Posted in History & Literature

The Most Kissed Face In The World

In the late 19th century, it was not uncommon to find a corpse who could not be identified. Such was the case for a young woman who was pulled out of the River Seine in Paris, likely a suicide. Her body was labelled ecadavre feminin inconnu (unknown female cadaver) and as was customary at the time, her body was displayed in a chilled room with a glass window at the morgue, in the hopes that some passer-by would recognise her face and identify her.

At some point, a morgue attendant made a death mask of her face – a wax plaster cast that preserves the face of a corpse before it decomposes. The attendant’s motives are unclear: some stories state that he was entranced by her beauty, but it is also possible that he was trying to better preserve the face for identification. Regardless, the mask became copied many times in the following years and became strangely popular in the artistic world.

The face became famous for its eerie smile, which looks enigmatic yet peaceful, even being compared to the smile of the Mona Lisa. The mask – known as L’Inconnue de la Seine (the unknown woman of the Seine) – became a popular, morbid fixture in the rooms of Parisian Bohemians.

In 1955, a Norwegian toymaker named Asmund Laerdal came across a novel material known as PVC, a soft plastic perfectly suitable for dolls. He found it to be a perfect material for the creation of a new training aid for the newly-invented CPR (cardiopulmonary resuscitation) technique to be taught to those learning first aid. He wanted the mannequin to look as natural as possible. This is when Laerdal remembered a fixture on the wall of his grandparents’ house when he was younger: the L’Inconnue de la Seine. He considered the face to be ideal for the purpose of a resuscitation aide, with its peaceful, non-threatening features.

Thus, the Resusci Anne was created. Resusci Anne is by far the most popular CPR teaching tool used worldwide. It is often said that it is “the most kissed face in the world“, as mouth-to-mouth resuscitation is a feature of CPR.

As charming and morbid the story may be, the story of L’Inconnue de la Seine has never been confirmed. It has only been passed on through history via novels, short stories and artists’ accounts. If you look closely at the face, the story seems less likely to be true, as a drowned corpse will often be much more bloated and disfigured from swelling, with a contorted, tortured face as victims frantically thrash and fight as the body screams for oxygen. The general consensus is that from a pathologist’s point of view, the mask is unlikely to be from a drowned young woman

Irregardless of the origin story of its face, the Resusci Anne has indubitably saved the lives of countless people around the world, by teaching people the important skills of CPR and first aid.

Posted in Psychology & Medicine

Agonal Breathing

When a person is on the verge of death, they may show a very strange pattern of breathing. They will begin gasping for breath, take deep laboured breaths, begin to make strange noises and possibly have some muscle jerks (which may look like a seizure). The breathing makes it look as if the person is taking a deep breath and sighing, while gasping every now and then irregularly. This is called agonal breathing and it is most likely caused by an oxygen-starved brain sending weak signals to try kick up the respiratory drive for more oxygen.

Agonal breathing is not uncommon in cases of cardiac arrest. It is important to note that agonal breathing is not an efficient form of breathing and thus it cannot be said that the victim is “breathing” when this occurs. Because it looks like the patient is taking deep breaths, bystanders may be fooled into thinking that they have been resuscitated and have begun breathing again. But this is not the case and the patient is still clinically dead. Ergo, one should not stop CPR even if the patient begins taking deep breaths and sighs. The presence of agonal breaths usually indicate a better outcome for the patient.

(Link to video examples of what agonal breathing looks like: http://emsbasics.com/2011/04/21/what-it-looks-like-agonal-respirations/)

Posted in Psychology & Medicine

Lazarus

In the New Testament of the Bible, there is a scene where Jesus resurrects a man by the name of Lazarus back four days after his death. This “miracle” is of course a fictitious event, but nonetheless, the name Lazarus has come to symbolise resurrection after death. For example, there are two actual medical conditions named after Lazarus, both related to death.

The first is called Lazarus phenomenon, where a person who is declared to be clinically dead spontaneously returns to life. This is an extremely rare event that has only been recorded in about 30 cases. In most of these cases, the patients had suffered a cardiac arrest, with all attempts at resuscitation (e.g. CPR, adrenaline) had failed. Sometime after the person was declared clinically dead (usually around 5~10 minutes), the person’s circulatory system would suddenly start on its own and the person would be “resurrected” (quite literally). In one case, a 61 year-old woman was declared officially dead after her heart stopped and her vitals did not return after continuous resuscitation. At the morgue, however, she was found to have a pulse and breathing on her own. She later sued the hospital for the neurological and physical injury caused by oxygen deprivation during her death. There is even a case report of a patient who returned to life two and a half hours after dying (although he died again 3 weeks later).

Of course, the Lazarus phenomenon is not a miracle. In most cases, it is hypothesised that when resuscitation is attempted then stopped, there is a rare chance of the relieving of pressure causing blood to fill the heart, causing a sudden expansion and kickstarting the electrical circuit. Other factors that may influence this is hyperkalaemia resulting from ischaemia and high doses of adrenaline given to the patient during resuscitation having a delayed effect.
Because of this rare “complication” of death, doctors are advised to observe the patient for about 10 minutes after declaring them dead. Just in case.

The second is called Lazarus sign and it occurs not in dead patients, but brain-dead patients. Brain-dead patients are immobile as their higher functions such as cognition and motor functions are destroyed. However, there are rare cases where the brainstem is somehow stimulated, triggering a reflex arc from the spinal cord. This reflex is seen as the patient suddenly raising their arms and dropping them on their chest in a crossed position, much like Egyptian mummies. As the spinal cord is not usually damaged in brain-dead patients, this reflex arc is possible, similar to a knee jerk reflex. The Lazarus sign should not be misinterpreted as a sign that a brain-dead patient is conscious, as it is an involuntary movement. However, it has been mistaken for the resuscitation of a patient, or in some cases, as a miracle.

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