Death.

Selected writings of John M. Scudder.

Unpleasant and uncanny as is the subject of death, yet should the physician be fully conversant with its approaching signs. The doctor must know the well man, the sick man, and the man sick unto death. Whether the dying should be told their real condition has been a much discussed question. Dr. Scudder, it seems to us, has fully and satisfactorily answered the question in this editorial.—Ed. Gleaner.

DEATH.—Have you ever thought on this grave subject—the end of all things earthly? I think it likely, for who that lives could fail to think of the end of that he prizes beyond all else? and especially the physician, who almost lives in the shadow of death.

Born to die! Yes, every one. Born to die young! Yes, a host of feeble lives from feeble parents, who must of necessity die in infancy, childhood, or adolescence, because they have not life to last longer. Born to die! Yes, a host of others who might live to do the work of men and women, and even make the span of threescore and ten, if it were not for the continuous violation of the laws of life.

Stricken with death! Yes, in many cases we are called to treat disease, but at the bedside we meet death, for which we have no cure. It is well for the physician if he can recognize the master— we can treat and cure disease, but not death.

The first study in medicine is to know healthy life; the second is to know the varied phases of unhealthy life, which we call disease; a third is to know and recognize this that we call death. Buoyancy of spirit, activity of body, and pleasurable sensations, characterize the first; depression of spirit, inactivity and feeble-ness of body, and unpleasant or painful sensations, mark the second: whilst loss of spirit, bodily power, and common sensation, mark the third.

It seems to me that a physician should make this third study, so that he might recognize the waning life. It is difficult to write it, but not so difficult to impress the mind with its prominent features as we watch the change in one of our patients. We note the coldness of parts distant from the heart—a peculiar coldness with relaxation which we term death-like. Not only is there coldness, but parts are shrunken and livid, and muscular movements are sluggish. The alae of the nose move in and out during respiration, the eyelids are less movable, and the eyes are dull and glassy. The respiratory movements are feeble, and when the person feels the want of air, the external inspiratory muscles are called into action. The pulse grows feeble, the impulse of the heart is hardly felt, capillary and venous circulation is impeded. It may be sudden or slow, but the loss of feeling and consciousness will be found in both.

The question is asked so frequently, "Will the patient die?"—or still more personal, "Doctor, will I live? will I die?"—that we want to be ready to give an answer. If there is any question of all-absorbing interest, it is this question of life and death, and if a physician has any truth in him, he should not lie to the person who is so gravely interested. I believe that in this, as in all things, honesty is the best policy, and when a case is inevitably fatal, the plain simple yes should follow the query, "Is it death ?"

Where it is a question of doubt or danger, the answer may well be hopeful, for hope may decide the question in favor of the patient. Yet there are cases where a knowledge of the worst nerves the sufferer to a resistance which wards off death. I can recall more than one case of this kind, where the contraction of the muscles and firm closure of the jaws showed the concentration of the will for life. Hope lulls to sleep, and if safety comes by rest, then it is well. Danger calls into play all that we have of strength and resistance, and with the brave is the most powerful stimulant— the cowardly succumb from shock.

Good judgment is necessary in this as in other things, and we will do that which seems best for our patient, but with a strong sense of our duty to deal honestly and speak truthfully.

Why should this subject be discussed during the holiday season? You remember the story of an Eastern king who had a skeleton present at every feast, and of another who had a grinning skull passed to every guest on a salver—in both cases with the motto, "Thou, too, art mortal." But outside of this the reader will see that it is a subject which deserves his attention, and that he should study.—SCUDDER, Eclectic Medical Journal, 1882.

The Biographies of King, Howe, and Scudder, 1912, was written by Harvey Wickes Felter, M. D.