“I placed him in charge of a careful keeper. It was agreed that he should be removed into lodgings in the environs of town; and he therefore submitted to the necessary medical treatment.
“He remained two days at home, till lodgings could be procured, during which he was calm and rational; but there existed the suicidal eye, which sufficiently denoted that he was not to be trusted.
“On the third morning, his keeper, having a violent attack of rheumatism in his right arm, could not shave him, and another person was obliged to be trusted. This person, unfortunately, laid the razor on the dressing-table; and, while his face was turned away, and the keeper was heating some water a few feet from the table, the patient suddenly jumped up, seized the razor, and in a moment applied it to his throat, and effectually divided the carotid artery.”
A case somewhat similar we find recorded by the same authority. Major—— had been wounded at the battle of Waterloo. He had since recovered his health, but a great depression of spirits followed. The maniacal diathesis was hereditary. By degrees he became more desponding, his ideas wandered, and at length a suicidal propensity was evident. On visiting him, Dr. Burrows strongly urged the necessity of placing him under the supervision of an experienced keeper; but here, as in too many cases, his family opposed this advice, and would not permit proper restraint, but put him under the care of a nurse only. In the evening, he retired early to bed. The nurse went to tea in his chamber, supposing her charge to be asleep. The patient watched the opportunity, jumped out of bed, seized a knife on the table, wounded, and would have effectually cut his throat, had not the nurse interposed.
“A clergyman in Warwickshire told me,” says Dr. Conolly, “that he was requested, some years ago, to interfere respecting certain measures proper for securing a neighbour who had exhibited unquestionable symptoms of insanity. His neighbour, however, was not to be met with on the day when it was intended to remove him, and when he reappeared, which was either the next day or in a day or two afterwards, he was quite in a sound state, in which condition he has lived with great comfort up to the present time. On the other hand, an instance came under my own observation in which a gentleman had shewn many proofs of disordered mind for the space of three or four months, and his actions becoming dangerous, it was resolved to remove him. About two hours before I was to call for him, he was so quiet and orderly in a conversation with the old family-apothecary, that the latter gentleman rode off to the relations of the patient, relenting all the way concerning the proposed restraint, and purposing to solicit its postponement; in which attempt he was only prevented by being overtaken by a messenger before he had ridden half a mile, who came to inform him that his apparently tranquil patient had nearly blown up his house and his whole family with gunpowder, having for that purpose thrown a pound and a half of it into the fire, sitting by to see it explode. In another case, a gentleman had made repeated attempts at self-destruction, but seemed to have got well, and was no longer much looked after; yet after living comfortably at home for a little while, and having passed a cheerful evening in reading to his wife, he concluded it, when she had retired, by hanging himself in the parlour.
“These lamentable accidents are, of course, always productive of disagreeable feelings in the mind of a practitioner; but never more so than when he has been too confident of the absence of danger. It is questionable, perhaps, whether there are not, in all these cases, certain means of which prudence might avail itself, for the purpose of ascertaining the exact state of the supposed convalescent’s mind, as well as the existence of such intentions in a lunatic as are inconsistent with the safety of other persons, or with the preservation of his own existence. The lunatic may maintain a very guarded silence on these matters so long as they remain quite unsuspected, but is not very well able, in general, to prevent his intentions becoming visible to those who have begun to suspect him. These intentions, too, are generally associated with certain recollections, or certain topics, or certain antipathies or prepossessions, which may be found out and brought into the conversation; in which case, the lunatic can seldom conceal his agitation, his superstitious belief, his anger, or his inly-cherished hope of full revenge. Indeed, he is often in no degree solicitous to conceal his feelings. There cannot be anywhere a more harmless person than Jonathan Martin; his manners are mild, his occupations are of the most peaceful description, his language is strikingly simple and unassuming; but take up the Bible, and you have touched the chord of his insanity; you find that, to destroy the noblest monuments of ancient piety and munificence seems to him a work to which God has especially called him. The effect of possessing a key to the excited feelings of a lunatic is, indeed, always surprising to those unaccustomed to their peculiarities. You walk with a man who seems to delight in the simplest pleasures of a state of innocence; he admires the flowers of the field and the beauty of the sky, or he dwells with satisfaction on the contemplation of whatever is generous and good; nothing can exceed the mildness of his manner: but a single word calculated to rouse a morbid train of ideas, a name, the reminiscence of a place, or any trifling inadvertency, will convert this placid being into a demon; the tones of his voice, his gestures, his countenance, his language, assume, in a moment, the expression of a fiend; and you discover that opportunity alone is wanting to effect some dreadful crime. The discovery of such a design is certainly not always so easy, but wherever suspicion exists, strict superintendence is warranted, or various degrees of restraint must be determined upon, and steadily adhered to.”[61]
The following cases will shew the necessity of guarding a person by the strictest surveillance from the moment that he evinces the slightest symptom of mental alienation, when it manifests itself by incongruous expressions or attempts at self-destruction. This precept should be engraven on the mind of every medical man, and no feeling of false delicacy should prevent his communicating his suspicions and wishes the moment he considers measures of precaution necessary. In these cases, the loss of an hour may make all the difference between life and death.
M. Piorry was called to the Hôtel de Bibliothèque, where he found a man of athletic form and military appearance in a state of complete insensibility. He manifested all the indications of apoplexy or epilepsy. Some time elapsed before the physician could ascertain what was the matter; he could not obtain any satisfactory answers to his repeated questions. At last the patient made Piorry understand that he had swallowed a key. Professor Roux was sent for, who, after considerable difficulty, succeeded in extracting the foreign body from the œsophagus, along with an oblong piece of copper attached by a chain to the handle of the instrument. On the succeeding night he made fresh attempts to destroy himself; first by hanging with the bed-clothes, and, on that mode not proving successful, he endeavoured to strangle himself by squeezing two chairs against his neck. Thwarted in effecting his design, he again swallowed the key, and he was nearly dead when he was discovered, and the key extracted from his throat. He was now confined in a strait-waistcoat, and was subjected to proper medical treatment. In the course of a short period, all disposition to suicide was removed, and his mind was restored to perfect integrity.[62]
A soldier, who was greatly beloved in his regiment for his exemplary conduct and amiable qualities, became affected with suicidal melancholy, and fired a pistol into his mouth. The havoc made was dreadful; but by great exertions on the part of M. Petit, who attended the case, his life was preserved. During his confinement, he manifested great anxiety for his recovery, and expressed himself horrified that he should ever have attempted to commit self-destruction. The surgeon and his friends entertained every hope that all suicidal tendency was dissipated. The result, however, proved that the whole was a manœuvre on the part of the patient to lull suspicion to rest, and when he had succeeded by this dissimulation in throwing his friends off their guard, he put an effectual period to his existence whilst in the wards of the hospital.
The following case exhibits some practical points exceedingly worthy of record, and displays besides, in a remarkable degree, the control a lunatic disposed to suicide acquires over himself, his conversation, and conduct, when he wishes to lull suspicion to sleep. In this instance, says Dr. Burrows, who relates the particulars of the case, a most judicious physician, and those in whom he had confidence, all experienced in the phases of this wonderful malady, insanity, and its no less wonderful concomitant, suicide, were completely deceived.