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nerally sudden. Death, in these cases, attacks the sentient principle, through the nervous system, as it were, directly. It surprises the sufferer sometimes when sighing for the consummation of life, but believing the term yet distant; sometimes in the midst of plans and schemes which are destined never to be realized. In consumption, and, in general, in diseases which are slow in their progress, this sudden termination of life is as common as that more protracted form, already noticed. It is best exemplified by death produced by lightning, in which the visible alterations in the frame afford a striking contrast to the ordinary ravages of what is termed disease. The machinery of the body appears nearly perfect, and unscathed, and yet in none of the multitudinous forms of death is the living principle so summarily annihilated. Certain poisons appear to act in a similar manner; and, occasionally, the more important operations of surgery are followed by the like result; for which the genius of John Hunter could find no better explanation than the figurative hypothesis, that the vis medicatrix, conscious that the injury is irreparable, gives up the contest in despair.
Severe injuries inflicted on the great centres of the nervous system, the brain, spine, and stomach, are followed by instantaneous death : of which, pithing or wounding the uppermost part of the spinal-marrow of the bull, in the arena, and the coup de grace, or blow on the stomach of the criminal, whose limbs have been previously broken on the wheel, are well-known examples. Emotions of the mind, especially such as, by their depressing character, exhaust the energies of life, often terminate in this mode of death. The slightest causes, a mere fainting fit, trivial in every other state of the frame, in this may be fatal. It is the euthanasia of a healthy old age, and the termination assigned by nature to a life in which the passions have been controlled and the energies regulated by the authority of reason and a sense of duty.
Whether we look at the one mode of dissolution or the other, the sting of death is certainly not contained in the physical act of dying. Sir Henry Halford, after forty years' experience, says
Of the great number to whom it has been my painful professional duty to have administered in the last hours of their lives, I have sometimes felt surprised that so few have appeared reluctant to go to “ the undiscovered country from whose bourne no traveller returns.” Many, we may easily suppose, have manifested this willingness to die, from an impatience of suffering, or from that passive indifference which is sometimes the result of debility and extreme bodily exhaustion. But I have seen those who have arrived at a fearless contemplation of the future, from faith in the doctrine which our religion
VOL. XLIX. NO, XCVII,
teaches. Such men were not only calm and supported, but even cheerful in the hour of death ; and I never quitted such a sick chamber without a wish that “my last end might be like theirs.”
• Some, indeed, have clung to life anxiously-painfully; but they were not influenced so much by a love of life for its own sake, as by the distressing prospect of leaving children, dependent upon them, to the mercy of the world, deprived of their parental care, in the pathetic language of Andromache
Νύν δ'αν πολλά πάθησι, φίλου από Πατρός αμαρτών. These, indeed, have sometimes wrung my heart.
• And here you will forgive me, perhaps, if I presume to state what appears to me to be the conduct proper to be observed by a physician in withholding, or making his patient acquainted with, his opinion of the probable issue of a malady manifesting mortal symptoms. I own I think it my first duty to protract his life by all practicable means, and to interpose myself between him and everything which may possibly aggravate his danger. And unless I shall have found him averse from doing what was necessary in aid of my remedies, from a want of a proper sense of his perilous situation, I forbear to step out of the bounds of my province in order to offer any advice which is not necessary to promote his cure. At the same time, I think it indispensable to let his friends know the danger of his case the instant I discover it. An arrangement of his worldly affairs, in which the comfort or unhappiness of those who are to come after him is involved, may be necessary; and a suggestion of his danger, by which the accomplishment of this object is to be obtained, naturally induces a contemplation of his more important spiritnal concerns, a careful review of his past life, and such sincere sorrow and contrition for what he has done amiss, as justifies our humble hope of his pardon and acceptance hereafter. If friends can do their good offices at a proper time, and under the suggestions of the physician, it is far better that they should undertake them than the medical adviser. They do so 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—no hope ; and, on that account, what is most awful to think of, perhaps the sick man's repentance may
be less available.
• But friends may be absent, and nobody near the patient in his extremity, of sufficient influence or pretension to inform him of his dangerous condition. And surely it is lamentable to think that any human being should leave the world unprepared to meet his Creator and Judge,
with all his crimes broad blown!” Rather than so, I have departed from my strict professional duty, done that which I would have done by myself, and apprized my patient of the great change he was about to undergo.'—p. 79. The following passage from the same Essay is, we think, in the
highest degree honourable to the physician who writes, and to his illustrious patient :
• If, in cases attended with danger in private life, the physician has need of discretion and sound sense to direct his conduct, the difficulty must doubtless be increased when his patient is of so elevated a station, that his safety becomes an object of anxiety to the nation. In such circumstances, the physician has a duty to perform, not only to the sick personage and his family, but also to the public, who, in their extreme solicitude for his recovery, sometimes desire disclosures which are incompatible with it. Bulletins respecting the health of a sovereign differ widely from the announcements which a physician is called upon to make in humbler life, and which he intrusts to the prudence of surrounding friends. These public documents may become known to the royal sufferer himself. Is the physician, then, whilst endeavouring to relieve the anxiety or satisfy the curiosity of the nation, to endanger the safety of the patient; or, at least, his comfort ? Surely not. But whilst it is his object to state as accurately as possible the present circumstances and the comparative condition of the disease, he will consider that conjectures respecting its cause and probable issue are not to be hazarded without extreme caution. He will not write one word which is calculated to mislead ; but neither ought he to be called upon to express so much as, if reported to the patient, would destroy all hope, and hasten that catastrophe which it is his duty and their first wish to prevent.
Meanwhile, the family of the monarch and the government have a claim to fuller information than can, with propriety or even common humanity, be imparted to the public at large. In the case of his late majesty, the king's government and the royal family were apprized, as early as 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 in the 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.
• Lord Bacon encourages physicians to make it a part of their art to smooth the bed of death, and to render the departure from life easy, placid, and gentle. This doctrine, so accordant with the best principles of our nature, commended not only by the wisdom of this consummate philosopher, but also by the experience of one of the most judicious and conscientious physicians of modern times (the late Dr.Heberden) was practised with such happy success in the case of our late lamented sovereign, that at the close of his painful disease
non tam mori videretur (as was said of a Roman emperor) quam dulci et alto sopore excipi."'-p. 89.
Occasionally, the last scene of life is marked by such strength, such unwonted vivacity of thought and solemnity of feeling, as led Aretæus to attribute prophetic power to individuals dying of peculiar maladies—especially of brain-fever; the effect of which, when the violence subsides, is, he says, to clear the patient's mind, and render his sensations exquisitely keen. • He is the first to discover that he is about to die, and announces this to the attendants; he seems to hold converse with the spirits of those departed before him, as if they stood in his presence.' In diseases of the intellect, the phenomena thus described by Aretæus are often observed. Cervantes has given so faithful an illustration in the death of Don Quixote, as proves him to have taken the scene from nature. But waiving the discussion of that general belief entertained by antiquity, that dying men were gifted with a prophetic spirit, illustrated as it is in the Old Testament, and in the dramatic use made by the Greek poets of the novissima verba, we may say, that the circumstances of the case explain all that it presents. If it be granted that diseases of the body act on the mind--if consumption excites the feelings of hope and security—palsy those of fretfulness and discontent-if diseases of the heart arouse involuntary terrors -and some morbid states of the brain excite and sharpen the faculties of the mind, the death-bed of those about to sink under the last-mentioned class of maladies must be singularly favourable to the exhibition of mental energy under bodily decay. The passions, which during life embarrassed the decisions of judgment, are extinguished at the approach of death-and, to use the words of Sir Henry, “ the inferences which wisdom had drawn from experience of the former behaviour of men are now made available to a correct estimate of their future conduct, in the sense of Milton's lines,
old experience doth attain To something like prophetic strain.'
We extract what follows from the sixth of these Essays, that on the Kavoos of Aretæus :'
A young gentleman, twenty-four years of age, who had been using mercury very largely, caught cold, and became seriously ill with fever. His head appeared to be affected on the fifth day, and on the seventh, when I was first called into consultation with another physician who had attended him with great care and judgment from the commencement of his illness, we found him in the highest possible state of excitement. He was stark naked, standing upright in bed, his eyes flashing fire, exquisitely alive to every movement about him, and so irascible as not to be approached without increasing his irritation to a degree of fury. He was put under coercion, and, amongst other expedients, emetic tartar was ordered to be administered to him, in doses of a grain each time, at proper intervals. On the eleventh day of his disease I was informed that he was become quite calm, and seemed much better. It was remarked, indeed, that he had said, repeatedly, that he should die; that under this conviction he had talked with great composure of his affairs; that he had mentioned several debts which he had contracted, and made provision for their payment; that he had dictated messages to his mother, who was abroad, expressive of his affection, and had talked much of a sister who had died the year before, and whom, he said, he knew he was about to follow immediately. To my questions, whether he had slept previously to this state of quietude, and whether his pulse had come down, it was answered— No; he had not slept, and his pulse was quicker than ever. Then it was evident that this specious improvement was unreal, that the clearing up of his mind was a mortal sign, “a lightening before death,” and that he would die forthwith. On entering his room, he did not notice us; his eyes were fixed on vacancy, he was occupied entirely within himself, and all that we could gather from his words was some indistinct mention of his sister. His hands were cold, and his pulse immeasurably quick,-he died that night.'—p. 96.
In another Essay, entitledOn Shakspeare's test of Insanity, we find various cases of the same or a like kind brought forward to illustrate the accuracy with which our great dramatist, and other poets of the first class, have delineated the phenomena of mental disorder. The ininute, even technical, study which Shakspeare had bestowed on this painful subject, is indeed apparent ; his delineations of mania, in its various degrees, embody quite as careful a record of realities as Lord Byron's Storm in the Gulf of Lyons, and Siege of Ismael, have been lately proved to do. Sir Henry's text is in these words of Hamlet :-.