Incurable bodily diseases, and the accompanying pain of some other disorders, are not uncommon causes of a voluntary death. It has been estimated that incurable diseases are even more powerful as a cause than very painful ones.

The heavy voluntary death rate of persons afflicted with pellagra has been already noticed, as has the dictum of Pliny that the presence of stone in the bladder constitutes a fair reason for self-destruction. Not long ago I held an inquest on the body of a medical man who hung himself to avoid the pain and worry of an apparently incurable stricture of the urethra.

Continental statisticians have calculated that bodily disease causes 8 per cent. of Italian suicides, 13 per cent. of French, 10 per cent. of Norwegian, and 12 per cent. of Prussian suicides. These are voluntary deaths, not deaths during delirium accompanying disease.

Loss of sight, and loss of hearing, are both causes of increased suicide rate; in Prussia it has been estimated that persons having suffered such deprivation contribute a rate almost double that of persons not so afflicted.

Insomnia.

Closely connected with mental and bodily disorders as a cause of suicide is sleeplessness, apart from organic disease. There is, I suppose, nothing more trying to the sensations, and nothing more exhausting to the nervous system, than this symptom. Its tendency to become habitual, and to become more and more complete, are its harassing qualities. I have held inquests on cases distinctly referable to the misery caused by want of sleep.

That sleeplessness is an important factor in producing suicide is pointed out very forcibly by Dr. Jos. Williams in an article in the “Lancet” of 1850. “Business men especially apply to their doctors for this ailment, and their request is often answered by a little anti-dyspeptic mixture, whereas a powerful sedative for a few nights, until rest and change can be arranged for, would be the means of preserving life.”

The “Medical Times and Gazette,” 1872, in referring to two similar deaths from suicide, those of Mr. Justice Willes and Hugh Miller the Geologist, insisted also on the necessity of procuring sleep and rest for worried men, and so did good service.

Alcohol.

Without doubt the habitual use of alcohol to excess is a very fertile suicide prompter, and it is found that the stronger the form of alcohol used, the more often crime and suicide are produced; such are as rare when the light wines are drunk, as they are frequent among spirit drinkers.

Lunier, Ann. Med. Psychol., 1872, calculating the results in 79 departments, states that the amount of crime in France is in direct proportion to the consumption of alcohol, and so are the rates of lunacy and suicide. As a mean of the estimates of many observers, about one-eighth of all suicides are directly caused by alcohol. It produces suicide in several ways; in a fit of drunkenness, during delirium tremens, by causing mania or melancholia, or by leading to complete imbecility.

Suicides due to alcoholic poisoning, and alcoholic mind failure, are indeed seen among those who are too rich to require to work at all, or to be regularly at work; but the greatest amount of disease and death due to alcohol exists among the poor, and especially among the poor of our great cities; a very large number of these spend almost the whole of their small earnings in poisonous drinks. The radical remedy for suicide caused by this form of indulgence is doubtless the improvement of the intellectual and moral status, the cultivation of habits of thrift, economy, and foresight. If the humble mechanic could only be led to the conviction of the paramount necessity of assuring himself against accidents, disease, and old age, and of avoiding the degradation of becoming chargeable during such misfortunes to the means of others who have provided such store, he would neglect the gross indulgences of the sot, for the self-esteem and honour arising from a consciousness of having worked while it was yet day, and laid up a store for the evil hours which do so surely come.

The drink question is one, however, which is now so frequently brought to our notice, by our worthy teetotal and temperance friends, that I am sure I need not occupy much space in discussing the amount of self-destruction caused by alcohol, directly or indirectly, through debauchery, loss of money, position, or self-respect.

Heredity.

The influence of Hereditary Predisposition is one of surpassing interest, but is also another of those causes of which it is very difficult to procure accurate statistics; and very few countries have as yet given any data in connection with it.

Relations of suicides are apt to be very reticent of confessing to lunacy in their families, and it is hereditary mental failure, lunacy, epilepsy, dipsomania, &c., which are the forerunners of a future death by suicide.

In Bavaria alone has an effort been made to estimate hereditary influence; from 1857-66, we are told it was shewn to exist in 13 per cent. of all voluntary deaths, since then in 18 per cent.

Voltaire narrates that he knew a professional man, his brother, and the father of both, who all killed themselves at the same age, in the same manner.

Bucknill and Tuke give examples of suicide from hereditary insanity, and remark, “that they abound;” similar cases will be found described in almost all works treating of insanity.

Falret gives several cases, for example:-In one, a grandmother, mother, and grandchild, killed themselves. In another, five sons and one daughter, of a questionably sane father, all committed the act.

Griesinger gives us an example:-A man and his wife became insane, he hung himself and she drowned herself; one daughter poisoned herself, a son strangled himself, and another daughter threw herself off a house top.

In Lisle, on “Suicide,” ten marked cases are given.

Burrows narrates, at full length, the case of one family, as follows:-The grandfather hanged himself; he left four sons, one hanged himself, one cut his throat, one drowned himself, and one died a natural death. Two of these sons had large families; of the third, two children became insane, one died a natural death, the other made several attempts on his life, and two others drowned themselves, apparently sane.

The effect of mental agitation in a person knowing that he is the descendant of insane persons or of suicides, is worthy of consideration; to a well-educated man, what a “skeleton in the closet” to live with, must be the constant recollection of the risk to which hereditary transmission exposes him. Such a spectre may well refuse to be laid, and must be a fertile cause in the production of another generation of suicides.

Spiritualism.

There is yet another mental cause which is credited both with causing insanity and with causing suicide, especially in the United States. I refer to Spiritualism, in the modern acceptation of the title. It has been seriously discussed in America, whether or not a believer in spiritualism is not ipso facto mad (Buckham) but without going to that extreme point of view, it is most wise to bear in mind that many cases of lunacy and many suicides have been assigned to this cause.

The combined effects of a belief in the doctrine that it is possible in our bodies to hold communication with the departed, and of attempts to practise this system of intercourse, conjoined with the corollary that what spirits reveal is true, and so to say, inspired, has frequently had a most fatal effect on minds of a dreamy sort. I knew, myself, a most sane and sensible young medical man, who became imbued, through a spiritualistic father, with a faith in the possibility of obtaining information of a mystic and occult character by means of somewhat mesmeric proceedings; sad to relate, he very soon became mentally upset with a religious terror, and took his life, without having previously evinced any tendency to self-destruction.