1005

can be no doubt, however, that many minerals are slowlyeliminated and that they are largely deposited in various there

tissues in which they may produce deleterious effects. The Iresults of the continued absorption of small quantities of iarsenic have been emphasised since attention was directed Ito the subject in connexion with the contamination of beerwith this substance. Antimony, mercury, and lead also

afford examples of mineral drugs which may similarly pro-duce toxic symptoms of long duration. Some symptoms of I

bromism and iodism, however, probably result from directirritation during elimination and thus do not afford examplesof cumulative action.

The importance of due appreciation of the relative ratesof absorption and elimination is not limited to the occa-

sional presence of impurities from which we should be

protected by examination of the drugs employed. This

knowledge should also govern the dosage and admini-stration of drugs which have the undesirable propertyof accumulating within the system, and it affords another

opportunity of laying stress upon the risks which may arisefrom the possession of prescriptions given without sufficientwarnings of the limits of safety or the need of caution.

Prosecutions for impurities and adulterations are interest-ing and necessary but they would fail in their full measureof instruction if they did not serve also to direct attentionto possible dangers which may arise during the injudicioususe of some most trusted remedies.

Remarkable Resuscitations.THE fear of baing buried alive seems to be inherent

in the minds of certain individuals and elaborate instruc- I

tions are occasionally included iu their last testaments inorder to prevent a fearful calamity, the occurrence of which

1

is not denied though its frequency has been much exaggerated ’i

by popular report. The uncertainty of the signs of death e

must be acknowledged but medical literature contains C

only one or two authenticated cases of a living person f

having actually been buried. The first man of science or I

philosopher whose opinion is available as to what con- I:

stitutes a proof of death is DEMOCRITUS and he maintainedthat there was no certain sign of the cessation of life.

CELSUS severely criticised this opinion and asserted that if the apparent identity of certain signs deceives an unskilfulphysician an experienced and intelligent man cannot be

t

mistaken. ORFILA, FODERE, and MICHEL LEVY all believed (

in the possibility of premature burial. LANCISI and Louis, on 1

the other hand, controverted such a doctrine. BROU ARDEL, 1 (

in his interesting work "Death and Sudden Death," which 1

has been translated into English by Dr. F. L. BENHAM, t

whilst admitting that premature burial cannot be absolutely t

denied, demonstrates that it must be extremely rare. In 1

support of this contention he instances the mortuary cham-bers established in Germany and elsewhere in which dead

1

bodies are placed, a bell rope being attached to the hand of E

each. He says "that from the time that mortuary chambers Iwere instituted-and that at Weimar dates from 1792-neither at Weimar nor at Munich ...... nor anywhere else, I

believe, has anybody ever rung that bell."

1 Death and Sudden Death. Translated by F. L. Benham.

Although, then, premature burial for all practical purposesmay be considered not to take place, nevertheless many in-stances are on record in which by skilful treatment the appa-rently dead have been restored to life. The majority of suchcases have occurred in individuals who have been removed

from the water apparently lifeless. It is difficult to fix

accurately the time in which drowning proves fatal. In

human beings, as a rule, asphyxia supervenes in from

one minute to two minutes after submersion and death

usually before the expiration of five or six minutes,but life may be considerably prolonged if from anycause water has been prevented from entering the lungs.A case was recorded in THE LANCET by Mr. CHARLESPOPE 2 in 1881 in which a man was sailing in a boat whenit capsized and he fell into the water with some weights ontop of him, so that with the exception of his left arm he

was entirely and continuously submerged for from 12 to 15minutes. He was resuscitated with considerable difficultyand eventually recovered. The weights probably preventedwater from entering the lungs. Longer periods of submersionwith recovery than this, however, have been recorded. In one

case submersion had lasted for 20 minutes,3 and in another,which is, however, 11 doubtful," one hour is the recorded time.’-

Examples again have been recorded of resuscitation after twohours’ employment of SILVESTER’S method of artificial re-

spiration, the subjects being apparently dead. 5 On one

occasion a boatman towed the body of a man ashore and

pronounced life to be extinct ; a medical man corroboratedthis opinion but two more sanguine bystanders beganvigorous treatment, with the result that the apparentlydrowned man entirely recovered from the effects of the

submersion. Another class of case in which resuscitation

has occurred, although the individual was apparently dead,.is after hanging. HOFMANN reports such a case. A criminal,who was sentenced to be hanged, had round his neck

enlarged glands which partly neutralised the constriction

of the encircling slip-knot. The body remained suspendedfor 20 minutes and death was certified to have taken.

place. The body was then transported in a van at

a rapid pace to the post-mortem room. There was some

distance to go and when the van arrived the physicianswere greatly surprised to see instead of a corpse an individualwho raised himself up before them and looked at them

with a scared expression. Three or four hours afterwards

the man died from pulmonary congestion, evidently a resultof the hanging. Obher criminals are believed to have been

luckier, for there are stories, which seem to have their

origin in fact, of the recovery and escape of men who havebeen judicially hanged.

It is not a matter for wonder that in cases of concussion of

the brain mistakes have arisen. During the retreat from

Russia General ORNANO had his head grazed by a bulletwhile in the act of charging the enemy ; he fell from hi&

horse and his orderly ran to his assistance but found that heshowed no signs of life ; he therefore buried him under a

heap of snow. The orderly then went to announce the deathto NAPOLEON. Two hours afterwards General ORNANO

2 THE LANCET, Oct. 1st, 1881, p. 606.3 American Journal of the Medical Sciences, April 22nd, 1853, p. 348.

4 Annales d’Hygiène, 1850-52, p. 306.5 Medical Press and Circular, Jan. 30th, 1867.

6 Dixon Mann : forensic Medicine and Toxicology, p. 242.7 Quoted by Brouardel, loc. cit., p. 30.

1006

appeared and reported himself to the EMPEROR ; he liveda long time afterwards and was actually one of the pall-bearers to the orderly who had buried him. The after-effects

of lightning have given rise to similar error. SESTIER, in hiswork entitled, "De la Foudre," relates seven cases in which

apparent death lasted for five or six hours. BROUARDEL

records the case of a boy, aged 13 years, who fell from thesixth storey of a house on to the pavement. The boy hadbeen taken to a druggist who had pronounced him to be deadand sent him on to a hospital where admission was refusedas he was supposed to be dead. BROUARDEL, however, sawhim and stated that the lad was alive, although the soundsof the heart could not be heard on auscultation. The boyreceived suitable treatment and recovered.

Alcohol may produce a condition of apparent death. A

case is recorded of an old woman who was found in the

street and in whom no sign of life was apparent. She was

conveyed to the hospital and the rectal temperature wasfound to be 77° F. Energetic treatment was resorted toand she recovered. Prolonged narcotism brought about

by other substances sometimes gives rise to natural

alarm. The late Sir BENJAMIN WARD RICHARDSON 8

mentioned the case of a medical man who took 120 grainsof chloral. When seen he was to all common observation

dead, there was no sound of respiration, it was very diffi-

cult to detect the sounds of the heart, there was no pulseat the wrist, and the temperature was 97° F. He had

been in that condition for some hours. He was revived byraising the temperature of the room to 84° F. and inject-ing warm milk.and-water into the stomach. He made

a perfect recovery. Finally, we may refer to a class

of case more or less familiar to all members of the profes-sion-namely, apparently stillborn infants who if left

simply to the care of the mother or to an ignorant midwife

surely perish but if properly attended to in all probabilitysurvive. DEPAUL succeeded in restoring newly born

children by means of pulmonary insufflation one and a

half, two, and even three hours after the heart had ceasedto beat.

The instances that we have recorded of resuscitation of the

apparently dead are, of course, of extremely rare occurrenceIn the vast majority of instances no difficulty is experiencedby a medical practitioner in determining whether or notdeath has taken place but occasionally cases are met within which some doubt may exist and it is needless to add

that in such circumstances no efforts to restore animation

should be relaxed until it is absolutely determined that

all vital processes are extinct.

Annotations.

THE NOMENCLATURE OF DEATH CERTIFICATION.

" Ne quid nimis."

The Registrar-General has just caused to be distributed

copies of the new list of diseases causing death which isnow in use in the General Register Office at Somerset Houseas well as in the similar offices of Scotland and Ireland.The list is based on the "Nomenclature of Diseases"authorised by the Royal College of Physicians of London.In the notes which accompany it a hope is expressed that

8 Transactions of the Medical Society of London, 1889, vol. xii., p. 105.

in future medical practitioners will assist the work

of registration and the compilation of statistics byabandoning so far as practicable sundry terms now

deemed obsolete, such as "convulsions," "scrofula,"and "phlegmon," which are given in the list, to saynothing of such vague words as "consumption" or

"decline," which belong only to the popular terminology.Certain suggestions which give evidence of a commendabledesire to establish the statistical tables upon a foundation ofscientific pathology are offered, as thus: "In certifyingdeaths from small-pox the patient’s condition with respect tovaccination should be carefully stated."

" Puerperal " fever "

is to be described as pyeamia, septicaemia, or septic intoxica-tion of puerperal origin. Three forms of pneumonia arerecognised and are included under "general diseases."

Malignant disease is to be differentiated into carcinoma orsarcoma when possible and care is to be taken to specify theparticular organ or part affected. The epidemic form ofcerebro-spinal meningitis is to be distinguished as cerebro-spinal fever; the exciting cause of "peritonitis" isto be mentioned and the nature of a "tumour" "

is to be explained. If any exception is to be takento these and to the other propositions set forth it can onlybe on the ground of want of feasibility. It may not

be possible always to state the cause of death with thewished-for accuracy. There is in private practice usually adifficulty in obtaining leave to make a post-mortem examina-tion and without such examinations it is doubtful whetherthe objects of the new arrangement stand much chance ofbeing realised. Nor is this the only direction in whichobstacles are to be found. A covering letter to the medicalofficers of asylums asks that in certifying the deaths ofpersons of unsound mind particulars of the definite braindisease for which the patient was under treatment inaddition to any disease other than brain disease which

may have been the immediate cause of death" " shallbe inserted in the certificate. In the present con-

dition of cerebral pathology this is hardly practicable.Patients in asylums are rarely under treatment for "definitebrain disease" in the pathological sense. The clinical

aspects of their disorders form the basis of the classifica-

tion of mental diseases. It is assumed with some show ofreason that every mental abnormality is correlated with astructural change in the brain but the exact nature of therelation is yet obscure, for the alterations in the brain sub-stance are not always visible and if visible may appearinconstant. Only, perhaps, in the case of general paralysisof the insane does the train of symptoms afford an index ofthe progression of the process of cerebral degeneration. Oneother point occurs to us. Alcoholism is mentioned as a causeof death but no allusion is made to it in the notes appended.

THE HOLMAN TESTIMONIAL.

FOR the last 50 years the name of Constantine Holman hasbeen prominent in all the public work of the profession astreasurer and vice-president of the British Medical Associa-tion, vice-president of the British Medical Benevolent Fund,president of the Surrey Benevolent Medical Society, treasurerand vice-president of Epsom College (for which he hascollected over .f.7000 by his personal efforts), and member ofcommittee of the Royal Asylum of St. Anne’s. He hasrendered signal services to his profession and the cause ofcharity. So great have been these services that, as we havealready announced, it is thought desirable by his friends andcolleagues that some record of their appreciation should beestablished. It is proposed to devote the proceeds of thistestimonial to the erection of an art and reading room atEpsom College to be called the "Holman Art and ReadingRoom." Subscriptions of any amount will be received byDr. John H. Galton, Ohunam, Sylvan-road, Norwood, S.E.