The loss of animal heat occurs first in the extremities,—a fact easily explicable by the smaller quantity of blood sent into them ; but it is probable that the state of the nervous system, and the cessation of the nutritive and other capillary actions, which perform so im portant a part in calorification, may participate in the production of the result in question. The recession of heat from the limbs was no ticed by Hippocrates, but his mode of stating the fact in one remarkable passage, his last aphorism, appears considerably affected by his theoretical views of the use of this agent in the economy.f The secretions present nothing very charac teristic. If the disorder has been of short duration, they may have undergone no consi derable change ; but when the declension of life has been more gradual, they are all more or less altered. The bile and the urine are often found in their proper receptacles, of a perfectly healthy character, after a short illness; while in senile dissolution they are almost always scanty and vitiated. The generation of gas in large quantities, so as to produce tym panites, is a very common occurrence at the termination of acute diseases.t We have also noticed loud borborygmi during the last few hours of life, occasioned by large collections of air, and by a preternatural excitement of intestinal irritability, analogous to what we have noticed in the heart and arteries. The secretion of saliva is almost always suppressed, and the mucus about the mouth and nasal passages is so deficient, that the lips and tongue require constant moistening when arti culation is attempted; not to mention the inex tinguishable thirst which is one of the most painful forerunners of some forms of dissolu tion. The perspirable secretions are generally rather profuse than scanty. The cutaneous surface, particularly about the face, is bedewed with a clammy exudation. It cannot be said that the weakness of the circulation is the immediate cause of this circumstance, because it frequently happens in a very opposite state of the function. It is true that the latter fact has been explained by supposing a transuda tion of the thinner part of the blood through the coats of the capillary vessels during their disten tion, while the former has been attributed to a spasm of the same vessels, consequent on the diminished force of the circulation, and said to have the effect of squeezing out the same serous liquid. In each case we must presume the perspired fluid to be in a_ state of separa tion before the supposed agency can come into operation. The hypothesis is supported by little evidence ; but we are not sure that any other interpretation can be found much more conclusive. It seems probable, however, that the fact in question results less from so mecha nical a process as has been hinted at, than from a chemical alteration in the fluids, in duced perhaps by a change of innervation, in a manner analogous to those extraordinary changes which the secretions so frequently pre sent under the influence of mental emotion.
It remains for us to enumerate a few of the signs of approaching dissolution, derived from the general aspect of the body. .Many of these have been described by IIippocrates with unrivalled accuracy. The sunken eyes, the holloi,v temples, the sharpened nose, the fore head dry, tense, and harsh, the complexion sallow, livid, or black, the lips cold, flaccid, and pale, or of a leaden hue—compose the celebratedfacies Hippocratica.'* All these signs admit of an easy rationale by the state of the circulation and of the muscular system. They are however in some measure due to the con dition of the cellular tissue, which, indepen dently of its loss of fat, is exhausted of that interstitial fluid, which in health contributes so much to the firmness and equality of the cu taneous surface. In proof of this we may men tion that all the appearances enumerated may be produced merely by a violent illness of a few hours; by cholera for instance, a disease in which the serous fluid is rapidly drained from the system into one channel. Excessive fatigue and fasting will occasion appearances very similar, and therefore the Father of Medi cine recommends us to ascertain whether such causes have been in action, before we pro nounce the patient to be moribund. A partial closure of the eyelids. and a gaping mouth are signs, when conjoined with the others, of fearful import. There must be an extreme depression of the nervous system when the orbicularis is unable to bring the lower lid into contact with the upper, which has drooped from relaxation of the levator palpebroe, and when the masseter and temporal muscles resign the lower jaw to gravitation. A supine posi
tion with the limbs extended, and a tendency to slide down to the lower part of the bed, are indications of mortal prostration. In the pos ture alluded to there is little or no muscular exertion ; for the extension of the legs, when the body lies upon the back, is not necessarily maintained by the action of the extensor mus cles, since the mere support of the surface on which they rest would keep them in that posi tion. The sliding down in the bed is owing to the inability of the glutwal muscles to resist the gravitation of the trunk down the inclined plane, upon which this part of the body is extended when the head and shoulders are resting upon the pillow. When the prostration is less extreme, it often happens that instead of the extremities being carried forward by the impulse alluded to, the thighs are raised, the knees bent, the soles rest flat upon the bed, and the heels afford a sufficient resistance to the nates to prevent any further descent. It is evident that this position of the legs and thighs, though requiring a. muscular effort for its pro ductiOn, needs little or none for its mainte nance.
The moribund are often impatient of any kind of covering. They throw off' the bed clothes, and lie with the chest bare, the arms abroad, and the neck as much exposed as possible. These actions we believe to be prompted by instinct, in order that neither covering' nor even contact with the rest of the body may prevent the operation of the air upon the skin. There are actions and re-ac tions between the air and the blood in the skin, similar to those which occur in the lungs, and hence in asphyxial disorders the symptoms alluded to are very marked ; but the mere influence of the air upon the cuta neous nerves has been proved by Dr. Edwards to be beneficial to the vital powers. Certain it is that these symptoms are sometimes prominent in cases where the respiration is very little in volved in the mortal struggle. Orfila, in one of his cases of poisoning by sulphuric acid, mentions that the subject of it made con stant efforts to remove even the lightest kind of covering.
The appearance of the face is by no means such as we have described it above, in all cases. The kind of death must always have a great influence on the expression. On fields of battle the corpses of those who died of stabs are easily distinguished by the countenance, from those who fell by gun-shot. In the for mer an extremely painful impression must have been transmitted to the brain, which pro duced the usual change in the nerves and muscles of expression ; in the latter a con cussion was given to the whole system, para lysing without any intermediate sensation, so that no expression remained more than that of the repose of the muscles. The nature of the disease also modifies the facial expression of the dying. In some we observe the impress of the *previous suffering, as in peritonitis and in cases of poisoning by irritants ; in others the character is derived from a peculiar affec tion of some part of the respiratory apparatus, as of the diaphragm in pericarditis ; or from an affection of the facial muscles themselves, as in tetanus and paralysis. But the condition of the mind is perhaps more often concerned in the expression than even the physical cir cumstances of the body. For, as some kind of intelligence is frequently retained, and strong emotions are experienced till within a few moments of dissolution, the features may be sealed by the band of death in the last look of rapture or of misery—of benignity or of anger. Every poetical reader knows the pic ture of the traits of death (no less true than beautiful) drawn by the author of the "Giaour." But such observations are not confined to poets. Haller could trace in the dying coun tenance the smile which had been lighted by the hope of a happier existence : " Agfill gentis fitgienti aninix spei ?ton rar6 in mori bundis signa vidi, qui serenissimo vultu, non sine blando subrisu, de vitil excesserunt.'"' Watchers of the dead have often affirmed, and we can ourselves testify to the fact, that a smile has appeared upon the countenance some hours after death, though no such expression had been witnessed at the time of the event ; which is not difficult of interpretation if we consider that an extremely slight muscular action is sufficient to give any kind of expres sion, particularly that of complacency,—that mortal rigidity is produced by a species of contraction in muscular fibres, (to be discussed more fully hereafter), and that this change seldom takes place till several hours after death.