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CHAPTER XLVI
DYING OF OLD AGE, AT FIFTY-EIGHT

Within the usual limits assigned me in the daily routine of my profession, but on its very verge, there resided an individual of much general reputation for worth of character, but of feeble constitution and cachetic or deranged habits, for whom as well as for his numerous family I had frequently prescribed.

He was at length, one autumn, unusually reduced in health and strength, and I was again sent for. There was evidently very little of real disease about him, and yet there was very great debility. All his bodily senses were greatly deranged, and all his intellectual faculties benumbed. His internal machinery – his breathing, circulation, and digestion – was all affected; but it seemed more the result of debility than any thing else. There was no violence or excess of action anywhere, except a slight increase of the circulation.

The man was about fifty-eight years of age. Had he been ninety-eight or even eighty-eight, I should have had no difficulty in understanding his case. I should have said to myself, "Nature, nearly exhausted by the wear and tear of life, is about to give way;" or in other words, "The man is about to did (?die) of mere old age." But could he have been thus worn out at the age of fifty-eight?

I gave him gentle, tonic medicine, but it did not work well. Without increasing his strength, it increased his tendencies to fever. Yet, as I well knew, depletion would not answer in a case like this, whether of bleeding, blistering, or cathartics. In these circumstances, I contrived to while away the time in a routine of that negative character which, in true medical language, means laboriously doing nothing.

He was visited about twice a week. I heard patiently all his complaints, and endeavored to be patient under all my disappointments, for disappointments I had to encounter at nearly every step. No active treatment whatever would have the general effect I desired and intended. If I gave him but a single dose of elixir paregoric for his nervousness, it only added, nine times in ten, to the very woes it was intended to relieve. My policy – and I fully believe it was the only true policy – was to leave him to himself and to Nature, as much as possible.

Though I have spoken here of what I regarded as the true policy in the case then under my care, yet, after all, the truest course would have been to call for consultation some wiser head than my own. Another individual, even though he were no wiser than I, might have aided me most essentially, in compliance with, and in confirmation of, the good old adage – "Two eyes see more than one."

Why, then, did I not call on some inquiring and highly experienced physician? It was not that I was too proud to do so, nor that I was too jealous of my reputation. It was not that I feared any evil result to myself. It was rather because I did not, at first, think it really necessary; and then, subsequently, when I supposed it to be really needful, I feared my patient would grudge the expense. This fear, by the way, was grounded in something more than mere conjecture. The proposal had been practically made, and had been rejected.

In this general way things went on for some time. The friends grew uneasy, as they should have done; and one or two of them, now that it was almost too late, spoke of another physician as counsel. My own readiness and more than readiness for this seemed to have the effect to quiet the patient, though it had the contrary effect on his friends. They appeared to construe my own liberality and the admixture of modesty and conscientiousness, which were conspicuous in my general behavior, into self-distrust, and hence began themselves to distrust me.

The patient's state of mind – for he was a man whose habits of thinking and feeling approximated very closely to those of the miser – more than once reminded me of some doggerel verses I have seen, perhaps in an old almanac, which are so pertinent in illustration of the point in my patient's character which these remarks are intended to expose, that I have ventured to insert them: —

"The miser Sherdi, on his sick-bed lying,

Affrighted, groaning, fainting, wheezing, dying,

 
Expecting every hour to lose his breath,
Enters a Dervise: 'Holy Father, say,
As life seems parting from this sinful clay,
What can preserve me from the jaws of death?'
 
 
"'Sacrifice, dear son, good joints of meat, —
Of lamb and mutton for the priest and poor.
Nay, shouldst thou from the Koran lines repeat,
Those lines might possibly thy health restore,'
 
 
"'Thank you, good father, you have said enough;
Your counsels have already given me ease.
Now as my sheep are all a great way off,
I'll quote holy our Koran, if you please.'"
 

At length my patient began, most evidently, to decline. There were various marks on him and in him, of approaching dissolution. When pressed, as I frequently was, to say definitely what the disease was – that is, to give it a name – under which Mr. – labored, I only replied that he was suffering from premature old age. This always awakened surprise, and led to much and frequent inquiry how it was that a man of fifty-eight years could be dying of mere old age. My explanations, whenever attempted, – for sometimes in my pride of profession I wholly evaded them, – were usually, in substance like the following: —

"Mr. – was feeble by inheritance. He never had that firmness of constitution which several of his brothers now possess. Then, too, he was precocious. His body and mind, both of them, came to maturity very early; which, as you know, always betokens premature decay. Men live about four times as long, when not cut short by disease, as they are in reaching maturity. As he was apparently mature at fourteen or fifteen, he might very naturally be expected to wear out at or before sixty.

"But then, in addition to this, he has all his lifetime labored too hard, not only from necessity, but from habit and choice. His ambition, it is well known, has been unlimited, except by his want of strength to accomplish. He has only ceased to labor hard when he had strength to labor no longer, or when it was so dark or so cold or so stormy as to prevent him.

"Then of late years he has had the care and anxiety which are almost inseparable from the work of bringing up a numerous family. It is indeed true that he has not been called to that severest of all possible trials pertaining to the family, the pain of seeing that family or any of its members go materially wrong. Still he has had a world of care; of its effects none are aware who have not been called to the same forms of experience.

"There is one thing more; Mr. – has, at times, taken a good deal of medicine: not alcohol, in any of its forms, I admit, but substances which for the time were, in their effects, almost equally bad for him. He has used tea immoderately, and even tobacco. His constant smoking has been very injurious to his nervous system, and along with other things has, doubtless, greatly hurried on the wheels of life."

Remarks like these had their intended effect on a few individuals, especially such of them as were couched in language with which they were already familiar. On most, however, they fell lifeless and hopeless. What knew they about precocity and its effects on the after life? In short, it was quite doubtful then, and is still more doubtful with me now, whether, on the whole, any thing was gained by attempts at explanation. For example, when I spoke of my patient being worn out, prematurely, by overworking, it was asked by one man, "But how is this? Other men as well as Mr. – have worked too hard, and brought up large families, and perhaps taken a great deal of medicine, and smoked a vast amount of tobacco? Why are they not affected in this way as well as Mr. – ?"

It was not easy to make current the idea that Mr. – was about to die of old age; although partly from conviction, but partly, also, to conceal my ignorance, I still endeavored to promulgate it. It was the only apology I could make for suffering a man to run down and die, without appearing to those around him to be very sick.

But he died, after some time, to my infinite mortification and great regret. I was invited to his funeral, as I was usually to the funerals of my patients. In this case, however, I contrived to be absent. So great was my consciousness of ignorance and so much ashamed was I of my ill success, that I felt as if the veriest ignoramus would be disposed to point at me, and to charge me with having been, practically, the murderer of the much-beloved head of a family, and a worthy and highly respected member of society. But, whether others would deem me culpable for my ignorance or not, I could not avoid the pangs of habitual condemnation.

There were, I grant, a few extenuating circumstances in the case. One or two causes existed, of premature decline, on which, in a work like this, I cannot stop to expatiate. It was also very unfortunate for him that he was accustomed to look on the dark side of things, and to forebode ills, where, oftentimes, none existed.

Notwithstanding my former ignorance and doubt, and numerous misgivings, in cases like the foregoing, I have of late years, on a maturer review, been obliged very frequently to confirm my earlier decisions. In the case which has been detailed in this chapter, I have, on the whole, come to a belief that my first judgment was nearly correct; and that the patient actually perished, as much as men ever do, of premature old age. It is, indeed, very possible that had I pursued a different course in several important particulars, his life might have been prolonged for a year or two. Men have a tendency to become what they are taken to be; and many a person has died much sooner for being taken to be near his end, and treated accordingly. If we would have our patients recover, we must take for granted that recovery is at least possible.

In the case above, I believe I lost reputation, in large measure. Several shrewd people insisted, at the time and long afterward, that I ought to have had medical counsel. Mr. – , they said, was too good a man to lose without a more persevering effort to raise him. They charged me with having got my name up, and having at the same time grown careless. Had he been properly doctored, they said, from the very first, they believed he might still have been alive to ornament and bless society.

CHAPTER XLVII
DAUGHTERS DESTROYING THEIR MOTHER

There are, of course, many ways of destroying or killing people. To kill, with malice aforethought, though sometimes done, is a much less frequent occurrence than killing in the heat of passion, or by carelessness; by leading into bad habits, or by the injudicious use of medicine.

Then, again, there is such a thing as killing by omitting to keep alive. Thus we have sins of omission as well as of commission. If I leave a man in a mill-pond and suffer him to drown, or if I suffer him to take a dose of arsenic or Prussic acid, when I might, with the utmost ease, or even with considerable difficulty, prevent it, – is it not, in a practical sense, to destroy or kill him?

It is certainly within the wide range of human possibility, that a daughter may, without bludgeon or pistol, and even without poison, kill her mother. And it is quite notorious and a plain matter of fact that many a mother kills her own children. It could be demonstrated that thousands, if not tens of thousands of children are destroyed every year by their own mothers; as truly so as if they had received at their hands a quantity of arsenic. Why, then, may not children sometimes kill their parents?

I have known people, in very many instances, kill, in trying to save. I have even known the medical man do this, as may be seen by turning back to Chapter XXX. Then, too, I have known the attendants of the sick, though among their dearest friends, sometimes kill in this very way. In truth, such killing is not uncommon.

One of the most painful instances of this last kind of killing came under my own immediate observation, and was in the range of my own practice.

I was visiting a sick woman, whose only property lay in three or four lovely and loving children. Two of these, who were full-grown daughters, resided in her house and took care of her. She was severely afflicted with typhoid dysentery. Her daughters in turn watched over her, both by day and night, and would not suffer her to be left in the care of anybody else for a single minute. And, in general, their faithfulness was above all praise.

One day, however, disliking the appearances of a part of my medicine, they mutually agreed to throw it into the fire; and the deed was done. They had supposed it to be calomel, as it had the color and general appearance of that drug, and to calomel they had a most inveterate and irreconcilable hatred. It was a hatred, however, which whether well or ill founded, very extensively prevails.

At first, I could not help wondering at the results of my supposed doses of medicine; and indeed it was a long time before I began to suspect the true cause. For, while I verily believed I was employing the only thing which could help her, – one which I then thought ought to help her, – I had the unspeakable mortification of finding her every day growing worse. What could be the possible cause, I often asked myself, of this downward tendency?

While thus perplexed and pained, I accidentally learned that the main ingredient in my plan of treatment – the main pillar in my fabric – had been habitually withdrawn by her anxious but injudicious attendants. I no longer wondered at the threatening symptoms. My only wonder was, that things had not gone wrong with her at a much more rapid rate.

The patient continued to sink from day to day, and to become more and more insensible. The daughters themselves saw her downward tendency, for it could not be concealed. I did not tell the young women of their error at first, although I did so afterwards. It was a most painful duty, but it was one from which I dared not shrink. I hoped and trusted it would be a means of saving some among the coming generations.

I have never met with either of these daughters since that day – for one of them, at least, is still living – without blushing for their sake. They, on their part, appear to be equally affected and agitated. They almost adored their mother, and yet they inadvertently destroyed her. She might have perished, it is true, without their aid; but I rather think she would have slowly recovered.

Let him that readeth understand: It is extremely hazardous for a second or third person to change the doses of a physician's medicine, either by the omission or addition of an ingredient. It would be safer – very much safer – to omit every thing, and leave the disease wholly to nature. The true course, however, in all cases, is to follow the prescription of the physician, to the best of our abilities, or else dismiss him.

I might pause here a moment to animadvert on the unreasonableness of the vulgar prejudice which almost everywhere prevails against calomel. That this drug does great harm, in many instances, is most certain; but that it does more mischief to the human constitution when in the hands of judicious practitioners, than some half a dozen articles of the materia medica I could name, about which complaint is seldom made, remains to be proved. Let us, if possible, prevent the necessity of using any of these two-edged weapons, by so living that disease cannot assail us, and then we shall not, of necessity, be exposed to the danger of medicinal agents, whether calomel or any thing else.

My own principal error in relation to this interesting case, consisted in not telling the attendants of the sick woman, in the plainest language, what my medicines were and how much, in my own estimation, depended on their careful and proper exhibition; that if they should take away or suffer to be taken away, one faggot from the bundle, they would not only spoil their effect, but might, very probably, turn the edge of the sword against the very citadel of life itself. But from the extreme of explaining every thing, in sick families where I was called, I had passed over to that of explaining nothing. Truth here, as elsewhere, usually lies midway between extremes.

CHAPTER XLVIII
POISONING WITH STRAMONIUM

One of my patients was subject to repeated attacks of rheumatism. He was by no means a man of good and temperate habits, and never had been so. And even his rheumatic attacks, though they were now frequently excited by taking cold, or by a sudden strain, as well as by many other causes of no considerable magnitude, often had both a foundation or predisposition in his former and later intemperance.

Let me here say, most distinctly and unequivocally, even at the risk of being charged with repetition, that a large proportion of even these casual or apparently accidental attacks of rheumatism, neuralgia, sick headache, etc., etc., with which our world – the fashionable part of it, at least – is half filled, instead of springing out of the ground, or coming upon us by the special appointment of high Heaven, have their origin in the intemperance, excess, or licentiousness of somebody. The cause may lie many years back, and may be almost forgotten; nay, it may be found in a preceding generation rather than the present. But it lies somewhere in the range of human agency. "Almighty man," as the poet has well said, "decrees it." Solomon never uttered a more palpable truth than when he said: "Because sentence against an evil work is not executed speedily, therefore the heart of the sons of men is fully set in them to do evil."

My rheumatic friend sent for me one day, to come and see him in great haste, for, as the messenger said, he could not long continue in such suffering. I found him in the greatest distress, and after making the usual temporary applications, I gave him what I had never given him before – a pretty full dose of tincture of stramonium. It had, in due time, its accustomed effect, and I left him, rather prematurely, to visit another patient in a somewhat distant part of the town, intending, however, to see him again in the evening.

But I had not been absent more than an hour, before I was sent for in post-haste. As soon as possible I hastened to the spot. I found my patient in a state somewhat peculiar and not easily described. He was evidently affected by the stramonium; but how, I said to myself, can this be? I certainly did not give him an overdose. Besides, as I well knew, the effects, so long as I remained with him, had been decidedly favorable.

The mystery was soon revealed. On finding himself much better, soon after my departure, he had resorted again to the stramonium bottle, which in my haste and contrary to my usual practice, I had left within his reach. The result was a degree of delirium that had alarmed his friends and induced them to send for me.

By means of careful and persevering management, a partial recovery soon took place, though a train of incidental evils followed which it is not necessary here to enumerate. The patient was one of those ignorant and selfish individuals on whom a permanent cure can rarely be effected.

This circumstance taught me one important lesson which ought to have been impressed on my mind long before. It was, not to leave medicine of any kind within reach of my patients or their friends. In many an instance, medicine thus left has been taken by others, under the belief that since it operated favorably in the case for which it had been prescribed by the physician, it would do so in another case which was vainly supposed to be just like it, when, in truth, it was not at all similar.

To the custom of keeping medicine in the house, of any sort, I am equally opposed, and for similar reasons. There will generally be time enough to send for it when its presence is really needed. Such at least is the fact, ninety-nine times in a hundred. And as a set-off against the fact of its being thus useful once in a hundred times, we have to acknowledge the multiplied dangers to which we are exposed, of using it without prescription, and to which we are otherwise exposed by having it constantly before us in our houses.