Curious Practices Arise from Fear of Being Buried Alive

Figure 1. Title page of the History and Memories of the Society for the Rescue of Drowned Persons (1780).

by Peter J. Koehler

Coma has been a phenomenon of interest for physicians as well as lay people through the ages and was associated chiefly with stroke (“apoplexy”) and trauma¹. One chapter in the history of coma has two extraordinary perspectives, notably coma following drowning and the fear of being buried alive, which played a role particularly during the late 18th century.

Drowning Rescue and Resuscitation

A considerable number of books on comatose persons, usually drowning victims, often referred to in the titles as “apparently dead,” appeared during the 18th century. These books were published when the first societies for the resuscitation of drowning people had been established. It is of no surprise that the first of these societies was founded in the Netherlands (1767), notably the Amsterdam Society for the Rescue of Drowning Persons (Maatschappij tot Redding van Drenkelingen). Due to the many canals, drowning was a frequent event in Holland. The society paid premiums for saved drowning persons and thus in the 1780 publication (Fig. 1), it is reported that “73 premiums had been distributed to good and indefatigable surgeons and other persons” in the years 1778-9. The lifesavers could choose between six gold ducats or a gold medal.

Figure 2. English translation of the Amsterdam Society by Thomas Cogan (1773).

Drowning persons were supposed to be brought inside a house, airways inspected, wet clothes removed, warmed up by rubbing with woollen clothes, and administered tobacco smoke fumigation by rectum. Following this warming up, bleeding could be applied from the arm or neck, but not too superfluous. Only if signs of swallowing acts were observed, not earlier, some hard liquor could be poured down in the mouth and the rapid spirit of ammonia salt kept under the nose. If this did not work, the drowning person should be laid in a preheated bed, accompanied by a naked person who provided natural heat. The book contains short histories of failed resuscitations and longer cases histories of successful ones.

A case history (March 27, 1778, 10;30 a.m., Noordwaddingsveen): a 5-year old boy, Jan van Someren, was missed for half an hour and found in the water, apparently dead, by his parents Cornelis van Someren and Aagje Joosten Robberts. A surgeon, Pieter de Nick, was sent for, the child brought inside and warmed up. The usual resuscitation methods were applied and only after a prolonged period (one hour) the blue lips disappeared and he began to cry. He was laid in a warm bed with another person and after some time he started to speak. He recovered completely the next day and Pieter de Nick received the gold medal.

Figure 3. American Society (Boston, 1788).

The Dutch example was soon followed by several other countries. In 1774, the English society was founded by physicians William Hawes and Thomas Cogan, the latter becoming interested after a visit to Amsterdam (Fig. 2). An American society was founded in 1787, notably The Institution of the Humane Society of the Commonwealth of Massachusetts (Fig. 3)^2-5. Although John Hunter (1776) suggested cessation of respiration was the primary cause of death and cardiac arrest secondary, and also wrote about ventilation, it would be more than a century before it was routinely applied (see also⁶).

Buried Alive

Next to coma in drowning persons, there was another aspect of apparently dead, notably a great fear for being buried alive, a.o. appearing from the titles of the publications, for instance, the book The uncertainty of the signs of death, and the danger of precipitate interments and dissections … with proper directions, both for preventing such accidents, and repairing the misfortunes brought upon the constitution by them. The book contains  chapter titles such as: “A woman, falling into a syncope, occasioned by a violent fit of passion, suppos’d to be dead, and put into a coffin” and “Precautions to be us’d in order to recover those who have been drown’d or buried alive” (Figs. 4 and 5)⁷. Another example is the French Lettres sur la certitude des signes de la mort. O๠l’on rassure les Citoyens de la crainte d’àªtres enterrés vivans (Fig. 6)⁸.

Figure 4. The Uncertainty of the Sign of Death (1746).

The English physician John Fothergill suggested that in some situations it might be profitable to “distend the lungs with air,” in particular in “sudden Deaths from some invisible Cause; Apoplexies, Fits of various Kinds, as Hysterics, Syncope’s, and many other Disorders, wherein, without any obvious Prae-indisposition, Persons in a Moment sink down and expire” (Fig. 7)⁹. Next to artificial ventilation, the use of electric shock, not unexpected in this age of medical electricity, was recommended¹⁰.

Figure 5. Fear of being buried alive (1746).

The fear of being buried alive led to curious practices including the one advised by the English lawyer and philosopher Jeremy Bentham to nail a wooden pin through the brain or heart for the prevention of interment of apparently dead (“require that a spike of appointed length, kept for the purpose, be run either through the heart, or into the brain, through the secket of the eye”) (Fig. 8)¹¹. The Danish-born French anatomist Jacob Winslow wrote a thesis about the uncertainties of the signs of death (translated and augmented by Jacques-Jean Bruhier), which contains stories of persons, who were buried almost too early. Huston was critical about Winslow’s and Bruhier’s “fabulous stories of recovery”¹². Winslow himself would have escaped a premature burial two times and concluded that putrefaction is the only real sign of death¹³. He referred to the well-known (but controversial) case, autopsied by the 16th century physician and anatomist Andreas Vesalius, who appeared to be alive, after which Vesalius was prosecuted for murder¹². The king of Spain changed the sentence into a voyage to the Holy Land.

Figure 6. French book on Certainty of Signs of Death by Louis (1752).

Later, even Charles Dickens was concerned about the apparent dead, as can be read in a contribution in his weekly journal, in which he warned against prematurely buried persons while still alive¹⁴. Coma, in drowning persons as well as the fear of being buried in such condition was an issue among physicians as well as lay persons for centuries in many countries.

Dr. Koehler is neurologist at Atrium Medical Centre, Heerlen, The Netherlands. Visit his website at www.neurohistory.nl.

This article was adapted from a section of Koehler PJ. The history of coma. In: Boes CJ (ed.). The History of Certain Disorders of the Nervous System. American Academy of Neurology, Philadelphia, 2014.

References

1. Koehler PJ, Wijdicks EFM. Historical study of coma: looking back through medical and neurological texts. Brain 2008;131:877-889
2. Historie en gedenkschriften van de maatschappij tot redding van drenkelingen. Amsterdam, Meijer, 1768.
3. Johnson A. A short account of a society at Amsterdam instituted in the year 1767 for the recovery of drowned persons with observations shewing that the utility and advantage that would accrue tot Great Britain from a similar institution etc. London, John Nource et al., 1778.
   

   Figure 7. John Fothergill’s publication (1744).

4. Hawes W. The transactions of the Royal Human Society. London, Nichols, 1796.
5. The Institution of the Humane Society of the Commonwealth of Massachusetts: With the Rules for Regulating Said Society, and the Methods of Treatment to be Used with Persons Apparently Dead: With a Number of Recent Cases Proving the Happy Effects Thereof. Boston, 1788.
6. Payne JP. On the resuscitation of the apparently dead. Ann R Coll Surg Engl. 1969;45:98–107
7. The uncertainty of the signs of death, and the danger of precipitate interments and dissections…with proper directions, both for preventing such accidents, and repairing the misfortunes brought upon the constitution by them. London, Cooper, 1746.
8. Louis M. Lettres sur la certitude des signes de la mort. O๠l’on rassure les Citoyens de la crainte d’àªtres enterrés vivans. Paris, Lambert, 1752.
9. Fothergill J. Observations on a Case Published in the last Volume of the Medical Essays, &c. “of recovering a Man dead in Appearance, by distending the Lungs with Air. Printed at Edinburgh, 1744” in The Works of John Fothergill, M. D . . . London, 1784. [Ed. J. C. Lettsom]
   

   Figure 8. Jeremy Bentham, English philosopher and jurist.

10. Kite, C. An Essay on the Recovery of the Apparently Dead. London, Dilly, 1788.
11. Bentham J. Works vol. 6. Edinburgh, Tait, 1843, p.571.
12. Huston KG. Resuscitation. An historical perspective. Wood Library – Museum, Park Ridge, Illinois, 1976, p.2.
13. Winslow JB. Dissertation sur l’incertitude des signes de la mort et l’abus des enterremens, & embaumens précipités. Transl and commented by Bruhier JJ. Paris, Morel et al. 1742.
14. Dickens, C. “Apparent Death” in All the Year Round, New Series, Vol.II, No. 31 (Saturday, July 3, 1869), pp. 109-114.

Organization Conducts Screenings in Uganda, India

Stroke is the third leading cause of premature death and disability worldwide. The burden of stroke is growing in low and middle-income countries due to many factors including population growth and aging, urbanization, unhealthy diets, physical inactivity and smoking. More importantly, these demographic and epidemiologic factors are driving a rise in the prevalence of high blood pressure, the leading independent risk factor for both ischemic and hemorrhagic stroke. In many less developed countries, particularly in rural areas, awareness of high blood pressure is extremely low and screening services are non-existent. On the other hand, treatment for high blood pressure is widely available and relatively inexpensive.

Figures 1. and 2. Dr. Jerome Chin and volunteers at an ASAPP project site in India in November 2014.

Since 2010, Dr. Jerome Chin, a neurologist in the U.S., has been volunteering for two months annually as an attending physician on the neurology ward at Mulago Hospital, the national referral hospital of Uganda in the capital Kampala. The neurology ward admits more than 50 acute stroke patients monthly, the majority with severe previously undiagnosed high blood pressure. In October 2011, Dr. Chin founded the Alliance for Stroke Awareness and Prevention Project (ASAPP) in Kampala to reduce the incidence of stroke in Uganda. ASAPP volunteers, who are mostly medical and other health professions students, provide free community-based screening and counseling for high blood pressure every week at places of religious worship. Individuals with elevated blood pressures are advised to make dietary and lifestyle changes and are referred for medical treatment if indicated. In December 2012, Dr. Chin visited the neurology ward at the All India Institute of Medical Sciences (AIIMS) in the capital Delhi. Similar to Mulago Hospital in Uganda, the majority of patients admitted to AIIMS with acute stroke have severe previously undiagnosed or untreated high blood pressure. In December 2013, Dr. Chin launched ASAPP in India.

ASAPP currently supports six project sites in Uganda and three projects sites in India. In addition, ASAPP is partnering with the Uganda Ministry of Health and other organizations including Rotary International and Impact India Foundation to provide free high blood pressure screening and counseling at special health camps and events. ASAPP project sites have provided more than 55,000 free screenings for high blood pressure since 2011. In the next few years, ASAPP plans to launch additional project sites in Uganda and India and expand to Nepal and other less developed countries. ASAPP is a U.S. tax-exempt non-profit charitable organization. For more information, visit www.asapp.org.