But once the simple question is elaborated by attempted paraphrases and explanations of the words "results from", logical and philosophical difficulties emerge however much judges and lawyers may assert that they are eschewing all philosophical consideration of the chain of causation. Attempted explanations of causation and consequence can, I feel, be as unhelpful and unhappy as definitions of reasonable doubt. In the search for some grounds for isolating a particular event from the totality of circumstances preceding a later event, various adjectives, such as "direct", "proximate", "decisive", "immediate", "effective" and "real," have been pressed into service to qualify "cause". From these there is an easy drift to such term as "materially contributing factor". But such formulae do not really dispel the difficulty; and they become especially unsatisfying when death is the alleged consequential event. As death sooner or later is inevitable for every man, it is impossible to ask the question - which in relation to other matters may be helpful, although not decisive - namely, whether the alleged consequence would necessarily occur at all without the happening of the earlier event to which it is sought to attribute it. Moreover, in relation to death, words such as "proximate" and "direct", as tests for choosing some one link in a chain of causation, introduce a special difficulty. For at the point of death ultimate cause and consequence tend to become indistinguishable. It is, for example, easy to say that a man's death resulted from a gunshot wound. In such a case a criminal jury might properly say that death was the result of a felonious act; yet a physician would equally properly say that the wound caused loss of blood, and that the death resulted from loss of blood. And the inquiry could be pushed a stage further by saying that the loss of blood operated to produce a fatal syncope. It is for this reason that the manner or method by which some particular injury actually operates in relation to the circulatory, respiratory or nervous system may for a physician constitute the proximate cause of death. For example, in Taylor on Medical Jurisprudence asphyxia is spoken of as the "actual cause" of death by strangulation; and there are in that work many other illustrations of physiological mechanisms, which, brought into operation by various events, end in death, being treated as its cause.