104 Termination of Disease. 



labored, deep groaning- respirations following at irregular inter- 

 vals the ordinary shallow breathing. With the appearance of pul- 

 monary oedema, rales, heard even at a distance, are produced by 

 the fluid exudate beaten into a foam in the air passages (death 

 rattle). Involuntary discharges occur from the bowel and blad- 

 der, when paralysis of the sphincter muscles develops. The heart 

 beats more rapidly, but the relaxed arteries are no longer able to 

 propel the blood forward and the pulse in consequence, although 

 quick, grows small and finally indistinguishable, and the skin i? 

 cool. The hair is bathed with a clammy sweat. The body tem- 

 perature in the agonal period in diseases accompanied by loss of 

 blood or inanition falls considerably below normal (hypothermia, 

 to 36-35° C), while in other types there may be an ante- 

 mortem rise in temperature. Extinction of life means complete 

 cessation of metabolism, of cellular growth and the existence of 

 the individual ; and death therefore manifests itself by complete 

 termination of the functions of all parts of the body. The last 

 breath, naturally in the form of expiration, and the moment of 

 complete cessation of the heart may ordinarily be looked upon as 

 marking the actual end of life. However, the organs do not all 

 perish at precisely the same moment; after the last breath the 

 heart may flutter a few minutes ; and after death from haemorrhage, 

 peristaltic movements of the intestines may sometimes be ob- 

 served for perhaps fifteen minutes ; and similarly after death from 

 electricity muscular contractions may be elicited as long as rigor 

 mortis does not set in (one to three hours after death). 



The following are the characteristic signs of true somatic 

 death : 



1. Muscular rigidity {rigor mortis), sometimes setting in im- 

 mediately after death, sometimes only after four to twenty hours 

 later, and depending upon the coagulation of the muscle albumen. 

 The muscles in this change become set, shortened and thickened, as 

 in vital contractions ; the extremities are rigid and either cannot 

 be flexed or only with the application of considerable force, and 

 the mouth cannot be opened by ordinary traction upon the lower 

 jaw. After twenty-four hours, or perhaps later, the rigidity 

 disappears [due to decomposition]. 



2. Cadaveric fall of temperature (algor mortis) develops in 

 from half an hour to twenty-four hours after death, varying with 

 the surrounding temperature and the degree of metabolic activity 

 prevailing at the time of the death agony. In some affections, as 

 in tetanus, because of the important heat production caused by the 



