SIGNS OF DEATH.
The cessation of respiration and the absence of audible heart-beats are signs generally regarded as sufficient in themselves to determine the reality of death. But persons have been resuscitated from a state of asphyxia or have recovered from a state of catalepsy or lethargy in whom, to all appearances, the respiratory and circulatory processes have been arrested.
So it is advisable that we should be acquainted with some absolute tests of death which are not connected with the heart-sounds or the respiration.
It is well known that these important functions, although apparently held in abeyance, must be speedily re-established so as to be recognized, or death will rapidly follow. This condition of apparently suspended animation is seen among hibernating animals; the bear, for instance, will remain for four or five months without food or drink in a state of lethargy—the heart-action and respiration hardly appreciable. Yet it will be sufficiently rapid to sustain life during the slow metabolic processes. A number of well-authenticated cases are reported in which persons could slacken their heart-action, so that no movement of the organ could be appreciated. The case of Colonel Townsend, reported by Cheyne, is an example. He possessed the power of apparently dying, by slowing his heart so that there was no pulse or heart-action discernible. The longest period he could remain in this inanimate state was half an hour.
Instances have occurred in the new-born child where without question there have been no heart-beats or respiratory movements for a number of minutes, the limit being set at five.
These are exceptional cases, and it is setting at defiance all physiological experience to suppose that the heart-action and respiration can be suspended entirely when once they are established, for a period as long. So, then, if no motion of the heart occurs during a period of five minutes—a period five times as great as observation warrants—death may be regarded as certain.
The respiratory movements of the chest are sometimes very difficult to observe. They can always be better appreciated if the abdomen and chest are observed together. There are two methods to determine whether respiration is absolutely suspended or not. First, by holding a mirror in front of the open mouth, observing whether any moisture collects on its surface. Second, by placing on the chest a looking-glass or basin of water, and reflecting from it an image by artificial or sun light. The slightest movement would be registered by a change in position of the image. While the writer considers the absence of heart-beats and of respiratory movement an absolute test of death, still some cases may occur in which the establishment of this test is very difficult, and the following additional tests may be employed:
1. Temperature of the body same as surrounding air.
2. Intermittent shocks of electricity at different tensions passed into various muscles, giving no indication whatever of irritability.
3. Careful movements of the joints of the extremities and of the lower jaw, showing that rigor mortis is found in several parts.
4. A bright needle plunged into the body of the biceps muscle (Cloquet’s needle test) and left there, showing on withdrawal no signs of oxidation.
5. The opening of a vein, showing that the blood has undergone coagulation.
6. The subcutaneous injection of ammonia (Monte Verde’s test), causing a dirty-brown stain indicative of dissolution.
7. A fillet applied to the veins of the arm (Richardson’s test), causing no filling of the veins on the distal side of the fillet.
8. “Diaphanous test:” after death there is an absence of the translucence seen in living people when the hand is held before a strong light with the fingers extended and in contact.
9. “Eye test:” after death there is a loss of sensibility of the eye to light, loss of corneal transparency, and the pupil is not responsive to mydriatics.