714 



DEATH 



bones and (to a less extent) the teeth are under- 

 going a perpetual although a slower change of this 

 nature ; and throughout the whole body there is a 

 continuous removal of effete or worn-out tissues, and 

 a corresponding deposition of new matter. Every 

 blow we strike, every thought we think, is accom- 

 panied by the death and disintegration of a certain 

 amount of muscular or nervous tissue as its neces- 

 sary condition ; and thus every action of our cor- 

 poreal life, from its beginning to its close, takes 

 place at the expense of the vitality of a certain 

 amount of organised structure. This is termed 

 molecular death, and, within its proper limits, is 

 obviously essential to the life and well-being of the 

 organism. 



The cessation of the circulation and respiration 

 may be regarded as constituting somatic death, or 

 the death of the entire organism, which must 

 obviously be shortly followed by the molecular 

 death of every portion of the body. 



We shall now briefly notice the principal modes 

 in which death occurs. Death happens either from 

 the natural decay of the organism, as in old age, 

 or ( and much more frequently ) from some of those 

 derangements or lesions of the vital organs which 

 occur in the course of the diseases and injuries to 

 which we are liable. These derangements of the 

 vital organs may occasion various modes of dying. 

 Dr Watson said that life rests on a tripod, whose 

 three vital supports are the heart, the brain, and 

 the lungs ; and Bichat, that ' the mode of dying 

 may begin at the head, the heart, or the lungs.' 

 The functions of these organs are, however, so 

 mutually dependent upon each other, that impair- 

 ment in the functions of one of them may lead to 

 death, though the immediate cause of death is the 

 failure of another. 



Death from failure of heart may be either sudden 

 or gradual. Sudden failure (death by syncope or 

 fainting) may occur from disease or weakness of 

 the heart itself, or from shock conveyed to it 

 through the nerves. Gradual failure takes place 

 when the whole system is enfeebled e.g. by the 

 action of certain poisons, and by many wasting 

 diseases (death by asthenia, Gr. , 'want of power'). 

 When death occurs from loss of blood (anremia), 

 the failure of the heart may be either sudden or 

 gradual, according to the extent of the loss ; but 

 in this case the heart ceases to contract not from 

 inability to do so, but because the blood, its natural 

 stimulus, is insufficient in amount to excite con- 

 traction. 



Death from faihire of respiration (Asphyxia, 

 q.v. ) occurs when access of the air to the lungs is 

 impeded, or when the actions of the muscles of 

 respiration cease. We have examples of it in 

 drowning, smothering, choking, strangulation, &c. 

 Forcible pressure upon the chest, such as sometimes 

 happens in great crowds, or as occurs to workmen 

 partially buried by the fall of earth, &c., will cause 

 death in a few minutes, if movement of the lungs 

 is prevented by the pressure. Tetanus and the 

 poison of strychnine prove fatal in this way. 



Death by coma, or beginning at the brain, is 

 caused by obstruction to the circulation through 

 that organ by pressure (as, for example, when there 

 is effused blood within the cranium, or when a 

 portion of bone is depressed in a fractured skull ) ; 

 by clots of blood within the vessels ; by various 

 narcotic poisons, such as opium, alcohol in exces- 

 sive quantity, carbonic acid, &c. 



To these forms of dying some writers propose to 

 add necrcemia, or death beginning in the blood, as 

 in typhoid fevers and in other diseases of a malig- 

 nant or pestilential kind. Such cases may, how- 

 ever, always be referred to one of the three forms 

 already enumerated, or a combination of them ; 

 and further complication seems unnecessary. 



The signs of approaching death require a briet 

 notice. The mind may be affected in various ways ; 

 there may be dullness of the senses, vacancy of the 

 intellect, and extinction of the sentiments, as in 

 natural death from old age ; or there may be a 

 peculiar delirium, closely resembling dreaming, 

 which usually is of a pleasing and cheerful char- 

 acter. 



Dementia or imbecility sometimes comes on 

 shortly before death, and manifests itself by an 

 incapacity of concentrating the ideas upon any one 

 subject, and by an almost total failure of memory. 

 The mental weakness is often exhibited by the 

 pleasure which is derived from puerile amusements. 

 Shakespeare notices ' playing with flowers ' as a 

 token of approaching dissolution. In the form 

 of delirium, ocular spectra seem frequently to be 

 present, the patient apparently trying to catch 

 some imaginary object. 



There is generally well-marked relaxation and 

 incapacity of the muscular system, and the voice is 

 usually weak and low as death approaches, often 

 dwindling to a mere whisper. The mode in which 

 the action of the heart declines is various ; in most 

 diseases of longstanding, the cessation of the heart's 

 action is gradual, the rate of the pulsations being 

 much increased, but their energy being very much 

 impaired. In some acute affections, the failure is 

 shown by the irregularity of the pulse, while the 

 force is little altered. In other cases ( especially in 

 cerebral diseases) the heart, before finally ceasing 

 to beat, contracts violently, and suddenly stops. 



The respiration is sometimes hurried and panting 

 till just before death, while in other cases it is slow, 

 laborious, and stertorous. The accumulation of 

 mucus, &c. in the air-passages increases the diffi- 

 culty of breathing ; the sound known as the ' death- 

 rattle ' being produced by the passage of the air 

 from the lungs through the fluid collected in the 

 trachea and upper respiratory passages. There is 

 also a loss of animal heat, beginning at the extremi- 

 ties. 



The signs of actual death may be arranged under 

 three heads : ( 1 ) Signs of the extinction of the vital 

 functions ; ( 2 ) Changes in the tissues ; ( 3 ) Changes 

 in the external appearance of the body. 



( 1 ) The arrest of the circulation and respiration 

 would at first sight appear to afford decisive evi- 

 dence of death ; but these functions, as in the case 

 of hybernating animals, may be reduced to so low 

 a condition that it is by no means easy to decide 

 whether or not they are completely annihilated. In 

 cases of apparent drowning, and in newly-born 

 infants, these functions are frequently suspended 

 and again restored ; and cases like that of Colonel 

 Townsend (see any standard work on medical 

 jurisprudence) occasionally occur, in which the 

 patient has the power of voluntarily suspending 

 these functions for a considerable period. The 

 gradual loss of animal heat is an important sign. 

 But it is sometimes delayed ; and in exceptional 

 cases a rise of temperature may even take place 

 after death. Loss of contractility of the muscles 

 when a galvanic current is applied to them is a 

 certain sign of death ; but the period at which it 

 takes place is very variable. The contractility of 

 the skin is also lost after death. When a cut is 

 made through the skin of a dead body, the edges of 

 the wound collapse, while a similar lesion inflicted 

 during life presents an open or gaping appearance. 



( 2 ) Among the changes in the tissues, the rigor 

 mortis, or rigidity of the muscles, which ensues at a 

 varying period after death, is the most important. 

 It may appear within half an hour after death, or 

 may be delayed twenty or thirty hours, according 

 to the nature of the disease ; and its mean duration 

 is from twenty-four to thirty-six hours. It com- 

 mences in the neck and trunk, then appears, 





