Mack[75] was called to a pregnant woman, and he found she had died suddenly about five minutes before he arrived. He at once opened the uterus with a small lancet and extracted a child which was beyond the livid stage and had no heart-sound. He worked on the child for forty minutes, using the ordinary methods for reviving asphyxiated children, but got no sign of life. Then he injected a hypodermic syringeful of a 1:1000 epinephrin solution through the umbilical cord into the abdomen and continued the reviving motions. In ten minutes the child was crying vigorously, and it was a healthy baby afterward.
Gunn and Martin,[76] in experiments on rabbits poisoned by chloroform and apparently dead, found they could resuscitate about 70 per cent. of the animals if treatment was begun within ten minutes after the heart ceased beating. They started artificial respiration through a tube in the trachea, then injected epinephrin into the pericardium, and afterward massaged the heart through an opening in the abdomen. The rate of compression of the heart in this massage must be somewhat less than half that of the normal beat, and at short intervals the massage is to be stopped to allow the spontaneous beats to develop. Compression should be gradual and the relaxation abrupt. The massage is applied by one of these four methods, and they are arranged here in the order of their efficiency: (1) by direct compression of the heart through an opening in the thorax; (2) by compression above the diaphragm through an opening in the belly-wall; (3) by simple compression of the abdomen; (4) by simple compression of the thorax. Epinephrin, or pituitary extract, is used as an adjuvant intravenously to increase the cardiac movement after it has been started. The same methods will probably be effective in man, and have been used successfully.
When a woman is in articulo mortis with a living fetus in her womb, one should not wait for her death. If one waits, he will nearly always lose the child. The cervix should be dilated forcibly, the child turned and delivered. Even if this forcible delivery should happen to hasten somewhat the mother's death, the action would be morally licit. It would be a double-effect action; the two effects would proceed immediately and equally from the act, which is indifferent morally; one effect, the good one, is to save the child for baptism at least, and possibly permanently; the second, evil but reluctantly permitted, is the possible hastening of the maternal death. I should be willing even to slit the cervix, if necessary, provided the diagnosis were certain, with the possibility of tearing the uterus, in a case where the dilatation of the cervix would be too slow a method; but this supposition is scarcely practical.
Zsako[77] gives a method for determining the interval since death by muscular phenomena. Tapping with a percussion hammer on certain muscles of the body excites a reflex contraction up to from an hour and a half to two hours after death. The contraction may be elicited in the same manner on the living, but it is more evident on a cadaver owing to the absence of antagonistic tonus in the muscles. Some muscles may move for four hours after death. Tapping along the radius from the elbow downward, he says, a point is found where the stroke causes extension of the hand; tapping along the radius above the wrist makes the thumb bend; tapping on the spaces between the bones of the hand closes up the corresponding fingers; tapping on the back of the foot extends the toes, on the leg adducts the foot, on the tibia along the middle third extends the leg. When the lower third of the thigh is tapped across the muscles move, and if the back is struck between the scapula and the spine the shoulder blades move toward each other. If there is no response the person must be dead from two to four hours. I have had no experience with this method.
Satre[78] reported that many soldiers brought into the dressing-stations apparently dead from shock, head or spinal wounds, or gas asphyxiation, were revived after artificial respiration had been applied, sometimes for even six hours before results were obtained. Two tests were used to find out whether the patient was alive or not. In such cases ten c.c. of a 20 per cent. alkaline solution of fluorescine is injected subcutaneously, and if there is any circulation this dye will be carried to the eye and turn the conjunctiva green. The second test is to push a fine puncture-needle into the spleen or liver and thus remove a particle of the pulp. This pulp is put on blue litmus-paper and drawn free from blood. If the litmus-paper turns red the man is dead; if it remains blue he is alive. The reaction of the living pulp is alkaline, blue; this becomes acid, red, a half-hour after death; an hour after death the acid reaction is quite marked.