IV.—EXAMINATION OF PERSONS FOUND DEAD
When a medical man is called to a case of sudden death, he should carefully note anything likely to throw any light on the cause of death. He should notice the place where the body was found, the position and attitude of the body, the soil or surface on which the body lies, the position of surrounding objects, and the condition of the clothes. He should also notice if there are any signs of a struggle having taken place, if the hands are clenched, if the face is distorted, if there has been foaming at the mouth, and if urine or fæces have been passed involuntarily. Urine may be drawn off with a catheter and tested for albumin and sugar.
If required to make a post-mortem examination, every cavity and important organ of the body must be carefully and minutely examined, the seat of injury being inspected first.
V.—MODES OF SUDDEN DEATH
There are three modes in which death may occur: (1) Syncope; (2) asphyxia; (3) coma.
1. Syncope is death beginning at the heart—in other words, failure of circulation. It may arise from—(1) Anæmia, or deficiency of blood due to hæmorrhage, such as occurs in injuries, or from bleeding from the lungs, stomach, uterus, or other internal organs. (2) Asthenia, or failure of the heart's action, met with in starvation, in exhausting diseases, such as phthisis, cancer, pernicious anæmia, and Bright's disease, and in some cases of poisoning—for example, aconite.
The symptoms of syncope are faintness, giddiness, pallor, slow, weak, and irregular pulse, sighing respiration, insensibility, dilated pupils, and convulsions.
Post mortem the heart is found empty and contracted. When, however, there is sudden stoppage of the heart, the right and left cavities contain blood in the normal quantities, and blood is found in the venæ cavæ and in the arterial trunks. There is no engorgement of either lungs or brain.
2. Asphyxia, or death beginning at the lungs, may be due to obstruction of the air-passages from foreign bodies in the larynx, drowning, suffocation, strangling, and hanging; from injury to the cervical cord; effusion into the pleuræ, with consequent pressure on the lungs; embolism of the pulmonary artery; and from spasmodic contraction of the thoracic and abdominal muscles in strychnine-poisoning.