75 



asystole, etc., need hardly be emphasized; such explanations 

 assumed a failure of rhythm or a sudden loss of muscular 

 power for which there is no warrant. Before the experi- 

 mental investigation of the mammalian heart had shown 

 the actual mode of abrupt and complete failure of the ven- 

 tricular pump by the occurrence of fibrillation, the observed 

 phenomena of sudden death by syncope — the sudden 

 abolition of pulsation and all other manifestations of the 

 beating of the heart — naturally led to the belief that the end 

 had come through a simple failure of contractility. It was 

 not realized how extraordinarily resistant and enduring the 

 contractile power of the heart is, even under experimental 

 conditions of exposure, manipulation, and severe strain of 

 various kinds. 



Sudden Death and the Pathological Changes found 

 post Mortem. 

 It is well known that in many cases where death is believed 

 to have resulted from cardiac failure the heart has been found 

 post mortem to present structural charactei-s apparently little 

 if at all removed from the normal. An elaborate study of 

 sudden death and the pathological conditions associated 

 with it was made by Brouardel and Benham.* In this book, 

 extending to more than ?00 pages, a great deal is to be found 

 as to numerous and varied morbid conditions and structural 

 changes in various organs, etc., in cases where death has 

 occurred suddenly, while it is stated that in some cases no 

 lesion is found. Elaborate details of dead-house anatomy 

 are presented, but no explanation is given, or indeed 

 attempted, as to how vital function has suddenly broken 

 down, when up to that point in many cases, in spite of 

 pathological conditions that have often been present, the 

 individual has been able to go about his affairs with fair 

 or good actiyity of body and mind. It is obvious that such 

 structural alterations (coronary lesions, myocardial de- 

 generative changes, etc.) as were found after death were, 

 up to the sudden catastrophe, quite compatible with tolerable 

 efficiency of the functions necessary for the maintenance of 

 a more or less active life; to determine death an abrupt 

 change must have occurred — a process fundamentally 

 different from such slow impairment or limitation of 

 function as may have been present up to the final disaster. 



Some Characters of Ventricular Fibrillation. 

 The inception of ventricular fibrillation is a sudden event, 

 though very often preceded by more or less complex dis- 

 turbances in the normal action. There is an abrupt replace- 

 ment of tiie effective systole by a continuous turmoil of 

 inco-ordinated activity in the muscular bundles, excessively 

 rapid small contractions, each of short duration, coursing 

 over the intercommunicating muscular fasciculi, so that, 

 while some portions are contracted, others are relaxed; the 



