802 



DEATH. 



secretion of saliva is almost always suppressed, 

 and the mucus about the mouth and nasal 

 passages is so deficient, that the lips and 

 tongue require constant moistening when arti- 

 culation is attempted ; not to mention the inex- 

 tinguishable thirst which is one of the most 

 painful forerunners of some forms of dissolu- 

 tion. The perspirable secretions are generally 

 rather profuse than scanty. The cutaneous 

 surface, particularly about the face, is bedewed 

 with a clammy exudation. It cannot be said 

 that the weakness of the circulation is the 

 immediate cause of this circumstance, because 

 it frequently happens in a very opposite state 

 of the function. It is true that the latter fact 

 has been explained by supposing a transuda- 

 tion of the thinner part of the blood through the 

 coats of the capillary vessels during their disten- 

 tion, while the former has been attributed to a 

 spasm of the same vessels, consequent on the 

 diminished force of the circulation, and said 

 to have the effect of squeezing out the same 

 serous liquid. In each case we must presume 

 the perspired fluid to be in a state of separa- 

 tion before the supposed agency can come into 

 operation. The hypothesis is supported by 

 little evidence ; but we are not sure that any 

 other interpretation can be found much more 

 conclusive. It seems probable, however, that 

 the fact in question results less from so mecha- 

 nical a process as has been hinted at, than 

 from a chemical alteration in the fluids, in- 

 duced perhaps by a change of innervation, in a 

 manner analogous to those extraordinary 

 changes which the secretions so frequently pre- 

 sent under the influence of mental emotion. 



It remains for us to enumerate a few of the 

 signs of approaching dissolution, derived from 

 the general aspect of the body. Many of 

 these have been described by Hippocrates with 

 unrivalled accuracy. The sunken eyes, the 

 hollow temples, the sharpened nose, the fore- 

 head dry, tense, and harsh, the complexion 

 sallow, livid, or black, the lips cold, flaccid, 

 and pale, or of a leaden hue compose the 

 celebrated fades Hippocratica* All these signs 

 admit of an easy rationale by the state of the 

 circulation and of the muscular system. They 

 are however in some measure due to the con- 

 dition of the cellular tissue, which, indepen- 

 dently of its loss of fat, is exhausted of that 

 interstitial fluid, which in health contributes so 

 much to the firmness and equality of the cu- 

 taneous surface. In proof of this we may men- 

 tion that all the appearances enumerated may 

 be produced merely by a violent illness of a 

 few hours ; by cholera for instance, a disease 

 in which the serous fluid is rapidly drained 

 from the system into one channel. Excessive 

 fatigue and fasting will occasion appearances 

 very similar, and therefore the Father of Medi- 

 cine recommends us to ascertain whether such 

 causes have been in action, before we pro- 

 nounce the patient to be moribund. A partial 

 closure of the eyelids and a gaping mouth 



* These signs are not thus grouped together in 

 the original, but are individually mentioned in the 

 book <4 TIpoyvuffTMOv," not the " rif>t 



are signs, when conjoined with the others, of 

 fearful import. There must be an extreme 

 depression of the nervous system when the 

 orbicularis is unable to bring the lower lid into 

 contact with the upper, which has drooped 

 from relaxation of the levator palpebra, and 

 when the masseter and temporal muscles resign 

 the lower jaw to gravitation. A supine posi- 

 tion with the limbs extended, and a tendency 

 to slide down to the lower part of the bed, are 

 indications of mortal prostration. In the pos- 

 ture alluded to there is little or no muscular 

 exertion ; for the extension of the legs, when 

 the body lies upon the back, is not necessarily 

 maintained by the action of the extensor mus- 

 cles, since the mere support of the surface on 

 which they rest would keep them in that posi- 

 tion. The sliding down in the bed is owing to 

 the inability of the glutseal muscles to resist 

 the gravitation of the trunk down the inclined 

 plane, upon which this part of the body is 

 extended when the head and shoulders are 

 resting upon the pillow. When the prostration 

 is less extreme, it often happens that instead of 

 the extremities being carried forward by the 

 impulse alluded to, the thighs are raised, the 

 knees bent, the soles rest flat upon the bed, 

 and the heels afford a sufficient resistance to 

 the nates to prevent any further descent. It is 

 evident that this position of the legs and thighs, 

 though requiring a muscular effort for its pro- 

 duction, needs little or none for its mainte- 

 nance. 



The moribund are often impatient of any 

 kind of covering. They throw off the bed- 

 clothes, and lie with the chest bare, the arms 

 abroad, and the neck as much exposed as 

 possible. These actions we believe to be 

 prompted by instinct, in order that neither 

 covering 7 nor even contact with the rest of the 

 body may prevent the operation of the air 

 upon the skin. There are actions and re-ac- 

 tions between the air and the blood in the 

 skin, similar to those wl.'ich occur in the 

 lungs, and hence in asphyxial disorders the 

 symptoms alluded to are very marked; but 

 the mere influence of the air upon the cuta- 

 neous nerves has been proved by Dr. Edwards 

 to be beneficial to the vital powers. Certain it 

 is that these symptoms are sometimes prominent 

 in cases where the respiration is very little in- 

 volved in the mortal struggle. Orfila, in one 

 of his cases of poisoning by sulphuric acid, 

 mentions that the subject of it made con- 

 stant efforts to remove even the lightest kind 

 of covering. 



The appearance of the face is by no means 

 such as we have described it above, in all cases. 

 The kind of death must always have a great 

 influence on the expression. On fields of 

 battle the corpses of those who died of stabs 

 are easily distinguished by the countenance, 

 from those who fell by gun-shot. In the for- 

 mer an extremely painful impression must 

 have been transmitted to the brain, which pro- 

 duced the usual change in the nerves and 

 muscles of expression; in the latter a con- 

 cussion was given to the whole system, para- 

 lysing without any intermediate sensation, so 



