starvation. Hæmorrhage is one of the commonest causes of death. Whenever a great artery is opened from any cause, permitting the copious outflow of blood, the skin grows pale, warmth declines, the breathing is intermittent, vertigo and dimness of sight follow, the expression of the features changes, cold and clammy sweat covers part of the face and the limbs, the pulse gets gradually weaker, and, at last, the heart stops. Virgil describes hæmorrhage with striking fidelity in the story of Dido's death.
Sudden death, unconnected with outward and accidental causes, may occur in various ways. Very violent impressions on the feelings sometimes abruptly check the movements of the heart, and produce a mortal swoon. Instances are well known of many persons dying of joy—Leo X. is one—and of persons who succumbed to fear. In foudroyant apoplexy, if real death is not instantaneous, there is at least the sudden occurrence of the phenomena of death. The sufferer is plunged in profound sleep, called by physicians coma, from which wakening is impossible; his breathing is difficult, his eyes set, his mouth twisted and distorted. The pulsations of the heart cease little by little, and soon life utterly vanishes. The breaking of an aneurism very often occasions sudden death. Not less often the cause of death is found in what is called an embolism, that is, a check to the circulation by a clot of blood suddenly plugging up some important vessel. And there are also cases of sudden death still unaccounted for, in the sense that subsequent dissection discovers nothing that could explain the stoppage in the operations of life.
Death is usually preceded by a group of phenomena that has received the name of the death-agony. In most cases of disease the beginning of this concluding period is marked by a sudden improvement of the functions. It is the last gleam springing from the dying flame; but soon the eyes become fixed and insensible to the action of light, the nose grows pointed and cold, the mouth, wide open, seems to call for the air that fails it, the cavity within it is parched, and the lips, as if withered, cling to the curves of the teeth. The last movements of respiration are spasmodic, and a wheezing, and sometimes a marked gurgling sound, may be heard at some distance, caused by obstruction of the bronchial tubes with a quantity of mucus. The breath is cold, the temperature of the skin lowered. If the heart is examined, we note the weakening of its sounds and pulsations. The hand, placed in its neighborhood, feels no throb. Such is the physiognomy of a person in the last moments of death in the greater number of cases, that is, when death follows upon a period of illness of some duration. The death-struggle is seldom painful, and almost always the patient feels nothing of it. He is plunged into a comatose stupor, so that he is no longer conscious of his situation or his sufferings, and he passes insensibly from life to death, in a manner that renders it sometimes difficult to fix the exact instant at which a dying person expires. This is true,
