Progress in Dying

To the Editors:

Neither Robert Darnton’s review [NYR, June 13] nor Philippe Ariès’s book on Western Attitudes toward Death seems to consider death as a biological event. Kulturgeschichte no doubt can make a contribution to our knowledge, but artistic and literary comments on death ought not blithely disregard the inescapable biomedical nature of the event.

Quite rightly, Robert Darton comments that Ariès’s analysis is limited to high culture and the upper classes. We do not know “How the Poor Die” despite George Orwell’s brilliantly written account of his experience in a Paris hospital in the 1920s.

I offer the following comment: Much of the attitude a given society has toward death is based upon its knowledge of biology and medicine and its expectations from the latter discipline. The modern hospital with its antiseptic, carefully screened rooms for the dying and dead reflects the institutionalization of medical technology. Most individuals in urban societies in Western Europe and America expect to die in hospitals, and their attitude to the act of dying is conditioned by that anticipation. Only in the past century has medical skill advanced to such a stage where it became necessary for people of means to enter the hospital for treatment. Until circa 1860-1870 most hospitals were for the “sick poor.” People of average means and the well-to-do were treated both medically and surgically in their own homes and either recovered or died there. A study of hospital architecture will show that private and semi-private rooms were almost non-existent until the middle of the nineteenth century.

I suggest that advances in biomedical technology—call them progress if you choose—were more decisive in modifying the ars moriendi than changes in religious attitude or practice.

William B. Ober, M.D.

New York City