Practically all physicians that have given any attention to the subject are convinced that not a few of the suicides, which are now so alarmingly on the increase in this country, are due to the frequent reading in newspapers of the accounts of suicides. As we have said elsewhere, brooding over the details of these is very likely to lessen the natural abhorrence of self-murder in persons that are predisposed, by melancholic dispositions, to such an act. The publication of cases of suicide can do no possible good, while it undoubtedly does, in this way, work incalculable harm. This is especially true with regard to suicides among young people, that is, individuals under twenty-five years of age. The saddest feature of recent [{134}] statistics with regard to suicide is that this crime has become proportionately much more frequent among young men and young girls, and even children, than it was two or three decades ago. It has been noted, too, in many cases that a previous suicide in the family seems to have familiarised the young mind with the idea of self-destruction and thus suggested its commission.
On the other hand, among young people especially, it has been noted that there is frequently an imitative element in suicides. Three or four suicides, practically with the same details, will occur, within a few days of each other. Suicides at all ages are especially likely to occur in groups, and are often cited to exemplify the truth of the old axiom that evils never come singly. It is especially among young people, however, that this relationship to previous suicides can be traced, and there is no doubt that it is the unfortunate publicity given to suicide, with the consequent suggestive influence, which constitutes the most important factor in these cases. All the influence that clergymen can exert, then, must be wielded to suppress this, as well as the many other evils which flow from sensational journalism.
JAMES J. WALSH.
XI
UNEXPECTED DEATH
Unexpected death and its problems constitute the principal reason why there should be a pastoral medicine, and why the clergyman must keep himself in close touch with advances in medicine. To have an ailing member of a congregation die unexpectedly, that is, without the rites of the Church, when perhaps there has been some warning as to the possibility of such an accident, can not but be a source of the gravest concern in pastoral work. Sudden death can be anticipated in many diseases that are acute, while in chronic forms of disease the sufferer can be prepared for its possibility by the administration of the sacraments at regular intervals. There is, however, an old proverb which says that death always comes unexpectedly; and even with all the modern advance in medicine, this still contains a modicum of truth. As an unprepared death is an occasion of the most poignant regret to the friends of the deceased and to the attending clergyman, it is with the idea of furnishing some data by which the occurrence of death without due anticipation may be rendered more infrequent, that the following medical points on the possibilities of a fatal termination in certain diseases have been brought together. Unfortunately, even with all our progress in modern medicine, they must be far from adequate for all cases.
Needless to say, the only rational standpoint in this matter must be that it is better to be sure than to be sorry. The impression is very prevalent now that at least the sacraments of Penance and the Holy Eucharist should be administered to the sick whenever there is even the possibility of a fatal termination of the illness. Extreme Unction is more usually delayed until there is some positive sign of [{136}] approaching dissolution. Delay in its administration, however, not infrequently leads to this sacrament being given when the patient is unable to appreciate its significance. This would seem to be very far from the intention of the Church. The idea has been constantly kept in mind, then, so to advise the clergyman with regard to the liability of a fatal termination as to secure, if possible, the administration of Extreme Unction while the patient is still in the full possession of his senses.
Assured prognosis, that is, positive foresight as to the course of any disease, is the most difficult problem in medicine. Nearly 2400 years ago, when Hippocrates wrote his chapter on the progress of diseases, he stated that the hardest question to answer in the practice of medicine is, will the patient live? That special chapter of his book remains, according to our best authorities, down even to our own day, a valuable document in medical literature. It can be read by young or old in medical practice with profit. While our knowledge of the course of disease has advanced very much, the wise old Greek physician anticipated most of the principles on which our present knowledge of prognosis is founded. This fact in itself will serve to show how unsatisfactory must be any absolute conclusion as to the termination of any given disease. Our forecasts are founded on empirical data,—that is, they are the result of a series of observations,—and the underlying basis of all the phenomena is the individual human being, whose constitution it is impossible to know adequately, and whose reaction to disease it is impossible, therefore, to state with absolute certainty.
With this warning as to the element of doubt that exists in all prognosis, we may proceed to the consideration of certain organic affections which make sudden death frequent.
At the beginning of the present century, Bichat, a distinguished French physician who revolutionised medical practice, said that health and the favourable or unfavourable termination of disease depends on the condition of three sets of organs—the brain, the heart, and the lungs. This was what he called the vital tripod. It was not until nearly thirty years after Bichat's death that Bright, an English [{137}] physician, taught the medical profession to recognise kidney disease. Since his time we have learned that even more important than Bichat's vital tripod, as regards health and the termination of disease, is the condition of the kidneys. We shall consider affections of these four organs, and their influence on the human system and intercurrent disease, in the order of their importance.