CHAPTER VI DEATH IN ITS MEDICO-LEGAL ASPECTS Definition.—Death is classified as somatic or systemic and molecular. JScmatic death is that state of the body in which there is complete cessation of the functions of the brain, heart and lungs which maintain life and health. and are, therefore, called u the tripod of life'". Molecular death means the death of the tissues and cells individually, which takes place some lime after the stoppage of the vital functions, and is accompanied by cooling of the body, the temperature of which is reduced to an equilibrium with the external world. MODES OF DEATH x Ju all kinds of death, whether natural or accidental, there are three primary modes of death, viz., 1. Coma. 2. Syncope. 3. Asphyxia. COMA Coma means insensibility resulting in death from some cause preventing the action of the brain. Causes.—1. .Compression of the brain resulting from injuries or diseases of the brain or its membranes, such as concussion, effusion of blood on, or in, the brain substance due to subarachnoid haemorrhage, fracture of the skull, inflammation, abscess or new growth of the brain, or embolism and thrombosis. 2. Poisons, such as opium, alcohol, carbolic acid, etc. having a specific action on the brain and nervous system. 3. Poisons acting on the brain after they are generated in the body in certain diseases of the liver and kidneys, e.g. cholsemia, acetonsemia, uraemia, etc. Symptoms.—First of all, there is a condition of stupor from which the patient may be roused temporarily for a few seconds or more. In_this condition the reflexes are usually present, or are exaggerated, and the patient may be able to swallow fluids. This is followed by complete unconscious- ness from which the patient cannot be roused. In some cases sudden insen- sibility supervenes without an initial stage of stupor. During the comatose condition the reflexes are lost, the sphincters are relaxed, and the pupils are dilated or contracted, and insensible to light. Tl^e skin is generally covered with cold perspiration, and the temperature is sub-normal or normal, except in the lesions of Pons Varolii, where it is high. TJue pulse is usually full and bounding, but slow. The breathing is slow, irregular and stertorous. Mucus collecting in the air passages causes the sound which is known as ~frtrie death rattle ". Post-mortem Appearances.—Injuries of the skull bones or of the brain and consequent effusion of the blood into the cranial cavity may be present. " The brain and its membranes are found congested. Haemorrhages within the cranium due to disease are found within the membranes or in the brain substance, but when due to injury, are commonly found in clots between the skull bones and the membranes, or on the surface of the brain. The right side of the heart is usually full and the left empty. The lungs and the venous systems are gorged with blood, but not so much as in death from asphyxia.