264 



ASPHYXIA. 



Gallois, Dr. Wilson Philip, Flourens, and 

 others have shewn, injuries of the brain and 

 spinal cord, (particularly injuries suddenly in- 

 flicted on any large portions of these organs,) 

 may directly influence, or even wholly sup- 

 press, vital actions belonging to the head of 

 organic life, for the performance of which we 

 have no evidence of their furnishing any ne- 

 cessary condition. 



As the function of respiration thus appears 

 to be the only link by which the organic life 

 is immediately and necessarily connected with 

 animal life, it is naturally to be expected that 

 the extinction of animal life should affect the 

 organic functions just in the same way as the 

 suspension of respiration does, and therefore 

 that in the case of death beginning at the 

 brain, as Bichat expressed it, (i. e. of death 

 consequent on the extinction of sensation and 

 voluntary motion,) the circulation and other 

 organic functions should be brought to a stand 

 just in the same manner as in death by as- 

 phyxia. And in what is strictly called death by 

 coma, this is really the case; the sensations being 

 gradually more and more impaired, the sense 

 of anxiety in the chest, which prompts to the 

 acts of respiration, is ultimately extinguished ; 

 but even after the last breath has been drawn, 

 the pulsations of the heart still continue, and 

 the blood then gradually stagnates in the lungs, 

 the circulation comes to a stand, and the blood 

 is found after death congested on the right side 

 of the heart, just as in the case of asphyxia 

 already described. 



That this is truly the mode of fatal termina- 

 tion in cases where death takes place strictly 

 in the way of coma, was first unequivocally 

 proved by Sir B. Brodie,* who found, by experi- 

 ment, that animals poisoned by opium or 

 other narcotics, and in which the acts of re- 

 spiration had ceased, in consequence of the 

 impression made on the brain and the gradu- 

 ally increasing insensibility, might be recovered 

 by the artificial respiration, just as asphyxiated 

 animals may be. Indeed the same expedient 

 had been previously employed with success 

 (although not suggested by an equally accurate 

 view of its mode of action) by Mr. Whately.f 



The reason why the same expedient cannot 

 be expected to avail in cases of disease termi- 

 nating by coma is simply that in these cases 

 the cause of the coma is not temporary, like 

 the effect of a narcotic poison, but permanent. 

 It seems possible that it may yet be found 

 successful in some cases of insensibility with 

 convulsion, in children, unconnected with or- 

 ganic lesion. 



In so far, therefore, as the extinction of the 

 organic life is concerned, the death by coma, 

 or beginning at the brain, resolves itself into the 

 death by asphyxia, or beginning at the lungs, 

 the difference lying merely in the mode in 

 which the arterialization of the blood is ar- 

 rested. 



But although this is strictly true as to cases 



* Phil. Transactions, 1812. 



t London Medical Observations and Inquiries, 

 vol. vi. 



of violent death, produced experimentally in 

 such a way that a single cause only is allowed 

 to operate ; and although we occasionally meet 

 with cases of equal simplicity in disease, and 

 ought always to keep in view the principles 

 which these simple cases illustrate in the treat- 

 ment of disease, yet it ought not to be sup- 

 posed that either the death by asphyxia, that 

 by coma, or that by syncope, often present 

 themselves to the observation of the medical 

 practitioner in the same simplicity as to the 

 experimental physiologist. We can state from 

 frequent observation, that it is only in a certain 

 number of cases of disease, strictly belonging 

 to the head, such as apoplexy or hydrocephalus, 

 that death takes place exactly in the way of 

 coma, as above described, or that the function 

 of circulation can be observed to survive that 

 of respiration ; and on the other hand there 

 are many instances of disease of the lungs, 

 particularly of phthisis, in which the ultimate 

 extinction of life is rather in the way of syncope 

 than of asphyxia. The simple principle, that 

 the circulation, though not dependent on any 

 action of the nervous system, is liable to be 

 influenced in various ways by causes acting 

 on the nervous system, enables us to under- 

 stand that death may often take place, in the 

 course of diseases, in a way different from that 

 which the seat of the disease may lead us to 

 anticipate. 



Nevertheless it may often be of real and 

 practical importance, with the view of ac- 

 quiring clear and precise ideas of the modes 

 of fatal termination which are to be expected 

 in the course of diseases, and particularly of 

 such diseases as fever where the symptoms 

 immediately preceding death, and the causes 

 evidently inducing death, are remarkably various 

 in different individual cases, to study atten- 

 tively the phenomena, and causes, of the 

 fatal termination, in the simpler cases of violent 

 death, such as those which have been here 

 considered. 



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