Part 26

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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XIV

THE PRIEST IN INFECTIOUS DISEASES

The subject of infection is complicated, and the medical doctrine concerning it is far from certainty despite the multitude of facts presented by bacteriologists, chemists, pathologists, and clinicians. Before the days of bacteriology the term Infectious commonly was applied to diseases produced by no known or definable influence of any person on another, but wherein common climatic or other widespread conditions were thought to be chiefly instrumental in the diffusion. The contagious disease was one transmitted by contact with the patient, either directly by touch, or indirectly through the use of the same articles.

Now we know that many diseases called infectious are caused by micro-organisms, and we group others under this class because we hold theoretically that they have their origin in microbes not yet isolated. Hence we define an infectious disease as one which is caused by a living pathogenic micro-organism, which enters the tissues from without, and is capable of multiplying therein. These micro-organisms have a time of incubation during which a poison is made in the tissues, and this brings about the intoxication we call the disease.

Infection is a general term that includes contagion; and contagious diseases are infective diseases that may be transmitted directly or indirectly from patient to patient.

The pathological micro-organisms with which we shall deal in this article are (1) the Schizomycetes or Fission-Fungi, which are microscopical organisms that multiply by fission, and are commonly known as Bacteria; and (2) a few Protozoa, which are animal micro-organisms.

The bacteria are classed with plants because, like plants, {169} they derive nourishment from both organic and inorganic material. They have no seeds or flowers, but many of them are reproduced by spores. They consist of cells, single or grouped, which when spherical are called cocci, when rod-shaped, bacilli, when spiral, spirilla. There are various subdivisions of these groups. We do not know whether bacterial cells have nuclei or not.

A micro-organism is a parasite when it can live in animal tissues. It is a saphrophyte when it can exist outside animal tissues. If a parasite cannot exist outside animal tissues, it is an obligatory parasite; if it can, it is a facultative saphrophyte. Similarly the saphrophytes are classed as obligatory saphrophytes and facultative parasites. Pathological micro-organisms have very complicated products which are in large part poisonous.

Bacteriologists require seven conditions to prove a micro-organism the specific cause of a given disease, and all these conditions have been fulfilled for anthrax, diphtheria, and tetanus. The specificity has been satisfactorily settled for glanders, malaria, tuberculosis, actinomycosis, gonorrhoea, and malignant oedema. It has been practically settled for typhoid, influenza, the Madura disease, and the bubonic plague; and incompletely defined for leprosy, relapsing fever, and Malta fever.

There are certain diseases which are not called specific, because they may be produced by various micro-organisms. These are pneumonia, osteomyelitis, septicaemia, pymaeia, endocarditis, meningitis, erysipelas, angina Ludovici, broncho-pneumonia, and similar maladies. Cholera and dysentery also might be grouped with these, as cholera appears to be produced by various vibrios and dysentery by different amoebae.

There are other infective diseases, in which we have not yet found the causative micro-organism, but we presume its existence. These are: rabies, syphilis, yellow fever, dengue, typhus, mumps, whooping-cough, smallpox, measles, scarlet fever, and others among the exanthemata.

Malaria and similar diseases are caused by plasmodia, which are protozoa and not bacteria.

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The priest is almost as frequently exposed to the danger arising from contagion as the physician is, and a priest that often ministers to the sick is liable to grow imprudently indifferent to danger. For one priest that is too much afraid of disease we find a hundred that have not sufficient dread.