Today’s Vital Yet Truly Morbid Fact!
In classical antiquity, the absence of a heartbeat was the accepted sign of death. The heart was the seat of life: the first organ to live and the last one to die. Breathing was considered just a regulator of the heat of the heart. There was an awareness that the brain influenced reason and sensation, but the brain’s actions were still deemed dependent on the existence of a functional heart. Aristotle taught that a person was an integral combination of body and soul; the soul could not exist without a body, and the death of the body meant the death of the soul. He recognized three parts of the soul with different actions: the vegetative soul regulated bodily vitality, the animative soul controlled motion and sensation, and the rational soul, or the mind, governed the higher mental faculties. The rational soul might die without affecting the vitality of the body; indeed, animals could subsist their entire lives without one. The death of the vegetative soul always caused bodily death, however. Relatively little is known about what criteria of death were actually used in classical antiquity: one would presume that feeling the pulse had a central part, given the emphasis on the action of the heart as the divider between life and death. Immobility, coldness, and incipient putrefaction probably also played a role. Actually, when the classical physician spoke of “signs of death,” he meant the physical signs in Hippocrates’ Prognostikon that death was inevitable; the presence of these signs indicated that the doctor’s work was done. According to the Hippocratic medical ethics, a doctor should then forecast the impending demise, collect his fee, and withdraw from the case. The actual diagnosis of death was left to the nonmedical attendants, often the patient’s own family and relations.
Naturally I had to look up the Prognostikon that was referenced in the above book and it’s well-worth a browse! Here are some excerpts:
“He should observe thus in acute diseases: first, the countenance of the patient, if it be like those of persons in health, and more so, if like itself, for this is the best of all; whereas the most opposite to it is the worst, such as the following; a sharp nose, hollow eyes, collapsed temples; the ears cold, contracted, and their lobes turned out: the skin about the forehead being rough, distended, and parched; the color of the whole face being green, black, livid, or lead-colored. If the countenance be such at the commencement of the disease, and if this cannot be accounted for from the other symptoms, inquiry must be made whether the patient has long wanted sleep; whether his bowels have been very loose; and whether he has suffered from want of food; and if any of these causes be confessed to, the danger is to be reckoned so far less; and it becomes obvious, in the course of a day and a night, whether or not the appearance of the countenance proceeded from these causes. But if none of these be said to exist, if the symptoms do not subside in the aforesaid time, it is to be known for certain that death is at hand. And, also, if the disease be in a more advanced stage either on the third or fourth day, and the countenance be such, the same inquiries as formerly directed are to be made, and the other symptoms are to be noted, those in the whole countenance, those on the body, and those in the eyes; for if they shun the light, or weep involuntarily, or squint, or if the one be less than the other, or if the white of them be red, livid, or has black veins in it; if there be a gum upon the eyes, if they are restless, protruding, or are become very hollow; and if the countenance be squalid and dark, or the color of the whole face be changed- all these are to be reckoned bad and fatal symptoms. The physician should also observe the appearance of the eyes from below the eyelids in sleep; for when a portion of the white appears, owing to the eyelids not being closed together, and when this is not connected with diarrhea or purgation from medicine, or when the patient does not sleep thus from habit, it is to be reckoned an unfavorable and very deadly symptom; but if the eyelid be contracted, livid, or pale, or also the lip, or nose, along with some of the other symptoms, one may know for certain that death is close at hand. It is a mortal symptom, also, when the lips are relaxed, pendent, cold, and blanched.
“It is a bad symptom when the head, hands, and feet are cold, while the belly and sides are hot; but it is a very good symptom when the whole body is equally hot. The patient ought to be able to turn round easily, and to be agile when raised up; but if he appear heavy in the rest of his body as well as in his hands and feet, it is more dangerous; and if, in addition to the weight, his nails and fingers become livid, immediate death may be anticipated; and if the hands and feet be black it is less dangerous than if they be livid, but the other symptoms must be attended, to; for if he appear to bear the illness well, and if certain of the salutary symptoms appear along with these there may be hope that the disease will turn to a deposition, so that the man may recover; but the blackened parts of the body will drop off. When the testicles and members are retracted upwards, they indicate strong pains and danger of death.
“That vomiting is of most service which consists of phlegm and bile mixed together, and neither very thick nor in great quantity; but those vomitings which are more unmixed are worse. But if that which is vomited be of the color of leeks or livid, or black, whatever of these colors it be, it is to be reckoned bad; but if the same man vomit all these colors, it is to be reckoned a very fatal symptom. But of all the vomitings, the livid indicates the danger of death, provided it be of a fetid smell. But all the smells which are somewhat putrid and fetid, are bad in all vomitings.”