THE
MEDICAL ASPECTS
OF
DEATH,
AND
THE MEDICAL ASPECTS
OF THE
HUMAN MIND.
BY JAMES BOWER HARRISON,
M.R.C.S.L. ETC.
FORMERLY ONE OF THE RESIDENT MEDICAL OFFICERS OF
THE MANCHESTER ROYAL INFIRMARY,
AND SURGEON TO THE ARDWICK AND ANCOATS DISPENSARY,
ETC.
LONDON:
LONGMAN, BROWN, GREEN, AND LONGMANS.
1852.
LONDON:
SPOTTISWOODES and SHAW,
New-street-Square.
PREFACE.
In youth it is not common to think much about death. A person would
be considered to be of a very serious turn of mind who gave attention
to such a subject in the earlier periods of his life. There comes a
time, however, sooner or later, in which it is perceived that there is
a reality in the meaning of the speeches we have so long unthinkingly
made or heard others make. We wake up to the conviction that we are
ourselves no exception to the rule; in fact, to the conviction that
we shall die. Already we find ourselves in the middle period of life;
already the scene is shifting, and we begin to perceive that it will
shift still more. It wants no great exhortation, then, to see that
every one is individually interested in all that relates to death. A
person must be wanting in reflection if he does not consider, at least
when he has made some progress in life, that he will very soon find
himself at his journey’s end. It is natural then to have a curiosity
about death; and it is partly with a view to satisfy this curiosity,
and partly with a view to fill up the intervals left by more arduous
professional studies, that I have written what follows.
But some will say the subject is a distasteful one, and, like Hotspur’s
fop, be offended that a slovenly, unhandsome corse should be brought
between the wind and their nobility. The true nobility of the mind does
not, however, shrink from contemplating human nature in all its phases,
untricked out with ornament or disguised by forms. I am sure the reader
who has the curiosity to look at these pages will not be wanting in
such nobility of mind.
In order to relieve the subject, I have purposely introduced more
collateral matter than might be absolutely necessary for its
elucidation.
I have never thought it essential that a book should be dry in order to
be useful.
* * * * *
The second paper in this volume I have been induced to reprint from the
Psychological Journal, because it has received the approbation of many
friends in whose judgment I am pleased to confide. I am aware that it
contains remarks to which some may take exception; but I write not to
echo the sentiments of others, but to make known my own. I regret that
at the time I wrote it I had not had the advantage of reading the very
able remarks of Dr. Conolly, in his Croonian lectures delivered before
the College of Physicians. The fearless and humane character of these
lectures deserves a higher praise than it is in the author’s power to
bestow.
_Higher Broughton, Manchester_,
1851.
CONTENTS.
Page
THE MEDICAL ASPECTS OF DEATH 1
THE MEDICAL ASPECTS OF THE HUMAN MIND 113
THE
MEDICAL ASPECTS OF DEATH.
_Hamlet._ Pr’ythee, Horatio, tell me one thing.
_Hor._ What’s that, my lord?
_Ham._ Dost thou think Alexander looked o’ this fashion i’ the earth?
_Hor._ Even so.
_Ham._ And smelt so? pah!
_Hor._ Even so, my lord.
SHAKSPEARE.
THE
MEDICAL ASPECTS OF DEATH.
“Dost thou think Alexander looked o’ this fashion i’ the earth?”
How pregnant is such a question with meaning,--the noble dust of
Alexander like the corrupting skull of the king’s jester! How natural
to ask ourselves the question, Shall we also look o’ this fashion
i’ the earth?--we want no Horatio to answer, “Even so.” But though
it is common to speak of death, I do not think it is very common to
_consider_ it. We are, in truth, too much afraid to look at it in
its physical aspects. The subject may seem repulsive, but it is one
which a rational being should not altogether disregard, because many
practical advantages arise from making it an object of study. It must
be remembered that it is a privilege peculiar to human nature, to
preconsider the last moments of existence. But I am not one of those
who would wish to throw a gloom upon life, and carry the skull round at
the feast--I would rather throw the light of reason, as far as it will
shine, on the mysteries of the grave.
How interesting are our first impressions of death!--when we first
looked timidly at the familiar features of a dear parent stiffened and
pinched with the hand of death! Who cannot recall to mind that cold
apartment which had so lately been the scene of anxious watching and
tender solicitude,--the formal sheeted corse,--the appalling stillness
of the compressed lip and icy coldness of that last kiss? It is at such
times that the feelings rise to the noblest sentiments of our nature,
and we see the littleness of human ambition, and the emptiness of
our fondest wishes;--at these periods alone can we perceive the real
significance of life, for then the hurry of business is suspended, and
there is a pause in the drama of events.
It would be curious to trace the forms and ceremonies which surviving
friends have adopted to show their respect for the dead. The custom of
strewing flowers on the tomb is, perhaps, one of the most simple and
touching. This custom is beautifully alluded to in “Cymbeline”:--
“With fairest flowers,
Whilst summer lasts and I live here, Fidele,
I’ll sweeten thy sad grave: thou shalt not lack
The flower that’s like thy face, pale primrose, nor
The azure hare-bell like thy veins; no nor
The leaf of eglantine, whom not to slander,
Outsweeten’d not thy breath.”
I shall not stop, however, to dwell on these topics, nor describe the
“trappings and suits of woe,” which are not always the accompaniments
of real grief. The nodding plumes and lengthened processions of
the great only betray how little wealth and rank can rescue their
possessors from the common fate of human kind.
In how many cases might we not say, with Byron,--
“Of all
The fools who flock’d to swell or see the show,
Who cared about the corpse? the funeral
Made the attraction, and the black the woe.”[1]
The _Signs_ of death are important in a medical point of view; for
though the extinction of life is generally too apparent to admit of
question, there can be no doubt but that occasional errors have arisen.
In most of these cases, it is certain that undue haste and culpable
carelessness have contributed to the result; but we all feel so deeply
the horror of such mistakes, that some fear is excusable, even when we
have no apprehension of such carelessness on the part of those who may
have to do the last offices for ourselves. In all periods the subject
of premature interment has excited great interest, and the very fears
which have been entertained have been the occasion of many stories
equally marvellous and horrible.
In order to provide against premature interment, the Romans are said
to have waited seven days before they interred the dead; those who had
charge of the corpse calling the name of the deceased many times in a
loud voice. It was this custom which constituted the _Conclamatio_.
Just before the body was finally buried, the name was again loudly
called; and then it was considered proper to enter on the funeral
ceremonies.
Terence makes allusion to this custom when he says,
“Desine,--jam conclamatum est.”
If we are to believe French writers, it would seem that, formerly,
premature interments were very common in France. It is to be hoped,
however, that many of their statements are exaggerated or incorrect.
Bruhier has collected together upwards of 180 cases, in which mistakes
were made as to the signs of death: of these, 52 were interred alive, 4
opened before death, 53 recovered spontaneously after having been shut
up in the coffin (renfermées dans le cerceuil), 72 reputed dead without
being so. At the same time that we are happy to think that Bruhier must
have greatly indulged his imagination, it is probable that the French
hospitals may have been the scene of many culpable errors.
Louis, in his more able letter on the Signs of Death, which was
published in 1752, relates the case of a young woman, _en couches_, who
left the Hôtel-Dieu on account of the prevalence of an epidemic, and
sought refuge at the Hôpital de la Salpétrière. On her way she fainted
twice, and again on her arrival fell into a fainting fit. She was
thought by the sisters of charity to be dead, and remained two hours
exposed in the court to a rigorous cold. She was then carried into the
_salle des morts_ (dead-house). Some time afterwards, a pupil hearing
groans, came affrighted to inform Louis. Louis went to the spot, but
found her already dead; though she had made efforts to get extricated
from the winding sheet in which she was enveloped, and had one foot
on the ground, out of the litter, and an arm leaning on the bar of
the trestle of a dissecting table, by the side of which she had been
placed.[2]
Many of the stories told of persons being buried alive, partake too
much of the marvellous, to meet with unqualified acceptance. In periods
of great mortality, and when epidemics have raged, there can be little
doubt, however, that such instances have occurred. The philanthropic
Howard, in his work on Prisons, says:--“I have known instances where
persons, supposed to be dead of the gaol fever and brought out for
burial, on being washed with cold water, have shown signs of life, and
soon afterwards recovered.” I have myself frequently heard people
express their fears of being interred alive. I remember a young lady
who, on her death-bed, made a solemn appeal to her father, that her
body might be thrown into the sea as soon as it should be known that
she was dead. Her father properly and ingeniously opposed her wish, in
expressing his desire that her remains should rest in the same grave
with his own. A lady in Manchester had so strong a fear of being buried
alive, that she left a sum of money, the interest of which was to be
received only on conditions that her body was kept above ground. The
body was bound over closely like a mummy, and was deposited in the
Natural History Museum, where, I believe, it may still be seen by the
curious.
Perhaps this feeling had been induced by some circumstances in her
life, which had rendered her extremely fearful of such mistakes.
Dr. Paris tells us, “that the daughter of Henry Laurens, the first
president of the American Congress, when an infant, was laid out as
dead of the smallpox; upon which the window of the apartment, that had
been carefully closed during the progress of the disease, was thrown
open to ventilate the chamber, when the fresh air revived the supposed
corpse, and restored her to her family: this circumstance occasioned in
her father so powerful a dread of living interment, that he directed by
will that his body should be burnt, and enjoined on his children the
performance of this wish as a sacred duty.”[3]
Amongst the ordinary signs of death the absence of respiration is
that which is most popular, but at the same time the most likely to
deceive. To ascertain whether the breathing be entirely suspended, it
is a common practice to hold a looking-glass to the face, that the
respiration may be indicated by the mist on its surface.
In King Lear we have the passage--
“Lend me a looking glass;
If that her breath will mist or stain the stone,
Why, then she lives.”
Act V. Sc. III.
For the same reason the stirring of any light substance, such as
down, which may rest about the mouth, has been regarded as a fine
indication of the act of respiration; but this, like the mist on the
looking-glass, is but a deceptive or inaccurate method; and Shakspeare
accordingly represented Prince Henry as having been deceived, when he
carried off the crown from his father’s pillow--
“By his gates of breath
There lies a downy feather which stirs not;
Did he suspire, that light and weightless down
Perchance must move.”[4]
If the observance of the respiration be taken as the indication of
life, and its absence as a proof of death, the exposure of the naked
chest and abdomen would enable the spectator to form a much more
accurate appreciation of it, especially if it be made carefully and for
a sufficient length of time.
One indication of death is found in the Rigidity of the corpse. It is
true that persons in some nervous diseases have been represented as
closely assimilating the dead, even with respect to the stiffness of
the body. The professional man could scarcely, however, be deceived
by such cases. The stiffness of death is often not fairly established
until the body is already cold[5], and, when overcome by pressure, does
not return, as the contractions which arise from nervous causes. Some
cases of catalepsy have been related which are indeed very astonishing,
but, as I have said, they could only deceive unprofessional people, and
those not familiar with the appearances of a corpse.
The rigidity of death appears to come on with various degrees of
rapidity, and its duration is also various. It usually commences in
about seven hours[6], but it may be deferred considerably longer,
even to twenty or thirty hours. When the body is greatly weakened by
disease, the rigidity comes on much sooner, but is more evanescent. It
has been known to arise in fifteen or twenty minutes. Again, in its
duration there is much variety; ordinarily it exists from twenty-four
to thirty-six hours, but may continue many days. Much may be supposed
to depend on the humidity and warmth of the atmosphere.
There is something singular in this stiffening of the body. It seems
like the final act of life, and has been supposed to be the last
effort of muscular power. Every one must be struck with the analogy
it presents to the coagulation of the blood; and, indeed, it has been
imagined by some physiologists that it was dependent on that cause.
This does not appear in reality to be the case; but there are still
many interesting points of similarity between these phenomena, and they
are both probably dependent on the last efforts of life.
The rigidity of the corpse is, perhaps, never entirely wanting, though
it may be brief in particular cases.
It does not seem to be confined to the external muscles of the body,
but is also evident, and indeed particularly manifested, in the heart
and great blood-vessels. The walls of the heart contract forcibly
after the external signs of death, and the arteries also contract, and
propel their contents into the veins. Before this circumstance was
properly understood, it was common to suppose that this contracted
state of the heart was the result of disease; and even in modern times
this error has been made. In the same way the ancients were misled
by this contraction; for, as they found the arteries void of blood,
they regarded them as tubes for the conveyance of air; and in this way
arose the term artery (ἀὴρ, air; τηρέω, to keep), improperly used to
indicate a blood-vessel.
The rapidity with which the body cools after death, must be very
dependent on the circumstances in which it is placed, and the manner in
which it is clothed. According to Dr. Taylor, the average time is about
fifteen or sixteen hours when not much clad, and when the temperature
is about 60°. He has known a body keep warm thirty or forty hours; and
as he remarks, the heat would obviously remain the longest, when the
death was violent and the person robust. There is always, however, some
uncertainty in judging of the period of death by the warmth of the
body.[7]
It is a curious fact in relation to the temperature of the body, that
in cases of Asiatic cholera, the body, previously quite cold, has
become warm immediately before, or even after death.[8]
The effects of Stimulants in producing muscular contractions soon
after the cessation of all outward signs of vitality, are curious
and interesting. When punctures are made in the limbs or heart,
contractions follow, and in some cases alternate contractions and
relaxations continue for some time. The most astonishing experiments of
this kind are, however, those made by the agency of galvanism on the
human body. The appearances produced by it are of the most frightful
nature, and awaken horrible fancies on the mind of the spectator;--the
eyes roll wildly, and the countenance is distorted with ghastly grins,
whilst the limbs move in forcible and convulsive actions. The most
successful effort to resuscitate by galvanism, was that made on the
body of John White, who was executed for a murder at Louisville.
The particulars are given in the Annals of Electricity. The body, after
hanging twenty-five minutes, was cut down, and, whilst yet warm, and
even trembling, was subjected to the stimulus of galvanism. The man
suddenly rose from his bench to a sitting posture, afterwards stood
on his feet, opened his eyes, and gave a terrific screech. His chest
worked as if in respiration. One of the surgeons present exclaimed that
he was alive. On another shock being given, he jumped up with a sudden
bound, disengaged himself from the wires, and ran into a corner of
the room. He frequently opened his eyes, and the breathing became so
regular, that many addressed him, but he made no sign of understanding.
Nevertheless, by the assistance of a medical student, he took a few
steps on the floor, and seated himself in an arm-chair. He seemed like
a man intoxicated, and overcome with the exertion he had made. Every
effort was put in practice to equalise the circulation; but congestion
of the brain eventually came on, and terminated his existence. A man
of the name of Clydesdale, who was executed for murder at Glasgow, was
also made the subject of a similar experiment.
In respect to the application of stimulants, it is not likely that the
more powerful, such as electricity or galvanism, will be made use of by
any other than medical men; and this mode of testing the continuance
of life is therefore more interesting in a physiological point of
view, than useful in its practical application. Cold water to the face
and sinapisms to the feet are often employed in the last moments of
life,--if not to test the existence of vitality, at least to act as
curative agents.
When Putrefaction commences, there can, of course, be no longer any
doubt of the departure of life,--premising, that the putrefaction is
general, and not of a local kind. There is nothing more appalling and
humiliating than the decomposition of the dead;
“Before Decay’s effacing fingers
Have swept the lines where Beauty lingers,”
we may, indeed, persuade ourselves, that the dead are only silent and
unmovable; but when changes gradually manifest themselves, and we can
no longer recognise the familiar features we have so often looked
upon, we see the greatness of that alteration, and feel what it is to
die.
Shall we “look upon those lips that we have kissed we know not how
oft,” pale, cold, and repulsive, and not experience the immensity of
this change!
The peculiar cadaverous odour of the body is well known to most people,
and the appearances of incipient putrefaction need no explanation.
The finer changes are, perhaps, best indicated by the flaccidity
of the cornea, and the loss of transparency in the eye. These can
seldom be mistaken by medical men, though death may undoubtedly take
place before they are strikingly apparent. Amongst other indications
of decomposition, the gravitation and transudation of the blood
to the surface on which the body lies, are important subjects for
consideration, because they have been mistaken by persons ignorant
of such matters for indications of injuries and bruises. They often
present very singular lines and marks, and have certainly a very close
resemblance to the extravasations produced by blows. These marks have
been termed sugillations,--the term sugillation is rather an awkward
word, but it is derived from the Latin _sugillatio_, which signifies a
black mark. Several instances are recorded of their being mistaken for
the ecchymoses produced by blows.
Belloc relates an instance where a woman, who was pregnant, was
ill-treated by her husband, who kicked her on the thigh and abdomen.
She subsequently fell ill of the smallpox, and died. The second day
of the fever she had an abundant hæmorrhage from the nose, the blood
being _dissolved and black_ (_dissous et très noir_). She died covered
with sugillations, and some traces of the smallpox. It then became a
question, whether she had died from violence. The body was exhumed for
the purpose of inspection, but the medical men who made the examination
concluded that her death was the result of the epidemic smallpox.[9]
Beck, in a note, quotes a case from Phillips’s Law of Evidence, of
a John Stringer, who was tried for the murder of his wife, in the
year 1765. It appeared that they had often quarrelled; and a young
surgeon gave it as his opinion that the marks found on the body had
the appearances of mortification produced by bruises. The man was
found guilty; but a Mr. Carsan, an eminent surgeon, who had from
mere curiosity also examined the body, was convinced that the marks
were those of incipient putrefaction; and on the case being fairly
represented to the Archbishop of Canterbury, a complete pardon was
eventually obtained.[10]
Sugillations may be distinguished from ecchymoses, by their being
found only on the more dependent parts of the body, or those which
_have_ already been dependent, and from their not being accompanied
by corresponding _subcutaneous extravasations_. In the case of
sugillations, therefore, if the skin be fairly divided, the livid
appearance will not be found traceable to any more deeply-seated cause.
The blood, too, in the case of sugillations is thin and fluid from its
decomposition; whereas, in the lividity from blows, clots are commonly
found beneath the spot indicated. But the effects of gravitation are
not only to be taken into consideration in estimating the external
appearances of the body, but also in considering the internal parts;
and this is of great consequence in the appreciation of the appearances
supposed to be the result of disease.
Sometimes discolourations of the body after death assume the appearance
of stripes, as if the subject had been previously beaten. The term
_Vibices_ (_vibex_, a stripe) has been adopted to express this
appearance. Certainly, any one not previously aware that such marks are
common, would be strongly tempted to suppose that they were produced by
flagellation. It seems that these marks are caused by the dress and
wrappings of the corpse causing the transudation of the blood to be
determined to particular parts.
In the year 1837, Μ. P. Manni, professor in the University of Rome,
offered to the Academy of Sciences, to place at its disposal the sum
of 1500 francs, to be given to the author of the best memoir on the
question of apparent death. In the same year the Academy proposed
the following questions on the subject for a prize: 1. What are the
distinctive characters of apparent death? 2. What are the means to
prevent premature interment?
It was not until the year 1846 that any memoir appeared which was
considered worthy of the prize; and it was then adjudicated to Μ.
Bouchut, whose treatise is now before the public.[11]
It appears from Μ. Bouchut’s able researches, that the _sounds_ of the
heart, as indicated by the stethoscope, are never entirely wanting,
except in real death; and that the longest interval between the last
beats of the heart is about six or seven seconds. These, therefore,
are very important points in ascertaining the departure of life at the
earliest possible period. The remarks of Μ. Bouchut are indeed such
as must naturally recommend themselves to our reason; but he is the
first who has fairly made the state of the heart in apparent death the
subject of direct observation and experiment.
Μ. Bouchut further insisted on the complete dilatation of the pupil as
a corroborative sign of death, remarking that, though contracted in the
death struggle, it afterwards and speedily becomes dilated; so truly
may we say that, “la pupille est la fenêtre de l’ame.”
It would seem, then, that the indications of death are sufficiently
marked to render it improbable that premature interment can often
take place; and whenever this occurs, it must be the result of great
carelessness, ignorance, and haste.
Even the alterations which take place after the body is committed to
the grave, have engaged the attention of medical inquirers, and Μ.
Orfila, in his treatise on Judicial Exhumations, has brought forward
much curious matter respecting them. It is not very probable that the
features of the dead can be recognized after fourteen or fifteen days’
interment; and in three or four months all vestiges of the face are
destroyed.
In cases, however, where pains are taken to exclude the air, the
preservation may be wonderfully protracted; and on this point I may
add some very interesting particulars relative to the posthumous
examination of the body of Charles I.
Until a recent period, doubt had been entertained as to the precise
spot where the remains of Charles I. were buried.
In the progress of some alterations which were made in connexion with
the tomb-house of St. George’s Chapel, an aperture was accidentally
made in Henry VIII.’s vault, through which the workmen saw two coffins,
supposed to contain the bodies of Henry VIII. and Jane Seymour, and
a third covered with a black velvet pall which, from Mr. Herbert’s
narrative (Athenæ Oxonienses), was conjectured to contain the body of
Charles I.
By the desire of the Prince Regent, and in his presence, an examination
of this latter was made on the 1st of April, 1813. On removing the
pall a plain leaden coffin was discovered, on which were inscribed, in
large letters, King Charles, 1648. A square opening was made into the
upper part of the lid, and through this a wooden coffin was seen, very
much decayed, inclosing the body, carefully wrapped up in cere-cloth.
It appeared that a quantity of greasy and resinous matter had been
melted into the coffin so as to fill it completely, and exclude the
air. It was not an easy matter to detach the cere-cloth from the body,
except at such parts as were covered with unctuous matter, and these
presented a correct impression of the features to which they had been
applied.
When the face was at length uncovered, it presented a dark discoloured
appearance, but the forehead and temples had lost nothing of their
muscular substance, and the face was long and oval. The cartilage of
the nose was gone; the left eye was open and full when first exposed,
but it rapidly vanished. The pointed beard, so characteristic of
this period, was perfect. Many of the teeth remained, and the left
ear was found entire. It was impossible not to perceive the likeness
which still remained to the coins and busts, and especially the
pictures of the king by Vandyke. When the cere-cloth was sufficiently
disengaged, the head was found loose and detached from the body; the
hair was thick at the back part of the neck, and had been apparently
cut short for the convenience of the executioner. At first it seemed
black, but when cleaned and dried, presented a beautiful brown colour.
The fourth cervical vertebra was cut transversely and smoothly, as
if from a heavy blow of a sharp instrument. The examination having
proceeded thus far, was thought to be sufficient to identify the
body, and the head was immediately restored, and the coffin soldered
up again. The other coffins were not disturbed; but the larger one,
which is believed to have contained Henry VIII., and was six feet ten
inches in length, was beaten in, as if by violence, and its outer
wooden covering was decayed, and in small fragments. Through the
opening the skeleton of the king might be perceived, but there was
nothing found of a discriminative character, and no inscription on
the coffin. It is supposed, that the coffin of King Henry had been
injured by the precipitous introduction of that of King Charles, at
a period when little respect was paid to the remains of monarchs. It
may be interesting to add, that a very small mahogany coffin, covered
with crimson velvet, lay on the pall which covered King Charles, and
contained the still-born child of the Princess George of Denmark,
afterwards Queen Anne.[12]
If the fear of premature interment be not unnatural, the fear of death
itself is obviously less so.
In some cases, however, illness gradually removes this dread, and the
change is welcomed, and even earnestly desired; the sufferer has ceased
to take an interest in the things around him: they have lost all the
charms they borrowed from hope and anticipation, and he has no future
earthly prospect but the grave.
But even where the act of dying is dreaded, there are many who would
not altogether be ignorant of the change. I have known people express
a strange fear of dying whilst they are asleep. I was once earnestly
asked by a patient who was on her death bed to awaken her if I thought
she was dying. I should imagine that this fear was not uncommon;
for I have heard it named more than once in my own experience.
In a very interesting memoir of Mr. Edgeworth, a part of which is
autobiographical, the writer states that his wife expressed this dread;
but, alas! the sleep of death is one from which we cannot awaken our
dearest friends!
“Three days before she died,” says Mr. Edgeworth, “I was suddenly
called up to her room. I found her in violent convulsions. Youth,
beauty, grace, charms of person and accomplishments of mind, reduced
to the extreme of human misery, must have wrung the most obdurate
heart. What must her husband feel at such a moment? I felt her pulse,
and whispered, ‘You are not dying;’ she looked at me with an effort of
resolution and kindness to thank me.
* * * * *
“She soon fell asleep, and awakened smiling. ‘I am smiling,’ said she,
‘at my asking you to sit beside me as a sort of protection, and at my
being afraid to _die in my sleep_, when I never felt afraid of dying
when awake.’”
Sometimes consciousness remains to the last moment of existence, and
even when the tongue refuses to speak, the wistful eye and wave of the
hand serve to impress the dying injunction. How beautifully and truly
is this pictured in the story of Lefevre, where the poor soldier looks
first at his son, and then at my Uncle Toby; “and the ligature, fine as
it is, was never broken!”
When death is inevitable, it becomes the duty of a medical man to
consider the propriety of informing his patient of his condition. The
subject is very ably treated in a paper by Sir H. Halford; and written
in his usual classical style. Sir Henry thinks it desirable that the
physician should make known his opinion rather to the friends than
to the patient, and allow the friends themselves to be the means of
communicating the intelligence to the sick. “They do so,” he says,
“without destroying his hopes, for the patient will still believe
that he has an appeal to his physician beyond their fears; whereas,
if the physician lay open his danger to him, however delicately he
may do this, he runs a risk of appearing to pronounce a sentence of
condemnation to death, against which there is no appeal.”[13] Sir H.
Halford goes on to say, “that in the case of his late majesty (alluding
to George IV., who died on the 25th of June, 1830), the Government
and the royal family were informed, on the 27th of April, that his
majesty’s disease was seated in his heart, and that an effusion of
water into the chest was soon to be expected. It was not, however,
until the latter end of May, when his majesty was so discouraged by
repeated attacks of embarrassment in his breathing, as to desire me to
explain to him the nature of his complaint, and to give him my candid
opinion of its probable termination, that the opportunity occurred of
acknowledging to his majesty the extent of my fears for his safety.
This communication was not necessary to suggest to the king the
propriety of religious offices, for his majesty had used them daily;
but it determined him, perhaps, to appoint an early day to receive the
sacrament. He did receive it with every appearance of the most fervent
piety and devotion, and acknowledged to me repeatedly afterwards, that
it had given him great consolation, true comfort. After this, when ‘he
had set his house in order,’ I thought myself at liberty to interpret
every new symptom, as it arose, in as favourable a light as I could,
for his majesty’s satisfaction; and we were enabled thereby to rally
his spirits in the intervals of his frightful attacks, to maintain
his confidence in his medical resources, and to spare him the pain of
contemplating approaching death, until a few minutes before his majesty
expired.”
The changes which immediately precede death are, of course, more or
less painful, according to their nature and severity; yet there can be
no doubt but that dissolution itself is the cessation of suffering. In
some instances the approach of death is betokened by strange and awful
sensations; and it is probable that where consciousness remains to the
last, the feelings are always peculiar and unmistakeable.
These premonitions of death often give rise to a degree of
restlessness, and a wish for change, which is odd and capricious in its
manifestations. Persons who have long remained tranquil will suddenly
express a desire to be dressed and go down stairs, or have their beds
moved to another position. Strange yearnings for particular places and
old scenes sometimes arise, which seem like the shadowing forth of dim
instincts, which have been concealed in the recesses of the mind. How
painfully must such longings have been felt when death has hovered over
the couch in the wild and inhospitable districts of the tropics, or the
frozen regions of the extreme north!
With the exception of those who are worn down by long illness, or
reduced to despair by mental anguish and misfortune, there are few who
can believe that they have accomplished all the purposes of life; and
we naturally look forward to the infirmities of old age to wean us from
the interests of the world. But even then we are reluctant to leave;
and it is only when deserted by friends, that we can say in the words
of the poet,--
“I have liv’d long enough; my way of life
Is fall’n into the sear--the yellow leaf.”
In speaking of others it is common to regard life as properly
terminating when usefulness, activity, and fortune are declining. When,
reverses succeed a happy and prosperous career, we say that existence
has been too protracted: it is on this account that the poets have
spoken of the happiest moment of life as the most proper time for
death; a notion certainly more poetical than rational. Thus, in Don
Juan, Byron says, speaking of his lovers,--
“Why did they
Then not die?--they had liv’d too long
Should an hour come to bid them breathe apart.”