tions of death still more are the hysterical conditions and the cases of catalepsy, where the various functions of the body are reduced to a minimum for periods of longer duration, and not only are the pulse and respiration almost imperceptible, but there is also a condition of rigidity of the entire muscular system, simulating the cadaveric rigidity. The conditions assumed by the fakirs of India, where they seal themselves in a tomb for several weeks, are, for the most part, tricks of jugglery; but there seem to be a few authentic instances of self-hypnotization, aided by long practice and the use of drugs.2 Perhaps the most authentic account of the simulation of death voluntarily is the case of Colonel Townsend, of Edinburgh,3 who, in the presence of three persons (two physicians and a druggist), so completely inhibited his heart action and his respiration that, for over a period of half an hour, all three of them considered him to be dead. Mr. Cheyne held Colonel Townsend's pulse, Mr. Baynard held his hand over the colonel's heart, and Mr. Shrine held a mirror in front of the colonel's mouth and nose. No one of the three found any sign of life, and they were about to leave the room at the end of a half hour, thinking that the demonstration had been too successful. Then the colonel gradually began to show signs of recovery, and regained consciousness. That afternoon, however, after having made his will, the colonel did actually die. In spite of these cases it does not seem at all probable that to-day a medical practitioner could, after a careful examination, make a mistake which would lead to the burial of a live person. II. TIME OF death. 393. Instant of death. The determination of the instant of death is, however, a very different matter. Here we are confronted with the same problem as in the determination of live births. The time of death of the individual is not coincident with that of the death of all of his tissues. The eye responds to certain kinds of stimulation for a while after death of the body. Muscles respond to other stimulation. In fact, Regnardt and Loye saw a judicial decapitation at Troyes where the heart beat for an hour after the head had been separated from the body. Hofmann reports a similar case where Brouardel, La Mort et la Mort Su bite. 'See Brouardel, La Mort et la Mort Subite. 'Hofmann, Nouveaux Méd. Lég., Paris, 1880. Eléments de the heart was beating at the time of the autopsy on the body of a man who had been hung at Pesth, remaining hung for twenty minutes, and then, on examination, being declared dead. And a similar case after a hanging in Boston, where, after a hanging of twenty-five minutes, the body was considered dead, and taken down. Here, too, on opening the thorax, the right auricle was found beating. The persistence of the heart-beat after death from decapitation or from hemorrhage was also shown experimentally on dogs by Brouardel and Loye. Hence, we find that even the continuation of the action of the heart, which is generally taken as the criterion of the continuation of life, is not an absolute proof that the person is still alive, any more than the beating of the heart at the time of birth is proof that the infant is viable. 394. Order of deaths. A still more difficult problem is associated with this one; namely, that of survival. In the case of multiple deaths, this is a question on which the inheritance may depend, when a whole family is destroyed by a single accident. For instance, in a railroad accident, if the husband has his head cut off, and the wife shows no lesion at all, still, from the medical evidence, we cannot tell which of the two died first. So in a case of drowning referred to by Brouardel, where both husband and wife were drowned, and in their wills each left the heritage to the other. The question arose as to which died first. The man was seen to rise to the surface and struggle, but the woman was not seen again. The attorneys for the man held that he had lived longer, for he had come to the surface, and so obtained more air. On the other hand, the wife's attorneys held that the person who fainted at the moment of striking the water, and went directly to the bottom, would live longer than the one who evidently had not had any such inhibition. Brouardel held that it was impossible to tell which had died first; and that decision was upheld, and the estate divided accordingly. 8 A more complicated condition arose in the Pranzini case. An assassin, entering Madame Regnault's apartments, cut her throat, severing both carotid arteries, but not injuring her spine. She fell at the side of her bed, but in her hand held the cord of the bell rope. The maid had evidently heard the bell of her mistress, and put on her clothing, when she had her throat cut, and her spinal cord severed. Madame Regnault's daughter likewise had been killed, her head being practically cut off, only a few fibers of tissue holding the head. Cited by Brouardel. 'Cited by Brouardel. 'Brouardel, Ann. d'Hyg. Pub., 1887, XVIII., p. 305. to the trunk. The inheritance depended upon the sequence of the deaths; but, though Madame Regnault must have died from hemorrhage, the servant from lesion of the spinal cord, and the daughter by decapitation, it was impossible to say which had died first. Even in cases where death is witnessed by a medical man, the exact time of death cannot be sharply defined. If a man is attacked by several murderers, each of whom, about the same time, inflicts upon him wounds that might be fatal, it is impossible to tell which of the many has been the immediate cause of death, or which man struck the fatal blow. III. SIGNS OF DEATH. 395. In general.— The signs of death are not such that we can say that at a given instant the person is alive and at the next he is dead. When chemical changes are going on in the body according to physiological principles, we can say that that part of the body, at least, is not dead; but it is not practicable to test these on the instant. Only the evidence of these chemical changes as they exist in putrefaction and the allied conditions is a positive sign of death, and even these changes may be found in limited areas during life; as, in the cases of gangrene. 396. Cessation of response to stimulation. The evidences of death are first shown in the loss of response to external stimulation of the various sense organs: the loss of sensation and the loss of consciousness. With these come the cessation of respiration and of circulation of the blood. On these, as a rule, are based the statement that life is extinct. The loss of consciousness and of sensation we recognize by the fact that the person does not respond, can not be made to respond when we speak to him, shake him, or in any way stimulate him. It is the general test applied by the layman, but there are too many other conditions which give the same lack of response for this to be of any great value. 397. Cessation of respiration.-The cessation of respiration is tested by listening for the movements of the lungs and hearing none. As a rule, this is sufficient evidence; but, if desired, it may be confirmed by holding a mirror before the nose and mouth and noting the absence of condensation that follows when the moist, warm breath is breathed out against its surface. At times it is tested by holding a downy feather or some other light material before the nose, and noting that it is not disturbed by any current of air. Again, it has been suggested to place a vessel of water on the chest and note that there is no motion of the chest wall to cause ripples on the surface of the water. But all of these tests are liable to misinterpretation unless they are done with great precaution. 398. Cessation of circulation. The cessation of circulation is noted first in the disappearance of the radial pulse, and then in the absence of the heart sound on listening over the heart. If these tests do not give the desired precision, a number of other tests have been suggested. If a ligature is tied around the finger, and the circulation still exists, there appears a congestion of the finger beyond the ligature. If the finger nail be pressed, the pink color of the nail can be destroyed; but if the circulation is still going on the color promptly reappears on relaxing the pressure on the finger nail. If the web of the finger is looked through towards a strong light the web will appear pink and translucent during the time blood is circulating, but opaque after the stoppage of circulation. (diaphanous test.) If a needle is stuck into the tissue while the blood is circulating, it will tarnish; but if there is no circulation there will be no tarnishing of the needle. If a bit of fluorescein (resorcin-phthalein and sodium bicarbonate, of each one gram in eight cubic centimeters of water) be injected hypodermatically, there will be no discoloration if the circulation has stopped; but if the circulation is still active, there will be not merely a yellowish-green discoloration for some distance around the area of the injection, but the fluorescein may be identified at the distant parts of the body by immersing silk thread in the blood removed from those parts of the body, and boiling, when the threads will assume a greenish color. As tests for the activity of the heart, also, it has been proposed to insert needles into the heart muscle, through the chest wall, and note whether or not they move; and to open one or more of the superficial arteries to see if they contain blood. Such tests are not always applicable, and are generally unLecessary. It has also been suggested to test the vital reaction by dropping a bit of hot sealing wax or some other substance, or even some caustic, on the skin, and noting whether or not there is an inflammatory area of reddening produced around the burn. 399. Cessation of movements of the chest. In the last few years, too, the X-ray has added another test to this already long list. Bourgade1o says that the X-ray pictures of the thorax in the living person show diffuse outlines of the ribs, heart, and diaphragm even in the cases when the movements are reduced to the quietest form, but 'Icard, La Mort Réele et la Mort Apparent, 1897. 10 Bourgade, Comp. Rend. Soc. de Biol. de Paris, Vol. V., p. 103, 1898. that after death the outlines of these objects, even after an exposure of over a quarter of an hour, show no movement. 400. Examination of the eye.— The examination of the eye often adds considerable to the positiveness of the diagnosis of death. Immediately after death the cornea loses its lustre, and becomes glazed. The tension and the firmness of the eyeball fall with the lowered blood pressure. The iris does not respond to the action of light, but it may, for a few hours, until local death takes place, respond to the action of atropin or eserin. If the fundus of the eye be examined with an ophthalmoscope after death it will appear pale, so that the entrance of the optic nerve is no longer visible. The arteries usually seen in the fundus cannot be identified, and the veins show interruptions in their course. Post-mortem changes of color occur early in the sclera in many cases. As these changes progress, the loss of tension in the eyeball falls to zero, the cornea sinks, and the iris becomes flaccid, and later, wrinkled. 401. External suggillation. The color of the skin after death changes from the pink of life to a distinct pallor, though this may not be seen for some time in persons of a very ruddy complexion. Pigmentation that has existed before death does not disappear after death. As the blood settles by gravity into the dependent parts of the body, new color changes, due to this hypostasis and diffusion of the blood from the blood vessels into the surrounding tissues, take place. The dependent tissues in from three to ten hours begin to show spots of purplish or bluish discoloration, and to become edematous. The areas where pressure is exerted, as by creases in the clothing, remain pale. Tourdes claims11 that these spots may be made to disappear if the position of the body is changed at the end of four hours; then the spots will be found in the parts that, after the change of position, become dependent. After twelve to fifteen hours the areas that at first showed hypostatic discolorations may, if the body be turned, grow pale, but they do not disappear. And after thirty hours the primary hypostatic discolorations may grow pale, but secondary spots will not be formed in other places. These hypostatic changes probably take place in all bodies, though they are less marked in the bodies of persons who have died of hemorrhage or from some other cause of depletion, as in the cases of cholera. The appearance of these spots may possibly lead to the suspicion that they have been caused by injuries before death, which have led to ecchymoses; but "Tourdes, Dict. Encyclop. des Sci. Méd. |