188 MEDICAL JURISPRUDENCE Causes of Death.—1. Shock.—Severe pain from extensive burns causes shock to the nervous system and produces a feeble pulse, pale and cold skin and collapse, resulting in death instantaneously or within twenty- four to forty-eight hours. In chil- dren it may lead to stupor and insensi- bility deepening into coma and death within forty-eight hours. In order to avoid the suggestion that coma was due to the drug it is advisable not to administer opium in any form for the alleviation of pain. Shock may also occur from fright before the individual is affected by burns, if his heart is weak or diseased. If death does not occur from shock, it may subsequently occur from toxae- mia due to the absorption of toxic products from the injured tissues in the burned area. In this condition the temperature rises perhaps to 104 °F., the pulse rate increases in frequency, and restlessness super- venes and passes into unconsciousness and death. 2. Suffocation.—Persons removed from houses destroyed by fire are often found dead from suffocation due to the inhalation of smoke, carbon- dioxide and carbon-monoxide—the products of combustion. In such a case burns found on the body are usually post-mortem. On or about the 12th January 1917, a lunatic in the asylum at Agra was suffocated in bed from smoke produced by the quilt with which he had covered his face catch- ing fire and the extensive superficial burns found on the body appeared to have been caused after death. Between 1 a.m. and 3 a.m. on the 6th January 1922, some dacoits broke into the house of one Kusher Lodh, aged 50 years, and, finding him and his son, 20 years old, sleeping in a room, chained it from outside. On leaving the house they set fire to rubbish lying at the door with the result that the father and the son died in the room. The post-mortem examination of both the bodies afforded clear evidence of death from suffocation. The larynx and trachea in both were congested with a deposit of soot along the interior. The lungs were congested and exuded frothy blood on section. The brain vessels were found engorged with blood. There was general venous engorgement. Externally the bodies showed a few small superficial burns on the face, thighs and legs with singeing of the hair of the head. 3. Accidents or Injuries.—Death may result from an accident occurring in an attempt to escape from a burning house or from injuries inflicted by walls and timbers falling on the body. 4. Inflammation of serous membranes and internal organs, such as meningitis, peritonitis, oedema glottidis, pleurisy, bronchitis, broncho-pneu- monia, pneumonia, enteritis and perforating ulcer of the duodenum. Fig. 62.—Extensive burns from clothes catching fire.