Henry V sign
A curious physical sign, recognized for centuries in literary and artistic works. It will be familiar to experienced clinicians, but not by name.
DescriptionA curious physical sign, recognized for centuries in literary and artistic works. It will be familiar to experienced clinicians, but not by name. It consists of continual grasping or fumbling with bed clothes, seemingly for some imaginary substance. It is often observed in seriously ill or delirious patients and in those otherwise close to death. Most often seen by physicians caring for the terminally ill, the sign is typically exhibited by patients who are within days or hours of death. It is known by the cold words, carphology - picking at bed clothes - and floccilation - picking at imaginary objects.
The sign was well known to Shakespeare, Flaubert and Tolstoy. Indeed, most of the great writers had much to say about doctors, diseases, life and death.
Four hundred years ago, William Shakespeare knew that disorientated fumbling with bed clothes heralded death. Mistress Quickly announces the death of Falstaff, stating that she saw him ‘fumble with the sheets and play with flowers and smile upon his fingers’ ends’ and that she ‘knew there was but one way’ (Shakespeare W. Henry V, Act II, Scene III.).
Gustave Flaubert (1821-1880), a surgeon’s son, also knew the sign heralded imminent death, and in 1857 in Madame Bovary, eloquently described Emma on her death bed: ‘Emma, her chin sunken upon her breast, had her eyes inordinately wide open and her poor hands wandered over the sheets with that hideous and soft movement of the dying, that seems as if they wanted already to cover themselves with the shroud. Emma committed suicide by taking
Leo Tolstoy (1828–1910) recorded the same sign in Anna Karenina published in 1878. The death of Levin’s brother Nikolai from tuberculosis is predicted by Maria Nikolayevna: ‘he has begun picking at himself, as if pulling at the folds of a woollen dress. Levin had notices how all day ‘the patient kept clutching at himself as if trying to tear something away.
The portrayal of grasping at bed clothes has been recognized by others as a common deathbed scene; it has appeared in other literary works and in works of art, the most notable example of the latter being that of Francisco Goya’s Self portrait with Dr Arrieta in 1820.
Why name this simple gesture? Does it matter? What matters, to borrow from George Orwell (1903-1950), are ‘individual relationships, and a completely helpless gesture, an embrace, a tear, a word spoken to a dying man, could have value in itself’. In the cold impersonal arena of evidence-based everything, a literary eponym can humanize, lend familiarity and personalize the medical encounter, for the carer and for the patient.
We thank Betty Johannsmeyer, Panketal Germany, for submitting the below article, which is the only source for this entry:
F. Shanahani, C. Houlihani and J. Charles Marks:
• In praise of the literary eponym—Henry V sign. QJM, January 2013, 106 (1): 93-94.
BibliographyGustave Flaubert (1821–1880):
• Madame Bovary. Michel Lévy Frères, 1857.
The book was first serialized in La Revue de Paris between
October 1 1856 and December 15 1856,
• Anna Karenina. Moscow, 1878.
First published in the journal Russkiy Vestnik in the years
1873-1877, then in book form in 1878.
• 1984. A Signet Book. 1948.