Aids to Forensic Medicine and Toxicology | Page 7

pulse, sighing respiration, insensibility, dilated pupils, and
convulsions.
Post mortem the heart is found empty and contracted. When, however,
there is sudden stoppage of the heart, the right and left cavities contain
blood in the normal quantities, and blood is found in the venæ cavæ
and in the arterial trunks. There is no engorgement of either lungs or
brain.
2. =Asphyxia=, or death beginning at the lungs, may be due to
obstruction of the air-passages from foreign bodies in the larynx,
drowning, suffocation, strangling, and hanging; from injury to the
cervical cord; effusion into the pleuræ, with consequent pressure on the
lungs; embolism of the pulmonary artery; and from spasmodic
contraction of the thoracic and abdominal muscles in

strychnine-poisoning.
The symptoms of this condition are fighting for breath, giddiness,
relaxation of the sphincters, and convulsions.
Post mortem, cadaveric lividity is well marked, especially in nose, lips,
ears, etc.; the right cavities of the heart and the venæ cavæ are found
gorged with dark fluid blood. The pulmonary veins, the left cavities of
the heart, and the aorta, are either empty or contain but little blood. The
lungs are dark and engorged with blood, and the lining of the air-tubes
is bright red in colour. Much bloody froth escapes on cutting into the
lungs. Numerous small hæmorrhages (Tardieu's spots) are found on the
surface and in the substance of the internal organs, as well as in the skin
of the neck and face.
3. =Coma=, or death beginning at the brain, may arise from concussion;
compression; cerebral pressure from hæmorrhage and other forms of
apoplexy; blocking of a cerebral artery from embolism; dietetic and
uræmic conditions; and from opium and other narcotic poisons.
The symptoms of this condition are stupor, loss of consciousness, and
stertorous breathing.
The post-mortem signs are congestion of the substance of the brain and
its membranes, with accumulation of the blood in the cavities of the
heart, more on the right side than on the left.
It must be remembered that, owing to the interdependence of all the
vital functions, there is no line of demarcation between the various
modes of death. In all cases of sudden death think of angina pectoris
and the rupture of an aneurism.
The following is a list of some of the commoner causes of sudden
death:
(a) =Instantaneously Sudden Death=--
1. Syncope (by far the commonest cause).

2. Aortic incompetence.
3. Rupture of heart.
4. Rupture of a valve.
5. Rupture of aortic aneurism.
6. Embolism of coronary artery.
7. Angina pectoris.
(b) =Less Sudden but Unexpected Death=--
1. Cerebral hæmorrhage or embolism.
2. Mitral and tricuspid valvular lesions if the patient exerts himself.
3. Rupture of a gastric or duodenal ulcer; rupture of liver, spleen, or
extra-uterine gestation, or abdominal aneurism.
4. Suffocation during an epileptic fit; vomited matter or other material
drawn into the trachea or air-passages; croup.
5. Arterio-sclerosis may lead to thrombosis, embolism, or aneurism.
6. Poisoning, as by hydrocyanic acid, cyanide of potassium, inhalation
of carbonic acid or coal gas, oedema of glottis following inhalation of
ammonia.
7. Rapid onset of some acute specific disease, such as pneumonia or
diphtheria; collapse from cholera.
8. Heat-stroke, lightning, shocks of electricity of high tension.
9. Mental or physical shock.
10. Exertion while the stomach is overloaded.

11. Diabetic coma; uræmia.
12. Status lymphaticus. This is a general hyperplastic condition of the
lymphatic structures in the body, and is seen in enlargement of tonsils,
thymus, spleen, as well as of Peyer's patches and mesenteric glands. It
is a frequent cause of death during chloroform anæsthesia for slight
operations in young people.
In addition, it may be as well to remember that death sometimes occurs
suddenly in exophthalmic goitre, hypertrophy of the thymus, and in
Addison's disease.
In some cases of sudden death nothing has been found post mortem,
even when the autopsy has been made by skilled observers, and the
brain and cord have been submitted to microscopical examination.

VI.--SIGNS OF DEATH
(1) Cadaveric appearance; ashy white colour. (2) Cessation of the
circulation and respiration, no sound being heard by the stethoscope.
Cessation of the circulation may be determined by (a) placing a ligature
round the base of a finger (Magnus' test); (b) injecting a solution of
fluorescin (Icard's test); (c) looking through the web of the fingers at a
bright light (diaphanous test); (d) the dulling of a steel needle when
thrust into the living body; (e) the clear outline of the dead heart when
viewed in the fluorescent screen. (3) The state of the eye; the tension is
at once lost; iris insensible to light, fundus yellow in colour; cornea dull
and sunken. (4) The state of the skin; pale, livid, with loss of elasticity.
(5) Extinction of muscular irritability. The above signs afford no means
of determining how