DEATH. 



801 



with all the other muscles in the system. In- 

 terruptions of the voice are obviously often due 

 to the state of the respiration. It must not be 

 omitted that in some instances the voice has 

 remained firm to the last. 



Of the signs of death derived from the 

 organic functions, the tirst in importance are 

 those belonging to the circulation. The mode 

 in which the action of the heart declines is 

 extremely various, but has for the most part 

 some connexion with the nature of the dis- 

 order. In maladies of considerable duration, 

 and in which for a long time all the func- 

 tions have suffered in a greater or less degree, 

 the cessation of the heart's motion is nearly 

 always gradual. The number of pulsations 

 may, within a brief period of decease, greatly 

 exceed the natural rate, but their energy is 

 impaired, and the quantity of blood expelled 

 at each systole is very small. In many 

 acute affections the failure is evidenced some- 

 times by increased frequency and diminished 

 vigour of the contractions, and sometimes by 

 their irregularity and frequency, the force being 

 but little altered. In such cases the cause of dis- 

 turbance is, without doubt, in some interruption 

 of the nervous connexions of the organ. In 

 other cases, the heart, before finally ceasing to 

 beat, contracts with great violence, and then 

 rapidly and suddenly comes to a stop. We 

 have frequently noticed this kind of action in 

 diseases of the brain, and have had reason to 

 think that the syncope was brought on by the 

 state of the respiration ; the latter effect, how- 

 ever, being itself due in no slight measure to 

 the irregular action of the heart. 



The increased frequency of the pulsations in 

 a debilitated state of the heart indicates a greater 

 susceptibility to the stimulus of the blood, at 

 the same time that the resulting contractions 

 are less efficient. The period of repose be- 

 tween the diastole and the systole is briefer 

 than in the normal action, besides that less 

 time is occupied by the systole itself, in conse- 

 quence perhaps of the very slight shortening of 

 the fibres. In a vigorous' heart the reverse of 

 this takes place; the irritability is not such as 

 to prevent a considerable pause after the dias- 

 tole, and the fibres undergo a much greater 

 degree of shortening. Why the irritability of 

 a part should increase to a certain extent with 

 increasing debility, is a problem yet to be 

 solved. But we have reason to think that it is 

 chiefly in acute diseases that the great rapidity 

 of the heart's action is presented, and that in 

 chronic affections there is a more gradual ex- 

 haustion of irritability. Inequality of arte- 

 rial action, when amounting to a great degree, 

 is one of the most threatening symptoms that 

 can be witnessed. We allude particularly to 

 that extraordinary pulsation of the carotids 

 which is sometimes observable, when the ra- 

 dial artery can scarcely be distinguished. It is 

 perhaps one of the strongest presumptions 

 that arteries possess a vital contractility, which 

 may be disturbed in them as in other parts of 

 the system. 



The state of the respiration in a moribund 

 person is extremely various; sometimes hur- 



ried and panting till within a few moments of 

 decease; sometimes ceasing gradually, in har- 

 mony with the languishing circulation ; but 

 sometimes slow, laborious, and stertorous, 

 and, as Haller expresses it, " dum anxietas 

 equidem cogit moliri, vetat debi!itas." : * In 

 addition to those causes of struggling respira- 

 tion which belong to the nervous centres and 

 to the circulation in the lungs, the function is 

 often dreadfully embarrassed by the accumu- 

 lation of fluids, mucous, serous, or purulent, 

 in the bronchia:. The quantity of these secre- 

 tions is often increased by a state of the bron- 

 chial membrane, analogous to what we shall 

 notice" presently in the skin, designated by 

 Laennec " the catarrh of the dying;" but the 

 mere accumulation of the natural quantity 

 from defect of those muscular actions which 

 usually remove it, whether in the fibres of 

 Keisseissen, or in the general respiratory appa- 

 ratus, is amply suiricient to cause exquisite 

 distress. Mediate or immediate auscultation 

 detects a loud guggling throughout the chest, 

 which is sometimes audible even at a little 

 distance, and the vibrations of which may be 

 felt by the hand. This sound must not be 

 confounded with the true" death-rattle," which 

 is produced not by struggles between air and 

 liquid in the bronchial ramifications, but by 

 the ejection of air from the lungs through the 

 fluid in the trachea. It is often followed by 

 a flow of spumous liquid through the mouth 

 and nostrils. 



The loss of animal heat occurs first in the 

 extremities, a fact easily explicable by the 

 smaller quantity of blood sent into them ; but 

 it is probable that the state of the nervous 

 system, and the cessation of the nutritive and 

 other capillary actions, which perform so im- 

 portant a part in calorification, may participate 

 in the production of the result in question. 

 The recession of heat from the limbs was no- 

 ticed by Hippocrates, but his mode of stating 

 the fact in one remarkable passage, his !.i>t 

 aphorism, appears considerably affected by his 

 theoretical views of the use of this agent in 

 the economy.f 



The secretions present nothing very charac- 

 teristic. If the disorder has been of short 

 duration, they may have undergone no consi- 

 derable change ; but when the declension of 

 life has been more gradual, they are all more 

 .or less altered. Tiie bile and the urine are 

 often found in their proper receptacles, of a 

 perfectly healthy character, after a short illness; 

 while in senile dissolution t ! iey are a!n;<-t 

 always scanty and vitiated. The generation of 

 gas in large quantities, so as to produce tym- 

 panites, is a very common occurrence at the 

 termination of acute diseases.]; We have al> 

 noticed loud borborygmi during the last few 

 hours of life, occasioned by large collections 

 of air, and by a preternatural excitement of 

 intestinal irritability, analogous to what we 

 have noticed in the heart and arteries. The 



* Elements Physiologiae, lib. xxx. $22. 

 t Hippocr. Aph. $ viii. 13. 

 j Hipp. Aph. viii. 17. 



