Physiological Researches on Life and Death

by Xavier Bichat

3dly.—At the moment when syncope takes place, we feel the attack at the heart, and not in the brain.

4thly.—In consequence of lively passions, which may have occasioned syncope, we find that the heart and not the brain becomes diseased, nothing is more common than organic affections of the former from sorrow, &c. The different sorts of madness, which are produced by the same cause, for the most part have their principal seat in some of the viscera of the epigastrium, and in such case, the irregularity of the cerebral action is the sympathetic effect of the profound affection of the internal organ.[76]

5thly.—I shall prove hereafter, that the cerebral system does not exert any direct influence over that of the circulation; that there is no reciprocity between the two, and that the changes of the first are not followed by similar changes in the second, however much the changes of the second may modify the first. Destroy all nervous communication between the brain and the heart, and the circulation will go on as usual; but if the vascular communications be intercepted, the cerebral action vanishes at once.

6thly.—Palpitations and other irregular movements of the heart are often the effect of the same causes, which in some individuals are the occasion of syncope. In such cases, it is easy to discover the seat of the affection, and such smaller effects of the passions on the heart, are very well calculated to throw light upon the nature of the greater.[77]

From these many considerations, we may conclude that the primitive seat of the attack in syncope, is the heart, which does not cease to act, because the action of the brain has been interrupted, but because it is the nature of some of the passions in such way to affect it, the brain at the same time, suffering a temporary death, because it no longer receives the fluid, which is necessary to its excitement. The nature of syncope is well enough illustrated, by the vulgar expression of being sick at heart.

It is of no importance to our present purpose, whether syncope depend on polypi, on aneurism, or be the result of some violent emotion. The successive affection of the organs is always the same. They die for the moment in the same way, as they really perish when the heart is wounded, or a ligature put upon the aorta. In the same manner also are those sorts of syncope produced, which succeed after any great evacuation of blood, pus or water. The heart is affected from sympathy, the brain for want of its excitant.[78]

Those cases of syncope which are occasioned by peculiar odours, by antipathies, &c. appear also to be attended with the same progression of symptoms, though their character be much less easily understood. There is a great difference between syncope, asphyxia, and apoplexy, in the first it is by the heart, in the second by the lungs, in the third by the brain that begins the general death of the body.

Death, as it happens in consequence of disease, in general exemplifies a concatenation of these different symptoms. The circulation, respiration, or cerebral action cease, the other functions are afterwards interrupted of necessity, but in these sorts of death, it rarely happens that the heart is the first to die. This however is sometimes the case. After long continued suffering, great suppuration, and sometimes, in dropsy, certain fevers, and gangrenes, one fit of syncope comes on after another, at last a longer one succeeds, and the patient dies, but whatever be the part affected, whatever the diseased viscus or organ, whenever the phenomena of death commence by the heart, they succeed each other as we have described them to do in sudden death, from lesion of that organ. In other cases, the heart is the last to act, is the ultimum moriens.

In general, in morbid affections, we much more commonly observe the ingress of death to be made by the lungs, than either by the heart, or the brain.

Whenever disease is terminated by syncope, the lungs are found to be almost empty, and if not affected by any organic disease, are collapsed, occupy a part only of the cavity of the thorax, and are of their natural colour.