CHAPTER XII.
SUDDEN DEATH.
The idea commonly entertained is that with animal bodies there are only two possible conditions—either life or death; that the presence of one of these conditions implies the absence of the other; that when the body has assumed the appearance of death, as during the sudden suspension of all the functional activities, it must be dead. This last is far from being true; for all the appearances of death are fallacious, especially those that accompany so-called sudden death. All such cases should be challenged as of doubtful character, and held so till recovery or putrefaction of the tissues proves the presence of life or of death. This subject is too often treated by medical writers with indifference. Technically, it is regarded as a failure of the brain, or lungs, or heart, to perform their functions; popularly, we say that “the thread of life is snapped asunder;” or it is “the going out of life,” like the sudden extinguishing of a candle. The author’s experience, however, at the sick bedside, and in the death-chamber, has taught him that life leaves the body in a gradual manner, and that death approaches, and takes the place of life, in one part or organ after another, thus creeping through the tissues, and sometimes defying all tests to prove its presence, leaving putrefaction to be its only sign. There can be no such thing as veritable sudden death, unless the body is crushed into a shapeless mass, like an insect under foot.
The late Dr. Farr, of the Registrar-General’s Department, London, says:—“No definition of the sense in which sudden death is practically understood by coroners has been given.” Dr. Granville says: “The writers on medical jurisprudence do not state with any strictness what they mean by sudden death, whether it be death in ten minutes, ten hours, or ten days.”[9] And he asks in the same vein, “Does sudden death mean death in three minutes, three hours, or three days?”[10] Still further he remarks regarding the customary definitions, “They lead one to infer that a certain mysterious principle, called LIFE, has been instantaneously withdrawn from a healthy and well-constituted individual, who was at the very moment, as heretofore, exercising his proper animal functions with a regularity that promised to endure for a long continuance of years.... No such phenomena occur in Nature, unless through violence or from accident. Under Nature’s laws there is no such thing as sudden death.... In every case where death has abruptly cut short the thread of life, there has been a preparation, more or less antecedent to the occurrence, which must inevitably have led to it.... The victim may seem to have been struck down, as if by lightning. But in reality the event was only the natural termination of an inward state of things which insidiously and unexpectedly was preparing the blow.”[11]
DR. TIDY ON CAUSES OF DEATH.
Dr. Tidy, in “Legal Medicine,” p. 29, says:—“As a rule, the action required to bring about complete molecular death—i.e., the suspension of vital activity in every part—is progressive. In a given case, therefore, we are unable to state any definite time as the period of its occurrence. The popular idea of death is that the entire body dies at once. Somatic death is an impossibility.” Thus, it is clear that the process of death, or the departure of life, may require days or weeks for its completion; and it may even be delayed to a time when putrefaction has set in quite generally, as when the hair and nails grow after the body has been buried some weeks, as has been credibly reported. Writers upon so-called sudden death recite a number of diseases and conditions which quickly destroy the machinery that carries on the vital functions, thus rendering resuscitation quite impossible. Tidy[12] names some twelve of such causes: prominent among them are diseases of the heart, rupture of the heart, clots in the blood vessels, aneurisms, effusions of blood in the brain, bursting of visceral abscesses, ulcers of the stomach, extra-uterine pregnancy, rupture of the uterus or bladder, large draughts of cold water taken when the body is heated, cholera, alcoholic poisoning, mental emotions, etc. But he remarks upon these causes—“Because a person dies suddenly, there being no evidence of violence or poison, the action adopted by many coroners in not requiring a post-mortem examination leaves the most important witness—the dead body itself—unheard, and the inquest so far valueless.” Which may mean that, without the risk of an autopsy, it is impossible in such cases to determine whether they are beyond resuscitation or not, unless putrefaction settles the question. Unfortunately there is nothing in the external appearance of those cases of so-called sudden death in which the vital machinery may be totally wrecked, to distinguish them from those of apparent death, in which all the organism is in a state of perfect integrity, and in which resuscitation is possible, provided the vital principle has not entirely left the body. Consequently, the only safe rule to observe in all cases in which death has not followed poisoning, or injuries which kill outright, or some known disease of sufficient duration and severity to bring on dissolution, is to wait for unmistakable evidences of decomposition before autopsy, embalming, cremation, or burial is allowed.
In former times precipitate interments of persons who died suddenly were specially guarded against.