A manual of medical jurisprudence / by Alfred Swaine Taylor.

Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: A manual of medical jurisprudence / by Alfred Swaine Taylor. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    53/872 (page 39)
    COMA. a result of the introduction of certain poisons into the blood, and of fractures of the skull leading to compression of the brain or destruction of its substance. Death beginning at the brain is, indeed, scarcely to be regarded as a mode of dying, since it may usually be resolved into either death from sudden paralysis of the respiratory centre, when death is often absolutely quiet; or the coma ends in asphyxia, when the extinction of respiration is brought about more slowly. In death by the brain, the appearances observed consist chiefly in a congested state of the cerebral membranes and substance of the brain. As, before death, the breathing is affected, the lungs are congested and blood accumulates in the cavities of the heart, more on the right than on the left side. The appearances described as characteristic of the different modes of death by the heart, lungs, and brain, are liable to variation by reason of the intimate relations of these organs. Thus, there may be a mixed condition of syncope and asphyxia, or of asphyxia with cerebral congestion. With regard to the interruption of the functions of the brain as a result of pressure by the effusion of blood or serum, it is to be observed that a very small quantity effused at the base or in the substance of the medulla oblongata is sufficient to cause death; while, generally speaking, a larger quantity is required to be effused in the membranes, ventricles, or substance of the brain, in order to produce a fatal result. In cases of chronic hydrocephalus, in which the brain has resisted the pressure of a large accumulation of serum for many years, a slight and sudden increase in the quantity at any period ol life may lead to coma and death by apoplexy. This condition may be mistaken for narcotic poisoning. All causes of death, whether from disease or violence, are referable to an effect produced primarily on the heart, the lungs, or the brain ; but, as it has been elsewhere stated, death does not take place until the action of the heart has entirely ceased. The arrest of the circula- tion produces an immediate impression upon the functions of the brain and lungs; while the lungs and brain are affected and can only affect each other indirectly through the medium of the circulation : hence, systemic death, or the death of the bod}1-, is resolvable into death by syncope or a failure of the action of the heart, and this depends in all cases either upon defect or deficiency of blood. Ihe natural causes of sudden death may be generally traced to some injury or impediment to the action of the heart, lungs, or brain. It would be foreign to the objects of this manual to give a description of them, ihe violent causes are those which demand the especial attention of a medical jurist; they will be considered hereafter. In its relation to medicine and medical jurisprudence the subject of sudden death has been most fully treated by Herrich and Kopp (‘ Der 1 lotzliche 1 od aus mneren Ursachen,’ 1848); by Devergie (‘Ann. r^ll) 18°8’ 2’ 15 ’ and by Fagge (‘Guy’s Hosp. Rep.,’ 1879, The violent causes of death, whether sudden or protracted, which