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peasant 'babbles o' green fields,' and Napoleon expires amid visions of battle, uttering with his last breath tête d'armée.'
The contrast between the state of the body and that of the mind is often very striking ; the struggles of the former are no measure of the emotion of the latter. Indeed, the laborious and convulsive heavings of the chest are wholly automatic, independent of the will,-a part of the mechanism of the body, contrived for its safety, which continues to act when the mind is unconscious of the sufferings of the frame, or is occupied by soothing illusions. No one has described this better than Abernethy.
• Delirium often takes place in consequence of an accident of no very momentous kind, -it may occur without fever, or it may be accompanied with that irritative sympathetic which is often the “last stage of all, that closes the sad eventful history” of a compound fracture. Delirium seems to be a very curious affection; in this state a man is quite unconscious of his disease; he will give rational answers to any questions you put to him, when you rouse him, but he relapses into a state of wandering, and his actions correspond with his dreaming. I remember a man with compound fracture in this hospital, whose leg was in a horrible state of sloughing. I have roused him, and said, “ Thomas, what is the matter with you ? how do you do?” He would reply, “Pretty hearty, thank ye; nothing is the matter with me; how do you do?" He would then go on dreaming of one thing or another; I have listened at his bedside, and I am sure his dreams were often of a pleasant kind. He met old acquaintances in his dreams,-people whom he remembered lang syne, his former companions, his kindred and relations, and he expressed his delight at seeing them. He would exclaim every now and then,—" That's a good one; well, I never heard a better joke,” and so on.
It is a curious circumstance that all consciousness of suffering is thus cut off, as it were, from the body; and it cannot but be regarded as a very benevolent effect of nature's operations that extremity of suffering should thus bring with it its antidote.'
Occasionally the last dreams of existence are of a more painful nature;-guilt is delirious with dread, -remorse peoples the fancy with terrific visions—but even these are chequered with scenes of a tranquil, not to say trivial character. The death-bed of Cardinal Beaufort, terribly true, is rare; the mixed feelings and shadowings of past life, exhibited in that of Falstaff, are much more frequent.
The second mode of dissolution is marked by the absence of all corporeal struggle. The mind is left free and unclouded, to the very verge of the grave, save by the influence which the particular malady itself exercises on the current of ideas and feelings. The sufferings of the patient are incidental to the progress of the disease; but the end of all’ is placid, painless, and ge
nerally 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 niore 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
Νυν δ'αν πολλά πάθησι, φίλου από Πατρός αμαρτων. These, indeed, have sometimes wrúng 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 spiritual 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 bis 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.'