798 



DEATH. 



produce a change in the nervous system in- 

 compatible with the continuance of the action 

 of the heart; but mere pain will not account 

 for the fact in question, since in other diseases 

 it attains a more intense degree, and lasts 

 longer, as in neuralgia, without inducing fatal 

 consequences. The causation is probably 

 analogous to that of syncope from mechanical 

 injuries of tissues, to which we have already 

 devoted some remarks. But why an inflam- 

 matory condition of serous membranes should 

 exert a more depressing influence upon the 

 circulation than that of many other tissues that 

 might be named, is a subject wrapped in deep 

 obscurity ; yet it is scarcely darker than the 

 question, why such changes should in the first 

 instance excite and perturb the heart, or why a 

 similar excitement should ensue upon the soft- 

 ening of a cluster of tubercles, and to a degree 

 inexplicable by the functional derangement 

 of the part in which the tubercles exist. Dis- 

 eases in which the powers of the system are 

 said to be worn out, are in reality such as have 

 gradually enfeebled the action of the heart, 

 partly perhaps through the intervention of 

 changes affecting the blood, the respiration and 

 the nervous system, but probably in a great 

 measure by as direct a relation between the 

 diseased part and the change in the circulation, 

 as between violent lesions of tissue and syn- 

 cope. Under the present liead are included 

 a host of chronic maladies. 6. Diseases 

 caused by vitiation of the blood. Such are 

 scorbutus, certain forms of marasmus, the 

 cachexice revealed by dropsies, and certain 

 fevers of a malignant character. We might 

 also mention those depravations indicated by 

 morbid secretions, such as tubercle, carcinoma, 

 melanosis, ike. but that the solids are so much 

 involved in these diseases, that it becomes 

 difficult to determine whether the heart's action 

 was weakened by the primary lesion of the 

 blood, or by the secondary one of the tissues. 

 7. Diseases which produce vitiation of the 

 blood. Such are that large class in which 

 there is disorder of the chylopoietic processes, 

 and that smaller group in which the convey- 

 ance of the chyle is impeded. Derangements 

 of the secernent and excernent organs must be 

 arranged in this division, and particularly 

 those of the liver, the skin, and the urinary 

 apparatus. Diabeles is a state of the system 

 in which the Wood is probably deteriorated 

 both by defective assimilation, and by faulty 

 excretion. Upon the whole of this class of 

 diseases it must be remarked that we seldom 

 or never have opportunities of witnessing their 

 uncombined influence in depressing the organs 

 of circulation. 



1 1. Syncope by old age. We have, in a for- 

 mer article (AGE) endeavoured to trace the 

 principal events in senile decay. The death 

 which follows this gradual decline of the func- 

 tions, presents the strongest possible contrast 

 to that of sudden syncope. In the latter in- 

 stance the assault is made upon the very citadel 

 of life, the conquest of which secures an im- 

 mediate surrender of the minor bulwarks and 

 dependencies; but in the former the fortress is 



reduced only after a long series of defections in 

 the outworks, and a consequent loss of supplies, 

 or, to quote the words of an illustrious author, 

 " Voici done la grande difference qui dis- 

 tingue la mort de vieillesse, d'avec celle qui 

 estTeffet d'un coup subit ; c'est que dans 1'une, 

 la vie commence a s'eteindre dans toutes les 

 parties, et cesse ensuite dans le cceur; la mort 

 exerce son empire de la circonference au 

 centre. Dans 1'autre, la vie s'e'teint dans le 

 cceur, et ensuite dans toutes les parties; c'est 

 du centre a la circonference que la mort en- 

 chaine ses phenomcnes."* 



SIGNS OF APPROACHING DEATH. 



It would be tedious and altogether beyond 

 the compass of this work to enumerate all the 

 phenomena presented by the dying system, 

 since they vary with the cause of death. W T e 

 shall aim rather at describing and accounting 

 for those which are common to most diseases 

 and to natural decay; reserving to ourselves 

 the liberty of noticing here and there some of 

 the more striking varieties. 



We might rationally expect that the first 

 indications of dissolution would appear in the 

 relative functions; hebetude of the senses, in- 

 action of the muscles, vacancy of the intellect, 

 extinction of the sentiments; and such is, in 

 fact, the course of events in natural death. 

 We have known the aged man remain feeling- 

 less, motionless, mindless, for many days be- 

 fore the cessation of the organic functions. 

 This kind of death is sometimes imitated by 

 apoplexy; but in the former the destruction of 

 the animal life does not, as in the latter, arise 

 from a lesion of the brain ; its organs appear to 

 undergo a gradual process of enfeeblement. In 

 many febrile maladies there is the same priority 

 of failure on the part of the cerebral functions, 

 but they are generally preceded by more or less 

 actual disease of the organ. But in the termi- 

 nation of some disorders the functions alluded 

 to continue to the very last, almost surviving 

 the circulation itself. It will be found however 

 that the seat of such disorders was remote from 

 the encephalon,that it did not communicate with 

 the latter by any special sympathy, and that 

 the extinction of the cerebral functions was at- 

 tributable to the arrest of circulation in that 

 organ, in common with many others. The 

 cases in which the mind is said to continue 

 clear and vigorous amid the ruin of the body, 

 will be found to agree in the fact that the 

 organ is correspondently unimpaired ; they are 

 for the most part chronic diseases of the thorax, 

 abdomen, pelvis, and extremities. Certain 

 affections even of the cerebro-spinal system 

 may not interfere with the understanding and 

 feelings until almost the last moments; but 

 they are such as do not involve those divisions 

 with which thought is believed to be more 

 immediately connected : we may instance 

 tetanus. But although in these maladies we 

 do occasionally observe considerable intellec- 

 tual soundness till within a very short period 

 of death, we have for more commonly been 

 able to detect some degree of delirium, an 



r Hkhat, Iluch. sur la Vie et la Mort, p. 151. 



