The Anatomy of Suicide

by Forbes Winslow

His frequent attacks of indigestion made him at times a perfect picture of misery and wretchedness. It clothed everything with a gloomy aspect, made him quarrel with his friends and domestics, and he has been known to say that he sighed for death as a reprieve from mental and bodily agony. Sir Samuel Garth was frequently consulted when he had these attacks; and it was only by exacting a strict attention to diet and exhibiting medicine that he was enabled to restore the mind of the poet to a healthy tone.

This physical ailment, as it often does when long continued, ultimately affected the cerebral functions. At times he had symptoms of pressure on the brain, or at least of an unequal and imperfect distribution of blood to that organ. Spence says, he frequently complained of seeing everything in the room as through a curtain, and on other occasions, of seeing false colours on certain objects. At another period, on a sick-bed, he asked Dodsley what arm it was that had the appearance of coming out from the wall.

When the disposition to suicide is present, the physician should carefully ascertain whether the patient is not labouring under cerebral congestion, or a determination of blood to the head. The loss of a small quantity of blood has frequently been known to remove the propensity to self-destruction. A case is referred to by Schlegel of a woman who was liable to periodical fits of suicidal mania whenever she allowed a redundancy of blood to accumulate in the system. On two occasions she attempted suicide. On the first indications of a return of her delirium, she was generally bled, and relief was instantaneously afforded.

A gentleman who had received, during the peninsular campaign, a sabre cut in the head, felt for some years, whenever he was exposed to great mental excitement, or allowed himself to over-indulge in the use of spirits, a kind of suicidal delirium. Twice he was detected in the act of attempting to commit suicide, and was fortunately prevented from doing so. The local abstraction of blood from the neighbourhood of the head was the only remedy which appeared to subdue the disposition.

The cases which are related in another chapter of individuals who were insane at the moment when the act of self-destruction was attempted, but who recovered the use of their reasoning after having inflicted a wound attended with loss of blood, fully testify the importance of general and local depletion in certain cases of cerebral disease attended by this unfortunate propensity.

A blow on the head has been known to develope this feeling. The affection of the sentient organ may remain latent for many years, and then suddenly manifest itself. A man had received, when young, a kick from a horse, which produced at the time no very urgent symptoms. Six years after the accident, he, without giving any indications of previous derangement of mind, cut his throat. Upon examining the brain, it was found extensively diseased.

A man, feeling the suicidal disposition, bled himself from the arm, and recovered.

It will not be proper in all cases to abstract blood; for the destructive propensity has been known to exist where there has been a deficiency of blood in the brain. The practitioner should examine the condition of the patient thoroughly before he recommends active depletion. Sixty per cent. of the cases of suicide will, however, be found with cerebral disease either of a primary or secondary nature; and to that organ the medical man’s attention should be particularly directed.

The following case happily illustrates the benefits which are sometimes derived from the local abstraction of blood in certain cases of temporary insanity, accompanied with a disposition to commit suicide. “A gentleman,” says Dr. Burrows, “of a very irascible and impetuous disposition, with whom I was intimate, experienced in a public meeting a rebuke which exceedingly mortified him, and made so deep an impression upon his mind, that he was quite miserable. At night, instead of going to bed, he roamed abroad; and at length, early in the morning, without knowing whither he went, he found himself near a sheet of water. The view of it at once determined him to drown himself, and he accordingly plunged in. The action was perceived, and he was rescued from the water, insensible, and immediately conveyed to a place where means of resuscitation were adopted. As his address was found in his pocket, a communication was directly made to his family, and Dr. Burrows was called in to see the patient. He found him in a state of insensibility. As soon as consciousness returned, he was dressed, put into a coach, and Dr. B. accompanied him to his residence. As yet, he had not spoken, neither did he appear to observe anything. The motion of the carriage on the stones seemed to rouse him, and he looked about. He took no notice of those who were in the carriage with him. He soon became violent; his eyes were wild, and rolled in their sockets; his face became flushed; the vessels of the forehead were excessively distended, and all the symptoms of genuine delirium came on.[57] Dr. Burrows ascribed the symptoms to a violent reaction in the vascular system from the state of collapse it had sustained, and ordered the oppressed vessels of the head to be relieved by the application of cupping glasses, and the abstraction of sixteen ounces of blood; the head to be kept cool, and enemata to be administered until the bowels were well cleansed out. After these operations, he soon became passive and disposed to sleep. He slept six hours, and awoke tolerably composed, but not quite coherent. He took light nourishment, and at night awoke perfectly collected, but exceedingly low. The next day he was well, but languid. An explanation was given him, which removed the impression that the offensive part of the speech had given him, and he by degrees recovered his usual state of mind.”

We are inclined to believe, with D’Israeli, “that there are crimes for which men are hanged, but of which they might easily have been cured by physical means.” Damien, who attempted the assassination of Louis XV., and who in consequence was subjected to the most refined tortures, persisted to the last in declaring that if he had been bled, as he wished and implored to be, the morning previously, he never would have endeavoured to take the life of the king.