Medical Jurisprudence, Volume 3 (of 3)Paris, John Ayrton
Science
Medical Jurisprudence, Volume 3 (of 3)
Paris, John Ayrton
Medical laws and legislation -- Great Britain
that it was as thin as the finest paper, in which part the rupture took
place, and which was succeeded by a fatal hemorrhage; and yet the king,
before his death, had not the slightest symptom that appeared to deserve
much attention. In every case of sudden death the heart should be
removed from the body for the purpose of examination, and no anatomical
evidence should be received as conclusive, unless such an operation has
been duly performed. For this purpose, the blood-vessels should be first
secured by ligatures, for it is very essential to prevent the effusion
of blood; and, having then separated it from its attachments, we should
proceed to examine the organ in the following manner. Slit open,
longitudinally, by means of scissars, the right auricle, at its
foreside, then make an incision from the mouth of the pulmonary artery
to the point of the heart, guarding against the accident of injuring the
two sets of valves; now cut open the whole length of the pulmonary
artery, except at its beginning, and at its valves, which ought to be
left entire; lastly, open the pulmonary veins, and then the left auricle
and ventricle, in a similar manner with what was done to the
corresponding parts of the right side.
We beg to direct the attentive consideration of the anatomist to this
important part of the inquiry; he ought to notice the quantity of blood
contained in the cavities of this organ, as well as its colour, and
state of coagulation, especially in relation to the arterial and venous
sides of the heart; the indications which such an examination may afford
will be fully appreciated by referring to our chapter upon “the causes
and phenomena of sudden death,” and that upon “suffocation.” In
examining the cavities of the heart, especially the ventricles, it not
unfrequently happens, that a mass of coagulated lymph, of a yellowish
colour, and of considerable firmness, is found to occupy them; this
phenomenon, from the manner in which its processes extend into the
fasciculi of muscular fibres of the heart, has acquired the name of
“_polypus of the heart_,” and was regarded by the older anatomists as a
very common and fatal disease. It is necessary to observe that the
phenomenon is now better understood, and it is universally admitted to
be the result of slow coagulation after death. The state of the valves
of the heart should be attentively inspected, for a disease in these
parts may have been the cause of the sudden death which we are
endeavouring to discover. The three _semi-lunar_ valves at the origin of
the aorta, and the _mitral valves_, are sometimes in a state of
ossification; those placed at the commencement of the pulmonary artery,
and the _tricuspid_ are less disposed to take on morbid action than the
preceding ones that occupy the arterial side; indeed, there are very few
well authenticated instances of such a change. Such a state of the
valves of the heart necessarily places the life of the individual in
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