JAMES J. WALSH.
XIII
THE MOMENT OF DEATH
It not infrequently happens that a priest reaches a patient who has just died. Conditional absolution, baptism, or other spiritual ministration might have been offered if there were signs of life, but the heart and lungs are still, "the patient is dead," and the priest leaves the place without doing anything. Yet the patient may not really be dead.
Our knowledge of the precise time the soul leaves the body is very imperfect. There is, we are aware, a close connection between the vital functions of the body, taken together or singly, and cellular activity. If the cells are not destroyed, a vital function sometimes may be restored after its cessation, but if the cells are destroyed up to a certain extent, the vital function is not recoverable. For example, if the various bodily cells of a patient dead from diphtheria are examined microscopically, it will be found that the diphtheria toxin has disintegrated the nuclei of these cells. What number of cells proportionate to the whole in, say, the heart should be destroyed before the vitality of that organ is lost, is not clearly known. Where the cells are intact, or nearly so, mere absence of respiration, or of even the heart movement, are not absolute proof of death. Numerous cases are found in medical records of persons that had been lying under water for many minutes, up to even an hour, but who were restored to life by patient and skilful efforts; and of late remarkable restorations after what was practically death, under anaesthesia and otherwise, have been reported. The technique consists chiefly in rhythmical compression of the heart, commonly after surgical exposure of that organ, with artificial respiration, and, in Crile's method, peripheral resistance is [{165}] employed to raise the blood pressure. Ludwig in 1842, experimented in cardiac massage, and Professor Schiff at Florence was the first to apply the method to human subjects. Kemp and Gardner, in the New York Medical Journal, May 7, 1904, described various methods used in attempting resuscitation.
Professor W. W. Keen of Philadelphia has collected the records of the chief cases of resuscitation after apparent death (see The Therapeutic Gazette, April, 1904), and some of these are the following: Dr. Christian Igelstrud of Tromsö, Norway, in 1901, was operating upon a woman, 43 years of age, for cancer. During the operation, which was a coeliotomy, she collapsed and her heart ceased beating. After the usual means for resuscitation had been ineffectively tried, her heart was laid bare. Igelstrud took hold of the heart with his hand and made rhythmic pressure upon it. In about one minute the heart began to pulsate. The patient was discharged from the hospital five weeks afterward.
Tuffier (Bull, et mém. soc. de chir., 1898, p. 937) in 1898 had a patient whose heart stopped after an operation for appendicitis. The surgeon had left the operating room, but he returned, laid bare the heart, pressed it rhythmically, and after two minutes it began to move again. The patient breathed regularly, his eyes opened, the dilated pupils contracted, and he turned his head. After the opening over the heart had been closed, however, he died.
Prus (Wiener klin. Woch., no. 21, 1900, p. 486) by the same method started contractions of the heart after 15 minutes in a man that had hanged himself. The effort at resuscitation was made two hours after the suicide had been discovered, but the recovery did not go beyond imperfect movements of the heart, which gradually ceased.
Maag (Centralbl. f. Chir., 1901, p. 20) reports the case of a man who under chloroform anaesthesia ceased breathing and whose heart stopped. After 10 minutes the patient was pulseless, without respiration, cyanotic, and cold. The heart was exposed and compressed rhythmically; it was restored to action, and he began to breathe. He remained alive for 12 hours, seemingly asleep; then he died.