I.

SOME OF THE PHENOMENA OF DYING.

“Quod ad nos Pertinet, et nescire malum est, agitamus.”

HORACE.

One of the wisest of our countrymen, Lord Verulam, saw reason to censure the physicians of his own time for not making the Euthanasia a part of their studies.[1] And, although more than two centuries have since elapsed, it may be doubted whether as much attention is even yet given to the subject as might be done, to the obvious benefit and comfort of the dying.

There is little to be found in medical writings on the management of the dying, or on the treatment best adapted to the relief of the sufferings incident to that condition. The subject is not specially taught in any of our medical schools; and the young physician entering on the active duties of his office has to learn for himself, as best he may, what to do, and what not to do, in the most solemn and delicate position in which he can be placed,--in attendance on the dying, and administering the resources of the medical art, in aid of an easy, gentle, and placid death. The whole subject of the Euthanasia,[2] or of a calm and easy death, in so far as it respects the physician is in need of special study; and of a systematic treatment that has not hitherto been accorded to it.[3] In the following pages I can but trace the outlines of this subject, leaving to abler hands that fuller treatment which its interest and importance claim for it.

Lord Verulam held it to be as much the duty of the physician to smooth the bed of death, and render the departure from this life easy and gentle, as it is to cure diseases and restore health.[4] And this doctrine, so accordant with the best principles of our nature,[5] is commended to us by that most estimable and judicious of modern physicians, Dr. Heberden;[6] as it was also by the example and counsel of one of the most popular and successful physicians of the present century--the late Sir Henry Halford.[7]

The process by which death is brought about varies greatly in different instances, and this according to the disease, or the organ of the body, from which it essentially results. On these diverse modes of dying, and of death, modern science has thrown much light; and with the consolatory result of showing that the process of dying, and the very act of death, is but rarely and exceptionally attended by those severe bodily sufferings, which in popular belief are all but inseparable from it, and are expressed and emphasized in the terms “mortal agony” and “death struggle.”

Montaigne was one of the first among modern writers to oppose, by close argument, the general opinion of the painfulness of death; and he was followed in the last century with more eloquence, if with less argument, by Buffon.[8] “There is hardly any subject,” writes an amiable physician, “on which books afford us more impressive topics, than the consideration of death; and perhaps there is none less studied in its intimate details.... It might be expected that a scene through which we must all pass should excite a closer attention especially as _the physical process of death loses much of its horror on a near view_.”[9]

Physicians, the clergy, and intelligent nurses--all, indeed, who are practically conversant with the dying--testify to the truth of this statement. Sir Henry Halford, towards the close of his medical career, and after opportunities of observation, such as have fallen to the lot of few physicians, expressed his surprise that of the great number to whom it had been his professional duty to have administered in the last hours of their lives, so few exhibited signs of severe suffering. Sir Benjamin Brodie, whose experience of death from surgical disease was second to none, states that, according to his observation, the mere act of dying is seldom, in any sense of the word, a very painful process.[10] And another distinguished surgeon, Mr. Savory, writing on the same subject, says, “Whatever may have been the amount of _previous_ suffering, we may fairly assume that, except in extreme cases, the actual process of dying is not one of intense agony, or indeed, for the most part, even of pain.”[11] Lastly, the great anatomist, Dr. William Hunter, bore his own dying testimony to the same effect. He retained his consciousness to the last, and just before he died he whispered to his friend, Dr. Combe, “If I had strength enough to hold a pen, I would write how easy and pleasant a thing it is to die.”[12]

But of far greater weight than the observations and conclusions of medical men, however eminent, towards the determination of such a question, is the evidence of those who have been restored from the state of apparent death from drowning--a state which differs only from actual death in the possibility of reanimation under the influence of external treatment. And although the accounts given after recovery from drowning vary much, there are a number of well-attested cases which show, that in them at any rate, the loss of sensibility and consciousness has been painless, or at most attended with a feeling of oppression across the chest. The process of recovery, however, is often one of great bodily suffering.

Lastly, there are those specially interesting cases of recovery from the apparent death of drowning, in which, although the mind has been keenly alive and active throughout, there was an entire absence of pain or other bodily suffering of any kind. The best authenticated of these instructive and suggestive instances is that of Admiral Beaufort, as described by himself in a letter to Dr. Wollaston.[13] When a youngster on board one of H.M. ships in Portsmouth harbour, he fell into the water, and, being unable to swim, was soon exhausted by his struggles, and before relief reached him, he had sunk below the surface. All hope had fled, all exertion ceased, and he felt that he was drowning. “From the moment that all exertion had ceased,” writes the admiral, “a calm feeling of the most perfect tranquillity superseded the previous tumultuous sensations--it might be called apathy, certainly not resignation, for drowning no longer appeared to be an evil. I no longer thought of being rescued, _nor was I in any bodily pain. On the contrary, my sensations were now of rather a pleasurable cast, partaking of that dull, but contented sort of feeling which precedes the sleep produced by fatigue._ Though the senses were thus deadened, not so the mind; its activity seemed to be invigorated in a ratio which defies all description--for thought rose after thought with a rapidity of succession, that is not only indescribable, but probably inconceivable, by any one who has not himself been in a similar situation. The course of these thoughts I can even now in a great measure retrace,--the event which had just taken place, the awkwardness that had produced it, the bustle it must have occasioned, the effect it would have on a most affectionate father, and a thousand other circumstances minutely associated with home were the first series of reflections that occurred. They then took a wider range--our last cruise, a former voyage and shipwreck, my school, the progress I had made there and the time I had misspent, and even all my boyish pursuits and adventures. Thus travelling backwards, every past incident of my life seemed to glance across my recollection in retrograde succession; not, however, in mere outline as here stated, but the picture filled up with every minute and collateral feature; in short, the whole period of my existence seemed to be placed before me in a kind of panoramic review, and each act of it seemed to be accompanied by a consciousness of right or wrong, or by some reflection on its cause or its consequences; indeed, many trifling events which had been long forgotten, then crowded into my imagination, and with the character of recent familiarity.” Certainly two minutes did not elapse from the moment of suffocation to that of being hauled up; and according to the account of the lookers on, he was very quickly restored to animation. “My feelings,” continues Admiral Beaufort, “while life was returning, were the very reverse in every point of those which have been described above. One single but confused idea--a miserable belief that I was drowning dwelt upon my mind, instead of the multitude of clear and definite ideas which had recently rushed through it--a helpless anxiety--a kind of continuous nightmare seemed to press heavily on every sense, and to prevent the formation of any one distinct thought, and it was with difficulty that I became convinced that I was really alive. Again, _instead of being absolutely free from all bodily pain, as in my drowning state_, I was now tortured by pain all over me.”

I have given this case at some length, because it seems to throw a new light on the act of dying, and because analogous instances are probably not uncommon. Admiral Beaufort tells us that he had heard from two or three persons, who had recovered from a similar state, a detail of their feelings, which resembled his own as nearly as was consistent with their different constitutions and dispositions. Sir Benjamin Brodie mentions an instance in a sailor;[14] De Quincey records a like instance in a female, a near relative of his own;[15] and I have myself heard of two similar cases, but the details are not sufficiently precise to justify their narration here.

In fact, all the best and all the most direct evidence that the subject admits of, goes to show, that as a rule, the immediate act of dying is in no sense a process of severe bodily suffering--or, indeed, for the most part even of pain.

The common belief that the act of dying is one of severe bodily suffering is due probably in part to theoretical views of the nature of the event itself;[16] but, principally, to the occurrence of conditions, physiological or pathological, which precede or accompany that act, and the nature and import of which are misinterpreted. Doubtless also, it is due in no small degree to confounding the actual stage of dying, with those urgent symptoms of disease that precede and lead up to it, and which are often as severe or more so in those who are to recover, as in those who are to die. As a rule, to which there are doubtless exceptions, the urgent symptoms of disease subside, when the act of dying really begins. “A pause in nature, as it were, seems to take place, the disease has done its worst, all strong action has ceased, the frame is fatigued by its efforts to sustain itself, and a general tranquillity pervades the whole system.”[17]

Again, convulsions, which so often attend the process of dying, are accepted in evidence of suffering, when in fact they are the reverse, for they imply a loss of consciousness and sensibility, and therefore, of the capacity to feel pain. They are automatic, and in all essential respects like the convulsions of epilepsy, of which the subject is wholly unconscious. The convulsive movements that sometimes attend the last moments, and with which the person expires, constituting the so-called “death struggle,” are doubtless of the same painless character.

Some few, however, do really suffer grievously in dying, and expire in great bodily torture. This occurs in some diseases of the heart and great vessels of the chest, in angina pectoris, and in ileus. But especially in that most fearful of diseases, hydrophobia, in tetanus, and in spasmodic cholera--in maladies characterized by spasm of the external muscles, as distinguished from their convulsion, for spasm implies no such unconsciousness as does convulsion, but the reverse. Such cases are rare, but they are so terrible that they fix themselves in the memory, exert an undue influence on the judgment, and, although really exceptional in occurrence, and in the sufferings they entail, come to be regarded as but extreme instances of what is assumed to be the universal and inevitable lot of the dying. Happily for mankind it is not so.

So long as consciousness and intelligence continue, and they often do so to the last, the influence of mind and of the emotions on the bodily process of dying must be kept steadily in view. They are well-nigh as potential in the dying man as they are in the healthy. Hope is as soothing and fear as depressing in the one condition as in the other. To the dying there is no greater solace and cordial than hope--it is the most soothing and cheering of our feelings, and if, when all hope of life and in the present has fled, the dying man can dwell with hope and confidence upon his future, it will be well for him. The retrospect of a well-spent life, “memoria bene actæ vitæ, multorumque benefactorum recordatio” is a cordial of infinitely more efficacy than all the resources of the medical art;[18] but a firm belief in the mercy of God, and in the promises of salvation will do more than anything in aid of an easy, calm, and collected death. To those who are sceptical on this point, and such there are, I would remark, that unless a man has himself felt the influence of religion on his own mind, he is unable fully and accurately to understand its influence on others. If I may trust my own experience I should say, that in the aggressive _dis_believer, as in the mere passive agnostic, doubt and anxiety as to his future is all but sure to obtrude itself on his last conscious moments, disturb them, and render such an euthanasia as we contemplate, impossible.

“The less fear a reasonable man entertains of death,” says Zimmerman, “the more placid is he in his last moments.” Happily such dread or terror of death as disturbs the dying is rare. For the most part an urgent fear of death, when it does exist, is observed not so much at the moment when death is actually impending, as it is at that earlier period when the individual realizes for the first time that he is about to die. The shock at _that_ moment may be great, but it is for the most part transient, and “the subsequent contemplation of approaching death seems to be far less terrible.”[19] A torpor seems indeed to steal softly over the whole being as death approaches, and the earnestness to live abates, as the possession of life, from whatever cause, is gradually withdrawn. Sir Henry Halford tells us that of the great number to whom he had administered in the last hours of their lives, he had felt surprised that so few have appeared reluctant to go to “the undiscovered country from whose bourn no traveller returns.”[20]

No one, writes Mr. Savory, who has often stood at the bedside of the dying, “can have failed to be struck by the fact of the comparative or complete absence of dismay as death draws near. Often, no doubt, the mind is otherwise too fully occupied, ... but even in the absence of this and all distracting influences, and with a clear conviction that the approaching change is near at hand,--the mind is calm and collected, the thoughts serene, there is no quailing, no giving way.”[21]

The nature of the disease under which a person succumbs, would seem to exert some influence in this respect. Sir Benjamin Brodie says, “I have myself never known but two instances, in which, in the act of dying there were manifest indications of the fear of death. The individuals to whom I allude were unexpectedly destroyed by hemorrhage, which from peculiar circumstances, it was impossible to suppress. The depressing effects which the gradual loss of blood produced on their corporeal system seemed to influence their minds, and they died earnestly imploring the relief which art was unable to afford.”[22]

When the intimation that death is at hand has been postponed to the latest possible moment, it comes upon the sufferer so late, that there may not be time for him to get over the shock of the first impression, and regain his serenity. Alarm associates itself with the act of dissolution, which is imminent, or has already commenced, disturbs its even, easy, tenor, and explains some at least of the harrowing scenes that occasionally mark the death-bed. An earlier intimation[23] to the dying person of the great change he is about to undergo is in all respects desirable, and if the communication be made tenderly and with prudence, nothing but good is likely to result from it. An important question here presents itself. By whom should that communication be made?

“You will forgive me,” said Sir Henry Halford at one of the evening meetings at the College of Physicians, “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.... 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, and have done that which I would have done by myself, and have apprized my patient of the great change he was about to undergo.”

“In short, no rule, not to be infringed sometimes, can be laid down on this subject. Every case requires its own considerations; but you may be assured, that if good sense and good feeling be not wanting, no difficulty can occur which you will not be able to surmount with satisfaction to your patient, his friends, and yourselves.”[24]

In some instances the patient himself is the first to discover, and this from his own internal feelings, that he is about to die, and he announces the fact calmly, and for the most part without alarm, to those about him.

Although a fear of death in itself, or for one’s own sake, is rare and exceptional, the last moments of too many are made miserable by solicitude for those they will leave behind, and their end is often one of great _mental_ anguish. “Such 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.”[25]

* * * * *

In some dying persons consciousness and the intellect remain perfect to the last. The cases in which this is observed will be found to agree in the fact that the brain is correspondently unimpaired; they are for the most part chronic diseases of the chest and abdomen. If the character of the dying person is naturally strong, the state of his mind at the approach of death will generally be influenced by it. Of those who retain consciousness and intellect, the majority die thinking and acting in accordance with the influences that have been exerted upon them in previous life, by education and example: and with those which may be then brought to bear upon them, towards and at its close.

More often some delirium is present. The delirium of the dying is often of a most interesting character, and according to Dr. Symonds resembles dreaming more than any form of derangement. The ideas are derived less from present perceptions than in insanity, and yet are more suggested by external circumstances than in the delirium of fever and phrenitis.[26] Such delirium is generally shown in quiet talkativeness, which becomes later on a low muttering. In some the mind is occupied on the events of childhood and early life, but when the delirium is somewhat more active, the conceptions of the dying man are generally derived from subjects, which, either in his speculative pursuits or in the business of life, have principally occupied his thoughts.[27] Lord Tenterden, as he approached his end, became delirious and talked very incoherently. Afterwards he seemed to recover his composure, and raising his head from his pillow, he was heard to say in a slow and solemn tone, as when he used to conclude his summing up, in cases of great importance, “And, now, Gentlemen of the Jury, you will consider of your verdict.” These were his last words; when he had uttered them, his head sunk down, and in a few minutes he expired without a groan.[28] And the last words of Dr. Armstrong were addressed to an imaginary patient, upon whom he was impressing the necessity of attention to the state of the digestive organs.

Instances occur, and not very rarely, where the delirium ceases, and the mind again for a time becomes clear and the sensations keen, to be followed, however, ere long by a return of delirium, or it may be of coma, or a rapid sinking of all the bodily powers and speedy death. But along with this temporary clearing of the mental powers, and in proof of its illusiveness, there are the usual signs of bodily failure--a pinching of the features, coldness of the surface, cold sweats, and a feeble rapid pulse.

Active delirium and violence are but rarely associated with the act of dying,--they are indeed scarcely compatible with it. They may pave the way to it, but when the act of dying really begins, they cease and give way to that low, rambling, muttering delirium, with which all watchers by the death-bed are so familiar.

It is especially at the stage of transition from the one to the other of these states, that we meet with that return of intelligence--that ‘lightening up before death’ which has impressed and surprised mankind from the earliest ages. “We have all observed,” writes Sir Henry Halford, “the mind clear up in an extraordinary manner in the last hours of life, when terminated even in the ordinary course of nature; but certainly still more remarkably when it has been cut short by disease, which had affected, for a time the intellectual faculties. We have seen it become capable of exercising a subtle judgment, when the passions which had been accustomed to bias and embarrass its decisions whilst they existed, are extinguished at the approach of death; and when the inferences which wisdom had drawn from experience of the former behaviour of men, were now made available to a correct estimate of their future conduct, in the sense of Milton’s lines--”

‘When old experience does attain To something like prophetic strain.’[29]

“This is most frequently the case when the resistance of the constitution against the influence of the disease has been long protracted, or when the struggle, though short, has been very violent.”[30]

“A young gentleman of family, about twenty-five years of age, took cold whilst under the influence of mercury. The disease increased daily until it was accompanied at last, by so much fever and delirium, as made it necessary to use, not only the most powerful medicines, but also personal restraint. At length, after three days of incessant exertion, during which he never slept for an instant, he ceased to rave, and was calm and collected. His perception of external objects became correct, and they no longer distressed him, and he asked pressingly if it were possible that he could live? On being answered tenderly, but not in a way calculated to deceive, that it was probable he might not, he dictated some affectionate communications to his friends abroad, recollected some claims upon his purse, ‘set his house in order,’ and died the following night. The reason why so unfavourable an opinion was entertained of his state, was, that the apparent amendment was not preceded by sleep, and was not accompanied by a slower pulse; two indispensable conditions--on which only a notion of real improvement could be justified. But here was merely a cessation of excitement occasioned by a diminution of power, and by a mitigated influence of the action of the heart upon the brain.” This case occurred in the practice of Sir Henry Halford.[31] Another instance, the counterpart to that just described, which happened to the same eminent physician, may not be out of place.

A young gentlemen, who had also 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.... On the eleventh day of his disease, I was informed by my colleague, when we met, and by the attendants, 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, 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.”[32]

Some pass away in sleep. In natural healthy sleep respiration becomes slower, the pulse weaker and less frequent, the circulation generally feebler. The difference in these respects between the waking and the sleeping states, is to the dying person often the difference between life, and death. The circulation already reduced to the lowest ebb compatible with life, is yet further reduced by sleep, and with this reduction the patient dies. These are those who ‘sleep away.’ Similar to, if not identical with them, are those to whom death comes so easily that not a ruffle disturbs any portion of the frame, and the most intelligent observer is unable to fix the moment when life has fled, so easy is the parting of the last link, ‘when the body drops to earth and the soul rises to eternity.’ It is probable that here, a mere act of dozing becomes the act of dying. In these instances as in old age, death is literally the last sleep, _uncharacterized_ by any peculiarity. The general languor of the functions in the _last_ waking interval, is attended with no peculiar suffering, and the last sleep commences with the usual grateful feelings of repose.[33]

The length of the interval between insensibility and the absolute cessation of existence, varies greatly from a few seconds to several hours or days. But consciousness is often retained much longer than is generally supposed, and it is difficult to determine when the external senses, and particularly that of hearing, are completely and absolutely closed.

The senses of smell, taste, and touch are generally the first to fail us and disappear, while those of sight and hearing continue much longer.

Abnormal visual impressions are common when death is near at hand. In many the sight fails,--there is complaint of commencing or of actual darkness, and a desire is expressed for more light; while more rarely, the dying one perceives a blaze of light, in the contemplation of which, or immediately afterwards, he calmly expires. “It happens not unfrequently,” writes Dr. Symonds in his admirable essay on Death,[34] “that the spectra of the dying owe their origin to contemplations of future existence, and consequently that the good man’s last hours are cheered with beatific visions and communion with heavenly visitors. Dreadfully contrasted with such visions are those which haunt the dying fancies of others.”[35] The testimony of many of those who have the largest experience, and have watched _continuously and attentively_ at the dying bed, is in support of Dr. Symonds’ statement. If some physicians are incredulous, and place little reliance on testimony and inferences of this kind, I am inclined with Dr. Conolly[36] to attribute it, to their being seldom engaged long enough in watching by the bedside, where the senses and thoughts naturally become concentrated on the events of the sick chamber alone. My own observation in cases, where circumstances have made my attendance on the dying close and protracted, goes to corroborate the evidence there is on these points--points which are certainly not of a nature to be made familiar to those, whose chief knowledge of the dying is acquired in formal consultations, or in short daily visits to the wards of hospitals.

Hearing is, probably in most cases, the last of our senses to leave us. “An elderly lady had a stroke of apoplexy; she lay motionless, and in what is called a state of stupor, and no one doubted that she was dying. But after the lapse of three or four days, there were signs of amendment, and she ultimately recovered. After her recovery she explained that she did not believe that she had been unconscious, or even insensible, during any part of the attack. She knew her situation, and heard much of what was said by those around her. Especially she recollected observations intimating that she would very soon be no more, but that at the same time she had felt satisfied that she would recover; that she had no power of expressing what she felt, but that nevertheless _her feelings, instead of being painful or in any way distressing, had been agreeable rather than otherwise_. She described them as very peculiar--as if she were constantly mounting upwards, and as something very different from what she had ever before experienced.”[37]

The case of Dr. Wollaston the physician and chemical philosopher is to the same effect. “Some time before his life was finally extinguished he was seen to be pale, as if there was scarcely any circulation of blood going on--motionless, and to all appearance in a state of complete insensibility. Being in this condition, his friends who were watching round him, observed some motions of the hand which was not affected by the paralysis. After some time it occurred to them, that he wished to have a pencil and paper, and these having been supplied, he contrived to write some figures in arithmetical progression, which however imperfectly scrawled, were yet sufficiently legible. It was supposed that he had overheard some remarks respecting the state in which he was, and that his object was to show, that he preserved his sensibility and consciousness. Something like this occurred some hours afterwards, and immediately before he died, but the scrawl of these last moments could not be deciphered.”[38]

“I have been curious,” writes Sir Benjamin Brodie in commenting on these cases, “to watch the state of dying persons in this respect, and I am satisfied,” (and I may add, my own experience confirms Sir Benjamin Brodie’s statement) “that, where an ordinary observer would not for an instant doubt that the individual is in a state of complete stupor, the mind is often active even at the very moment of death. A friend of mine, who had been for many years the excellent chaplain of a large hospital, informed me, that his still larger experience had led him to the same conclusion.”[39]

Instances such as these should teach the physician and all who are about the dying, to be careful neither to say, nor do anything in the presence of the patient, which they would wish him not to hear. Their bearing on religious offices to the dying is obvious.

* * * * *

Sometimes, immediately preceding the very act of death, the eyelids are raised, and a look of recognition of those around seems to be permitted to the dying man. Less often there is an expression of agony in the eye. “It is consolatory to know,” says Sir Charles Bell, “that this does not indicate suffering, but increasing insensibility. The pupils are turned upwards and inwards. This is especially observed in those who are expiring from loss of blood. It is the strabismus patheticus orantium of Boerhaave.”[40]

The nature of the disease and the mode of death exert a marked influence on the expression of face of the dying, and this is often retained by the features after death. In some we observe the impress of the previous suffering, as in peritonitis and in cases of poisoning by irritants; in others the character is derived from a peculiar affection of some part of the respiratory apparatus; or from an affection of the facial muscles themselves, as in tetanus and paralysis. But the condition of the mind is perhaps more often concerned in the expression than even the physical circumstances of the body. For, as some kind of intelligence is frequently retained, and strong emotions are experienced till within a few moments of dissolution, the features may be sealed by the hand of death in the last look of rapture or of misery, of benignity or of anger. Every poetical reader knows the picture of the traits of death (no less true than beautiful) drawn by the author of “The Giaour.” But such observations are not confined to poets. Haller could trace in the dying countenance the smile which had been lighted by the hope of a happier existence. “Adfulgentis fugienti animæ spei non raro in moribundis signa vidi, qui serenissimo vultu non sine blando subrisu, de vita excesserunt.”[41]

FOOTNOTES:

[1] “At nostris temporibus, Medici quasi religio est, ægrotis, postquam deplorati sint, assidere; ubi meo judicio, si officio suo, atque adeo humanitati ipsi deesse nolint, et artem ediscere et diligentiam præstare deberent, qua animam agentes facilius et mitius e vita demigrent--Hanc autem partem, inquisitionem de _Euthanasia_ exteriori (ad differentiam ejus euthanasiæ quæ animæ præparationem respicit) appellamus; eamque inter desiderata reponimus.” (Verulamus, De Augmentis Scientiarum, lib. iv. cap. ij.)

[2] “Εὐθανασία naturalis nobis dicitur facilis et quam minimo cum cruciatu e vita exitus, qua tenus moriendi facilitas e causis naturalibus proxime pendet.... Ad medicinam hujus εὐθανασίας contemplatio pertinet: est enim naturalis, non moralis, nisi qua tenus hæc ad illam momenti habet plurimum. Exteriorem idcirco Verulamius appellavit.” (Nicolai Paradysii, Opuscula Academica, 8vo, Lugd. Batav, 1813. Oratio de Εὐθανασία naturali et quid ad eam conciliandam Medicina valeat, pp. 63 et 65.)

[3] “A medicis vix inchoatum, nedum pertractatum huc usque esset.” (Paradysius, p. 63.)

[4] “Etiam plane censeo ad officium medici pertinere, non tantum ut sanitatem restituat: verum etiam ut dolores et cruciatus morborum mitiget: neque id ipsum solummodo, cum illa mitigatio doloris, veluti symptomatis periculosi, ad convalescentiam faciat et conducat: imo vero cum abjecta prorsus omni sanitatis spe, excessum tantum præbeat e vita magis lenem et placidum. Siquidem non parva est felicitatis pars, illa Euthanasia.” (De Augmentis Scientiarum.)

[5] Sir Henry Halford, Essays and Orations read and delivered at the Royal College of Physicians. Third edition, 12mo, London, 1842. p. 84.

[6] “Magnus ille veræ philosophiæ instaurator Verulamus, queritur studium Euthanasiæ medicis haud satis cultum fuisse. Medici profecto munus est ægrotis sanitatem reddere; cum tamen ex lege naturæ erit tandem unicuique mortalium ægrotatio nulla arte medicabilis, benevolæ hujus artis professoribus conveniret, mortem inevitabilem, quantum fieri potest, terrore omni spoliare; et ubi non datum est prædam morti extorquere, sed vita necessario amittenda est, operam saltem dare, ut cum minima crudelitatis specie amittatur.” (Heberdeni Gulielmi, Commentaria de Morborum Historia et Curatione. Cap _De Ileo_.)

[7] Essays and Orations, _ut supra passim_.

[8] John Ferriar, M.D., Medical Histories and Reflections. 8vo, London, 1798. Vol. iii. p. 196.

[9] John Ferriar, M.D., On the Treatment of the Dying, _ut supra_, p. 191.

[10] The Works of Sir Benjamin Collins Brodie. Arranged by Charles Hawkins. 3 Vols., 8vo, London, 1865. Vol. i. p. 184.

[11] On Life and Death. 8vo. London, 1863, p. 175.

[12] “Ipsæ animæ discessus a corpore fit, sine dolore, et fit plerumque sine sensu, _nonnunquam etiam cum voluptate_.” (Vopisci Fortunati Plempii. de Togatorum Valetudine tuenda Commentatio. 4to. Bruxellis, 1670. p. 26.)

[13] Autobiographical Memoir of Sir John Barrow, Bart. 8vo, London, 1847, p. 398.

[14] “A sailor who had been snatched from the waves, after lying for some time insensible on the deck of the vessel, proclaimed on his recovery that he had been in Heaven, and complained bitterly of his being restored to life as a great hardship. The man had been regarded as a worthless fellow; but from the time of the accident having occurred, his moral character was altered, and he became one of the best conducted sailors in the ship.” (The Works of Sir Benjamin Brodie, vol. i. p. 184.)

[15] I was once told by a near relative of mine--says De Quincey--that having in her childhood fallen into a river, and being on the very verge of death but for the assistance which reached her at the last critical moment, she saw in a moment her whole life, clothed in its forgotten incidents, arrayed before her as in a mirror, not successively, but simultaneously; and she had a faculty developed as suddenly for comprehending the whole and every part. The heroine of this remarkable case, continues De Quincey, was a girl about nine years old; and there can be little doubt that she looked down as far within the _crater_ of death--that awful volcano--as any human being ever _can_ have done that has lived to draw back and to report her experience. Not less than ninety years did she survive this memorable escape, and I may describe her as in all respects a woman of remarkable and interesting qualities. She enjoyed throughout her long life serene and cloudless health; had a masculine understanding; reverenced truth not less than did the Evangelists; and led a life of saintly devotion, such as might have glorified Hilarion or Paul! I mention these traits as characterising her in a memorable extent, that the reader may not suppose himself relying upon a dealer in exaggerations, upon a credulous enthusiast, or upon a careless wielder of language. Forty-five years had intervened between the first time and the last time of her telling me this anecdote, and not one iota had shifted its ground amongst the incidents, nor had any of the most trivial of the circumstances suffered change. How long the child lay in the water was probably never inquired earnestly until the answer had become irrecoverable: for a servant to whose care the child was then confided, had a natural interest in suppressing the whole case. From the child’s own account it would seem that asphyxia must have announced its commencement. A process of struggle and deadly suffocation was passed through half-consciously. This process terminated in a sudden blow apparently _on_ or _in_ the brain, after which there was no pain or conflict: but in an instant succeeded a dazzling rush of light; immediately after which came the solemn apocalypse of the entire past life. (De Quincey’s Works, Edinb., 1862, Vol. I., Confessions of an English Opium-Eater, p. 259.) Sir Dyce Duckworth reminds us that the mental condition of some who have been put to sleep with anæsthetics may throw some light on this matter. “Patients,” says he, “have told us they dreamed they were transported from earth and carried off into space, were supremely happy and at rest: but that on gradually recovering consciousness, they seemed to light back again upon this world, were most reluctant to leave the Elysium they had reached, and to recommence their earthly toils and struggles.” (The Agony of Dying, in Monthly Paper of the Guild of St. Barnabas for Nurses. Vol. iii. p. 81).

[16] J. A. Symonds, M.D., Art. Death, in the Cyclopædia of Anatomy and Physiology, 4 vols., royal 8vo, Lond. Vol. i. p. 800.

[17] Halford, p. 18.

[18] Halford, p. 14.

[19] Savory, _ut supra_, p. 178.

[20] p. 74.

[21] On Life and Death, 8vo, London, 1863, p. 177.

[22] Brodie _ut supra_, p. 185.

[23] “I think there is reason for affirming that the risk of evil from this cause is rated generally above the truth. In cases of imminent danger, the mind is not always, or even commonly, to be interpreted by the rule of health. Mental emotions are often altered in kind, or greatly abated in degree. Death itself is beheld under different views--a fact familiar to all who have watched over these scenes, and regarded the patient apart from those who are grieving around his death-bed. Suspicion of a painful truth often disturbs much more than the truth plainly stated.” (Sir Henry Holland’s Medical Notes and Reflections. Third edition, 8vo. Lond. 1853, p. 362).

[24] Halford, p. 76.

[25] Halford, p. 75.

[26] Cyclopædia of Anatomy and Physiology, art. Death, vol. i. p. 799.

[27] Symonds _ut supra_, p. 799.

[28] Lord Campbell, Lives of the Chief Justices of England, vol. i.

[29] On the Καῦσος of Aretæus, p. 96.

[30] Halford, On the Cautious Estimation of Symptoms, p. 17.

[31] Halford _ut supra_, p. 19.

[32] On the Καῦσος of Aretæus, p. 91.

[33] A. P. Wilson Philip, On Sleep and Death, 8vo, London, 1834, p. 165.

[34] Cyclopædia of Anatomy and Physiology, vol. i. p. 799.

[35] Dr. Symonds continues, “The previous habits and conduct of the individual have sometimes been such as to incline spectators to inquire, whether in the mode of his departure from existence, he might not already be receiving retribution, just as, in other cases, celestial dreams and colloquies have seemed fitting rewards for blameless lives and religious meditation.”

[36] Cyclopædia of Practical Medicine, art. Disease, vol. i. p. 629.

[37] Brodie, _ut supra_, vol. i. p. 281.

[38] Brodie _ut supra_, p. 182.

[39] Brodie, p. 182.

[40] The Anatomy and Philosophy of Expression. Fourth Edition, 1847, p. 185.

[41] Symonds, _ut supra_, p. 803.