It must not be forgotten that patients who are burned extensively very frequently die shortly after the accident. A burn that involves more than one-half of the body, no matter how superficial the burning may be, will always have a fatal termination. Deep burns in one part, unless it is some very vital part, are not so serious as extensive superficial burns. Patients with extensive burns frequently remain in encouragingly good condition for several days, and then have a sudden change for the worse. Sometimes death takes place in coma. Sometimes it takes place as the result of a perforation of the duodenum. These perforations of duodenal ulcers may take place as late as a week to ten days after the burn. They are always followed by symptoms of peritonitis and the condition of intense prostration which this brings on. Such cases need to be prepared for the worst after the first acute symptoms of the burn have subsided, when a certain amount of peace of mind is restored. Cirrhosis of the liver not infrequently causes sudden death. Cirrhosis is an affection in which a large part of the liver substance proper degenerates, and its place is taken by connective tissue. It is typically a disease of people of alcoholic habit. It occurs in those who are engaged in the sale of spirits, though the alcoholic absorption does not take place {157} through the skin, but in a much more direct way. It is most frequent in people who take strong spirits on an empty stomach. Those who are much exposed to changes of temperature are especially liable to form such habits. It is found most frequently in the drivers of wagons and cars, in policemen, and in sea-captains, sailors, and the like. When cirrhosis causes sudden death, it is nearly always by hemorrhage. The hemorrhage takes place from the oesophagus, some of the large veins of which have become dilated until the thin walls are unable to retain the blood. The dilatation is due to interference with the venous circulation in the liver.