The second site of the Hospital on Lexington Avenue
This is an excerpt from the minutes of the Board of Directors of The Mount Sinai Hospital, March 11, 1888. It is a report from Mr. De Witt J. Seligman, a Director, concerning the proper verification of deaths occurring in the Hospital. The punctuation has not been changed. It provides an interesting view into what was then – and now – a very important issue: how to determine when someone is, in fact, dead.
“Mr. Seligman who was appointed a committee of one…read the following report:
To the Board of Directors of Mount Sinai Hospital:
Having been appointed at the last regular meeting of your Board a Committee of one to look into the matter of certifying to deaths I beg to submit the following report.
In getting at the facts of this matter I have seen three doctors of our visiting staff, the Pathologist of the New York Hospital, the House Surgeon and the House Physician of Mount Sinai Hospital and the Superintendent of Mount Sinai Hospital. There can be no doubt that it happens at times that patients are declared dead before life has become extinct. The Superintendent of our Hospital informs me that on one occasion a nurse told him that her patient was dead and that she was going to announce it to the doctor. The superintendent, Mr. Hadel, went to the Ward and found the alleged dead man sitting bolt upright.
A man informed our Superintendent, Mr. Hadel, that when he was a patient at Blackwell’s Island he was being carried from the Ward to the dead house. On the way they passed through the open air and the effect was that the man on the stretcher became revived and lived to tell this tale of carelessness to our Superintendent. Only this winter a relative by marriage of my wife was, I am informed, declared dead by a physician, but today that same man is as lively as a cricket. Had he been a patient of the Mount Sinai Hospital might he not under our present rules, have ·been hurried from his warm bed in the Ward into the death house and there frozen to death in a short time?
The Pathologist of the New York Hospital informs me that the Ambulance surgeon of the New York Hospital has been repeatedly in doubt as to whether a patient was dead or not and the same Pathologist of the New York Hospital tells me that a certain Dr. Ridlow thought a patient was dead and but two hours later the patient showed life; on the following day Dr. Ridlow again thought that the same patient was dead but even after that on the second day the patient showed life. There was in this case trouble with the heart. An intelligent gentleman connected with the Mount Sinai Hospital as a Director informs me that he and his wife have a mutual agreement by which in the case of the supposed death of one of them, the survivor is to carry out the following agreement: the word of the family physician is not to be taken that death has come but an outside physician is to be summoned to apply the death tests. After that is done no ice is to be placed on the body for 8 hours and the burial is not to take place for three days. In a large institution like ours where deaths are naturally occurring continually, the question arises, what method shall we adopt to avoid the possible mistake of hurrying a supposed corpse into the dead house where in case some life is still in the body it would soon by the sudden change of temperature be frozen out of the body.
One of our visiting physicians whom I saw suggested that the supposed corpse be placed in a warm room for 6 hours and that after 6 hours a second examination be made and then if no sign of life be found place the corps in the dead house. If decomposition has already set in this 6 hours additional precaution, the said visiting physician thought, ought not be taken, nor ought it be taken in warm weather when the cool temperature of the dead house would even aid to revive the flickering flame of life.
This idea seems to me the best idea that was suggested provided it be conscientiously carried out at the Hospital. But whatever rule you may make, one thing is sure and that is that no one but the House Physician on his side and no one but the House Surgeon on his side ought to make the death tests and in each and every case the House Physician or the House Surgeon ought to feel and bear the whole responsibility. To this end I would recommend that we have printed slips which shall run about as follows:
Mount Sinai Hospital, N. Y.
This is to certify that I have this day carefully examined __________________________
a patient of Mount Sinai Hospital in Ward No.____ Bed No.____ and found (him or her) dead.
These slips are to be signed only by the House Surgeon on his side of the Hospital and all these slips are to be kept by the Superintendent of Mount Sinai Hospital in a book for that purpose. In consultations with Drs. Rich and Walsh, the House Surgeon and House Physician of this Hospital, I find that there are no rules as to who shall declare that life has left a patient. Dr. Rich informed me that he always attended to this but Dr. Walsh informed me that in nearly all cases he did and in the remaining cases he left the investigation of the alleged corpse to any doctor, it mattered not which one.
The Pathologist of the New York Hospital informs me that at the New York Hospital the House Physician or the House Surgeon and nobody else testifies to death and even if he has been but a short time previous to death say three times at the bedside said House Physician or House Surgeon is personally compelled to go to the Ward and examine the patient after he has been declared dead. Even at night at the New York Hospital the House Physician or the House Surgeon is compelled to go to the body and examine it.
It may be of interest to you to know that at the New York Hospital every single corpse is washed and put in a shroud and as this operation usually takes half an hour or more, in the opinion of the Pathologist of the New York Hospital who gave me this information, is an additional safeguard against treating the patient as dead before life has left the body.
A great deal more could be written on this important subject, but I think I have written enough to make it clear that this Hospital should have the most stringent rules that can possibly be made in the matter of death certification.
(signed) DeWitt J. Seligman
Mr. [Isaac] Wallach moved that the report of Mr. Seligman dated March 11, 1888 be spread on the minutes in full and that the recommendations contained in said report that the House Physician and House Surgeon must examine persons supposed to have died and sign certificates of death and no one else, in the manner suggested in said report.
That a book be provided for the purpose by the Comm. on Printing.
That the suggestion to place alleged dead persons for 6 hours in a warm room from and during cold months before such bodies are placed in the dead house be referred to the Executive Committee to provide the room if possible.
These provisions are intended as safeguards to prevent the slightest possibility of patients being placed in Dead House who may be apparently dead but not actually so. This whole motion of Mr. Wallach was adopted.