Seeing, then, that death from disease or accident is the rule, it behooves us, as guardians of the public health, to do our utmost to remove the causes of disease, and to treat that which is unavoidable with the greatest skill and caution. Death from disease may take place in two ways-either suddenly, the transition from life to death being made in a moment, without warning, or slowly and gradually, as the termination of some lingering disorder.. The most frequent causes of sudden death are, apoplexy; rupture of an aneurism or large blood vessel into one of the three great cavities of the body; disease of the valves of the heart-the liability to sudden death being greater in disease of the mitral valve than in aortic valvular disease; rupture of the heart, from fatty degeneration; laceration of the chordæ tendineæ; asphyxia, from obstruction of the glottis, or the bursting of purulent cysts into the air-passages; syncope, from severe shock or alarm; and injury of the spinal cord. As regards the last-mentioned cause of sudden death, it must be remembered that as the phrenic nerve arises from the third, fourth, and fifth cervical nerves, so any severe injury to the cord above the origin of the third nerve will produce instant death, by suddenly paralyzing the diaphragm and intercostal muscles; while if the injury occurs below the sixth vertebra the patient may live for some hours, if not days, although the action of the greater number of the intercostal muscles must be wholly or partially arrested. One or two examples of sudden death have occurred lately, in which the cause seemed to be latent pneumonia of one lung. Slight indisposition appears to have been complained of for a day or two, when suddenly, without any apparent reason, death has taken place. Dr. Quain and Mr. Ashton have related cases to this effect. A large number of instances of sudden death occur annually in this country from the different causes just enumerated. Very curiously, it appears that women have less chance of dying suddenly than men in the proportion of ten to eighteen —but that more women than men die from paralysis. This is proved by the following table, taken by Dr. Granville from the reports of the Registrar-General, of the number of sudden deaths, and of deaths from apoplexy and paralysis, in all England and Wales, males and females, for the years as fol lows:1 1 Granville on Sudden Death. SUDDEN. APOPLEXY. PARALYSIS. Male. Female. Total. Male. Female. Total. Male. Female. Total. Years. 1847 2154 1554 3708 4007 3874 7881 3376 3695 7069 1848 1811 1386 3197 3898 3704 7602 3213 3458 6671 1849 2012 1543 3555 3896 3901 7797 3428 3900 7328 1850 2025 1535 3560 4078 4016 8094 3473 3844 7317 Total, 8002 6018 14020 15879 15495 3137413490 14895 28385 Death as it occurs in disease is usually complicated: but in all cases, whether it take place suddenly or gradually, or whatever may be the malady, it approaches through one of the three vital organs-the brain, the heart, or the lungs. Life being inseparately connected with the circulation of arterial blood, death takes place directly the action of the heart is completely arrested; and since the action of the heart is dependent upon the more or less perfect condition of all the vital organs, which stand in a peculiar reciprocal relation to each other, a cessation of the functions of either of the three speedily arrests the remaining two. Thus innervation of the muscles of respiration depends upon the medulla oblongata, the energy of the medulla oblongata upon the decarbonization of the blood, and the decarbonization of the blood upon the circulation and respiration. The force of the heart, if not directly, is indirectly connected with the medulla oblongata, because the circulation of venous blood destroys the irritability of the muscles. And so it results that failure in any one of the three links in the chain is fatal. Hence Bichat spoke correctly of death beginning at the head, at the heart, and at the lungs. We may have then-1st, Death by Anaemia, that form which is caused by a want of the due supply of blood to the heart. The deaths from flooding after labor, from the bursting of aneurisms, &c., are good examples of this form; on examining the heart afterwards, the cavities are found empty, or nearly so, and contracted. 2d, Death by Asthenia, in which there is no deficiency of the proper stimulus to the heart's action-the blood, but a total failure of the contractile power of this organ. The effects of certain poisons-as hydrocyanic acid, of strong mental emotion, of lightning, &c., furnish good illustrations of this form. The state of suspended animation common to both these modes of dying, is termed syncope. 3d. Death by Asphyxia-or, as Dr. Watson terms it, by apnæa, or, as we say commonly, by suffocation-is that which occurs when the entrance of air into the lungs is in any way stopped, as in drowning, strangulation, spasmodic closure of the rima glottidis, &c.; in this mode death begins in the lungs. The blood being unaerated, continues venous, passes through the pulmonary veins into the left side of the heart, and thence through the arteries to all parts of the body. Venous blood, however, being unable to sustain the functions of the organs to which it is sent, its effect on the brain is at once seen by the convulsions and insensibility which ensue; the blood in the pulmonary capillaries becomes retarded, and gradually stagnates, leaving the lungs and right chambers of the heart full and distended. 4th, Death by Coma, in which extinction of organic life takes place in the same way as in the preceding case, the difference between the two forms of dying being this-that in death by apnoea, the chemical functions of the lungs cease first, and then the circulation of venous blood through the arteries suspend the sensibility; whereas in death by coma, the sensibility ceases first, and in consequence of this the movements of the thorax are arrested, as well as the chemical functions of the lungs. Thus the circulation of venous blood through the arteries is in the one case the cause, in the other the effect, of the cessation of animal life.1 CHAPTER IV. ON THE VARIOUS CIRCUMSTANCES WHICH HAVING shown in the previous chapter that disease consists of disordered action in one or more parts of the machinery of the body, it becomes necessary now to prove that these disordered actions vary much, in their nature, severity, and duration, in different individuals; being modified by age, sex, constitution, temperament, and many other circumstances which I now propose to speak of. To discriminate well the malady and the exact condition of the patient, and to regard both in the attempt to cure disease, must be the constant endeavor of the skilled practitioner. The same disease in one individual often assumes a different character in another, and requires consequently a different method of cure. as we never find two individuals perfectly alike in features, stature, strength, constitution, &c., so we learn that disease 1 Dr. Watson, op cit. Lecture V. Just becomes varied and modified, although its broad principles may remain unaltered. Physiologists have long since shown us, that a poison of such potency as to destroy the life of an animal in two minutes when introduced into the system, will produce its fatal effect in half a minute if the animal's strength be reduced by bleeding. We are all familiar with the fact that in typhus fever, for example, the patient will bear a very large quantity of alcohol without being affected by it, just as in tetanus and hydrophobia scarcely any amount of opium will tranquillize the nervous system. So, again, there are some few persons with constitutions so insensible to the action of mercury, that no quantity will affect their gums or increase the secretion of the salivary glands; while others, on the contrary, are so susceptible, that it is scarcely possible to administer a grain of this metal without giving rise to its specific effects. If, then, disease or constitution so qualifies the action of these powerful agents, is it not reasonable to suppose that many conditions of the system may in like manner modify disease? And this is really the case. How often, for instance, do we see many people differently circumstanced exposed to the same morbid agency with a varied result. Thus, of half a dozen persons exposed to the same noxious influence-say that of wet and cold-one shall have rheumatism, one an attack of influenza, a third catarrh, a fourth ophthalmia, and so on. Again, a man may be exposed to the influence of some infectious disease-as small-pox-and not being predisposed to suffer from infection may escape unharmed. Yet in a few days, nay, in a few hours, with his system depressed from fatigue, the same morbid element being encountered, he no longer escapes its influence, and the variolous poison takes root-so to speak-and produces its well-known fruit. Nature, thus apparently capricious, works according to certain general laws; and although our present knowledge may not enable us on all occasions to solve these laws, yet that they admit of solution there can be no doubt. The following are the circumstances which chiefly modify the nature, severity, and duration of disease: 1. Sex. Both sexes are equally liable to many diseases. Females, however, on account of the greater excitability of their nervous system, and owing to their possessing an organ -the uterus-whose lesions affect the whole system, are especially predisposed to nervous complaints; and such causes as give rise to inflammation in males, will in them often produce merely functional disorder. Thus gout and rheumatism often lurk unsuspected in the female system, causing dyspepsia, palpitation, uterine and neuralgic affections, without manifesting themselves more openly. It has been said that during the prevalence of epidemics women suffer less than men; which is probably to be accounted for. by their more regular habits, and their being less exposed to the exciting causes of these diseases. The uterus is the active centre of sympathies, from puberty to the period of the change of life. The regular flow of the catamenia becomes essential to health, and the interruption or cessation of the discharge, except under certain circumstances, often proves the cause of great constitutional disturbance. About the age of puberty women are apt to suffer from anæmia, chorea, and hysteria. The condition of pregnancy is favorable to health; while at the cessation of menstruation chronic inflammations and lesions of the uterus, diseases of the breast, disorders of the colon and rectum, and cancerous affections, are likely to occur. 2. Age. Each of the various epochs of life is liable to certain peculiar diseases. During the earliest period-from birth to first dentition-not only is the body very frail, but there is great irritability and sensitiveness, a predisposition to spasms and convulsions, to hydrocephalus, inflammation of the brain or its membranes, and to rickets, &c. Mankind spring not up full-formed, and ready armed for battling with adversity, like the fabled army from the teeth of dragons sown by Cadmus; but rather as the seed which is scattered from the hand of God over all the earth.' As then the young plant requires care and attention proportioned to its frailness, so the tender infant demands the most constant watchfulness and judicious management. The process of dentition alone keeps up a constant irritation which impairs the functions of the brain, alimentary canal, and skin; and many children die during teething. So slender indeed is the thread of life, and so serious are the various infantile diseases, that one child in every five dies within a year after birth, and one in three before the end of the fifth year. After the first dentition to the sixth or seventh year, the powers of life become more energetic; there is great excitement of the vascular and nervous system, easy exhaustion but also easy restoration. The predisposition is to inflammatory affections, to attacks of fever, and to the exanthematous disorders. In the inflammatory diseases of children there is a strong tendency to the formation of coagulable lymph, 1 On the Use of the Body in relation to the Mind. By G. Moore, M.D. |