In which the pulsations of the heart cease, before the action of the
respiratory organs.
The heart may cease to beat either from organic lesions in its own
structure, or in that of its vessels; or from being sympathetically
affected by injuries in other parts[20]; or from the operation of
certain poisons; or from a shock of the general nervous system, as
experienced in paroxysms of certain passions.
In ordinary fainting it is evident that some slight and feeble motions
of the heart still continue, although insufficient to produce a sensible
pulsation in the more distant arteries; and where this has continued for
an unusual period, and the respiration has been so obscure as to escape
common observation, the phenomenon has been eagerly seized by the
admirers of the marvellous, and credulity has attached to its history,
under the name of _Trance_,[21] circumstances of extravagance and
mystery, to which it can hardly be necessary to allude on the present
occasion. But the motions of the heart may have ceased altogether, and
in such cases it becomes a question, no less interesting to the
practical physician than to the physiologist, whether they can ever be
restored, and if so, we have to inquire under what limitation, as to
time; under what circumstances; and by what means? The views which have
been already offered respecting the pathology of Syncope will afford us
considerable assistance in the solution of a problem, so intimately
connected with inquiries of forensic importance. It would appear that
where the heart has ceased to pulsate, _in consequence of the cessation
of respiration, it can never again be set in motion_; but that where it
has stopped from other causes, as from the operation of certain poisons,
its muscular irritability not having been exhausted, its action may be
occasionally revived. Where Syncope arises from hemorrhage, we shall
find, on dissection, that the heart and its great vessels are either
empty, or contain only a small quantity of blood in their cavities; but
where Syncope arises from other causes, the heart is seen distended to
an unusual magnitude, and the blood in the left auricle and ventricle is
generally of a more or less florid colour, and has not the hue of venous
blood; a circumstance which depends upon the pulsation of the heart
ceasing before the function of respiration, and which is the very
reverse of what happens in death from suffocation, as we shall hereafter
explain.
Violent passions of the mind very commonly produce syncope, which has in
some instances terminated in death; we are however inclined to believe
that in fatal cases of this nature the persons must have laboured under
some organic affection of the heart, or its vessels; _Philip V._ died
suddenly on being told that the Spaniards had been defeated, and on
opening the body, his heart was found ruptured.
_Dr. Tissot_ relates also the case of the father of a numerous family,
who having lost his wife whom he tenderly loved, was suddenly seized
with laborious respiration, and died at the end of two days; when the
lungs were found gorged with blood, and the heart ruptured. Now in both
these cases, it is probable that the muscular structure of the heart had
been softened by previous disease.[22] So in the case of _Mr. John
Hunter_, whose life was suddenly extinguished by mental emotion, the
valves of the heart had been long in a state of disease, and so well
aware was he of the danger to which he was constantly exposed, that he
had for some time previous to his death, been in the habit of retiring
from all those situations, in which his passions were likely to be
excited. It is said that the instances of death from sudden joy are more
numerous than those from grief, probably because the effect of this
latter passion is rather to retard than to accelerate the circulation;
_Sophocles_, being desirous of proving that at an advanced age he was in
full possession of his intellectual powers, composed a tragedy, was
crowned, and died through joy; the same fate befel _Philippides_ the
comic writer; thus too the Lacedemonian _Chilon_ expired in the embrace
of his son who had borne away the prize at the Olympic games; and we
read of Roman women who died in the same manner, upon seeing their sons
return from the battles of Thrasymene and Cannæ. On the other hand, we
might adduce much classical authority to shew that death has frequently
been the sudden effect of grief.
_Montaigne_ relates the case of a German, who after having performed
great feats of valour, was killed at the siege of Osen; one of the
general officers having desired to see the corpse of so gallant a man,
was conducted to the body, when he instantly recognised the features of
his own son, and died on the spot. The record of our own times will
furnish us with an instance in which an actor of celebrity suddenly
expired upon repeating a passage that contained a fancied allusion to
the domestic affliction under which he was suffering.
_Dr. Ozanam_,[23] in illustration of the influence of pain and terror in
producing sudden extinction of life, relates the case of a middle aged
criminal, who having throughout evinced extreme weakness and depression,
expired in his way to the scaffold, and was stiff before he arrived at
the place of execution, which was about seven miles distant.
In such cases of sudden death, from the operation of violent mental
emotions, we apprehend that dissection will frequently demonstrate the
existence of previous disease in some of the organs immediately
essential to life; and we shall hereafter have occasion to refer to the
influence of the passions in hastening the fatal termination of a
chronic disease; on the present occasion we introduce the following
extremely interesting case, in confirmation of the position we are
endeavouring to maintain; the case was originally published in the
_Transactions of the Physico-Medical Society of New York, by Dr.
Valentine Mott_; it afterwards appeared in the _Journal Universel des
Sciences Medicales, Avril, 1819_; and lately it has found its way into
the _Medical Repository_ of this country. A robust and plethoric female,
aged 22, long addicted to dissolute and intemperate habits, had
complained for some time of slight and apparently rheumatic pains; but
within a day or two of the fatal event, she had been deserted by a man
to whom she was engaged in marriage; in consequence of which her mind
became very deeply affected; after having supped on the preceding night,
she retired to rest as usual, and in the morning was found dead in bed;
she lay in a bent position on the left side; and was hence supposed at
first to be in a profound sleep; neither the countenance nor the limbs
were in the least distorted. On dissection the pericardium was found to
contain ten ounces of coagulated blood, and two of serum; the heart on
all sides being covered by it, was of ordinary volume, but much loaded
with fat; at the summit of the aortic ventricle was discovered the
breach from which the effused blood had issued; the parietes of the
ventricle around the rupture were much thicker than in the natural
state, and on close examination a very sensible fluctuation was
distinguished, to the extent of an inch on one side of it, from which
flocculi of a cheese-like substance were discharged on pressure; the
pericardium also presented traces of inflammation.
We have here then a case in which a morbid change in the structure of
the heart had existed for a considerable period, and which was suddenly
brought to a fatal termination by an affection of the mind.
Before we quit the consideration of _Syncope_, we have to notice a fatal
variety of that disease, which well deserves the attentive consideration
of the forensic Physician, whose highest duty, let it be remembered, is
the investigation of sudden death. It is described by _Mr.
Chevalier_[24] under the term _Asphyxia Idiopathica_, in which the
patient suddenly faints and dies; the essential circumstances of the
disease evidently denote, says _Mr. Chevalier_, a sudden loss of power
in the extreme vessels to propel the blood; in consequence of which the
heart after having contracted, so as to empty itself, and then dilated
again, continues relaxed for want of the return of its accustomed
stimulus, and dies in that dilated state. On dissection all the cavities
of the heart are found completely empty, and the viscus itself in a
state of extreme flaccidity.