a deep interest in the subject, with the determination to do what they could to enlighten and safeguard the public from so terrible a danger. In other cases, members of their families have been the unhappy victims of mistaken certificates. Mr. George T. Angell, the editor of “Dumb Animals,” Boston, U.S., whose father was pronounced by his physician dead, and returned to consciousness after preparations for the funeral had been made, has repeatedly alluded to the subject in his paper, and published preventive suggestions at various times, including the following from a physician:— “When I arrived, the man had been dead twenty-four hours. I empanelled a jury; the family of the deceased testified to the extent of their knowledge; but I was unable to find he had any disease sufficient to kill him. I looked at the body and examined it carefully. Then I lighted a match, and applied it to the end of one of the fingers of the corpse. Immediately a blister formed. I had the man put back into his bed, applied various restoratives, and to-day he is alive and well. “That is the test. Do you see the philosophy of it? If you are alive, you cannot burn your hand without raising a blister. Nature, in the effort to protect the inner tissues, throws a covering of water, a non-conductor of heat, between the fire and the flesh. If you were dead, and flames should come in contact with any part of your body, no blister would appear, and the flesh would be burned. “All you have to do is to apply a match to any part of the supposed corpse. If life remains, however little, a blister will at once form.” The test, like the following one, is deceptive, because life may be so torpid and inactive as to be unable to respond to the irritation of heat, or even to the application of red hot irons. THE BLISTER TEST. The British Medical Journal, January 18, 1896, p. 180, under the head of “Living or Dead?” prints the following communication concerning this test:— “Sir,—Burial alive, though of exceedingly rare occurrence, sometimes does happen, and calls for increased attention to the means of detecting with certainty the presence of vitality, however feeble. The ordinary means of deciding the vital question are known to all persons. Auscultation may detect the enfeebled heart-beat, while the electric battery can elicit any existing muscular contractility. Conditions of trance are occasionally almost mystical in their profundity (Brahmin trance), and a simple and ready-to-hand test to decide whether death has occurred is of prime importance. We can ascertain whether or not life still lingers in uncertain cases by THE BLISTER TEST. applying (say) to the back of the forearm a small stream of boiling water directly from “J. Milford Barnett, M.D., Edin. “Belfast, January 11, 1896.” This test has frequently failed, and should not be relied upon. AUSCULTATION. The stethoscope, which is regarded by many medical practitioners as an infallible means of preventing premature burial, has proved a broken reed in hundreds of cases, and can be of use only when applied with other tests. Dr. Roger S. Chew, of Calcutta, writes to me, February, 1896:— “The British Medical Journal (September 28, 1895) tells us that the careful use of the stethoscope will enable a medical man to distinguish a living from a dead body. AUSCULTATION.Auscultation may give startling results, and the body yet be absolutely dead. I recollect an instance of death from cobra-bite, when, though decomposition had set in, the relatives refused to believe she was dead, because one of them declared that, though he did not see her chest rise and fall, he had distinctly heard her sigh. A medical man was called in, applied the stethoscope over her thorax, and declared he could hear sounds from her lungs, and a peculiar ‘sough,’ ‘sough’ towards the “In another case, that of my son, aged two years, after a series of brain symptoms and severe clonic convulsions preceding an outbreak of confluent small-pox, the stethoscope told me and a medical friend who was present that my little boy had ceased to exist; but a liberal application of ice to his head and cardiac region, together with violent friction and artificial respiration vigorously employed for forty minutes, restored the child to me, and I thanked God that I had refused to accept the evidence of the stethoscope as final.” ELECTRICITY. The application of the electric current is a powerful restorative agent in cases of suspended animation, if judiciously applied. Struve in his essay, “Suspended Animation,” p. 151, under the head of “Apparent death from a fall,” says:—“A girl, three years of age, fell from a window two stories high upon the pavement. Though she was considered as lifeless, THE ELECTRICAL TEST. Referring to the subject of premature burial, Dr. W. S. Hedley, writing to the Lancet, October 5, 1895, says:—“Forty years ago the subject was investigated by Crimotel, twenty years later by Rosenthal, and more recently by Onimus. It seems safe to say that in no disease, certainly in none of those conditions usually enumerated as likely to be mistaken for death, is galvanic and faradaic excitability abolished in every muscle of the body. On the other hand, electro-muscular contractility disappears in all the muscles within a few hours after death (generally ninety minutes to three hours, according to Rosenthal), its persistence varying to some extent with the particular muscle examined (1), and with the mode of death (2). Therefore, if electro-muscular contractility be present in any muscle, it means life or death only a few hours before. It is clear that no interment or post-mortem examination ought to take place so long as there is any flicker of electric excitability. To me it seems almost equally obvious that in all doubtful cases, sometimes in sudden death, and often to allay the anxiety of friends, this test ought to be applied, and applied by one who is accustomed The Medical Record, New York, March 30, 1895, contains the following:—“In a case reported by M. D’Arsonval, a man was struck with a current of four thousand five hundred volts. The current entered at his hand and issued at his back. Half an hour or more elapsed before any attempts at resuscitation were made, but, on artificial respiration being practised on Silvester’s method, recovery took place. Dr. Donnellan reports a case of the passage of a current of one thousand volts through a man, which instantly caused coma, dilated pupils, pallor of the face, and sweating; delirium and tonic, alternating with clonic, spasms followed. The pulse was eighty. The respiration, at first stertorous, passed into the Cheyne-Stokes type. After the injection, first of morphia, and then of strychnia, the patient fell into a deep sleep, from which he awoke convalescent.—Centralblatt fÜr die medicinischen Wissenschaften.” The apparatus for applying electrical currents, long used by the Humane Society for restoration of the drowned, might with advantage be kept at public mortuaries, for use in cases of apparent death due to other causes, where decomposition has not manifested itself. The Weather Bureau at Washington advises those who are in the neighbourhood of persons struck by lightning to make immediate efforts to restore consciousness, because the effect of lightning is to suspend animation rather than to produce death. Respiration and circulation should be stimulated, and the usual remedies for relief in such cases should be administered Dr. Moore Russell Fletcher says:—“When persons without pulse or breathing are found in bed, in the field, or elsewhere, treat them in such manner as will restore from stroke of lightning, paralysis, or suspended animation from catalepsy, trance, or somnambulism, and continue the treatment until resuscitation rewards the exertions, or decomposition is evident.”—Suspended Animation, pp. 7, 8. HYPODERMIC INJECTIONS. Mr. E. E. Carpmael, of the Medical Department, Berkeley University, U.S.A., recommends, in the Morning Post, London, September 19, 1895, the injection of strychnine in “a supposed corpse;” while “Medicus,” in the Daily Chronicle, September 17, 1895, considers that post-mortems “would be to the advantage of the patient, to his relations, to science, and the community at large.” No doubt either of these plans would prevent live sepulture, by killing the cataleptic subject; while “M.R.C.S.,” in Morning Post, September 20, says:—“Obviously the simplest and best proof of death is putrefaction—shown chiefly by the discolouration of the abdomen.” HYPODERMIC INJECTIONS. A correspondent in the English Mechanic, October 25, 1895, says:—“I have long advised hypodermic injection of morphia before placing in coffin for burial. Ex hypothesi, the vital spark is not supposed to have expired, and the circulatory system not finally stopped. Hence the hypodermic injection cannot be futile.” A medical correspondent writing from Dresden, August 18, 1895, sends me the following as showing the value of ARTIFICIAL RESPIRATION. “Major J. H. Patzki, Surgeon, U.S. Army, reports that in 1882, at St. Augustine, Florida, a lady patient of his had an attack of tetanus, caused by a scratch upon her foot by a nail while bathing. The convulsive symptoms commenced in the muscles of the face, and increased in violence in spite of energetic treatment, until the fifth day, when the respiratory muscles became involved. The breathing was completely suspended by the spasmodic action, and the radial and carotid pulse ceased. The cardiac sounds became utterly inaudible to careful stethoscopic examination repeatedly employed. The lady assumed all the appearances of death, and there was rigor mortis, the result of muscular spasm. Artificial respiration was resorted to, but not until after the expiration of eighteen minutes did the first faint efforts of respiration, and a feeble action of the heart, become perceptible. Artificial respiration was continued for an hour afterwards, and the life of the patient was saved, although the muscular spasms continued to some extent for six days. “This case is instructive in showing that tetanus, when it involves the chest, may produce a state of apparent death, by interfering with the respiratory and cardiac functions; and that artificial respiration, if persistently employed, may rescue patients so affected from the perils of apparent death.” DR. JOHN OSWALD’S OPINION. Dr. John Oswald, in “Suspended Animal Life,” Philadelphia, 1802, p. 65, says:—“The books of authors The following extracts from an instructive but apparently forgotten article in Dickens’ “All the Year Round,” July, 1869 (À propos of a pamphlet, “Lettre sur la Mort Apparente, les ConsÉquences RÉelles des Inhumations PrÉcipitÉes, et le Temps pendant lequel peut persister l’Aptitude À Être rappellÉ À la Vie,” by “Suffocation by foul air and mephitical gas is not a rare form of death in the United Kingdom. It is possible that suspended animation may now and then have been mistaken for the absolute extinction of life. Dr. Londe gives an instructive case to the purpose. At the extremity of a large grocer’s shop, a close, narrow corner, or rather hole, was the sleeping-place of the shopman who managed the night sale till the shop was closed, and who opened the shutters at four in the morning. On the 16th of January, 1825, there were loud knocks at the grocer’s door. As nobody stirred to open it, the grocer rose himself, grumbling at the shopman’s laziness, and, proceeding to his sleeping-hole to scold him, he found him motionless in bed, completely deprived of consciousness. Terror-struck by the idea of sudden death, he immediately sent in search of a doctor, who suspected a case of asphyxia by mephitism. His suspicions were confirmed by the sight of a night-lamp, which had gone out, although supplied with oil and wick, and by a portable stove containing the remains of charcoal partly reduced to ashes. In spite of a severe frost, he immediately had the patient taken into the open air, and kept on a chair in a position as nearly vertical as possible. The limbs of the sufferer hung loose and drooping, the pupils were motionless, with no trace either of breathing or pulsation of the heart or arteries; in short, there were all the signs of death. The most approved modes of restoring animation were persisted in for a long while without success. At last, about three in the afternoon—that is, after eleven hours’ continued exertion—a slight movement was heard in the region of the heart. A few hours afterwards the patient opened his eyes, regained consciousness, and was able to converse with the spectators attracted by his resurrection. Dr. Londe draws the same conclusions as before—namely, that persons suffocated by mephitism are not unfrequently buried when they might be saved.” DANGER TO CHOLERA PATIENTS. “We have had cholera in Great Britain, and we may have it again. At such trying times, if ever, hurried interments are not merely excusable, but almost unavoidable. Nevertheless, one of “Dr. Veyrat, attached to the Bath Establishment, Aix, Savoy, was sent for to La Roche (Department of the Yonne), to visit a cholera patient, ThÉrÈse X., who had lost all the members of her family by the same disease. He found her in a complete state of asphyxia. He opened a vein; not a drop of blood flowed. He applied leeches; they bit, and immediately loosed their hold. He covered the body with stimulant applications, and went to take a little rest, requesting to be called if the patient manifested any signs of life. The night and next day passed without any change. While making preparations for the burial, they noticed a little blood oozing out of the leech-bites. Dr. Veyrat, informed of the circumstance, entered the chamber just as the nurse was about to wrap the corpse in its winding-sheet. Suddenly a rattling noise issued from ThÉrÈse’s chest. She opened her eyes, and in a hollow voice said to the nurse: ‘What are you doing here? I am not dead. Get away with you.’ She recovered, and felt no other inconvenience than a deafness, which lasted about two months.” “Exposure to cold may also induce a suspension of vitality liable to be mistaken for actual death. This year the French Senate has again received several petitions relative to premature interments.... And, considering the length of time that trances, catalepsies, lethargies, and cases of suspended animation have been known occasionally to continue, it is scarcely, in England, less interesting to us, though public feeling, which is only an expression of natural affection, approves, and indeed almost compels, a longer delay. The attention of the French Government being once more directed to the subject, there is little doubt that all reasonable grounds for fear will be removed. “The petitioners have requested, as a precaution, that all burials for the future should, in the first instance, be only provisional. Before filling a grave, a communication is to be made between the coffin and the upper atmosphere by means of a respiratory tube; and the grave is not to be finally closed until all hope of life is abandoned. These precautions, it will be seen at once, however good in theory, are scarcely practicable. Others have demanded the general establishment of mortuary chambers, or dead-houses, like those in Germany. And not only the petitioners, but several senators, seem to consider that measure the full solution of the problem. Article 77 of the Civil Code prescribes a delay of twenty-four hours only, which appears to them to be insufficient, since, they urge, it admits the certainty that death has taken place only after putrefactive decomposition has set in. Now, a much longer time than twenty-four hours may elapse before that decomposition manifests itself. Deposit, therefore, your dead in a mortuary chapel, until you are perfectly sure, from the evidence of your senses, that life is utterly and hopelessly extinct. DIFFICULTY OF DIAGNOSIS. “When Article 77 of the Civil Code was under discussion by the Council of State, Fourcroy added: ‘It shall be specified that the civil officer be assisted by an officier de santÉ (a medical man of inferior rank to a doctor of medicine); because “In Paris, especially since Baron Hausmann’s administration, Article 77 has been strictly fulfilled; but the same exactitude cannot be expected in out-of-the-way nooks and corners of the country, where a doctor cannot always be found at a minute’s warning, to declare whether death be real or apparent only. It is clear that the Legislature has hit upon the sole indisputable practical solution; the difficulty lies in its rigorous and efficient application. “It has been judiciously remarked that it would be a good plan to spread the knowledge of the sure and certain characteristics which enable us to distinguish every form of lethargy from real death. It cannot be denied that at the present epoch the utmost pains are taken to popularise every kind of knowledge. Nevertheless, it makes slow way through the jungles of prejudice and vulgar error. Not long ago it was over and over again asserted that an infallible mode of ascertaining whether a person was dead or not was to inflict a burn on the sole of the foot. If a blister full of water resulted, the individual was not dead; if the contrary happened, there was no further hope. This error was unhesitatingly accepted as an item of the popular creed. “The Council of Hygiene, applied to by the Government, indicated putrefaction and cadaverous rigidity as infallible signs of actual death. In respect to the first—putrefaction—a professional man is not likely to make a mistake; but nothing is more possible than for non-professionals to confound hospital rottenness (gangrene) with true post-mortem putrefaction. M. de Parville declines to admit it as a test adapted for popular application. Moreover, in winter, the time required for putrefaction to manifest itself is extremely uncertain. “The cadaverous rigidity—the stiffness of a corpse—offers an excellent mode of verifying death; but its value and importance are not yet appreciable by everybody, or by the first comer. Cadaverous rigidity occurs a few hours after death; the limbs, hitherto supple, stiffen; and it requires a certain effort to make them bend. But when once the faculty of bending a joint is “These characteristics are very clearly marked; but they must be caught in the fact, and at the moment of their appearance, because, after a time of variable duration, they disappear. The contraction of the members no longer exists, and the suppleness of the joints returns. Many other symptoms might be added to the above; but they demand still greater clearness of perception, more extended professional knowledge, and more practised habits of observation. “Although the French Government is anxious to enforce throughout the whole empire the rules carried out in Paris, it is to be feared that great difficulties lie in the way. The verification of deaths on so enormous a scale, with strict minuteness, is almost impracticable. But, even if it were not, many timid persons would say: ‘Who is to assure us of the correctness of the doctor’s observations? Unfortunately, too many terrible examples of their fallibility are on record. The professional man is pressed for time. He pays a passing visit; gives a hurried glance; and a fatal mistake is so easily made!’ Public opinion will not be reassured until you can show, every time a death occurs, an irrefutable demonstration that life has departed. “M. de Parville now announces the possibility of this great desideratum. He professes to place in any one’s hands a self-acting apparatus which would declare not only whether the death be real, but would leave in the hands of the experimenter a written proof of the reality of the death. The scheme is this: It is well known that atropine—the active principle of belladonna—possesses the property of considerably dilating the pupil of the eye. Oculists constantly make use of it when they want to perform an operation, or to examine the interior of the eye. Now, M. le Docteur Bouchut has shown that atropine has no action on the pupil when death is real. In a state of lethargy, the pupil, under the influence of a few drops of atropine, dilates in the AN INGENIOUS CONTRIVANCE. “This premised, imagine a little camera obscura, scarcely so big as an opera-glass, containing a slip of photographic paper, which is kept unrolling for five-and-twenty or thirty minutes by means of clockwork. This apparatus, placed a short distance in front of the dead person’s eye, will depict on the paper the pupil of the eye, which will have been previously moistened with a few drops of atropine. It is evident that, as the paper slides before the eye of the corpse, if the pupil dilate, its photographic image will be dilated; if, on the contrary, it remains unchanged, the image will retain its original size. An inspection of the paper then enables the experimenter to read upon it whether the death is real or apparent only. This sort of declaration can be handed to the civil officer, who will give a permit to bury in return. “By this simple method a hasty or careless certificate of death becomes impossible. The instrument applies the test, and counts the minutes. The doctor and the civil officer are relieved from further responsibility. The paper gives evidence that the verification has actually and carefully been made; for suppose that half an hour is required to produce a test that can be relied on, the length of the strip of paper unrolled marks the time during which the experiment has been continued. An apparatus of the kind might be placed in the hands of the minister or one of the notables of every parish. Such a system would silence the apprehensions of the most timid; fears—natural enough—would disappear, and the world would be shocked by no fresh cases of premature burial.” The authors have not heard whether this ingenious contrivance had been put into practice, or with what result. Various prizes have been offered, and awards made, by scientific and medical societies, but, with one exception, the so-called proofs of death for which the Dr. Gowers, on “Diseases of the Nervous System,” vol. ii., p. 1037, says:—“In cases of ‘death-trance,’ in which no sign of vitality can be recognised, the presence of life may be ascertained (1) by the absence of any sign of decomposition; (2) by the normal appearance of the fundus oculi as seen with the ophthalmoscope; (3) by the persistence of the excitability of the muscles to electricity. This excitability disappears in three hours after actual death. In a case observed by Rosenthal, thirty hours after supposed death, the muscles were still excitable, and the patient awoke.” The British Medical Journal, January 21, 1893, p. 145, |
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