DEATH. 



793 



respiratory. We cannot enter into the discus- 

 sion, and therefore refer to the article SYM- 

 PATHY. But \ve beg to state that we have no 

 where seen the subject treated with more eru- 

 dition and acuteness, than in Dr. Fletcher's 

 Rudiments of Physiology.* 



But while there can be no question that all 

 the organs are more or less related in the man- 

 ner above indicated, it is not less evident that 

 the connection between some is of a far more 

 intimate nature than between others. It is 

 almost needless to instance the brain and the 

 stomach, the brain, spinal marrow, and the 

 heart, the heart and every part of the system, 

 c. &c. By overlooking the sympathetic re- 

 lation between the brain and the heart, Bichat 

 fancied that when he had proved the functional 

 independence of the latter or^an, he was com- 

 pelled to search in some third part for the link 

 between the death of the one and that of the 

 other, f It cannot be denied that in a large 

 proportion of cases, the syncope which follows 

 lesions of the cerebro-spinal system, is not a 

 direct consequence, and that there is an in- 

 termediate suppression of the function of the 

 lungs, that in other words the syncope is the 

 effect of asphyxia.! (S ee ASPHYXIA.) It is 

 somewhat remarkable that the illustrious phy- 

 siologist just mentioned should have forgotten 

 certain pathological facts which afford con- 

 vincing evidence that cerebral injury may pro- 

 duce death without developing the phenomena 

 of asphyxia; the " apoplexie foudroyante," 

 for example, and the concussion of a blow or 

 a fall. Nor is it less surprising that in his 

 numerous experiments upon animals he should 

 not have noticed what was afterwards fully 

 demonstrated by Legallois and W. Philip, that 

 both the heart and the capillaries may be imme- 

 diately paralysed by violence done to the brain 

 and spinal marrow. It must be remembered, 

 however, that this result is much affected bolh 

 by the extent and by the nature of the injury. 

 Thus the brain may be sliced and the spinal 

 cord divided, with no other influence upon the 

 circulation than that which depends upon the 

 interference with the respiratory actions ; but 

 laceration or crushing of the cerebral matter 

 is immediately felt by the heart and capil- 

 laries. In these cases the circulation ceases, 

 not because the cerebro-spinal axis takes any 

 part in that function, but because it is con- 

 nected with the heart in the same manner as 

 we have stated that all the parts of the body 

 are more or less connected, in bonds of 

 alliance though not of dependence. We have 

 reason, however, to believe that the intimacy 

 of the alliance between the brain and the heart 



* Part ii. chap. vi. 



t Recherches sur la Vie et la Mort, art. xii. 2. 



j We must not forget that even iu many of these 

 cases there is no immediate communication of 

 injury from the part primarily affected to the organs 

 of respiration. Thus, when a slight hemorrhage 

 in one of the hemispheres of the brain occasions 

 asphyxia, we are bound to believe that there is in 

 the first place a sympathetic communication of de- 

 rangement to the medulla oblongata, unless the 

 hemorrhage has been so considerable as to cause 

 compression of the whole encephalic mass. 



is scarcely equalled by that of any other organs 

 in the system. 



The anatomical characters of syncope by 

 nervous lesion are determined by the modus 

 operandi of the injury. If the latter arrests 

 the action of the heart only by obstructing the 

 lespiratory movements, the appearances are 

 those of asphyxia, (see ASPHYXIA.) But if 

 the operation be immediately upon the heart, 

 there will be a difference in the appear- 

 ances, a difference which likewise be- 

 longs to all cases in which the circulation 

 ceases without previous obstruction of respi- 

 ration. The blood, instead of being accumu- 

 lated in the right cavities of the heart, and in 

 the pulmonary arteries, is more equally dis- 

 tributed between these and the left cavities, 

 and the pulmonary veins. There is generally 

 a perceptible difference in the colour of the 

 blood in the two sides of the heart, but some- 

 what less than might at first be expected. The 

 defect of arterial tint in the coagula of the 

 left side may be fairly attributed to the drain- 

 ing away of the serum, and consequently 

 with it of the saline particles upon the pre- 

 sence of which the red colour depends. Blood 

 is found in the aorta and in many of the ar- 

 teries. The signs produced by venous con- 

 gestion, such as engorgement of the liver and 

 spleen, turgescence of the cerebral veins and 

 of those of the mucous membranes, are want- 

 ing, as well as the tumefaction of the face, 

 the puffing of the lips, the projection of the 

 eyes, and the deep lividities characteristic of 

 that condition. We must remember that the 

 appearances are considerably modified if syn- 

 cope has taken place gradually. In such in- 

 stances the heart is generally found empty. 

 The cause of this condition is obvious. In 

 the first place, as the degree of the diastole 

 must be proportionate to the systole, it is 

 obvious that when the latter is enfeebled, less 

 blood will be received into the cavities; and, 

 secondly, as less blood is driven into the pul- 

 monary artery and the aorta, there will be less 

 to return in a given space of time, and con- 

 sequently there will be less impetus in the 

 returning currents. It is easy to perceive that 

 before the final and feeblest contraction, which 

 must be succeeded by a correspondently slight 

 dilatation, the current of blood pressing for 

 admission must be very trifling. 



3. Syncope by injuries of the heart itself. 

 This is of too obvious a nature to require 

 comment. 



4. Syncope by injuries of other organs and 

 tissues. When death follows quickly upon a 

 lesion which does not necessarily implicate the 

 vital organs, properly so called, we say in ge- 

 neral terms that a shock has been given to the 

 nervous system, in consequence of the strong- 

 probability that some portion of this system is 

 the agent of sympathy. If violent pain at- 

 tends the injury, and to this succeeds loss 

 of consciousness, and then cessation of the 

 heart's action, it is fair to infer that the brain 

 was first operated upon through the nerves of 

 sensation, and that the derangement of this 



But there are 

 :} r 2 



organ affected the circulation. 



