Note 22 — SYNCOPE: In which the pulsations of the heart cease, before the action of the respiratory organs.

A great question has arisen upon this subject, whether rupture of the heart ever takes place in the sound state of that organ? And it has been answered by several pathologists in the affirmative. Fischer’s case from the Journal der Practischen Heilkunde, may be seen in the Medical Repository, Vol. 11, p. 427, and Vol. 12, p. 164. Harvey found in a male subject a rupture in the aortic ventricle, capable of admitting a finger, and remarked that the parietes of the cavity possessed their natural strength and thickness (Exercitat III. De Circulo Sanguinis, T. p. 1. 281.) Bohn also gives a case of a man who had died suddenly, when a fissure was discovered in the Ostium Aortæ. Portal has informed us, that in a rupture of the basis of the heart, which he examined, the structure of the organ was as firm and compact as in the natural state, and that in another case the parietes of the heart displayed their natural solidity. (Memoires de l’Academie des Sciences, a Paris, 1784, p. 51.) Soemering considers it as having been very correctly remarked by Portal, that the Aortic ventricle commonly bursts without any previous weakening of the substance of the heart. (See Soemering’s German Translation of Baillie’s Morbid Anatomy, with Additions.) Dr. Whytt has likewise seen the heart burst from protracted grief, and therefore does not regard the term, “BROKEN HEART,” in the light of a mere metaphor. On the contrary, Boerhaave has recorded two cases, and believes that the rupture was occasioned by the morbid accumulation of fat; Kreysig suspects that in most of these cases of ruptured heart an insidious inflammation had been established, and he considers that the quantity of adipose substance in which ruptured hearts are so commonly found enveloped, furnishes an evidence of this inflammatory state (Sopra i Malattée del cuore.) We are decidedly of opinion that such ruptures take place in consequence of a morbid state of the heart capable of diminishing the cohesive power of its fibres. See a Treatise on the Diseases of the Chest by R. T. H. Laennec, M. D. translated by J. Forbes, M. D. London, 1821.