cooling if death from hemorrhage; initial post-mortem rise in infectious diseases; rectal temperature equals axillary in about 30 hours); no oxidation of steel needle thrust into flesh for half an hour; finger web does not appear pink when held toward sun; burns show no areola (may produce blister); ammonia injected under skin shows no reaction (deep red or purple spot during life); rigor mortis (usually appears in 3 to 5 hours, lasting on an average 24 to 36 hours; early and short if weather hot; late and long if weather cold); putrefaction (only pathognomonic sign; green patches, usually first over iliac fossa; bullae containing sanious reddish fluid; production of gases in abdominal viscera; time of appearance varies with temperature and previous condition of patient; arsenic or carbon monoxid may postpone putrefaction for a long time).

ACUTE POISONS: If accidental, often follows taking of food or supposed medicine; several persons may exhibit similar symp

toms.

CIRCULATORY LESIONS: Premonitory symptoms are precordial uneasiness, bradycardia or tachycardia, arrhythmia, angina pectoris and cardiac dilation.

HEART:

Fatty Overgrowth: Cold baths, excitement; heart somewhat enlarged with slightly feeble sounds and impulse during life; all ages.

Fatty Degeneration: From exhausting diseases or in late stage of hypertrophy.

Fibroid Degeneration: Due to chronic myocarditis; may lead to rupture of heart during fit of anger, violent emotion or coitus.

Rupture of Heart: Fibroid degeneration or acute myocarditis of typhoid, smallpox, pneumonia, etc.; also from necrosis following thrombosis or embolism of coronary artery.

Coronary Lesions: Arteriosclerosis with diminished blood supply to heart and degeneration of cardiac muscle.

Angina Pectoris: Severe vise-like pain in precordium and down left arm, with immobility.

Aortic Incompetency: Follows articular rheumatism of youth; pallor, aortic murmur, capillary pulsation, water-hammer pulse, great hypertrophy of left ventricle; cardiac or cerebral syncope from shock or great effort.

Mitral Incompetency: Dyspnea, edema of lower limbs, feeble pulse, systolic regurgitant murmur at apex and around to spine; pulmonary congestion, especially on running or other violent exertion, particularly after a full meal; bronchitis, lateral curvature, renal disease and edema of lungs are grave complica

tions.

Tricuspid Incompetency: Similar to mitral; emphysema and bronchitis.

Infectious Ulcerative Endocarditis: Frequently a result of slight wounds; often causes cerebral embolism and hemiplegia. Tubercle or Neoplasms of Walls of Heart.

Fragmentation of Heart: Peculiar friability of myocardium; most frequent with cardiac dilation and failure, infective disease and acute and chronic disease of central nervous system.

Congenital Malformations.

Pericarditis:

Particularly when effusion or adhesions; death usually under influence of emotions in rheumatic or alcoholic patients.

blood.

Rupture of Coronary Artery: Filling pericardium with

ARTERIES:

Congenital Lesions: Contracted aortic orifice and narrowing of aorta lead to rupture of aorta with great pain in young adults.

Arteriosclerosis: Tense, hard pulse; accentuated aortic sec

ond sound.

Rupture of Atheromatous Aorta: Usually determined by a struggle, fall or dispute.

Rupture of Aortic, Pulmonary or Basilar Aneurysm: Sometimes vomiting, cold extremities or hemoptysis; ecchymoses common; may be history of hemoptysis.

Basilar Thrombosis: Hypoglossal palsy.

VEINS.

Rupture: Usually from cough or violent exertion.

Thrombosis or Embolism of Pulmonary Artery: Urgent dyspnea, hemoptysis; from pneumonia, inflamed varicose veins, phlegmasia alba dolens, uterine fibroids, ovarian cysts, periuterine thrombosis before confinement, temporal caries following middle ear disease, boils on face, gonorrhea, fractures, dislocations or phthisical or cancerous cachexia.

Air in Veins: Neck wounds; sudden removal from compressed air; possibly from open uterine sinuses after confinement or abortion.

CAPILLARIES.

Miliary Aneurysms: Cerebral hemorrhage; usually in aged people; sudden if considerable hemorrhage, especially into lateral ventricles; often movements of rotation with hemorrhage into crus; sometimes coincident subepicranial ecchymoses.

Meningeal Hemorrhage: Alcohol, syphilis, insanity-may be early-predispose; often follows fit of anger or fright; patient may be able to go home, and life is often prolonged for some hours.

Capillary Embolisms of Lung: Usually from septic wounds or bedsores; pain and sense of suffocation; sometimes fat emboli after fractures.

LOCAL CIRCULATORY DISTURBANCES.

Syncope from cerebral anemia due to hemorrhage or paracentesis of abdomen, or getting up for first time after long illness. Cerebral Congestion following alcoholic excesses, with vomiting and suffocation by stomach contents.

HEAT:

Sunstroke: Headache, delirium, frenzy, vomiting, coma, suicidal tendencies, hyperpyrexia.

tion.

Heatstroke: Usually from moist heat; pulmonary conges

COLD: New-born and aged very susceptible; torpor, sopor, deadened sensibility, dim vision, polyuria, muscular contraction and stiffness, slow pulse, difficult speech, prostration; pulmonary catarrh or congestion.

CEREBROSPINAL LESIONS: May be quite latent, without mental impairment, headache, fever, vomiting or paralysis. INTRACRANIAL:

Suppurative Meningitis: Especially alcoholic.

Tubercular Meningitis of Children: All at once dull, sullen, irritable and quarrelsome.

Chronic Meningitis of Insanity: Pupil contracted on side of hemorrhage, in hemorrhagic type.

Cerebrospinal Meningitis: Epidemic or sporadic; vomiting and paralysis or no symptoms.

Latent Abscess of Brain: May be large as hen's egg; usually consecutive to temporal caries following otitis media.

Brain Tumor: May be mental impairment, vomiting, hemichorea, vertigo or diabetes mellitus or insipidus; fatality usually excited by alcoholic excesses, dancing or fatigue.

Glossolabiopharyngeal Paralysis:

facial, then pneumogastric.

First hypoglosal, then

Parctic Dementia: Pin-point pupils persist after death.
Acromegaly: Prognathism.

Epilepsy: Flea-bite spots on neck and shoulders; injected conjunctiva, bitten tongue, frothing at mouth; sometimes death from suffocation by passage of food into air tract or asphyxia from lying on face.

Hysteria: Very rarely.

Cranial Trauma: Contusion or cut may be due to fail. Lesions of Cerebellum and Medulla: Often previous vertigo and forced movements.

Vertigo: Cases of drowning from so-called sudden cramps really due to incapacitating ear vertigo with loss of equilibrium, by sudden entrance of cold water into ear, particularly when membrana tympani is perforated.

SPINAL CORD LESIONS.

Medullary Hemorrhage: Sudden, flaccid paraplegia and often severe pain in back.

Pott's Disease: Sudden death in early stage if just below occiput; local pain, torticollis, loss of consciousness.

Broken Neck: Breaking of odontoid process and compression of cord from abrupt movements or violent effort.

Neoplasms of Upper Portion of Cord: Respiratory failure.
REFLEX AND INHIBITORY CAUSES.

Slight Blows: Symptoms quite negative-especially in epigastrium (if digestion going on), less often in hypogastrium or over genital organs, nose or larynx.

Circulatory Inhibition by Neoplasms or Inflammation of Nerve Trunks, Plexi or Endings: As in hypertrophied thymus (children), goiter, aneurysm of aorta or brachiocephalic region, neuritis of cardiac plexus, boils and tumors of cervical region, or from vaginal examination, sounding or injections into uterus, or from electric shock.

Respiratory Inhibition: From laryngitis, laryngeal tumors, pleurisy, foreign bodies, inhalation of ammonia, gastritis, enteritis, intestinal parasites, neoplasms and lymphatic ganglia compressing vagus.

Lightning: Usually superficial discoloration, burns, hemorrhage or laceration of tissues; may be shock, palsy or spasms. RESPIRATORY LESIONS: Largely dependent on cardiac and renal disease; cough, dyspnea, physical signs.

LARYNX.

Edema: Tubercular or syphilitic ulceration or anasarca
Polyp.

Laryngismus Stridulus: Sudden stoppage of breath in neurotic child; may be crowing sound.

TRACHEA.

Fatal Asphyxia: By food from stomach (sometimes caused by efforts to restrain vomiting) or from contents of pulmonary cavity.

Lumbricus ascended from stomach.

Tracheotomy: On removing canula.

THYROID.

Hypertrophy: Goiter may be quite small and symptomless.
Hemorrhage Into Cyst: Pregnancy predisposes.

MEDIASTINUM.

Tuberculosis of Bronchial Glands: Usually children; percussion dullness; attacks of suffocation followed by fatal syncope.

Cancer: Wearing pain, pressure symptoms, cachexia.

LUNGS.

Pulmonary Congestion: Usually dependent on cardiac dilation; sometimes with puerperium, erysipelas or rheumatism. Latent Pneumonia: Aged, alcoholic or pregnant chiefly; may be normal or subnormal temperature.

Capillary Bronchitis: "Suffocative catarrh" of children and old people, from exposure to cold, drinking cold water while heated or exposure to foul or irritating gases; frothing at mouth. Latent Phthisis: Death from thrombosis, embolism, pro

fuse hemoptysis or acute tuberculosis of alcoholism.

Emphysema: Always secondary or with complications.
Infarction of Lungs: From acute or chronic endocarditis.
PLEURA.

Pleurisy: Only slight dyspnea if effusion gradual; obstructive hyperemia; cerebral embolism; death most liable in excessive serofibrinous and diaphragmatic forms.

Double Pneumothorax, Hydrothorax or Hematothorax.