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JAMA 100 Years Ago
December 18, 2002


Author Affiliations

JenniferReiling, Assistant Editor

JAMA. 2002;288(23):3054. doi:10.1001/jama.288.23.3054-JJY20040-2-1

Massage of the heart, in case of its stoppage, to revive its movements has been recommended and experimentally demonstrated, but the first successful case of its use in man was reported by Dr. E. A. Starling 1 at a recent meeting of the British Society of Anesthetists. In an operation for appendicitis on a man aged 65 under nitrous oxid and other anesthesia, both pulse and respiration ceased together, and artificial respiration and traction on the tongue failed to revive them. Then the surgeon, Mr. W. Arbuthnot Lane, pushed his hand up through the abdominal wound and grasped the motionless heart through the diaphragm. He squeezed it and felt it start pulsating, though no radial pulse could be felt. Artificial respiration and other restoratives were continued, and in about twelve minutes natural respiration reappeared and the pulse became perceptible at the wrist. The operation was then completed without the use of anesthetic and the patient made a good recovery, with, however, some diaphragmatic tenderness. This rough-and-ready method and its success in this case is suggestive of important possibilities, and demonstrates that cutting operations in these cases are not essential and can be avoided. The previous failures followed extensive exposures of the heart either by rib resection or incision through the diaphragm, as recommended by Mauclaire (in two cases). This of itself introduces a serious complication, and Lane's success was probably mainly due to his avoidance of this. The case, as the Lancet remarks, "justifies us in saying that, if during laparotomy the patient's heart stops, the case should never be abandoned as hopeless until manual compression of the heart through the diaphragm has been performed."