That a living animal body cannot long survive without the ingestion of
alimentary matter, is too self-evident to require demonstration. Living
bodies, says _Cuvier_, may be considered as a kind of furnaces into
which inert substances are successively thrown, which combine among
themselves in various manners, maintain a certain place, and perform an
action determined by the nature of the combinations they have formed,
and at last fly off in order to become again subject to the laws of
inanimate nature.
It must, however, be observed, that there is a difference, depending on
age and health, in the proportion of the parts which enter into the
current, and those which abandon it; and that the velocity of the motion
usually varies according to the different conditions of each living
body; hence it follows, that the period during which an individual may
exist without food, will be liable to variation. We have already stated
(page 394) that, _cæteris paribus_, he will perish from inanition with a
rapidity proportioned to his youth, and state of robust vigour; and we
remarked in what strict conformity with physiological principles the
poet _Dante_ had described the fate of _Ugolino_ and his family.[58] The
same fact appears also to have been well understood by the ancient
physicians;[59] equally evident is it that women are able to support
abstinence longer than men. It has been also observed that a moist
atmosphere contributes to the protraction of life, under circumstances
of privation; this may depend, not only upon the fluid matter thus
furnished to the body, but upon the non-conducting power of the medium,
in relation to aqueous vapour; the ingestion of a very small proportion
of water revives in an extraordinary degree, the animal perishing from
famine, and prolongs his existence. _Redi_[60] instituted a series of
experiments with the sole view of ascertaining how long animals can live
without food. Of a number of capons which he kept without either solid
or liquid food, not one survived the ninth day; but one to which he
allowed water, drank it with avidity, and did not perish until the
twentieth day. _Elizabeth Woodcock_, who was buried under the snow, near
Cambridge, for the space of eight days, undoubtedly owed her
preservation to the snow which she occasionally sucked.[61]
Those cases of extraordinary fasting, which are recorded in the
different Transactions and Journals of almost every country, are to be
generally regarded as gross impositions; we[62] have already exposed the
fallacy of several of the more popular histories of this kind. Such
impostors, however, in their attempt to delude the world, have
unintentionally offered themselves as the voluntary victims of
physiological experiment; for we have at least learnt from them how
small a portion of aliment is sufficient to preserve the life of a human
being; a fact which had never before been satisfactorily proved, however
probable it had been rendered, by the recorded habits of many of the
early Christians, especially those of the East, who retired from
persecution into the deserts of Arabia and Egypt.
The sufferings of a person perishing from inanition[63] must be
considered as the most acute that can befall humanity; and yet we have
instances on record of their having been voluntarily encountered as the
means of suicide; a very interesting and well-authenticated instance of
this kind has been related as having occurred in Corsica;[64] and, as it
is calculated to afford, at once, a history of the symptoms of
Starvation, and an exemplification of their severity, we shall introduce
a brief account of the case in this place. _Luc Antoine Viterbi_ was
condemned to death as an accomplice in the assassination of _Frediani_,
a crime which he denied to the last moment, and appealed against a
sentence passed upon him by a Court composed of his personal enemies.
Towards the end of November, _Viterbi_ (knowing his condemnation, and
being confined in the prison of Bastia), resolved to die. To effect his
purpose, he abstained from food for three days, and then ate
voraciously, and to a forced excess, in the hope that, after fasting so
long, he should thereby put an end to his existence; in this however he
was deceived, and, on the second of December, he determined to starve
himself to death; from that day nothing could shake his awful
resolution, although he did not expire until the night of the 21st of
that month. During the three first days, _Viterbi_ felt himself
progressively tormented by hunger; under these circumstances a report
was made to the public minister, who ordered bread, water, wine, and
soup to be taken daily to his cell, and placed conspicuously in view. No
debility was manifested during these three days, no irregular muscular
movement was remarked, his ideas continued sound, and he wrote with his
usual facility, but took no nourishment.
From the 5th to the 6th, to hunger insensibly succeeded the much more
grievous suffering of thirst, which became so acute, that on the 6th,
without ever deviating from his resolution, he began to moisten his lips
and mouth occasionally, and to gargle with a few drops of water, to
relieve the burning pain in his throat; but he let nothing pass the
organs of deglutition, being desirous not to assuage the most
insupportable cravings, but to mitigate a pain which might have shaken
his resolution. On the 6th, his physical powers were a little weakened;
his voice was nevertheless still sonorous, pulsation regular, and a
natural heat equally extended over his whole frame. From the 3d to the
6th, he had continued to write; at night several hours of tranquil sleep
seemed to suspend the progress of his sufferings, no change was
observable in his mental faculties, and he complained of no local pain.
Until the 10th, the thirst became more and more insupportable; _Viterbi_
merely continued to gargle, without once swallowing a single drop of
water; but in the course of the 10th, overcome by excess of pain, he
seized the jug of water, which was near him, and drank immoderately.
During the last three days, debility had made sensible progress, his
voice became feeble, pulsation had declined, and the extremities were
cold. _Viterbi_, however, continued to write; and sleep, each night,
still afforded him several hours ease.
From the 10th to the 12th the symptoms made a slight progress. The
constancy of _Viterbi_ never yielded an instant; he dictated his
journal, and afterwards approved and signed what had been thus written
agreeably to his dictation. During the night of the 12th, the symptoms
assumed a more decided character, debility was extreme, pulsation
scarcely sensible, his voice extraordinarily feeble, the cold had
extended itself all over the body, and the pangs of thirst were more
acute than ever. On the 13th the unhappy man thinking himself at the
point of death, again seized the jug of water, and drank twice, after
which the cold became more severe; and congratulating himself that death
was nigh, he stretched his body on the bed, and said to the gendarmes
who were guarding him, “Look how well I have laid myself out.” At the
expiration of a quarter of an hour, he asked for some brandy; the keeper
not having any, he called for some wine, of which he took four
spoonsful; when he had swallowed these the cold suddenly ceased, heat
returned, and _Viterbi_ enjoyed a sleep of four hours. On awaking (on
the morning of the 13th) and finding his powers restored, he fell into a
rage with the keeper, protesting that they had deceived him, and then
began beating his head violently against the wall of his prison, and
would inevitably have killed himself, had he not been prevented by the
gendarmes. During the two following days he resisted his inclination to
drink, but continued to gargle occasionally with water; during the two
nights he suffered a little from exhaustion, but in the morning found
himself rather relieved. It was then that he penned some stanzas. On the
16th, at five o’clock in the morning, his powers were almost
annihilated, pulsation could hardly be felt, and his voice was almost
inaudible; his body was benumbed with cold, and it was thought that he
was on the point of expiring. At ten o’clock he began to feel better,
pulsation was more sensible, his voice strengthened, and, finally, heat
again extended over his frame, and in this state he continued during the
whole of the 17th. From the latter day until the 20th, _Viterbi_ only
became more inexorable in his resolution to die. During the 19th, the
pangs of hunger and thirst appeared more grievous than ever; so
insufferable, indeed, were they, that for the first time, _Viterbi_ let
a few tears escape him; but his invincible mind instantly spurned this
human tribute. For a moment he seemed to have resumed his wonted energy,
and said, in the presence of his guards, and the gaoler, “I will
persist, whatever may be the consequence; my mind shall be stronger than
my body; my strength of mind does not vary, that of my body daily
becomes weaker.” A little after this energetic expression, an icy
coldness again assailed his body, the shiverings were frequent and
dreadful, and his loins, in particular, were seized with a stone-like
coldness, which extended itself down his thighs. During the 19th a
slight pain at intervals affected his heart, and for the first time, he
felt a ringing sensation in his ears; at noon, on this day, his head
became heavy; his sight, however, was perfect, and he conversed almost
as usual, making some signs with his hands.
On the 20th, _Viterbi_ declared to the gaoler and physician, that he
would not again moisten his mouth; and feeling the approach of death he
stretched himself, asking, as on a former occasion, whether he was well
out, and added, “I am prepared to leave this world.” Death did not this
time betray his hopes. On the 21st _Viterbi_ was no more.
In this interesting history, we receive a faithful account of the
physical effects of starvation upon a human being, and perceive how
greatly a very inconsiderable portion of liquid is capable of producing
an invigorating effect upon the body, when in a state of extreme
inanition; but the mind of the subject before us was stern and
invincible, inflexibly bent upon self destruction; and we therefore do
not perceive the developement of those moral effects, which in other
cases are the general consequences of starvation. The histories of
besieged towns[65] would afford us ample evidence upon this subject; and
would shew that famine destroys all the most powerful instincts of our
nature. We know not, however, a more awful illustration of this fact
than that furnished by the account of the wreck of the _Méduse_,[66] and
its appalling consequences; it appears that this frigate struck on the
bank of Arguin, and as all attempts to save her were fruitless, nothing
remained but to concert immediate measures for the escape of the
passengers and crew; five boats were accordingly got in readiness, and a
raft, destined to carry the greatest number of people, was hastily
constructed; biscuit, wine, and fresh water were also apportioned to
each; but in the tumult of abandoning the wreck, it so happened that the
raft had the least share of the provisions, and in which there was not a
single barrel of biscuit. This raft, containing no less than one hundred
and fifty souls, was to have been towed by the boats, with which it was
connected by ropes; but the adventurers had not proceeded far, when the
boats cast off, and cruelly abandoned the raft to the mercy of the
ocean; to the scene which ensued it is impossible for any language,
however florid, to do adequate justice. Despair, aided by the pangs of
hunger, soon excited a mutiny; a dreadful slaughter ensued, and the
flesh of their murdered comrades afforded to the survivors a short
respite from the immediate sufferings of famine.
THE APPLICATION OF THE PHYSIOLOGICAL FACTS ESTABLISHED IN THE PRECEDING
CHAPTERS, TO THE GENERAL TREATMENT OF ASPHYXIA.
Although our researches into the causes and phenomena of asphyxia, or
suspended animation, will afford, on many occasions, but very scanty
encouragement with regard to the extent and value of the resources of
art, yet we apprehend that to the intelligent practitioner they will not
on that account be less acceptable; for to him it must be well known,
that the detection of error is the first step in the discovery of truth,
and although the tendency of the present investigation will be to
reject, as useless, many of those plans of treatment which have long
enjoyed the confidence of the public and the profession; yet it will
suggest the application of some that have not hitherto been duly
appreciated, and regulate that of others whose efficiency entirely
depends upon the time and manner of their administration. But the fact
is not to be concealed, that the medical profession, as well as the
public, have long been too sanguine in their estimate of the
probabilities of recovery by art, in cases where life is suddenly
arrested by the operation of external causes; and upon this occasion,
the establishment of the “ROYAL HUMANE SOCIETY for the recovery of
persons apparently dead,” requires some notice, in relation to the
possible extent of its successful exertions. Without some explanation it
will be impossible to reconcile the reports of that philanthropic
institution, with the physiological views which we have attempted to
establish in the present work; it therefore becomes a part of our duty
to explain the nature of the fallacies into which the witnesses and
reporters of cases of suspended animation appear to us to have been
unconsciously betrayed, and which have so frequently bestowed upon fable
the colour of truth, and given to vague report, the apparent stability
of credible testimony. In the first place we would observe, that in
those cases in which a long interval is stated to have occurred between
the suspension of breathing, from drowning, and the restoration of that
function by art, it is probable that the anxiety of by-standers who
witnessed the struggles, and the impossibility of justly appreciating
the lapse of time in such moments of anxiety[67] and distress, have led
to the erroneous statements with which the subject is embarrassed. There
is, moreover, another fallacy into which the anxious observer is very
likely to fall,—the sufferer may have breathed unobserved during the
alleged interval of asphyxia; and if this fact be admitted, we at once
reduce some of the most incredible of these reports to the rational
standard of physiological probability. Nor shall we hesitate in the
present chapter to offer our remarks upon the plan of recovery proposed
by this society with as much freedom, and as little reserve, as we have
ventured to question the literal accuracy of their reports. But while,
thus fortified by physiological arguments, we profess to discredit many
of the results stated by this society, let it not be supposed that we
would prefer a charge of insincerity against their authors, or attempt
to withhold any portion of that public patronage and consideration, to
which their zeal and philanthropy so justly entitle them.
The agents which are employed in cases of suspended animation, are far
too indiscriminately recommended; some of them, without doubt, offer
valuable resources to the physician, and only require a judicious
application to ensure their success; while others are entirely useless
and frivolous, and ought to be dismissed from our service, since the
retaining them only embarrasses the practitioner, and that too at a
period which of all others requires the utmost decision in the selection
of a plan of treatment, and the greatest promptness in its execution.
The following may be considered as the principal resources upon which
the _Humane Society_ rely for restoration of persons apparently dead
from sudden accidents, viz.
1. _Inflation of the lungs._
2. _Application of heat._
3. _Internal Exhibition of stimulants._
4. _Friction._
5. _Electricity._
6. _Exposure of the surface of the body to cool air._
7. _Blood-letting._
We shall offer a few observations upon the methods of applying these
agents.
_On the manner of producing artificial respiration._
We are indebted to _Mr. Brodie_ for the valuable directions that are to
guide the execution of this important operation. (_Manuscript Notes._) A
common pair of bellows will be found as manageable and efficient an
apparatus for the inflation of the lungs, as any instrument that could
be contrived; those manufactured for the service of the Humane Society
are not of a size sufficient to inflate the lungs of even a large dog,
much less those of man; nor is it necessary to employ double bellows on
this occasion, for the air will escape from the lungs without being
withdrawn by suction; besides which, it is stated that the forcible
exhaustion of the lungs is liable to occasion pulmonic hemorrhage. It
has been proposed to insert the tube of the bellows into the trachea, by
means of a wound in that structure, but there are great objections to
such a proceeding; the hemorrhage which is likely to occur,[68] may
inundate the windpipe; besides which, the operation occasions delay,
which, however trifling, will be important in cases where the action of
the heart has become much enfeebled; and moreover the wound itself is an
evil which ought to be avoided, if artificial respiration can be
established without it; and were these objections even overruled, there
still remains another; experience has shewn that the air thus introduced
issues by the opening of the larynx, without having dilated the lungs.
A tube may be constructed for the purpose of being inserted through the
mouth into the _rima glottidis_; if the patient be sensible, the
introduction of such a tube might be difficult; but as the patient is in
a state of insensibility, the introduction may usually be effected
without much difficulty, but not altogether without trouble; for the
mere circumstance of having to open the mouth, to pull forward the
epiglottis, to direct the tube into the proper aperture, may occasion
delay which will be of importance in cases where success depends upon
the skill with which the time has been economised.
It is for such reasons more expedient to inflate the lungs by means of a
tube inserted into one nostril, keeping the other and the mouth
carefully closed: the bellows having been thus disposed, the air should
be driven into the lungs with a certain degree of force; the lungs will
thus become fully inflated, and in the intervals between the different
inflations, the air from the lungs will escape by the mouth and by the
other nostril, and when the lungs are thus emptied, the process may be
repeated. There is but one objection to this method of exciting
artificial respiration, viz. that at each inflation, a portion of air
will sometimes find its way into the stomach, through the œsophagus: it
is very desirable to prevent such an occurrence, for when the stomach is
much distended with air, the descent of the diaphragm is prevented, and,
consequently, a perfect inspiration cannot be accomplished. The passage
of air into the stomach may be prevented by pressing on the thyroid
cartilage, so as to close the communication between the pharynx and
œsophagus. All that is necessary for the operator is, to produce the
inspiration; we are recommended indeed to press the margin of the ribs
gently upwards, so as to expel the air, and produce expiration; but this
is altogether unnecessary, for the elasticity of the ribs, and the
pressure of the abdominal muscles and viscera, and the elasticity of the
lungs themselves, are quite sufficient to occasion the expiration
without any assistance from external pressure. We must not omit to state
that the inhalation of oxygen gas, instead of common air, has been
strongly recommended, not only as being in itself a more powerful
stimulus, but as being more efficient in the removal of the accumulation
of that carbonized matter which, under ordinary circumstances of
respiration, is regularly thrown off; the practical eligibility however,
of such a plan is very questionable, and to say nothing of the
difficulty of obtaining oxygen upon an occasion where the least delay is
fatal, it is very doubtful whether the effects of this gas are really
such as our theory would at once lead us to believe. We have deemed it
necessary to enter into these details, in order to afford some practical
instruction upon a subject of manipulation but little understood, but
which is undoubtedly the most valuable of all the resources which art
can furnish for the preservation of human beings that are in danger of
perishing from accidental causes. The principal circumstances to be
remembered are comprised in the following precepts.