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In this, death occurs from the stoppage of the heart's action, the causes
of which are as follows : —
1. Anaemia due to the sudden and excessive haemorrhage from
wounds of the large blood vessels, or of the internal organs, such as the lungs,
spleen, etc., or bursting of an aneurysm or a varicose vein.
2. Asthenia from the deficient power of the heart muscle as in fatty
degeneration of the heart, aortic regurgitation and certain poisons.
3. Shock inhibiting the action of the heart from sudden fright, blows
on the head or on the epigastrium, drinking a large quantity of cold water
when in a heated condition, extensive injuries to the spine or other parts
of the body, or from the sudden evacuation of natural or pathological fluids
from the body.
4. Exhausting diseases.
< Symptoms.—These are pallor of the face and lips, dimness of vision,
^dilated pupils, cold perspiration, feeling of sinking and impending death,
great restlessness, air hunger, noises in the ears, gasping respirations, nausea
^and possibly vomiting. The pulse is slow, weak and fluttering in anaemia,
and rapid in asthenia. Slight delirium, insensibility and convulsions precede
death. In collapse the patient retains consciousness, though the condition is
attended with failure of the heart's action.
Post-mortem Appearances.—The heart is contracted and the chambers
are empty when death has occurred from anaemia, but both the chambers
are found to contain blood in the case of death resulting from asthenia. The
lungs, brain and abdominal organs are usually found pale.
Heath is said to have taken place from asphyxia when the respiratory
function stops before the heart ceases to act.
Causes.—1. .Mechanical obstruction to the air-passages, e.g. foreign]
bodies, exudations, tumours, suffocation and drowning by blocking their
lumen from within ; strangulation and hanging by their compression from
without; and spasm of the glottis from mechanical irritation and irritant;
2. Absence of sufficient oxygen as in high altitudes or presence of inert
gases in the atmosphere,
3. Stoppage of movements of the chest resulting from exhaustion of the
respiratory muscles due to cold or debility ; paralysis of the respiratory
muscles from disease or injury of the medulla or phrenic or pneumogastric
nerves, mechanical pressure on the chest or abdomen, and tonic spasm due
to tetanus or poisoning by strychnine.
^* «£2^aPse °^ "tne hmgs from penetrating wounds of the thorax and
diseases, such as pleurisy with effusion, empyema, or pneumothorax.
**" ^Hon~entrance °^ kl00^ in"k° the lungs, as in embolism plugging the
Symptoms.—These are divided into three stages: (IXJIhe stage of
exaggerated breathing, (2) the stage of convulsions, and (3) the stage of
exhaustion. -*—-- —
-12. *ke :^rs* stage the face bears an anxious look, and the patient com-
plains of heaviness in the head and ringing in the ears. The lips are livid,
and the^ eyes are prominent. The accumulation of carbon dioxide in the
blood stimulates the respiratory^centre in the medulla, and the respirations
become deep, hurried and laboured, the extraordinary muscles of respira-