194 ON THE NATURE AND PRINCIPLES OF 



this syncope may be fatal. Now since a trifling 

 increase in the resisting pressure of the aortic blood 

 suffices, in these cases, to deprive the heart of its 

 power of contraction, why may not the extraordinary 

 obstruction to the flow of blood from the ventricle, 

 constituted by the mass of fluid accumulated in the 

 aorta during excessive and prolonged mental excite- 

 ment or muscular exertion, occasion the same effect 

 in an individual previously in the enjoyment of 

 tolerable or even perfect health ? And I cannot 

 but think that, in many cases of sudden death, where 

 no morbid appearances are perceptible, the fatal 

 occurrence is referrible to a paralysis of the heart 

 consequent on this physical disorder of the circula- 

 tion. It is certainly the most frequent immediate 

 cause of death in all forms of heart disease, when 

 the life of the individual has for a long time been, 

 as it were, supported by a single thread. And in 

 all chronic diseases, where the powers of life are 

 slowly exhausted, a trifling addition to the pressure 

 of the aortic blood, by inducing the dissipation of 

 the slight remnant of contractile power yet possessed 

 by the heart, is often the action which ushers in the 

 fatal catastrophe. 



But, irrespective of its exhausting influence upon 

 the contractile power of the heart, this physical 

 disorder of the mass of arterial blood operates as the 

 immediate cause of the most common forms of 

 ventricular disease. For whether there be simple 

 hypertrophy of the ventricle, or hypertrophy with 

 dilatation, or enlargement of the ventricular cavity 

 with attenuation of its parietcs, the pathological 



