In former, nay, even in recent times, we are told that pirates and robbers have resorted to half-hanging, to extort confession as to hidden treasure. Is it possible that they can have so much mistaken the means they employ as thus to use pleasurable appliances for the purposes of torture?
The mistake of most reasoners on the subject, Winslow and Hufeland more especially, consists in this, that they fix their attention exclusively upon the final moments of dissolution. But the act of dying may be in disease, as we know it to be in many modes of violence, impalement, for example, or crucifixion, very variously protracted and progressive. “Insensibly as we enter life,” says Hufeland, “equally insensibly do we leave it. Man can have no sensation of dying.” Here the insensibility of death completed, that is, of the dead body, is strangely predicated of the moribund while still living. This transitive condition, to use the graphic language of the Southern writer whom we have already more than once quoted, is “a terra incognita, where vitality, extinguished in some tissues, smouldering in others, and disappearing gradually from all, resembles the region of a volcano, whose eruptions subsiding, leave the surface covered with cinders and ashes, concealing the rents and lesions which have on all sides scarred and disfigured the face of nature.”
Besides this, we have no right to assume, as Hufeland has here done, the insensibility of the child at birth. It is subject to disease before birth; as soon as it draws a breath, it utters loud cries and sobs. To pronounce all its actions “mechanical, instinctive, necessary, automatic,” in fact, is a very easy solution of the question; but I think neither rational nor conclusive. If you prick it or burn it, you regard its cries as proving sensibility to pain; but on the application of air to its delicate and hitherto protected skin, and the distension of its hitherto quiet lung, the same cry, you say, is mechanical and inexpressive. So Leibnitz explained, to his own satisfaction, the struggles and moans of the lower animals as automatic, being embarrassed with metaphysical and moral difficulties on the score of their intelligence and liability to suffering. But no one now espouses his theory, and we must accept, whether we can explain them or not, the facts that the lower animals are liable to pain during their entire existence, and that the heritage of their master is, from and during birth to the last moment of languishing vitality, a sad legacy of wo and suffering.
Unhappily we may appeal, in this discussion, directly to the evidence of our senses, to universal experience and observation. Who can doubt the tortures inflicted in tetanus? to alleviate which, indeed, I have more than once been solicited for poison. Does not every one know the grievous inflictions of cancer, lasting through months and years, and continuing, as I have myself seen, within a short hour of the absolute extinction of life, in spite of every effort to relieve it? The most painful of deaths apparently is that which closes the frightful tragedy of hydrophobia, and patients, to hurry it, often ask most urgently for any means of prompt destruction. But these more intense and acute pangs are not the only form of intolerable agony. Unquenchable thirst, a dreadfully progressive suffocation, confusion of the senses and of thought—these are inflictions that nature shudderingly recoils from, and these, or their manifestations, are scarcely ever wanting on the death-bed.
If any one should ask why I thus endeavor to prove what it is revolting to us all to believe or admit, I answer—first, that truth is always desirable to be known both for its own sake and because it is ever pregnant with ultimate benefit and utility. More than one moribund has expressed to me his surprise and horror—shall I say disappointment too? at finding the dark valley of the shadow of death so rough and gloomy and full of terrors. Is it not better that we should be as thoroughly and adequately prepared for the stern reality as may be, and that we should summon up all the patience and fortitude requisite to bear us through? When the last moment is actually at hand, we can safely assure our friends that they will soon reach a state of rest and unconsciousness, and that meanwhile, as they die more and more, they will less and less feel the pain of dying. Secondly, by appreciating properly the nature and amount of the pangs of death, we shall be led to a due estimate of the demand for their relief or palliation, and of the obligation incumbent on us to institute every proper effort for that purpose with zeal and assiduity. He who believes with Hufeland, that the moribund is insensible, is likely to do little to solace or comfort him.
There are doubtless instances of death entirely easy. “I wish,” said Doctor Black, “I could hold a pen; I would write how pleasant a thing it is to die.” Dr. George Fordyce desired his youngest daughter to read to him. When she had been reading some time, he called to her—“Stop; go out of the room; I am going to die.” She left him, and an attendant, entering immediately, found him dead. “Is it possible I am dying?” exclaimed a lady patient of mine; “I feel as if going into a sweet sleep.” “I am drowsy, had I better indulge myself?” asked Capt. G. On my giving him an affirmative answer, he turned, and sank into a slumber from which he awoke no more. It is indeed pleasant to know that examples occur of this unconscious and painless dissolution; but I fear they are comparatively rare exceptions to a natural rule; and I regard it as the duty of the medical profession to add to the number by the judicious employment of every means in our power.
And this leads me to a brief consideration of the question so often pressed upon us in one shape or another by the friends of our patients, and sometimes by our patients themselves: If the tendency of any medicinal or palliative agent be to shorten life, while it assuages pain, has the physician a right to resort to it? Even in the latter stages of some inflammatory affections, loss of blood, especially if carried to fainting, will arrest the sharp pangs, but the patient will probably die somewhat sooner: shall we bleed him? Large doses of opium will tranquilize him, or render him insensible; but he will probably sink somewhat earlier into the stupor of death. Shall we administer it, or shall we let him linger on in pain, merely that he may linger? Chloroform, ether, and other anæsthetics in full dose inspired render us insensible to all forms of anguish, and make death as easy, to use the phrase of Hufeland, as being born! Shall we allow our agonized moribund to inhale them? Used in less amount, a degree of relief and palliation is procured, but at the risk of exhausting or prostrating more promptly the failing energies of the system. Shall we avail ourselves of their anæsthetic influences, or are they forbidden us, either absolutely or partially?
These are by some moralists considered very delicate questions in ethics. Desgenettes has been highly applauded for the reply he made to Bonaparte’s suggestion, that it would be better for the miserable sick left by the French army at Jaffa to be drugged with opium: “It is my business to save life, not to destroy it.” But, in approving the physician, we must not harshly condemn the commanding officer. When we reflect on the condition of the men whom the fortune of war compelled him to abandon, and the certainty of a horrible death to each victim from wasting disease or Turkish cruelty, a rational philanthropist might well desire to smooth their passage to the grave.
During the employment of torture for the purposes of tyranny in Church and State, a physician or surgeon was at hand, whose whole duty it was to suspend the process whenever it became probable that nature would yield under its pressure, and the victim would escape through the opening, glad gates of death. It was then esteemed an act of mercy to give, or permit to be given by the executioner, a fatal blow, hence called emphatically and justly the coup de grace. In the terrible history of the invasion of Russia by Napoleon, we shudder to read that, after their expulsion from Moscow, the French soldiers, in repassing the fields of battles fought days and even weeks previously, found many of their comrades, there wounded and left, still dragging out a wretched and hopeless existence, amidst the corpses of those more fortunately slain outright, and perishing miserably and slowly of cold and hunger, and festering and gangrenous wounds. One need not surely offer a single argument to prove, all must feel and admit that the kindest office of humanity, under the circumstances, would have been to put an end to this indescribable mass of protracted wretchedness by the promptest means that could be used to extinguish so horrible a life.
A common case presents itself from time to time to every practitioner, in which all hope is avowedly extinct, and yet, in consonance with uniform custom, stimulants are assiduously prescribed to prolong existence in the midst of convulsive and delirious throes, not to be looked on without dismay. In some such contingencies, where the ultimate result was palpably certain, I have seen them at last abandoned as useless and worse, in order that nature, irritated and excited, lashed into factitious and transitory energy, might sink into repose; and have felt a melancholy satisfaction in witnessing the tranquillity, so soft and gentle, that soon ensued; the stormy agitation subsiding into a calm and peaceful decay.