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.

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.