And Shakspeare makes Othello exclaim:--
“If I were now to die,
’Twere now to be most happy; for I fear
My soul hath her content so absolute,
That not another comfort like to this
Succeeds in unknown fate.”
I might bring forward many other illustrations of the same kind, but it
would only be to digress. There is, in truth, in many minds a fearful
presentiment that great happiness cannot be of long duration; but if
the prosperous periods of life are those which seem to form the natural
climax and terminating point of life, they are those in which we could
least bear the loss of others. The sudden removal of one who is in the
very midst of his usefulness, in whose success we had “garnered up
our hearts,” creates a revulsion of feeling which poor humanity can
ill support. The consolations of religion are the only consolations
which deserve the name, and it is the idea alone that separation is
temporary, that can stem the torrent of overpowering grief. It is the
anticipation of a re-union hereafter which throws the only ray of light
that can penetrate the gloom of the mourner’s mind. He is yet to have
a meeting beyond the grave; and whilst this idea mitigates grief, it
renders the prospect of death itself less terrible. It was in this way
that Mrs. Garrick endeavoured to remove the terrors of death, after the
loss of the great actor.
On the 20th of April, 1781, Boswell writes, “Mrs. Garrick had this day,
for the first time since his death (her husband’s), a select party
of his friends to dine with her. The company were Miss Hannah More,
who lived with her, and whom she called her chaplain; Mrs. Boscawen,
Mrs. Elizabeth Carter, Sir Joshua Reynolds, Dr. Burney, Dr. Johnson,
and myself. We found ourselves very elegantly entertained at her
house in the Adelphi, where I have passed many a pleasing hour with
him ‘who gladdened life.’ She looked well, talked of her husband with
complacency; and while she cast her eyes on his portrait which hung
over the chimneypiece, said that ‘death was now the most agreeable
object to her.’”
The uncertainty and brevity of life would furnish fit topics for
medical as well as for moral reflection. How often must they present
themselves to the physician’s mind!--Sometimes he meets death in early
tender infancy;--sometimes in robust manhood;--sometimes in feeble
old age;--sometimes in the sudden apoplexy;--sometimes in the wasting
consumption.
As he looks upon the aged sufferer, he must often call to mind how
transient are youth and beauty, and the boast of manly strength and of
womanly elegance.
It is with something of this feeling that the following passage will be
read which I extract from Andersen’s Story of My Life.
As a little boy, Andersen had formerly seen the great actress, the
Donau-weibchen, at the theatre of Odense. He saw how much she was
honoured, and the homage that was paid to her. “Many years afterwards,”
says he, “when, as a student, I visited Odense, I saw in one of the
chambers of the Hospital, where the poor widows lived, and where one
bed stood by another, a female portrait, hanging over one bed in a gilt
frame.
“It was Lessing’s Emelia Galotti, and represented her as pulling the
rose to pieces; but the picture was a portrait. It appeared singular in
contrast with the poverty by which it was surrounded.
“‘Whom does it represent?’ asked I.
“‘Oh,’ said one of the old women, ‘it is the face of the German lady
who was once an actress.’ And then I saw a little delicate woman,
whose face was covered with wrinkles, and in an old silk gown that
once had been black. This was the once celebrated singer, who, as the
Donau-weibchen, had been applauded by every one.”[14]
But if life is but brief and vain in the retrospect of age, how shall
we speak of it with the uncertainties of the most promising career?
In the spring of 1781, all the talent and fashion of London had been
invited to the town-house of Mr. Thrale in Grosvenor square, to partake
of a sumptuous entertainment. On the dawn which followed that very
night, the owner of the mansion had terminated his existence in an
attack of apoplexy.--The same catastrophe, perhaps, now awaits many who
are looking to the future with equal joy and with equal promise.
* * * * *
The _bodily changes_ which immediately precede, and, in some sense, may
be said to constitute, death, deserve and repay consideration. It might
seem, on a first attention, that the modes in which death takes place
are so various, and the diseases to which the human frame is liable
so numerous, that it would be impossible to reduce the subject to any
simple and practical form of inquiry.
It will be found, however, on a more intimate acquaintance, that much
advantage may be gained by classification and arrangement, and a
sort of analysis made which requires no forced construction, and no
metaphysical nicety.
Death may indeed be said to _begin_ at different parts of the body,
according as they are severally the first to suffer those irreparable
and grave changes which issue in the destruction of life. It will
be found that the nature, symptoms, and peculiarities of the act of
dying, are determined by the organ first mortally attacked; so that, by
considering the subject in relation to these parts, we are assisted in
arranging our ideas.
The alterations which directly occasion dissolution seem principally
effective, either in the arrest of the _circulation_ or the
_respiration_; and the manner in which they tell in producing these
effects, will now, therefore, briefly, come under our consideration.
As the heart is the great mover of the circulation, we can easily
conceive that whatever brings it to a stop must be fatal to life.
Extensive losses of blood operate in this manner, and they furnish us
with a good illustration of the manner in which death takes place. The
sufferer becomes pale and faint, his lips white and trembling: after
a while the breathing becomes distressed, and a rushing noise seems
to fill the ears. The pulse is soft, feeble, and wavering; and the
exhaustion and prostration are more and more alarming. Soon a curious
restlessness arises, and he tosses himself from side to side. At length
the pulse becomes uncertain, and the blood is feebly thrown to the
brain. The surface assumes an icy coldness. The mind is yet untouched,
and the sufferer knows himself to be dying. In vain the pulse is sought
at the wrist--in vain efforts are made to re-excite warmth--the body
is like a living corpse. Now a few convulsive gaspings arise, and
the countenance sets in the stiff image of death. Such are the more
striking phenomena which attend the fatal hæmorrhages.
The failure of the vital powers, from the withdrawal of blood, may be
regarded as a sort of type of this mode of death, since the various
symptoms which have been named, arise from the cessation of the
healthy circulation.
A dread of the loss of blood may almost be considered as an instinctive
feeling; at any rate its importance is early impressed on the mind, and
is never forgotten. In childhood it is looked at with alarm; and the
stoutest mind, cannot but view with horror those perilous gushes of
blood which bring us into the very jaws of destruction.
The description which Byron gives us of Manfred’s death, may be
considered as a highly poetical representation of the state we have
portrayed.
“_Abbot._ Alas! how pale thou art--thy lips are white--
And thy breast heaves--and in thy gasping throat
The accents rattle--Give thy prayers to heaven--
Pray--albeit but in thought,--but die not thus.
_Manfred._ ’Tis over--my dull eyes can fix thee not;
But all things swim around me, and the earth
Heaves as it were beneath me. Fare thee well--
Give me thy hand.”
Gradually exhausting complaints, such as interfere with the nutrition
of the body, act much in the same manner as direct losses of blood,
but obviously more slowly. Privations of various kinds and wasting
complaints which impair the general strength, tell at last, in
exhausting the heart’s power, and life terminates in the gradual
failure of the circulation of the blood. In chronic ailments, the
weary sufferer feels the extreme exhaustion which months and years of
suffering have produced. He cannot lift himself in bed--he fears to
raise his head, and can scarcely grasp the extended hand of friendship,
or return the pressure of affection. The heart’s power is at last
fatally depressed.
The following, which is quoted from Thackrah’s work on Digestion and
Diet, is extracted from Hufeland’s Journal, and gives an interesting
picture of the effects of extreme abstinence. “A German merchant, æt.
32, depressed by severe reverses of fortune and consequent slights
of his relatives, formed the resolution of destroying himself by
abstinence. With this view he repaired on the 15th of September, 1818,
to an unfrequented wood, where he constructed a hut of boughs, and
remained without food till the 3rd of October following. At this period
he was found by the landlord of a neighbouring pothouse, still alive,
but feeble, speechless, and insensible. Broth, with yolk of an egg,
was given him. He swallowed it with difficulty, and died immediately.
In the pocket of the unfortunate man was found a journal written in
pencil, singular in its kind, and remarkable as a narrative of his
feelings and sentiments.” It begins thus:--“The generous philanthropist
who shall one day find me here after my death, is requested to inter
me; and, in consideration of this service, to keep my clothes, purse,
knife, and letter-case. I moreover observe that I am no suicide, but
have died of hunger, because, through wicked men, I have lost the whole
of my very considerable property, and am unwilling to become a burden
to my friends.” The ensuing remark is dated Sept. 17th, the second
day of abstinence. “I yet live; but how have I been soaked during
the night, and how cold has it been! O God! when will my sufferings
terminate! No human being has for three days been seen here--only
some birds.” The next extract continues--“And again three days; and I
have been so soaked during the night, that my clothes to-day are not
yet dry. How hard is this, no one knows; and my last hour must soon
arrive. Doubtless during the heavy rain a little water has got into
my throat, but the thirst is not to be slaked with water; moreover, I
have had none even of this for six days, since I am no longer able to
move from the place. Yesterday, for the first time during the eternity
which, alas! I have already passed here, a man approached me within
the distance of eight or ten paces. He was certainly a shepherd; I
saluted him in silence, and he returned it in the same manner. Probably
he will find me after my death! Finally, I here protest before the
all-wise God, that notwithstanding all the misfortunes which I have
suffered from my youth, I yet die very unwillingly; although necessity
has imperiously driven me to it. Nevertheless, I pray for it.--More
can I not write for faintness and spasms; and this will be the last.
Dated near Forest, by the side of the Goat public-house, Sept. 29th,
1818.--J. F. N.”
Stories are related of persons remaining months, and even years,
without food; but they are unworthy of belief. It is not probable that
life can be continued many days without food; and a week is perhaps an
average period, if fluids also be withheld. In the hospitals for the
insane, instances are sometimes met with of obstinate refusal of food,
and in these cases of insanity it seems that the abstinence is better
tolerated. In the brute creation fasting is more endurable. Müller
says, referring to Tiedemann, that salamanders, tortoises, and gold
fish may be kept for years without food; some birds from twenty-five to
twenty-eight days; and dogs for twenty-five to thirty-six days.
Some time after I had entered into the medical profession, but
whilst yet a pupil, I was invited by a fellow-student to dine with
him. Whilst we were chatting together after dinner, we fell into
conversation respecting a man who had recently died from an extensive
burn. The gentleman’s father, who was an intelligent man, overheard our
remarks, and joining in the conversation, asked me to explain to him
how it happened that the burn occasioned death.
I attempted an explanation, but soon felt my incompetence to offer a
satisfactory reply, and I was not a little surprised to find myself
foiled in what I considered the simplest possible matter; for I had
imagined, before I attempted the explanation, that the subject did not
require a moment’s consideration. I remember that my fellow-student
was equally unsuccessful. It seemed curious to me at the time, that I
should hesitate in rendering a reason for a fact which so frequently
presents itself to the medical inquirer.
The phenomena, however, which are the most familiar to us, are often
the last to challenge our attention.
Now, independently of the mere loss of blood, other causes may depress
the action of the heart.
The heart’s action may be arrested by what is called a _shock_. It is
not easy to explain in what manner it acts, nor to define the meaning
in a precise manner; but every one knows what is meant by it. A shock
is a sudden impression on the nervous system. It plays an important
part in many cases of violent death, and in those remarkable instances
of disease in which life is extinguished with fearful rapidity.
There are many accidents in which there is little loss of blood; and
yet the injury is great, and its consequences terrible. The sufferer
turns pale--his countenance changes, and he feels that he is fatally
wounded. Sickness and complete prostration follow, and the heart never
rallies. In this manner, extensive burns and scalds, and dreadful
blows, or internal lacerations produce death. In the same way the
strong mineral acids, when taken internally, appear to destroy, by
their depressing influence on the heart.
The internal lesion of the stomach causes a sympathetic failure of the
circulation.
But the effects of _shock_ are much more numerous and interesting
than might at first be imagined. At least, impressions on the nervous
system, analogous in their nature, play an important part in the fatal
termination of many diseases. Violent inflammations seem, when fatal,
to act by their depressing influence.
We do not see, _à priori_, any actual reason why these inflammations
should be productive of death; but we know it to be an ultimate fact
that they operate in lowering the vital powers, and bringing the
circulation to a stand.
Amongst the instances of fatal collapse there are none more striking
than those which arise from perforating ulcers. Insidious disease may
go on, in persons having every appearance of health, and be suddenly
fatal by ulceration of the stomach or bowels, and the escape of their
contents into the abdominal cavity. The apertures produced by the
perforating ulcers are often singularly defined, and resemble the holes
cut out by a punch or sharp circular instrument. The fatal issue of
these lesions is generally so unexpected, so rapid, and so painful, as
to suggest the idea of poisoning, or of _hernia_.
My late and valued friend, Dr. Howard, related to me a case, which, at
the time, made great impression on his mind.
On the 10th of February, 1845, Dr. Howard was requested to visit a
young woman who was taken suddenly ill at a factory in Manchester.
When he got there, he found her lying on the floor with a pale, sunken
countenance, a weak pulse, and a cold surface. She spoke in a feeble
whisper, and was too much exhausted to reply to many questions, but
by her gestures she indicated that she had pain in her stomach. It
appeared that she had been taken ill about three o’clock. Dr. Howard
recommended that she should be taken to the Infirmary, and she died
there, in about twelve hours after her removal. It was thought at the
Infirmary that she had taken poison, but on examination of the body
after death, a round hole was found in the stomach, such as is produced
by a perforating ulcer. The edges of the ulcer were smooth and even.
One or two such instances have fallen under my own notice, and must be
met with in the course of the experience of every medical man.
Fatal fainting is not unfrequently the result of actual disease of the
heart, although death from affections of the heart is not always of a
sudden or uncomplicated kind. The walls of the heart are sometimes thin
and dilated, and there is a soft struggling palpitation which has been
aptly compared to the fluttering of a bird against the bars of its cage.
At other times the heart is overloaded with fatty deposits, so that
its natural fleshy structure is proportionally defective. In very
inordinately fat people the heart is often found in this state, and is
unable to propel the blood with sufficient force to meet the exigencies
of the system. Occasionally, bony deposits are found in the heart and
great vessels, and the natural contractions of the heart are painful
and irregular. From these, and other causes, which probably produce a
spasm of the heart, arises the disease called _angina pectoris_.
The celebrated John Hunter died of this disease, and it is well known
to be suddenly fatal. Sir Everard Home tells us that, “On the 16th
of October, 1793, when in his usual state of health, he went to St.
George’s Hospital, and meeting with some things which irritated his
mind, and not being perfectly master of the circumstances, he withheld
his sentiments; in which state of restraint he went into the next
room, and turning round to Dr. Robinson, one of the physicians of the
hospital, he gave a deep groan, and dropped down dead.”
The sudden death of the benevolent and highly accomplished Dr. Arnold,
as represented by his biographer, may serve as a further illustration
of the angina pectoris. It was between five and six o’clock on Sunday
morning that he awoke with a sharp pain across his chest, which he
mentioned to his wife on her asking whether he felt well, adding that
he had felt it slightly on the preceding day, before and after bathing.
He then again composed himself to sleep; but Mrs. Arnold watched him
with extreme anxiety, and was soon led to infer that he was seriously
ill. The pain seemed to increase and to pass down the left arm, which
called to Mrs. Arnold’s remembrance what she had heard of this fatal
disease. About a quarter to seven Dr. Bucknill (the son of their usual
medical attendant) visited him. “He was then lying on his back--his
countenance much as usual--his pulse, though regular, was very quick,
and there was cold perspiration on the brow and cheeks.” He apologised
in a cheerful manner for troubling Dr. Bucknill at so early an hour,
and then proceeded to inquire as to the nature and danger of his
illness. After the physician had informed him that his complaint was a
spasm of the heart, and answered the questions which were proposed, he
quitted the house to furnish himself with the necessary remedies. On
his return, Dr. Arnold said, “If the pain is again as severe as it was
before you left, I do not know how I can bear it.” He again questioned
Dr. Bucknill as to the danger of his complaint, and in such a manner
that it was impossible to avoid telling him the truth. He afterwards
inquired as to the remedies to be adopted, and on being told, answered
“Ah! very well.” The physician, who was dropping the laudanum into
a glass, turned round and saw him looking quite calm, but with his
eyes shut. In another minute he heard a rattle in his throat, and a
convulsive struggle, flew to the bed, and called to one of the servants
to fetch Mrs. Arnold. The family soon arrived; but the sobs and cries
of his children were unable to affect him--“the eyes were fixed, the
countenance was unmoved: there was a heaving of the chest, deep gasps
escaped at prolonged intervals, and just as the usual medical attendant
arrived, and as the old schoolhouse servant, in an agony of grief,
rushed with the others into the room in the hope of seeing his master
once more, he breathed his last.”[15] This occurred shortly before
eight in the morning. His biographer continues, “What that Sunday
was in Rugby, it is hard fully to represent,--the incredulity,--the
bewilderment,--the agitating inquiries for every detail,--the blank,
more awful than sorrow, that prevailed through the vacant services
of that long and dreary day,--the feeling as if the very place had
passed away with him who had so emphatically been in every sense its
head,--the sympathy which hardly dared to contemplate, and which yet
could not but fix the thoughts and looks of all on the desolate house,
where the fatherless family were gathered round the chamber of death.”
In Dr. Arnold’s case, the heart was found soft and thin, but without
any valvular disease. A great many more cases might be cited in
illustration of this interesting disease, but I shall content myself
with one which I take from Dr. Latham’s excellent “Clinical Lectures on
Diseases of the Heart.”
“N. P. was about fifty-five years of age. He had filled a high judicial
office in India, and when his stated period of service had expired,
he returned home with unimpaired health. Ten years had wrought little
change in his person, except that from having been thin and muscular,
he was slightly tending to fat and corpulency.
“He had now been more than a twelvemonth in England, and had taken
up his residence in Hampshire, and was in the enjoyment of his
wonted health, when one day after a morning’s shooting, without any
extraordinary fatigue or exertion, he felt at dinner an unusual pain in
the region of his heart. The pain was not extreme, but enough to make
him leave the table, and retire into his library. Warm applications
were made to the chest, and the pain soon ceased altogether. He then
begged that he might be left alone to repose until tea-time. In less
than an hour his wife returned into the room, and found him lying upon
the sofa, just in the position she had left him.--She believed him
asleep, but found him dead. The examination of his body (continues Dr.
Latham), as it was reported to me, disclosed nothing that could account
for his death, but a thin fat heart; fat was deposited on it at the
expense of its muscular substance.”[16]
Besides disease of the heart itself, we may have disease of the great
blood-vessels,--what is called Aneurism. Sometimes these diseases of
the blood-vessels are very obscure; often they originate on the great
vessel, the _aorta_, which arises immediately from the heart. Dr.
Farre described to Dr. Watson a case which inculcates the necessity of
attending minutely to what a patient says. A man consulted Dr. Farre,
having just been told by another physician that he was fanciful, and
that there was nothing amiss with him.
Dr. Farre was very particular in his inquiries at every visit he paid,
so much so, indeed, that the man became vexed and said pettishly, “I
know, that if you split me down the middle, I am sound on my right side
and diseased on my left.” This was unfortunately too true: he was found
dead in bed a short time afterwards.[17] I remember a man who came
regularly as an out-patient to the Manchester Infirmary, complaining of
pain in the shoulder; I supposed at first that he had rheumatism, but
one day I told him to strip off his coat, and then I found that he had
an aneurism of the subclavian artery, of which he subsequently died.
I need scarcely say that these cases of aneurism are fatal, much as
disease of the heart itself. The blood-vessel at length gives way, and
the patient dies from the escape of blood and the fatal fainting which
ensues.
Some attention has been given by medical men to the state in which
the blood is found to be distributed after death. The heart contains
several cavities, through which the blood is progressively received and
expelled. Where the arrest of the circulation has commenced, however,
in the heart itself, it is obvious that the cavities will be pretty
equally affected, and that we shall not find one side to be gorged with
blood whilst the other is empty. The subject will again come before us
when we treat of the next division of this subject, in which it will be
seen that unequal distributions arise from another species of death.
The mode of death which has been described is not one of pain. It may
have been preceded by considerable suffering, as in the case of burns
and scalds. But the act of dying is one of relief; or if the sensations
are uneasy and fearful, they cannot be called painful in the common
sense of the term.
I now come to speak of another mode of death, which has been called,
but not very correctly, _Asphyxia_. In the cases which I have
previously described, the first great or palpable interference with
the continuance of life, has been the failure of the heart--so that
actual death may be said to have begun at the heart. I have further to
consider the cases where death begins at the lungs. Important as it is
that the blood should be circulated through the body, it is of equal
importance that it should be in a state of purity. In order to maintain
its purity, it is essential that it should be exposed to the air in the
lungs.
The existence of air is so well known to be necessary for life, that
the term _expire_, which signifies to breathe out, is also adopted
to express the act of dying. The symptoms which attend asphyxia vary
considerably from those previously described. They are, obviously, more
or less protracted according as the cause operates with greater or less
severity. When the breathing is largely obstructed, the complexion
becomes dark, and the lips bluish--the veins turgid and prominent, and
the face bloated and enlarged. After a time the brain is confused, and
stupor creeps on, whilst the air is with difficulty sucked through the
accumulated secretions of the air passages.
The blood becomes thus gradually more and more perverted, until at
length its circulation through the lungs is rendered difficult or
impossible. The heavy gurgling respiration gradually passes into a
state of extreme effort;--now the breathing seems stopped, and now a
deep inspiration again lights up the mechanism of the body, but life
eventually fails, as the blood ceases to circulate. All causes which
operate in preventing access of air to the lungs may occasion death.
Thus drowning, strangling, and suffocation from gaseous exhalations,
are fatal, by obstructing the purification of the blood.
In general, this mode of death is not so rapid as that which has just
been described, but occasionally it is very brief. In drowning, it
does not seem that life can be preserved more than three or four
minutes, that is, when submersion is complete. The respiration may, no
doubt, be somewhat longer suspended when fainting ensues, for then the
circulation, being temporarily arrested, the necessity for air is less
urgent. The accounts which are given of persons remaining alive for
hours under water cannot be trusted to.
The access of air to the lungs may be immediately prevented by
inflammation of the windpipe, as in the case of croup, or, still more
strikingly, by spasmodic affections.
The complaint known to medical men by the name of Laryngismus
stridulus, is, in this manner, suddenly fatal to infants.
Some diseases of the lungs are so gradual in their progress, that the
quantity of blood in the body becomes diminished in proportion to
their limited capacity for respiration. Hence the balance is so finely
preserved to the last, that death takes place with great difficulty. I
have sat for hours beside patients in the last stages of consumption,
and watched the emaciated and dying frame alternately reviving and
sinking until the patient himself became fearful that he should never
die. It is erroneously imagined that death in consumption is always
easy: fortunately it may be so in some cases; it is very much otherwise
in most.
Mechanical obstructions are well known to occasion death by impeding
the breathing. Pieces of meat or other bodies may get impacted in the
windpipe, and cause death before they can be removed.
I remember an instance of this sort which occurred in the market-place
in Manchester. A woman, whilst eating an oyster, fell into a fit of
laughter, when she was suddenly observed to become livid in the face,
and shortly afterwards died of suffocation. The oyster was found partly
fixed in the upper part of the windpipe.
There is an interesting and instructive case of the same nature related
in the Lancet. A man, who had just been married, got into a dispute
with one of his own party, and was knocked down by a blow. Eventually
he was able to rejoin his party; but it was observed that whilst
engaged at his dinner he hastily got up and went out of the room. A
friend followed him, but immediately returned to announce that the man
was dead. On examining the body after death, a surgeon pronounced that
he had died from apoplexy, and attributed the fit to the injuries he
had received in the quarrel. The coroner, Mr. Wakley, asked the surgeon
if he had examined the windpipe. The surgeon confessed that he had
not done so; whereupon he was desired to complete the examination. He
repaired presently to perform his task, and on his return stated that
he found a piece of meat wedged firmly in the _glottis_. Thus death
had, in reality, arisen from this source; and the congested state of
the brain was the effect of impeded respiration, and not the first
occasion of his death.
Whilst treating upon the subject of Asphyxia, I cannot refrain from
introducing some particulars of the awful catastrophe which occurred
at the Black Hole at Calcutta, as they will furnish an interesting
exemplification of the effects of deprivation of air. In 1756, the
viceroy of Bengal laid siege to the factory at Calcutta. Mr. Holwell
and the garrison carried on the defence with great spirit and bravery,
but were ultimately obliged to surrender. They consisted of about
145 men and one woman. The whole of this company, many of whom were
dangerously wounded, were shut up the same night in a small prison,
about eighteen feet square. The prison, which was strongly built round
with walls, had only two small windows at one end, which were secured
by strong bars. As the prisoners had only about eighteen square inches
of space for each individual, the heat and oppression soon became
insupportable.
Attempts were, at first, vainly made to force open the door. Mr.
Holwell, who was near one of the windows, endeavoured to reason with
the prisoners, and advised them not to exhaust their strength. This
recommendation had the effect of producing some calm, but it was only
temporary, for they could not long bear the frightful position, and
many already were in the act of dying. Mr. Holwell then suggested that
they should take off their clothes to afford more room. An effort was
subsequently made to fan the air with their hats, but the exertion
could not be borne. One of the company suggested that they should all
kneel down, and rise up alternately. This was done several times,
but many could not raise themselves when the signal was given. The
situation was now frightful. The weak were trodden to death. One hour
had only yet elapsed. About nine o’clock, renewed efforts were made to
force the door; some became furiously delirious; others vainly sought
to provoke the sentinels to fire upon them. Thirst became excessive.
At last the guards gave Mr. Holwell and two of his friends some water
in their hats, but it was soon spilled, and the two friends were
suffocated in the general eagerness to obtain it. Mr. Holwell was, for
a long while, respected as the leader of the unfortunate assembly, but
in time the natural love of life prevailed over all other feelings.
The crowd eagerly pressed to the window, and, seizing the iron bars,
climbed on his shoulders. He begged for his life, and giving up his
position near the window, got to the other end of the dungeon; but
here the air was so corrupt, that his breathing was almost impossible.
He again, therefore, tried to make his way to the window over the
bodies of the dead, and there he resolved to wait patiently for death.
He struggled through four rows of his companions, but one row still
intervened between him and the window. His thirst was excessive, and
he endeavoured to allay it by sucking the moisture from his shirt. As
midnight approached, the despair became unbounded and terrible; they
all called out aloud for air, and then the noise suddenly ceased, and
the greater part laid down and died. A Dutchman got on one of Mr.
Holwell’s shoulders, and a black soldier on the other: he remained
thus till two in the morning, when a marine officer forced him from
his place. Mr. Holwell retired to the end of the prison, where he
was soon deprived of sense. About five in the morning, the viceroy
inquired if Mr. Holwell was still living; and being informed that it
might be possible to recover him, if the door was immediately opened,
gave commands to that effect. Unfortunately, however, the door opened
inwards; and, owing to the numbers of the dead, twenty minutes elapsed
before it could be accomplished. Eventually Mr. Holwell was rescued
alive from a heap of the dead. At a quarter past six, 23 persons
were taken away alive from 146, who had been incarcerated the night
previously.
When the air which is breathed, is not, by its chemical nature,
calculated for the purposes of respiration, it produces effects very
similar to a deficiency of air: thus, gases, which are not actually
poisonous in themselves, cause fatal results, just as the exclusion of
air altogether.
It is probable that the carbonic acid gas, which is commonly known as
fixed air, _is_ injurious in itself[18]; but it is certain, also, that
its fatal effects are greatly dependent on its preventing the access
of the air. Many accidents have arisen from the use of charcoal fires
and stoves. Mr. Coathupe, of Wraxall, was nearly killed in making some
experiments with Joyce’s stove, which was absurdly imagined by the
inventor to burn charcoal without contaminating the air. He closed
every aperture in the room, kindled the stove, and waited for the
results. In a few hours giddiness came on, with sickness and great
prostration; afterwards agonising headache, throbbing of the arteries,
and sense of suffocation. With difficulty he opened the window, and
sought to remove the stove; but when his wife entered the room, seven
hours after, he was unable to explain what had occurred, although
conscious of what was passing.
I think the charcoal fire is a favourite means of death with the
French. It is stated that, in 1834 and 1835, no fewer than 360 cases
of poisoning with charcoal occurred in Paris. I have read of French
people sitting down coolly to note their sensations whilst breathing
the deadly atmosphere, until the pen has fallen from their hands.
There is often a love story mixed with these French deaths; and we
cannot but regret that affection should be so curiously mingled with
deplorable irregularities of mind.
The respiration may be prevented by mechanical pressure; but no doubt,
where death is produced in this manner, it is often accompanied with
injuries to the internal organs. The barbarities of former times
furnish us with dreadful instances of death resulting from compression
of the chest. In order to oblige a criminal to plead at the bar when
he refused to do so, he was sometimes stretched on his back, whilst
a large iron weight was placed on his chest, and additions gradually
made until he consented to do what was required, or sank under the
infliction. Even as late as the reign of George the Second, such
practice has been adopted. The press yard in the Old Bailey was the
site of some of these dreadful torments. From this mode of death Major
Strangeways died in 1659. The story is of considerable interest. The
major lived with a sister very happily in a farm, until the latter
became acquainted with one Fussel, a lawyer. This gave great offence to
Strangeways, who swore that he would kill him. The brother and sister,
consequently, parted. Some time after, whilst Fussel was in London, he
was shot whilst he sat in his lodgings. Suspicion fell on Strangeways,
but difficulty was experienced in tracing the murder to him. At last
the expedient suggested itself of examining all the gunsmiths in
London, to discover, if possible, what guns had been lent or sold
on the day of the murder. This plan only excited ridicule as an
impracticable one; but, curiously enough, the matter was thus traced to
Strangeways. Strangeways refusing to plead at the bar, was sentenced,
by Lord Chief Justice Glynn, “‘to be put into a mean house stopped from
any light, and that he be laid upon his back with his body bare, and
his arms and legs stretched by cords in opposite directions; and that
upon his body shall be laid as much iron and stone as he can bear, _and
more_; and the first day he shall have three morsels of barley-bread;
and the next shall he drink thrice of the water in the next channel
to the prison door, but of no spring or fountain: and this shall
be his punishment till he die.’ On the Monday following, at eleven
in the forenoon, the sheriffs and other officers came to the press
yard, whither the miserable prisoner was presently brought. He wore a
mourning cloak, beneath which he appeared clothed in white from head
to foot. By the sheriffs he was conducted to a dungeon, where, after
prayers, his friends placed themselves at the corner of the press, whom
he desired, when he gave the word, to lay on the weights! This they
did at the signal ‘Lord Jesus receive my soul;’ but, finding the weight
too light for sudden execution, many of those standing by added their
burdens to disburthen him of his pain. He died in about eight or ten
minutes.”[19]
The respiration is sometimes brought to a stop by causes which operate
on the brain, and the peculiarities of this mode of death are so
characteristic, as to deserve consideration under a separate head.
Death may be said, in this case, to begin at the head, and the
respiration comes to a stand, after a period of stupor and
insensibility. This is the state which is familiarly known as apoplexy.
The patient lies snoring out his existence, unconscious of the weeping
friends who sit around his bed.
The phenomena of apoplexy seem to be produced by causes which obstruct
the circulation in the brain, or which injure the brain itself.[20]
The giving way of blood-vessels is the common cause of apoplexy. The
patient falls into a state of insensibility and complete helplessness.
He breathes with a heavy snoring noise, and a blowing of the lips may
often be remarked, which has been aptly compared to the smoking of a
pipe. The blood-vessels of the neck and face are gorged, and the veins
are especially prominent. The pupils of the eyes are dilated, and
often unequally so. Consciousness is abolished. This state continues
indefinitely, but at length the breathing becomes laborious--the mucus
is heard rattling in the throat--the temperature falls--spasmodic
twitchings play on the countenance, and sometimes horrible distortions
flit over the face: death after a time closes the scene.
The action of poisons called _narcotics_ is well known to be fatal
in this way: opium produces this species of death, when given in
overdoses.
I have stated that the pupils of the eye are generally dilated in death
by coma; but when the coma is produced by narcotics, this effect is
not so common. Dr. Elliotson relates the case of a German gentleman,
who was a friend of his, and who had remarkably large pupils. This
gentleman took it into his head to destroy himself, and for this
purpose took a large quantity of opium. After taking the poison, he
mentioned what he had done, and, amongst other persons, Dr. Elliotson
was sent for. Insensibility did not come on for a considerable time;
and the gentleman resisted powerfully all attempts to relieve him,
asserting, that if he chose to die, it was only barbarity to attempt
to prevent him. At length his countenance became livid, the pulse
slow, the breathing stertorous, and the pupil contracted to the size
of a pin’s point. The jugular vein was opened, and cold water dashed
on his face. In spite of all efforts he died; and Dr. Elliotson
remarks, “I have never seen a case recover in which the pupil was so
contracted.”[21]
Extreme cold produces death, perhaps chiefly in the way of apoplexy, by
retarding the circulation, and preventing its equable diffusion on the
surface of the body. That it acts, at least in a great measure, in this
way would seem likely from the torpor which it occasions, and which is
so commonly remarked. The effects of intense cold are well exemplified
in the interesting narrative of Captain Cook, where he relates what
befell Dr. Solander and Sir J. Banks on the hills of Terra del Fuego.
Sir J. Banks and Dr. Solander had been botanising, and had travelled
a considerable way through swamps, when the weather, which had been
fine, changed and became intensely cold and gloomy, and the wind was
accompanied with snow. Finding it impossible to return to the ship
before morning, they resolved to penetrate into a wood, and build a
wigwam, and kindle a fire. For this purpose they passed through another
swamp. Dr. Solander, aware of the effects of cold on the human body,
from experience he had already had in Norway and Sweden, cautioned
his friends against the torpor which it occasions, and conjured the
company, under any circumstances, not to give way to it. “Whoever
sits down,” said he, “will sleep; and whoever sleeps, will wake no
more.” Thus admonished, they continued their journey; and they had not
proceeded far, before the cold was so great as to produce the effects
he had named. Dr. Solander himself was the first to experience the
torpor, and entreated his companions to let him lie down. Sir J. Banks
in vain remonstrated with him; and he lay down on the ground, although
it was covered with snow. A black servant was affected similarly, and,
in spite of remonstrance, also lay down. In a few minutes they fell
into a profound sleep. Fortunately, some of the party who had been sent
in advance, soon brought intelligence that a fire had been lighted
about a quarter of a mile on the way. Sir J. Banks then endeavoured to
awake Dr. Solander, and happily succeeded, though he had already almost
lost the use of his limbs. The poor black died, as well as another
black servant who had been left with him.
In the interesting account which Barry O’Meara gives, of the residence
of Napoleon at St. Helena[22], he mentions that, on one occasion,
Buonaparte asked him what he thought was the easiest mode of dying; and
himself observed, that death by cold was the easiest of all others,
because, “si muore dormiendo,” one dies sleeping. In describing the
Russian campaign, Napoleon further remarked, “Parties when sent out on
duty in advance, abandoned their posts, and went to seek the means of
warming themselves in the houses. They separated in all directions,
became helpless, and fell an easy prey to the enemy; others lay
down,--fell asleep--a little blood came from their nostrils, and,
sleeping, they died.”[23]
When death is produced by hanging or strangling, it may be supposed
that it is brought about entirely by the exclusion of air from the
lungs: in many cases, however, this mode of death is complicated by the
apoplexy which arises from the pressure exercised on the blood-vessels
of the neck. From these combined causes insensibility arises in a few
seconds, and death follows in a few minutes afterwards.
Persons who have recovered from suspension do not commonly remember
what has passed, but it may be possible to recollect some of the
sensations. The celebrated poet Cowper, whose fine talents were
unhappily touched with madness and melancholy, relates his own unhappy
experience. It may not be uninteresting in this place to glance at the
particulars which he has left us.
The death of the reader of the Journals of the House of Lords had
opened a situation which Cowper was desirous to occupy, but for which,
he feared that he had not sufficiently prepared himself. When the time
drew near in which he was to present himself before the House of Lords,
to be examined as to his competency, he became nervous and excited,
and his madness came over him like a cloud. In November, 1763, he went
to an apothecary’s shop, and bought some laudanum with a view to put
an end to his existence. This he carried about with him, and often was
on the point of taking it, but his resolution as often gave way, or he
was prevented by the fear of interruption. Once he thought of taking
it whilst he was travelling in a coach, and once he shut himself up in
his room in the Temple, and placed the laudanum by his bedside in a
basin. He then got on the bed, and stretched out his hand to put the
basin to his lips; but just then the key turned in the door, and his
laundress’s husband entered. He started up, hid the basin, and affected
an air of composure. On the day previous to that on which he was to
go before the House, he resolved once more to effect his purpose; he
bolted his door, and with a piece of scarlet binding attempted to hang
himself. First he fixed it to some ornamental work at the corner of
the bed, drawing up his feet that they might not touch the ground. The
carved work gave way and the binding with it. Then he fixed it to the
tester of his bed, but the frame broke and again let him down. The
third time he fastened it to the angle of the door, using a chair to
reach it, which he afterwards pushed away with his feet. Whilst he hung
he thought he heard a voice say three times, “’Tis over.” When he came
to himself he heard his own groans, and experienced a feeling like that
of a flash of lightning passing over his whole body. In a few seconds
more he found himself on his face on the floor. He immediately jumped
up and got into bed: he had a red mark round his neck, and a broad
crimson spot showed the stagnation of the blood under one eye. Soon
after he had got into bed he heard a noise in the dining room where
the laundress was lighting a fire. She must have passed the door which
was open whilst he was hanging, but did not perceive him. Presently,
however, she came, having heard his fall, and supposing that he was in
a fit. “I sent her,” says Cowper, describing the scene, “to a friend,
to whom I related the whole affair, and despatched him to my kinsman
at his coffee house. As soon as the latter arrived, I pointed to the
broken garter which lay in the middle of the room; I apprised him
also of the attempts I had been making. His words were, ‘My dear Mr.
Cowper, you terrify me! To be sure you cannot hold the office at this
rate--where is the deputation?’ I gave him the key of the drawer where
it was deposited; and, his business requiring his immediate attendance,
he took it away with him: and thus ended all my connection with the
Parliament office.”[24]
When death is produced by a failure of the respiratory organs, whether
commencing or not with apoplectic coma, the blood is found chiefly
accumulated in the right side of the heart, the difficult transmission
of the blood through the lungs preventing its due arrival at the left
side. This, therefore, is a distinguishing character of the appearances
presented after death by Asphyxia. The two great modes of death which
have been noticed, are, however, in themselves sufficiently apparent,
and cannot well escape the attention of any persons of observation. In
the very work from which I have recently quoted there is an interesting
illustration of this. I will give it in O’Meara’s own words.--Whilst
conversing with Napoleon he had fallen into a fainting fit, and dropped
on the floor:--
“When I recovered my senses,” says he, “and opened my eyes, the first
object which presented itself to my view I shall never forget; it was
the countenance of Napoleon bending over my face, and regarding me
with an expression of great concern and anxiety. With one hand he
was opening my shirt collar, and with the other holding a bottle _de
vinaigre de quatre voleurs_ to my nostrils. He had taken off my cravat,
and dashed the contents of a bottle of eau de Cologne over my face.
‘When I saw you fall,’ said he, ‘I at first thought that your foot
had slipped; but seeing you remain without motion, I apprehended that
it was a fit of apoplexy; observing, however, that your face was the
colour of death, your lips white and without motion, and no evident
respiration or bloated countenance, I concluded directly that it was a
fit of syncope, or that your soul had departed.’”
It is obvious, however, that death may take place in more complicated
ways than those which have engaged our attention. The same causes which
enfeeble the action of the heart, not unfrequently destroy also the
healthy changes of the blood in the lungs. Thus the patient is often
equally in danger of death from syncope and asphyxia, and he sinks
partly from the one, and partly from the other. Apoplexy is sometimes
so suddenly fatal, that the sufferer seems to die chiefly from the
shock which he has received; and many violent causes of death, which
obstruct the respiration, such as hanging or strangling, are also
prejudicial in impeding the circulation in the neck, and occasioning
apoplectic congestion. When death is produced by starvation, it is
attended with inflammation of the stomach and bowels, and a degree of
febrile action, which more or less complicate the process. There can
be little doubt, however, from the emaciation and great debility which
ensue, that life is chiefly destroyed in the manner already considered
as a failure of the action of the heart.
In addition to the influence of cold in producing coma, it also, no
doubt, tends to depress the heart’s action, and destroy the nervous
energy. At the same time, the very prominent manner in which the brain
is affected by reduction of temperature, renders it probable that the
condition of coma is a first great step in the arrest of the vital
actions.
The modes of death, then, which we have considered, have close
alliances with each other, but, for the sake of simplicity, they have
been spoken of in their more elementary forms. Nor is the consideration
of them in a separate manner devoid of practical advantages; for it is
of the greatest importance, in many diseases, especially in fevers, to
bear in mind the tendencies which present themselves to one or other
mode of death; and frequently the safety of the patient is attributable
to the perseverance with which such tendencies are obviated.
Sometimes coma has to be relieved--sometimes difficult respiration has
to be alleviated--sometimes the sinking strength requires the timely
and diligent administration of nutriment. The medical man has thus, not
seldom, to become the nurse of his patient, and often the machinery of
life is alone kept in motion by the opportune aid which he affords. But
how often has the more devoted attention of woman called back to life
the unconscious child! how often relieved the agonies of man when the
finger of death was pressing heavily on his eyelids! The chamber of
sickness is thus hallowed by affection, and the torch of life rekindled
by the light of love.
We may state then, broadly, that any great and perilous arrest in the
circle of actions which constitutes life, is induced principally in the
way of syncope or asphyxia, though it is unquestionable that death may
arise in a manner which cannot be well classed under either of those
heads.
In some of the putrid fevers, for example, the depravation of the blood
seems so general, that death (as evidenced by the decomposition of the
solids and fluids of the body) appears actually in progress before any
complete failure of the respiration or circulation.
The introduction of some poisons, also, is peculiarly inimical to the
_vitality_ of the blood.
Thus the death of King John is beautifully described by Shakspeare, as
commencing even in the blood itself--
“It is too late; _the life of all his blood_
Is touch’d corruptibly; and his pure brain,
Which some suppose the soul’s frail dwelling-house,
Doth, by the idle comments that it makes,
Foretell the ending of mortality.”