THE MEDICAL ASPECTS OF DEATH. (continued 2)
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For several nights after this period she was troubled with a starting in her sleep, which, however, was gradually removed by the administration of twenty drops of laudanum every night at bed time. She also suffered a good deal from the condition of her legs, which were severely scalded, especially on the posterior part, where they had been in contact with the hot water which had fallen on the bed. On the 27th of August she left the hospital, cured.
After this account, which I have purposely given at length, as it illustrates the subject in a remarkable manner, it is natural to wish to know the previous circumstances of her case. The woman’s husband, who was a master plumber, failed about four years before her admission. Since that time he had lived irregularly, a circumstance which caused her to be much distressed and dejected in spirits.
Two years after this failure she left her husband to reside with her mother, but was persuaded again to live with her husband, who had promised an amendment, which, it seems, he did not keep; she again became low spirited, pawned her clothes, and was ashamed to return to her mother.
On Sunday, the 16th of June, she sat down to dinner at one o’clock, when, after a quarrel, she left the house, and purchased sixpennyworth of laudanum at four different shops: she said she obtained about a dessert spoonful for a penny, and drank it as she purchased it. She then went to a neighbour’s house, and can only recollect feeling heavy, and that she had brandy given her.[26]
When death is anticipated, there is a common curiosity to know the period at which it will take place. But from what has been just said, it will be evident that it is not always possible to predict the precise time, nor are the symptoms which indicate its approach always to be relied on. When the evidences of dissolution, however, begin to manifest themselves, a general failure of the temperature, with a cold dew on the skin, may generally be considered as indicative that the scene is about to close. In many cases it is easy to recognise the fatal turn which diseases take by the alterations which the symptoms undergo. Where internal inflammations are about to issue in death, there is mostly a striking change in the expression of the face, and sometimes a curious shrinking of the body.
I shall never forget one instance in which these signs were particularly manifest. A young woman, who had formerly been a servant in Manchester, became ill, was unable to continue in service, and was eventually removed to the Infirmary. One day, as I went to visit her as usual, I observed a complete alteration in her countenance. It seemed shrunk and diminutive, with a ghastly paleness. She put out her hand and said, “You seem as if you did not know me.”—She spoke in a changed voice.
She complained of no pain, but I remarked a trembling in her hands, like that of the shaking palsy. The mind was perfectly collected, but her usual features seemed only mimicked by their pale shrunk copy. She said she knew that she was going to die,—and so it proved.
The nose and lips are very characteristic in the dying. The lips become pale, the nostrils dilated and dark looking, and the hairs about the lips seem more than usually apparent; the teeth look like pieces of ordinary bone, and the eyes seem to shadow through the eyelids, or are partially turned under the lids; the nails look dark, and the ends of the fingers sodden.
Finally, convulsive twitchings often show themselves in the face, with singular elevations of the eyebrows, and staring of the eyes. A gaping attempt to breathe terminates the struggle.
When coma is present, a mucous rattle is generally of fatal import; and, è contrario, when the lungs are affected, the supervention of coma is equally to be dreaded.
When fluids taken by the patient flow back from his mouth, or fall heavily down his throat as if poured into an ordinary tube, death is soon to be expected.
In young children, a curious playing with the bed-clothes often attends fatal affections of the brain. I remember a little child, who had her handkerchief in her hand, which she spread out repeatedly with apparent care, and in a fantastic manner, that would have been amusing but for its fatal import. The picking of bed-clothes and catching of the hands, as if at imaginary objects, are well known as terrible indications.
Chomel remarks, as of serious presage, the automatic manner in which a patient will unceasingly draw his hand to his side, in spite of the efforts of the physician to ascertain his pulse. I might enlarge much on such points, but it would, perhaps, be “to consider too curiously to consider so.”
The signs of death are not, however, always very marked; for when death arises in advanced and feeble age, the vital powers are so easily depressed, and the heart’s action brought to a stand in so imperceptible a manner, that it is common to speak of it as a quiet sleep. Madame D’Arblay, writing to her husband, graphically describes the death of her revered father, Dr. Burney, the celebrated author of the History of Music.
“An awful stillness pervaded his apartment; and so soft became his breathing, that I dropped my head by the side of his pillow, to be sure that he breathed at all. There, anxiously, I remained, and such was my position, when his faithful man-servant, George, after watchfully looking at him from the foot of his bed, suddenly burst out into an audible sob, crying out, ‘My master! My dear master!’
“For a moment, however, only; an alarm from his outcry had been raised, and the servants, full of sorrow, hurried into the chamber, which none of the family, that could assemble, ever quitted, and a general lamentation broke forth.
“Yet could I not believe that all had ceased thus suddenly, without a movement, without even a sigh! and, conjuring that no one would speak or interfere, I solemnly and steadily persisted in passing a full hour or more in listening to catch again a breath I could so reluctantly lose; but all of life, of earthly life, was gone for ever; and here, mon ami, I drop the curtain.”[27]
So frequently as medical men are called upon to contemplate the last hours of human existence, it is to be regretted that they have not more often given to their fellow men the reflections into which they must naturally have been led. It cannot but be, that many accomplished minds are to be found in a profession which is so enlightened; and it is not then easy to assign any sufficient reason for this silence. Possibly a kind of false delicacy may have operated on some minds, and others may have been diverted from such thoughts by the pressure of active occupation. It is common to suppose that medical men are blunted in their feelings by the nature of their avocations. It may be that there is some foundation for such an opinion; but I think the apparent want of sympathy sometimes found, is more frequently the effect of a strong temporary direction of the mind to the contemplation of curative means. Yet it must be owned that habit does much to lessen that exquisite sensibility with which we instinctively regard the chamber of death. The anatomist, as he traces with curious scalpel the secret structure of the frame, loses in professional technicalities the awful truth that he contemplates his own likeness. The hoary-headed gravedigger, as he turns up the mould to receive his fellow man, thinks not how soon the sand will rattle on his own coffin, and his humble name “shine upon the plate.” This indifference is, to some extent, good and necessary; but it is sadly too common and too great. But yet to the medical man, above all others, there is something of terrible reality in death. The student pictures death in his own manner: he looks upon it as the distant prospect which is to surround him at the remotest period of his life, the haven and resting place of his toil, the slumber and quiet repose which is to terminate the harvest of his day. The father tells his children of a peaceful and a better country, and smooths the pillow of his sick child as he whispers words of consolation and affection. The medical man has fresh in his mind, with all its ghastly reality, the cold image of his once dear friend; he yet hears the choking rattle in his throat, and yet wipes in imagination the perspiration from his corpse-like brow.
To what result then shall we come after the contemplation of death?—to the greatest and the best: the daylight of life is still around us, but the gloom of that night, in which no man can work, will soon be foreshadowed by sickness, infirmity, and age. Before this night steals upon us, and our ability for useful exertion ceases in the thickening obscurity, let us remember the reality of these things,—and, as we write our characters in the indelible language of deeds that can never be changed, let us remember, also, how soon the story will be told, and the book closed for ever.
It is, indeed, a mortifying thing to think what a laborious preparation we make for a few years of existence. It is humiliating to look back to the cares of infancy—the nights of maternal watching and anxiety—the hopes of childhood—the dreary toils and frequent tasks of school life—the ambition of riper years, with its unceasing efforts to attain what we find at last to be vanity and vexation. For what do we prepare,—if gold and silver at last tire the eye—if the applause of the world is found empty and interested—if ambition estranges friendship—if wealth cools our best affections, and separates man from his fellow man? For what do we prepare whilst the grave is so near to all of us, and the feet of those who are to carry us out are already lingering at the threshold of our doors?
But who is there that timely thinks on these things? Who can imagine his own death—anticipate the time when he shall be the object of fearful regard in others—when he himself shall be the almost unconscious being struggling with the thickening breath, and gasping with the convulsive throes of death? Who can think of the world being without himself; of the things which he has called his own being entirely at the disposal of others? To realise such ideas is to catch a glimpse of the true value of present interests. What then think we of the approbation of the great—the vanity of fashion, the pride of learning and the dignity of title;—the remembrance of one kind feeling, one charitable action, one generous sentiment and loving emotion, is more grateful to the heart, and more satisfying to the understanding. We are all too ready to avoid the contemplation of death. The subject is not an agreeable one, and can seldom find a fitting place in our consideration. It is too soon, and we would put it off “till a more convenient season.” But if we may not consider our own end, have we no one dear and precious to us in whose life our interests are intimately and affectionately entwined!—How shall we stand on the grave-side of such precious one, and with what thoughts shall we hereafter turn from the little circle of our mourning friends to the fresh landscape which surrounds the tomb?