Influence of climate—The foggy climate of England does not increase the number of suicides—Average number of suicides in each month, from 1817 to 1826—Influence of seasons—Suicides at Rouen—The English not a suicidal people—Philip Mordaunt’s singular reasons for self-destruction—Causes of French suicides—Influence of physical pain—Unnatural vices—Suicide the effect of intoxication—Influence of hepatic disease on the mind—Melancholy and hypochondriasis, Burton’s account of—Cowper’s case of suicide—Particulars of his extreme depression of spirits—Byron and Burns’s melancholy from stomach and liver derangement—Influence of bodily disease on the mind—Importance of paying attention to it—A case of insanity from gastric irritation—Dr. Johnson’s hypochondria—Hereditary suicide, illustrated by cases—Suicide from blows on the head, and from moral shocks communicated to the brain—Dr. G. Mantell’s valuable observations and cases demonstrative of the point—Concluding remarks.

The following are the physical causes which are commonly found to operate in producing the suicidal disposition—viz., climate, seasons, hereditary predisposition, cerebral injuries, physical suffering, disease of the stomach and liver complicated with melancholia and hypochondriasis, insanity, suppressed secretions, intoxication, unnatural vices, and derangement of the primÆ viÆ. These causes can only act by influencing sympathetically the brain and nervous system, and in that way interfering with the healthy operations of the mind. Much will, of course, depend upon the physical conformation of the individual exposed to such agents. Should he labour under an hereditary predisposition to insanity, or to suicidal delirium, a very trifling corporeal derangement may call into existence the self-destructive propensity, and vice versa. It will be our object to consider seriatim all the physical agents just enumerated.

Among the causes of suicide, the foggy climate of England has been brought prominently forward. The specious and inaccurate conclusions of Montesquieu on this point have misled the public mind. The climate of Holland is much more gloomy than that of England, and yet in that country suicide is by no means common. The reader will perceive from the following tabular statement that the popular notion of the month of November being the “suicide’s month” is founded on erroneous data.

The average number of suicides in each month, from 1817 to 1826, was as follows:—

It has been clearly established that in all the European capitals, when anything approaching to correct statistical evidence can be procured, the maximum of suicide is in the months of June and July; the minimum in October and November. Temperature appears to exercise a much more decided influence than the circumstances of moisture and dryness, storms or serenity. M. Villeneuve has observed a warm, humid, and cloudy atmosphere to produce a marked bad effect at Paris; and that so long as the barometer indicated stormy weather, this effect continued.44 Contrary, however, to the opinion of Villeneuve, it appears that by far the fewer number of suicides occur in the autumn and winter at Paris, than in the spring and summer.

Number of suicides for seven years.

When the thermometer of Fahrenheit ranges from 80° to 90° suicide is most prevalent.

The English have been accused by foreigners of being the beau-ideal of a suicidal people. The charge is almost too ridiculous to merit serious refutation. It has clearly been established that where there is one suicide in London, there are five in Paris. In the year 1810, the number of suicides committed in London amounted to 188; the population of Paris being near 400,000 less than that of London. From the year 1827 to 1830, no less than 6900 suicides occurred; that is, an average of nearly 1800 per annum. Out of 120,000 persons who ensured their lives in the London Equitable Insurance Company, the number of suicides in twenty years was only fifteen; so much for the English being par excellence disposed to suicide.

The causes which frequently lead to self-destruction in France are, defective religious education, ennui, and loss at dice or cards. In considering the circumstances which produce this disparity in the number of voluntary deaths in the two countries, we must bear in mind the moral and religious habits of the people. When Christianity is not acknowledged as a matter of vital importance in the affairs of man; when morality is considered only as a conventional term, conveying no definite idea to the mind, it is natural that there should exist, co-relative with this tone of feeling, a marked recklessness of human life. Some notion may be formed of the state of religious feeling in Paris, when our readers are informed of the existence in the French metropolis of a “society for the mutual encouragement of suicide,” all the members of which, on joining it, swear to terminate their existence by their own hands, when life becomes insupportable.

Dr. Schlegel dwells at much length on the abandoned state of Paris, and after giving us some important statistical evidence, he alludes to the gross immorality of the people, and denounces the French capital as “a suffocating boiling cauldron, in which, as in the stew of Macbeth’s witches, there simmer, with a modicum of virtue, all kinds of passions, vices, and crimes.”

Alluding to the peculiarities of the French people, particularly their indifference to human life, an eminent writer observes, speaking of their notions of suicide, that a Frenchman asks you to see him “go off,” as if death were a place in the malle poste. “Will you dine with me to-day?” said a Frenchman to a friend. “With the greatest pleasure;—yet, now I think of it, I am particularly engaged to shoot myself; one cannot get off such an engagement.” This is not the suicide À la mode with us. We ape at no such extra civilization and refinement. We can be romantic without blowing out our brains. English lovers do not, when “the course of true love” does not run smooth, retire to some sequestered spot, and rush into the next world by a brace of pistols tied with cherry-coloured ribbons. When we do shoot ourselves, it is done with true English gravity. It is no joke with us. We have no inherent predilection for the act; no “hereditary imperfection of the nervous juices,” as Montesquieu, with all the impudence and gravity of a philosopher, asserts, forcing us to commit suicide. “Life,” said a man who had exhausted all his external sources of enjoyment, and had no internal ones to fly to, “has given me a headache; and I want a good sleep in the churchyard to set me to rights,” to procure which, he deliberately shot himself.45

A late French writer thus attempts to account for the prevalence of suicide in France:—“The external circumstances which tend to suggest the idea of suicide are very numerous, at the present day, in France; but more particularly so in the capital. The high development of civilization and refinement which prevails here—the clash of interests—the repeated political changes—all contribute to keep the moral feelings in a perpetual state of tension. Life does not roll on among us in a peaceful and steady current; it rushes forward with the force and precipitation of a torrent. In the terrible mÊlÉe, it often happens that the little minority, which has obtained a footing high above the multitude for a time, falls down as suddenly as they have risen. The struggles of life are full of miscalculations, disappointments, despair, and disgust. Hence the general source of our frequent suicides. But there are other causes in operation; and not the least, the strange turn that plays and spectacles have lately taken. The public taste has undergone a complete revolution in this respect. Nothing is more patronized now at the theatre than the display of crime unpunished, human misery unconsoled, and a low literature, impregnated by a spurious philosophy, declaiming against society, against domestic life, against virtue itself; applauding the vengeance of the assassin, and recognising genius only as it is seen in company with spleen, poison, and pistols. We appeal to all who read the novels of the present day, and who visit the theatres, whether what we say is not the fact.”

It has been questioned whether physical suffering often originates the desire for suicide. Too many lamentable cases are on record to prevent us from coming to an opposite conclusion. Esquirol has justly observed, that “He who has no intervals of ease from corporeal pain; who sees no prospects of relief from his cruel malady, fails at length in resignation, and destroys his life in order to put a period to his sufferings. He calculates that the pain of dying is but momentary, and commits the act in a cool and meditated despair. It is the same in respect to moral condition, that drives the hypochondriac to suicide, who is firmly persuaded that his sufferings are beyond imagining; that they are irremediable, either from some fatal peculiarity in his own constitution, or the ignorance of his physicians. It is a remarkable feature in hypochondriasis, and in no other disease, that there is such a fear of death and a desire to die combined. Both fears proceed from the same pusillanimity. Finally, it may be remarked that the hypochondriac talks most of death; often wishes his attendants to perform the friendly office; even makes attempts on his own life, but rarely accomplishes the act. The most trifling motive, the most frivolous pretext, is a sufficient excuse for procrastinating, from day to day, the threatened catastrophe.”

The following case occurred in a provincial mad-house, in France. An apothecary who was confined there was haunted with ennui, and was always begging his companions to put him to death. At length, an insane patient was admitted, who instantly complied with the apothecary’s request. They both watched an opportunity, got out of a window in the back yard, and from thence into the kitchen. They pitched upon the cook’s chopper, and the apothecary laying his head on a block, his companion deliberately and effectually severed it from his body. He was seized, and examined before a tribunal, where he candidly confessed the whole transaction, and observed that he would again perform the same friendly office for any unhappy wretch who was tired of his existence!46

Lucinius CÆcinius, the prÆtor, subdued by the pain and ennui of a tedious disease, swallowed opium. Dr. Haslam relates the case of a gentleman who destroyed himself to avoid the tortures of the gout. It is recorded that the pain of the same disease drove Servius the grammarian to take poison. Pliny informs us that one of his friends, Corellius Rufus, having in vain sought relief from the pangs of a disease under which he was labouring, starved himself to death at the age of sixty-seven. It is related of Pomponius Atticus and the philosopher Cleanthes, that they both starved themselves to death in order to get rid of physical pain. In the course of these attempts, the corporeal sufferings were removed—probably in consequence of the great exhaustion and attenuation; but both individuals persevered till death took place, observing that as this final ordeal must one day be undergone, they would not now retrace their steps or give up the undertaking.

Few, perhaps, are aware how frequently suicide results from the habit of indulging, in early youth, in a certain secret vice which, we are afraid, is practised to an enormous extent in our public schools. A feeling of false delicacy has operated with medical men in inducing them to refrain from dwelling upon the destructive consequences of this habit, both to the moral and physical constitution, as openly and honestly as the importance of the subject imperatively demands.

Medical men are, in the most enlarged acceptation of the term, guardians of the public health; and no fastidious desire to avoid saying what might possibly offend the taste of some, ought to keep them from discharging what may be termed a sacred duty. The physical disease, particularly that connected with the nervous system, engendered by the pernicious practice alluded to, frequently leads to the act of self-destruction. We have before us the cases of many suicides in whom the disposition may clearly be traced to this cause. This habit most seriously affects the brain and nervous system; and insanity, hypochondriasis, and melancholia, in their worst forms, are frequently the baneful consequences.

If disease, structural or functional, of the abdominal viscera gives rise to the disposition to commit suicide, it will not require much ingenuity to establish the fact that the habitual indulgence in intoxicating liquors may originate a similar feeling.

It has been already established by statistical evidence, that, in a very large proportion of the cases of insanity admitted into the asylums and hospitals devoted to the reception of this unhappy class of patients, the mental impairment can clearly be traced to habits of intemperance.

The brain and nervous system become materially affected in those who indulge frequently in “potations pottle deep.” Delirium tremens, softening of the cerebral substance, palsy, epilepsy, extreme hypochondriasis, are daily witnessed as the melancholy effects of intoxication.

M. Falret knew the case of a man who always felt disposed to cut his throat when under the influence of spirits. No reasoning could induce him to abstain from his favourite draught. The inevitable consequences were pointed out to him; he was reasoned with, and threatened with confinement in a mad-house; but nothing had the desired effect. One Sunday evening, after having drunk several glasses of spirits, although not sufficient to produce complete inebriation, he stabbed himself to the heart, and died in a few minutes.

Incurable indigestion and organic disease of the liver are very commonly met with in habitual drunkards. In such persons, the constitution of the mind appears to undergo a complete change. At first it may not be perceptible, and the patient may not be conscious of it himself, but the mental disease will, sooner or later, unequivocally evince itself.

In such cases, the medical man has fearful odds to contend against.

A young man, who had become insane in consequence of long continued intoxication, made violent efforts to maim himself, and especially to pull out his right eye, which appeared to give him great offence. Rest, temperance, seclusion, the application of half a dozen leeches to the temple, and a few doses of opening medicine, restored him, in about a fortnight, to the full possession of his faculties.

Many cases of suicide, in those who have a natural predisposition to it, arise from the brain sympathizing with the liver; nor can this be a matter of surprise to any one who has felt the depression of spirits incident to disease of that organ. So many cases have occurred from this cause, that some writers, from not finding, on subsequent dissection, any organic lesion of the brain, have referred it to diseased viscera only. But as we find that the insanity ceases when the liver is restored to health, there is no reason for supposing that the mental alienation is, in these instances, any other than the effect of disease of the brain.

J. C., about fifty years of age, was insane for two years. He was formerly in respectable circumstances, and employed in the situation of writer in an office. He made several attempts on his life. He had been in the habit of drinking spirits very freely, and had a disease of the liver which appeared of some standing. At the time of his admission into Hanwell asylum, under the care of Sir W. Ellis, he was in a most emaciated state; his legs scarcely able to support him. His face and body also were covered with an eruption; tongue furred; his stools very dark: he was much depressed, and always moaning most piteously; complained of heat and numbness in his head, and pain in all his limbs. Leeches and cold lotions were applied to his head, his bowels opened by calomel and colocynth, and he went into the warm bath every other day. He was much relieved by these means. He still continued, however, to moan as before. His tongue remained furred, and stools unhealthy. He took five grains of blue pill every alternate night for some time. These were then left off awhile; no improvement taking place, he began the pills again, and continued them for two months, with evident advantage. His tongue was clean; he was less depressed; became strong, and gained flesh; the biliary secretions were much improved. He is now occupied in the office; and every day, as the action of the liver seems to improve, his mind makes a corresponding advance.

There is no more frequent cause of suicide than visceral derangement, leading to melancholia and hypochondriasis. It has been a matter of dispute with medical men whether hypochondriacal affections have their origin in the mental or physical portion of the economy. Many maintain that the mind is the seat of the disease; others, that the liver and stomach are primarily affected, and the brain only secondarily. In this disputed point, as in most others, truth will generally be found to lie between the two extremities. That cases of hypochondria and melancholia can clearly be traced to purely mental irritation cannot for one moment be disputed; and that there are many instances in which the derangement appears to have commenced in one of the gastric organs, is as equally self-evident. Whatever may be the origin of these affections, there can be no doubt of their producing most disastrous consequences. Burton’s account of the horrors of hypochondria is truly graphic. “As the rain,” says Austin, “penetrates the stone, so does this passion of melancholy penetrate the mind. It commonly accompanies men to their graves. Physicians may ease, but they cannot cure it; it may lie hid for a time, but it will return again, as violent as ever, on slight occasions, as well as on casual excesses. Its humour is like Mercury’s weather-beaten statue, which had once been gilt; the surface was clean and uniform, but in the chinks there was still a remnant of gold: and in the purest bodies, if once tainted by hypochondria, there will be some relics of melancholy still left, not so easily to be rooted out. Seldom does this disease produce death, except (which is the most grievous calamity of all) when these patients make away with themselves—a thing familiar enough amongst them, when they are driven to do violence to themselves to escape from present insufferable pain. They can take no rest in the night, or, if they slumber, fearful dreams astonish them. Their soul abhorreth all meat, and they are brought to death’s door, being bound in misery and in iron. Like Job, they curse their stars, for Job was melancholy to despair, and almost to madness. They are weary of the sun, and yet afraid to die, vivere nolunt et mori nesciunt. And then, like Æsop’s fishes, they leap from the frying pan into the fire, when they hope to be cured by means of physic—a miserable end to the disease; when ultimately left to their fate by a jury of physicians, are furiously disposed; and there remains no more to such persons, if that heavenly physician, by his grace and mercy, (whose aid alone avails,) do not heal and help them. One day of such grief as theirs is as a hundred years: it is a plague of the sense, a convulsion of the soul, an epitome of hell; and if there be a hell upon earth, it is to be found in a melancholy man’s heart. No bodily torture is like unto it; all other griefs are swallowed up in this great Euripus. I say the melancholy man then is the cream and quintessence of human adversity. All other diseases are trifles to hypochondria; it is the pith and marrow of them all! A melancholy man is the true Prometheus, bound to Caucasus; the true Tityrus, whose bowels are still devoured by a vulture.”

“There are individuals who, from various physical or moral causes,” says Esquirol, “fall into a state of corporeal torpor and mental depression. They complain of want of appetite, dull pain in the head, sense of heat in the stomach and viscera, borborygmi, and constipation of the bowels; while they exhibit little or no indication of disease. In the female sex, the natural secretions become suspended. As the complaint advances, the features alter, and the countenance exhibits anxiety; the complexion becomes pale or sallow; there is a sense of tightness, or even pain, in the epigastrium; a kind of compression in the head, which prevents them from fixing their attention, or arranging their thoughts; a general torpor or lassitude, which keeps them inactive. They dislike to move out, and love to loll about on a sofa; they are irritated if you advise them to take exercise; they abandon their ordinary avocations, neglect their domestic concerns, become indifferent to their nearest connexions; in short, they will neither converse, nor study, nor read, nor write, shunning society, and being impatient of the inquiries and importunities of friends. In this state they become filled with gloomy ideas (idÉes noires), despair of ever being better, desire or even invoke death, and sometimes destroy themselves, from a conviction that they are no longer capable of fulfilling their duties in society. These people are perfectly sane on all subjects of conversation; their impulse to suicide being strong in proportion to the activity of their former avocations, and the importance of their former duties. I have seen their disease (for it is a disease) continue for months, and even years. I have seen it alternate with mania and with perfect health. I have seen patients who would be six months of the year maniacal or in sound health, and the other six months tormented with these gloomy ideas and impulses to suicide.”

In confirmation of this view of Esquirol’s, the following cases are related:47—A gentleman of apparently sound constitution, aged 32, was married to a woman whom he affectionately loved. His affairs became deranged a few years after his marriage, which greatly discouraged him, and rendered him inactive, but without apparently affecting his health. He now embarked in a speculation which promised much advantage, and at first applied himself to business with unremitting assiduity. In the course of a month he encountered some difficulties, which depressed him beyond measure. He considered himself ruined, refused to quit his bed, and would not superintend his workmen, from a conviction that he was no longer capable of directing their operations. He complained of headache, heat in his stomach, &c. His affection for his wife and children, his pecuniary interests, all failed to rouse him from this moral and physical prostration. He reasoned sanely on the critical state of his affairs, and yet made no effort to rescue himself from his difficulties. Eight days passed in this way, when all at once he sprung from his bed in perfect integrity of mind and body. He resumed instantaneously all his activity for business, all his affection for his family. The same state, however, recurred ten or twelve times since, at irregular intervals, caused in general by trifling contrarieties of business, which, under other circumstances, would be considered as nothing. During several of these paroxysms he had impulses to suicide; but this dreaded catastrophe has not yet taken place.

A female was admitted into the Salpetriere on the 23d of September, 1819, in the 34th year of her age, and fourteen years after marriage. At the age of 21 she had a child, after which she was affected with an ulcer in the foot, which was healed in six months. From this time she was troubled with cardialgia, at first slight, but afterwards with intense pain and vomiting of her food. At the age of 33 she became irresolute in her ideas and actions. She expressed an aversion for those things which she had been previously pleased with, and was occasionally incoherent. After suffering from other derangements of her general health, she abandoned her household affairs, became quite despondent, and tried more than once to commit suicide. In this state she was admitted into the hospital, and was put upon diluents, low diet, &c. As she shewed indications of having recovered, she was allowed to return to her family; but in a short period she was harassed with gloomy ideas, despaired of recovery, and expressed a desire to quit life, the duties of which she said she was no longer able to fulfil.

In the case of Cowper, we have a melancholy instance of hypochondriasis leading to suicidal mental derangement. That the poet’s mind was unsound when he attempted to kill himself, must be evident to those who are conversant with the history of his life. He never appears to have been free from hypochondriacal disorder. In a letter to Lady Hesketh, he says, “Could I be translated to paradise, unless I could leave my body behind me, my melancholy would cleave to me there.” A friend procured him the situation of reading clerk to the House of Lords, forgetting that the nervous shyness which made a public exhibition of himself “mortal poison,” would render it impossible for him ever to discharge the duties of his office. This difficulty presented itself to the mind of the poet, and gloom instantly enveloped his faculties. At his request, his situation was changed to that of clerk of the journals; but even before he could be installed into office he was threatened with a public examination before the House. This made him completely wretched; he had not resolution to decline what he had not strength to do: the interest of his friend, and his own reputation and want of support, pressed him forward to an attempt which he knew from the first could never succeed. In this miserable state, like Goldsmith’s traveller,

he attended every day for six months at the office where he was to examine the journals in preparation for his trust. His feelings were like those of a man at the place of execution, every time he entered the office door; and he only gazed mechanically at the books, without drawing from them the least portion of information he wanted. As the time of his examination approached, his agony became more and more intense; he hoped and believed that madness would come to relieve him; he attempted also to make up his mind to suicide, though his conscience bore stern testimony against it; he could not by any argument persuade himself that it was right; but his desperation prevailed, and he procured from an apothecary the means of self-destruction. On the day before his public appearance was to be made, he happened to notice a letter in the newspaper, which to his disordered mind seemed like a malignant libel on himself. He immediately threw down the paper, and rushed into the fields, determined to die in a ditch; but the thought struck him that he might escape from the country. With the same violence he proceeded to make hasty preparations for his flight; but while he was engaged in packing his portmanteau his mind changed, and he threw himself into a coach, ordering the man to drive to the Tower wharf, intending to throw himself into the river, and not reflecting that it would be impossible to accomplish his purpose, in that public spot, unobserved. On approaching the water, he found a porter seated upon some goods; he then returned to the coach, and drove home to his lodgings in the Temple. On the way, he attempted to drink the laudanum, but as often as he raised it, a convulsive agitation of his frame prevented its reaching his lips; and thus, regretting the loss of the opportunity, but unable to avail himself of it, he arrived half dead with anguish at his apartments. He then closed the door and threw himself on the bed, with the laudanum near him, trying to lash himself up to the deed; but a voice within seemed constantly to forbid it; and as often as he extended his hand to the poison, his fingers were contracted, and held back by spasms. At this time some of the inmates of the place came in, but he concealed his agitation; and as soon as he was left alone, a change came over him, and so detestable did the deed appear, that he threw away the laudanum, and dashed the phial to pieces. The rest of the day was spent in heavy insensibility, and at night he slept as usual; but on waking at three in the morning, he took his penknife and laid with his weight upon it, the point being directed towards his heart. It was broken, and would not penetrate. At day-break he rose, and passing a strong garter round his neck, fastened it to the frame of his bed. This gave way with his weight; but on securing it to the door, he was more successful, and remained suspended until he had lost all consciousness of existence. After a time, the garter broke, and he fell to the floor, so that his life was saved; but the conflict had been greater than his reason could endure. He felt a contempt for himself not to be expressed or imagined. Whenever he went into the street, it seemed as if every eye flashed upon him with indignation and scorn. He felt as if he had offended God so deeply that his guilt could never be forgiven, and his whole heart was filled with pangs of tumultuous despair.48

When Cowper had once admitted the thought of self-destruction, he could not go into the street without meeting with something to tempt or drive him to the act. It seemed to him as if the whole world had conspired to make death by his own hand inevitable. When he ventured into the streets, after the failure of all his efforts, a ghastly shame and alarmed suspicion were his torments; and perhaps nothing in Cowper’s autobiography goes deeper into the heart than the following description of his sufferings.

“I never went into the street but I thought the people stood and laughed at me, and held me in contempt; and could hardly persuade myself but that the voice of conscience was loud enough for any one to hear it. They who knew me, appeared to avoid me, and if they spoke to me, seemed to do it in scorn. I bought a ballad of one who was singing it in the street, because I thought it was written on me. I dined alone, either at a tavern, where I went in the dark, or at the chop-house, where I always took care to hide myself in the darkest corner of the room. I slept generally an hour in the evening, but it was only to be terrified in dreams; and when I awoke, it was some time before I could steadily walk through the passage into the dining-room. I reeled and staggered like a drunken man. The eyes of man I did not fear; but when I thought that the eyes of God were upon me, (which I felt assured of,) it gave me the most intolerable anguish. If, for a moment, a book or a companion stole away my attention from myself, a flash from hell seemed to be thrown into my mind immediately; and I said within myself, ‘What are these things to me, who am damned?’”

Cowper is not the only instance, however, of a man of exquisite taste and genius whose life has been rendered miserable by hypochondria. We have alluded elsewhere to Byron’s morbid sensitiveness, and the reader’s attention is now called to the influence of hypochondriasis on the poet’s mind. He says in his journal, “What can be the reason I awake every morning in actual despair and despondency?” He had a great apprehension of insanity. In order to overcome his melancholy, considering that his diet had much to do with it, he put himself under a strict regimen, avoiding most scrupulously all animal food. He states that his diet for a week consisted of tea and six dry biscuits per diem. After having indulged in an ordinary dinner, he writes, “I wish to God I had not dined now; it kills me with heaviness; and yet it was but a pint of bucellas, and fish. Oh, my head! how it aches!—the horrors of indigestion!” Again he says, “This head was given me to ache with.” After a severe fit of indigestion, he writes, “I’ve no more charity than a vinegar cruet. Would that I were an ostrich, and dieted on fire-irons! O fool! I shall go mad!”

Burns suffered much from indigestion, producing hypochondria. Writing to his friend, Mr. Cunningham, he says, “Canst thou not minister to a mind diseased? Canst thou speak peace and rest to a soul tost on a sea of troubles, without one friendly star to guide her course, and dreading that the next surge may overwhelm her? Canst thou give to a frame tremblingly alive to the tortures of suspense the stability and hardihood of a rock that braves the blast? If thou canst not do the least of these, why wouldst thou disturb me in my miseries with thy inquiries after me?” From early life, the poet was subject to a disordered stomach, a disposition to headache, and irregular action of the heart.

He describes, in one of his letters, the horrors of his complaint:—“I have been for some time pining under secret wretchedness. The pang of disappointment, the sting of pride, and some wandering stabs of remorse, settle on my life like vultures, when my attention is not called away by the claims of society, or the vagaries of the muse. Even in the hour of social mirth my gaiety is the madness of an intoxicated criminal under the hands of an executioner. My constitution was blasted ab origine with a deep incurable taint of melancholy that poisoned my existence.”

Nothing can be more interesting to a physician who is endowed with only a moderate share of the spirit of observation than to watch the progress of hypochondriasis in a number of patients, especially in regard to its effect on the mind. They always struggle, more or less in the beginning, with the lowness and dejection which affect them; and it is not until many a severe contest has taken place between their natural good sense and the involuntary suggestions which arise from the obscure and painful feelings of the diseased nerves, that a firm belief in the reality of such thoughts gains a full conquest over their judgment. A firm belief in any one perception never takes place until it has acquired a certain degree of force; and as all impressions which arise from the viscera of the abdomen are naturally obscure, we see the reason why these must continue for a great length of time, or be often repeated, before they can withdraw a person’s attention from the ordinary impression of external objects, which are clear and distinct, and before they acquire such a degree of vividness as to destroy the operations of reason.

We meet every day with hypochondriacs in whom the disease is just beginning to be formed, and who, being possessed of a good understanding, seem unwilling to tell, even to their medical friends, the singular, and often melancholy, thoughts with which they are tormented. They acknowledge them to be unreasonable, and yet insist that they cannot help believing in them. A very curious display of this kind of struggle between the habitudes of reason and the approach of delirium is to be found in the diary of an hypochondriac, from which we make the following extract:—

“On the 14th of November, the idea that some person intended to kill me sprung up suddenly and involuntarily in my mind, and yet, I must confess, there was no reason why I should have harboured this thought, for I am convinced that no one ever formed such a cruel design against me. People who had a stick in their hands I looked on as murderers. As I was walking out of town, a countryman happened to follow me, and I was instantly filled with the greatest apprehension, and stood still to let him pass. I asked the fellow in a threatening voice, and with a view of intimidating him from his purpose, what was the name of the town before us. The man answered my question and walked on, and I found great relief, because he was no longer behind me.

“In the evening, I observed some water in the glass out of which I commonly drink, and I instantly believed it was poisoned. I therefore washed it carefully out, and yet I knew, at the same time, that I myself had left the water in it.

“18th November.—At particular periods I believe all mankind have conspired to murder me. I think I am deprived of my office; that I am doomed to die of hunger; and, to add to all this, I am tormented with horrid doubts concerning futurity, and these thoughts persecute me like furies. Those whom I used to love most, I now hate. I avoid my best friends, and my dear wife appears to me a much worse kind of woman than she really is.

“I cannot describe the exertion it requires to conquer in society the aversion I feel to my fellow-creatures, and to prevent my ill-humour from breaking out against the most innocent people. When it really does so, I spare no one. I am sorry for it afterwards, but then I am too proud to acknowledge my error.

“I find myself so enraged on seeing a stupid, vacant countenance, that I have almost an irresistible inclination to box the person’s ears to whom it belongs: the refraining from it is a severe effort.

“20th November.—A boy with a face like a satyr met me, and occasioned me the greatest uneasiness. Although he did nothing to displease me, I was forced to go to him, and tell him that I was sure he would die on the gallows.

“23rd November.—My sensibility is often extreme, and then my best friends become insupportable to me. To their expressions of regard I am either purposely cold or else I answer by rude and offensive speeches. I can seldom explain to myself the reason of this too great sensibility. If two people whisper to each other in my presence, I grow uneasy, and lose all command of mind, because I think they are speaking ill of me; and I often assume a satirical manner in company, in order to frighten them. Anxiety, dreadful anxiety, seizes me, if a person overlooks my hand at cards, or if a person sits down beside me when I am playing the harpsichord.”

“From numerous facts which have come within my own observation,” says a distinguished living medical authority,49 “I am convinced that many strange antipathies, disgusts, caprices of temper, and eccentricities which are considered solely as obliquities of intellect, have their source in corporeal disorder.

“The great majority of these complaints, which are considered as purely mental, such as irascibility, melancholy, timidity, and irresolution, might be greatly remedied, if not entirely removed, by a proper system of temperance, and with very little medicine. There is no accounting for the magic-like spell which annihilates for a time the whole energy of the mind, and renders the victim of dyspepsia afraid of his own shadow, or of things, if possible, more unsubstantial than shadows.

“It is not likely that the great men of the earth should be exempt from these visitations any more than the little; and if so, we may reasonably conclude, that there are other things beside ‘conscience’ which ‘make cowards of us all,’ and that, by a temporary gastric irritation, many an ‘enterprise of vast pith and moment’ has had ‘its current turned away,’ and ‘lost the name of action.’

“The philosopher and the metaphysician, who know but little of these reciprocities of mind and matter, have drawn many a false conclusion from, and erected many a baseless hypothesis on, the actions of men. Many a happy thought has sprung from an empty stomach; many a terrible and merciless edict has gone forth in consequence of an irritated gastric nerve. Thus health may make the same man a hero in the field whom dyspepsia may render imbecile in the cabinet.”

The following case will shew how powerfully indigestion may affect the mind’s operations:—

A young lady, after eating some heavy paste, was attacked by a sensation of burning heat at the pit of the stomach, which increased till the whole of the upper part of the body, both externally and internally, appeared to her to be all in flames. She rose up suddenly, left the dinner table, and ran into the street, from which she was immediately brought back. She soon came to herself, and thus described her horrible ideas. She declared that she had been very wicked, and had been dragged into the flames of hell. She continued in a precarious situation for some time. Whenever she experienced the burning sensation of which she first complained, the same dreadful thoughts occurred to her mind. She seized hold of whatever was nearest to prevent her from being forced away; and such was her alarm that she dreaded to be alone. This lady had long been distressed by family concerns, and harassed by restless and sleepless nights, which greatly affected her health.

Dr. Johnson used to declare that he inherited “a vile melancholy” from his father, which made him “mad all his life, or, at least, not sober.” Insanity was his constant terror. Boswell says that, at the period when this great philosopher was giving to the world proofs of no ordinary vigour of understanding, he actually fancied himself insane, or in a state as nearly as possible approaching to it.

Murphy says, “For many years before Johnson’s death, so terrible was the prospect of final dissolution that when he was not disposed to enter into the conversation which was going forward, he sat in his chair, repeating the well-known lines of Shakspeare—

Like Metastasio, he would not, if he could help it, permit the word death to be pronounced in his presence. Boswell once introduced the topic in the course of conversation, which made Johnson highly indignant. He observed, that he never had a moment in which it was not terrible to him.

Three or four days before he died, he declared that he would give one of his legs for a year more of life. The ruling passion was exhibited strong in death. At Dr. Johnson’s own suggestion, the surgeon was making slight punctures in the legs, with the hope of relieving his dropsical affection, when he cried out, “Deeper! deeper! I want length of life, and you are afraid of giving me pain, which I do not value.” If we had not a thorough conviction that this fear of death was but the result of physical disease, which no moral and religious principles could subdue, Dr. Johnson’s conduct towards the end of his life would excite a feeling in our mind towards him very opposite to that of respect.

With reference to suicide, there is no fact that has been more clearly established than that of its hereditary character. Of all diseases to which the various organs are subject, there are none more generally transmitted from one generation to another than affections of the brain. It is not necessary that the disposition to suicide should manifest itself in every generation; it often passes over one, and appears in the next, like insanity unattended with this propensity. But if the members of the family so predisposed are carefully examined, it will be found that the various shades and gradations of the malady will be easily perceptible. Some are distinguished for their flightiness of manner, others for their strange eccentricity, likings and dislikings, irregularity of their passions, capricious and excitable temperament, hypochondriasis and melancholia. These are often but the minute shades and variations of an hereditary disposition to suicidal madness. A gentleman suddenly, and without any apparent reason, cut his throat. The father had always been a man of strong passions, easily roused, and when so, was extremely violent. The brother was a man of impulse; he always acted by fits and starts, and therefore never could be depended upon. The sister had a strange, unnatural, and superstitious horror of particular colours and odours. A yellow dress caused a feeling approaching to syncope, and the smell of hay produced great nervous excitement. The grandfather had been convicted of homicide, and had been confined for two years in a mad-house.

Andral relates the case of a father who died from the effects of disease of the brain; the mother died sane. They had six children, three boys and three girls. Of the boys, the eldest was a man of original mind; the second was very extravagant in his habits, and was ultimately confined in a mad-house; the third was extremely violent in his temper. Of the girls, one had fits of apoplexy, and became insane; the other died at her accouchement, with symptoms of derangement; the third died of cholera, not, however, until she exhibited indications of mental aberration.

A case more singular than the last is recorded. All the members of a particular family, being hereditarily disposed, exhibited, when they arrived at a certain age, a desire to commit self-destruction. It required no exciting cause to develope the fatal disposition. No wish was expressed, or attempt made, to overpower the suicidal inclination, and the greatest industry and ingenuity were exercised by the parties in order to effect their purpose. In two cases, the propensity was subdued by proper medical and moral treatment; but, just in proportion to its being suppressed, did the idea of suicide appear to fix itself resolutely in the mind. The desire came upon the individuals like the attacks of intermittent fever.

A. K., a man aged 57, was twice married. He was a shoe-maker by trade; but not having received any education, his wife was compelled to attend to all his accounts. He had experienced, when young, a blow on the head, which occasionally gave him pain. He became very intemperate in his habits, and at particular intervals he exhibited an uncontrollable temper, quarrelled with everybody, neglected his business, abused his wife, and became extravagant and melancholy. During the paroxysm he would exclaim—“Oh, my unlucky head! I am again a lost man!” When the attack subsided, he returned to his business, was affectionate to his wife and family, most humbly begged her pardon for having ill-treated her, and expressed the greatest contrition for his conduct. These attacks came on at regular intervals. He procured a piece of rope for the purpose of hanging himself, and for some months carried it about with him in his pocket for that purpose. During one of his fits he effected his object. His grandfather had strangled himself, and his brother and sister had attempted suicide.

Dr. Gall knew several families in which the suicidal propensity prevailed through several generations. Among the cases he mentions is the following very remarkable one:—“The Sieur Ganthier, the owner of various houses built without the barriers of Paris, to be used as entrepÔts of goods, left seven children, and a fortune of about two millions of francs to be divided among them. All remained at Paris, or in the neighbourhood, and preserved their patrimony; some even increased it by commercial speculations. None of them met with any real misfortunes, but all enjoyed good health, a competency, and general esteem. All, however, were possessed with a rage for suicide, and all seven succumbed to it within the space of thirty or forty years. Some hanged, some drowned themselves, and others blew out their brains. One of the first two had invited sixteen persons to dine with him one Sunday. The company collected, the dinner was served, and the guests were at the table. The master of the house was called, but did not answer; he was found hanging in the garret. Scarcely an hour before, he was quietly giving orders to the servants, and chattering with his friends. The last, the owner of a house in the Rue de Richelieu, having raised his house two stories, became frightened at the expense, imagined himself ruined, and was anxious to kill himself. Thrice they prevented him; but soon after, he was found dead, having shot himself. The estate, after all the debts were paid, amounted to three hundred thousand francs, and he might have been forty-five years old at the time of his death.”

Falret, whose researches have thrown much light on this affection, believes that it is more disposed to be hereditary than any other kind of insanity. He saw a mother and her daughter attacked with suicidal melancholy, and the grandmother of the latter was at Charenton for the same cause. An individual, he says, committed suicide in Paris. His brother, who came to attend the funeral, cried out on seeing the body—“What fatality! My father and uncle both destroyed themselves; my brother has imitated their example; and twenty times during my journey hither I thought of throwing myself into the Seine!”

Gall also relates the case of a dyer, of a very taciturn humour, who had five sons and a daughter. The eldest son, after being settled in a prosperous business with a family around him, succeeded, after many attempts, in killing himself by jumping from the third story of his house. The second son, who was rather taciturn, had some domestic troubles, lost part of his fortune at play, and strangled himself at the age of thirty-five. The third threw himself from the window into his garden, but did not hurt himself; he pretended he was trying to fly. The fourth tried one day to fire a pistol down his throat, but was prevented. The fifth was of a bilious, melancholic temperament, quiet, and devoted to business; he and his sister shewed no signs of being affected with their brothers’ malady. One of their cousins committed suicide.

Among the physical causes of self-destruction, insidious affections of the brain must stand prominently forward. It is not often that the physician is permitted to examine after death the state of this organ; but there can be no doubt that, in the great majority of instances, the brain will be found to have undergone a serious structural alteration. “During the last twenty-five years,” says Dr. G. Mantell, “many cases of suicide have come under my notice in which the mental hallucination which led to self-destruction has depended on lesions of the brain, occasioned by slight or neglected injuries of the head, to which neither the patient nor his friends attached any importance. In several instances of self-destruction, without any assignable moral cause, and in which no previous signs of fatuity or insanity were manifested, I have found, upon a post mortem examination, either circumscribed induration or softening of the brain, or thickening and adhesions of some portions of its membranes. The conviction was forced upon my mind that very many of the so called nervous or hypochondriacal affections, which are generally considered as imaginary and dependent on mental emotions, are ascribable to physical causes, and frequently originate from slight lesions of the brain.”

The learned doctor relates the following cases in illustration of his views:—

“A respectable tradesman, between fifty and sixty years of age, of temperate habits, was knocked down during an electioneering contest, and struck his head on the ground. He was stunned for a few minutes by the shock, and slightly bruised above the right temple, but experienced no further inconvenience, and the circumstance was considered of no consequence.

“About six months after the event, he was seized, one evening, with rigors and a pain over the right brow; a smart reaction took place, which terminated in perspiration, and the following morning, the symptoms disappeared. A similar paroxysm came on daily for five or six days; the attack was considered intermittent, and, I believe, bark was freely administered. At the end of a week, the patient was well. After this period, he was subject to occasional pain over the right brow, accompanied with great mental despondency, the prevailing apprehension being that of eternal damnation. This state would continue for an uncertain time, the duration varying from a few days to three weeks; and by slow degrees he would lose all trace of disease, regain his accustomed cheerfulness, and be able to transact the affairs of an extensive business.

“About two years from the occurrence of the accident, I saw him, at the request of his friends, while he was labouring under great despondency, which his relations assured me arose from some religious opinions he had imbibed; and I found that the medical treatment had been in accordance with such a notion. My inquiries led to the detection of the injury he had received two years previously, but neither the patient nor his friends would allow that there was any connexion between the blow and the symptoms under which he now suffered. Both general and local bleeding appeared to me necessary; a strict regimen was adopted, and he regained his usual flow of spirits, and expressed himself much better than he had been for years. The occasional use of leeches, and a rigid abstinence from fermented liquors, spirits, and stimuli of all kinds, maintained this favourable condition for a considerable time; but his occupation led him to occasional excess in diet, and a moderate quantity of wine or beer invariably brought on despondency and its accompanying hallucination; in other words, when the system was kept in a tranquil state, the cerebral functions were not impaired; but when excited, the morbid manifestations of the mind were produced.

“During one of these attacks he cut his throat, and expired in the course of a few hours. A short time previous to his death, when greatly exhausted by the loss of blood from his wound, his intellect was unclouded, and he expressed to me his astonishment at what he had done, and assured me he had no reason for acting thus; but it was an impulse which he could not resist.

“The only abnormal appearance upon inspecting the body after death was, a circumscribed adhesion of the dura mater to the pia mater, to the extent of about two inches in diameter, over the upper and anterior portion of the right hemisphere of the brain, opposite to the spot where the blow of the head had been inflicted some years previously.

“I will not presume to offer any comment on a case which I am well aware presents nothing unusual, my only object being that of calling particular attention to those slight injuries of the head which, although unmarked by any striking symptoms at the moment of their occurrence, may give rise to the most distressing results years after their infliction, and when the original cause of disordered action is forgotten, and can no longer be detected; and of pointing out the possibility that many cases of suicide, apparently referrible to moral causes only, may be found to result solely from physical derangement of the organ through which the manifestations of the mind must be displayed. It is under circumstances of this kind that the medical philosopher, in his painful duty of exploring the relics of mortality, may have the high gratification of protecting the memory of an unfortunate individual from the censure of a world but too apt to judge harshly, and thus afford a lasting consolation to those by whom that memory will be cherished and revered.”

No complaints can be more insidious than those connected with the brain. An apparently slight blow on the head in early life has been known, if not to give rise at the time to actual disease of the sentient organ, to predispose the person to attacks of cerebral derangement when exposed to the influence of causes so trivial as to be incapable, under any other circumstances, of producing any effect. The following case will demonstrate that moral irritation may derange the structure of the brain as effectually as any physical injury:—

A gentleman in early life was exposed for a few weeks to an amount of mental excitement almost sufficient to bring on a severe maniacal attack. He complained for some time of a sensation in his head as if some person was hammering on his brain. In the course of a few years he apparently recovered. During a tour through Italy, he had a renewal of his old sensation, and became liable to head-aches, giddiness, and severe attacks of indigestion. He placed himself under the care of an Italian physician of eminence, who did his best to restore him to health. Instead of improving, the symptoms of his disease became more apparent; and one morning he was found dead on the floor of his dressing-room, having with a penknife effectually divided the carotid artery. On examining the brain, extensive ramollissement was discovered. In this case the structural disease originated in a moral shock, the effects of which remained suspended for some years, and then gave rise to the train of symptoms that drove the unfortunate man to terminate his life. It is one of the most important facts connected with this subject, that mental excitement may produce as extensive and serious organic disease as that which so commonly follows the receipt of physical injury. With a knowledge of this fact, how cautious we ought to be in pronouncing an opinion as to the absence of disease of the brain in cases of suicide resulting from an apparently trifling departure from mental quietude, without being intimate with the previous history of the individual.

“The English,” says Montesquieu, “frequently destroy themselves without any apparent cause to determine them to such an act, and even in the midst of prosperity. Among the Romans, suicide was the effect of education; it depended upon their customs and manner of thinking: with the English, it is the effect of disease, and depending upon the physical condition of the system.” A young man, twenty-two years of age, was intended by his parents for the church. He disliked the profession exceedingly, and absolutely refused to take orders. For this act, at once of integrity and disobedience, he was forced to quit his father’s house, and to exert his inexperienced energies for a precarious subsistence. He turned his thoughts to several different employments; and, at length, he went to reside with a family, where he was treated with great kindness, and where he appeared to enjoy a degree of tranquillity. His enjoyment, however, was not of long continuance, for his imagination was assailed by gloomy and distressing reflections. His life became more and more burdensome to him, and he considered by what method he should put an end to it. He one day formed the resolution of precipitating himself from the top of the house, but his courage failed him, and the execution of the project was postponed. Some days after, he took up a pistol with the same design of self-destruction. His perplexities and terrors returned. A friend of this unhappy youth called upon Pinel one day to inform him of the projected tragedy. Every means of prevention were adopted that prudence could suggest, but the most pressing solicitations and friendly remonstrances were in vain. The propensity to suicide unceasingly haunted him, and he precipitately quitted the family from whom he had experienced so many proofs of friendship and attachment. Financial considerations prohibited the suggestion of a distant voyage or a change of climate. He was therefore advised, as the best substitute, some constant and laborious employment. The young melancholic, sensibly alive to the horror of his situation, entered fully into Pinel’s views, and procured an engagement at Bled Harbour, where he mingled with the other labourers with a full determination to deserve his stipulated wages. But, completely fatigued and exhausted by the exertion of the first two days of his engagement, he was obliged to have recourse to some other expedient. He entered into the employment of a master-mason, in the neighbourhood of Paris, to whom his services were peculiarly acceptable, as he devoted his leisure hours to the instruction of an only son. No situation, apparently, could have been more suitable to his case than one of this kind, admitting of alternate mental and bodily exercise. Wholesome food, comfortable lodgings, and every attention due to misfortune, seemed rather to aggravate than to divert his gloomy propensities. After the expiration of a fortnight, he returned to his friend, and, with tears in his eyes, acquainted him with the internal struggles which he felt, and the insuperable disgust of life, which bore him irresistibly to self-destruction. The reproaches of his friend affected him exceedingly, and, in a state of the utmost anxiety and despair, he silently withdrew, probably to terminate a hated existence by throwing himself into the Seine.

When laying down rules for the physical treatment of suicide, we have developed our view as to the influence of derangement of the primÆ viÆ, suppressed secretions, &c., on the healthy state of the mind; and we have only to refer the reader to that portion of the work for information on these points. In discussing the important question whether suicide invariably results from mental derangement, numerous instances have been brought forward that may be undoubtedly traced to that cause, therefore it will not be necessary to recapitulate in this chapter what has been there advanced.