1*11;


 
UNITED STATES OF AMERICA
*" «  .
FOUNDED  1836
WASHINGTON, D. C.
OPO  16—67244-1
fy:
 
 
 
     EXPERIMENTAL inquiry     / *

                INTO THE

PROXIMATE CAUSE OFBEATH
                  FROM

   SUSPENDED RESPIRATION

                   IN

     DROWNING AND HANGING,

            WITH THE MEANS
         RESUSCITATION.

Submitted as an inaugural essay to the public examina-
 tion of the trustees and professors of the college
   of Physicians and Surgeons in the university of
           the state op new-york,
        SAMUEL BARD, M. D. Peesidt-s-.
                 FOR THE
      DEGREE OF DOCTOR OF ATrVJCTX?
           On the 3d of May, 1?M ^   ^



           BY ANSEL W. ms ■ s\
   Honorary Member of the American ... ^.^ ?»■  - ?*??''*£>:
NEW-YORK'. PRINTED FOR THE AUTHOF
788} 
 
TO
               VALENTINE MOTT, M. D.
Professor of the Principles and Practice of Surgery in the Univer-
  sity of the State  of New-York, Corresponding Member of the
  Medical Society of London, Sfc. SfC.

  This humble Essay is respectfully inscribed as the only tribute
an the Author's power to ofifer, for private friendship, and profes-
sional instructions, which no tribute, however ample, could com-
pensate.
  That the success of DOCTOR MOTT, in his professional pur-
suits may be equal to his merit, and that the first disposition of
bis heart—the desire of doing good to  his fellow-men, may be
Cully gratified, will  ever be the first  wish of his
                           Sincere friend, and

                                 grateful Pupil.

                                       ANSEL W. IVES. 
 
TO
           DOCTOR BARTOW WHITE,



President of the Dutchess Medical Society, New-Yorkj



           DOCTOR ELISHA NORTH,



               New London, (conn.)



                     and



          DOCTOR ERASTUS L. HART?



                Goshen, (Conn.)



              THIS DISSERTATION



      X9 MOST RESPECTFULLY DEDICATED BY THEIR



                 GRATEFUL FRIEND AND PUPIL,



                                THE AUTHOR. 
<c 
                           AS

EXPERIMENTAL INQUIRY, &g.
   The investigation of the proximate cause of death in Sus-
 pended Respiration from Drowning and Hanging, is difficult  and
 abstruse, as it immediately involves the consideration of the es«
 sential principles of life.  Not to dwell on the incomprehensible
 connection between mind and matter ; and the mysterious  law
 by which one operates upon, and vivifies the other ; not to deal
 in speculations too deep and refined for the human intellect to
 grasp,  let us for  a moment, advert to the complexity of  the
 human machine, considered as matter alone.  We see a machine
 operated on by a power which we cannot define  cannot exam-
 ine cannot comprehend.  Let us, therefore, dismiss this invisi-
 ble agent, and confine ourselves solely to that machine.  Every
 part of this curious piece of mechanism is  essential to the per-
 fect operation and unabated energy of the  whole : one part in,
 a greater, another part in a lesser degree. But our greatest  in-
 quiry is, what parts  are, and what parts are not essential to its
 operating at all.

  By determining on these, we shall find those principles on which
life most immediately, and in the strictest sense essentially depends ;
and of course the  cause of those disorders which instantly stop
the vital action of the human frame.  This subject is not less 
(  8  )
 important, than curious  and interesting.  In those disorders of
 our slender machine which produce their effect slowly, there is
 time  for  the  Physician, who may be called the human mechan-
 ist, to study their cause, and to vary his expedients ; but where
 the vital functions are instantaneously suspended, the effort must
 be immediate.  Stop to consideV, and the  patient is irrevocably
 lost.

   Those vital functions upon which life so immediately depends,
 were  formerly supposed to be  the  Brain, the Heart, and  the
 Lungs.  The Brain was considered as the only source of nervous
 power; that is, the only source of motion, and sensation.  But
 many phenomena were found inconsistent with this Theory, as
 for example, the life which  remained in decapitated  animals,
 and in the heart when detached from the body. To obviate this
 difficulty a fourth power was added by Haller, denominated vis
 vnsita, a mysterious principle which no one pretended to  under-
 stand, and which might therefore be made a safe head of refer-
 ence for every incomprehensible phenomenon.  Thus the expla-
 nations of philosophy are often more unintelligible than the facts
 Bhe attempts to explain, and when  she cannot enlighten,  she
 shrouds her subject in deeper mystery.

  In the course of this essay, I shall attempt to show, that there is
 a fourth vital organ which has been but recently understood; the
functions of which, will explain all the phenomena  formerly  at-
tributed to the vis insita; and therefore as there i3 no longer any
need of this mysterious principle, the offspring of Hypothesis, it
is, or  ought to  be exploded.  But before I attempt this, it will be
necessary briefly to state the Hallerian doctrine.

  Taking it for granted that  the  Brain was the only  source of
 nervous power, Haller  supposed that the nerves and the Spinal
 Marrow which he considered as a larger nerve, were  the agents 
                           (  9  )
 by which the brain performed its office.  He also supposed  that
 the muscles possessed a contractile power, or disposition to con-
 tract, which he called irritability or vis insita. All animal motion
 was attributed by him to this contractile power, acted upon by a
 stimulus, the stimulus being different according to the muscle on
 which it was to act.  Thus he supposed  the  muscles which are
 submitted to the control of the will, and therefore called volun-
 tary  muscles, are  stimulated to act  by the Brain  through the
 medium of the nerves;  but those muscles which contract inde-
 pendent of the will, do not in any measure depend on the nervous
 power, as the Heart and Stomach for example, which are suppo-
 sed to be stimulated by their respective contents, without any aid
 or agency of the nerves.  This Theory accounts in a  beautiful
 manner for the action of those muscles in coma when the  will
 is sleeping on its post.  But however ingenious and Convenient
 the theory, it never fully satisfied either Haller or Jhis Disciples—
 various modifications were introduced and even facts were con-
 troverted.   Difficulties, inexplicable, were involved in the theory
 itself, and removing one absurdity, only introduced  another.  It
 was denied for instance, that the heart possessed any  nerves; and
 though this removed, the Heart entirely from the influence of the
 Brain, and gave it up wholly to the vis insita ; yet it introduced
 another absurdity—that the Heart could be operated  upon by the
 passions, without the intervention of nerves.

   As the science of Anatomy advanced; as the distribution  and
 connection of the nerves were  better understood; and the func-
 tions of the vital organs more clearly defined, difficulties in  the
 way of this doctrine multiplied.

   The medical profession are in the highest  degree indebted to
M. Bichat, for the light he has thrown on this subject.   Though
in his physiological researches, he did not hit upon the novel ideas
of Le Gallois, his experiments  actually tended  to the same con-
                             B 
elusion, contrary  as that conclusion  was, to  own  belief.   To
attempt to overthrow a dor Pine so well established and supported
by the great body of (he profession, required more than ordinary
boldness;  yet it found opponents in men distinguished for science
and  talents.  The difficulties which  embarrassed it,  would, in
spite of prejudice, predilection,  and the  fear of ridicule, force
themselves on the mind of the original thinker,  and compel him
to doubt.  As an instance of the dissatisfaction which iHsc'-nio;.;-.-
and reflecting men felt with  this theory, and of the advances
which were making  to the true hypothesis,  I insert the  follow-
ing extract from a manuscript lecture of Doctor Hosack, delivered
at Columbia  College, in this City, 1798:

  After describing the distribution of  the nerves, he adds, " see-
ing, therefore, this universal distribution of the nerves through the
different parts of the body—the means by which the capacity of
performing their functions is preserved, and the numerous connec-
tions wiiich takes place between  the  nerves  of the various  and
distant  parts of the body, by means of the great sympathetic
nerve, and by  plexus,  we infer the presumption, that they serve
the great purpose of supplying the body,  not only with sensation,
but motion j  and that the vis insita is unnecessary for this purpose"

  But without multiplying authorities, it will be sufficient, briefly
to state, that in 1809, Dr. Le Gallois, a distinguished French ph}*-
siolygist, performed his experiments on the principles of life.  He
look a path  untrodden by former anatomists.  The discoveries
which he  made, were wonderful, and such as have caused, or will
cause, an entire revolution in the theory of the vital functions,

   From all his experiments he deduces the following principles
 That the  brain is the organ of intelligence, but not as Ha'l r
 supposed of sensation and motion. 
                          f   »   )
  That the only part of the brain which is immediately essential
to life, is that portion of the medulla oblongata, from  which the
par-vngum, or eighth pair of nerves  arises, viz:  the Corporla
Olivaria.

   That if  this portion of the  medulla oblongata be  preserved;
life will not be destroyed,  though the  remainder of the brain be
dissected off.

   That this portion of the Brain is essential to  life in a two fold
capacity.

   1st. As the origin of the eighth pair of nerves, which are dis-
tributed to the Heart, the Stomach and the Lungs, and upon which
the functions of the Lungs exclusively depend ; and,

   2dly.  As it gives influence to the nerves which supply the res-
piratory muscles.

   That the Medulla Spinalis is the source of sensation and motion,
independent of the Brain,  and that if artificial respiration be kept
Up in decapitated animals,  life will be preserved.

   But as the Brain is the residence of the intellectual functions,
the motions of the body, in this case,  will be accidental, and not
under the  control of the will.

   That the life of every portion of the body  depends upon the
nerves of  a corresponding portion of the Spinal Marrow, and
hence if the Spinal Marrow be cut into  different sections, each
section will be a distinct center of sensation and motion.

   That the Heart receives  its principles of life and of power
from the Medulla Spinalis, but not like the trunk from a limited
portion of  it, but from the  whole. 
                          (   12  )
  Hence if any portion of the Spinal Marrow be destroyed, the
force of the Heart will be weakened, but if the whole be destroy-
ed, its action will suddenly cease.
  That this influence which the Medulla Spinalis exercises over.
the Heart,  is through the medium of the great sympathetic nerve.

  That as this nerve arises from every portion of the Medulla Spi-
nalis, and not like the nerves supplying every other part of the
body, from a single point, it serves to explain why  the  action of
those organs to which it is distributed, is uninterrupted and invol-
untary.

  That the action of the Heart is not more dependent  upon the
nervous power than the nervous power is upon the  blood.

  That if a portion of  the aorta be included in ligatures,  a  para-
lysis of the corresponding portion of the  body ensues.

  Finally he concludes, that the Brain and Spinal Marrow are the
sources of sensation, and motion, in short j of every thing which
constitutes life; and that life is produced, and maintained, by the
impression of arterial blood upon these organs.

  Thus we see that to  support life, a reciprocity must  be main-
tained in these functions, the destruction  of which  is always the
proximate, whatever may be the remote cause of death.

   We have said that the Brain and nerves were excited to action
by the impression of arterial blood.  But  this blood in its  passage
through the arteries from the left side  of the heart to  the  most
extreme parts of the body, and in its return through the veins  to
the  right side of the heart,  acquires a superabundance  of carbon.
 This has the effect of changing it from  the florid colour observed
 in the arteries, to the dark  purple it  exhibits in the veins.   But
 what is more important, it  is by this means rendered unfit for the 
                         i  «  )
purposes'of nutrition, and  secretion, and  its'stimulating'effect
upon the Brain and nerves is  destroyed.  But these principles
are restored by Respiration; for in passing through the Lungs,
carbon is emitted through their thin air vessicles, and uniting with
the oxygen of the inspired air, is evolved in the form of carbonic
acid gas.   Thus  the  blood is constantly acquiring properties
which would destroy its agency in supporting life; but by this
process it is as constantly purified.

  Such are the physiological and chemical principles on which I
have founded my opinion, as to the proximate cause of  death in
Suspended Respiration.  The treatment of the disease will natu-
rally result from, and be suggested by the  cause.  But  before I
proceed to state my own opinion,  I shall examine the mostpopu
lar  Theories which have been advanced on this subject. Volumes
on  volumes  have been written,  and almost every author has
started a Theory of his own:  some have enlightened, others have
only afforded more matter for doubt.  Men of great ingenuity and
ability, they have erred like great men and have supported each
his own Hypothesis with a strength of argument which appeared
matchless and unanswerable till you read  his opponent.  It has
been from its own nature an object of great importance  to ascer-
tain the best mode of treatment in this disease, and to this intrin
sic  importance, adventitious motives  have been  added.  The
Humane Society of London have offered rewards to the most
successful  champion in this  arduous and  honorable  contest
The prize has been won, only to be contended for and wen again.
The reason of this seemingly interminable doubt as to the proxi-
mate cause of the disease, subsisted in the imperfect knowledge
and misapprehension of those functions upon which life immedi-
ately depends.

   It was formerly the most prevalent opinion that death was re-
motely caused in Drowning, by the presence of water in the Lungs, 
                          C   I*  )
 and that flic circulation of the blood through the pulniuuary arte
 ries was by that means interrupted, which was the immediate cause
 of death.  Others suppo ed water to get into the stoma< h, nm\ by
 distention to produce apoplexy.  The practice founded upon this
 opinion was to suspend the patient b}r'the heel -and agitate Mm as
 much as possible with the intention of exciting the action of  the
 usera, and evacuating the water.  Though the bad effects of this
 practice were acknowledged by its advocates ; yet they contended
 that remedies in some respects hurtful, should be  used when the
 advantages arising from them preponderated.  Not to mention
 the great  number  of Theories previously advanced, it will be
 sufficient for our present purpose to recur  no further back thai?
 to the important experiments of Doctor  Goodwin.

   His first object was to ascertain whether death was  caused  by
 water in theLungs.  For  tkis  purpose he immersed cats and
 dogs in coloured  fluids,  and in quicksilver.  Eight Cats were
suffocated in quicksilver; in  three of which none  was found
in the  Lungs after death ;  and in no case  was there  more
 than half an  ounce. As the specific  gravity  of quicksilver
is so much greater than  that of water, he  concluded that  a
much greater quantity  would  ibrce itself into the Lungs.  But
even the greatest quantity of quicksilver taken in, was only equal
in bulk, to seventeen grains of water.  But more  fully  to  ascer-
 tain the  fact,  he  next  injected two  ounces of water into  the
trachea of a Cat,  The only inconveniencies were a difficulty of
breathing, and feeble pulse.  Hence he concluded, that the small
 quantity of water  which  might sometimes be taken in, was not
sufficient,  in any case, to cause the death of the animal.*  This
 opinion of Doctor Goodwin has been confirmed  by  the  subse-
quent experiments of Messrs.  Kite  and Coleman.   And in  a
 number of Cats which I  have dissected, after drowning,  but  p,
    * Goodwin on the connection of life with respiration. 
                          (   *5  )
f ery small  quantity of water vras  found  in the lungs.  As no
menuon has been made by the above authors of the appearances
of the Lungs,  when the animal had been long in the water after
motion had ceased, and as we might be induced to suppose water
might be admitted from the relaxation of tiie glottis which ensues,
I determined on making the following:

                     EXPERIMENT:
  A Cat  was drowned and suffered to remain under water twenty
minutes.   After motion  had ceased,  no  air escaped trom the
Lungs, and on examination they were found  to contain no  more
water than had been observed after ordinary  drowning.  This
experiment  was repeated with the same  result;  from which ii
appears that water in the Lungs, in no case, has any agency in
destroying life.

  Doctor Goodwin having proved that death was not c:mscd by
water in  the Lungs, he could only suppose it  to be from  suspen-
ded respiration, but whether this effected the system mechanically
or chemically, was a question unsettled.   He supposed it  to be
chemically, that the black blood in the right side  of the Heart,
was unfit to  stimulate the left side to n •'.)on, and that the change
the blood underwent in the circulation, was solely to prepare it
for  that purpose ;  that in  consequence of Suspended Respiration,
the blood in the left side became black, and " that  the left auricle
and ventricle first cease  to act, from the inaptitude of venous
blood to excite their contraction, and that in  Drowning"—this is
the immediate cause that suspends circulation—that by the  con-
tact of black blood in the left side of the Heart, its motions became
weaker and weaker till  they ceased ;  whereas,  the right sid?,
being stimulated by the black blood to which it had  been accus
tomed, continued to contract with full force.  But the appearances
on dissection do not correspond with the Theory of Doctor Goo*'' 
                          (   io  )
win.  If as he supposed the left side of the Heart ceased to  act
in consequence of the  sedative effect of the black blood, then
the left side of the Heart would be found  engorged with blood,
instead of the right, and the right which according to him retains
the power of forcible contraction, would be found empty; for it
is obvious that the blood must be lodged in the part where there
is the greatest obstruction to its passage, and the least power to
overcome it.

  Now Doctor Goodwin has  acknowledged  that  from his own
experiments, he believes the Lung3  are never entirely destitute
of air, but even after the most complete expiration in  Drowning
or Hanging, that they contain a considerable quantity.  Though I
am not induced from my own experiments to believe the quantity
to be very great, I am fully satisfied that they are never empty.
Taking it for granted then, that there is always more or less air
in the Lungs,  and that  there is in the blood a stimulating quality
which is neutralized by carbon, I  shall upon this supposition
attempt to account for  the  accumulation of blood  in the right
side of the Heart.  It cannot be owing to the greater thinness of
the parietes, for we must suppose that each side has power pro-
portional to the cause through which it has to propel the blood.
But is it not owing to the greater impunity of the blood in  the
right side of the Heart  than in the left? I am aware that it may
be  said in objection that the blood is always more impure in  the
right side than in the left, and that there is not a greater relative
difference of impurity when respiration is stopped, than when it
goes on freely, But admitting this, let us recur to another con-
sideration, which we ought by no means to disregard.

  We suppose that the  stimulating quality  of the  blood can be
completely neutralized with carbon, and this will take place when
the saturation is complete.  And will not this happen first in  the 
                          (  "   )
right side of the heart ? When Respiration is suspended, blood,
arrives at the left side, but imperfectly purified, and is it not rea-
sonable to conclude that it may be saturated with carbon  before
coming again to the right, as it passes through and imbibes carbon
from the whole system ? But the blood which passes from the
right side of the Heart to  the left, though overloaded with carbon
at the moment it starts, is never completely saturated, for if so,
the contraction of the ventricle would not be sufficient to  propel
it through the Lungs, and  it passes from the right to the left side
of the Heart without any  new accession of carbon, as its whole
course is through the Lungs, in which it has  been shown  that a
small quantity of air remains  We may rather suppose that even
to the last, it  receives some degree of purification in passing
through the pulmonary vessels, and should conclude a priori thafi
the blood in the left side of the Heart, would never be completely
saturated with carbon.  With this supposition  experiments per-
fectly agree, for in six cases which  I  examined after death, the
blood in the left auricle was more or less florid.  Hence the rea-
son why little or no blood is found in the left ventrical; for there
the last  stimulus is excited, and the last efficient contraction takes
place.

   It may be asked why, if this Theory be true, the right ventricle
contracts longer than the left ? The reason is obvious; the right
ventricle is stimulated by  warmth and distension, which would no
doubt excite a feeble contraction even if the distending fluid were
water. But its contractions are without power,* and though more
frequent, are evidently less  forcible than those of the left side
while they continue. And after the.left side has stopped beating,
if  the blood in the right side could be transmitted to the left, the
left ventricle would contract, as was proved by the experiment
of Bichat.f
         * Le Gallois, Experiments on the principles of life,
         t Physiological Researches, p. 1.12,
                             C 
                         (  18   )
  Mr. Kite supposes that in consequence of suspended respira-
tion the motion of the Lungs cease, and a collapse suceeeds, which
mechnaically obstructs the passage of  the blood  from the righ*
to the left side of the Heart; and that  death  is produced by an
effect of  this obstruction either on  the Heart, the Lungs, or the
Brain.  This effect, he  thinks,  is not produced on  the Heart,
because the right side, where the  greatest quantity of blood is
accumulated,  continues to beat longer than  the left;  nor on the
Lungs, because their office is merely passive; and,  he therefore
concludes, that it can only be produced  on the Brain, by a con-
gestion of blood upon this organ, causing apoplexy.*

  The objections to the opinion, that the blood is mechanically
interrupted in its passage through the Lungs, will be  mentioned
hereafter.  I shall at present attempt to show that death is not
caused by a congestion  of  blood  in   the  Brain.   This is a
theory that has not only been supported by Mr. Kite, but also by
the celebrated Doctors Borehaave,  Cullen,  and  others; and at
the present day,  it is believed by many physicians of the  first
eminence, that in Hanging, the pressure of the cord upon the super-
ficial veins of  the neck, prevents the return of the blood from the
head, and produces a fatal apoplexy.  If apoplexy is produced in
either of the diseases under consideration, it would most probably
be  in Hanging, for there is the same collapse of the Lungs as in
Drowning, and there is also the pressure  of the cord on the veins
of the neck, to prevent the return  of blood from the Brain.

   In reasoning from analogy, we cannot  suppose that  if apoplexy
 was  produced in this disease, death would ensue in  the short
 space of five or six minutes after the stoppage of the blood • for
 Mr. Kit   acknowledges, that " extravasation does not take place
 in any part of the Brain;" and it is well known, that even in apo-
               * Kite's Medical Essays, 
                            (  19 ■)
 fflexy, produced by extravasation, which is of all others, the most
 suddenly fatal—death rarely happens so soon.  But the opinion
 of Mr. Kite is not merely rendered improbable by analogy ; it is
 incontrovertably disproved by experiments.

   Mr.. Coleman secured both the Carotids of a Dog, and in half an
 hour after suspended him by the neck.   He died in four minutes.
 On examination, the vessels of the Brain were found less distend-
 ed than ordinary.*  This experiment has been so often repeated
 with the same result, that there can be no doubt of its correctness.

                       EXPERIMENT.

   1 secured the jugular and thyroidal veins of  a Cat by ligatures
 at the same moment; no symptoms of  apoplexy were apparent.
 At the  end of twenty minutes  the animal  was killed, and on
 removing the cranium, the vessels were found much distended,
 but there was no extravasation.  This experiment was  repeated
 on another animal, and the jugular and  thyroidal veins remained
 jn ligatures forty five minutes—the result was the same.

                       EXPERIMENT.
   The trachea  of a Cat was laid bare, and an opening made jusi
 below the Thyroid cartilage, a cord was passed round  the neck.
 immediately  above the opening, by which  it  was suspended.
 Air was inspired through the opening in the trachea, and respiration
 Went on without apparent inconvenience.   There was no visible
 change in the colour of the lips, tongue or  nose, and the eyes
 appeared perfectly natural.  At the expiration of ten minutes, it
 was taken down, the hole in the trachea  closed, and it breathed as
usual.  It was again suspended in the same manner, and the open-
ing closed.  It immediately struggled violently,  the lips, nose and
            * Coloman on Respiration, page 143. 
(  20   )
 tongue gradually turned purple, the eyes became glassy,  and it
 appeared to be dying.   At the expiration of one minute, air was
 again admitted into the trachea, and all symptoms of suffocation
 disappeared.

   From these experiments is it not incontrovertably proved, that
 apoplexy is not the cause of death in Hanging ? And is  it not
 Tendered fully evident by the last experiment, that want of air is
 the only cause of distress to a suspended animal, and  ultimately
 of death ?

   Mr. Coleman, in his Treatise on this subject, has attempted tq
 prove that the proximate cause  of death is both mechanical and
 chemical; that in Drowning and Hanging, the muscles of expira-
 tion continue to  act till they expel all the air  from the Lungs,,
 which they are capable of acting on; that in consequence of this
 exhausted state of the Lungs, their air cells collapse, which pro-
 duces a mechanical obstruction to the passage of the  blood in
the small branches of the pulmonary  vessels, and  that  this,
together with the want of latent  heat in the blood, constitutes the
 proximate cause of the disease.*

  That the Lungs are in a collapsed state  after Drowning  and
Hanging will readily be granted. But the collapse is not perfect.
It has been proved by Doctor Goodwin, that after the most com-
plete expiration, they contain a sufficient quantity of air to per-
mit the passage of the blood; and I  have before observed, that
from my own experiments I was fully satisfied  that they were
never empty.

  But granting for the present, that the air is all exhausted in the
last efforts to respire, and the collapse of the Lungs complete,  I
shall attempt to prove, that even in this  case, the blood would
not be mechanically obstructed.   We know that the blood circa
                   * Poleman on Respiration: 
                          .  —  V
lates freely in organs  which are alternately distended, and  col
lapsed; as in the Heart, Stomach, and urinary bladder—and  that
in other parts of the  system, though the vessels are contorted
and convoluted, as in the  motions of the limbs, the mesentery,
&c.;  and though these  changes take place, while the blood is
flowing from the part, they neither prevent nor impede it.  Judg-
ing from analogy, therefore, we have no reason to conclude  thafc
a  mechanical obstruction  takes  place in the Lungs.   And to
show that it is not the case, we have  not only analogical proof,
but experiments to ascertain the trUth directly in point.   Bichat,
to ascertain the truth  of this doctrine, adapted the tube of a syr-
inge to the trachea of a dog, after cutting it transversely, and sud-
denly emptied the Lungs of all their air, at the  same time opening
the caroted artery. In this experiment, the circulation, he observes,
should have been suddenly interrupted, as the  pulmonary vessels
passed all at once from their ordinary degree of extension, to the
greatest possible involution; yet the blood continued for some  time
to be thrown out with force by the open artery, and consequently,
to circulate through the collapsed Lungs.*

   But to ascertain if possible, more decisively, whether the great
quantity of blood found in the right side of the Heart was owing
to a collapse of the Lungs, I had recourse to the following

                     EXPERIMENTS:

   The trachea of a Cat was cut transversely, and the capacity of
the Lungs about half  filled with  atmospheric  air.  The  trachea
was then secured by a ligature.   The left ventricle continued to
contract forty minutes.  The right ventricle  continued to  con-
tract twenty  minutes longer, when all motion ceased;  on ex-
amination, the quantity of blood, in the  right side, was  to  th&-
in the left, as two to one.
                 • Physiological Researches, p. 174. 
    (  22  )
EXPERIMENT.
   The thorax of a Cat was opened and from the pressure of the
 dense atmosphere, the Lungs suddenly collapsed and  respiration
 ceased.   The Heart and arteries contracted with great force, and
 on opening into the abdomen, the mesenteric arteries continued
 to pulsate distinctly.  As their florid colour gradually changed to
 purple, their motions became feeble; but at the  expiration of
 twenty minutes, the blood evidently circulated through the Lungs.
 On opening into the Heart, the right  ventricle and auricles were
 found surcharged with venous blood, the left auricle and ventricle
 contained a small quantity of blood, but more florid than  that iu
 the right.

  From the first of these experiments, it appears, that death  en-
 sues in Suspended Respiration, when the Lungs are not collapsed;
 and that the blood is found a3 in death from other  causes, prin-
 cipally lodged in the right side of the Heart.  From the second,
 that the circulation continues sometime after the  Lungs are col-
 lapsed ; whereas, if it was impeded by the collapse, the obstruction
 would be as complete at  the time of the  last expiration, as it
Would at any future period.  This fact is  sufficient to disprove
Mr. Coleman's opinion, for he does not agree with Mr. Kite, thai
the circulation is impeded by a want of motion,  but  says, " the
right side of the Heart can propel blood to the left immediately
siter the last expiration, independent of the mechanical action of
 the Lungs, and as it can perform this function after Respiration
has ceased, it is probable that the Lungs have  naturally no active
 power of  propelling the blood onward."

  To what has been said  against Mr. Coleman's theory, so far as
 i.aspects the collapse of the lungs, I shall only add one of his own
experiments,  by which he attempted to disprove the opinion of
 Mr, Ki'e: 
                         (  23  )
                    " EXPERIMENT."
  " The trachea of a Dog was laid bare, and secured by a ligature^
and this was endeavoured to be performed at the instant an en-
spiration was  made; in  less  than  four  minutes  he ceased to
struggle.  On  examining the Heart, we found the  quantity of
blood in the left, when compared to  that of the right, as thirteen
to twelve.   A  portion of the cranium  was removed, and the
veins of the head were  evidently  less distended than natural.
" Here then," says Mr. Coleman, " there being no obstruction to
the passage of the blood through the lungs, it could not be  col-
lected in  the  right  side of the heart, and consequently no ac-
cumulation was found in the head,  and yet this animal died as
soon as other animals from ordinary Hanging,  which carries
conviction  to  my mind,  that apoplexy  forms no part of the
disease."*

   In this experiment of Mr. Coleman's, I have found it difficuK
 to account for the death of the animal by any theory at that time,
extant.  He proves that it did  not happen by apoplexy, and full
as conclusively, that it did not happen by a collapse of the lungs,
and we must conclude, a priori, that the senses of  Mr. Coleman
deceived him, and that the animal  did not die;  otherwise we
must deny this poor Dog the common right exercised by all ani-
mals, of dying philosophically.

   If then a collapse of the lungs is not the proximate cause of
tleath,  I shall next examine whether it is a diminution of animal
heat.

   Mr. Coleman supposed the motion of the Heart to depend uposi
irritability, which was always in proportion to the degree of animal
heat; that animal heat was generated by Respiration alone; conse-
            * Coleman en Respiration, page 142, 
(  24   J
 quently Suspended Respiration would be a remote, and a diminu-
 tion of animal heat, a proximate cause of death.

   I have already shown that the contractions of the Heart do not
 depend exclusively on irritability, and in some late experiments
 Mr. Brodie has demonstrated that animal heat is neither generated
 solely by Respiration, nor is it immediately essential to life.  He
 kept alive decapitated Dogs and Rabits, two hours, by artificially
 inflating the Lungs,  though the heat in the thorax diminished in
 the mean time sixteen degrees.  This experiment was frequently
 repeated, and in every case the heat diminished faster in animals
 kept alive by artificial respiration, than in those of the same age
 and  species which  were suffered to die.   Hence he concludes
 that the generation of animal heat depends upon the influence of
 the Brain, though by supporting respiration, life may be preserved.
 These experiments were repeated by La Gallois, and though he
 says " the results did not appear to him as regular as pretended
by Brodie, the temperature was  considerably reduced."  If, in
 addition to this,  we reflect that experiments are recorded in the
philosophical transactions,  in which, by a person being placed in
a cold bath, and afterwards  exposed to a cold easterly wind, the
heat of the body was diminished sixteen degrees, without causing
 any material injury; we cannot suppose a diminution of animal
 heat to have any immediate effect in destroying life.

  Dr. Fothergill, in  his excellent treatise on Suspended Respira-
 tion, from  drowning and  suffocation,  supposes  the  proximate
 cause of death to be " the exclusion of air from the lungs, and.
 the extinction of irratibility."  The first  part of this theory  is
 practically, but not critically correct.  The exclusion of air from
 the lungs is the remote or exciting cause of the disease, but is not
 the proximfdc cause, according to the general acceptation of the
 fprm 
                            C  2#  )
    As to the'second part of Dr. Fothergill's theory, viz:  that which
  respects the extinction of irritibility, a more particular examina-
  tion of it is necessary.   The  Doctor insists upon it with great
  tenacity and zeal, and  introduces it for the solution of a variety
  of phenomena.  We have already had occasion to object to the
  existence of  irritibility,  as  independent of the nerves.   That
  there is an irritibility existing in the muscles, will not be doubted;
  but we consider this irritability as depending, in all cases, on the
  vis nervea, which, as heretofore explained, is sufficient to account
  for all the phenomena of the animal economy.  Why then resort to
  a  hypothetical agent, of whose existence there  was never any
  other proof, than that it was convenient as a medium of explana-
 tion, and helped the physiologist out of difficulties,  from which
 he could not otherwise escape 1

   In proof, that the motions of the Heart do not depend upon the
 nerves, it has been said by some, that the heart had no  nerves;
 by others, that it had but few, and that those were not effected by
 irritation.*   But other anatomists, who  have been either more
 honest, or more perspicacious, have affirmed, that the nerves of
 the Heart are as numerous, and are  distributed in the same man-
 ner, as in the other muscles.f  If, on irritating the nerves of the
 Heart,  they  do not  disturb the motions of that  organ,  it only
 proves, that these nerves are sui generis, and sensible to a peculiar
 stimulus.  In apoplexy,  says Dr. Fothergill, all the fnnctions de-
 pending on the  nerves, are suspended; but not the motions of the
 heart; and this he adduces as a proof,  that these motions do not
 depend on the  nerves.  But sensation is not destroyed in apo-
plexy; as the Brain is diseased, which is  the organ  of volition,
diat faculty is suspended, and of course has no power  to direct
the action of the muscles.  For if  the  limb of an  appoplectic

  * Fothergill on Suspended Respiratinn, p. 63.  f Lo Gallois, 248.
                             D 
                         C  26   i
person be pinched, or pricked, it will be  partially drawn up.
Though this motion be weak, the reason is obvious, for as Lc
Gallois observes,  " the  Medulla Spinalis is in  a  morbid state,
after  the injury or destruction of the  Brain,  as there is an
intimate connection between them."

  Dr. Fothergill supposes,  that the vis nervea would be insuffi-
cient  to support the continued action of the Heart.  " It does
not,"  says he,  " like other muscles, become weary by incessant
motion; neither does it become less irritable to the blood by the
daily repetition of the  stimulus, any more than the eye does to
light the ear to sound,  &c."  But the Doctor seems to have for-
gotten, that the eye and the ear exercise their functions  through
the medium of nerves; and that it is a law of the animal econo-
my, that the  nerves of certain organs should be operated upon
by stimuli, peculiar to  themselves, and that the heart may as well
be  supposed to be  an organ of this description,  and  to have
nerves excited by  a  peculiar stimulus,  as  the  eye or  the ear.
And the Doctor seems also to have forgotten, that the  eye and
the ear are  excited by a continued stimulus, in nearly the same
manner as the  Heart.

    EFFECTS  OF  SUSPENDED RESPIRATION FROM
                       DROWNING.

  When an animal is'immersed in water, it immediately struggles
violently, and from its  disposition to breathe, air is expelled from
the Lungs,  as is  evident from the bubbles  rising through the
water.  As the distress for the want of air, increases with every
expiration,  efforts  to  inspire are repeated,  and the expiration
made more complete.   During these struggles which continue a
minute, and in some cases, a minute and a half, the eyes gradu- 
                          f   27  )
ally assume a glassy appearance, and  are  somewhat protrude*!
the pupils are, unusually dilated, and the nose, lips, and tongue, are
in some cases pale, in others,  lived.  After all  external motion
has ceased, and the animal is taken from the water, the Heart is
felt to beat feebly; on pricking,  or pinching the  legs, they are
partially drawn up, and if amputated, dark coloured blood issues
from  the arteries.

   On opening into  the  Thorax, the Lungs are  found much
collapsed; a small  quantity  of  frothy fluid, can generally be
squeezed  from them; being evidently, the mixture of the air re=
maining after the last expiration, with a small quantity of water,
wiiich in the attempt to inspire was taken in.  The veins appear
preternaturally full, and of an  unusually dark colour; the  right
auricle and ventricle, are much more distended than the left, and
are of a darker colour; both auricles and ventricles now contract
uniformly, but their motions soon become weak. In about twenty
minutes, the  contractions in the left ventricle begin  to intermit;
the right auricle and ventricle, are comparatively much distended,
and are of a dark purple; their contractions continue, but are fee-
ble and ineffective, and much less forcible  than those of the left
side when they do occur.  The  right ventricle next ceases to con-
tract,  and  the last motion is seen in the corresponding auricle,
commonly at the expiration of an hour and a half.   If after all
motion has ceased, the Heart be opened, the right ventricle and
auricle, and all the contiguous  veins are filled with black  blood,
the left auricle contains  aboutone  third as much blood  as the
right,  and it is of a more florid  colour.

   On opening into the Brain, the  superficial veins appear a little
fliore  full  than ordinary, but in no case is there any extravasation? 
                         C  28  )
   EFFECTS  OF SUSPENDED RESPIRATION FROM
                        HANGING.

  When an animal is suspended by the neck, death is not so im-
mediate as in drowning, for as observed above, in the one case
motion ceases in a minute, or a minute  and|a half, whereas, in the
other, it commonly continues five or six minutes. This is prob-
ably owing to the imperfect stoppage of the trachea  in  Hanging,
and the admission of  a small quantity of air in the efforts to  in-
spire.  This imperfect exclusion of the air, is no  doubt the cause
of the difference in the appearances in Drowning and Hanging, du-
ring and after death. For in Hanging, the mouth and nose gradually
assume a livid hue, and before death, are of a dark purple colour,
the eyes are  more prominent than in Drowning, and the muscles
in some cases are stiff.

  On opening into the chest, the Lungs are collapsed  the same
as in Drowning, they  contain but a small quantity of air, and the
Heart, and bloodvessels in both cases exhibit nearly the same ap
pearance.

   The veinse  of the Brain  are  a  little more turged than
after Drowning, but as in that case there is no extravasation.

  After describing the changes effected by Drowning and Hang-
ing, and the appearances of the vital functions  after death,  we
may conclude, that whatever is the proximate cause of death in
the one, is also the proximate cause of death in the other;  that
the trifling difference  in the appearances on  dissection,  is owing
principally to the difference, both of the medium in which the
animal is destroyed, and the time in which it is dying.

  In Drowning and Hanging, the ingress of air into  the lungs it
interrupted,  and their mechanical action arrested.  The effect 
                           (   29  )
upon the system is immediate;  for upon this mechanical action,
is that chemical process founded,  which is indispensable for  the
purification of the blood.  The blood now returns to the right
side of the Heart,  and is again  propelled  through  the lungs.
A portion of the carbon is disengaged by uniting with the small
quantity of oxygen yet remaining; but  the quantity is so small,
that the change is imperfect.  The blood now begins  to loose its
influence upon the nervous system : but where, and in what de-
gree, is this effect produced ?   Is it as some have supposed upon
a particular organ ?  We presume the paralysis to be limited only
by the extent of the nervous power.   If it has more  effect upon
one  side of the Heart than the  other, it is  only  because  in that
side, its impurity is greatest.  For though every part of the body
suddenly feels the effect, it is exclusively through the medium of
the nerves, and the failure of excitement is always in proportion
to the change of colour in the blood, that is in proportion to the
accumulation of carbon.   Hence I conclude the Proximate Cause
of the disease, to be an excess of carbon in the blood.

  Whether  this  effect of carbon on the nerves, is  negative or
positive, mediate or  immediate, may be doubted;  or in other
words, it is doubtful, whether carbon paralizes the nerves them-
selves,  or destroys some stimulating quality in the  blood,  and
causes it to fail in its usual effect in exciting the nervous energy.
But  I am inclined to the latter opinion,  namely : that the carbon
neutralizes some quality of the blood;  for when Respiration is
restored after being suspended, and the carbon is thrown off, the
nerves instantaneously recover their tone :  whereas,  if the influ-
ence upon them had been positive, their tone would not be instanta-
neously,  but gradually recovered.  But in either case,  where
does this deleterious principle first exert its  influence ?  It first
comes in contact with the  Lungs and the Heart; the vis nerva
feels the want of its accustomed stimulus—the power of the heart 
                             {  so  }
    begins to diminish—the  carbonized  blood enters  the  coronary
    arteries, and every fiber of the Heart  feels the effect.  No sooner
    is the blood propelled through the system, than the Brain and.
    Spinal Marrow begin  to loose their influence  upon the Heart,
    No longer excited by the arterial blood, upon which their energy
    depends, the effect is now as extensive as the  nervous system.
    The glands and absorbents loose their power of action,  and the
    secretions and excretions are stopped.  The nerves of the Heart,
    accustomed to the stimulus of the blood, continue to excite it to
    contraction, after the energy of every  other part is destroyed.
    The left ventricle, which, for reasons before mentioned, is most
    powerfully stimulated,  forces the  blood through the arteries,  it
    returns slowly in the veins,  incapable of exerting  a contraction,
    sufficiently forcible  in  the right side  of the Heart to propel  it
    through the Lungs, it accumulates in the veins,  and right side of
    the  Heart;  and by warmth and distention, excites a feeble motion
    in the right auricle and ventricle, till life is totally extinguished.

                          TREATMENT.

      It would be highly interesting and important,  to ascertain pre
    cisely how long Respiration may be suspended without destroying
    life.  " The last signs of life" says Doctor Le Gallois, " are sen-
    sation and the circulation of the blood."  We have already said
    that Doctor Le Gallois, supposed life to be produced, and main-
    tained by the impression of arterial  blood upon  the Brain  and
    medulla spinalis, or by a principle, resulting from this impression.*
    Life, therefore, can only be  restored in those  cases, where the
    Heart has sufficient power to propel the blood to the Spinal Mar-
    row, that the Spinal Marrow may be excited again to give energy
.^  to the Heart.   But there is no infallible criterion, whichjwill ena-
    Me  us to determine the degree of nervous  energy remaining in
* Experiments on the Principles of Life. 
                         (  si   )
the Heart.   Much will depend upon the age and constitution of
the person.  Cases are related by the Royal Humane Society, of
recoveries, thirty, thirty five, and in one case,  forty five minutes
after submersion.  But in others,  after the utmost exertion the
patient died, though he had been in the water but three minutes.

   Seldom is a person recovered after he has been under water
 fifteen minutes.   Either no credit is to be given to the accounts
 of certain early  writers, or we must conclude the people of their
 time to have been amphibious.  Kunckel, says, " that in Sweden,
 no one doubted the possibility of restoring the  life of a person
 who had been under water eight days;" and Burmann, relates  a
 case, where " a person continued  under water seven  weeks,
 notwithstanding, which, he  not only  recovered, but enjoyed
 health many years after."

   We may, however, form some opinion, as to  the probability of
 a recovery, when we can obtain no information respecting the
 time the body has been in the water. If pricking or pinching the
 limbs excites any motion;  if they are flexible, if on placing  a
 thermometer under the tongue, we find that animal  heat is not
 all extinguished, there  is hope of recovery.  But if the  limbe
 and body  be stiff, the countenance cadaverous,  the eyes dim and
 sunken, and the heat of the body extinguished,  we have no more
 encouragement to  attempt  Resuscitation, than  after a  natural
 death.  But if all the circumstances attending the submersion can
 be ascertained,  it will aid us  much in forming an opinion  as to
 the probable result of the case.   It is important to know whether
 the person was  timid, intoxicated, or subject  to  fits, or  whether
 he fell from a great height.  The temperature of the water ought
 also to be taken into consideration.   But we would tolerate no
 inquiries at the expense of time.  The most important, nay the
 essential means of recovery, first to be used, is in all cases the seme 
                           (   32   j
  tVe have been recommended to convey the patient carefully to
 the most convenient place for using the means of recovery; but
 if we reflect that the force of the  Heart diminishes with every
 pulsation, and that if life is restored, it can only be done by re
 storing the circulation, we shall never  be driven from the spot.
 except by intensity of cold, until respiration is restored.

   I shall not attempt to detail the numerous modes of treatment
 that have been recommended and adopted,  by various writers on
 this subject.  If the cause which has been assigned for the disease
 be correct, the treatment will be simple, viz. those means that are
 immediately essential to restore Respiration. Neither the symp-
 toms that will exist, nor the treatment which  will be necessary
 after Respiration is restored, can be anticipated.   The one will
 in all cases naturally result from the other.

   When a person is taken from the water, unless we know he has
 been immersed so long that there are no hopes of his recovery.
 we would immediately attempt to renew Respiration, by artificial
 mean-.  This we would do with the first instrument that came to
 'land, by which air could be conveyed  into the Lungs. A bellows
 would be prcfered, to any article in  common  use.   In case  we
 could procure no instrument for inflating  the  Lungs, we would
 make use of  Astley Cooper's expedient, and by pressing on  the
 sternum and ribs, compress them, when by lifting the hands, those
 parts by their elasticity will restore themselves, the chest be ex-
 panded, and the air rush in.

  We  have supposed the cause of the  disease, to be excess of
carbon in the blood, that  while the circulation continued,  a small
quantity was emitted to unite with oxygen gas, in the Lungs, and
we must conclude,  therefore, that the air inthe Lungs, is not only
absolutely unfit for"Recpirafion, but positively deleterious, the oxy-
5^n gas being changed into the form of carbonic acid gas.  This 
                         (  S3  )
deleterious air, can only be" expelled from the Lungs, by inflating
them with pure  air,  with  which it  will mix, and gradually be
thrown out by artificial expiration.

  In order to inflate the Lungs, we would place the body in a
convenient posture, with  the head  elevated, and introduce the
pipe of a bellows into  one nostril, while the other nostril and
mouth were closed by an assistant.  The inflation  should be
gradual—after which the  air should be pressed out by the assis-
tant, and this process continued.  To prevent the passage of the
air into the stomach, and  direct it into the trachea, the assistant
should press upon the thyroid cartilage, and to raise the epiglottis
for the admission of the air, the tongue may be  pulled forward.
This process should be  commenced as soon as the patient is
taken out of the water, and no other means should ever be suf-
fered to interpose a moments delay.  Many things may be done,
which are in some  degree advantageous, but nothing can  com-
pensate  for the neglect of inflating the  Lungs.   Thus  the wet
clothes should be stripped off, and the body should be wiped dry,
wrapped  in flannel, and  rubbed with a flesh brush, or with the
hand.
   Electricity will  be found very  beneficial in stimulating the
 action of  the Heart.  It  should be communicated  through the
 region  of that  organ in  slight shocks; and in order to  aid the
 purification of the  blood,  the excitement should be given while
 the Lungs are inflated.   Care should be taken that the shocks be
 not too violent. It is well known from experience, that a very
 powerful shock paralizes, instead of stimulating the energy of the
 heart.
    When the body has been taken from under the ice, and gene-
 rally  whenever we have reason to believe that it is very m«ch
 chilled, we should be cautious in the application of warmth.  We
                              E 
                          (   3*  ;
would, in such cases, endeavour to place the patient in a tempera.
ture, a few degrees higher, than that from which he had  been
taken, and increase it as warmth returned to  the  body.  The
temperature  of the body may be  best regulated  by a  bath,
in which the patient ought always  to be  placed when it can
be  procured.  We  suppose that artificial Respiration  has  been
kept up, and been made to resemble natural Respiration as much
as possible, both in manner and degree, that the body of the pa-
tient has been wiped dry—hat he has been placed in a proper tem-
perature, and that his skin has  been gently rubbed with the hand,
or with a flesh brush.   These  are the  means on which we re)>
for Resuscitation; and if these fail, after a faithful trial of abou*
three  hours, the case is hopeless.  But  persons are frequently
taken from the water  in a  lifeless state, who have been other-
wise seriously injurged,  than  by drowning; as  by a fall from a
great height, by intense cold,  £~c. and when we have reason to
conclude, that sv.ch  has been the case, W3 shall  of  course,  vary
our treatment..

  As to bleeding, emetics, enemas, c-c. it is sufficient  to say gene
rally, that we cockier all deleting remedies as injurious in tin
first stage of cure  that is, before the full re-establishment of Res
piration.  Even if bleeding should remove the black blood fron
the right side of the Heart, which we  much doubt, it would nc
restore its arterial quality, on which life immediately  depend
We shall not point out the path to be pursued in the second stag*
of care.  The ireaiment  will  be regulated by the symptoms o
die patient, and the judgment of the  physician.  Ik oxygen could
be procure;1,  it would unquestionably be  a  much more probable
means of purifying the biota!,  ami restoring the  circulation,  than
common atmospheric air; but we  cauuot espeef, in  ordinary
cis?cs, to  be aide to ^recu-e it. 
(  S3  )
               TREATMENT IN HANGING.

   In attempting to restore life,  after Hanging, the means we
 would practise, are much the same as above described.  The
 most important thing to be done, is to inflate the Lungs,  and to
 establish artificial Respiration.  Bleeding is very  generally re-
 commended, but as we have reason to believe, from our experi-
 ments,  as  Avell as those of others, that apoplexy  seldom takes
 place, we  would bleed only in cases where there is more than
 ordinary reason to believe, that either apoplexy, or a turgescence
 of blood in the Brain has ensued, as where the patient has been
 long hanging, or was uncommonly  heavy.  In such cases, we
 would open a jugular vein.  But in the mean time, artificial Res-
 piration should never be intermitted; and  we  wish it to be well
 understood, that  we  consider artificial Respiration as the great
 and paramount remedy, as well in Hanging, as in Drowning, and
 all other remedies, as merely subservient to it.   To stop artificial
 Respiration, for the purpose of practising any other expedient,
 would, in our opinion, be as inexpedient,  as to open a vein, or
 apply a blister in  an ordinary case, and at the same time,  to suf-
 focate the patient, by immersing his head in water.

  Before I conclude, I  cannot deny myself the pleasure  of
 expressing  my sentiments  towards the Professors of this Univer-
 sity.  The  zeal which they have shown for the improvement  of
 their pupils, and the ability with which that zeal has been second-
 ed, must have left an impression upon the mind of every student,
 which time will not obliterate.  It is  a subject on  which I feel
 more than I shall  venture to express—a subject  on which the
heart would dictate,  without any toil  of the intellect.  When I
contemplate the satisfaction With which I shall, through the whole
course of my  life, look back on the time I have spent  in this 
                          i  36  )
University, I cannot forbear to take a parting glance at the advan-
tages I have enjoyed, and to return  thus publicly, my thanks to
the gentlemen,  whose instructions have contributed to my im-
provement, and  whose benevolent condescensions, have truly
made the paths of wisdom " ways of pleasantness,"
FINIS. 
 
 
NUci.. H i.st.






  It If
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