DYING OF OLD AGE, AT FIFTY-EIGHT.
Within the usual limits assigned me in the daily routine of my
profession, but on its very verge, there resided an individual of much
general reputation for worth of character, but of feeble constitution
and cachetic or deranged habits, for whom as well as for his numerous
family I had frequently prescribed.
He was at length, one autumn, unusually reduced in health and strength,
and I was again sent for. There was evidently very little of real
disease about him, and yet there was very great debility. All his bodily
senses were greatly deranged, and all his intellectual faculties
benumbed. His internal machinery--his breathing, circulation, and
digestion--was all affected; but it seemed more the result of debility
than any thing else. There was no violence or excess of action anywhere,
except a slight increase of the circulation.
The man was about fifty-eight years of age. Had he been ninety-eight or
even eighty-eight, I should have had no difficulty in understanding his
case. I should have said to myself, "Nature, nearly exhausted by the
wear and tear of life, is about to give way;" or in other words, "The
man is about to did (?die) of mere old age." But could he have been thus
worn out at the age of fifty-eight?
I gave him gentle, tonic medicine, but it did not work well. Without
increasing his strength, it increased his tendencies to fever. Yet, as I
well knew, depletion would not answer in a case like this, whether of
bleeding, blistering, or cathartics. In these circumstances, I contrived
to while away the time in a routine of that negative character which, in
true medical language, means laboriously doing nothing.
He was visited about twice a week. I heard patiently all his
complaints, and endeavored to be patient under all my disappointments,
for disappointments I had to encounter at nearly every step. No active
treatment whatever would have the general effect I desired and intended.
If I gave him but a single dose of elixir paregoric for his nervousness,
it only added, nine times in ten, to the very woes it was intended to
relieve. My policy--and I fully believe it was the only true policy--was
to leave him to himself and to Nature, as much as possible.
Though I have spoken here of what I regarded as the true policy in the
case then under my care, yet, after all, the truest course would have
been to call for consultation some wiser head than my own. Another
individual, even though he were no wiser than I, might have aided me
most essentially, in compliance with, and in confirmation of, the good
old adage--"Two eyes see more than one."
Why, then, did I not call on some inquiring and highly experienced
physician? It was not that I was too proud to do so, nor that I was too
jealous of my reputation. It was not that I feared any evil result to
myself. It was rather because I did not, at first, think it really
necessary; and then, subsequently, when I supposed it to be really
needful, I feared my patient would grudge the expense. This fear, by the
way, was grounded in something more than mere conjecture. The proposal
had been practically made, and had been rejected.
In this general way things went on for some time. The friends grew
uneasy, as they should have done; and one or two of them, now that it
was almost too late, spoke of another physician as counsel. My own
readiness and more than readiness for this seemed to have the effect to
quiet the patient, though it had the contrary effect on his friends.
They appeared to construe my own liberality and the admixture of modesty
and conscientiousness, which were conspicuous in my general behavior,
into self-distrust, and hence began themselves to distrust me.
The patient's state of mind--for he was a man whose habits of thinking
and feeling approximated very closely to those of the miser--more than
once reminded me of some doggerel verses I have seen, perhaps in an old
almanac, which are so pertinent in illustration of the point in my
patient's character which these remarks are intended to expose, that I
have ventured to insert them:--
"The miser Sherdi, on his sick-bed lying,
Affrighted, groaning, fainting, wheezing, dying,
Expecting every hour to lose his breath,
Enters a Dervise: 'Holy Father, say,
As life seems parting from this sinful clay,
What can preserve me from the jaws of death?'
"'Sacrifice, dear son, good joints of meat,--
Of lamb and mutton for the priest and poor.
Nay, shouldst thou from the Koran lines repeat,
Those lines might possibly thy health restore,'
"'Thank you, good father, you have said enough;
Your counsels have already given me ease.
Now as my sheep are all a great way off,
I'll quote holy our Koran, if you please.'"
At length my patient began, most evidently, to decline. There were
various marks on him and in him, of approaching dissolution. When
pressed, as I frequently was, to say definitely what the disease
was--that is, to give it a name--under which Mr. ---- labored, I only
replied that he was suffering from premature old age. This always
awakened surprise, and led to much and frequent inquiry how it was that
a man of fifty-eight years could be dying of mere old age. My
explanations, whenever attempted,--for sometimes in my pride of
profession I wholly evaded them,--were usually, in substance like the
following:--
"Mr. ---- was feeble by inheritance. He never had that firmness of
constitution which several of his brothers now possess. Then, too, he
was precocious. His body and mind, both of them, came to maturity very
early; which, as you know, always betokens premature decay. Men live
about four times as long, when not cut short by disease, as they are in
reaching maturity. As he was apparently mature at fourteen or fifteen,
he might very naturally be expected to wear out at or before sixty.
"But then, in addition to this, he has all his lifetime labored too
hard, not only from necessity, but from habit and choice. His ambition,
it is well known, has been unlimited, except by his want of strength to
accomplish. He has only ceased to labor hard when he had strength to
labor no longer, or when it was so dark or so cold or so stormy as to
prevent him.
"Then of late years he has had the care and anxiety which are almost
inseparable from the work of bringing up a numerous family. It is indeed
true that he has not been called to that severest of all possible trials
pertaining to the family, the pain of seeing that family or any of its
members go materially wrong. Still he has had a world of care; of its
effects none are aware who have not been called to the same forms of
experience.
"There is one thing more; Mr. ---- has, at times, taken a good deal of
medicine: not alcohol, in any of its forms, I admit, but substances
which for the time were, in their effects, almost equally bad for him.
He has used tea immoderately, and even tobacco. His constant smoking has
been very injurious to his nervous system, and along with other things
has, doubtless, greatly hurried on the wheels of life."
Remarks like these had their intended effect on a few individuals,
especially such of them as were couched in language with which they were
already familiar. On most, however, they fell lifeless and hopeless.
What knew they about precocity and its effects on the after life? In
short, it was quite doubtful then, and is still more doubtful with me
now, whether, on the whole, any thing was gained by attempts at
explanation. For example, when I spoke of my patient being worn out,
prematurely, by overworking, it was asked by one man, "But how is this?
Other men as well as Mr. ---- have worked too hard, and brought up large
families, and perhaps taken a great deal of medicine, and smoked a vast
amount of tobacco? Why are they not affected in this way as well as Mr.
----?"
It was not easy to make current the idea that Mr. ---- was about to die
of old age; although partly from conviction, but partly, also, to
conceal my ignorance, I still endeavored to promulgate it. It was the
only apology I could make for suffering a man to run down and die,
without appearing to those around him to be very sick.
But he died, after some time, to my infinite mortification and great
regret. I was invited to his funeral, as I was usually to the funerals
of my patients. In this case, however, I contrived to be absent. So
great was my consciousness of ignorance and so much ashamed was I of my
ill success, that I felt as if the veriest ignoramus would be disposed
to point at me, and to charge me with having been, practically, the
murderer of the much-beloved head of a family, and a worthy and highly
respected member of society. But, whether others would deem me culpable
for my ignorance or not, I could not avoid the pangs of habitual
condemnation.
There were, I grant, a few extenuating circumstances in the case. One or
two causes existed, of premature decline, on which, in a work like this,
I cannot stop to expatiate. It was also very unfortunate for him that he
was accustomed to look on the dark side of things, and to forebode ills,
where, oftentimes, none existed.
Notwithstanding my former ignorance and doubt, and numerous misgivings,
in cases like the foregoing, I have of late years, on a maturer review,
been obliged very frequently to confirm my earlier decisions. In the
case which has been detailed in this chapter, I have, on the whole, come
to a belief that my first judgment was nearly correct; and that the
patient actually perished, as much as men ever do, of premature old age.
It is, indeed, very possible that had I pursued a different course in
several important particulars, his life might have been prolonged for a
year or two. Men have a tendency to become what they are taken to be;
and many a person has died much sooner for being taken to be near his
end, and treated accordingly. If we would have our patients recover, we
must take for granted that recovery is at least possible.
In the case above, I believe I lost reputation, in large measure.
Several shrewd people insisted, at the time and long afterward, that I
ought to have had medical counsel. Mr. ----, they said, was too good a
man to lose without a more persevering effort to raise him. They charged
me with having got my name up, and having at the same time grown
careless. Had he been properly doctored, they said, from the very first,
they believed he might still have been alive to ornament and bless
society.