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120                                              MEDICAL JURISPRUDENCE

by external compression on the chest and abdominal walls, e.g. from falls
of earth; (d) by primary cessation of respiratory movements causing respi-
ratory failure, e.g. narcotic poisoning and deaths^ from electrical injuries;
(e) by breathing in vitiated atmospheres in which there is an excess of
carbon dioxide or inert gases.

II.    Reduced   oxygen-carrying   capacity   of   the   blood—ansemic   anoxia
occurring in acute  poisoning by carbon monoxide,  chlorates, nitrites, and
ccal-tar derivatives.

III.    Depression  of   the   oxidative   processes   in   the   tissues—histotoxic
anoxia seen in acute cyanide poisoning.

IV.    Inefficient  circulation  of the blood through the  tissues—stagnant
anoxia  occurring in deaths from traumatic shock, heat stroke, and acute
irritant and corrosive poisoning.

All these types of anoxia produce circulatory failure, which may lead
to death.

The post-mortem findings in all forms of death of medico-legal impor-
tance should be divided into two groups, namely, the basic pathological
changes of circulatory failure, such as visceral congestion and capillary
haemorrhages, and the special pathological changes depending upon the
particular type of death, e.g. local injuries to the neck in throttling, strangu-
lation and hanging. Gordon is of opinion that tissue anoxia, however in-
duced, leads to circulatory failure; hence the fundamental pathological
changes are uniform in all forms of death, although they vary in degree.
He adds that the relative absence of visceral congestion in deaths occurring"
from sudden primary cardiac failure supports the view that the degree of
visceral congestion is relatively less in rapid deaths as compared with deaths
occurring slowly. He further remarks that asphyxia cannot be regarded as
a distinct pathological entity which is recognizable on the basis of morbid


Sudden or unexpected death occurs from unnatural causes, such as vio-
lence~~oT poison, as well as from natural causes. Unnatural deaths have
always to be investigated by the police, but very often natural deaths form
the basis of medico-legal investigations if they have occurred suddenly and
under suspicious circumstances. In such cases a medical practitioner should
not certify to the cause of death without holding a post-mortem examination
even if there is strong evidence of disease.

Causes.—The natural causes producing sudden death are—

1.   Diseases of the heart, such as fatty degeneration of the heart, myo-
cardial degeneration, angina pectoris, valvular diseases with compensatory
failure, especially in aortic incompetence, spontaneous rupture of the heart
or its valves, acute diseases of the endocardium and pericardium and con-
genital abnormal conditions of the heart in infants and children.

2.   XUgeases of the blood vessels especially occlusion of the lumen of the
coronary artery from arteriosclerosis,  thrombosis  of the  coronary artery,
systemic   embolism,   pulmonary   embolism,   syphilitic   aortitis,   spontaneous
rupture of the aorta in chronic arteriosclerosis and rupture of aneurysms or
vericose veins.

A case2 is recorded in which an enema caused fatal cardiac embolism. Two weeks
after a suprapubic cystatomy was performed under laughing gas ansesthesia by Henry
an orderly gave the patient, aged 72, a simple soap water enema. He suddenly gave a
gasp and ceased to breathe. The autopsy showed that the pressure of the water dis-
lodged some blood clots in the prostatic venous plexus, and that the patient died of an
embolism in the right side of the heart.

2.   C. P. Henry and Harisbury, Atlantic Med. Jour., Nov. 1927, p. 77.