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Title: The medical aspects of death, and the medical aspects of the human mind
Author: James Bower Harrison
Release date: July 27, 2026 [eBook #79198]
Language: English
Original publication: London: Longman, Brown, Green and Longmans, 1852
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*** START OF THE PROJECT GUTENBERG EBOOK THE MEDICAL ASPECTS OF DEATH, AND THE MEDICAL ASPECTS OF THE HUMAN MIND ***
THE
MEDICAL ASPECTS
OF
DEATH,
AND
THE MEDICAL ASPECTS
OF THE
HUMAN MIND.
BY JAMES BOWER HARRISON,
M.R.C.S.L. ETC.
FORMERLY ONE OF THE RESIDENT MEDICAL OFFICERS OF
THE MANCHESTER ROYAL INFIRMARY,
AND SURGEON TO THE ARDWICK AND ANCOATS DISPENSARY,
ETC.
LONDON:
LONGMAN, BROWN, GREEN, AND LONGMANS.
1852.
LONDON:
SPOTTISWOODES and SHAW,
New-street-Square.
PREFACE.
In youth it is not common to think much about death. A person would
be considered to be of a very serious turn of mind who gave attention
to such a subject in the earlier periods of his life. There comes a
time, however, sooner or later, in which it is perceived that there is
a reality in the meaning of the speeches we have so long unthinkingly
made or heard others make. We wake up to the conviction that we are
ourselves no exception to the rule; in fact, to the conviction that
we shall die. Already we find ourselves in the middle period of life;
already the scene is shifting, and we begin to perceive that it will
shift still more. It wants no great exhortation, then, to see that
every one is individually interested in all that relates to death. A
person must be wanting in reflection if he does not consider, at least
when he has made some progress in life, that he will very soon find
himself at his journey’s end. It is natural then to have a curiosity
about death; and it is partly with a view to satisfy this curiosity,
and partly with a view to fill up the intervals left by more arduous
professional studies, that I have written what follows.
But some will say the subject is a distasteful one, and, like Hotspur’s
fop, be offended that a slovenly, unhandsome corse should be brought
between the wind and their nobility. The true nobility of the mind does
not, however, shrink from contemplating human nature in all its phases,
untricked out with ornament or disguised by forms. I am sure the reader
who has the curiosity to look at these pages will not be wanting in
such nobility of mind.
In order to relieve the subject, I have purposely introduced more
collateral matter than might be absolutely necessary for its
elucidation.
I have never thought it essential that a book should be dry in order to
be useful.
* * * * *
The second paper in this volume I have been induced to reprint from the
Psychological Journal, because it has received the approbation of many
friends in whose judgment I am pleased to confide. I am aware that it
contains remarks to which some may take exception; but I write not to
echo the sentiments of others, but to make known my own. I regret that
at the time I wrote it I had not had the advantage of reading the very
able remarks of Dr. Conolly, in his Croonian lectures delivered before
the College of Physicians. The fearless and humane character of these
lectures deserves a higher praise than it is in the author’s power to
bestow.
_Higher Broughton, Manchester_,
1851.
CONTENTS.
Page
THE MEDICAL ASPECTS OF DEATH 1
THE MEDICAL ASPECTS OF THE HUMAN MIND 113
THE
MEDICAL ASPECTS OF DEATH.
_Hamlet._ Pr’ythee, Horatio, tell me one thing.
_Hor._ What’s that, my lord?
_Ham._ Dost thou think Alexander looked o’ this fashion i’ the earth?
_Hor._ Even so.
_Ham._ And smelt so? pah!
_Hor._ Even so, my lord.
SHAKSPEARE.
THE
MEDICAL ASPECTS OF DEATH.
“Dost thou think Alexander looked o’ this fashion i’ the earth?”
How pregnant is such a question with meaning,--the noble dust of
Alexander like the corrupting skull of the king’s jester! How natural
to ask ourselves the question, Shall we also look o’ this fashion
i’ the earth?--we want no Horatio to answer, “Even so.” But though
it is common to speak of death, I do not think it is very common to
_consider_ it. We are, in truth, too much afraid to look at it in
its physical aspects. The subject may seem repulsive, but it is one
which a rational being should not altogether disregard, because many
practical advantages arise from making it an object of study. It must
be remembered that it is a privilege peculiar to human nature, to
preconsider the last moments of existence. But I am not one of those
who would wish to throw a gloom upon life, and carry the skull round at
the feast--I would rather throw the light of reason, as far as it will
shine, on the mysteries of the grave.
How interesting are our first impressions of death!--when we first
looked timidly at the familiar features of a dear parent stiffened and
pinched with the hand of death! Who cannot recall to mind that cold
apartment which had so lately been the scene of anxious watching and
tender solicitude,--the formal sheeted corse,--the appalling stillness
of the compressed lip and icy coldness of that last kiss? It is at such
times that the feelings rise to the noblest sentiments of our nature,
and we see the littleness of human ambition, and the emptiness of
our fondest wishes;--at these periods alone can we perceive the real
significance of life, for then the hurry of business is suspended, and
there is a pause in the drama of events.
It would be curious to trace the forms and ceremonies which surviving
friends have adopted to show their respect for the dead. The custom of
strewing flowers on the tomb is, perhaps, one of the most simple and
touching. This custom is beautifully alluded to in “Cymbeline”:--
“With fairest flowers,
Whilst summer lasts and I live here, Fidele,
I’ll sweeten thy sad grave: thou shalt not lack
The flower that’s like thy face, pale primrose, nor
The azure hare-bell like thy veins; no nor
The leaf of eglantine, whom not to slander,
Outsweeten’d not thy breath.”
I shall not stop, however, to dwell on these topics, nor describe the
“trappings and suits of woe,” which are not always the accompaniments
of real grief. The nodding plumes and lengthened processions of
the great only betray how little wealth and rank can rescue their
possessors from the common fate of human kind.
In how many cases might we not say, with Byron,--
“Of all
The fools who flock’d to swell or see the show,
Who cared about the corpse? the funeral
Made the attraction, and the black the woe.”[1]
The _Signs_ of death are important in a medical point of view; for
though the extinction of life is generally too apparent to admit of
question, there can be no doubt but that occasional errors have arisen.
In most of these cases, it is certain that undue haste and culpable
carelessness have contributed to the result; but we all feel so deeply
the horror of such mistakes, that some fear is excusable, even when we
have no apprehension of such carelessness on the part of those who may
have to do the last offices for ourselves. In all periods the subject
of premature interment has excited great interest, and the very fears
which have been entertained have been the occasion of many stories
equally marvellous and horrible.
In order to provide against premature interment, the Romans are said
to have waited seven days before they interred the dead; those who had
charge of the corpse calling the name of the deceased many times in a
loud voice. It was this custom which constituted the _Conclamatio_.
Just before the body was finally buried, the name was again loudly
called; and then it was considered proper to enter on the funeral
ceremonies.
Terence makes allusion to this custom when he says,
“Desine,--jam conclamatum est.”
If we are to believe French writers, it would seem that, formerly,
premature interments were very common in France. It is to be hoped,
however, that many of their statements are exaggerated or incorrect.
Bruhier has collected together upwards of 180 cases, in which mistakes
were made as to the signs of death: of these, 52 were interred alive, 4
opened before death, 53 recovered spontaneously after having been shut
up in the coffin (renfermées dans le cerceuil), 72 reputed dead without
being so. At the same time that we are happy to think that Bruhier must
have greatly indulged his imagination, it is probable that the French
hospitals may have been the scene of many culpable errors.
Louis, in his more able letter on the Signs of Death, which was
published in 1752, relates the case of a young woman, _en couches_, who
left the Hôtel-Dieu on account of the prevalence of an epidemic, and
sought refuge at the Hôpital de la Salpétrière. On her way she fainted
twice, and again on her arrival fell into a fainting fit. She was
thought by the sisters of charity to be dead, and remained two hours
exposed in the court to a rigorous cold. She was then carried into the
_salle des morts_ (dead-house). Some time afterwards, a pupil hearing
groans, came affrighted to inform Louis. Louis went to the spot, but
found her already dead; though she had made efforts to get extricated
from the winding sheet in which she was enveloped, and had one foot
on the ground, out of the litter, and an arm leaning on the bar of
the trestle of a dissecting table, by the side of which she had been
placed.[2]
Many of the stories told of persons being buried alive, partake too
much of the marvellous, to meet with unqualified acceptance. In periods
of great mortality, and when epidemics have raged, there can be little
doubt, however, that such instances have occurred. The philanthropic
Howard, in his work on Prisons, says:--“I have known instances where
persons, supposed to be dead of the gaol fever and brought out for
burial, on being washed with cold water, have shown signs of life, and
soon afterwards recovered.” I have myself frequently heard people
express their fears of being interred alive. I remember a young lady
who, on her death-bed, made a solemn appeal to her father, that her
body might be thrown into the sea as soon as it should be known that
she was dead. Her father properly and ingeniously opposed her wish, in
expressing his desire that her remains should rest in the same grave
with his own. A lady in Manchester had so strong a fear of being buried
alive, that she left a sum of money, the interest of which was to be
received only on conditions that her body was kept above ground. The
body was bound over closely like a mummy, and was deposited in the
Natural History Museum, where, I believe, it may still be seen by the
curious.
Perhaps this feeling had been induced by some circumstances in her
life, which had rendered her extremely fearful of such mistakes.
Dr. Paris tells us, “that the daughter of Henry Laurens, the first
president of the American Congress, when an infant, was laid out as
dead of the smallpox; upon which the window of the apartment, that had
been carefully closed during the progress of the disease, was thrown
open to ventilate the chamber, when the fresh air revived the supposed
corpse, and restored her to her family: this circumstance occasioned in
her father so powerful a dread of living interment, that he directed by
will that his body should be burnt, and enjoined on his children the
performance of this wish as a sacred duty.”[3]
Amongst the ordinary signs of death the absence of respiration is
that which is most popular, but at the same time the most likely to
deceive. To ascertain whether the breathing be entirely suspended, it
is a common practice to hold a looking-glass to the face, that the
respiration may be indicated by the mist on its surface.
In King Lear we have the passage--
“Lend me a looking glass;
If that her breath will mist or stain the stone,
Why, then she lives.”
Act V. Sc. III.
For the same reason the stirring of any light substance, such as
down, which may rest about the mouth, has been regarded as a fine
indication of the act of respiration; but this, like the mist on the
looking-glass, is but a deceptive or inaccurate method; and Shakspeare
accordingly represented Prince Henry as having been deceived, when he
carried off the crown from his father’s pillow--
“By his gates of breath
There lies a downy feather which stirs not;
Did he suspire, that light and weightless down
Perchance must move.”[4]
If the observance of the respiration be taken as the indication of
life, and its absence as a proof of death, the exposure of the naked
chest and abdomen would enable the spectator to form a much more
accurate appreciation of it, especially if it be made carefully and for
a sufficient length of time.
One indication of death is found in the Rigidity of the corpse. It is
true that persons in some nervous diseases have been represented as
closely assimilating the dead, even with respect to the stiffness of
the body. The professional man could scarcely, however, be deceived
by such cases. The stiffness of death is often not fairly established
until the body is already cold[5], and, when overcome by pressure, does
not return, as the contractions which arise from nervous causes. Some
cases of catalepsy have been related which are indeed very astonishing,
but, as I have said, they could only deceive unprofessional people, and
those not familiar with the appearances of a corpse.
The rigidity of death appears to come on with various degrees of
rapidity, and its duration is also various. It usually commences in
about seven hours[6], but it may be deferred considerably longer,
even to twenty or thirty hours. When the body is greatly weakened by
disease, the rigidity comes on much sooner, but is more evanescent. It
has been known to arise in fifteen or twenty minutes. Again, in its
duration there is much variety; ordinarily it exists from twenty-four
to thirty-six hours, but may continue many days. Much may be supposed
to depend on the humidity and warmth of the atmosphere.
There is something singular in this stiffening of the body. It seems
like the final act of life, and has been supposed to be the last
effort of muscular power. Every one must be struck with the analogy
it presents to the coagulation of the blood; and, indeed, it has been
imagined by some physiologists that it was dependent on that cause.
This does not appear in reality to be the case; but there are still
many interesting points of similarity between these phenomena, and they
are both probably dependent on the last efforts of life.
The rigidity of the corpse is, perhaps, never entirely wanting, though
it may be brief in particular cases.
It does not seem to be confined to the external muscles of the body,
but is also evident, and indeed particularly manifested, in the heart
and great blood-vessels. The walls of the heart contract forcibly
after the external signs of death, and the arteries also contract, and
propel their contents into the veins. Before this circumstance was
properly understood, it was common to suppose that this contracted
state of the heart was the result of disease; and even in modern times
this error has been made. In the same way the ancients were misled
by this contraction; for, as they found the arteries void of blood,
they regarded them as tubes for the conveyance of air; and in this way
arose the term artery (ἀὴρ, air; τηρέω, to keep), improperly used to
indicate a blood-vessel.
The rapidity with which the body cools after death, must be very
dependent on the circumstances in which it is placed, and the manner in
which it is clothed. According to Dr. Taylor, the average time is about
fifteen or sixteen hours when not much clad, and when the temperature
is about 60°. He has known a body keep warm thirty or forty hours; and
as he remarks, the heat would obviously remain the longest, when the
death was violent and the person robust. There is always, however, some
uncertainty in judging of the period of death by the warmth of the
body.[7]
It is a curious fact in relation to the temperature of the body, that
in cases of Asiatic cholera, the body, previously quite cold, has
become warm immediately before, or even after death.[8]
The effects of Stimulants in producing muscular contractions soon
after the cessation of all outward signs of vitality, are curious
and interesting. When punctures are made in the limbs or heart,
contractions follow, and in some cases alternate contractions and
relaxations continue for some time. The most astonishing experiments of
this kind are, however, those made by the agency of galvanism on the
human body. The appearances produced by it are of the most frightful
nature, and awaken horrible fancies on the mind of the spectator;--the
eyes roll wildly, and the countenance is distorted with ghastly grins,
whilst the limbs move in forcible and convulsive actions. The most
successful effort to resuscitate by galvanism, was that made on the
body of John White, who was executed for a murder at Louisville.
The particulars are given in the Annals of Electricity. The body, after
hanging twenty-five minutes, was cut down, and, whilst yet warm, and
even trembling, was subjected to the stimulus of galvanism. The man
suddenly rose from his bench to a sitting posture, afterwards stood
on his feet, opened his eyes, and gave a terrific screech. His chest
worked as if in respiration. One of the surgeons present exclaimed that
he was alive. On another shock being given, he jumped up with a sudden
bound, disengaged himself from the wires, and ran into a corner of
the room. He frequently opened his eyes, and the breathing became so
regular, that many addressed him, but he made no sign of understanding.
Nevertheless, by the assistance of a medical student, he took a few
steps on the floor, and seated himself in an arm-chair. He seemed like
a man intoxicated, and overcome with the exertion he had made. Every
effort was put in practice to equalise the circulation; but congestion
of the brain eventually came on, and terminated his existence. A man
of the name of Clydesdale, who was executed for murder at Glasgow, was
also made the subject of a similar experiment.
In respect to the application of stimulants, it is not likely that the
more powerful, such as electricity or galvanism, will be made use of by
any other than medical men; and this mode of testing the continuance
of life is therefore more interesting in a physiological point of
view, than useful in its practical application. Cold water to the face
and sinapisms to the feet are often employed in the last moments of
life,--if not to test the existence of vitality, at least to act as
curative agents.
When Putrefaction commences, there can, of course, be no longer any
doubt of the departure of life,--premising, that the putrefaction is
general, and not of a local kind. There is nothing more appalling and
humiliating than the decomposition of the dead;
“Before Decay’s effacing fingers
Have swept the lines where Beauty lingers,”
we may, indeed, persuade ourselves, that the dead are only silent and
unmovable; but when changes gradually manifest themselves, and we can
no longer recognise the familiar features we have so often looked
upon, we see the greatness of that alteration, and feel what it is to
die.
Shall we “look upon those lips that we have kissed we know not how
oft,” pale, cold, and repulsive, and not experience the immensity of
this change!
The peculiar cadaverous odour of the body is well known to most people,
and the appearances of incipient putrefaction need no explanation.
The finer changes are, perhaps, best indicated by the flaccidity
of the cornea, and the loss of transparency in the eye. These can
seldom be mistaken by medical men, though death may undoubtedly take
place before they are strikingly apparent. Amongst other indications
of decomposition, the gravitation and transudation of the blood
to the surface on which the body lies, are important subjects for
consideration, because they have been mistaken by persons ignorant
of such matters for indications of injuries and bruises. They often
present very singular lines and marks, and have certainly a very close
resemblance to the extravasations produced by blows. These marks have
been termed sugillations,--the term sugillation is rather an awkward
word, but it is derived from the Latin _sugillatio_, which signifies a
black mark. Several instances are recorded of their being mistaken for
the ecchymoses produced by blows.
Belloc relates an instance where a woman, who was pregnant, was
ill-treated by her husband, who kicked her on the thigh and abdomen.
She subsequently fell ill of the smallpox, and died. The second day
of the fever she had an abundant hæmorrhage from the nose, the blood
being _dissolved and black_ (_dissous et très noir_). She died covered
with sugillations, and some traces of the smallpox. It then became a
question, whether she had died from violence. The body was exhumed for
the purpose of inspection, but the medical men who made the examination
concluded that her death was the result of the epidemic smallpox.[9]
Beck, in a note, quotes a case from Phillips’s Law of Evidence, of
a John Stringer, who was tried for the murder of his wife, in the
year 1765. It appeared that they had often quarrelled; and a young
surgeon gave it as his opinion that the marks found on the body had
the appearances of mortification produced by bruises. The man was
found guilty; but a Mr. Carsan, an eminent surgeon, who had from
mere curiosity also examined the body, was convinced that the marks
were those of incipient putrefaction; and on the case being fairly
represented to the Archbishop of Canterbury, a complete pardon was
eventually obtained.[10]
Sugillations may be distinguished from ecchymoses, by their being
found only on the more dependent parts of the body, or those which
_have_ already been dependent, and from their not being accompanied
by corresponding _subcutaneous extravasations_. In the case of
sugillations, therefore, if the skin be fairly divided, the livid
appearance will not be found traceable to any more deeply-seated cause.
The blood, too, in the case of sugillations is thin and fluid from its
decomposition; whereas, in the lividity from blows, clots are commonly
found beneath the spot indicated. But the effects of gravitation are
not only to be taken into consideration in estimating the external
appearances of the body, but also in considering the internal parts;
and this is of great consequence in the appreciation of the appearances
supposed to be the result of disease.
Sometimes discolourations of the body after death assume the appearance
of stripes, as if the subject had been previously beaten. The term
_Vibices_ (_vibex_, a stripe) has been adopted to express this
appearance. Certainly, any one not previously aware that such marks are
common, would be strongly tempted to suppose that they were produced by
flagellation. It seems that these marks are caused by the dress and
wrappings of the corpse causing the transudation of the blood to be
determined to particular parts.
In the year 1837, Μ. P. Manni, professor in the University of Rome,
offered to the Academy of Sciences, to place at its disposal the sum
of 1500 francs, to be given to the author of the best memoir on the
question of apparent death. In the same year the Academy proposed
the following questions on the subject for a prize: 1. What are the
distinctive characters of apparent death? 2. What are the means to
prevent premature interment?
It was not until the year 1846 that any memoir appeared which was
considered worthy of the prize; and it was then adjudicated to Μ.
Bouchut, whose treatise is now before the public.[11]
It appears from Μ. Bouchut’s able researches, that the _sounds_ of the
heart, as indicated by the stethoscope, are never entirely wanting,
except in real death; and that the longest interval between the last
beats of the heart is about six or seven seconds. These, therefore,
are very important points in ascertaining the departure of life at the
earliest possible period. The remarks of Μ. Bouchut are indeed such
as must naturally recommend themselves to our reason; but he is the
first who has fairly made the state of the heart in apparent death the
subject of direct observation and experiment.
Μ. Bouchut further insisted on the complete dilatation of the pupil as
a corroborative sign of death, remarking that, though contracted in the
death struggle, it afterwards and speedily becomes dilated; so truly
may we say that, “la pupille est la fenêtre de l’ame.”
It would seem, then, that the indications of death are sufficiently
marked to render it improbable that premature interment can often
take place; and whenever this occurs, it must be the result of great
carelessness, ignorance, and haste.
Even the alterations which take place after the body is committed to
the grave, have engaged the attention of medical inquirers, and Μ.
Orfila, in his treatise on Judicial Exhumations, has brought forward
much curious matter respecting them. It is not very probable that the
features of the dead can be recognized after fourteen or fifteen days’
interment; and in three or four months all vestiges of the face are
destroyed.
In cases, however, where pains are taken to exclude the air, the
preservation may be wonderfully protracted; and on this point I may
add some very interesting particulars relative to the posthumous
examination of the body of Charles I.
Until a recent period, doubt had been entertained as to the precise
spot where the remains of Charles I. were buried.
In the progress of some alterations which were made in connexion with
the tomb-house of St. George’s Chapel, an aperture was accidentally
made in Henry VIII.’s vault, through which the workmen saw two coffins,
supposed to contain the bodies of Henry VIII. and Jane Seymour, and
a third covered with a black velvet pall which, from Mr. Herbert’s
narrative (Athenæ Oxonienses), was conjectured to contain the body of
Charles I.
By the desire of the Prince Regent, and in his presence, an examination
of this latter was made on the 1st of April, 1813. On removing the
pall a plain leaden coffin was discovered, on which were inscribed, in
large letters, King Charles, 1648. A square opening was made into the
upper part of the lid, and through this a wooden coffin was seen, very
much decayed, inclosing the body, carefully wrapped up in cere-cloth.
It appeared that a quantity of greasy and resinous matter had been
melted into the coffin so as to fill it completely, and exclude the
air. It was not an easy matter to detach the cere-cloth from the body,
except at such parts as were covered with unctuous matter, and these
presented a correct impression of the features to which they had been
applied.
When the face was at length uncovered, it presented a dark discoloured
appearance, but the forehead and temples had lost nothing of their
muscular substance, and the face was long and oval. The cartilage of
the nose was gone; the left eye was open and full when first exposed,
but it rapidly vanished. The pointed beard, so characteristic of
this period, was perfect. Many of the teeth remained, and the left
ear was found entire. It was impossible not to perceive the likeness
which still remained to the coins and busts, and especially the
pictures of the king by Vandyke. When the cere-cloth was sufficiently
disengaged, the head was found loose and detached from the body; the
hair was thick at the back part of the neck, and had been apparently
cut short for the convenience of the executioner. At first it seemed
black, but when cleaned and dried, presented a beautiful brown colour.
The fourth cervical vertebra was cut transversely and smoothly, as
if from a heavy blow of a sharp instrument. The examination having
proceeded thus far, was thought to be sufficient to identify the
body, and the head was immediately restored, and the coffin soldered
up again. The other coffins were not disturbed; but the larger one,
which is believed to have contained Henry VIII., and was six feet ten
inches in length, was beaten in, as if by violence, and its outer
wooden covering was decayed, and in small fragments. Through the
opening the skeleton of the king might be perceived, but there was
nothing found of a discriminative character, and no inscription on
the coffin. It is supposed, that the coffin of King Henry had been
injured by the precipitous introduction of that of King Charles, at
a period when little respect was paid to the remains of monarchs. It
may be interesting to add, that a very small mahogany coffin, covered
with crimson velvet, lay on the pall which covered King Charles, and
contained the still-born child of the Princess George of Denmark,
afterwards Queen Anne.[12]
If the fear of premature interment be not unnatural, the fear of death
itself is obviously less so.
In some cases, however, illness gradually removes this dread, and the
change is welcomed, and even earnestly desired; the sufferer has ceased
to take an interest in the things around him: they have lost all the
charms they borrowed from hope and anticipation, and he has no future
earthly prospect but the grave.
But even where the act of dying is dreaded, there are many who would
not altogether be ignorant of the change. I have known people express
a strange fear of dying whilst they are asleep. I was once earnestly
asked by a patient who was on her death bed to awaken her if I thought
she was dying. I should imagine that this fear was not uncommon;
for I have heard it named more than once in my own experience.
In a very interesting memoir of Mr. Edgeworth, a part of which is
autobiographical, the writer states that his wife expressed this dread;
but, alas! the sleep of death is one from which we cannot awaken our
dearest friends!
“Three days before she died,” says Mr. Edgeworth, “I was suddenly
called up to her room. I found her in violent convulsions. Youth,
beauty, grace, charms of person and accomplishments of mind, reduced
to the extreme of human misery, must have wrung the most obdurate
heart. What must her husband feel at such a moment? I felt her pulse,
and whispered, ‘You are not dying;’ she looked at me with an effort of
resolution and kindness to thank me.
* * * * *
“She soon fell asleep, and awakened smiling. ‘I am smiling,’ said she,
‘at my asking you to sit beside me as a sort of protection, and at my
being afraid to _die in my sleep_, when I never felt afraid of dying
when awake.’”
Sometimes consciousness remains to the last moment of existence, and
even when the tongue refuses to speak, the wistful eye and wave of the
hand serve to impress the dying injunction. How beautifully and truly
is this pictured in the story of Lefevre, where the poor soldier looks
first at his son, and then at my Uncle Toby; “and the ligature, fine as
it is, was never broken!”
When death is inevitable, it becomes the duty of a medical man to
consider the propriety of informing his patient of his condition. The
subject is very ably treated in a paper by Sir H. Halford; and written
in his usual classical style. Sir Henry thinks it desirable that the
physician should make known his opinion rather to the friends than
to the patient, and allow the friends themselves to be the means of
communicating the intelligence to the sick. “They do so,” he says,
“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.”[13] Sir H.
Halford goes on to say, “that in the case of his late majesty (alluding
to George IV., who died on the 25th of June, 1830), the Government
and the royal family were informed, on 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 of 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.”
The changes which immediately precede death are, of course, more or
less painful, according to their nature and severity; yet there can be
no doubt but that dissolution itself is the cessation of suffering. In
some instances the approach of death is betokened by strange and awful
sensations; and it is probable that where consciousness remains to the
last, the feelings are always peculiar and unmistakeable.
These premonitions of death often give rise to a degree of
restlessness, and a wish for change, which is odd and capricious in its
manifestations. Persons who have long remained tranquil will suddenly
express a desire to be dressed and go down stairs, or have their beds
moved to another position. Strange yearnings for particular places and
old scenes sometimes arise, which seem like the shadowing forth of dim
instincts, which have been concealed in the recesses of the mind. How
painfully must such longings have been felt when death has hovered over
the couch in the wild and inhospitable districts of the tropics, or the
frozen regions of the extreme north!
With the exception of those who are worn down by long illness, or
reduced to despair by mental anguish and misfortune, there are few who
can believe that they have accomplished all the purposes of life; and
we naturally look forward to the infirmities of old age to wean us from
the interests of the world. But even then we are reluctant to leave;
and it is only when deserted by friends, that we can say in the words
of the poet,--
“I have liv’d long enough; my way of life
Is fall’n into the sear--the yellow leaf.”
In speaking of others it is common to regard life as properly
terminating when usefulness, activity, and fortune are declining. When,
reverses succeed a happy and prosperous career, we say that existence
has been too protracted: it is on this account that the poets have
spoken of the happiest moment of life as the most proper time for
death; a notion certainly more poetical than rational. Thus, in Don
Juan, Byron says, speaking of his lovers,--
“Why did they
Then not die?--they had liv’d too long
Should an hour come to bid them breathe apart.”
Canto IV. v. 28.
And Shakspeare makes Othello exclaim:--
“If I were now to die,
’Twere now to be most happy; for I fear
My soul hath her content so absolute,
That not another comfort like to this
Succeeds in unknown fate.”
I might bring forward many other illustrations of the same kind, but it
would only be to digress. There is, in truth, in many minds a fearful
presentiment that great happiness cannot be of long duration; but if
the prosperous periods of life are those which seem to form the natural
climax and terminating point of life, they are those in which we could
least bear the loss of others. The sudden removal of one who is in the
very midst of his usefulness, in whose success we had “garnered up
our hearts,” creates a revulsion of feeling which poor humanity can
ill support. The consolations of religion are the only consolations
which deserve the name, and it is the idea alone that separation is
temporary, that can stem the torrent of overpowering grief. It is the
anticipation of a re-union hereafter which throws the only ray of light
that can penetrate the gloom of the mourner’s mind. He is yet to have
a meeting beyond the grave; and whilst this idea mitigates grief, it
renders the prospect of death itself less terrible. It was in this way
that Mrs. Garrick endeavoured to remove the terrors of death, after the
loss of the great actor.
On the 20th of April, 1781, Boswell writes, “Mrs. Garrick had this day,
for the first time since his death (her husband’s), a select party
of his friends to dine with her. The company were Miss Hannah More,
who lived with her, and whom she called her chaplain; Mrs. Boscawen,
Mrs. Elizabeth Carter, Sir Joshua Reynolds, Dr. Burney, Dr. Johnson,
and myself. We found ourselves very elegantly entertained at her
house in the Adelphi, where I have passed many a pleasing hour with
him ‘who gladdened life.’ She looked well, talked of her husband with
complacency; and while she cast her eyes on his portrait which hung
over the chimneypiece, said that ‘death was now the most agreeable
object to her.’”
The uncertainty and brevity of life would furnish fit topics for
medical as well as for moral reflection. How often must they present
themselves to the physician’s mind!--Sometimes he meets death in early
tender infancy;--sometimes in robust manhood;--sometimes in feeble
old age;--sometimes in the sudden apoplexy;--sometimes in the wasting
consumption.
As he looks upon the aged sufferer, he must often call to mind how
transient are youth and beauty, and the boast of manly strength and of
womanly elegance.
It is with something of this feeling that the following passage will be
read which I extract from Andersen’s Story of My Life.
As a little boy, Andersen had formerly seen the great actress, the
Donau-weibchen, at the theatre of Odense. He saw how much she was
honoured, and the homage that was paid to her. “Many years afterwards,”
says he, “when, as a student, I visited Odense, I saw in one of the
chambers of the Hospital, where the poor widows lived, and where one
bed stood by another, a female portrait, hanging over one bed in a gilt
frame.
“It was Lessing’s Emelia Galotti, and represented her as pulling the
rose to pieces; but the picture was a portrait. It appeared singular in
contrast with the poverty by which it was surrounded.
“‘Whom does it represent?’ asked I.
“‘Oh,’ said one of the old women, ‘it is the face of the German lady
who was once an actress.’ And then I saw a little delicate woman,
whose face was covered with wrinkles, and in an old silk gown that
once had been black. This was the once celebrated singer, who, as the
Donau-weibchen, had been applauded by every one.”[14]
But if life is but brief and vain in the retrospect of age, how shall
we speak of it with the uncertainties of the most promising career?
In the spring of 1781, all the talent and fashion of London had been
invited to the town-house of Mr. Thrale in Grosvenor square, to partake
of a sumptuous entertainment. On the dawn which followed that very
night, the owner of the mansion had terminated his existence in an
attack of apoplexy.--The same catastrophe, perhaps, now awaits many who
are looking to the future with equal joy and with equal promise.
* * * * *
The _bodily changes_ which immediately precede, and, in some sense, may
be said to constitute, death, deserve and repay consideration. It might
seem, on a first attention, that the modes in which death takes place
are so various, and the diseases to which the human frame is liable
so numerous, that it would be impossible to reduce the subject to any
simple and practical form of inquiry.
It will be found, however, on a more intimate acquaintance, that much
advantage may be gained by classification and arrangement, and a
sort of analysis made which requires no forced construction, and no
metaphysical nicety.
Death may indeed be said to _begin_ at different parts of the body,
according as they are severally the first to suffer those irreparable
and grave changes which issue in the destruction of life. It will
be found that the nature, symptoms, and peculiarities of the act of
dying, are determined by the organ first mortally attacked; so that, by
considering the subject in relation to these parts, we are assisted in
arranging our ideas.
The alterations which directly occasion dissolution seem principally
effective, either in the arrest of the _circulation_ or the
_respiration_; and the manner in which they tell in producing these
effects, will now, therefore, briefly, come under our consideration.
As the heart is the great mover of the circulation, we can easily
conceive that whatever brings it to a stop must be fatal to life.
Extensive losses of blood operate in this manner, and they furnish us
with a good illustration of the manner in which death takes place. The
sufferer becomes pale and faint, his lips white and trembling: after
a while the breathing becomes distressed, and a rushing noise seems
to fill the ears. The pulse is soft, feeble, and wavering; and the
exhaustion and prostration are more and more alarming. Soon a curious
restlessness arises, and he tosses himself from side to side. At length
the pulse becomes uncertain, and the blood is feebly thrown to the
brain. The surface assumes an icy coldness. The mind is yet untouched,
and the sufferer knows himself to be dying. In vain the pulse is sought
at the wrist--in vain efforts are made to re-excite warmth--the body
is like a living corpse. Now a few convulsive gaspings arise, and
the countenance sets in the stiff image of death. Such are the more
striking phenomena which attend the fatal hæmorrhages.
The failure of the vital powers, from the withdrawal of blood, may be
regarded as a sort of type of this mode of death, since the various
symptoms which have been named, arise from the cessation of the
healthy circulation.
A dread of the loss of blood may almost be considered as an instinctive
feeling; at any rate its importance is early impressed on the mind, and
is never forgotten. In childhood it is looked at with alarm; and the
stoutest mind, cannot but view with horror those perilous gushes of
blood which bring us into the very jaws of destruction.
The description which Byron gives us of Manfred’s death, may be
considered as a highly poetical representation of the state we have
portrayed.
“_Abbot._ Alas! how pale thou art--thy lips are white--
And thy breast heaves--and in thy gasping throat
The accents rattle--Give thy prayers to heaven--
Pray--albeit but in thought,--but die not thus.
_Manfred._ ’Tis over--my dull eyes can fix thee not;
But all things swim around me, and the earth
Heaves as it were beneath me. Fare thee well--
Give me thy hand.”
Gradually exhausting complaints, such as interfere with the nutrition
of the body, act much in the same manner as direct losses of blood,
but obviously more slowly. Privations of various kinds and wasting
complaints which impair the general strength, tell at last, in
exhausting the heart’s power, and life terminates in the gradual
failure of the circulation of the blood. In chronic ailments, the
weary sufferer feels the extreme exhaustion which months and years of
suffering have produced. He cannot lift himself in bed--he fears to
raise his head, and can scarcely grasp the extended hand of friendship,
or return the pressure of affection. The heart’s power is at last
fatally depressed.
The following, which is quoted from Thackrah’s work on Digestion and
Diet, is extracted from Hufeland’s Journal, and gives an interesting
picture of the effects of extreme abstinence. “A German merchant, æt.
32, depressed by severe reverses of fortune and consequent slights
of his relatives, formed the resolution of destroying himself by
abstinence. With this view he repaired on the 15th of September, 1818,
to an unfrequented wood, where he constructed a hut of boughs, and
remained without food till the 3rd of October following. At this period
he was found by the landlord of a neighbouring pothouse, still alive,
but feeble, speechless, and insensible. Broth, with yolk of an egg,
was given him. He swallowed it with difficulty, and died immediately.
In the pocket of the unfortunate man was found a journal written in
pencil, singular in its kind, and remarkable as a narrative of his
feelings and sentiments.” It begins thus:--“The generous philanthropist
who shall one day find me here after my death, is requested to inter
me; and, in consideration of this service, to keep my clothes, purse,
knife, and letter-case. I moreover observe that I am no suicide, but
have died of hunger, because, through wicked men, I have lost the whole
of my very considerable property, and am unwilling to become a burden
to my friends.” The ensuing remark is dated Sept. 17th, the second
day of abstinence. “I yet live; but how have I been soaked during
the night, and how cold has it been! O God! when will my sufferings
terminate! No human being has for three days been seen here--only
some birds.” The next extract continues--“And again three days; and I
have been so soaked during the night, that my clothes to-day are not
yet dry. How hard is this, no one knows; and my last hour must soon
arrive. Doubtless during the heavy rain a little water has got into
my throat, but the thirst is not to be slaked with water; moreover, I
have had none even of this for six days, since I am no longer able to
move from the place. Yesterday, for the first time during the eternity
which, alas! I have already passed here, a man approached me within
the distance of eight or ten paces. He was certainly a shepherd; I
saluted him in silence, and he returned it in the same manner. Probably
he will find me after my death! Finally, I here protest before the
all-wise God, that notwithstanding all the misfortunes which I have
suffered from my youth, I yet die very unwillingly; although necessity
has imperiously driven me to it. Nevertheless, I pray for it.--More
can I not write for faintness and spasms; and this will be the last.
Dated near Forest, by the side of the Goat public-house, Sept. 29th,
1818.--J. F. N.”
Stories are related of persons remaining months, and even years,
without food; but they are unworthy of belief. It is not probable that
life can be continued many days without food; and a week is perhaps an
average period, if fluids also be withheld. In the hospitals for the
insane, instances are sometimes met with of obstinate refusal of food,
and in these cases of insanity it seems that the abstinence is better
tolerated. In the brute creation fasting is more endurable. Müller
says, referring to Tiedemann, that salamanders, tortoises, and gold
fish may be kept for years without food; some birds from twenty-five to
twenty-eight days; and dogs for twenty-five to thirty-six days.
Some time after I had entered into the medical profession, but
whilst yet a pupil, I was invited by a fellow-student to dine with
him. Whilst we were chatting together after dinner, we fell into
conversation respecting a man who had recently died from an extensive
burn. The gentleman’s father, who was an intelligent man, overheard our
remarks, and joining in the conversation, asked me to explain to him
how it happened that the burn occasioned death.
I attempted an explanation, but soon felt my incompetence to offer a
satisfactory reply, and I was not a little surprised to find myself
foiled in what I considered the simplest possible matter; for I had
imagined, before I attempted the explanation, that the subject did not
require a moment’s consideration. I remember that my fellow-student
was equally unsuccessful. It seemed curious to me at the time, that I
should hesitate in rendering a reason for a fact which so frequently
presents itself to the medical inquirer.
The phenomena, however, which are the most familiar to us, are often
the last to challenge our attention.
Now, independently of the mere loss of blood, other causes may depress
the action of the heart.
The heart’s action may be arrested by what is called a _shock_. It is
not easy to explain in what manner it acts, nor to define the meaning
in a precise manner; but every one knows what is meant by it. A shock
is a sudden impression on the nervous system. It plays an important
part in many cases of violent death, and in those remarkable instances
of disease in which life is extinguished with fearful rapidity.
There are many accidents in which there is little loss of blood; and
yet the injury is great, and its consequences terrible. The sufferer
turns pale--his countenance changes, and he feels that he is fatally
wounded. Sickness and complete prostration follow, and the heart never
rallies. In this manner, extensive burns and scalds, and dreadful
blows, or internal lacerations produce death. In the same way the
strong mineral acids, when taken internally, appear to destroy, by
their depressing influence on the heart.
The internal lesion of the stomach causes a sympathetic failure of the
circulation.
But the effects of _shock_ are much more numerous and interesting
than might at first be imagined. At least, impressions on the nervous
system, analogous in their nature, play an important part in the fatal
termination of many diseases. Violent inflammations seem, when fatal,
to act by their depressing influence.
We do not see, _à priori_, any actual reason why these inflammations
should be productive of death; but we know it to be an ultimate fact
that they operate in lowering the vital powers, and bringing the
circulation to a stand.
Amongst the instances of fatal collapse there are none more striking
than those which arise from perforating ulcers. Insidious disease may
go on, in persons having every appearance of health, and be suddenly
fatal by ulceration of the stomach or bowels, and the escape of their
contents into the abdominal cavity. The apertures produced by the
perforating ulcers are often singularly defined, and resemble the holes
cut out by a punch or sharp circular instrument. The fatal issue of
these lesions is generally so unexpected, so rapid, and so painful, as
to suggest the idea of poisoning, or of _hernia_.
My late and valued friend, Dr. Howard, related to me a case, which, at
the time, made great impression on his mind.
On the 10th of February, 1845, Dr. Howard was requested to visit a
young woman who was taken suddenly ill at a factory in Manchester.
When he got there, he found her lying on the floor with a pale, sunken
countenance, a weak pulse, and a cold surface. She spoke in a feeble
whisper, and was too much exhausted to reply to many questions, but
by her gestures she indicated that she had pain in her stomach. It
appeared that she had been taken ill about three o’clock. Dr. Howard
recommended that she should be taken to the Infirmary, and she died
there, in about twelve hours after her removal. It was thought at the
Infirmary that she had taken poison, but on examination of the body
after death, a round hole was found in the stomach, such as is produced
by a perforating ulcer. The edges of the ulcer were smooth and even.
One or two such instances have fallen under my own notice, and must be
met with in the course of the experience of every medical man.
Fatal fainting is not unfrequently the result of actual disease of the
heart, although death from affections of the heart is not always of a
sudden or uncomplicated kind. The walls of the heart are sometimes thin
and dilated, and there is a soft struggling palpitation which has been
aptly compared to the fluttering of a bird against the bars of its cage.
At other times the heart is overloaded with fatty deposits, so that
its natural fleshy structure is proportionally defective. In very
inordinately fat people the heart is often found in this state, and is
unable to propel the blood with sufficient force to meet the exigencies
of the system. Occasionally, bony deposits are found in the heart and
great vessels, and the natural contractions of the heart are painful
and irregular. From these, and other causes, which probably produce a
spasm of the heart, arises the disease called _angina pectoris_.
The celebrated John Hunter died of this disease, and it is well known
to be suddenly fatal. Sir Everard Home tells us that, “On the 16th
of October, 1793, when in his usual state of health, he went to St.
George’s Hospital, and meeting with some things which irritated his
mind, and not being perfectly master of the circumstances, he withheld
his sentiments; in which state of restraint he went into the next
room, and turning round to Dr. Robinson, one of the physicians of the
hospital, he gave a deep groan, and dropped down dead.”
The sudden death of the benevolent and highly accomplished Dr. Arnold,
as represented by his biographer, may serve as a further illustration
of the angina pectoris. It was between five and six o’clock on Sunday
morning that he awoke with a sharp pain across his chest, which he
mentioned to his wife on her asking whether he felt well, adding that
he had felt it slightly on the preceding day, before and after bathing.
He then again composed himself to sleep; but Mrs. Arnold watched him
with extreme anxiety, and was soon led to infer that he was seriously
ill. The pain seemed to increase and to pass down the left arm, which
called to Mrs. Arnold’s remembrance what she had heard of this fatal
disease. About a quarter to seven Dr. Bucknill (the son of their usual
medical attendant) visited him. “He was then lying on his back--his
countenance much as usual--his pulse, though regular, was very quick,
and there was cold perspiration on the brow and cheeks.” He apologised
in a cheerful manner for troubling Dr. Bucknill at so early an hour,
and then proceeded to inquire as to the nature and danger of his
illness. After the physician had informed him that his complaint was a
spasm of the heart, and answered the questions which were proposed, he
quitted the house to furnish himself with the necessary remedies. On
his return, Dr. Arnold said, “If the pain is again as severe as it was
before you left, I do not know how I can bear it.” He again questioned
Dr. Bucknill as to the danger of his complaint, and in such a manner
that it was impossible to avoid telling him the truth. He afterwards
inquired as to the remedies to be adopted, and on being told, answered
“Ah! very well.” The physician, who was dropping the laudanum into
a glass, turned round and saw him looking quite calm, but with his
eyes shut. In another minute he heard a rattle in his throat, and a
convulsive struggle, flew to the bed, and called to one of the servants
to fetch Mrs. Arnold. The family soon arrived; but the sobs and cries
of his children were unable to affect him--“the eyes were fixed, the
countenance was unmoved: there was a heaving of the chest, deep gasps
escaped at prolonged intervals, and just as the usual medical attendant
arrived, and as the old schoolhouse servant, in an agony of grief,
rushed with the others into the room in the hope of seeing his master
once more, he breathed his last.”[15] This occurred shortly before
eight in the morning. His biographer continues, “What that Sunday
was in Rugby, it is hard fully to represent,--the incredulity,--the
bewilderment,--the agitating inquiries for every detail,--the blank,
more awful than sorrow, that prevailed through the vacant services
of that long and dreary day,--the feeling as if the very place had
passed away with him who had so emphatically been in every sense its
head,--the sympathy which hardly dared to contemplate, and which yet
could not but fix the thoughts and looks of all on the desolate house,
where the fatherless family were gathered round the chamber of death.”
In Dr. Arnold’s case, the heart was found soft and thin, but without
any valvular disease. A great many more cases might be cited in
illustration of this interesting disease, but I shall content myself
with one which I take from Dr. Latham’s excellent “Clinical Lectures on
Diseases of the Heart.”
“N. P. was about fifty-five years of age. He had filled a high judicial
office in India, and when his stated period of service had expired,
he returned home with unimpaired health. Ten years had wrought little
change in his person, except that from having been thin and muscular,
he was slightly tending to fat and corpulency.
“He had now been more than a twelvemonth in England, and had taken
up his residence in Hampshire, and was in the enjoyment of his
wonted health, when one day after a morning’s shooting, without any
extraordinary fatigue or exertion, he felt at dinner an unusual pain in
the region of his heart. The pain was not extreme, but enough to make
him leave the table, and retire into his library. Warm applications
were made to the chest, and the pain soon ceased altogether. He then
begged that he might be left alone to repose until tea-time. In less
than an hour his wife returned into the room, and found him lying upon
the sofa, just in the position she had left him.--She believed him
asleep, but found him dead. The examination of his body (continues Dr.
Latham), as it was reported to me, disclosed nothing that could account
for his death, but a thin fat heart; fat was deposited on it at the
expense of its muscular substance.”[16]
Besides disease of the heart itself, we may have disease of the great
blood-vessels,--what is called Aneurism. Sometimes these diseases of
the blood-vessels are very obscure; often they originate on the great
vessel, the _aorta_, which arises immediately from the heart. Dr.
Farre described to Dr. Watson a case which inculcates the necessity of
attending minutely to what a patient says. A man consulted Dr. Farre,
having just been told by another physician that he was fanciful, and
that there was nothing amiss with him.
Dr. Farre was very particular in his inquiries at every visit he paid,
so much so, indeed, that the man became vexed and said pettishly, “I
know, that if you split me down the middle, I am sound on my right side
and diseased on my left.” This was unfortunately too true: he was found
dead in bed a short time afterwards.[17] I remember a man who came
regularly as an out-patient to the Manchester Infirmary, complaining of
pain in the shoulder; I supposed at first that he had rheumatism, but
one day I told him to strip off his coat, and then I found that he had
an aneurism of the subclavian artery, of which he subsequently died.
I need scarcely say that these cases of aneurism are fatal, much as
disease of the heart itself. The blood-vessel at length gives way, and
the patient dies from the escape of blood and the fatal fainting which
ensues.
Some attention has been given by medical men to the state in which
the blood is found to be distributed after death. The heart contains
several cavities, through which the blood is progressively received and
expelled. Where the arrest of the circulation has commenced, however,
in the heart itself, it is obvious that the cavities will be pretty
equally affected, and that we shall not find one side to be gorged with
blood whilst the other is empty. The subject will again come before us
when we treat of the next division of this subject, in which it will be
seen that unequal distributions arise from another species of death.
The mode of death which has been described is not one of pain. It may
have been preceded by considerable suffering, as in the case of burns
and scalds. But the act of dying is one of relief; or if the sensations
are uneasy and fearful, they cannot be called painful in the common
sense of the term.
I now come to speak of another mode of death, which has been called,
but not very correctly, _Asphyxia_. In the cases which I have
previously described, the first great or palpable interference with
the continuance of life, has been the failure of the heart--so that
actual death may be said to have begun at the heart. I have further to
consider the cases where death begins at the lungs. Important as it is
that the blood should be circulated through the body, it is of equal
importance that it should be in a state of purity. In order to maintain
its purity, it is essential that it should be exposed to the air in the
lungs.
The existence of air is so well known to be necessary for life, that
the term _expire_, which signifies to breathe out, is also adopted
to express the act of dying. The symptoms which attend asphyxia vary
considerably from those previously described. They are, obviously, more
or less protracted according as the cause operates with greater or less
severity. When the breathing is largely obstructed, the complexion
becomes dark, and the lips bluish--the veins turgid and prominent, and
the face bloated and enlarged. After a time the brain is confused, and
stupor creeps on, whilst the air is with difficulty sucked through the
accumulated secretions of the air passages.
The blood becomes thus gradually more and more perverted, until at
length its circulation through the lungs is rendered difficult or
impossible. The heavy gurgling respiration gradually passes into a
state of extreme effort;--now the breathing seems stopped, and now a
deep inspiration again lights up the mechanism of the body, but life
eventually fails, as the blood ceases to circulate. All causes which
operate in preventing access of air to the lungs may occasion death.
Thus drowning, strangling, and suffocation from gaseous exhalations,
are fatal, by obstructing the purification of the blood.
In general, this mode of death is not so rapid as that which has just
been described, but occasionally it is very brief. In drowning, it
does not seem that life can be preserved more than three or four
minutes, that is, when submersion is complete. The respiration may, no
doubt, be somewhat longer suspended when fainting ensues, for then the
circulation, being temporarily arrested, the necessity for air is less
urgent. The accounts which are given of persons remaining alive for
hours under water cannot be trusted to.
The access of air to the lungs may be immediately prevented by
inflammation of the windpipe, as in the case of croup, or, still more
strikingly, by spasmodic affections.
The complaint known to medical men by the name of Laryngismus
stridulus, is, in this manner, suddenly fatal to infants.
Some diseases of the lungs are so gradual in their progress, that the
quantity of blood in the body becomes diminished in proportion to
their limited capacity for respiration. Hence the balance is so finely
preserved to the last, that death takes place with great difficulty. I
have sat for hours beside patients in the last stages of consumption,
and watched the emaciated and dying frame alternately reviving and
sinking until the patient himself became fearful that he should never
die. It is erroneously imagined that death in consumption is always
easy: fortunately it may be so in some cases; it is very much otherwise
in most.
Mechanical obstructions are well known to occasion death by impeding
the breathing. Pieces of meat or other bodies may get impacted in the
windpipe, and cause death before they can be removed.
I remember an instance of this sort which occurred in the market-place
in Manchester. A woman, whilst eating an oyster, fell into a fit of
laughter, when she was suddenly observed to become livid in the face,
and shortly afterwards died of suffocation. The oyster was found partly
fixed in the upper part of the windpipe.
There is an interesting and instructive case of the same nature related
in the Lancet. A man, who had just been married, got into a dispute
with one of his own party, and was knocked down by a blow. Eventually
he was able to rejoin his party; but it was observed that whilst
engaged at his dinner he hastily got up and went out of the room. A
friend followed him, but immediately returned to announce that the man
was dead. On examining the body after death, a surgeon pronounced that
he had died from apoplexy, and attributed the fit to the injuries he
had received in the quarrel. The coroner, Mr. Wakley, asked the surgeon
if he had examined the windpipe. The surgeon confessed that he had
not done so; whereupon he was desired to complete the examination. He
repaired presently to perform his task, and on his return stated that
he found a piece of meat wedged firmly in the _glottis_. Thus death
had, in reality, arisen from this source; and the congested state of
the brain was the effect of impeded respiration, and not the first
occasion of his death.
Whilst treating upon the subject of Asphyxia, I cannot refrain from
introducing some particulars of the awful catastrophe which occurred
at the Black Hole at Calcutta, as they will furnish an interesting
exemplification of the effects of deprivation of air. In 1756, the
viceroy of Bengal laid siege to the factory at Calcutta. Mr. Holwell
and the garrison carried on the defence with great spirit and bravery,
but were ultimately obliged to surrender. They consisted of about
145 men and one woman. The whole of this company, many of whom were
dangerously wounded, were shut up the same night in a small prison,
about eighteen feet square. The prison, which was strongly built round
with walls, had only two small windows at one end, which were secured
by strong bars. As the prisoners had only about eighteen square inches
of space for each individual, the heat and oppression soon became
insupportable.
Attempts were, at first, vainly made to force open the door. Mr.
Holwell, who was near one of the windows, endeavoured to reason with
the prisoners, and advised them not to exhaust their strength. This
recommendation had the effect of producing some calm, but it was only
temporary, for they could not long bear the frightful position, and
many already were in the act of dying. Mr. Holwell then suggested that
they should take off their clothes to afford more room. An effort was
subsequently made to fan the air with their hats, but the exertion
could not be borne. One of the company suggested that they should all
kneel down, and rise up alternately. This was done several times,
but many could not raise themselves when the signal was given. The
situation was now frightful. The weak were trodden to death. One hour
had only yet elapsed. About nine o’clock, renewed efforts were made to
force the door; some became furiously delirious; others vainly sought
to provoke the sentinels to fire upon them. Thirst became excessive.
At last the guards gave Mr. Holwell and two of his friends some water
in their hats, but it was soon spilled, and the two friends were
suffocated in the general eagerness to obtain it. Mr. Holwell was, for
a long while, respected as the leader of the unfortunate assembly, but
in time the natural love of life prevailed over all other feelings.
The crowd eagerly pressed to the window, and, seizing the iron bars,
climbed on his shoulders. He begged for his life, and giving up his
position near the window, got to the other end of the dungeon; but
here the air was so corrupt, that his breathing was almost impossible.
He again, therefore, tried to make his way to the window over the
bodies of the dead, and there he resolved to wait patiently for death.
He struggled through four rows of his companions, but one row still
intervened between him and the window. His thirst was excessive, and
he endeavoured to allay it by sucking the moisture from his shirt. As
midnight approached, the despair became unbounded and terrible; they
all called out aloud for air, and then the noise suddenly ceased, and
the greater part laid down and died. A Dutchman got on one of Mr.
Holwell’s shoulders, and a black soldier on the other: he remained
thus till two in the morning, when a marine officer forced him from
his place. Mr. Holwell retired to the end of the prison, where he
was soon deprived of sense. About five in the morning, the viceroy
inquired if Mr. Holwell was still living; and being informed that it
might be possible to recover him, if the door was immediately opened,
gave commands to that effect. Unfortunately, however, the door opened
inwards; and, owing to the numbers of the dead, twenty minutes elapsed
before it could be accomplished. Eventually Mr. Holwell was rescued
alive from a heap of the dead. At a quarter past six, 23 persons
were taken away alive from 146, who had been incarcerated the night
previously.
When the air which is breathed, is not, by its chemical nature,
calculated for the purposes of respiration, it produces effects very
similar to a deficiency of air: thus, gases, which are not actually
poisonous in themselves, cause fatal results, just as the exclusion of
air altogether.
It is probable that the carbonic acid gas, which is commonly known as
fixed air, _is_ injurious in itself[18]; but it is certain, also, that
its fatal effects are greatly dependent on its preventing the access
of the air. Many accidents have arisen from the use of charcoal fires
and stoves. Mr. Coathupe, of Wraxall, was nearly killed in making some
experiments with Joyce’s stove, which was absurdly imagined by the
inventor to burn charcoal without contaminating the air. He closed
every aperture in the room, kindled the stove, and waited for the
results. In a few hours giddiness came on, with sickness and great
prostration; afterwards agonising headache, throbbing of the arteries,
and sense of suffocation. With difficulty he opened the window, and
sought to remove the stove; but when his wife entered the room, seven
hours after, he was unable to explain what had occurred, although
conscious of what was passing.
I think the charcoal fire is a favourite means of death with the
French. It is stated that, in 1834 and 1835, no fewer than 360 cases
of poisoning with charcoal occurred in Paris. I have read of French
people sitting down coolly to note their sensations whilst breathing
the deadly atmosphere, until the pen has fallen from their hands.
There is often a love story mixed with these French deaths; and we
cannot but regret that affection should be so curiously mingled with
deplorable irregularities of mind.
The respiration may be prevented by mechanical pressure; but no doubt,
where death is produced in this manner, it is often accompanied with
injuries to the internal organs. The barbarities of former times
furnish us with dreadful instances of death resulting from compression
of the chest. In order to oblige a criminal to plead at the bar when
he refused to do so, he was sometimes stretched on his back, whilst
a large iron weight was placed on his chest, and additions gradually
made until he consented to do what was required, or sank under the
infliction. Even as late as the reign of George the Second, such
practice has been adopted. The press yard in the Old Bailey was the
site of some of these dreadful torments. From this mode of death Major
Strangeways died in 1659. The story is of considerable interest. The
major lived with a sister very happily in a farm, until the latter
became acquainted with one Fussel, a lawyer. This gave great offence to
Strangeways, who swore that he would kill him. The brother and sister,
consequently, parted. Some time after, whilst Fussel was in London, he
was shot whilst he sat in his lodgings. Suspicion fell on Strangeways,
but difficulty was experienced in tracing the murder to him. At last
the expedient suggested itself of examining all the gunsmiths in
London, to discover, if possible, what guns had been lent or sold
on the day of the murder. This plan only excited ridicule as an
impracticable one; but, curiously enough, the matter was thus traced to
Strangeways. Strangeways refusing to plead at the bar, was sentenced,
by Lord Chief Justice Glynn, “‘to be put into a mean house stopped from
any light, and that he be laid upon his back with his body bare, and
his arms and legs stretched by cords in opposite directions; and that
upon his body shall be laid as much iron and stone as he can bear, _and
more_; and the first day he shall have three morsels of barley-bread;
and the next shall he drink thrice of the water in the next channel
to the prison door, but of no spring or fountain: and this shall
be his punishment till he die.’ On the Monday following, at eleven
in the forenoon, the sheriffs and other officers came to the press
yard, whither the miserable prisoner was presently brought. He wore a
mourning cloak, beneath which he appeared clothed in white from head
to foot. By the sheriffs he was conducted to a dungeon, where, after
prayers, his friends placed themselves at the corner of the press, whom
he desired, when he gave the word, to lay on the weights! This they
did at the signal ‘Lord Jesus receive my soul;’ but, finding the weight
too light for sudden execution, many of those standing by added their
burdens to disburthen him of his pain. He died in about eight or ten
minutes.”[19]
The respiration is sometimes brought to a stop by causes which operate
on the brain, and the peculiarities of this mode of death are so
characteristic, as to deserve consideration under a separate head.
Death may be said, in this case, to begin at the head, and the
respiration comes to a stand, after a period of stupor and
insensibility. This is the state which is familiarly known as apoplexy.
The patient lies snoring out his existence, unconscious of the weeping
friends who sit around his bed.
The phenomena of apoplexy seem to be produced by causes which obstruct
the circulation in the brain, or which injure the brain itself.[20]
The giving way of blood-vessels is the common cause of apoplexy. The
patient falls into a state of insensibility and complete helplessness.
He breathes with a heavy snoring noise, and a blowing of the lips may
often be remarked, which has been aptly compared to the smoking of a
pipe. The blood-vessels of the neck and face are gorged, and the veins
are especially prominent. The pupils of the eyes are dilated, and
often unequally so. Consciousness is abolished. This state continues
indefinitely, but at length the breathing becomes laborious--the mucus
is heard rattling in the throat--the temperature falls--spasmodic
twitchings play on the countenance, and sometimes horrible distortions
flit over the face: death after a time closes the scene.
The action of poisons called _narcotics_ is well known to be fatal
in this way: opium produces this species of death, when given in
overdoses.
I have stated that the pupils of the eye are generally dilated in death
by coma; but when the coma is produced by narcotics, this effect is
not so common. Dr. Elliotson relates the case of a German gentleman,
who was a friend of his, and who had remarkably large pupils. This
gentleman took it into his head to destroy himself, and for this
purpose took a large quantity of opium. After taking the poison, he
mentioned what he had done, and, amongst other persons, Dr. Elliotson
was sent for. Insensibility did not come on for a considerable time;
and the gentleman resisted powerfully all attempts to relieve him,
asserting, that if he chose to die, it was only barbarity to attempt
to prevent him. At length his countenance became livid, the pulse
slow, the breathing stertorous, and the pupil contracted to the size
of a pin’s point. The jugular vein was opened, and cold water dashed
on his face. In spite of all efforts he died; and Dr. Elliotson
remarks, “I have never seen a case recover in which the pupil was so
contracted.”[21]
Extreme cold produces death, perhaps chiefly in the way of apoplexy, by
retarding the circulation, and preventing its equable diffusion on the
surface of the body. That it acts, at least in a great measure, in this
way would seem likely from the torpor which it occasions, and which is
so commonly remarked. The effects of intense cold are well exemplified
in the interesting narrative of Captain Cook, where he relates what
befell Dr. Solander and Sir J. Banks on the hills of Terra del Fuego.
Sir J. Banks and Dr. Solander had been botanising, and had travelled
a considerable way through swamps, when the weather, which had been
fine, changed and became intensely cold and gloomy, and the wind was
accompanied with snow. Finding it impossible to return to the ship
before morning, they resolved to penetrate into a wood, and build a
wigwam, and kindle a fire. For this purpose they passed through another
swamp. Dr. Solander, aware of the effects of cold on the human body,
from experience he had already had in Norway and Sweden, cautioned
his friends against the torpor which it occasions, and conjured the
company, under any circumstances, not to give way to it. “Whoever
sits down,” said he, “will sleep; and whoever sleeps, will wake no
more.” Thus admonished, they continued their journey; and they had not
proceeded far, before the cold was so great as to produce the effects
he had named. Dr. Solander himself was the first to experience the
torpor, and entreated his companions to let him lie down. Sir J. Banks
in vain remonstrated with him; and he lay down on the ground, although
it was covered with snow. A black servant was affected similarly, and,
in spite of remonstrance, also lay down. In a few minutes they fell
into a profound sleep. Fortunately, some of the party who had been sent
in advance, soon brought intelligence that a fire had been lighted
about a quarter of a mile on the way. Sir J. Banks then endeavoured to
awake Dr. Solander, and happily succeeded, though he had already almost
lost the use of his limbs. The poor black died, as well as another
black servant who had been left with him.
In the interesting account which Barry O’Meara gives, of the residence
of Napoleon at St. Helena[22], he mentions that, on one occasion,
Buonaparte asked him what he thought was the easiest mode of dying; and
himself observed, that death by cold was the easiest of all others,
because, “si muore dormiendo,” one dies sleeping. In describing the
Russian campaign, Napoleon further remarked, “Parties when sent out on
duty in advance, abandoned their posts, and went to seek the means of
warming themselves in the houses. They separated in all directions,
became helpless, and fell an easy prey to the enemy; others lay
down,--fell asleep--a little blood came from their nostrils, and,
sleeping, they died.”[23]
When death is produced by hanging or strangling, it may be supposed
that it is brought about entirely by the exclusion of air from the
lungs: in many cases, however, this mode of death is complicated by the
apoplexy which arises from the pressure exercised on the blood-vessels
of the neck. From these combined causes insensibility arises in a few
seconds, and death follows in a few minutes afterwards.
Persons who have recovered from suspension do not commonly remember
what has passed, but it may be possible to recollect some of the
sensations. The celebrated poet Cowper, whose fine talents were
unhappily touched with madness and melancholy, relates his own unhappy
experience. It may not be uninteresting in this place to glance at the
particulars which he has left us.
The death of the reader of the Journals of the House of Lords had
opened a situation which Cowper was desirous to occupy, but for which,
he feared that he had not sufficiently prepared himself. When the time
drew near in which he was to present himself before the House of Lords,
to be examined as to his competency, he became nervous and excited,
and his madness came over him like a cloud. In November, 1763, he went
to an apothecary’s shop, and bought some laudanum with a view to put
an end to his existence. This he carried about with him, and often was
on the point of taking it, but his resolution as often gave way, or he
was prevented by the fear of interruption. Once he thought of taking
it whilst he was travelling in a coach, and once he shut himself up in
his room in the Temple, and placed the laudanum by his bedside in a
basin. He then got on the bed, and stretched out his hand to put the
basin to his lips; but just then the key turned in the door, and his
laundress’s husband entered. He started up, hid the basin, and affected
an air of composure. On the day previous to that on which he was to
go before the House, he resolved once more to effect his purpose; he
bolted his door, and with a piece of scarlet binding attempted to hang
himself. First he fixed it to some ornamental work at the corner of
the bed, drawing up his feet that they might not touch the ground. The
carved work gave way and the binding with it. Then he fixed it to the
tester of his bed, but the frame broke and again let him down. The
third time he fastened it to the angle of the door, using a chair to
reach it, which he afterwards pushed away with his feet. Whilst he hung
he thought he heard a voice say three times, “’Tis over.” When he came
to himself he heard his own groans, and experienced a feeling like that
of a flash of lightning passing over his whole body. In a few seconds
more he found himself on his face on the floor. He immediately jumped
up and got into bed: he had a red mark round his neck, and a broad
crimson spot showed the stagnation of the blood under one eye. Soon
after he had got into bed he heard a noise in the dining room where
the laundress was lighting a fire. She must have passed the door which
was open whilst he was hanging, but did not perceive him. Presently,
however, she came, having heard his fall, and supposing that he was in
a fit. “I sent her,” says Cowper, describing the scene, “to a friend,
to whom I related the whole affair, and despatched him to my kinsman
at his coffee house. As soon as the latter arrived, I pointed to the
broken garter which lay in the middle of the room; I apprised him
also of the attempts I had been making. His words were, ‘My dear Mr.
Cowper, you terrify me! To be sure you cannot hold the office at this
rate--where is the deputation?’ I gave him the key of the drawer where
it was deposited; and, his business requiring his immediate attendance,
he took it away with him: and thus ended all my connection with the
Parliament office.”[24]
When death is produced by a failure of the respiratory organs, whether
commencing or not with apoplectic coma, the blood is found chiefly
accumulated in the right side of the heart, the difficult transmission
of the blood through the lungs preventing its due arrival at the left
side. This, therefore, is a distinguishing character of the appearances
presented after death by Asphyxia. The two great modes of death which
have been noticed, are, however, in themselves sufficiently apparent,
and cannot well escape the attention of any persons of observation. In
the very work from which I have recently quoted there is an interesting
illustration of this. I will give it in O’Meara’s own words.--Whilst
conversing with Napoleon he had fallen into a fainting fit, and dropped
on the floor:--
“When I recovered my senses,” says he, “and opened my eyes, the first
object which presented itself to my view I shall never forget; it was
the countenance of Napoleon bending over my face, and regarding me
with an expression of great concern and anxiety. With one hand he
was opening my shirt collar, and with the other holding a bottle _de
vinaigre de quatre voleurs_ to my nostrils. He had taken off my cravat,
and dashed the contents of a bottle of eau de Cologne over my face.
‘When I saw you fall,’ said he, ‘I at first thought that your foot
had slipped; but seeing you remain without motion, I apprehended that
it was a fit of apoplexy; observing, however, that your face was the
colour of death, your lips white and without motion, and no evident
respiration or bloated countenance, I concluded directly that it was a
fit of syncope, or that your soul had departed.’”
It is obvious, however, that death may take place in more complicated
ways than those which have engaged our attention. The same causes which
enfeeble the action of the heart, not unfrequently destroy also the
healthy changes of the blood in the lungs. Thus the patient is often
equally in danger of death from syncope and asphyxia, and he sinks
partly from the one, and partly from the other. Apoplexy is sometimes
so suddenly fatal, that the sufferer seems to die chiefly from the
shock which he has received; and many violent causes of death, which
obstruct the respiration, such as hanging or strangling, are also
prejudicial in impeding the circulation in the neck, and occasioning
apoplectic congestion. When death is produced by starvation, it is
attended with inflammation of the stomach and bowels, and a degree of
febrile action, which more or less complicate the process. There can
be little doubt, however, from the emaciation and great debility which
ensue, that life is chiefly destroyed in the manner already considered
as a failure of the action of the heart.
In addition to the influence of cold in producing coma, it also, no
doubt, tends to depress the heart’s action, and destroy the nervous
energy. At the same time, the very prominent manner in which the brain
is affected by reduction of temperature, renders it probable that the
condition of coma is a first great step in the arrest of the vital
actions.
The modes of death, then, which we have considered, have close
alliances with each other, but, for the sake of simplicity, they have
been spoken of in their more elementary forms. Nor is the consideration
of them in a separate manner devoid of practical advantages; for it is
of the greatest importance, in many diseases, especially in fevers, to
bear in mind the tendencies which present themselves to one or other
mode of death; and frequently the safety of the patient is attributable
to the perseverance with which such tendencies are obviated.
Sometimes coma has to be relieved--sometimes difficult respiration has
to be alleviated--sometimes the sinking strength requires the timely
and diligent administration of nutriment. The medical man has thus, not
seldom, to become the nurse of his patient, and often the machinery of
life is alone kept in motion by the opportune aid which he affords. But
how often has the more devoted attention of woman called back to life
the unconscious child! how often relieved the agonies of man when the
finger of death was pressing heavily on his eyelids! The chamber of
sickness is thus hallowed by affection, and the torch of life rekindled
by the light of love.
We may state then, broadly, that any great and perilous arrest in the
circle of actions which constitutes life, is induced principally in the
way of syncope or asphyxia, though it is unquestionable that death may
arise in a manner which cannot be well classed under either of those
heads.
In some of the putrid fevers, for example, the depravation of the blood
seems so general, that death (as evidenced by the decomposition of the
solids and fluids of the body) appears actually in progress before any
complete failure of the respiration or circulation.
The introduction of some poisons, also, is peculiarly inimical to the
_vitality_ of the blood.
Thus the death of King John is beautifully described by Shakspeare, as
commencing even in the blood itself--
“It is too late; _the life of all his blood_
Is touch’d corruptibly; and his pure brain,
Which some suppose the soul’s frail dwelling-house,
Doth, by the idle comments that it makes,
Foretell the ending of mortality.”
ACT V.
The resuscitation of dying persons is founded on a knowledge of the
subjects which have engaged our attention; for where the failure of the
circulation or respiration depends on causes which are not necessarily
permanent, temporary assistance may restore life. The use of stimulants
and opiates, in cases of loss of blood, are the means of renewing the
action of the heart when it has already nearly ceased to beat.
The transfusion of blood is also sometimes resorted to. The late Mr.
Ingleby, of Birmingham, in his work on Hæmorrhage[25], mentions an
instance in which he employed it with advantage in the case of a woman
who had just been confined. All the usual means had been tried, and
the patient did not rally. She was “in a constant state of jactitation,
with a dewy sweat and pinched features.” The respiration was difficult,
“with the sound of air passing through the mucus.”
The patient became cold and insensible. With the assistance of two
other medical gentlemen, with whom he advised, Mr. Ingleby proceeded
to inject some blood into her veins which he had obtained from the arm
of her husband. In less than five minutes, a perceptible improvement
arose, which was confirmed in about an hour. This operation is not,
however, always so fortunate, and is liable to some serious objections.
We require, no doubt, more experience on the subject; but, in the mean
time, it is one of considerable interest. Mr. Ingleby remarks, at the
conclusion of his case, that the scriptural expression applied by Adam
to Eve--“bone of my bone, and flesh of my flesh,”--seems in this case,
to have been literally applicable.
It is, however, in cases where the respiration is suspended by the
narcotic poisons that the most marked advantages may be seen from
artificial aid. I shall relate a case with which I was much interested
and surprised, and though a considerable time has now elapsed since it
occurred, I feel no diminution of the astonishment I first experienced.
A young woman of the name of Caroline Mercy was brought into the
Infirmary at Manchester, on the 16th of June, 1849, at half past
three, P.M. She had taken opium with a view to destroy herself, and
was in a complete state of insensibility. It was impossible, by
pulling the hair or pinching the skin, to excite any wincing or signs
of uneasiness; nor was any effect produced by the sudden affusion of
cold water. The pupils were contracted in an extreme degree; and the
countenance presented that peculiar vacancy, or want of expression,
which is so characteristic of the influence of opium. The breathing
was very considerably embarrassed, the inspirations and expirations
being separated by an unusually long interval, and accompanied by a
slight rattle. The extremities were warm. As soon as she was put to
bed, Mr. Gaskell, the resident medical officer, introduced the stomach
pump, with which he injected and withdrew about a gallon of cold
water; but towards the end of the operation, as the breathing became
laborious, the rattle louder, and the surface assumed a more livid
appearance, he thought it prudent to desist. He accordingly introduced
into the stomach a solution of ammonia, afterwards removing with the
pump as much as could be conveniently withdrawn. Large sinapisms were
then placed down the back, but she appeared, notwithstanding, to get
gradually worse; the respiration became more difficult, the lividity
greater, and the pulse less full, and slightly irregular.
Boiling water was now applied to the feet and legs, which had the
effect for a time of increasing both the power and frequency of the
respirations; but the benefit was only of a very transitory kind. At
about a quarter past five, Mr. Gaskell thought it desirable to assist
the respiration by artificial means, and he accordingly proceeded to
adopt the following expedient. He placed a large pitch plaster on
the abdomen, and, by this means maintaining his hold, endeavoured to
solicit the usual respiratory movements. This did not, however, give
him so much assistance as he had expected, and he was, therefore,
induced to abandon it after a short trial. He then placed a similar
plaster on each side of the chest, by which he was able to command
a more decisive effect: he thus, with the assistance of the man
nurse, alternately raised and depressed the ribs in imitation of the
breathing. This plan was productive of some amendment; the lividity
diminished, and the natural muscular efforts were more frequent and
apparent; the assistance was adapted as carefully as possible to the
indications of nature.
In addition to these means, boiling water was occasionally applied
to the arms and legs. At about five o’clock I came to Mr. Gaskell’s
assistance. At this period the temperature of the body had become
considerably reduced; and I remember the patient’s appearance was
exactly that of a dying woman; and I believe it was the impression both
of Mr. Gaskell and myself that our patient could not survive long.
The lips were of a livid colour, the expression of the countenance
altogether cadaverous, and the rattle in the throat had become
exceedingly loud. Boiling water poured on the legs did not now excite
the slightest movement, so that we were almost disposed to regard the
case as hopeless. The circumstance, however, that whilst the exertions
lasted, they had evidently been productive of advantage, did not suffer
us to abandon further trial. We now laid aside the plasters, and taking
hold of the margins of the ribs, endeavoured to support the respiration
with our hands alone. Standing on each side of the bed, with our
faces towards the feet of the patient, and our fingers curved round
the cartilages of the ribs, we could easily enlarge the capacity of
the chest, by approximating the ribs at the same time that they were
elevated; while, in expiration, the reverse movement could as easily
be accomplished. By a steady continuance of these efforts, we had the
pleasure of seeing a gradual improvement in our patient; and towards
six o’clock, the pulse had acquired the hard jerk which is commonly
felt when the system is under the influence of opium. Shortly after
six, indications of returning sensation were evinced by occasional
spasmodic quiverings of the muscles of the chest and abdomen. These
spasmodic movements resembled the actions which usually denote
approaching dissolution, with this essential difference, however, that
they became more frequent and prolonged at each time that they were
renewed. A little before seven o’clock she raised her eyelids, and at
the same time her left arm was slightly elevated. By persisting in
artificial respiration, and using means to rouse sensibility, such as
forcibly striking the face and chest with a wet towel, and applying
ammonia to the nostrils, in about half an hour from this period the
state of stupor had in a great measure disappeared. Instead of lying
prostrate on the back, she now lay on her side, and was enabled to
breathe without assistance. We then caused her clothes to be put on,
and the vesicated parts being dressed, she was taken out of bed, and
compelled to walk about the room.
It is worthy of remark, that whenever from fatigue we had been led to
suspend our efforts to maintain the respiration, a degree of relapse
followed; the lips became more intensely livid, the pulsations of
the heart more feeble and irregular, and the respirations fewer, and
accompanied with a louder rattle. On again resuming operations, the
converse was also noticed. When the amendment became decided, and the
sensibility returned, the rattle disappeared altogether; and this
took place without any expectoration, notwithstanding it was natural
to suppose that a considerable quantity of mucus was contained in the
air passages. The woman was fortunately a favourable subject for our
manipulations, as the abdominal parietes were sufficiently lax to admit
the easy prehension of the chest. As far as it could be done, we always
waited for the natural indications of the act of respiration, and paid
great attention to regulate our movements in correspondence with each
other. At the conclusion, the cartilages of the ribs were slightly
everted, and the cuticle removed in places by the unavoidable chafing
of the hands.
_June 17._--It was found that she had been kept out of bed all night,
which scarcely appeared necessary, and was, indeed, contrary to
instructions. She had vomited through the night, and complained of
shooting pains in the head. The pupils were less contracted; the pulse
was not ascertained, owing to the vesicated condition of the arms.
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?
FOOTNOTES:
[1] Byron’s Vision of Judgment.
[2] Art. Inhumations precipitées: Dict. de Médecine et de Chirurgie.
[3] Medical Jurisprudence, p. 5.
[4] For the suggestion of these apt quotations, I am indebted to
Paris’s Med. Jurisprudence.
[5] Sommer observed, that, contrary to the statement of Nysten, the
body became rigid before it was completely cold.
[6] According to Sommer, seldom if ever later.
[7] See Guy’s Hospital Reports, p. 388. vol. vii. 1851, Remarks on
Strangulation.
[8] See Alison’s Pathology.
[9] Belloc, Cours de Médicine Légale, p. 318.
[10] Medical Jurisprudence, p. 492. Edit. for 1838.
[11] Traité des Signes de la Mort, et des Moyens de prévenir les
Enterrements prématurés. Par E. Bouchut, Paris, chez J. B. Baillière,
1849.
[12] See Sir H. Halford’s Essays.
[13] Influence of Disease on the Mind, Essays and Orations, p. 83.
[14] Hans Christian Andersen’s Story of My Life, translated by Mary
Howitt, p. 114.
[15] Arnold’s Life, vol. ii. p. 337.
[16] Latham’s Clinical Medicine, vol. ii. p. 388.
[17] Vide Watson’s Lectures.
[18] See Christison on Poisons.
[19] Knight’s London, vol. iv. p. 301.
[20] What is called _pressure_ on the brain is not necessary for the
production of _coma_.
[21] Vide Elliotson’s Lect. on the Practice of Physic.
[22] Vide O’Meara’s Residence at St. Helena, vol. i. p. 179.
[23] Op. Cit. vol. i. p. 192.
[24] Vide Cowper’s Life and Correspondence, by Southey, vol. i. p. 130.
[25] Ingleby on Uterine Hæmorrhage.
[26] See Lancet, for Oct. 1840. Case of recovery from the effects of
opium, by J. Bower Harrison.
[27] Memoirs of Dr. Burney, p. 432.
THE
HUMAN MIND
CONSIDERED IN SOME OF ITS MEDICAL
ASPECTS.
_Macbeth._ How does your patient, doctor?
_Doctor._ Not so sick, my lord,
As she is troubled with thickcoming fancies,
That keep her from her rest.
SHAKSPEARE.
THE HUMAN MIND, &c.[28]
There is nothing which is more common than to hear people speak of
possessing a knowledge of human nature. It is usual to signify by this
a mere acquaintance with the vices of mankind, which does, indeed,
form one part of such knowledge, but it is not all. What is called
a knowledge of human nature is said to be acquired only by mixing
with the world, which implies that a real intimacy with the workings,
tendencies, and capabilities of the human mind is industriously kept
back in our literature, and that by the general consent of mankind it
is deemed better that a great part of the world should be ignorant
of the true position of their fellow beings. Many of those who are
teachers of religion and morality, have certainly derived their ideas
on this subject from sources which show, in point of fact, a complete
ignorance of human nature, or, at least, the studious _disguisement_ of
such knowledge.
The reserve, which is common and proper in society, may screen from the
unreflecting, and those little conversant with life, much of the real
nature of the human mind.
The prescribed forms of living, of speaking and writing, and the
conventional usages of mankind, have given an artificial hue to our
actions and language, and thus the words of the great dramatist have
become literally true, that “all the world is a stage, and all the men
and women merely players.” The true character of the human mind in its
more intimate workings, is little confessed in our literature, and
little acknowledged in our laws. Unfortunately, the real appreciation
of the human mind (with regard to its actual state, and not its
abstract consideration) has scarcely appeared to fall within the
province either of the moralist or metaphysician, and has remained a
kind of neutral ground, uncultivated because unclaimed. That knowledge
which is sometimes designated a _knowledge of the world_, approaches,
perhaps, nearest to the subject in question, but is seldom possessed
by those who are either desirous or capable of systematizing their
information, and thus, much of what is really known of our common
nature is lost both to the philosopher and the philanthropist. In the
writings of some of our novelists, it is true, we find a considerable
amount of this species of information, but it is for the most part
rendered subservient only to the entertainment of the reader, and
not in every case calculated for his edification. The writings of
Fielding, Smollett, Cervantes, and Le Sage, with many others of more
modern date, amongst which I may mention those of Mr. Charles Dickens,
abound in judicious reflections on men and manners, and discover no
little penetration into character and mind. After all, however, there
is an evident deficiency in published or recognised information of this
kind; and hence the surprise or affected surprise with which it is
common to view what are called the _inconsistencies_ of human nature.
That certain infirmities of mind are not incompatible with genius, it
may be common to admit; but when we approach the subject closer, we
shall find the poetic temperament, more frequently than not, clouded
with insanity or touched with perversity. The same bright spirit which
rejoices in the sunshine of nature is not less sensitive of the gloom.
There is often a foreboding of evil, and often the imagination will
heighten the calamities which are really present, until a thousand
heart-rending associations grow up in the fertility of the mind.
The consideration of the human mind, then, in what may be called its
medical aspects, seems to me one which has not yet sufficiently engaged
the general attention of mankind; and I wish on the present occasion to
bring it before your notice, as a subject which is neither devoid of
interest, nor wanting in utility.
The effect of temperament may first claim our attention. I shall not,
however, confine myself to the divisions which strictly medical writers
have formed on this subject, reserving to myself the freedom of the
popular acceptation of the word.
The constitution of the body as to its bulk and general aspect, as
well seen in the countenance as in the conformation of other parts, is
known to be connected with accompanying peculiarities of mind which
are of every day observation. There is an asperity in the countenance
and figure of some people which immediately strikes us, and we feel a
sort of intuitive dislike. There are others whose open countenance and
portly bearing tell at once of generous feelings and easy dispositions.
Every one remembers the passage in the play of Julius Cæsar:--
“Would he were fatter; but I fear him not,--
Yet if my name were _liable_ to fear,
I do not know the man I should avoid
So soon as that _spare_ Cassius.”
The Sanguine Temperament, as the very name implies, is characterised by
a constitution in which the blood-vessels are predominant; the face is
red, and easily flushed, the complexion often light; the temper hasty,
the actions quick. Those who have this temperament in a marked form,
often act by impulse; they are restless, and have difficulty in waiting
for the result of their undertakings. The mind is often too easily
excited to allow of a proper operation of its workings; the ideas flow
too quickly, and in a little while become confused. Such persons, when
called upon in exciting circumstances, become embarrassed,--are what
they call nervous, and lose self-possession--or act to disadvantage.
The character of Peter in the sacred writings gives us a good example
of this sanguine temper: we find him saying to his Lord, “Though all
men shall be offended because of thee, yet I will never be offended;
I will lay down my life for thy sake:” and again; “though I die with
thee, yet will I not deny thee.” But, as in many other sanguine people,
the feeling wanted the support of a steady equanimity. When Jesus was
betrayed, and Peter found himself accused of being in his company, he
denied any knowledge of him; and when he found that he was known by his
accent, (“surely thou also art one of them, for thy speech betrayeth
thee,”) “he began to curse and to swear, saying, I know not the man.”
Such is often the fate of the warm protestations of sanguine people.
The emotion which attends the expression of their sentiments gives the
complexion to them whilst it exists, but it is not enduring, and is
succeeded by other emotions, which, for the time, overcome the better
feelings of the heart. This sanguine temperament gives what we call
the generous character; the warmth of temper which, in moderation,
we rather admire as heightening the affections, and giving joy and
gladness: but it has also its sorrows and its errors.--There is the
quick resentment and the passionate grief, and these are the dark
aspects which are full of tears and lamentation. Hamlet, you know, says
to Horatio:--
“Give me the man that is not passion’s slave,
And I will wear him in my heart’s core;
Aye, in my heart of hearts, as I do thee.”
In sanguine people, the train of thoughts appears to be much quicker
than in others. This is attended with certain advantages, but
corresponding disadvantages. Such minds are imaginative--what is called
ingenious. The associations are not too strong to forbid erratic
thoughts; relations are often readily perceived, but there is less
exactness. The memory is, perhaps, less retentive, and the speed of
the thoughts leads often to confusion. They crowd on one another until
indistinctness arises. This indistinctness is sometimes painful.
This kind of mind is what is called passionate; hence the term _hasty_,
which may be well used as indicative of a too rapid procession of
thoughts. The mind cannot well operate in this hurried state. The ideas
flash across, but they light up too fiercely a train of associations to
admit the suggestions of other minds.
The brain is, perhaps, over sensitive, and its powers too readily
exhausted, and too intense whilst in operation.
The Lymphatic Temperament is quite the reverse of the sanguine. Those
who have this temperament are not easily moved, or excited; the skin
is pale. Such persons are better calculated to undergo anxieties, or
meet the exigencies of sudden emergencies. The mind has not those
quick sympathies, or brilliant imaginings, which distinguish a warmer
temperament.
There is a steady, cool calculation, which is more adapted to worldly
prosperity; feelings less readily wounded, and less apt to betray
themselves in the excitement of life. Some possess this in a surprising
degree, and many assume it. Many cover a natural sensibility by the
forms and usages which polite life has invented, and studiously avoid
showing the natural burst of affection, or the bitter outpourings of
grief.
It is well, in some degree, that this should be done; but let not
nature be altogether destroyed, and all the fine sensibilities crushed,
under an artful and sophisticated mannerism.
There is a story told of a cockney, who visited the beautiful and
romantic scenery of the Alps, and being asked his impression of a
sublime prospect, which suddenly burst on his view, said, that he must
confess “_it was a well got up thing_.” This is the school of fashion,
which gives us two fingers to touch as a welcome, after the absence of
as many years.
In some, the operations of the mind are so slow that they seem
to stagnate, and pass into reverie. The extreme of this condition
lapses into a state of imbecility and fatuity; but a certain degree
of apathy has its advantages. The mind has time to act; there is no
overcrowding of ideas--no hurry of thought. There is more continuance
of application--less impatience of consideration. The _affections_
do not trouble the operations of the mind. There are not those quick
sympathies which have relations with every thing that passes.
There are some people, again, in whose constitution the nervous
system seems to have an unnatural preponderance; the mind seems to be
constantly in a restless state, and to wear out the body in a ceaseless
activity, or in the struggles of overweening ambition. Such characters
are ever pressing on in the competition of social life; often a prey
to cares and anxieties, which follow each other in a never-ending
succession. “_After life’s fitful fever_,” they indeed “_sleep well_.”
Hypochondriacal feelings are, no doubt, in a great measure, connected
with constitution or temperament. Melancholy is much more common than
is generally conceived, and may be, as I have already hinted, perhaps
in some degree inseparable from a mind which highly appreciates the
beautiful, has quick sympathies with all around, and a thoughtful
regard to the possibilities, and even probabilities of a changing
world. On this account it has always been considered by the poets as
a poetic feeling, and though this view may have attracted the sneers
of some, or the ridicule of others, there is a certain truth in the
opinion. Ben Jonson alludes to this notion, with respect to melancholy,
as an accompaniment of sensibility, in his “_Every Man in his Humour_.”
“_Stephen._ Ay, truly, sir, I am mightily given to melancholy.
“_Matthew._ Oh! it’s your only fine humour, sir; your true
melancholy breeds your perfect fine wit, sir. I am melancholy myself
divers times, sir; and then do I no more but take pen and paper
presently, and overflow your half a score or a dozen of sonnets at a
sitting.”--Act III., Scene 1.
Again:--
“_Ed. Knowall_.... What think you of this, coz?
“_Stephen._ Why, I do think of it; and I will be more proud and
melancholy and gentlemanlike than I have been, I’ll insure you.”--Act
I., Scene 2.
In Scott’s “Diary” (May, 1827,) he says:--“Imagination renders us the
victim of occasional low spirits. All belonging to this gifted, as
it is called, but often unhappy class, must have felt, but for the
dictates of religion, or the natural recoil of the mind from the idea
of dissolution, there have been times when they would have been willing
to throw away life, as a child does a broken toy. I am sure I know one
who has often felt so.”
A disposition to melancholy is by no means, as might at first be
imagined, necessarily indicated by a grave and staid deportment.
In a large proportion of instances, it is even coupled with an
exuberance of spirits, which would seem to promise a perpetual sunshine
of cheerfulness.
The mind, however, which is alive to joy, is also, and perhaps
equally, alive to sorrow; and often passes by quick transitions from
the one to the other.
Our great dramatist, in mingling the ludicrous with the tragic, has
evidently shown his acquaintance with this tendency of the human mind.
Byron has happily blended in some of his most successful passages the
sublime and the ridiculous, thereby greatly heightening the effect of
both. In his “_Corsair_,” however, he has directly touched upon this
peculiarity of the mind, where he says--
“Strange though it seem, yet with extremest grief
Is linked a mirth,--it doth not bring relief.
That playfulness of sorrow ne’er beguiles,
And smiles in bitterness,--but still it smiles.”
In Dr. Currie’s Life of Burns, allusion is made to the combination of
melancholy and gaiety in the character of that extraordinary poet.
Notwithstanding the gaiety of Burns’ writings, he was constitutionally
a melancholy man, and was subject “to those depressions of mind, which
are perhaps not wholly separable from the sensibility of genius, but
which, in him, arose to an uncommon degree.” ... “Such a disposition
is far from being at variance with social enjoyments. Those who
have studied the affinities of mind, know that a melancholy of this
description after a while seeks relief in the endearments of society,
and that it has no distant connexion with the flow of cheerfulness, or
even the extravagance of mirth.”[29]
In a letter from Sir Walter Scott to his daughter in-law, the following
mention is made of Matthews, the comedian. “I am glad you like my old
acquaintance, Matthews. Some day I will make him show his talent for
your amusement in private--for I know him well. It is very odd--he is
often subject to fits of deep melancholy.”[30]
From these cursory remarks on melancholy, I may proceed to speak of
some particular states of mind, which attend the same peculiarity of
temperament, and though not incompatible with mental sanity, are yet
to be considered as bordering upon derangement.
Some of the illustrations I shall bring forward are from works of
poetry, but may be considered, nevertheless, as expressive of actual
facts, because I have scrupulously avoided making use of them where the
subject had need of graver support; so that in effect they are rather
introduced to relieve and exemplify the matter, than to substantiate
it. The curious feelings to which I allude, exist in various degrees of
intensity in different people. They cannot be considered as common to
everybody, and are far more frequent or powerful in the imaginative and
eccentric, than in others. Yet I should conceive that they prevail to a
greater extent than is commonly supposed.
Amongst this class of feelings may be placed the disposition which is
sometimes manifested by those who stand on precipitous cliffs to cast
themselves down. This seems suggested by a kind of insane impulse,
which is dreaded by the very person who indulges it.
Scott beautifully alludes to such a feeling in “The Lady of the Lake.”
“There are, who have at midnight hour,
In slumber scaled a dizzy tower,
And on the verge that beetled o’er
The ocean tides incessant roar,
Dreamed calmly out their dangerous dream,
Till wakened by the morning beam;
When dazzled by the eastern glow,
Such startler cast his glance below,
And saw unmeasured depths around,
And heard unintermitted sound,
And thought the battled fence so frail,
It waved like cobweb in the gale;
Amid his senses giddy wheel
Did he not desperate impulse feel
Headlong to plunge himself below,
And meet the worst his fears foreshow?”
Canto II. 22.
The same is alluded to by Shakspeare in his “Hamlet,” when he is
cautioned by Horatio not to follow the Ghost,--
“What if it tempt you towards the flood, my lord,
Or to the dreadful summit of the cliff
That beetles o’er his base into the sea;
And there assume some other horrible form,
Which might deprive your sovereignty of reason,
And _draw you into madness_? Think of it,--
The _very place_ puts toys of desperation,
_Without more motive_, into every brain,
That looks so many fathoms to the sea,
And hears it roar beneath.”
This, though fiction, is true to nature. We know how many have jumped
from monuments, and given way to an impulse to suicide created by
circumstances. Many instances of the same kind might be brought
together, not merely from our classical writers, but from the pages of
our journals and newspapers. The cases of suicide which seem to have
been suggested by the contemplation of frightful precipices, deadly
poisons, or dangerous weapons, may be considered under this head. Hence
the importance of avoiding evil thoughts, and tampering with dangerous
ideas. The same kind of feeling sometimes urges people to contemplate
scenes of suffering and distress, which are painful to be witnessed, or
pushes them on to acts which they at the same time dread. This tendency
is also well alluded to by the great poet of nature in the scene in
“Romeo and Juliet,” where the latter contemplates her anticipated
position in the tomb of all the Capulets:--
“How if, when I’m laid into the tomb,
I wake before the time that Romeo
Comes to redeem me?
* * * * *
Alack! alack! shall I not be distraught,
Environed with all these hideous fears?
And madly play with my forefathers’ joints,
And pluck the mangled Tybalt from his shroud?
And in this rage with some great kinsman’s bone,
As with a club, dash out my desperate brains?”
This insane feeling is here well portrayed, where the very speaker has
been previously expressing her horror of that dreadful place, where--
“Bloody Tybalt, yet but green in earth,
Lies festering in his shroud.”
There are feelings sometimes which are contradictory in their
nature and objects. The mind is strangely perplexed in a war of
emotions--emotions which are cherished whilst they are painful. Actions
are not always dictated by the simple feelings which seem to have
given them birth. How many persecuting spirits have wept for those
they have persecuted! There are those whose feelings of mercy and
forgiveness have struggled hard and yet yielded to pride and an ignoble
revenge. Such contradictory feelings do indeed partake of an insane
character, and there is a fine significance in the words of the poet,--
“That to be wroth with those we love,
Doth work like madness in the brain.”
I bring forward these remarks on such states of mind, because I think
it of great importance (as they really do exist) that they should be
at once deprecated as unhealthy and insane feelings; and in order
if possible to make it appear that the proper control of the mind,
which constitutes virtue, is in reality the most conducive to a sound
understanding. Let it not be considered, however, that I mean to assert
that mental derangement is necessarily the result of vice--it is more
often the cause of it. To resume, however. In the autobiography of
the celebrated Goëthe, he makes reference to this most unfortunate
contention of feeling.
Goëthe says,--“I accordingly fell into that evil disposition of mind
which often misleads us so far as to make us find a pleasure in
tormenting those whom we love; and I abused the fondness of a young
female by tyrannical and arbitrary caprices. Secure of the affection
of Annette, and of her anxiety to please me, I vented on her all
the ill-humour that the failure of my poetical essays, the apparent
impossibility of doing myself honour by them, and everything else that
occurred to vex me. I poisoned our best days by groundless and unworthy
jealousies. She long endured all these follies with angelic patience;
but I had the cruelty to tire it out.”[31]
Hazlitt observes, that men often “take a perverse delight in
acting, not only contrary to reason, but in opposition to their own
inclinations.”[32]
Again and again I may say that the contemplation of these curious
workings of the mind should lead us to see the importance of attending
to its due regulation, and make us regard improper feelings as insane
impulses which are to be dreaded as disease.
The peculiar notions which some eminent men entertain, probably against
their better judgments, may be also just alluded to. Scott speaks of a
feeling of _pre-existence_ in his Diary (Feb. 17.):--
“A hard day of working, being I think eight pages before dinner. I
cannot, I am sure, tell if it is worth marking down, that yesterday, at
dinner time, I was strongly haunted by what I would call the sense of
pre-existence--viz. a confused idea that nothing that passed was said
for the first time; that the same topics had been discussed, and that
the same persons had stated the same opinions on them.... There was a
vile sense of want of reality in all I said and did.... Something of
this insane feeling remains to-day, but a trifle only.”[33]
This feeling of pre-existence is a sort of poetical feeling;--I mean
that it is most frequently met with in persons of highly imaginative
minds, or in those engaged in metaphysical pursuits. Dickens mentions,
in his “Pictures from Italy,” his first sight of Ferrara in the
following terms:--
“On the foreground was a group of silent peasant girls leaning over the
parapet of a little bridge, looking now up at the sky, now down into
the water; in the distance a deep bell; the shadow of approaching night
on everything. If I had been murdered there on some former life I could
not have seemed to remember the place more thoroughly, or with more
emphatic chilling of the blood; and the real remembrance of it acquired
in that minute is so strengthened by the imaginary recollection, that I
hardly think I could forget it.”[34]
Shelley states, “that whilst walking with a friend in the neighbourhood
of Oxford, a scene presented itself which he remembered long ago to
have seen _in a dream_.”[35] Mrs. Shelley remarks on this, “I remember
well his coming to me pale and agitated to seek refuge in conversation
from the fearful emotions it excited.”
Many of us may have a sort of feeling of reminiscence of things which
we in reality see for the first time, probably because they awaken a
train of thought similar to what other objects may have previously
excited.
From these desultory remarks on the characters of mind which
accompany the more highly, and may be unduly, developed powers of the
imagination, I may proceed to speak of the connexion of bodily disease
with mental peculiarity.
Every one knows the effect of disease on the human mind in rendering
it a prey to uneasy feelings and capricious changes. Happy, indeed,
is he who has no reminiscences of weary hours spent in midnight
vigils, or long days of unrest, in which the mind refused to take its
wonted pleasure in occupation or literature. We are, perhaps, too
apt to regard our minds as above the influence of circumstances, and
altogether dependent on self-control and voluntary effort. Disease may
teach us that the mind itself is the gift of a superior power, and its
very complexion dependent on causes which we cannot command.
Shakspeare, as you all well know, makes a happy allusion to the effect
of disease in enervating the mind, in Cassius’s speech in contempt of
Cæsar:--
“He had a fever when he was in Spain,
And when the fit was on him, I did mark
How he did shake. ’Tis true, this god did shake;
His coward lips did from their colour fly;
And that same eye, whose bend doth awe the world,
Did lose his lustre! I did hear him groan;
Ay! and that tongue of his, that bade the Romans
Mark him, and write his speeches in their books,
Alas! it cried, Give me some drink, Titinius,
_As a sick girl_.”
Apoplexy and palsy bring the finest minds to imbecility. The sufferer
yields to fits of passion, and readily “dissolves in tears,” in
alternate succession, and thus remains an object for pity and the
tolerance of friendship, until another attack completes the ruin, and
leaves him a miserable wreck--the shadow of his former self. “By this
distemper,” Sir Henry Halford tells us, “the talents of the great
Marlborough were confounded.” The most serene and powerful minds are
troubled by disorders of this nature,--curious aversions, fits of
irritation, and whining imbecility, take the place of easy and kindly
dispositions; so that our very virtues are dependent on the sufferance
of a superior power.
The languor and lassitude which accompany biliary derangements are
well known and of common remark. The peculiar perverse states of mind
which attend various forms of hysteria, furnish us with some of the
most curious instances of human weakness which can possibly engage the
attention. The effects of indigestion in creating frightful dreams,
have been experienced by us all. How rejoiced we are, after suffering
from the most terrible nocturnal alarm, to awake, and “find it all a
dream.” Perchance a bull pursues us, and our limbs refuse to move,--a
wild and disgusting animal fastens its teeth on us, and escape is
in vain,--an immense load bears on us, and instant suffocation is
impending.
Sterne, in his “Sentimental Journey,” illustrates the effects of
disease on the mind in his usual striking manner:--
“The learned Smelfungus travelled from Boulogne to Paris, and from
Paris to Rome, and so on. But he set out with the spleen and jaundice,
and every object he passed by was discoloured or distorted. He wrote
an account of them, but ’twas nothing but the account of his miserable
feelings. I met Smelfungus in the grand portico of the Pantheon,--‘’Tis
nothing but a huge cockpit,’ said he.... I popped upon Smelfungus
again at Turin in his return home, and a sad tale of sorrowful
adventures had he to tell.... He had been flayed alive, and bedevilled,
and used worse than St. Bartholomew, at every stage he had come to.
‘I’ll tell it,’ cried Smelfungus, ‘to the world.’--‘You had better tell
it,’ said I, ‘to your physician.’”
It is well known that age induces great mental changes. We are all
willing to suppose that we grow wiser as we grow older, and it is to
be hoped that this is really the case; but so far as our morality is
concerned, we should bear in mind that we forsake many of our vices
only because the temptation no longer exists. We “_put away childish
things_” when we cease to have the desires of childhood; and the vices
of youth would often come back in advanced life if we could bring back
the fresh feelings of youth, and all the impulses which first took
possession of our souls. How much such considerations should make us
humble, charitable, and forgiving; should render us distrustful of our
own virtue, and compassionate for the failings of others.
Delicate states of health often induce, or are connected with, states
of mind which seem too refined for the common intercourse of life.
There is often a precocity of mind in delicate children which far
surpasses in nicety of feeling the ideas of those more advanced in
age. They who have remembrance of their early sick beds can tell how
little their own ideal creations were understood, and how little known
were the deep recesses of their infant minds. The practical in after
life takes the place of the poetical, and the fine sensibility shrinks
and withers in the rude competition of actual life, and in reality
“concealment, like a worm i’ th’ bud, feeds on the damask cheek.”
Debility of body is often, in fact, generally, productive of great
mental susceptibility, and sometimes irritability of mind. Shakspeare
says, “Conceit in weakest bodies strongest works.” People who have
robust health, and have always enjoyed such, can enter little into
the sentiments of others, nor appreciate the feelings which accompany
feeble and imperfect states of health, or constitutions of greater
delicacy and refinement. Shelley says, “I know not the internal
constitution of other men. I see that in some external attributes they
resemble me; but when, misled by that appearance, I have thought to
appeal to something in common, and unburden my inmost soul, I have
found my language misunderstood, like one in a desert and savage
land.”[36]
In considering the human mind, in its medical aspects, it might
naturally enough be supposed, that the subject of insanity would
form a principal part. I shall not, however, for many reasons, enter
upon it in this place, further than to touch upon those lighter, or
more partial derangements, which are less commonly made matter of
observation or remark.
It has often appeared to me, that much good might arise from the
consideration of mental sanity, on a finer scale than has hitherto
been afforded. The condition of the mind may not be properly healthy,
without being betrayed into those complete aberrations which shock
the observer, or call for the interference of friendly restraint.
The subject has its relations, both to morals and jurisprudence; but
there is, perhaps, no education which so fits the mind to enter on its
consideration, as that which is prescribed by the study of medicine.
When we contemplate our species in the workings of great and good
minds, we cannot fail to feel proud of a humanity which is capable
of achieving vast designs, and compassing mighty undertakings. The
names of Newton and Locke inspire us with a kind of reverence for the
capabilities of our nature. We then, indeed, perceive, that there is
“a divinity which stirs within us, and indicates eternity to man.” How
high and godlike is the mind which can scan its own operations, sit
in judgment on itself, review the events of past ages, and anticipate
the future progress of societies and nations. It would be a pleasing
task to dwell on the greatness of the human mind. We see it in the
honest and sturdy Franklin--the humble and philosophic Dalton--the
persevering and indefatigable Priestley--the bold and imaginative
Davy--the philanthropic Howard--the laborious and highly-gifted Hunter.
If we turn from this picture of the more lofty style of man, and look
to those aberrations of the intellect which we find in the receptacles
for the insane, we must feel a humiliation at least equal to our
previous gratification. Here we have the drivelling idiot--the raving
madman--the moping melancholic--the incoherent dreamer--and the timid
and suspicious hypochondriac. Nor is it a correct opinion, that the
division between the intellectual and insane portion of mankind is so
broad as it appears on a cursory consideration. That there are minor
aberrations of mind which do not come within the limits of actual
madness, there can be no doubt; nor is real insanity so far dissevered
from the more healthy operations of the mind, as to be altogether
incompatible with intermissions of extraordinary brightness.
It is well known that many of our eminent writers, especially those
of an imaginative kind, were hypochondriacs. The unfortunate Cowper
and Collins were of this class; and Chatterton and Haydon, it will be
remembered, destroyed themselves under its influence. The Rev. Robert
Hall had periods of actual insanity, and the elegant Charles Lamb
probably escaped from his sister’s fate only by the necessities of his
own position. Whitbread, Romilly, Londonderry, and Calcraft, put an end
to their own existences; but the list is too great to particularise,
and it is enough to know, that learning and genius are not removed from
the worst of human calamities.
The fate of the unfortunate Swift is too well known to need comment;
but even before the period at which his mind gave way, it is too
probable that he inwardly laboured under a mental infirmity which, in
itself, might be nearly allied to his genius.
The last document which we possess of Swift, as a rational and
reflecting being, is given by Sir W. Scott, in his life of the Dean;
and, as Sir Walter says, awfully foretells the catastrophe which
shortly afterwards took place.
“I have been very miserable all night, and to-day extremely deaf, and
full of pain. I am so stupid and confounded, that I cannot express
the mortification I am under, both in body and in mind. All I say is,
that I am not in torture; but I daily and hourly expect it. Pray let
me know how your health is, and your family. I hardly understand one
word I write. I am sure my days will be very few--few and miserable
they must be.
“I am, for those few days, yours entirely, J. SWIFT.
“If I do not blunder, it is Saturday.”
From these glimpses of the misfortunes and imperfections of great men
we may see that genius is not unalloyed. Carlyle, in his estimate of
Scott, has much sense in the following remark:--“The truth is, our
best definition of Scott were perhaps even this, that he was, if no
great man, then something much pleasanter to be, a robust, thoroughly
healthy, and withal very prosperous and victorious man.” What we call
genius has often a degree of eccentricity connected with it, and, as
Dr. Ferriar has hinted, may even have an alliance with insanity. “No
doubt,” says he, “the same causes which in a strong degree produce
madness, may, in a lower, increase the natural powers of the mind.”
High cultivation and extraordinary talents are not in themselves the
certain means of goodness nor of happiness. The mind, rendered more
subtle and more oppressed with thought and ambition, looks back even to
its primitive simplicity with a feeling little short of regret. Byron
says--
“I feel almost at times as I have felt
In happy childhood; trees, and flowers, and brooks,
Which do remember me of where I dwelt
Ere my young mind was sacrificed to books,
Come as of yore upon me, and can melt
My heart with recognition of their looks.”[37]
On the other hand, the mental powers which are the farthest removed
from insanity are not perhaps the most ingenious, fertile, or
imaginative. The more brilliant mind which sees relations not
perceptible to others--the associations of which are not too strong and
constant to forbid erratic flights, may be, on that very account, the
more capricious, unsettled, and uncertain in its operations--possibly,
the more easily pushed from its own balance, and lost from its very
want of anchorage to slow and settled, albeit erroneous, doctrines.
They who have undergone great changes of opinion can alone know what
it is to abandon the landmarks of thought, and go out into a sea of
meditation, without any well-known beacon to guide them, or familiar
appearance to mark their course. Errors may be dear, _even sacred_ to
the mind, and to abandon the errors which ages have nursed, may indeed
be difficult to those who have cherished them from their earliest
infancy.
As minds differ greatly in respect to the intellectual powers, so they
differ also in regard to the affections and instinctive impulses, and
these latter appear to be subject to aberrations independently of
the former. The late Dr. Prichard, in a very able work on “Insanity
in its Relations to Jurisprudence,” has treated of the subject under
the head of “Moral Insanity;” and were I to state all that I think
important, I should not content myself without transcribing the
greater part of what he has written. It may seem rather startling to
look upon _moral_ aberrations as resulting from mental infirmities. I
am far from wishing to appear as an apologist for vice, but a close
attention to the subject obliges me, in fairness, to admit, that the
propensities and impulses of the mind may want a just balance as well
as the intellectual powers. I feel that I have not here room to do
justice to the subject, but I may say that those who have given most
attention to the various phases of insanity are coming to this opinion.
Such views cannot, perhaps, alter materially our social relations
nor penal institutions, but they will at least make our charity more
broad and lasting, and our compassion for the erring more enlightened.
Undoubtedly the protection of society requires that the morally insane
be arrested in the career of crime; for if it _needs be that offences
come_, it must also needs be that there _be woe to him through whom
they come_.
The facts upon which the evidence of moral insanity rests are too
striking and numerous to admit of doubt, and the subject would probably
have long ago been more fully investigated, had it not been for the
privacy attached to instances of this kind, and the reluctance which
is naturally felt to admit a plea which appears, at least on first
consideration, to have dangerous consequences.
The existence of moral insanity is recognised by Esquirol and Georget,
on the continent, as well as by Dr. Prichard, Dr. Hitch, and others,
in England,--indeed, by the best authorities we have on the subject.
Insanity is far from showing itself merely in hallucinations and
illusions, as is commonly supposed. Often the first overt act of
insanity is one of moral delinquency or extravagance, and however
delicate the question may appear in a moral consideration, it is
impossible to shut our eyes to the truth. In many of these instances
it seems that the absence of moral control constitutes the essence
of the disorder; and persons are known to conduct themselves well in
asylums who, immediately on being released, give way to excesses of
maniacal excitement, or betray the most ridiculous eccentricities and
absurdities. I may probably, on some future occasion, return to this
subject; here I can only hint at it.
Independently of this moral insanity, there are also grades of
difference in the passions and propensities of the mind, less
excessive, but still worthy of study in connexion with such
considerations as these.
That attachments are to some extent instinctive, would appear from the
maternal fondness even of the brute creation; and it is beautiful to
witness the tender offices to which it leads. There can be no doubt
but that feelings of personal attachment are much stronger in some
people than in others, and may even exist to a morbid degree. Sheridan,
in his play called the _Rivals_, apostrophises LOVE as the tormentor
and fiend, “whose influence acting on men of dull souls makes idiots
of them, but meeting subtler spirits betrays their course, and urges
sensibility to madness.” Dramatists and novelists have in all ages
amused mankind with the tragical creations of fiction, but such stories
interest only because the annals of real life have also their _broken
hearts_.
Perhaps one of the most beautiful delineations of human attachment in
comparatively modern literature, is that of Goëthe’s Margaret, in his
celebrated Faust. The clinging of affection in the last hour of horror
and of crime rises to a sublimity which is only heightened by the
confiding simplicity of the character. The mystical and unholy career
of Faust contrasts with the beautiful love of Margaret, nor can there
be imagined in the downward career of destruction any reproach which
can speak so eloquently as the voice of unaltered love:--
“Where I have him not,
Is the grave to me,
The whole world
Is embittered to me.
For him alone look I
Out at the window.
For him alone go I
Out of the house.
My peace is gone,
My heart is heavy,
I shall find it never,
And never more.”[38]
How delicate is the sentiment of pity,--how exquisite the combination
of sorrow and of love!
Attachment to place may exist with more or less strength. Some persons
have strong preferences for particular places, and feel, when removed,
as if transplanted to an uncongenial soil, and pine for the scenes they
have left.
Amongst the Swiss, love of country sometimes rises to a degree which
actually impairs the health. I think Sir Walter Scott in his last
illness felt, in the spirit of his own poetry, a strange yearning for
the scenes of his native country, after literally “wandering on a
foreign strand.”
Man is, perhaps, as beautiful in the passions and affections of his
nature as in the highest reach of his intellectual powers. Terrible,
indeed, are the passions, but they are also glorious and lovely.
The very emotions, feelings, and instinctive impulses of our nature
constitute more than all else our _humanity_. The cold calculations of
the strongest minds are dead, without the warm influence of affection;
and we would rather pardon the frowardness of childhood, and the
caprice of woman, than lose all those endearing sentiments which bind
us to the one and to the other. But there is a maddening impulse, which
breaks out fiercely, and blinds the reason, or acts in spite of it. It
comes fearfully over the horizon of the mind, like a storm, and rages
in cruelty and guilt. The voice of pity pleads unheeded;--but there
comes a day when serenity is restored, and then all the better feelings
of the heart come up as a memorial against it. It is at such times that
every kind emotion and every tender sympathy of our nature bears with
it a sting more terrible than reproof or revenge.
Very strong and enduring hatreds are sometimes indicative of insanity
itself, especially where they are cherished without a sufficient cause.
Happiness is compatible alone with a healthy balance of the mind, and
the indulgence of proud hatred and uncharitable hostility is only a
small remove from the ravings of the madman, and the sound and fury
“which signify nothing.”
In connexion with the subject of hatred, I may mention a law of
the human mind which has always appeared to me of the greatest
importance--I mean, that the passions are greatly augmented by the
manifestation or expression of them. I have sometimes overheard an
animated conversation, passing by transitions of bitterness into the
most violent quarrel, each party rather fanning his own feelings by the
expression of them than listening to the abuse of his opponent.
A woman will sometimes set her arms akimbo in the street and
commence in a moderate tone of reproof, but after a time she will
acquire greater and greater warmth until she flies at the cap of her
antagonist. This law of the mind is very apparent in Lunatic Asylums.
I remember an old woman at the County Hospital at Lancaster, who is
always abusive, but the first few words she says, especially to a
stranger, are tranquil enough; after a little time, however, she waxes
louder and louder, and more and more vehement, although no remark or
opposition may have been offered to what she has said.
A tendency to excess sometimes seems to take its origin in mental
peculiarity. Where the imagination strongly predominates there is often
a liability to intemperance or excess, which brings talent to contempt,
and is a matter of surprise to those of more obtuse but evenly
regulated minds. The fate of the unfortunate Savage has been rendered
familiar to all the lovers of literature by the able pen of Johnson.
Addison and Parnell are said to have drunk to excess, and Burns is well
known to have given way to the same vice.
Anthony Wood, speaking of John Skelton, who, according to Erasmus, was
“the light and glory of English literature,” says, “that he was guilty
of many crimes, _as most poets are_.”[39]
Carlyle, in speaking of the _literary man_, says, “His fame rarely
exerts a favourable influence on his dignity of character, and
never on his peace of mind; its glitter is external for the eyes of
others; within, it is but the aliment of unrest, the oil cast upon
the ever-gnawing fire of ambition, quickening into fresh vehemence
the blaze which it stills for a moment.... The calamities of these
people are a fertile topic, and too often their faults and vices have
kept pace with their calamities. Nor is it difficult to see how this
has happened. Talent of any sort is generally accompanied with a
peculiar fineness of sensibility. Of genius, this is the most essential
constituent, and life in any shape has sorrows enough for hearts so
formed.”[40]
In conclusion, I may observe, that it is impossible, for many obvious
reasons, to enter fully, in this place, into the subject of medical
psychology, but it does seem to me that it is one which has not yet
found its due place in human consideration.
The very routine and common-place order of life are disadvantageous
to reflections of such a nature.--We hear the yell of the lunatic in
his ward, and see around the hideous congregation of his associates,
but as we close the door the sound dies on the ear--and it fades from
the recollection also. We see poverty and guilt stalking about the
streets of our cities, but we step into saloons, and forget, in the
forms and usages of society, the misery we shut out. There are _forms
and usages_ in our very thoughts, also, which stop the generous flow of
nobler and better feelings. We do not love mankind as we ought, because
we do not know it--or we know it only in our own selfish circle, and
forget that the same pattern of humanity is abroad; sometimes great in
the pride of beauty and vigour, and again miserable in depravity and
crime. We respect the high-born and the successful,--we build statues
to celebrate military prowess and statesman-like policy,--but we should
learn, also, to love man as _man_, to regard his failings as it
becomes those whose judgments can only be made with partial knowledge
and limited comprehension, and in all his wanderings still to recognise
his dear humanity.
There are facts before us, respecting the habitudes of the human mind,
which are as much to be relied on as any in physics, and as capable of
being generalised and rendered available for practical ends. Ignorance
of these facts is daily and hourly leading to cruel judgments, and to
misery in all its various forms. I am glad to say that we have now a
“Journal of Psychological Medicine,” which will, no doubt, greatly aid
in bringing about just views, and removing old and injurious notions.
For my part, I most solemnly believe that there are varieties of mental
constitution as great as any in outward form: and when I further
consider the difference which circumstances and education produce, it
appears most unfair and cruelly uncharitable to measure all by the same
standard, and expect like results from different minds. Yet this is
the practical effect of common notions--the doctrine which is tacitly
implied in our literature and in our law. There is an old adage, that
what _man has done, man may do_, but it would be ridiculous logic to
interpret such a passage to signify that what _one man_ has done,
_every man_ may do.
The abstract mind--the _general term_ of logicians--I grant, has no
disorders, no grades of health, no varieties of power--but of this
abstraction there is nothing in nature. The mind is connected with the
body, and affected by the body, and there is still a lesson of charity
to be learnt from a knowledge of such an association.
There is a common cry against the doctrine of different grades of
mental and moral capacity, as though it impugned the goodness of the
Deity; but to me it seems only in accordance with the great plan of
Divine government which commits different talents to the care of his
creatures. Some men are deformed, others good-looking--some invalids
from infancy, others robust--some idiots, epileptics, insane--some rich
from birth, others poor--some the descendants of a long and, may be,
an honourable line of ancestors, others the children of beggars and
of pick-pockets. The brains of men differ in shape and in volume; and
shall the mind be the same in all?
It seems to me on such a subject that _not_ to think _boldly_, is to
think _unjustly_, and to fear the truth on such a question, is to
imagine that the works of the _eternal_ Creator have need to be veiled
by the flimsy apologies of his perishing creatures.
* * * * *
Whilst these sheets were passing through the press, a remarkable
instance of suicide occurred in Leicester, some notice of which may not
be deemed irrelevant, as illustrative of the connexion of disordered
imagination with accomplishment of mind.
A lady, respectable both by birth and education, experienced a
succession of misfortunes, and was eventually reduced to a state of
want.
Being of literary habits, she endeavoured to maintain herself by the
sale of some books which she had published, but she did not meet with
much success. Her means became gradually more and more limited; and
one evening having experienced disappointment, she put an end to her
existence with poison.
It would appear, from the papers she left behind her, that her mind
was of a highly sensitive nature, and somewhat under the influence
of insane feelings. How far these latter may have been cherished or
evolved by misfortune, it is difficult to say. It is probable that they
might, at least, have remained in subjection if it had not been for
the pressure of calamities. The idea of suicide seems frequently to
have entered her mind, and she had actually composed a prayer to the
Almighty that no temptations might lead her to such an end.
It seems that she had written a statement of her case to Lady Peel, but
the document had never been presented. At an appropriate address, which
was delivered over her remains, some manuscripts were read, which show
her to have been capable of high poetic feeling, but reveal also the
strange peculiarities of her mind. One extract runs thus, and will be
read with interest.
“The visitor was gone, but still the glory of his presence seemed
to shine on the spot--still the solitary air seemed to murmur with
tremulous delight--and thus ever shall it be with those who have
once, detaching themselves utterly from life, received the visit of
the Angel. Faith, solitude, and space retain the splendour, and it
settles like a halo round their graves. Wherever the soul can wander,
the eternal soul of all things protects it still! The thoughts of
souls that would aspire like hers are all prayer! Canst thou think
it no sorrow, either to reject all human ties, all friendship, all
love, or to see day after day friendship and love wither from our life
as blossoms from the stem? Canst thou wonder how, with the power to
live while the world shall last, that ere even our ordinary date be
finished, we yet may prefer to die?--She arose fevered and oppressed
with new thoughts which raged within her, opened the casement, and
the ocean lay suffused in the stormy light; and the stillness of the
heavens never more eloquently preached the morality of repose to the
madness of earthly passions; the very hush seemed only to deepen the
wild desires of her soul, and the solemn stars, that are mysteries in
themselves, seemed, by a kindred sympathy, to agitate the wings of the
spirit, no longer contented with its thrall. As she gazed, a star shot
from its brethren, and vanished from the depths of space!”[41]
THE END.
LONDON:
SPOTTISWOODES and SHAW,
New-street-Square.
FOOTNOTES:
[28] Read at a _Conversazione_ of the Manchester Royal Institution, and
published in No. 10. of the Psychological Journal, edited by Dr. Forbes
Winslow.
[29] P. 105.
[30] Vol. iv. p. 10., Lockhart’s Life.
[31] P. 218. vol. i.
[32] Characteristics, p. 82.
[33] P. 114. vol. vii.
[34] P. 102.
[35] Shelley’s Memoirs, p. 135.
[36] Memoirs, p. 189.
[37] Poetical epistle written to his sister.
[38] From a prose translation of Faust.
[39] Quoted from the “Memorials of London,” p. 237.
[40] Life of Schiller, p. 54.
[41] The particulars of this lady’s death (whose name was Caroline
Charlotte Veasey Gilldea), are contained in the Leicester Chronicle for
the 29th of November, 1851.
THE
MEDICAL ASPECTS OF DEATH,
AND
THE MEDICAL ASPECTS
OF THE
HUMAN MIND.
BY JAMES BOWER HARRISON, M.R.C.S.E. ETC.
FORMERLY SURGEON TO THE ARDWICK AND ANCOATS DISPENSARY, ETC. ETC.
Opinions of the Medical Press.
“Mr. HARRISON, the author of the very interesting little work before
us, has succeeded in his attempt to add another stone to the pyramid so
well commenced by previous inquirers. The first essay on the ‘Medical
Aspects of Death’ is a truly masterly account of all those appearances
which simulate death, and of death itself;--and it is written in so
philosophical a spirit, that it cannot but tend to fulfil the dictum
of Johnson, that ‘he had found physicians to be amongst the most
intelligent and well-informed of his friends.’ From a production like
the present it would be most difficult to find a quotation which would
convey an idea of its general tendency; but we extract the following as
a specimen of the author’s mode of treating the subject. * * * * * *
The second essay, which is one of _rare merit_, has been reprinted from
Dr. Forbes Winslow’s ‘Psychological Journal.’”--_Lancet_, January 10.
1852.
* * * * *
“‘The Medical Aspects of Death’ is an excellently-written essay on the
signs of death, the changes the body experiences after death, premature
interment, the bodily changes which immediately precede death, the
mode in which death takes place, the way in which the various suicidal
agents act in inducing death, and the signs of dying. Each of these
sections is illustrated by well-told anecdotes, and ornamented with
most appropriate quotations. The following extract will convey to our
readers a good idea of Mr. Harrison’s powers and style. * * * *
“The second essay ‘On the Human Mind, considered in some of its
Medical Aspects,’ is well written, and will well repay reading. It was
originally published in the ‘Psychological Journal.’”--_Medical Times
and Gazette_, January 24. 1852.
* * * * *
“In the elegant little volume now before us, bearing the above title,
Mr. Harrison, of Manchester, already very favourably known as a medical
writer, presents an interesting view of two important aspects of
mortality. The latter, ‘On the Medical Aspects of the Mind of Man,’ a
most able essay, has already appeared in the pages of our excellent
contemporary, the ‘Psychological Journal,’ and we doubt not has there
fallen under the observation of the majority of our readers. The former
contains first an excellent _resumé_ of the signs of death, a subject
which has lately been very fully investigated, chiefly by the French
physiologists, and the important results arrived at by whom we have
recently noticed at length; second, a review of the causes of death,
or the mode in which life terminates; and third, a notice of the
antecedent symptoms of death, or the bodily changes which immediately
precede it. The entire is written in a highly philosophic spirit,
containing throughout, not alone judicious observations on the intimate
link between life and death, which do honour to the author, but
valuable medical hints. We cordially commend the tone and character of
these essays, and we earnestly press their perusal on the profession.
Indeed they may be read too, with advantage, by the non-professional
public.”--_Dublin Quarterly Medical Journal_, February, 1852.
* * * * *
“In this little volume, Mr. Harrison presents us with a couple of
remarkably readable and pleasantly-written essays on two subjects,
neither of which it is easy to treat pleasantly. In his preface, the
author _naïvely_ observes that he has ‘never thought it essential that
a book should be dry in order to be useful.’ We think that he has
produced a useful book: we are sure that he has not added to the stock
of dry ones.
“In the first essay, the premonitory signs of death, the several modes
in which death is occasioned, and the indications of death having
really taken place, are discussed with an absence of disagreeable
detail, and yet with a fulness of description, that bespeak a skilful
and not unpractised hand. We do not know of any other work in which
the unprofessional reader could meet with the same information so
intelligibly and pleasingly conveyed, nor in which the medical man
would find the subject so appositely garnished with anecdotes and
classical illustrations. * * *
“The second essay touches pointedly, but gently, upon the slighter
deviations from health of mind, such as, not constituting acknowledged
insanity, are still indicative of disorder of the mental balance. To
do justice to Mr. Harrison’s mode of treating his subject, we should
have to transcribe his essay. We need scarcely say that we commend this
work to our readers. It is such as we may frequently find convenient
to place in the hands of our more intelligent patients. The author has
managed to combine the _utile_ with the _dulce_ in a way _which must
ensure success_.”--_Provincial, Medical, and Surgical Journal_, March
3, 1852.
* * * * *
LONDON:
LONGMAN, BROWN, GREEN, AND LONGMANS.
_By the same Author_,
POPULAR MEDICAL ERRORS.
Price 3_s._ 6_d._
LONDON: LONGMAN AND CO.
* * * * *
SOME REMARKS
ON
THE CONTAMINATION OF WATER WITH THE POISON OF LEAD.
LONDON: CHURCHILL.
* * * * *
LETTER TO THE EARL OF SHAFTESBURY
ON THE INJURIOUS EFFECTS OF
THE MANUFACTURE OF LUCIFER MATCHES, &c. &c.
MANCHESTER: HAYCRAFT.
Transcriber’s Notes
Italic text is denoted by _underscores_.
Perceived typographical errors have been silently corrected.
Footnotes have been moved to the end of each chapter.
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