The Anatomy of Suicide

by Forbes Winslow

Medical men are, in the most enlarged acceptation of the term, guardians of the public health; and no fastidious desire to avoid saying what might possibly offend the taste of some, ought to keep them from discharging what may be termed a sacred duty. The physical disease, particularly that connected with the nervous system, engendered by the pernicious practice alluded to, frequently leads to the act of self-destruction. We have before us the cases of many suicides in whom the disposition may clearly be traced to this cause. This habit most seriously affects the brain and nervous system; and insanity, hypochondriasis, and melancholia, in their worst forms, are frequently the baneful consequences.

If disease, structural or functional, of the abdominal viscera gives rise to the disposition to commit suicide, it will not require much ingenuity to establish the fact that the habitual indulgence in intoxicating liquors may originate a similar feeling.

It has been already established by statistical evidence, that, in a very large proportion of the cases of insanity admitted into the asylums and hospitals devoted to the reception of this unhappy class of patients, the mental impairment can clearly be traced to habits of intemperance.

The brain and nervous system become materially affected in those who indulge frequently in “potations pottle deep.” Delirium tremens, softening of the cerebral substance, palsy, epilepsy, extreme hypochondriasis, are daily witnessed as the melancholy effects of intoxication.

M. Falret knew the case of a man who always felt disposed to cut his throat when under the influence of spirits. No reasoning could induce him to abstain from his favourite draught. The inevitable consequences were pointed out to him; he was reasoned with, and threatened with confinement in a mad-house; but nothing had the desired effect. One Sunday evening, after having drunk several glasses of spirits, although not sufficient to produce complete inebriation, he stabbed himself to the heart, and died in a few minutes.

Incurable indigestion and organic disease of the liver are very commonly met with in habitual drunkards. In such persons, the constitution of the mind appears to undergo a complete change. At first it may not be perceptible, and the patient may not be conscious of it himself, but the mental disease will, sooner or later, unequivocally evince itself.

In such cases, the medical man has fearful odds to contend against.

A young man, who had become insane in consequence of long continued intoxication, made violent efforts to maim himself, and especially to pull out his right eye, which appeared to give him great offence. Rest, temperance, seclusion, the application of half a dozen leeches to the temple, and a few doses of opening medicine, restored him, in about a fortnight, to the full possession of his faculties.

Many cases of suicide, in those who have a natural predisposition to it, arise from the brain sympathizing with the liver; nor can this be a matter of surprise to any one who has felt the depression of spirits incident to disease of that organ. So many cases have occurred from this cause, that some writers, from not finding, on subsequent dissection, any organic lesion of the brain, have referred it to diseased viscera only. But as we find that the insanity ceases when the liver is restored to health, there is no reason for supposing that the mental alienation is, in these instances, any other than the effect of disease of the brain.

J. C., about fifty years of age, was insane for two years. He was formerly in respectable circumstances, and employed in the situation of writer in an office. He made several attempts on his life. He had been in the habit of drinking spirits very freely, and had a disease of the liver which appeared of some standing. At the time of his admission into Hanwell asylum, under the care of Sir W. Ellis, he was in a most emaciated state; his legs scarcely able to support him. His face and body also were covered with an eruption; tongue furred; his stools very dark: he was much depressed, and always moaning most piteously; complained of heat and numbness in his head, and pain in all his limbs. Leeches and cold lotions were applied to his head, his bowels opened by calomel and colocynth, and he went into the warm bath every other day. He was much relieved by these means. He still continued, however, to moan as before. His tongue remained furred, and stools unhealthy. He took five grains of blue pill every alternate night for some time. These were then left off awhile; no improvement taking place, he began the pills again, and continued them for two months, with evident advantage. His tongue was clean; he was less depressed; became strong, and gained flesh; the biliary secretions were much improved. He is now occupied in the office; and every day, as the action of the liver seems to improve, his mind makes a corresponding advance.