SIGNS OF ACTUAL DEATII.
The discrimination of true from apparent death is not a matter of mere physiological interest. It is of great importance that the medical practitioner should be able to decide in doubtful cases whether the resources of art may be dispensed with, or the rites of sepul ture be permitted, as well as to give evidence, in certain medico-legal inquiries, of the pre cise period at which an individual expired. We have not space to record the numerous cases that may be met with in various authors, proving that even the most sagacious and ex penenced observers have been at times de ceived as to the reality of death. In the works of the ancients there are frequent allusions to premature interments. Pliny has a chapter, " De his qui elati revixerunt ;" and among other cases mentions that of a young man of rank, who was revived by the beat of his funeral pyre, but who perished before he could be rescued from the flames. " Moe est con ditio mortalium," is the reflection of the phi losopher, " basce ejusmodi occasiones for tunw gignimur, tit de homine ne morti quidem debeat credi." Celsus asks, " si certa futurm mortis indicia sunt, quomodo interdum de serti medicis convalescant, quosdamque fama prodiderit in ipsis funeribus revixisse ? " " Complura fuerunt exempla," says Lord Bacon, " hominum, tanquam mortuorum aut expositorum a lecto, aut delatorum ad funus, quinetiam nonnullorum in terra conditorum, qui nihilominus revixerunt." In the writings of Winslowt and Bruhier will be found an ample collection of melan choly instances of premature interment, besides those which are scattered through various sys, tematic works upon forensic medicine. Un intentional vivisection, moreover, has befallen other instances than the celebrated subject of Vesalius. Few of our readers have not shuddered at the tale of the dismal fate of the Abbe Prevost, who, having been struck with apoplexy in the forest of Chantilly, was taken home for dead, but recovered his con sciousness under the scalpel, and died im mediately afterwards. We must not recount the marvellous recoveries recorded by French authors, of Madame Mervache, the wife of a jeweller at Poitiers, who was restored to life in her grave, by the attempts of a robber to despoil her of the rings with which she had been buried ; and of Francois Civille, a Nor man gentleman, whose custom it was to add to the signature of his name, " trois fois mort, trois fois enteral, et trois fois par la grace de Dieu ressuscite." The English reader will find an interesting selection of cases in the Appendix to Dr. Smith's Principles of Fo rensic Medicine, and in the article Premature Interments in the Encyclopzedia Britannica. We shall only add that Bruluer collected fifty two cases of persons buried alive, four of per sons dissected prematurely, fifty-three of per sons who recovered without assistance after they were laid in their coffins, and seventy-two falsely reported dead.§ We shall arrange the indications of death under three heads :— 1st. Signs of the extinction of vital functions and .properties.
2dly. Changes in the tissues.
3dly. Changes in the external appearance of the body.
1. The arrest of the circulation and respi ration would at first appear to afford decisive evidence.that a person is no longer alive. But this sign is liable to the two-fold objection that we cannot distinguish with absolute certainty the minimum of the functions mentioned, from their complete annihilation, and that re coveries have taken place after their real or apparent cessation. The case of Colonel Townsliend, related by Cheyne,l' is too well known to need recital here. Perhaps the most
unequivocal examples of their suspension are certain cases on record of restoration after sub mersion for several minutes. In some of these there is good reason to believe that there was no genuine asphyxia, but that syncope took place immediately, and consequently that there was no stagnation of blood in the extremities of the pulmonary arteries. As to the alleged cases of persons who have been said to lie many hours and even days without pulse or breathing, we do not hesitate to express a belief that the observers were deceived, and that in reality both these functions were per formed, but in so low a degree as to escape detection, just as hybernating animals were supposed to be, during their torpor, in the pre dicament alluded to, until the researches of Dr. M. Hall proved that these animals do actually respire and maintain their circulation, though in a much less degree than when awake. It will be the duty- of the practitioner to adopt every method within his reach of ascertaining the actual condition of these func tions; but he must remember that they are often inefficient and even fallacious. Thus, with regard to the common modes of trying the respiration by a mirror, or by light downy bodies placed near the mouth and nostrils, it is obvious that the former may retain its clearness, because the halitus is not in suf ficient quantity to stain it, or may be dimmed by exhalations from the air-passages which are not the products of respiration ; and that the downy substances may be stirred by currents of air, or remain unmoved by the trivial ex change which takes place between the external atmosphere and the air in the chest of the person examined. Winslow's test of a vessel full of water placed on the lowest part of the thorax is of little utility, since we know that the diaphragm may be the only muscle em ployed in expanding the chest. As to the circulation, it may continue though no pul sation can be felt over the arteries or the car diac region, and no sound be perceptible by auscultation mediate or iinmediate. Few prac titioners would be vvilling to apply M. Fou bert's test, to wit, that of making an incision in one of the intercostal spaces, and feeling the heart with the finger ! The loss of irritability in the muscular fibres is of far greater consequence than either of the. foregoing signs. It may be present when re covery is out of the question, but its absence is quite conclusive. Galvanism affords a cer tain and ready method of detecting this pro perty. According to the researches-of Nystent irritability is first extinguished in the left ven tricle; after forty-five minutes it has left the intestines and stomach ; a little later the blad der; after an hour the right ventricle; after an hour and a half the cesophagus; after an hour and three quarters the iris. It next takes leave of the muscles of the trunk, then the lower and upper extremities, and lastly the right auricle. The duration of contractility' is short ened by a warm and humid state of the at mosphere by ammoniacal gas, carbonic acid, and sulphuretted hydrogen. It is unaffected by carburetted hydrogen chlorine, and sulphur ous acid ; nor is it found diminished in cases of asphyxia by strangulation and immersion. The annihilation of that particular kind of contractility of tissue, which is equally dis tinct from muscular contractility, irritability, and elasticity, is one of the surest signs of death. We see it wanting in the collapsed edges of a wound which has been inflicted on the skin of a dead body, as contrasted with the gapino- appearance of a similar lesion made during life.