Euthanasia

Part 1

Transcriber’s Note.

Italic text is indicated with underscores, bold text with =equals=. Small/mixed capitals have been replaced with ALL CAPITALS.

Obvious typographical and punctuation errors have been corrected silently. Inconsistent hyphenation has been normalised.

Half-titles & reiterations of the chapter title have been discarded.

EUTHANASIA:

OR,

MEDICAL TREATMENT IN AID OF AN EASY DEATH.

WILLIAM MUNK, M.D., F.S.A.

FELLOW AND LATE SENIOR CENSOR OF THE ROYAL COLLEGE OF PHYSICIANS, &c., &c., &c.

LONDON:

LONGMANS, GREEN, AND CO.

AND NEW YORK: 15, EAST 16th STREET.

1887.

All rights reserved.

PREFACE.

Much has been ably written on Death, and on the physiology of the various modes of Dying, by Bichat, Alison, Wilson Philip, Symonds, and others; while but little has been written on the medical management of the Dying; or on the Euthanasia, to which such management should contribute. A short but valuable essay of less than twenty pages, “On the Treatment of the Dying”, by Dr. Ferriar, of Manchester, in 1798: and a very elegant academical oration, of about the same length, at my own alma mater, Leyden, in 1794, by Professor Paradys, “Oratio de Εὐθανασία Naturali; et quid ad eam conciliandam Medicina valeat”:--comprise all I know that has been written specially on these subjects in modern times.

Sir Henry Halford, who was confessedly a master in all that concerns the management of the Dying, did much by his example and counsel to commend the subject to the attention of his medical brethren. But the generation he personally influenced has passed away. His little volume of “Essays and Orations” contains much on this subject that is very valuable, and not to be found elsewhere. But his remarks are unconnected; they occur incidentally in the course of his various essays, and are now but little known. They were the result of an experience so large, and so carefully thought out, that I have been glad to adduce them, whenever I could, in support of, or in addition to, what I have had myself to state, on the delicate and difficult subjects considered in the following pages.

40, FINSBURY SQUARE. Sept. 24, 1887.

CONTENTS.

ON SOME OF THE PHENOMENA OF DYING 1

II.

ON THE SYMPTOMS AND MODES OF DYING 51

III.

ON THE GENERAL AND MEDICAL MANAGEMENT OF THE DYING 63

SOME OF THE PHENOMENA OF DYING.

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

HORACE.

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

Part 2

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

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

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

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

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

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

Lastly, there are those specially interesting cases of recovery from the apparent death of drowning, in which, although the mind has been keenly alive and active throughout, there was an entire absence of pain or other bodily suffering of any kind. The best authenticated of these instructive and suggestive instances is that of Admiral Beaufort, as described by himself in a letter to Dr. Wollaston. When a youngster on board one of H.M. ships in Portsmouth harbour, he fell into the water, and, being unable to swim, was soon exhausted by his struggles, and before relief reached him, he had sunk below the surface. All hope had fled, all exertion ceased, and he felt that he was drowning. “From the moment that all exertion had ceased,” writes the admiral, “a calm feeling of the most perfect tranquillity superseded the previous tumultuous sensations--it might be called apathy, certainly not resignation, for drowning no longer appeared to be an evil. I no longer thought of being rescued, nor was I in any bodily pain. On the contrary, my sensations were now of rather a pleasurable cast, partaking of that dull, but contented sort of feeling which precedes the sleep produced by fatigue. Though the senses were thus deadened, not so the mind; its activity seemed to be invigorated in a ratio which defies all description--for thought rose after thought with a rapidity of succession, that is not only indescribable, but probably inconceivable, by any one who has not himself been in a similar situation. The course of these thoughts I can even now in a great measure retrace,--the event which had just taken place, the awkwardness that had produced it, the bustle it must have occasioned, the effect it would have on a most affectionate father, and a thousand other circumstances minutely associated with home were the first series of reflections that occurred. They then took a wider range--our last cruise, a former voyage and shipwreck, my school, the progress I had made there and the time I had misspent, and even all my boyish pursuits and adventures. Thus travelling backwards, every past incident of my life seemed to glance across my recollection in retrograde succession; not, however, in mere outline as here stated, but the picture filled up with every minute and collateral feature; in short, the whole period of my existence seemed to be placed before me in a kind of panoramic review, and each act of it seemed to be accompanied by a consciousness of right or wrong, or by some reflection on its cause or its consequences; indeed, many trifling events which had been long forgotten, then crowded into my imagination, and with the character of recent familiarity.” Certainly two minutes did not elapse from the moment of suffocation to that of being hauled up; and according to the account of the lookers on, he was very quickly restored to animation. “My feelings,” continues Admiral Beaufort, “while life was returning, were the very reverse in every point of those which have been described above. One single but confused idea--a miserable belief that I was drowning dwelt upon my mind, instead of the multitude of clear and definite ideas which had recently rushed through it--a helpless anxiety--a kind of continuous nightmare seemed to press heavily on every sense, and to prevent the formation of any one distinct thought, and it was with difficulty that I became convinced that I was really alive. Again, instead of being absolutely free from all bodily pain, as in my drowning state, I was now tortured by pain all over me.”

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