48 SUDDEN DEATH. 



DEATH FROM BURNING. 



Death may be caused by the inspiration of smoke and flame ; by the 

 drinking of hot fluids ; by the direct contact of flame or hot substances 

 with the external surface of body. It may be due to the direct effect of 

 the agents, to secondary affections of the viscera, or to the exhaustion 

 produced by long-continued inflammation and suppuration. Su,ddeu 

 death may occur after extensive burnings of the skin. ' 



The burned skin divested of epidermis may present a peculiar red, 

 hard, parchment-like appearance. If the patient have lived for some 

 time, suppuration of the injured surface may ensue. Or there are small, 

 bladder-like -elevations of the epidermis. The base of these blisters is 

 red, and they are surrounded by a red zone, or suppuration may have 

 commenced. These appearances cannot be produced by heat applied to 

 the skin after death. 



After death from severe burns there is apt to be congestion of the 

 brain, and the thoracic and abdominal viscera. The lymph nodes and 

 the lymphatic tissues throughout the body may be swollen and the seat 

 of eiidothelial cell proliferation and necrosis. There is usually albumi- 

 nous degeneration of the liver and kidneys ; the spleen is swollen and 

 the seat of focal necrosis. Focal necrosis in the bone marrow has been 

 noted. There may be capillary thromboses, interstitial hemorrhages in 

 the kidney, and leucocytosis. These lesions indicate the presence of 

 toxic substances in the body fluids, and thus the general condition may 

 be regarded as an instance of auto-intoxication. 2 



Secondary lesion are not infrequent after severe burns. There may 

 be oadema of the glottis, pseudo -membranous inflammation of the larynx 

 and trachea, pneumonia, ulceratiou of the duodenum, and pyaemia with 

 infarctions in the lungs, liver, spleen, and kidneys. 



Sudden Death. 



Some forms of sudden death from violence have been already consid- 

 ered. Aside from these, by sudden death, in the ordinary sense, is usually 

 meant "the rapid and unforeseen termination of a latent acute or chronic 

 disease." We shall not consider here sudden death either from violence 

 or poisoning or in well-defined and evident acute or chronic diseases: it 

 will be practicable only to enumerate some of the more common condi- 

 tions under which sudden death may occur and first in the adult. 



Circulatory System. Heart fatty degeneration, chronic myocardtiis, 

 abscess of the myocardium, rupture, lesions of the coronary arteries, 

 endocarditis, and pericarditis. Blood-vessels arterio- sclerosis, aueu- 

 rysms especially intracranial, intrapericardial, abdominal, and pulmo- 



1 For a study of sudden death following severe burns, consult Silbermann, Yircli. 

 Arch., Bd. cxix., p. 488, 1890. Bibliog. 



2 For a study of the visceral changes following extensive burns, consult Banleen, 

 Jour. Exp. Med., vol. ii., p. 501, 1897, Bibliog. ^fcCrae. Trans. Ass. Am. Phys., vol 

 xvi., p. 153; also, Locke; Boston Med. and Surg. Jour., October 30, 1903, Bibliog 



