The learned doctor relates the following cases in illustration of his views:—
“A respectable tradesman, between fifty and sixty years of age, of temperate habits, was knocked down during an electioneering contest, and struck his head on the ground. He was stunned for a few minutes by the shock, and slightly bruised above the right temple, but experienced no further inconvenience, and the circumstance was considered of no consequence.
“About six months after the event, he was seized, one evening, with rigors and a pain over the right brow; a smart reaction took place, which terminated in perspiration, and the following morning, the symptoms disappeared. A similar paroxysm came on daily for five or six days; the attack was considered intermittent, and, I believe, bark was freely administered. At the end of a week, the patient was well. After this period, he was subject to occasional pain over the right brow, accompanied with great mental despondency, the prevailing apprehension being that of eternal damnation. This state would continue for an uncertain time, the duration varying from a few days to three weeks; and by slow degrees he would lose all trace of disease, regain his accustomed cheerfulness, and be able to transact the affairs of an extensive business.
“About two years from the occurrence of the accident, I saw him, at the request of his friends, while he was labouring under great despondency, which his relations assured me arose from some religious opinions he had imbibed; and I found that the medical treatment had been in accordance with such a notion. My inquiries led to the detection of the injury he had received two years previously, but neither the patient nor his friends would allow that there was any connexion between the blow and the symptoms under which he now suffered. Both general and local bleeding appeared to me necessary; a strict regimen was adopted, and he regained his usual flow of spirits, and expressed himself much better than he had been for years. The occasional use of leeches, and a rigid abstinence from fermented liquors, spirits, and stimuli of all kinds, maintained this favourable condition for a considerable time; but his occupation led him to occasional excess in diet, and a moderate quantity of wine or beer invariably brought on despondency and its accompanying hallucination; in other words, when the system was kept in a tranquil state, the cerebral functions were not impaired; but when excited, the morbid manifestations of the mind were produced.
“During one of these attacks he cut his throat, and expired in the course of a few hours. A short time previous to his death, when greatly exhausted by the loss of blood from his wound, his intellect was unclouded, and he expressed to me his astonishment at what he had done, and assured me he had no reason for acting thus; but it was an impulse which he could not resist.
“The only abnormal appearance upon inspecting the body after death was, a circumscribed adhesion of the dura mater to the pia mater, to the extent of about two inches in diameter, over the upper and anterior portion of the right hemisphere of the brain, opposite to the spot where the blow of the head had been inflicted some years previously.
“I will not presume to offer any comment on a case which I am well aware presents nothing unusual, my only object being that of calling particular attention to those slight injuries of the head which, although unmarked by any striking symptoms at the moment of their occurrence, may give rise to the most distressing results years after their infliction, and when the original cause of disordered action is forgotten, and can no longer be detected; and of pointing out the possibility that many cases of suicide, apparently referrible to moral causes only, may be found to result solely from physical derangement of the organ through which the manifestations of the mind must be displayed. It is under circumstances of this kind that the medical philosopher, in his painful duty of exploring the relics of mortality, may have the high gratification of protecting the memory of an unfortunate individual from the censure of a world but too apt to judge harshly, and thus afford a lasting consolation to those by whom that memory will be cherished and revered.”
No complaints can be more insidious than those connected with the brain. An apparently slight blow on the head in early life has been known, if not to give rise at the time to actual disease of the sentient organ, to predispose the person to attacks of cerebral derangement when exposed to the influence of causes so trivial as to be incapable, under any other circumstances, of producing any effect. The following case will demonstrate that moral irritation may derange the structure of the brain as effectually as any physical injury:—
A gentleman in early life was exposed for a few weeks to an amount of mental excitement almost sufficient to bring on a severe maniacal attack. He complained for some time of a sensation in his head as if some person was hammering on his brain. In the course of a few years he apparently recovered. During a tour through Italy, he had a renewal of his old sensation, and became liable to head-aches, giddiness, and severe attacks of indigestion. He placed himself under the care of an Italian physician of eminence, who did his best to restore him to health. Instead of improving, the symptoms of his disease became more apparent; and one morning he was found dead on the floor of his dressing-room, having with a penknife effectually divided the carotid artery. On examining the brain, extensive ramollissement was discovered. In this case the structural disease originated in a moral shock, the effects of which remained suspended for some years, and then gave rise to the train of symptoms that drove the unfortunate man to terminate his life. It is one of the most important facts connected with this subject, that mental excitement may produce as extensive and serious organic disease as that which so commonly follows the receipt of physical injury. With a knowledge of this fact, how cautious we ought to be in pronouncing an opinion as to the absence of disease of the brain in cases of suicide resulting from an apparently trifling departure from mental quietude, without being intimate with the previous history of the individual.
“The English,” says Montesquieu, “frequently destroy themselves without any apparent cause to determine them to such an act, and even in the midst of prosperity. Among the Romans, suicide was the effect of education; it depended upon their customs and manner of thinking: with the English, it is the effect of disease, and depending upon the physical condition of the system.” A young man, twenty-two years of age, was intended by his parents for the church. He disliked the profession exceedingly, and absolutely refused to take orders. For this act, at once of integrity and disobedience, he was forced to quit his father’s house, and to exert his inexperienced energies for a precarious subsistence. He turned his thoughts to several different employments; and, at length, he went to reside with a family, where he was treated with great kindness, and where he appeared to enjoy a degree of tranquillity. His enjoyment, however, was not of long continuance, for his imagination was assailed by gloomy and distressing reflections. His life became more and more burdensome to him, and he considered by what method he should put an end to it. He one day formed the resolution of precipitating himself from the top of the house, but his courage failed him, and the execution of the project was postponed. Some days after, he took up a pistol with the same design of self-destruction. His perplexities and terrors returned. A friend of this unhappy youth called upon Pinel one day to inform him of the projected tragedy. Every means of prevention were adopted that prudence could suggest, but the most pressing solicitations and friendly remonstrances were in vain. The propensity to suicide unceasingly haunted him, and he precipitately quitted the family from whom he had experienced so many proofs of friendship and attachment. Financial considerations prohibited the suggestion of a distant voyage or a change of climate. He was therefore advised, as the best substitute, some constant and laborious employment. The young melancholic, sensibly alive to the horror of his situation, entered fully into Pinel’s views, and procured an engagement at Bled Harbour, where he mingled with the other labourers with a full determination to deserve his stipulated wages. But, completely fatigued and exhausted by the exertion of the first two days of his engagement, he was obliged to have recourse to some other expedient. He entered into the employment of a master-mason, in the neighbourhood of Paris, to whom his services were peculiarly acceptable, as he devoted his leisure hours to the instruction of an only son. No situation, apparently, could have been more suitable to his case than one of this kind, admitting of alternate mental and bodily exercise. Wholesome food, comfortable lodgings, and every attention due to misfortune, seemed rather to aggravate than to divert his gloomy propensities. After the expiration of a fortnight, he returned to his friend, and, with tears in his eyes, acquainted him with the internal struggles which he felt, and the insuperable disgust of life, which bore him irresistibly to self-destruction. The reproaches of his friend affected him exceedingly, and, in a state of the utmost anxiety and despair, he silently withdrew, probably to terminate a hated existence by throwing himself into the Seine.