4. Lesions of the respiratory system: œdema or spasm of the glottis, membranous deposit or foreign bodies in the larynx or trachea, foreign bodies in the pharynx, tumours, whooping-cough, asthma, embolism of the pulmonary artery, air embolism, fat embolism, rupture of a vessel or aneurysm into the air-passages, as in phthisical cavities, pneumothorax, hæmothorax, pleuritic effusion, and in acute pneumonia. 5. Rupture of a gastric ulcer or ulcer of some other part of the alimentary tract. 6. Sudden hæmorrhage into the peritoneal cavity from ruptured uterus, ectopic gestation, &c. 7. Rupture of internal organs: distended bladder, spleen, pregnant uterus, or other abdominal viscus. 8. Hæmorrhage into the pancreas. 9. Conditions associated with the nervous system: mental emotions, epilepsy, uræmia, laryngismus stridulus in children. 10. Sudden death has occurred in Addison‘s disease, in diabetes, in cases of lymphatism or status lymphaticus in young people, during the early stage of chloroform anæsthesia, during simple vaginal examination in women, during the injection of fluids into the vagina or uterus. Bouvalat (_Annales d‘Hygiène_, 1892) relates a case in which, as the cannula of a syringe was being introduced into the os uteri of a woman with the object of criminal abortion, she fell back before any fluid was injected, and died in a few minutes. A similar case came under my notice, in which death took place while the husband of the woman was attempting to introduce a solution of 20 minims of tincture of iodine, mixed with water to measure two drachms, into her uterus through a No. 3 catheter. SIGNS OF DEATH Real or Apparent Death It will be unnecessary here to discuss any of the theories put forward with regard to cases of apparent death or prolonged trance, but simply to note in the order of their occurrence the phenomena which attend real death. Real Death Under this heading it is important to draw a distinction between “Somatic death” and “Molecular death.” “Somatic death” is defined as “the cessation of the vital functions and of the general renewal of tissue consequent on that cessation”; “Molecular death” is the death of the tissues themselves. The signs of death occur as follows:-- 1. _Entire and continuous cessation of the respiration and circulation; no sounds heard on auscultation._ The absence of the heart sounds is the most important sign of death, for even in the severest forms of syncope the cardiac pulsations, as shown by M. Bouchet, can with care be heard. =Tests for cessation of respiration:--= (_a_) Auscultation. (_b_) Placing a cold hand-mirror or empty drinking-glass over the mouth or nostrils, or a light feather, and noting the presence or absence of bedewing or movement. (_c_) Placing a shallow vessel, such as a saucer, full of water on the chest or abdomen, and observing the presence or absence of rippling of the fluid (Winslow‘s test). =Tests for cessation of the circulation:--= (_a_) Auscultation.