He was placed in lodgings with a careful attendant. In about three weeks he was nearly well, when unluckily a whitlow formed on his finger, and as one of his delusions was that he was rotten in every part, it was the cause, besides pain, of considerable irritation, and it broke his rest; other delusions returned, but subsided with the pain of the whitlow, and he again greatly improved.
In six weeks he was so well that the Doctor took his leave, advising him to travel during the remainder of the autumn. The next day some domestic occurrence occasioned violent irritation, and he again relapsed into despondency, unattended by paroxysms of violence; but he shortly recovered.
However, instead of going into the country and varying the scene, his lady brought him into town and permitted unrestricted intercourse with his relations, &c. He grew quarrelsome, suspicious, and very low-spirited, and began to abuse his wife. It was then earnestly recommended that he should be completely separated from all intercourse with her and his connexions, but the advice was disregarded.
A boil now formed on his body. This irritated him more than the whitlow, and his delusions about his rottenness were more prominent than ever; but when the boil suppurated and discharged, his mind again improved.
No persuasion could induce his friends to give him exercise or diversion, or change the scene. He therefore sat all day brooding over his fantasies, and reading religious books; for now there was added to his delusions an impression that he was very wicked, and had neglected his religious duties. His face, too, assumed the suicidal expression.
A month afterwards, a consultation with two eminent physicians confirmed Dr. Burrows’ opinion of the treatment to be pursued. But, notwithstanding this consultation, all remedial aid was neglected, and he was allowed to follow his own inclinations, both in religious matters and in totally secluding himself. In about three weeks all the symptoms were so much increased that he was sent to a private asylum. A few days afterwards, while walking out, he tried to drown himself, but was rescued by his keeper. He continued in this desponding state some months, when, rather suddenly, he appeared much better; and continuing to improve, his physician thought him well, and he returned home. Two days only had passed, when he called on the same physician, acknowledged that he was as bad as ever, and entreated earnestly that he might again be received into his house. He was so on that day. The next day he poisoned himself and died.
It proved, that he had never abandoned the desire of committing suicide; but he so well concealed it, and otherwise conducted himself, as to lead to the conclusion that he had recovered. It was, in fact, a scheme, the sole object of which was to get out and buy laudanum. Having procured a sufficient quantity, but anxious to save his wife the agony of witnessing the act he meditated, he preferred returning to the asylum to execute it.
A few general principles have been laid down in this chapter to direct the practitioner in the management of certain cases of suicidal insanity. The success of the treatment will in a great measure be dependent on the physician making himself acquainted with the minute history of each case submitted to his professional care. No particular rules can be adduced that will be applicable to all cases of this description; much must be left to the judgment of the medical man. The physician should, however, never forget that whatever apparently may be the physical disturbance going on in the system, the brain, and the brain alone, is the seat of the disease in all cases of suicide, and to the condition of that organ most particular attention ought to be paid.