The most fatal and common form of injury to the central nervous system is shock. Death may take place immediately from inhibition of the medullary and basal ganglia. There are many causes which may give rise to this paralysis. 

Psychic causes of sudden death

They may be psychic in character; thus, the emotions of joy, fear, anger, anxiety may initiate death. The idea of happiness and satisfaction may be so entrancing as to inhibit the heart’s action.

A poor woman went to meet her husband, who had for a long time been a prisoner; she flung her arms around his neck and embraced him passionately, only the next moment to relax her hold and slip to the ground dead.

However, fear, dread or horror are much more common causes of sudden death. There are few, doubtless, who have not felt the heart stop during moments of intense excitement. Should the emotion be overpowering or the heart weak, then a fatal termination may follow.

An event which might cause momentary anxiety to one individual may cause profound dread to another, and hence it is very difficult to state categorically that such and such an event could not possibly have led to the death of an individual. The emotions act very differently in different persons, and again in the same person they act dissimilarly at different times.

A healthy woman who was brushing her teeth accidentally swallowed a mouthful of harmless mouth-wash, and died from fright, under the belief that it was poisonous.

The bursting into her bedroom in the middle of the night by an insane Irishman in a state of nudity caused the death of a healthy woman of 48 years. 

Wakened out of a sound sleep by an unusual noise outside her bedroom, a woman, imaging that robbers were about to break into her room, called out twice and fell back dead.

Children, nervous women and hysterical men

It must be remembered that children and nervous women or hysterical men are much more susceptible to emotions than are others.

A little boy, aged 12, feeling hungry and knowing that there were some nice cakes in a cupboard, opened the door gently in order to abstract one without drawing the attention of others to his proceeding. Unfortunately for the boy, a black cat had been shut up in the cupboard and had taken refuge on the top shelf.

It jumped down at the instant the boy was lifting the cake; he uttered a scream, thinking it was the devil come to take him for his theft; he rushed upstairs to his mother and fell dead at her feet.

As a practical joke, a youth dropped a living frog into the bosom of a lady dressed in low-cut evening dress, with the result that she died almost at once from shock.

The above cases will suffice to show how in many cases the causal agent is in the opinion of most people a trivial one. Trivial or not, it at any rate has led to the death of many apparently healthy people.

Emotional excitement will act much more energetically on those who have an unstable nervous system or who have any organic disease (chiefly those which affect the heart or great vessels). Fatty degeneration of the heart is the most frequent of all causes of sudden death; the actual exciting cause of the heart’s cessation being either emotion or slight exertion, as in running for a car or train.

It is necessary to exercise extreme care in intimating sad or bad news to any of one’s patients whom we know to be suffering from such cardiac affections, for a fatal syncope may follow the intimation.

Thus the unexpectedly sudden intimation to a miner’s wife that she was a widow, her husband having just been killed by a fall of stone in the workings, caused her immediate death. She already suffered from heart disease.