althy
state, for the purpose of forming a comparison. Its firmness was not
proportioned to its bulk, but it was considerably flaccid. Near the
apex, over the left ventricle, was a soft spot, similar to that found
in the preceding case. The venae cavae were then divided, and a torrent
of black blood issued from each of the orifices, in spite of our
efforts to restrain it. All the cavities of the heart were filled, as
we afterwards saw, with similar blood; in which circumstance this
resembles the other cases; though in this case the blood was entirely
fluid, and thinner than in cases of different disease: whereas, in
every other instance, was partly or wholly coagulated. This therefore
must be considered as another appearance peculiar to this complaint,
because it is well known, that blood is not usually found in the left
cavities of the hearts of those who die of other disorders. The cause
of it is doubtless an obstruction, which opposes the free discharge of
blood from the heart, whether that obstruction be in the aortal
valves, in the aorta itself, or in the disproportion between the
heart, or more precisely the left ventricle, and the parts it supplies
with blood.

Why was the blood entirely fluid in this case? If we compare the
appearance of the cellular membrane, and of the lungs, in both of
which there was a deficiency of blood, with the aspect of the face,
where there was an accumulation of blood, and consider at the same
time the mode of termination of this case, we shall find reason to
believe, that death was produced by a violent pressure of the brain
from a congestion of blood in its vessels, in consequence of the
obstruction to the return of that fluid to the heart. An additional
proof of this opinion is derived from the great quantity of blood,
which poured from the vena cava superior, during the whole time of the
examination, and afterward; so that it was found impossible to
preserve the subject from the blood flowing between the ligatures,
notwithstanding the thorax was entirely emptied, before it was closed.
In cases of sudden death from apoplexy, related by Morgagni, the blood
was frequently fluid, and this may be supposed to be the cause of that
appearance in the present case. The extraordinary thinness or watery
state of the blood is a distinct circumstance, which will be presently
noticed.

An examination of the brain, to ascertain the truth of the supposition
above mentioned, was relinquished with