MODES, SIGNS AND TESTS OF DEATH.
Just as surely as we are born, just so surely must we die, and just as
it is the physician's duty to care for the living body, if possible to
keep it in a strong and healthful condition, so it is the embalmer's
duty to care for the body after death, not so much for the body itself,
but from a sanitary standpoint, namely, to see that the body is well
disinfected and embalmed so that there will be absolutely no chance for
the spread of disease.
Any one who is familiar with hospital work must know that all do not
die in the same way. For some it is the long lingering disease, chronic
in form, which after a long and tedious course the thread of life is
finally broken, and we hardly know the instant at which the change was
completed. For others, it is the short, acute attack, which snaps the
life away in a very instant, only after a very short duration. For some
it is to die from accidental causes, while for others it is only the
passing out from the period of old age. For some the mind may be active
and the intellectual faculties useful up to the last moment, while for
others the contrary is all but too true.
Although there may be many different kinds of disease infecting the
human race, yet we find that death ultimately results from the stoppage
of any one, or maybe, all three of the vital organs, namely the heart,
brain or lungs. Anything whatsoever which plays upon the body, to such
an extent, as to affect the functions absolutely, of either the heart,
brain or lungs, will result in the death of that body. And since these
organs are of such vital importance to us, and since the stoppage of
any one of them will result in death, they have been termed the vital
organs.
=Modes of Death.=—There are, then, only three modes of death: syncope,
or the stoppage of the heart; coma, or the failure of the brain to
perform its functions; apnea, or the stoppage of the lungs.
_Syncope._—For the heart to properly perform its function, namely
that of propelling the blood to all parts of the body, it must first
be properly nourished itself. If for any reason the heart does not
get this proper nourishment, say the coronary arteries should become
clogged, or a fatty infiltration, or a lack of red blood corpuscles, we
would have a condition in the body known as anemia.
The heart must also have a proper nerve supply from the brain, and if
because of any disease, the vaso-motor or the vaso-constrictor fibers
should become affected, the heart would cease to contract and expand,
and hence the complete stoppage of the heart. A condition of this kind
is known as asthenia.
But whether it is death by anemia or asthenia, the state of suspended
animation, common to both these forms is expressed by the single
term—syncope.
_Coma._—In cases of apoplexy, where we have the blood escaping from the
ruptured vessels, compressing the brain, we find death ensuing. Also in
accidental cases such as fracture of the skull, the injury will often
cause death. These are examples of coma, and can be explained in this
way, viz.; the power of the brain becomes inactive either through the
result of an injury or a disease, and when this inactivity occurs the
respiratory apparatus subsides and the heart deprived of its normal
stimulus through the vaso-motor and constrictor fibers, soon ceases to
beat, and death is the result.
_Apnea_, _Asphyxia_.—If for any reason the supply of oxygen is cut off
from the lungs, we will have the body dying the result of asphyxia or
apnea. The most common forms found of this mode of death are those of
hanging, drowning or coal gas poisoning.
=Signs of Impending Death.=—The signs of impending death are those
conditions which exist on the body or the peculiar features of the
body which aid the physician in ascertaining the exact condition
of the body. These signs assume many different forms and in no two
instances may they be found alike. They of course, are not positive in
themselves, but are sufficient to guide us in forming an opinion as to
the approach of death.
One of the first signs to be noticed is the coldness of the
extremities. In this case the coldness begins at the extreme tips of
the fingers and toes and gradually extends toward the trunk. This,
of course, is due to the gradual diminishing activity of the heart to
propel the blood to the extremities.
The brain also fails to receive its proper blood supply and becomes
weakened and we find the mind wandering. This wandering results in the
patient going through movements representing the playing with flowers,
or picking at the bed clothing. A further result of this weakness is
that the patient may have visions of angels and heaven.
Speech begins to grow thick, and a large lump of phlegm gathers in the
throat.
The hands now feel cold and clammy, and if they are raised they
instantly fall. One cannot detect the act of respiration, as the
movements of the thoracic walls are so slight as to be scarcely
perceptible.
The heart loses its power to propel the blood and the stoppage of every
organ in the body ensues.
The eyes become fixed with a staring look as though they were not
focused on anything directly. The eyes lose their lustre on account of
the lachrymal glands refusing to secrete.
The vital organs, the heart, brain and lungs come to a halt, and we
find the body passing from life to the great beyond.
=Tests of Actual Death.=—From the large number of statistics that
have been gathered together for our purpose, we find that the time
of greatest mortality is in the early morning hours between three and
six A. M., for it is between these hours that the body is in a perfect
state of relaxation, and at the lowest ebb of vitality.
The time of least mortality is between the hours of eleven and two P.
M., as the body is in a relatively high state of vitality during these
hours.
The tests of actual death can be placed in two classes, the common
tests and the expert tests.
The common tests are those that have long been used by the
inexperienced to ascertain the fact of death. They are not necessarily
conclusive in themselves, but when all are taken together there can not
be much doubt.
(a) _The Feather Test._—In this test a feather is held to the nostrils
to observe whether it moves. The feather being so light, the slightest
respiration of the lung would be apt to move it.
(b) _The Mirror Test._—In this test a mirror is held to the mouth
and nostrils. If moisture collects on the mirror it is evident that
respiratory movements are going on. If there is an absence of moisture
we are quite safe in saying that the patient is dead.
(c) _The Bandage Test._—In this test a bandage is placed around the arm
and then twisted very tightly. If there is the slightest circulation
existing in the body the blood will accumulate back of the bandage in
the venous system and thus demonstrate the fact. There will also be no
swelling or discoloration beyond the ligature.
(d) By placing the ear to the chest over the heart, no sounds will be
heard.
(e) If the ear is applied over the lungs, no sounds will be heard.
(f) If a cup of water is placed on the chest there will be no movement
of rays or ripples on the surface.
(g) If the skin is cut, no blood will flow, nor will the wound close.
(h) If heat, say for instance a burning match be applied to the skin
it will not blister, or if ammonia is hypodermically injected under
the skin there will be no redness, but rather the skin will turn to a
yellowish color.
(i) The living hand when held to the light shows pink through the inner
edges of the fingers, but with the dead hand it shows opaqueness.
(j) When a strong light is brought before the eye the pupil of the eye
will not dilate or contract.
(2) The expert tests are those which a doctor or coroner might use to
ascertain the fact of death. These tests are made with the stethoscope
and the ophthalmoscope.
(a) By the use of the stethoscope the physician can hear the sounds of
the heart and if there is the slightest sound he can detect it. In the
absence of any sound the body is pronounced dead.
(b) By the use of the ophthalmoscope the physician is enabled to look
into the pupil of the eye and if there is life he can see the blood
circulating through the tiny capillaries of the retina. If he does not
see this capillary circulation he is quite safe in saying the body is
dead.
(c) Another method consists in the hypodermic or intravenous injection
of certain substances, and ascertaining whether these substances have
been dispersed throughout the body. If they have, then a circulation
exists and life continues, although the pulsation of the heart may
not be detected by auscultation. Among the substances recommended for
injection are fluorescin, sodium iodide, lithium iodide and potassium
ferro-cyanide. The injection of the small quantities as used will not
cause death should the patient still be living.
Fluorescin is usually injected, one gramme dissolved with an equal
weight of sodium carbonate in eight cubic centimeters of water, and
the whole quantity injected hypodermically. If the circulation is
persisting, the skin and the mucous membranes after a very few minutes
assume a greenish color; about twenty minutes after the injection,
the portion of the eye within the iris assumes a green color from
penetration of the fluorescin into the vitreous and aqueous humors, and
in the blood the fluorescin may be detected by the following method:
One or two threads of cotton are passed under the skin in the form of
a seton, and when saturated with blood are transferred to a test tube,
and boiled with a little water. As the liquid clears the green color
of the fluorescin becomes evident, if that substance has been absorbed
into the blood.
(d) Another method for the distinction of real from apparent death
consists in picking up a fold of the skin and compressing it with a
pair of artery forceps. If the skin does not completely settle down,
and if the fine furrows produced by the teeth of the forceps continue
indefinitely, then death has occurred. Whereas, if the circulation
is continuous, the fold and the marks of the forceps would disappear.
Moreover, if death has occurred the portion of the skin compressed by
the forceps assumes a parchment-like appearance.
(e) The electrical current affords a means of determining death. It
is now known that the muscles, after cadaveric rigidity has set in, do
not respond to electric stimuli. The faradic current will cause, when
death has occurred, muscular contractions until a short time before
post-mortem rigidity occurs. The faradic stimulus is lost first and
the galvanic stimulus soon after. We may be enabled to approximate the
time at which death occurred, for, if we find any response to either
the faradic or the galvanic current, we know at once that post-mortem
rigidity has not yet occurred.
No person should be buried as long as the muscles contract when
stimulated by either the faradic or the galvanic current. If the
electrical test were always applied before a death certificate was
signed, there would be absolutely no possibility of a person being
buried alive and the public would soon lose the morbid fear of such an
occurrence.
=Later and More Positive Signs.=—(a) After a few hours the blood
gradually sinks to the dependent parts of the body giving a
reddish-blue discoloration, known as post-mortem discoloration, or
cadaveric lividity.
(b) The eyes become sunken in the sockets, the eye balls become
flattened, the cornea opaque and the pupil irregular in shape.
(c) The eyelid loses its elasticity, and the white transparent color of
the conjunctiva is lost, often becoming black or gray.
(d) Rigor mortis may or may not be present.
(e) The body gradually cools to the temperature of the surrounding
atmosphere.
(f) On opening an artery it is generally found to be empty after death.
(g) The latest and most positive sign of all is putrefaction, and when
this is found to be present all other signs may be ignored.
(h) Skin slip present on the body is only another manifestation of
putrefaction, and also signifies that the body is dead.