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JAMA Revisited
January 12, 2016

The Signs and Symptoms of Impending Death

JAMA. 2016;315(2):206. doi:10.1001/jama.2015.17070

To all men death must come soon or late, and there is an old saying that death always comes unexpectedly. But to tell when death will surely occur is the most difficult problem in the whole art of medicine. It is quite true that we know that the ultimate outcome of certain diseases, such as hydrophobia, Addison’s disease, cancer, etc., is death, and that death will occur within a certain more or less definite period of time; yet when we come face to face with the ordinary serious case in practice, how many of us can say that the patient will die of this disease, or that he cannot recover from this illness and will die shortly? In spite of the millions of observations made on the approach of death, the literature on this phase of the subject is almost nil. I am afraid that the public is frequently a better judge of this imminent danger than the physician. I am quite sure that women sense the appearance of the fearful scythe bearer much more keenly than do men. This is particularly true of the woman relative who nurses the sick one, even though we admit that sometimes she conjures up the grim shadow when there is no cause for alarm. If we could mentally see the possibility of death in every severe case, we should less often miss the prognosis.

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