The Wichita daily eagle. [volume] (Wichita, Kan.) 1890-1906, 1897-07-14
Causes of Sudden Death.
q. D. Mann, MD, in London Lancet

Roughly speaking, about one-half of the
total number of cases of sudden death from
natural causes in adults is, more or less,
due TO heart disease, which has existed for
some time. and in which no further change
Is in progress at the time Of death-such as
yalvuiar disease, angina, fatty heart, and
sclerosis of the cardiac muscle from chronic
myocardits. In many cases concurrent
lung or kidney disease complexities the sta
tistics, such cases frequently being tabulat-
ed deaths solely due to heart disease. Spon-
taneous rupture of the heart, mostly in
men, may exceptionally occur; the left VEN
tr.cle. often towards the front, is almost
invariably the seat of the rupture. 1t Is to
be remembered that in traumatic rupture of
the heart the right side, usually the aur.cle,
suffers more frequently than the left in the
proportion of about as 70 to "a. Apoplexy
and other cognate brain LESSONS rank sec
ond as natural causes of sudden death. 1t
is to be noted that military aneurisms of
the vessels Of the brain, although most com
mon in persons past middle life, occasion
ally occur in young people. even in children.
and by bursting cause death from apoplexy.
Chronic alcoholism, potent factor among
the causes of sudden death, is frequently
associated with rapidly terminating heart
and brain disease.
Aspyxia, a not unfrequent cause, may be
due to oedema of the CLOTHS. membranous
deposit in the trachea, pressure of neo-
plasm on the trachea, spasm of the vocal
cords, pulmonary embolism. air embolism
rupture Of vessel or of an aneurism into
the air-passages. asthma. whooping-cough,
penumo and haemo-thorax, pleuritic effu-
sion, and epilepsy. The rupture of gas
slf r, IN q al NH n a
or Of a varicose vain, of the surroundings
Of an ectopic CESSATION, the formation Of a
reri-uterine haematocele. may severely
prove quickly fatal. Nephritis (uraemit
and apoplexy), diabetes, exophthalmic goi-
tire, and Addison's disease may also ternni-
nate with unexpected rapidity. Hemor-
rhage into the pancreas occasionally causes
sudden death, apparently from the impress
sion producer on the contiguous nerve GEN.
ters. 1t Is most common in males over
forty years of age who may UP to the &C.
currence of the hemorrhage to all appear
ances be in perfect health. Obesity, the
habitual use of alcohol, and the presence Of
heart disease appear in many of the cases
to be pred;sposing cause. Koetschau, how
ever, observed hemorrhage into the pam
creas in a woman-an alcoholic-in her
twenty-fourth year. Occasionally it occurs
in spare people who are free from obvious
disease and who are abstemtous as regards
alcohol. The sufferer may die within half
an hour after the occurrence Of the hem
orrhage, or he may survive for twenty
four or even thirty-six hours. Draper re-
cords five cases between the ages of twen-
ty-four and thirty-s;x years, of which three
were men and two women. Fitz tabulated
sixteen cases, of which eleven were males
between thirty-one and seventy years of
age, and five were females between twen-
ty-six and forty-sven years.
Sudden death has in instances followed
spontaneous rupture of an enlarged spleen,
the result of tropical malarial influences,
the individual Immediately before rupture
being to all-intents and purposes quite well.
Pellereaux gives the history of thirteen
cases of rupture of the enlarged spleen; In
five the rupture was spontaneous, and in
the remainder it was due to apparently in
adequate causes, such as simple fall in
the street. 1t is to DE borne in mind that
when the spleen is thus enlarged a mere pat
with the palm of the hand may determine
rupture and consequent speedy death which
in the absence of knowledge Of the expe-
rience of others, might readily be assumed
to be the result of criminal violence.
II is to be remembered that some of the
above-named diseases may exist without
giving rise to any symptoms until the fatal
moment arrives; this applies with special
force to diseases which have prolonged
course, during which, as a rule, symptoms
Indicative of the disease declare themselves
Such a disease is gastric ulcer. have seen
more than one case in which, until the fatal
rupture occurred, absolutely no symptoms
were experienced, not even such as might
have been attributed to simple dyspepsia;
in one such instance second ulcer was pre-
sent in the walls of the stomach in addi-
ton to the one that ruptured and caused
death, and yet until perforation occurred
the patient never felt any abnormal SEN
sation whatever