SUDDEN DEATH
Sudden death may proceed from natural or violent causes. From the former, death may occur unexpectedly and very rapidly, but as a rule the period of time occupied by the phenomena of “dying” is measurable, though inconstant. Should such period of time be immeasurable, death may be considered as instantaneous.
Apart from sudden death resulting from violence or poisoning, the common causes are as follows:—
1. Diseases of the heart: angina pectoris, valvular diseases with failure of compensation, especially aortic regurgitation, degeneration of the heart muscle, rupture of the heart, heart failure from diphtheria or toxic diseases.
2. Diseases of the blood-vessels: rupture of aneurysms or varicose veins, thrombosis, embolism.
3. Cerebral hæmorrhage, especially when in the region of the pons Varolii or cerebellum.
4. Lesions of the respiratory system: œdema or spasm of the glottis, membranous deposit or foreign bodies in the larynx or trachea, foreign bodies in the pharynx, tumours, whooping-cough, asthma, embolism of the pulmonary artery, air embolism, fat embolism, rupture of a vessel or aneurysm into the air-passages, as in phthisical cavities, pneumothorax, hæmothorax, pleuritic effusion, and in acute pneumonia.
5. Rupture of a gastric ulcer or ulcer of some other part of the alimentary tract.
6. Sudden hæmorrhage into the peritoneal cavity from ruptured uterus, ectopic gestation, &c.
7. Rupture of internal organs: distended bladder, spleen, pregnant uterus, or other abdominal viscus.
8. Hæmorrhage into the pancreas.
9. Conditions associated with the nervous system: mental emotions, epilepsy, uræmia, laryngismus stridulus in children.
10. Sudden death has occurred in Addison‘s disease, in diabetes, in cases of lymphatism or status lymphaticus in young people, during the early stage of chloroform anæsthesia, during simple vaginal examination in women, during the injection of fluids into the vagina or uterus. Bouvalat (Annales d‘Hygiène, 1892) relates a case in which, as the cannula of a syringe was being introduced into the os uteri of a woman with the object of criminal abortion, she fell back before any fluid was injected, and died in a few minutes.
A similar case came under my notice, in which death took place while the husband of the woman was attempting to introduce a solution of 20 minims of tincture of iodine, mixed with water to measure two drachms, into her uterus through a No. 3 catheter.