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
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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!