Bronchial cold — Aggravated cardiac symptoms — Farewell to SÈvres — Return to the Institute — Protracted sufferings — Intellectual preoccupations — Observations on his own condition — The end — Cremation. If in this sad last chapter I occasionally dwell on details which may seem insignificant in themselves, it is because, at this supreme moment of Elie Metchnikoff’s existence, everything was full of significance, for everything converged to emphasise the powerful unity and the ascending and continuous progress of his ideas. His attitude in the face of illness and death was a teaching, a support, and an example. That is why, relating the story of his last days, I piously describe everything. Towards the end of November, he caught a slight cold, which did not prevent him from leading his usual life, but which, nevertheless, was the starting-point of the illness which took him from us. On the 2nd of December, during a walk, he suddenly felt a cardiac commotion such that he thought he was dying. For hours, his pulse remained intermittent and very rapid, and from that day he felt unwell but continued to go to the laboratory. On the 9th of December his condition became worse and forced him to interrupt his normal life. All the doctors were away or very busy on account of the war, But the disease was making giant strides. In the night of the 12th to 13th a first attack of cardiac asthma supervened, an extremely painful one; we had the impression that the end was near. Elie suffered agonies but remained morally calm and ready for death, as he had ever been since his first heart attack, two years previously. He repeated that he had accomplished his task and run through his vital cycle; that what he could yet do would be but a supplement, and that it was better to die than to outlive his own decadence. He only wished not to suffer too long, but that humble desire was not to be realised. We spent two more nights at SÈvres, terrible nights not to be forgotten if one had centuries to live, and we then decided to go to a nursing home in Paris, as it was imprudent to remain any longer isolated as we were. Having heard of Metchnikoff’s illness, Dr. Roux offered to receive us at the Pasteur Institute in a small lodging which was now free, the house-physician who had occupied it having been killed. Dr. Widal, in whom Metchnikoff had absolute confidence, came to SÈvres on the 14th and found myocarditis. Thanks to an absolutely incomprehensible phenomenon, Elie had suddenly ceased to realise the rapidity of his pulse; he had 160 beats in a minute and only perceived less than half; it was therefore easy to keep the truth from him. After a last night of suffering we left our SÈvres nest, which we had so loved. Leaning on my arm, The automobile bore us slowly from SÈvres to the Pasteur Institute, and we found ourselves in the small flat which had been inhabited by the young doctor who had been killed in the war. He had only spent a short stage of his life there. How long should we remain? And what road should we take when we left it? We tried to smile, though our hearts were terribly heavy, in order to cheer each other. But, in the course of the day, we were surrounded by friends full of solicitude, the tension relaxed, and we felt a growing sense of comfort and security. No more nights of mortal dread and loneliness, with no help at hand! That thought alone inspired courage and hope. In case of need, I had only to send down to the next floor to ask for a doctor. For a few days, Elie felt much better, perhaps on account of the mental relief, but his heart was weak and his pulse extremely rapid. Drs. Widal, Martin, Veillon, Salimbeni, and DarrÉ came to see him every day; during the whole of his long illness, they never ceased to show him the most attentive and devoted care. They attempted by every means to save him from pain, for, alas, they had no hope of curing him. Nothing was neglected, and many still greater sufferings were spared him. The war was an inexhaustible and passionately interesting subject of conversation; Elie read a number of newspapers and listened with avidity to every news from private sources. Often, too, scientific questions were discussed, which continued to interest him intensely. These talks were an invaluable relaxation. Feeling infinitely grateful towards his medical advisers and friends, he showed himself a most docile patient, following their prescriptions with absolute punctuality. When his condition grew worse and he felt no hope whatever of his recovery, he often used to say, “What is to be done? the doctors can do nothing, for medicine is powerless. Unhappily, it will remain so for a long time. Much work will have to be done to rid humanity of the scourge of diseases. But, surely, one day science will succeed in doing so; that will be chiefly through prophylaxis and rational hygiene. There will also be a new science—the science of death; it will be known how to make it less hard.” After lunch and a short sleep, he received the daily visit of his friend Dr. Roux, with whom he talked in the full intimacy of friendship and affection. He confided to him his apprehensions and desires, and felt unlimited gratitude for his kindness to us, often saying to me, with tears in his eyes, “I knew Roux was a kind man and a true friend, but I see now that he is incomparable.” Other friends also did their utmost to serve him and to show their sympathy. He had the great joy of feeling himself beloved and surrounded with an atmosphere of real kindness. Many times he said to me, Yet all the care and devotion of which he was the object could neither arrest the fatal progress of disease nor spare cruel suffering to him who had thought of nothing but relieving the pains of others. All our efforts were as flowers scattered over a tomb; he, poor tortured one, was slowly, consciously sinking into it through the implacable logic of Fate. From the beginning of his illness, he foresaw the issue; he lived in constant expectation of death, on the threshold of which his calm and serenity remained as unalterable as were his patience and resignation. After a temporary and comparative lull, which lasted until the end of December, the disease began to progress again, and almost every week brought a fresh alarming symptom. It was especially during the night that the pain, treacherously, reappeared. After dropping asleep fairly early, he would begin to breathe with difficulty and then awake in an indescribable state of anguish; perspiration drenched his head, neck, and chest, several towels often being required to dry him. His breathing was hard; during bad attacks, the wheezing of his bronchial tubes was terrifying. He would sit up, his hands clenched, his face blue and contracted by suffering, his darkened lips apart, his eyes dilated—the face of a man on the rack. He gasped like a suffocating man; at last a tearing cough supervened, followed by expectoration, and the attack gradually subsided. For a time we were able to relieve him without the use of narcotics. As long as there was a ray of hope But how many were the nights of insomnia and suffering! How many times did he call for death as a deliverer, and say that he resigned himself to live for my sake only! And in spite of the martyrdom he endured, he always had gentle words, a caress, a consolation even! He constantly returned to the thought that he had nothing to complain of, that he had had a large share of happiness and good fortune in having accomplished his task, and even arrived at the development of the natural death-instinct. All those who saw him every day knew that he was courageous and patient, every one admired his serenity, but no one could realise the degree of his courage and patience, for no one had seen and lived through those miserable nights. Often, even, when asked how he was, he said “not bad!” after a terrible night, saying to me afterwards in explanation, “Why grieve them, since it cannot be helped?” At the beginning of our stay in the Institute, he was not yet quite bedridden. After his morning toilet, he would lie for some hours on a sofa, reading almost continuously, newspapers, scientific reviews, and many works in connection with the book he had Another question occupied him at that time, that of first-born children. Certain data led him to think that men of genius were but rarely the first-born of their parents, and he sought for every possible information on the subject. In his constant desire to improve life-conditions, he even thought that a demonstration of this fact might have a desirable influence on the increase of population in France after the war; if it were proved that the most successful children are not the first-born, perhaps the system of having two children only would be given up in order to have a chance of giving the country a more capable population. His reflections on the sexual questions led him to seek for experimental means of studying gonorrhoea. He thought of inoculating the gonococcus into the eye of new-born mice and entrusted M. Rubinstein, the only worker left in the laboratory, with these experiments. The latter began them and obtained encouraging results, but he left Paris in the spring and the work remained unfinished. Metchnikoff’s mind never ceased to work unless He was deeply disillusioned by the Germans. Having always felt great esteem for their scientific work, he had believed in their high culture, and now he was absolutely disconcerted by the mentality which they manifested during the war. Neither could he understand how the war had been allowed to come about. He thought it ought to have been avoided, and considered the authorities guilty for not having done so. He said that nothing could compensate the harm done by this insane butchery. The deserted laboratories, the interruption of scientific work, filled his soul with melancholy. For, he said, all the great, all the real questions should have been solved by Science and were kept waiting.... He also had material worries, the war having brought great perturbation in his affairs. The fate of his mobilised pupils preoccupied him constantly. The least indisposition, however trifling, of those he loved made him unhappy. His sensibility, which had always been very marked, increased still more, and He sought a refuge from his sufferings in his own ivory tower; these sufferings themselves were to him a source of observations. He studied his body and his soul as he would have studied any subject under experiment. Every day he wrote down his auto-observations, and carefully read the diary which I kept for him. During the whole of the winter he had ups and downs. Towards the end of December the cough and respiratory symptoms increased, and at the beginning of January he expectorated clots of blood, due to a passive congestion of the right lung. On the 19th January, some liquid appeared in the pleura on the same side. Pleurisy persisted for a whole month and necessitated three punctures. Every time we feared to tell him that the puncture was necessary, but he received the news with complete coolness, saying that he had always been in favour of radical measures. After the third puncture, which took place on the 19th February, a marked relief supervened, and the improvement lasted for some time; it was the only moment when we saw a ray of hope. Though keeping to his bed, he worked a great deal, read, and received not only his friends but other visitors. At the beginning of March and at the end of April he again expectorated blood, and the terrible, tragical nights began again. Yet the days were fairly good. During that period, he had the pleasure of seeing some of his pupils again, and of receiving several Russian deputies and journalists. They talked to him of political events, of the war, of the moral state of Russia. All that interested him immensely; he plied them with the most varied questions. It must be remembered that, before that interview, we had lost all touch with Russia. During the whole of May he again had ups and downs, but the progress of the disease was indisputable. Tachycardia was constant, urine more and more scanty, the swelling of the legs never decreased, cough and oppression occurred frequently even during the day. Elie awaited his seventy-first birthday with impatience. Often during the night, after a painful attack, he would count the days, hours, and minutes which separated him from that date. At last it arrived. Here are the lines which he added to his notes on that day: 16th May. Against all expectation, I have lived until this day. I have reached my 71 years. My dream of a rapid death without a long illness has not been realised. I have now been bedridden for five months. After several crises of tachycardia, following upon a slight grippe with asthma, I had congestion of one lung with pleuritic exudate. Though some improvement followed after that, nevertheless I am tormented by fits of sweating followed by cough and oppression. My psychical state is twofold. In one way, I should like to get well, but, on the other hand, I see no sense in living any longer. Illness has not provoked in me any fear of death, and I am more deprived than formerly of the joy of living. The reawakening of spring leaves me quite indifferent. There can be no question for me of that pleasure which convalescents often feel, nor indeed of any pleasure. To the despair that I feel in the face of medicine’s powerlessness to cure the ills of my friends is added the feeling of its powerlessness towards my own illness. I think that my desire to recover and to continue to live is connected with practical causes. The war has compromised our finances, our income from Russia has practically disappeared. If I die, my wife may find herself in a very difficult situation. Given her lack of practical notions, that may lead to very sad results. Yet it is quite impossible to straighten our affairs before the end of the war and the re-establishment of normal conditions. These were the last words he wrote in his book of notes; his hand had become weak and trembling; he tired very soon, and henceforth I wrote under his dictation. On the 18th June, one month before his cremation, he dictated to me for the last time, and this is what he said: This is the seventh month that I have been ill and it brings my thoughts back to the gravity of my condition. I therefore continually realise how much satisfaction I have derived from life during my long years. The gradual disappearance of my “life-instinct,” which already began a few years ago, is now more marked, more precise. I no longer feel that degree of pleasure which I felt only a few years ago. My affection for my nearest and dearest shows itself much more by the anxiety and suffering provoked by their diseases and Those to whom I describe my feelings tell me that satiety with living is not normal at my age. To that I oppose the following: Longevity, at least to a certain point, is hereditary. Now I have already mentioned, on the occasion of my 70th anniversary, that my parents, sister, and brothers died before reaching my present age. I knew neither of my grandparents, which shows that they could not have been very old when they died. Let us now turn to the profession, since it is an established fact that it has an influence on the duration of life. Pasteur died at 72, but for a long time he had been unable to do scientific work. Koch did not reach the age of 67. Other bacteriologists died at a much earlier age than I (Duclaux, Nocard, Chamberland, Ehrlich, BÜchner, Loeffler, Pfeiffer, Carl Fraenkel, Emmerich, Escherich). Among those bacteriologists of my generation who are still living the majority have already ceased from working. All that should indicate that my scientific life is over and confirm at the same time the fact that my “orthobiosis” has actually reached the desirable limit. He was anxious to prove that his end, which seemed premature at first sight, did not contradict his theories, but had deep causes such as heredity and the belated introduction of a rational diet. He had only begun to follow it at fifty-three. Facts corroborated him after his death, for the post-mortem examination showed that the heart lesions were of long standing. He himself thought they went back at least to 1881, when he had had a very grave relapsing fever. The doctors even wondered how he had lived with his heart in such a state, and only accounted for it by the strict rÉgime which he had followed during the latter part of his life. And indeed when it is remembered how pugnacious, He was very desirous that the example of his serenity in the face of death should be encouraging and comforting. It should prove that, at the end of his vital cycle, man fears death no longer; it has lost its sting for him. Early in June his condition became still worse. The nights were so painful that, every evening, recourse had to be had to pantopon. After Dr. DarrÉ had finished his complete and thorough medical examination, we three remained talking around Elie’s bed for a short hour. He often recalled his personal or scientific memories when he was not too weary; we talked of the war, of medical questions; often, too, we would evoke, with Salimbeni, recollections of our journey to the Kalmuk Steppes. We loved that peaceful hour, which ended by an injection of pantopon, the only relief, alas, that could be procured for him. He would thank Dr. DarrÉ with gratitude, and drop his poor weary head on the pillow, awaiting in absolute security the blessed sensation of warm heaviness which pervaded him, for he knew that sleep and rest from his sufferings would not be long in coming. The spectre of tragical nights never ceased to haunt us. Until the hot weather came, he was quite comfortable in the small flat in the Pasteur hospital; the temperature there had been perfectly regular all M. Roux then proposed that we should be transferred to Pasteur’s old flat; the rooms were spacious and much cooler. This idea rejoiced and touched Elie very much. As he thanked M. Roux, he said to him: “See how my life is bound with the Pasteur Institute. I have worked here for years; I am nursed here during my illness; in order to complete the connection I ought to be incinerated in the great oven where our dead animals are burnt, and my ashes could be kept in an urn in one of the cupboards in the library.” “What a gruesome joke!” answered M. Roux, really taking those words for a joke. But directly after he was gone Elie turned to me with an anxious look and said, “Well, what do you think of my idea?” I saw by his earnest expression that he meant what he said, and I answered that I thought it a very good idea. The Pasteur Institute had become his refuge, the centre of all his scientific interests; he loved it; he had spent his best years there. Let his ashes be laid there some day; it would be in perfect harmony with his past. Let us only hope that would not be too soon! But why had he given his words that jesting form which must have misled M. Roux? He explained it to me: knowing how deeply conscientious his friend was, he did not wish to express his desire as a dying wish in order that he should feel no obligation. A simple jest, on the contrary, left him absolutely free. On the 26th June, Elie was carried into Pasteur’s flat; it was a very great satisfaction to him, it brought him nearer his laboratory. Now and then, very seldom now, he thought he might return there one Those words were uttered with heart-rending resignation. He continued to get worse.... It was fortunate that pantopon should have given him good nights, for attacks of oppression now supervened several times during the day; tachycardia was continuous, the heart was weakening. The quantity of urine diminished; it often did not surpass 250 cubic centimetres, and no diuretic succeeded in increasing it; the legs remained swollen, ascitis was beginning to become visible; in the night he occasionally grew slightly delirious. At the beginning of July he wished to sit up; he spent part of the afternoon in an armchair, his legs lying on cushions. We thought it was a good sign, but in reality he found it difficult to breathe lying down. Several times he asked me to play to him, very soft music, as noisy sounds wearied him. I On the 9th his temperature went down in an alarming way to 35.2° C. (95 F.). For the first time he would not write down his ordinary observations. “What is the good?” said he, “it has no longer any interest.” Yet the next day he did so, for the last time. On the 11th and 12th he put down his temperature, and glanced superficially at the notes I had written. On the 12th, about five o’clock in the morning, he had a bad fit of breathlessness followed by coughing, and brought up large clots of very red blood. He smiled faintly. “You understand what that means,” he said, adding some tender words. I wheeled him to his bed, which he never left again. On the 13th, in the early morning, he felt very ill. Calmly and gently he warned me to be ready. “It will surely be to-day or to-morrow.” My heart breaking, I asked him why he said that; was he feeling very weak? or suffering very much? “No,” he said, “it is difficult to say what I feel; I have never felt anything like it; it is, so to speak, a death-sensation.... But I feel very calm, with no fear. You will hold my hand, will you not?” How can I describe those last three days? He preserved all his lucidity and serenity, often smiling at me and drawing me towards him. He inhaled oxygen very often, as breathlessness became almost continuous. On the 14th there was to be a matinÉe performance of Manon Lescaut, and remembering that his god-children had long wished to see that opera, he had had a box taken for them. He was now quite uneasy about it. “What ill-luck,” he said, Thanks to pantopon, he spent a very good night. He awoke about five o’clock, but remained so quiet that I thought him asleep. When I rose about six he held out his hand to me and told me he had been awake for a long time. He talked to me tenderly, in the full intimacy of our affection; he spoke sweet, unforgettable words. He made me promise once again not to give way to grief. “At first, our friends will help you, and then work, that infallible remedy, and duty.... You will have that of writing my biography. Remember how much I wish the last chapter to be complete. You alone can write it, for you have seen me all the time; I have told you all my thoughts, and yet....” I understood that he had occasionally, out of pity for me, hidden his sufferings and his sad thoughts. But he did not know how often I guessed what he did not say; love and pain have a dumb language, more eloquent than any human words. “You will hold my hand when the moment comes,” he repeated. “But do not think I am afraid, now that it is near. No, I assure you, I have an absolute serenity of soul! I spent a divine night. It seemed to me that I was already half outside life. This night has taught me many things.... Everything which troubled me, everything that seemed so disturbing, so terrible, like this war for instance, seems so transitory now, such a small thing by the side of the great problems of existence!... Science will solve them some day.” He ceased speaking. He seemed But life is cruel. He lived through two more days of suffering. On the 14th he inhaled oxygen almost continually. He asked for pantopon, but we feared to give him too much. I told him it would induce such continuous sleep that he would not even be able to enjoy it. “But an eternal sleep is precisely what I want! Do understand that now nothing is left to me but pantopon. What is the good of making me last? Is this a life? A few days or a month have no importance when one is not going to recover. And you cannot wish to prolong my sufferings.” His breathlessness increased; he said, “Give me your hand; stay near me!” I knew what he meant; he had the “death-sensation.” His poor hands were hot and warmed my cold ones.... The next day I could not warm his hands, ice-cold for ever. The whole day he awaited with impatience the hour for pantopon. About nine o’clock, when Dr. DarrÉ came in, he said, “Dear DarrÉ, at last!” There was no talk that evening, he was so weary. With what anguish I awaited the stroke of midnight, which ended those two dread days! He had been mistaken by barely one day. The night was not bad, in spite of breathlessness and some fits of coughing. The next morning he felt better. He had not read the papers the day before, to-day I read him the communiquÉs in the Petit Parisien, he said it was enough. He also turned the pages of a book he had recently begun to read, La Science et les Allemands. I told him how pleased I was to see him better. “It is true,” he said, “to-day I have no death-sensation, but I beg you, have no illusions!” Always that preoccupation of breaking the shock for me. He made me bring a pocket-book with some money in it and a few envelopes; in each of them he made me place notes of similar value, then with his already shaking hand, he himself wrote on each envelope the value of the notes multiplied by their number, and explained that it was to help me to find quickly what I should require after the catastrophe. He ate better at lunch than he had done lately; but already at two o’clock the breathlessness increased. Yet he did not look pale; he had preserved his rosy complexion. As he inhaled the oxygen, he was shaken by a hiccough. He pressed my hand. “It is the end,” he said, “the death rattle; that is how people die.” He looked at his watch on the small table, it marked four o’clock. “No,” he said, “it must have stopped. Four o’clock struck some time ago.” And he smiled. “Is it not strange that it should have stopped before I? Go and see what time it is.” I ran out to see the clock from the window of another room; it was twenty minutes to five. I met some one in the passage and asked him to go quickly to fetch one of the Institute doctors. Then I begged Elie not to have such ideas, and tried to cheer him. “But, my child, why do you want to calm me? I am quite calm; I am only stating facts,” he said, adding tender words. At that moment Salimbeni came in. Elie said to him: “Salimbeni, you are a friend; tell me, is it the end?” And as he protested, he added, As I was attending to him I felt him move suddenly, and said, “I beg you, do not make such sudden movements; you know it is not good for you.” He did not answer. I raised my head; his was thrown back on the pillows, his face had assumed a blue tinge, the white of the eyes alone could be seen under the half-closed lids. Not a word, not a sound. All was over. Then an abyss of oblivion.... I saw him again, stretched on his deathbed. He was white, cold, and dumb. His face bore a calm and very serious expression. He looked like a martyr who had at last entered into rest. Death had marked his face with no dread seal. The lids had closed of their own accord, and he seemed to be sleeping after great lassitude; one might have thought that, with his usual kindness, he wished to spare us all too painful an impression.... All through the night and the next morning his face preserved the same expression. In the afternoon Salimbeni performed the autopsy. Then he was laid in his coffin; twenty-four hours had elapsed since the end. Wrapped in a white sheet, which framed his fine face, he had the appearance of a biblical prophet. Now his expression had assumed absolute serenity, It was his final image, a splendid one, the last ... for ever. The bier was closed and covered with a heavy black pall. On life also a blacker and heavier pall had fallen. The light had gone out. Two days later, on the 18th July, he was carried to the cemetery of the PÈre Lachaise, to be cremated in all simplicity, as he had wished. Faithful to his ideas, he had wished for a lay funeral, with no speeches, flowers, or invitations. His bier disappeared into a large sarcophagus; on each side black curtains fell to hide what was going on.... Then one hour of heavy silence whilst the poor body was being consumed by the flames.... A death silence.... And that was all.... The mercurial, vivacious child, good-hearted, intelligent, and precocious; the young man, ardent, impetuous, passionate, a lover of science and of all that was exalted; the mature man, a bold thinker, an indefatigable investigator, eager, generous, tender, and devoted; the old man, in everything faithful to himself, but progressing in serenity, shining with an ever softer light, like a mountain peak in the setting sun; the martyr at last, enduring suffering with patience and resignation, seeing the approach of death without fear, observing it as he had observed life.... The hour of silence was over; the incineration accomplished. Of his body, little was left—a handful of ashes. They were enclosed within an urn and placed in the library of the Pasteur Institute. But his beautiful, ardent soul, his audacious and fertile ideas, all that rich inner life which had developed into a harmonious and puissant symphony, all that cannot be dead, cannot disappear! The ideas, the influence we give to life must persist, must live; they are the sacred flame which we hand on to others and are eternal. |