31st August 2018, Volume 131 Number 1481

By Carrick Robertson, F.R.C.S.

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I'm a dead man; he's near my heart." (Observer, 16 June 1906). Alexander Turnbull Library, Wellington, New Zealand. /records/6881364 

August 1918 

A sailor came to the Auckland Hospital with a septic thumb. He was seen in the casualty department, when it was decided that the thumb should be opened under a general anaesthetic. The man was apparently in good health. The anaesthetic was proceeded with, and when the man was “under,” the house surgeon incised the abscess. As soon as he had done this he noticed that no bleeding took place from the incision; this was the first intimation he had that the man’s heart had stopped. It was then discovered that there was no radial pulse and the respirations were dying away. Artificial respiration was immediately started, and, as I happened to be in the hospital at the time, I was sent for. On my arrival in the casualty room the man was quite white and there were no heart sounds. Artificial respiration was going on but there was no attempt at voluntary respiration. The man seemed quite dead, so I quickly put iodine on the skin and made an incision in the upper right rectus region. Introducing my hand through this incision, I was able to grasp the heart firmly in my hand, for the diaphragm was so flaccid that this was quite easy. I then waited for a few seconds to see if there was any muscular movement in the heart, but could feel none, so I squeezed the heart between the hand and the ribs several times, whereupon it gave a distinct but feeble kick, followed by slow and feeble contractions, which soon became bounding and rapid. At this time the appearance of the man was quite alarming, for owing to the excessive pulsations in all the arteries of the body, he almost seemed to life off the couch with each beat. We were afraid that there must be clots in the smaller vessels which required this excessive driving force to push them along. However, as events showed no embolism or thrombosis took place, the wound was sewn up and the man put to bed. On recovery he became maniacal and had to be put in a restraining—sheet. He remained in this excited state for twelve hours; after this he quietened down, but was quite childish for another day. In two days’ time he was quite normal, but could not remember coming to the hospital or anything that had happened for two days afterwards.

I have had several cases of heart massage during the last year or two, but I have never seen so striking an example of its saving powers. The interest of this case lies particularly in the fact that at the lowest calculation this man must have been dead for three minutes, probably five. His mental symptoms I put down to an oedema of the brain supervening on the stasis of the circulation. I think it was only because he was a comparatively young man (34 years) that he did not burst a cerebral blood-vessel during the first five minutes after the heart started to beat again, for I feel sure that no arteries at all senile in type could have withstood such excessive heart action.

The first case of heart massage which I tried was upon a man on whom I was operating for appendicitis. His heart stopped after I had made the appendix incision, and as I could not reach the heart from this incision another was made below the costal margin as related in the above case. This man did well, but, of course, the result was not so stri, for a very little time elapsed between his heart stopping and the massage which restarted it. In a third case in which this manoeuvre was tried I am sorry to say it was unsuccessful.

An only child, nine years of age, was being operated on for enlarged tonsils. The anaesthetist said she was ready, and I could see that the respirations were quiet and steady. I guillotined one tonsil and noticed there was no bleeding, and at once listened to the heart. It had stopped. I performed heart massage as before through the diaphragm, but could get no response whatever from the cardiac muscles. In this case, as in the first described, the heart had stopped some time before the respirations. A post-mortem examination was held on this child and a thymus four ounces in weight was found, together with pronounced glandular hyperplasia throughout the body: a well-marked case of status lymphaticus.

Although heart massage is fairly well known as a possible procedure, I have not heard any personal reports of such cases, so I venture to think the record of these cases may be of interest to the profession in New Zealand. It will be seen that heart massage adds another efficient method of dealing with cases of sudden collapse on the operating—table. With the experiences recorded above I am firmly convinced that when the surgeon is sure that the heart has stopped there should be no excuse for not applying this procedure; but I should like to emphasise the fact that this should only be done after failure to restore animation with the usual restoratives, and, judging from the first case, it would seem that there is no great hurry, for the heart will respond after a comparatively long latent period.

In each of these cases there was the one striking observation that no bleeding or oozing took place from the wound. Even with a slight flickering heart there will at least be some oozing.