CHAPTER XIV.

APPEARANCES PRESENTED AFTER DEATH IN THOSE WHO HAVE COMMITTED SUICIDE.

Thickness of cranium—State of membranes and vessels of brain—Osseous excrescences—Appearances discovered in one thousand three hundred and thirty-three cases—Lesions of the lungs, heart, stomach, and intestines—Effect of long-continued indigestion.

As in cases of insanity, the morbid appearances discovered in the bodies of suicides are varied and contradictory. Nothing has yet been detected which can lead the pathologist to a correct conclusion as to the nature of the organic change which precedes and accompanies the suicidal mania.

The cranium has in many cases been found preternaturally thick, and in others the reverse. Greeding and Gall give their testimony in favour of the skull’s thickness. Out of 216 examined, a preternatural thickness of cranium was found in 167. Out of 100 who died of furious mania, 78 had the skull thick, and 20 very thin. Out of 30 fatuous patients, 21 had thick crania, and six thin. The thickness of the cranial bones in melancholy and maniacal patients, and in old people, was supposed by Dr. Gall to be connected with diminished size of the brain, to which the inner table of the cranial bone accommodated itself; and together with this thickness, he considered there was also thickness of the membranes, and ossification of the blood-vessels.

Malformations of the cranium are often detected. Osiander relates the case of an old man who had suffered for a considerable time from dreadful headache, and who, weary of life, hanged himself. On examining the head, small osseous excrescences were found near the carotid foramen. Lancisi refers to a case of hypochondriasis and suicide, in which, after death, a sharp long excrescence was found near the apex of the lambdoid suture.

From an examination of the particulars of 1333 cases of persons who have committed suicide, and who have been examined after death, the following analysis is made. The particulars of the cases referred to are recorded in the works of Pinel, Esquirol, Falret, Foderé, Arntzenius, Schlegel, Burrows, Haslam, &c.

Thickness of cranium 150 No apparent structural change 100 Bony excrescences 50 Tumours in brain 10 Simple congestion 300 Disease of membranes 170 Disease of lungs 100 Softening of brain 100 Appearances of inflammation in brain 90 Disease of stomach 100 Disease of intestines 50 Disease of liver 80 Suppressed natural secretions 15 Disease of heart 10 Syphilitic disease 8 ---- 1333

Accretions of the membranes of the brain are often found in suicides. The dura mater is often ossified, and the pia mater inflamed, and the arachnoid thickened. Osiander considers congestion of the vessels of the brain a frequent cause of suicide.

Auenbrugger refers to the case of a man who had suffered for a long duration severe headache, and who committed suicide. After death, a fissure was found in the middle of the pons varolii.

Lesions of the lungs are among the common morbid appearances in the bodies of lunatics. Esquirol states that one fourth of the melancholic die of consumption.

The heart is sometimes found seriously disorganized. The stomach, liver, and intestines, are the most frequent seats of morbid phenomena in these cases. It is difficult, however, to say whether they ought to be considered as the effect or cause of the suicidal disposition. In many cases of gastric disease, the brain is also found organically affected. How is it possible for us to say which organ was primarily affected? The stomach, intestines, and liver, may be originally the seat of the irritation, and the brain may be sympathetically deranged. This is often the case. Again, the patient may have laboured under a severe mental ailment, which may give rise to disease of the splanchnic viscera. Severe and long-continued indigestion, from whatever cause it may originate, will, in certain dispositions, produce the suicidal mania. Very few cases are examined in which we are not able to detect some disease of the gastric organ or its appendages.

It is not our wish to throw discredit on, or to underrate the value of, morbid anatomy; but, with reference to the peculiar branch of inquiry now under investigation, we must confess that very little practical importance can be attached to the structural lesions which the industry and scalpel of the anatomists have enabled them to discover in the bodies of those who have committed suicide. The morbid appearances are so varied and capricious that they cannot lead to a sound conclusion as to the exact seat of the disease. In many cases, the brain is apparently free from structural derangement; and yet, reasoning physiologically, we must believe that in every case the sentient organ must be affected, either primarily or secondarily. There are many instances in which there cannot be a doubt but that the cerebral organ is the seat of the disease, but in which, after death, no vestige of the malady can be discovered!