The Anatomy of Suicide

by Forbes Winslow

A lady, shortly after her accouchement, expressed, with great determination, her intention to kill herself. Her bowels had not been properly attended to, and a brisk cathartic was given. This entirely removed the suicidal disposition.

Any irregularity in the action of the uterine organ may give rise to the same inclination. Under such circumstances, emmenagogues will do much good.

German writers dwell much upon the connexion between suicide and derangement of the cutaneous secretion. That this function should also be attended to there cannot be a doubt, although we cannot call to mind any cases of suicide which could be directly traced to suppressed perspiration.

In some cases, a blister applied and kept open in the neighbourhood of the head has effected much good. In other instances, issues have been beneficial, particularly in persons subject to cerebral congestion. There is, however, a condition of brain accompanying the suicidal disposition which may be denominated a state of cerebral irritation, in which bleeding or depletion would be injurious. In such cases, friction on the spine, and the administration of anti-spasmodics, gentle aperients, and alteratives, will be serviceable.

Sufficient attention is not paid to those precursory symptoms which indicate the existence of a disposition to suicide. In two-thirds of the cases that occur, the act is preceded by premonitory signs, which, if attended to, will prevent the developement of the propensity.

With very few exceptions, the mental symptoms are those which are principally manifested in these cases. Lowness of spirits, a love of solitude, an indisposition to follow any occupation which requires exercise of the mind, are generally exhibited. The person’s suspicions become roused; he fancies his dearest friends are regardless of his interests, or are plotting against his life. He takes no pleasure in the family circle. He may be suffering from some evident physical malady, acting through sympathy on the brain, and deranging its functions; and then he will often refer to his disease, and express his utter hopelessness of ever being cured. There is an expression of countenance generally present in a person who meditates suicide, which, if once seen, cannot easily be forgotten. Suicidal mania is easily recognised by the experienced physician. The surgeon of a large establishment in the environs of the metropolis informed me, that in six cases out of ten he could detect, by the appearance of the eye, the existence of the desire to commit self-destruction. A young gentleman, a few days previously, had been admitted into the house as a patient. The surgeon, after examining and prescribing for the lunatic, said to one of the keepers, “You must watch Mr. —— carefully, for I feel assured he will attempt his life.” Everything with which he might injure himself, were he so disposed, was taken from him; but it appears that he had resolved to make away with himself, and had carefully concealed a pen-knife in his boot. On the evening of the day on which he was admitted he made a dreadful gash in his throat, but failed in injuring any large vessel. He confessed that he had determined to sacrifice his life; he said, “It has been pre-ordained that I should fall by my own hands, and I am only fulfilling my destiny by cutting my throat!” Shortly after this he was removed; and as we have been subsequently informed, sufficient care not being taken of him, he eventually succeeded in killing himself.

How difficult it is for the medical man to persuade the friends of a person who has evinced a disposition to suicide, of the absolute necessity of his being confined and carefully watched! A physician, dining with a friend, met by accident a young lady who had exhibited, for a few days previously, a shrewdness of manner that attracted the notice of those with whom she associated. He also observed a wildness and incoherence about her ideas; but what particularly struck his attention was, the peculiar expression of countenance which so often denotes the presence of suicidal mania.[59] He felt convinced in his own mind that the lady meditated self-destruction; and so firmly persuaded was he of the fact, that he seriously spoke to the gentleman at whose table he was dining on the subject, and urged him, as he was intimately acquainted with the young lady’s family, to suggest the propriety of having medical advice, and of carefully watching the movements of the lady. This suggestion was treated with ridicule, and of course the subject was not broached again. Two days after the conversation took place, intelligence was brought that the lady had taken a large dose of laudanum, and had died from its effects! A little prudent caution might have saved the life of this poor unfortunate being.

In cases in which the disposition to suicide has been evinced, the patient ought to be carefully watched, and, under some circumstances, placed under restraint. Men who talk loudly of the effects of moral coercion, and who repudiate the idea of strait-waistcoats &c., have had but little practical experience of the treatment of the insane. Moral discipline has done much good. Deeply should we regret to see the system which has been in force within our own recollection again introduced into our lunatic asylums. In endeavouring to avoid Scylla we have fallen into Charybdis. How many lives are lost in consequence of the patients not being properly secured when they have exhibited a desire to commit self-destruction.

A lady who had attempted to destroy herself was very properly sent to an asylum. Having expressed a determination to avail herself of the first opportunity for carrying her intentions into execution, she was most carefully guarded. She was never allowed to be out of sight; a trustworthy nurse always kept by her side; and in the course of time she was pronounced recovered. But as it was not considered prudent to send her home at once, she was separated from the other inmates of the house, and allowed to reside with the surgeon and matron of the establishment. Even under these circumstances it was thought better not to allow her to be wholly by herself, fearful that the disposition might again suddenly develope itself. She resided with the surgeon for some weeks, and appeared completely well. She expressed much astonishment when told that she had attempted her own life; she was apparently horrified at the idea. She was sitting with the matron one morning after breakfast; the surgeon was going round the asylum, when a child was heard to cry up stairs, as if it had received some injury. The matron immediately left the room; she was not absent three minutes, and when she returned she was astonished to find the young lady had vanished. Immediate search was made for her, but she was not to be found, when, looking behind the curtain in the parlour, the lady was discovered hanging to the cornice! In that short space of time she had succeeded in suspending herself, and was quite dead. Of course we cannot determine whether she had recovered, and this was but a sudden recurrence of the suicidal mania, or whether she had cunningly concealed her ailment for the purpose of throwing her attendant off her guard, and thus being enabled to effect her dreadful purpose. We should be more disposed to accede to the latter solution of the question, knowing the extreme cunning of such lunatics, and the ingenious stratagems they often have recourse to in order to accomplish any mischievous object they have in view.

A person who manifested indications of mental aberration was found in the act of hanging himself. Upon being detected, he promised most solemnly to abandon his rash resolution. He attempted a second time to kill himself by cutting his throat, but the wound was not fatal. He was now placed under the care of a gentleman who had devoted much attention to the treatment of insanity; and, knowing his propensity, the keeper received strict injunctions to watch his movements carefully. Everything by which he could injure himself was removed from his room, he was shaved every day by a barber, and no instrument of any kind was allowed to be in his possession. He was confined for nine months; and it appeared, from what afterwards occurred, that he had, during the whole of this period, been absorbed in the one idea of how he should contrive to commit suicide. He was discovered one morning hanging by the neck from the bedstead, quite dead. How he got possession of the cord which suspended him, puzzled everybody acquainted with the history of the case. At last the enigma was solved. It appears that parcels of books and newspapers had occasionally been sent to him by his family, tied with twine; and he had carefully, and unknown to the keeper, concealed each piece, until he had collected a quantity to constitute a cord sufficiently strong with which to hang himself. For nine months this idea had exclusive possession of his mind; and although he exhibited no apparent symptoms of insanity, he had evidently been contemplating suicide for the period already specified.