796 



DEATH. 



cases of injury in which syncope occurs with- 

 out any antecedence of pain or of leipothymia, 

 and in which there is no reason for supposing 

 any cerebral affection in the chain of events. 

 Of this kind are extensive mechanical injuries 

 of the extremities, burns, rupture or over-dis- 

 tention of the stomach, &c. Whether the 

 nerves which convey the morbid impression 

 belong to the gangl ionic or to the respiratory 

 class, we do not profess to decide. The im- 

 mediately fatal effect of a blow upon the epi- 

 gastrium or of a draught of cold water when the 

 body is heated, has been attributed by some 

 to a shock given to the semilunar ganglion, 

 and the communication of the impression to 

 the heart ; while others are of opinion that the 

 injury is fatal by " paralysing the whole res- 

 piratory set of nerves from the violent shock 

 com municated to the phrenic, -and thus shut- 

 ting up as it were the fountain of all the 

 sympathetic actions of the body."* " A blow 

 on the pit of the stomach," says Sir Charles 

 Bell, "doubles up the bruiser and occasions 

 the gasping and crowing, which sufficiently 

 indicate the course of the injury a little more 

 severe, and the blow is fatal. A man broken 

 on the wheel suffers dreadful blows, and his 

 bones are broken, but life endures the coup- 

 de-grace is a blow on the stomach." 



5. Syncope by mental emotion. Instances 

 of this occurrence must be familiar to every 

 one both by reading and by observation. In 

 some of them th-e cause in question has 

 operated either by aggravating some pre-exist- 

 ing malady, or by calling into action some 

 strong predisposition to disease ; as in struc- 

 tural lesions of the heart on the one hand, and 

 in the apoplectic diathesis on the other. But 

 in other instances the mere violence of a pas- 

 sion has at once extinguished its subject with- 

 out the intervention of morbid tendency or of 

 actual disease. Such cases belong to the 

 Nervous Apoplexy of some authors; and cer- 

 tain it is that they present a complete annihi- 

 lation of sense and motion, but this condition 

 is only simultaneous with, or immediately suc- 

 ceeded by the failure of the circulation. We 

 have no doubt that the change in the organ of 

 the mind, corresponding to the emotion, ope- 

 rates upon other parts of the cerebro-spinal 

 axis, which in their turn affect the heart in the 

 same manner as other preternatural states of 

 that system. We are not acquainted with any 

 example in which either high intellectual ex- 

 citement unaccompanied by vehemence of pas- 

 sion, or mere intensity of external sensation, 

 has been the cause of sudden death ; nor could 

 it be expected a priori, since in the normal 

 condition of the economy there is by no means 

 the same degree of connection between the 

 action of the heart and intellectual and sen- 

 sific conditions, as between the former and the 

 emotions and affections. 



6. Syncope by hemorrhage. The functions 

 of the brain are in man so dependent upon a 

 regular supply of blood to the organ, that a 

 sudden diminution of it is alone sufficient to 



* Dr. Fletcher, op. cit. partii. chap. 6. p. 60. 



occasion vertigo and unconsciousness; and 

 this occurrence often takes place when the 

 action of the heart itself is little or not at all 

 affected. Every one is acquainted with the 

 effect of a change in the relative quantity of the 

 blood in the cerebral vessels, determined by 

 suddenly rising from the recumbent posture. 

 Now it has been often observed that vertigo in- 

 duced by other causes has been followed by 

 suspension of the circulation ; that is to say, 

 the state of the brain, which was attended by 

 giddiness, arrested the motions of the heart. 

 It has therefore been inferred that loss of blood 

 operates indirectly upon the heart through the 

 affection of the brain. When two phenomena 

 follow each other in such quick succession as 

 to be all but simultaneous, it is difficult to 

 determine which is cause and which is effect, 

 or whether they may not be the common ef- 

 fects of some other event. Certain facts 

 would seem to indicate that the latter is the 

 true interpretation of the phenomena which 

 we are considering. Thus haemorrhage some- 

 times affects the nervous system in the manner 

 alluded to, without presenting any check to 

 the contractions of the heart ; not to mention 

 that it appears more consistent with analogy to 

 conclude that the heart must be more directly 

 influenced by the loss of that which is its 

 natural stimulus, than by a change in a 

 remote organ. Again, there are cases in 

 which haemorrhage makes a decided impres- 

 sion upon the organs of circulation before the 

 brain has given signs of any material derange- 

 ment of its functions ; but in these the loss 

 of blood is more gradual than in the former 

 instances. " When haemorrhage is very gra- 

 dual," says Dr. Alison, " all the indications 

 of failure of the circulation may come on the 

 feebleness of muscular action, the paleness 

 and collapse of the countenance, the cold- 

 ness beginning at the extremities, the cold 

 sweat beginning on the face, and the pulse 

 may become imperceptible ; without the 

 senses or the intellect being impaired, and a 

 slightly laborious or heaving respiration may 

 be almost the only indication of injury of the 

 nervous system up to the moment of death." * 

 From facts of this description we should be 

 willing to decide at once that it is a superfluous 

 multiplication of causes to attribute the stop- 

 page of the circulation in any case of haemor- 

 rhage to the influence of cerebral changes, when 

 the direct operation of the cause upon the heart 

 itself is adequate to the explanation; were 

 it not for the important fact that haemorrhage 

 alone often fails to produce syncope till some 

 circumstance has intervened, the operation of 

 which is manifestly upon the nervous system. 

 Thus nothing is more common in bloodletting 

 than to find the heart unaffected by the with- 

 drawal of a considerable quantity of its stimu- 

 lus, so long as the posture of the body is 

 horizontal ; but on raising the head, a change 

 which for obvious reasons renders the brain 



* Outlines of Physiology and Pathology, p. 344. 

 This work contains a most valuable chapter upon 

 the causes of sudden death. 



