Several cases of cut-throat are on record, in which the patient, who had just been raving, became sane after the bleeding which followed his act: Dr. Southwood Smith mentions this, see “Philosophy of Health,” vol. i., p. 109; and the elder Disraeli mentions that a surgeon narrated such a case to him. See “Curiosities of Literature.” The case of the late Sir Samuel Romilly was one example of this point; the bleeding restored his senses, and he did all in his power to check the hæmorrhage. See Wynter. “Borderlands of Insanity.”
Suicidal patients require most watching early in the morning; a good lunch often dispels the tendency for the day. During convalescence from mania, &c., relapses into suicidal condition are very common, and it is frequently in these remissions that nurses become less watchful just when they should be vigilant, and the act is committed.
When the tendency is the result of alcoholism, we are met by this difficulty; restraint is needed, and yet no one has the power to enforce restraint; the physician succeeds well enough in relieving the alcoholic delirium and coincident risk of suicide, perhaps time after time; but is powerless to prevent a succeeding attack. Unless a sufferer can be induced to volunteer his entry into a retreat, there are no means of saving him from himself. So long as a man is sensible when sober, be it only for an hour a day, he is beyond the reach of compulsory cure.
In the suicidal mania of parturition, on the other hand, the patient is happy in being already, from her state, under the practical control of her medical attendant, and hence such cases are almost always restrained successfully.
The essence of impulsive insanity is its occurrence without any warning; yet many such suicides might be prevented by a more careful observation on the part of the companions of a patient. Whenever there be any hereditary taint of insanity, or of dipsomania, or of chronic nervous disease, or epilepsy; if there be heredity of self-destruction, or if there have been a previous attack of insanity, or if there be insomnia, the slightest symptoms of mental alteration should be watched for; alterations of conduct, the attitude of suspicion, or of self-accusation, or of unnecessary melancholy. The facial expression will frequently raise the alarm; the restless uneasy eye, and ever varying play of the muscles of the face in one case; and the settled glare of the eye, and expressionless features in another, should warn observers of an approaching crisis of disordered intellect.
Suicide of Sane Persons.
The suicidal tendency so often coexists, either with straightened circumstances, or sudden deprivation of income, that the very modes of treatment most likely to remove the tendency are by these very causes rendered impracticable. Temporary abstention from duty or business, coupled with change of climate and scene, would doubtless cure a very large percentage of cases, but it is exactly the inability to drop the chains of employment, and the absence of the monetary means for travel which are lacking.
The means of cure when they are practicable are obvious enough to any physician; a healthy and not too arduous employment; change of air, and scene; and of companionship; the improvement of the bodily health, the exhibition of nervine tonics; and last, but not by any means least, the exercise of every possible means of making sleep a certainty.
The continuous poring over one’s troubles, and contemplating one’s fate, without the definite lengthy intermissions given by healthy sleep, are most fertile causes of nervous breakdown and attempted self-destruction. The occurrence of a long night’s slumber frequently entirely removes the pernicious intentions at which an overwrought brain arrived over night.
I have already alluded to the debated question as to the tendencies of religion and education.