However various may be the opinions regarding the mental state of suicides, there is no practical dissent from the acknowledgment of the desirability of preventing the commission of suicide.
For our purpose, then, it will suffice to consider, on the one hand, what means are necessary to restrain patients who are acknowledged to be insane; and on the other hand, what measures are permissible to dissuade and prevent those in trouble or pain from taking their own lives; such means will be equally available whether we think these sufferers sane in their deaths, or insane from the time when they attempt the destruction of their lives.
There are doubtless cases of suicide in which it is impossible to decide as to the mental state of the patient; no definition of insanity has ever yet been agreed to, and probably never will; and until medical science has advanced so far as to be able to estimate how much grief or pain a man can support without attempting to evade his sufferings, there always will be voluntary deaths of persons who are so notoriously sane as to forbid the application of restraint. Yet survivors will postulate a momentary insanity, when such persons shall have destroyed themselves to avoid the possibility of an error of judgment.
Suicide of the Insane.
In a work such as this, intended not entirely for physicians, but also for students of Social Science, I do not think it fitting to enter into particulars as to the exact means of treating the suicidal propensity in such cases, nor do I suggest any definite medical prescriptions to relieve collateral symptoms; such may be safely left in the hands of the skilful physician. I have only to insist on the urgent necessity that exists for the immediate removal from society of any person exhibiting mind failure, who shows any tendency to self-destruction; and even if suicide be not definitely threatened, no time should be lost in commencing the care and treatment of a lunatic.
And, again, the means of treatment, and, if necessary, of coercion of those definitely of weak, or of unsound mind, fall to the alienist.
The whole question of Asylum treatment is now under consideration; whether any private establishments at all should exist, is debated with zeal; the further question of whether the treatment and care of the insane ought not to be begun and perhaps continued, just as is the treatment of bodily disease, without any formal certification, has also been broached of late, by an editorial in the “Lancet” of last year. These questions do not fall within the scope of a treatise on “Suicide as a fact.” The managers and attendants in English asylums may at any rate be congratulated on their care of their patients in this matter, for the rate of suicide in asylums is but 1 per 1,000 annually.
Many once popular modes of treatment of insane persons are now almost forgotten, just as many modes of treating bodily diseases have disappeared.
As a preventive of suicide in melancholia, the noted Avenbrugger recommended that the patient should be made to drink a pint of cold water every hour, whilst his feet were wrapped in flannel. Hufeland also advised the ingestion of plenty of cold water for mania. The eminent alienist Burrows recommended emetics, bleeding, and warm baths, accompanied by cold douche to the head, as measures fitted to remove the suicidal propensity. The means recommended by Brierre de Boismont for avoiding the suicidal propensity in the insane were the persistent use of morphia to ensure sleep, and the prolonged use of baths, the continuous immersion of the body for four, five, or six hours. Griesinger remarks that medication is of no use, and that mechanical restraint does not remove the tendency, even if it renders the act impossible for the time; nothing but constant watching is of any avail until the inclination passes off.
It has been suggested by many physicians that bleeding would remove the suicidal tendency in cases where it is associated with cerebral irritation, congestion, or inflammation.