Chapter 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 Tromsoe, 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 mem. 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.

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Starling and Lane (_Lancet_, Nov. 22, 1902, p. 1397) were operating upon a man 65 years of age. The heart and respiration ceased. Lane put his hand into the abdominal incision and squeezed the heart through the diaphragm. After twelve minutes of artificial respiration the lungs and heart began to act. The patient afterward was discharged from the hospital cured.

Sick (_Centralblatt f. Chirurgie_, Sept. 5, 1903, p. 981) reports a very remarkable case. A boy of 15 years of age died upon the operating table. _Three quarters of an hour_ after the heart had ceased to beat it was laid bare. The flaps did not bleed, the pericardium was bloodless, the heart was motionless, relaxed, and cold. After a quarter of an hour, during which the heart was compressed, and artificial respiration was kept up, that is, one hour after what any physician would call death, the heart was beating and respiration was restored. Two hours later the boy became conscious and complained of great thirst and dyspnoea. He remained in this condition for twenty-seven hours, and during that time his speech was indistinct but intelligible. He then died.

Dr. George W. Crile, of Cleveland, Ohio, reports the case of a woman whose heart movement and respiration had ceased for six minutes. She was restored completely, even without exposing the heart. Dr. Crile uses an inflated rubber suit on the patient to raise the blood pressure by peripheral resistance--he does not expose the heart. He had another case, a man 38 years of age, who "died during operation, was resuscitated, and died again two hours later."

Two Hungarian labourers, whose skulls had been crushed in the same accident, were brought into Dr. Crile's clinic in a dying condition. The heart of one of these men ceased beating as he was brought into the operating room. After nine minutes the surgeons began to work upon him to resuscitate him. They succeeded, but he lived for only 28 minutes.

They then examined the other man and found him dead. Just 45 minutes after this second patient had been brought into the operating room the effort to resuscitate him began. As he had not been observed while the physicians had been engaged with the first man, they do not know when his heart {167} had ceased to beat, but he certainly was dead in the opinion of skilled observers. They resuscitated him so well that he moved his head away from the operator who was relieving the depression of the skull, but he died again in 34 minutes.

These cases are not what is commonly called conditions of suspended animation. All the patients would have been pronounced dead by any physician, and if they had been left untouched, they surely never would have been revived.

There have been about thirty attempts made by surgeons to restore patients who were dead in the full acceptance of the term as used at present. Four of these attempts resulted in complete success, others in a partial recovery, and many were without positive result. The number of complete and partial resuscitations, however, are enough to justify a priest in giving conditional absolution or baptism within an hour, or even two hours, after a patient has to all appearance died, especially in accident cases. We do not know when the soul enters the body, and there is the same doubt as to the moment when the soul leaves the body. In these latter cases we should give the patient the benefit of the doubt.

AUSTIN OMALLEY.

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