Death beginning at the brain destroys life indirectly--by its influence on the lungs or on the heart, and so by the way of coma or of asthenia. In death by coma there is “stupor more or less profound; the sensibility to outward impressions is destroyed, sometimes wholly and at once, much oftener gradually; the respiration becomes slow, irregular, stertorous; all voluntary attention to the act of breathing is lost, but the instinctive motions continue. At length the chest ceases to expand, the blood is no longer aërated,”[50] and thenceforward precisely the same internal changes occur as in death, beginning at the lung. It is in this way that most fatal disorders of the brain produce death. When death starting from the brain acts through the heart, it occurs somewhat suddenly, and in the way of shock, as in some of the worst cases of apoplexy--the “apoplexie foudroyante,” for example--or more slowly, in the way of exhaustion or asthenia, as in some cases of delirium tremens, or of phrensy--and as happened in the two cases described at pages 36 and 38. The several modes of dying described above, are often combined in the same person, complicating the process and confusing our views of it; with the effect too, in some cases, of increasing the sufferings of the dying, but in others of lessening them. Thus coma, from implication of the brain supervening on diseases of the lung, first lessens the perception of the distress and anguish which attend them, and then extinguishes it. These mixed forms of death are seen especially in fevers. FOOTNOTES: [42] “At Medicus moriendi initium altius repetet, et jam ab eo inde tempore ducet, quo signis minime dubiis cognoverit, morbum naturæ artique non tantum insuperabilem esse, sed et sub eo vires sic perire ut reparari nequeant.” (Paradys, Oratio de Εὐθανασία naturali, p. 67). [43] In the words of Lucretius, vi. 1, 190-- “Item, ad supremum denique tempus, Compressæ nares, nasi primoris acumen Tenue, cavatei oculei, cava tempora; frigida pellis, Duraque, inhorrebat tactum; frons tenta meabat: Nec nimio rigida post artus morte jacebant.” Or, as rendered by an accomplished physician, Dr. Mason Good-- “Then, tow’rds the last, the nostrils close collaps’d; The nose acute; eyes hollow; temples scoop’d; Frigid the skin, retracted; o’er the mouth A ghastly grin; the shrivell’d forehead tense; The limbs outstretch’d for instant death prepar’d.” [44] “Omnia tum vero vitai claustra lababant.” (Lucretius, vi. 1,151). “Then all the powers of life were loosen’d.” (Mason Good). [45] Lectures on the Principles and Practice of Physic. Fifth edition, 2 vols. 8vo, London, 1871, vol. i. p. 62. Sir Thomas Watson in his admirable lecture on the Different Modes of Dying, has treated the whole subject so graphically, that I shall follow him as closely as possible in what I have to adduce on this part of my subject. [46] Watson, p. 66. [47] Watson, p. 68. [48] _Ibid._, p. 70.