A QUESTIONNAIRE AND A PLEA FOR A NEGLECTED STUDY[2]

Is it possible to watch the "vital spark of heavenly flame," as it quits "this mortal frame" and not be overcome by the mystery of death as the termination of that even greater mystery, life? Is there inspiration in the pagan emperor's address to his soul—those Latin verses which Pope has so beautifully translated?

To the speculative philosopher death may have a different significance, and one not altogether included in that given to it by the physiologist. To the former it is a subject for transcendental speculation; to the latter it is the terminal stage of that adjustment of internal and external relations which, for Spencer, constitutes life. For us its primary and immediate significance is purely mundane, yet it deserves such serious study from a practical viewpoint as it seldom receives.

What is death? When does it actually occur? How can it occur when the majority of cells in the previously living organism live on for hours or for days or, under certain favoring circumstances, retain potentialities of life for indefinite periods? These and numberless related questions constitute a line of inquiry that may well call for a separate department of science. Pondering in this wise, I long ago coined an expression which years later I found had been incorporated in the scientific dictionaries, though never before heard by me or encountered in my reading. "Thanatology" is this word, and it may be defined as the study of the nature and causes of death. Inseparable from it, however, are certain considerations regarding the nature and causes of life. Yet I would not introduce a compound term such as "biothanatology," wishing so far as possible to limit the study and the meaning.

Let us ask ourselves a few more questions. Does life inhere in any particular cell? In the leukocytes? In the neurons? Both are capable of stimulated activity long after the death of their host. In fact, by suitable electric stimulation, nearly all the phenomena of life may be reproduced after death, save consciousness and mentality alone. Do these then constitute life, and their suppression or abolition death? If so what about the condition of trance, or of absolute imbecility, congenital or induced? Or, again, how can a decapitated frog go on living for hours? Is it perhaps because the heart is the vital organ that the hearts of some animals will continue to palpitate for hours after their removal from the bodies? Yet the animals which have lost them certainly promptly die. Suddenly stop a man's heart-action by electrocution, or the guillotine, or a bullet, and he dies, we say, instantly. Let it stop equally suddenly under chloroform and there is a period of several minutes during which it may be set going. Let a man apparently drown and this viable period becomes even longer—say a goodly fraction of an hour. During the interval is he alive or dead, or is there an intermediate period of absolutely suspended animation? And if so, in what does it consist?

Is there a vital principle? If so what is it? Is such a thing conceivable? Can such a concept prevail among physicists? Can we consent even to entertain in this direction the notion of what is so vaguely called "the soul?" Of course, those who talk most lucidly about the soul know least about it, and no man can define it in comprehensible terms; but can consideration of the soul (whatever it may be) be omitted from our thanatology? Probably not, at least by many thinkers who cannot segregate their physics from their theology. Sad it is that theology, which might be so consolatory had it any fixed foundation, should be utterly impotent when so much is wanted of it. Theology, however, has little if aught to do with thanatology.

Is protoplasm alive? If so, then why may we not believe, with Binet, in the psychic life of micro-organisms? He seems to have advanced good reason for assuming that we may do so, albeit such manifestations in either direction may be scarcely more than expressions of chemiotaxis. But if protoplasm be alive in any proper sense, as it would appear (else where draw the line?), just when does it so appear and whence comes its life? If it be alive, then life inheres in the nitrogen compounds composing it, or else is an adjunct of matter, imponderable, elusive, something un-conceivable if undeniable. The vitalists are of late perhaps attaining an ascendency which for decades they had lost, since they maintain that life is not to be explained by chemical activities alone. And yet it is possible to set going in the eggs of certain sea animals the phenomena of life, or to liberate them by certain weak solutions of alkaline cyanides, without the pressure or assistance of fructifying spermatozoa. In such cases life or death are determined by ionization and certain chemicals, or by their absence. Where then, again, is the vital principle? Or is it inherent in the ion, and was Bion correct when he said "electricity is life?"

The life of a cell is then necessarily quite distinct from the life of its host, nor can the latter be composed simply of the numerical total lives of its components. Some lower animals bear semidivision, in which case each half soon becomes a complete unit by itself. Others seem to bear the loss of almost any individual part without loss of life, and it is hard to say just which is the vital part. The central pumping organ is perhaps the sine qua non, when it exists. But when non-existent, then what?

Again, while a living organism may be artificially divided into viable portions, no method seems known by which a series of separate cells may be, as it were, assembled or combined into one, of which a new unit may result from assemblage or combination. The more highly specialized or complex the cell, the more easily does it part with life, and the more difficult becomes its preservation and its reproduction. We may assume that after the death of a man his most specialized cells are the first to die, or more, that their death has perhaps preceded his own. In the ante-mortem collapse seen in many diseases and poisonings, has not this very thing occurred, i. e., that the patient has outlived his most important cells? Certainly when a patient dies of progressive gangrene he has outlived, perhaps, a large proportion of his millions of competent cells. Viewed properly, what a strange spectacle is here presented! Perhaps twenty per cent. of his cells actually dead, the rest bathed in more or less poisonous media, still their host endures yet a little while. "Behold, I show you a great mystery." About which of the poisoned cells does the flame of life still flicker?

The life-giving germ-and sperm-cells may exist and persist for some time after the body dies, as numerous experiences and experiments have shown. Ova and spermatozoa do not die the instant the host dies. And herein appears another great mystery, that cells from the undoubtedly dead body may possess and unfold the potentialities of life when properly environed. Among the lower forms of life cells but slightly differentiated go on living and even creating new organisms, though the larger organisms be dead. Moreover, in what way shall we regard the division of one ameboid cell into two, equally alive and complete? Here two living organisms are made out of one, without death intervening, and by permutation alone may one calculate, through how few generations cells need pass in order to be numbered by millions, without a death necessary to the process.

Thus far we have had in mind life and death in the animal kingdom alone. But most of what has been said, and much that has not, is equally true in the vegetable kingdom. Even in the mineral kingdom—as some think—the invariable and inevitable tendency to assume definite crystalline form represents the lowest type of life. Indeed it might fall in with Spencer's definition as evincing a tendency to adjust internal to external relations, though exhibited only after such ruthless disturbance as liquefaction by heat or solution. But then, is not every disturbance of relations "ruthless," because it follows inexorable habits of Nature? Even a crystal will reform as frequently as appear certain other phenomena of life, if made to do so. Were atoms alive they would suffer with every fresh chemical change, and who knows but that they do?

But in the vegetable world we certainly have all the features of life and death in complete form: fructification of certain cells by certain others, development in unicellular form or in most profuse and complex form, a selection of necessary constituents of growth from apparently unpromising soil, and the production of startling results. Does not the sensitive plant evince a contact sensibility almost equal to that of the conjunctiva? And who shall say that it does not suffer when rudely handled? Does not the production of the complex essential oils and volatile ethers which give to certain flowers their wonderful fragrance, indicating what strange combinations of crude materials have been effected within their cells, show as wonderful a laboratory as any concealed within the animal organisms? Yet death comes to these plants with equal certainty, and presents equally perplexing mysteries. When dies the flower? When plucked and separated from its natural supply or when it begins to fade (a period made more or less variable by the care given it), or when it ceases to emit its odor? And is then death a matter of hours? When the floral stem was snapped what else snapped with it? At what instant did the floral murder occur?

Every seed and every seedling possesses marvelous potentiality of life, and so long as it does we say it is not dead; nor yet is it alive. It resists considerable degrees of heat, will bear the lowest temperature, will remain latent for long periods, and still its cells will instantly respond to favoring stimuli. Its actual life is apparently aroused by purely thermic and chemical (electrionic?) activities environing it. In what do its life and its death consist?

But life and death are influenced—we say "strangely" only because it all seems strange to us—by uncommon or purely artificial conditions. Radium emanations have always an injurious effect on embryonic development. Under their influence, for example, the eggs of amphibia become greatly disturbed. Cells that should specialize into nerve, ganglion and muscle fail to develop, and consequently there may be produced minute amphibian monsters, destitute of nerves and muscles, but otherwise nearly normal. Hertwig has submitted the sperm-cells of sea urchins to these rays, without killing them, but invariably with consequent abnormal development.

The effect of cathode or x-rays is even more widely recognized and has been more generally demonstrated. They seem to possess properties injurious to most cell-life and even fatal to some.

Still more puzzling, and weird in a way, are the results of experiments, now widely practiced, which have to do with juggling, as it were, with ova, larvÆ and embryos, by all imaginable combinations of subdivision and reattachment of parts, so that there have resulted all kinds of monstrosities and abnormalities. To such an extent has this laboratory play been carried that almost any desired product can be furnished—living creatures with two heads, two tails, or whatever combination may be determined.

Among the most remarkable of these efforts have been those of Vianney, of Lyons, who has shown that it is possible to remove the head end of several different insect larvÆ without preventing their development and metamorphosis into the butterfly stage. In Bombyx larvÆ, for example, the butterflies arrived at the mature stage, with streaked wings and beautiful coloration, but almost headless. These anencephalous insects lived for some time.

Few animals survive exposures of any length to a temperature much over 150 F., and most of them are killed by considerably less heat. Freezing has always been considered equally fatal. Gangrene is the common result of freezing a part of the human body, and that means local death. Extraordinary pains must be taken with a frozen ear or finger if its vitality is to be restored. And so even with the hibernating, or the cold-blooded animals, a really low temperature has been generally regarded as fatal.

But the recent experiments of Pictet, who did so much in the production of exceedingly low temperatures, freezing of gases, etc., have shown some startling results in the failure to kill goldfish and other of the lower animals by refrigeration. For instance, goldfish were placed in a tank whose water was gradually frozen while the fish were still moving therein. The result was a cake of ice with imprisoned supposedly dead fish. This ice was then reduced to a still lower temperature, at which it was maintained for over two months. It was then very slowly thawed out, whereupon the fish came to life and moved in apparently their normal and natural ways as if nothing had happened.

This confirms Pictet's early experiments and convictions, that if the chemical reactions of living organisms can be suspended without causing organic lesions the phenomena of life will temporarily disappear, to return when conditions are again as usual. It is worth relating that his fish frozen in this way could be broken in small pieces just as if they were part of the ice itself.

How often during these recent decades when events have seemed to move faster, when discoveries and inventions have been announced at such frequent and brief intervals that we fail to note them all for lack of time, when haste and rush characterize habits alike of life and thought, do we find that we simply must stop, as it were for breath, while we unload a large amount of accumulated mental rubbish and clear a space in our storage capacity for up-to-date knowledge! It is a decennial mental house-cleaning process. We must unlearn so much of that which ten to forty years ago we so laboriously learned. We must adopt new and improved reasoning processes. But it is hard to do all this. For instance, as a boy I learned the old chemistry quite thoroughly. During a subsequent interval, when I did not need to study it, came the new chemistry, and when I again required it I had not only to study a practically new science—which was not so bad—but to rid my brain of much that had really found firm lodgment there, and this was difficult or impossible. So it is with one who, having been brought up on Euclidean geometry, finds himself confronted with the comparatively new non-Euclidean, and who has then not merely to forget, but to unlearn all those fundamental axioms which seemed so plain and so indisputable, that is, if he would accept the teachings of Bolyai and others. For example, that a straight line is not necessarily the shortest route between two points shocks our Euclidean orthodoxy, and is at the same time, to us, inconceivable; as also that parallel lines indefinitely prolonged may touch, and the like; likewise the concept of four-dimensional spaces, or worse yet, n-dimensional. And now, in somewhat like manner and to a certain degree, must we revise our previous conceptions of death, at least to this extent: Not that we yet know much better than we did what it really is, but that we know more about what it is not. Even save, perhaps, in its instantaneous happening it is but a step toward dissolution, usually not the first, certainly not the last, but yet the most conspicuous.

Death is in many respects a biochemical fact. It is so intertwined with ionic changes in the arrangement of matter that we may hope for more information regarding some of its aspects as knowledge of the latter accumulates.

But, evidently, we need to clarify our notions as we rearrange our facts. Somatic death is, after all, a most complex process. It may be shortened by instant and complete incineration, but scarcely in any other way. Even dynamite would scarcely simplify the problem. As to conscious death, that is probably (though not certainly) a matter of seconds only or possibly fractions of a second. While we have no accurate appreciation of what constitutes consciousness, nor even just where it resides, the central nervous system appears to be its most probable seat. But conscious death may occur almost instantly without injury to this system, as when a bullet passes through the thorax and the heart, without injuring the spine.

But what is it that suddenly checks all concerted and interdependent activity? Or does something or some controlling agency suddenly leave the body?

A recent theory, having features to commend it, is to the effect that life is a property or a feature of the ultimate corpuscles which compose the atom. Since these corpuscles bear to their containing atom a relative size comparable to that of the tiniest visible insect winging its way in a large church edifice, the intricacies of this particular theory readily appear. But it does seem as though among ourselves life has much to do with the hitherto neglected and despised nitrogen atom or molecule, since life inheres par excellence in nitrogen compounds. Moreover, vitality is conspicuously a feature of those chemical elements which have the lowest atomic weight, while at the other end of the table of atomic weights stands radium, of whose destructive emanations I have already spoken.

Another phase of the general subject of thanatology was suggested especially by Osier, who a few years ago called attention to the fact that but few, if any patients really die of the disease from which they have been suffering. This is not a paradox, and needs only reason and observation to confirm it. His statement was a preliminary to the consideration of terminal infections and toxemias, which of itself would be sufficient to erect thanatology into a dignified special study. Take, for instance, a patient who has long suffered from diabetes. The end is characterized by coma, i. e., an evidence of profound toxemia, and is in large measure due to acetonemia. A patient with chronic Bright's disease dies of uremic poisoning, or one with pneumonia dies of genuine heart-failure. The terminal stage of cancer is, again, toxemia of one kind or another, according as it has interfered with digestion, with respiration, or some other vital function, or has broken down, thus saturating the patient with septic products.

This aspect of the subject will bear any amount of study and elaboration, and its mention here should be sufficient for my purpose. Accordingly as it is properly appreciated, it will be recognized as having an important practical bearing, since, if we may foresee the direction from which the final danger threatens, it may be the better and the longer averted.

Another very important and practical subject is wrapped up in this one, namely, the utilization of apparently dead, or at least of only potentially living material (tissue) in the various methods of grafting or transplantation, which are to-day a part of the surgeon's work. The methods are themselves a transplantation of experiences gained by work in the vegetable kingdom. What wonder that the marvels revealed in one department should have incited work along parallel lines in the other? That flowers and fruit of one kind may be made to grow on a tree of a very different kind excites but a small amount of the astonishment it deserves, mainly because it is now a common occurrence, though properly regarded it might seem a miracle.

Differing only in minor respect is, for example, the removal of thyroidal tissue from one human being and its implantation into another, with functional success. One may ask just here, how is this matter concerned with thanatology? And the reply is: If this tissue were taken from a fresh corpse it would be by most people regarded as dead tissue. If so, does the dead come to life? Without violating the proper scientific use of the imagination one may fancy something like the following: Let a healthy young woman meet accidental and instantaneous death. It would be possible to use no inconsiderable portion of her body for grafting or other justifiable surgical procedures. The arteries and nerves could be used, both in the fresh state, and the former even after preservation, for suitable transplantation or repair work on the vascular and nervous systems of a considerable number of other people. So also could the thyroid, the cornea, the ovaries and especially the bones. All the teeth, if healthy, could be reimplanted. With the thin bones, ribs especially, plastic operations—particularly on the noses—of fifty people could be made. And then the exterior of the body could be made to supply any amount of normal integument with which to do heterologous dermatoplastic operations, or would furnish an almost inexhaustible supply of epidermis for Thiersch grafts, which latter material need not be used in the fresh state, but could be preserved and made available some days and even weeks later. A portion of the muscles might possibly be made available for checking oozing from bleeding surfaces of others, if used while still fresh and warm, and possibly portions of the ureters or some other portion of the remains might be utilized for some unusual purpose. Then what extracts or extractives might be prepared from other parts of the body, pituitary, adrenals, bone-marrow, etc.? The tendons might also be prepared for sutures. Every one of these procedures would give promise of success, the technic being in every respect satisfactory.

But the possible limit is not yet reached, since with each kidney might be carried out experiments like those feats of physiologic jugglery such as Carrel has shown us, by implanting one, say in the neck, connecting up the renal with the carotid artery, and the renal vein with the jugular, while some receptacle would have to be provided as a terminal for the ureter.

This is, after all, not a fantastic dream, nor such an extreme picture as would at first appear, since every organ or tissue above-mentioned—and more—has been used as indicated, and with success.

But imagine the dead body affording viable products, even indirectly life itself, to (possibly) so many others! Does this complicate the study of death? And what must become of the simple credulous faith of the zealot who believes in the actual and absolute resurrection, at some later date?

There is something more than mere transcendentalism in the science of thanatology; it has a plausible medico-legal and pragmatic import. Right glad should I be if I might arouse a deserved interest in it.

How may I more fittingly conclude than by quoting a few lines from our own Bryant's "Thanatopsis":

Though were I minded to rehearse certain difficulties met in the preparation of this paper, which I have long had in mind, I might also add the following lines from the same poet's "Hymn to Death":

One may well quote, at this point, Lamartine, who asked, "What is life but a series of preludes to that mystery whose initial solemn note is tolled by death?" (On this theme Liszt built up that wonderful symphonic tone poem "Les Preludes.")

Even infinity is now questioned by the mathematicians. This being the case, where shall we, where can we stop?

Note.—While writing the foregoing paper there came to my notice the recent book "Death; Its Causes and Phenomena," by Carrington and Meader (London, 1911). It is interesting, but save that it contains a helpful bibliography, is of little assistance to one wishing to pursue the study from its pragmatic aspect. One of the authors is committed to a personal theory that death is caused by cessation of the vibrations which during life maintain vital activity; the other that death is, as it were, the culmination of a bad habit of expectancy that something of the kind must occur, into which we have fallen, in spite of the fact that other living beings below man undergo the same fate, though not capable of expecting anything.