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Un dee symboles suivents sppereltra sur la demlAre imege de cheque microfiche, seion le eaa: le symbole •^ signifie "A SUIVRE". le symbols ▼ signifie "FIN". Mepe, plataa. etiarts, stc., may be filmed at differem reduction ratioa. Thoee too lerge to be entirely included in one expoeure are filmed beginning in the upper left hand comer, left to right and top to bsttom. aa many framae ae required. The following diagrama illuatrata the method: Lee cartae, planchea. tableeux. etc.. peuvent itre filmte i dee taux de riduction diffirents. Lorsque le document eet trop grend pour 4tre reproduit en un seui ciicli4. 11 eet film* k pertir de Tangle supMeur geuche, de geuche i droKe. et de haut en bee, en prenent le nombre d'Imegee n^ceaaaira. Lea diagrammes suivents illustrent le mAthode. rrsta o >«lura. I* 3 32X 1 2 3 f 1 i 4 if \Ao N7orkvnDi.Ti. ^, [Reprint from The Auesist aud Nburologist, July, 1888, St. Louis.] MORAL INSANITY. Translated by Joseph Workman, M. D., Toronto, Canada. WE are indebted to our distinguished friends of the Italian Phreniatric Society for a copy of the report of the proceedings of their Fifth Congress, held at Siena in September, 1886 The entire contents are exceedingly inter- esting and very instructive. The sittings of the Congress extended over six days; the papers read were very numerous, and the discussions which followed were of an unusually high order. Nothing less was to be expected from the eminent gentlemen in attendance. Our readers may readily understand this when we present the names of even a few of the members in attendance. It would be a pleasing duty to give the whole list, but car disposable space does not permit the gratification. No American psychologist or alienist will require any confir- mation of our eulogy after recognising the following well known names of the distinguished writers and speakers whom we here present, viz : Senator Verga, Doctors Tamburini, Buonomo, Lam- broso, Algeri, Bianchi, Marchi, Seppilli, Verga, Tonnini, Tanzi, Morselli, Michetti, Amadei: — we must halt, for however much we desire to manifest our appreciation of the merits and great talents of the whole body, we are convinced the readers of the Aliknist are well prepared to admit that a phreniatric society, showing in its mem- bership the illustrious names above given, must be an honour to the nation which they so ably represent ; nor is it without fraternal satisfaction, and even some degree of pride, that we are able to say it has been through the pages of the Alienist, almost exclusively, that American [11 2 Italian Phreniatric Society. readers, (and, we may venture the insinuation, a few English ones also,) have become acquainted with the merits of Italian phreniatric and psychological literature. We have selected from the proceedings of the Siena Congress, as probably most interesting, and perhaps not untimeously instructive, to our readers, the discussion on the paper of Dr. L. Brajoft, on " Acquired Moral Insanity" — a rather short one, but its brevity is amply compensated by the long discussion evoked by it. As it would be unfair towards the distinguished speakers who partici- pated in this discussion, to curtail the report, we have decided on reproducing it in full, though it will hardly be possible to present it in a single number of our journal. The following abstracts from the paper of Dr. Brajon will be sufficient to indicate the prompting origin of the discussion which followed, which certainly covered far wider ground than its author had anticipated. The little spark kindled a great, indeed a brilliant fire. Dr. Brajon's case of so-called "Moral Insanity Consecu- tive to Mania" is thus described by him : " G. T. L. was 24 years of age ; both on the paternal and the maternal side, there had been neurotic relatives. Up to the age of 17 he had behaved wisely and well, apply- ing himself to elementary school studies, from which he profited sufficiently, and afterwards he willingly undertook the work of attending in a mercer's shop. But on reach- ing the age of 17, he became suddenly taken with a state of stupor, mutism, indolence, and inaction, and he kept in bed, a prey to obstinate sitophobia. This lasted about a month, after which it changed into the opposite condi- tion of maniacal excitement with furious delirium, in which he broke and tore everything, and accused and threatened all around him, so that it became necessary to have him removed to a place of security. He then became clam- orous, had hallucinations of sight, and tendency to sui- cide. This state continued for about eight months, after 4. I + » i Moral Insanity. - 3 which he gradually became calm and regained the use of his mental faculties, and being found apparently rational he was discharged ; but very soon after getting home, a radical change in him was observed, and his deportment was altogether different. He was no longer docile, but unmanageable, imperious and lazy. In order to carry out his new mode of life he first sold his own clothes, and next other things of the house. He extorted money from his mother, a poor widow, who, by struggling as a teacher, had to provide for the sustenance of four other children. If he failed to be gratified in his desires, he set to work in tearing, breaking and turning upside down everything in the house. Things having arrived at this pitch, his mother was forced to send him to the asylum of S. Servolo." It is unnecessary to give the details of his asylum behaviour. Every asylum physician will be able, from his own experience, to fill them in ; and even the closing paragraph might be left to his conjectural capacity ; but as it presents an important practical admonition, it will not be read without profit. Dr. Brajon closes his paper thus: *' Finally, by captivating the affections of those in charge, with the view of obtaining his liberation, he began to be very good, tranquil and obsequious; he assisted in some of the work in his own ward and elsewhere ; and after a year's asylum residence, he promised to behave honestly and industriously, so that he obtained his wished for liberation. But he very soon gave himself up to his former mode of evil life. He was placed in the position of a shopboy ; he was admitted as a boatman to a pri- vate family; next among the revenue guards; but he either left all places voluntarily, or was discharged from them, in a few days. He finally became a quarrelsome rowdy, and having assaulted the police, he has gone on in his evil courses, and within the last few years, he has beep often under arrest and confined. Between drunken- ness, prison and the asylum he has passed his days." 1 Italian Phreniatric Society. The discussion which followed the reading of this paper took a very wide range, covering the whole field of moral insanity; it was commenced by Verga, who spoke as follows: Moral insanity has commanded my attention during the three years that have elapsed since the Congress at Voghera. I have felt bound to this duty not only by my position as a member of the committee which was charged with the consideration of this subject, but also by its very great importance ; it may be said to be a sociological rather than a psychological subject, because of the influ- ence it may have on the state of society. The little, indeed the very little, fruit that I have gathered, I would very gladly have given to the gentleman who assumed the position of reporting, had he been here. I shall now, begging to be excused for my dullness of hearing, state, perhaps imperfectly, what would have been told by another. In the first place I think we ought to insist on the distinguishing of reasoning mania from moral insanity. The former is a genus, the latter is a species. * All the subjects of moral insanity are reasoning persons, but all the reasoning insane are not the subjects of moral insan- ity. The latter have a particular ingredient; they have the perversion of instincts, the tendency to badness, and that delirium of actions which Brierre de Boismont has so called. Moral insanity is usually native, or congenital. It seems to me that this is the idea held by our able col- league. Dr. Grilli. It is the idea which led me to place moral insanity immediately under the phrenasthenias, as if it were a bridge of passage from the congenital insanity to the acquired. Dr. Semal expressed very nearly the same idea in the Congress of Auvcrsan. Professor Paul Moreau (de Tours), in his memoir, entitled ** I' Homicide commis par Us en/ants,^' has mentioned a moral insanity evident in children ; and not long ago I myself sent a splendid sample of it to the asylum of Mombello. Dr. Gonzales very well knows of whom I speak. \t * Moral Insanity. fc ♦ In some rare cases, or, if you so wish to call them exceptional, moral insanity appears to have been acquired; and if I have rightly understood him, Dr. Brajon has to-day exactly described a case of moral insanity consec- utive to another mental form. It is notorious that a more or less protracted period of moral insanity is the prelude to some forms of insanity and especially to paralytic phrenosis (general paresis). We might therefore make a primary distinction between congenital moral insanity, and acquired moral insanity. As to its essence moral insanity presents two species or varieties. There are some individuals who, though conserving free, and even potent, their syllogistic facul- ties, yet often commit extravagancies, obscenities and real crimes, because they possess not that which is called the moral sense; they do not perceive the impropriety of their acts, so that they feel no remorse or penitence, and they even wonder that other persons see anything wrong in them. To these persons the very energy of their intellect is prejudicial, because they are able to justify their offences, and, bless the mark! to render them amiable. This psychological condition has by some writers been called moral daltonism. There are others who, from time to time, for a mere trifle, or even without any cause whatever, rush into grave excesses, such as homicide, sui- cide, etc. These understand how to act wrong; tht> also deplore their bad deeds, but they assert that they couic not act differently, and that they are dragged to evil by an irresistible force. This is a fact which has been observed but too often of late years. The distinguished Professor Lombroso, in this relation, very sagaciously observes, that such individuals, when carefully examined, are found to be subjects of epilepsy, and that their evil acts may be influenced by accesses of epilepsia latvata or a substitu- tive mania. The cases clearly detailed by my nephew, Dr. G. B. Verga, seem to give some support to this view. We next have some individuals, and they naturally are the worst of all, in whom both species or varieties of i; Italian Phreniatric Society. moral insanity are combined. These perhaps figured in the ancient codes as brutal ci'iminals. In the meantime moral insanity has been gaining ground, and though in the beginning of the present cen- tury it was excluded from all the statistical tables of mental diseases, as a savage thrust against justice and law, it is now admitted as a guest in almost all the sta- tistics of asylums. The American, Dr. Hughes, of St, Louis, editor of the Alienst, when at the Medical Con- gress in London, admitted it under the title of affective insanity. Van Persyn, the distinguished director of the most important asylum in Holland, has also accepted it. Dr. Kesteven, of England, does not doubt it; he even extends its domain, saying that all crime is insanity. The famous Guiteau appeared to Lutaud and others to be morally insane. As respects Italy it may suffice to say that in the four censuses which 1 have made in a tabular form, moral insanity has been recognised in nearly all the asylums, including those of Trento and Trieste. On this occasion I observed that moral insanity is most fre- quent in the male sex, and in the upper classes. We must not however admit moral insanity with our eyes closed. It would then be too easy for real delin- quents to escape the consequences of their offences. Lawyers would, in some cases, magnificently comprehend the value of moral daltonism, and in others of larvate epilepsy. There are poor devils who do wrong, believing it to be right ; these creatures, because of a violent and untimely discharge of some cerebral cells, involuntarily and irresistibly, or even unconsciously, commit serious oftences. It is necessary therefore, to distinguish the true cases of moral insanity from the false or simulated. If some individuals pretend to have a bad headache, or to be very weak, in order to avoid work, it does not fol- low that other unfortunates ones are not, from such causes, rnable to work. It is indeed difficult to distin- guish with certainty, these two classes, the real and the simulated or fictitious. This was the question which was .. r > -a« Moral Insanity. v.. r > ' especially recommended to us by the Congress of Voghera. We may however decide, with much probability, on the presence of moral insanity, by adopting the following criteria : 1st. By ascertaining whether the parents, living or dead, of the individual submitted to our judgment, were affected with mental or nervous diseases. 2nd. Whether the same individual presents degenera- tive characters, as anomalies of the cranium, asymmetry, depression of general sensibility, hyperaesthesia, convul- sions, recurrent, nervous tics. 3rd. Whether the offences committed by him had any relation with their cause, and finally whether he has become incorrigible. What must we do with these persons? I believe that rather than irritating them by undeserved rigors in com- mon prisons, where they may become still worse by contact with real delinquents, and from which they will go out to commit new and more grave offences, we should declare them affected with moral insanity, and therefore irresponsible or semi-irresponsible, and they should be placed in criminal asylums, and be detained there until they give signs of amendment, for it is unjust, as I have said on another occasion, that because of their intellectual eclipses, the good members of society should have to live in constant fear and suspicion. Michetti spoke next. He said, I have asked the priv- ilege, not with the intention of entering into the merits of the discussion with which we are now occupied, as it seems to me that the subject of moral insanity, in order to be fully and profoundly discussed, would require much time and a great accumulation of observed facts ; and in the present state of our Congress, though these may not be defective, yet we have them not all now present. Pro- fessor Verga has, in my opinion, said enough to estab- lish the limits within which the discussion should be con- ducted, but this will not suffice for the substantial solution of the problem into which we have entered. I , i- jiii "9 I Italian Phreniatric Society, As for myself, I set forth by declaring that the fact of an entity, which I venture to call morbid, is now indis- putable ; it is manifested in a perversion of the affections, and although this may be connected with an enfeeble- ment of the mental faculties, it certainly has no relations which permit us to derive it immediately from intellectual deficiency. It appears that there are, in the sphere of the affections, rather than in that of the intellect, such lesions as lead the unfortunate victims of these maladies to commit acts that are repugnant to the moral sense, but yet not contrary to any logical co-ordination of ideas. It is a fact that though moral insanity should not be confounded with reasoning mania, (and Professor Verga has very learnedly detailed the reasons), yet it very closely approaches the latter; and, although it may, in some cases, be easily distinguished, in many others, I think it might very well be defined as a form of reason- ing mania. I also admit that moral insanity is always congenital ; I believe that it is absolutely a hereditary malady, and I also venture to differ from the opinion of my illustrious master, when he holds that it is sometimes acquired. I do not think this can happen, or it will hap- pen very exceptionally ; I do not believe this, because the cases in which it may have been regarded as acquired are those with paralytic phenomena, and in these cases I cannot see how we can any longer speak of moral insanity ; we shall here have somatic lesions which have been clearly determined by science, and these may fully account for a perversion of the mental faculties ; hence it does not appear to me that in this case we can speak of moral insanity, but of a paralytic incipient delirium which will have a form modifying the habits and the affections, without yet affecting the logical order of the ideas ; but this phenomenon is substantially the product of a lesion, and we cannot have moral insanity if a paralysis is included in it. I fully admit that [in a real case of moral insanity there is realised what the illustrious professor Verga has I tt Moral Insanity, '9 ' \ said: the intellect in some way injures the affections; that the sense of the useful to himself, the sense of self-grati- fication, so far domineers over that of duty, that these persons are unable to abstain from acts which they regard as advantageous to themselves, and they care not for the harm they do to others; I believe that in these persons the sentiment of self-advantage, self-benefit ; prevails over the sentiment of duty and fraternal love, so as to pro- duce a loss of equilibrium in the intellective and the affec- tive functions, sufficient to constitute a true disease. These unfortunates do wrong for the sheer purpose of doing so; they know it, and they do it with full determination. But in order to know whether they do it because they are irresistibly drawn to it, this we have to accept on mere faitk, because we have to believe them ; but we have not any proof whatever, truly to establish that, if had they strongly wished to avoid the act, they would have been unable to do so. If we could obtain this proof, the question would be solved, and we should no longer speak of wickedness and criminal ten- dencies, but, in the strict sense of the word, of a disease characterised by want of will-power. I have also some doubts respecting the statement of the illustrious Lombroso, in whom, in another relation, I recognise the very great merit of having established the affinity between epilepsy and moral insanity. As a gen- eral rule, Lombroso has found the key of the phenome- non, yet I venture to doubt whether it is a constant fact, an absolute law, that the epileptic condition is invariably conjoined with moral insanity ; in very many cases, indeed in the majority, an epileptic state, either manifest or larvate, is so complicated as to carry with it the phenomena which, in our estimation, characterise moral insanity ; but that there is an intimate relation, an immediate descendence, an absolute fraternity, so to say, between these two forms, I absolutely refuse to admit. I know very many epileptics who are anything but morally vicious; I also know many persons who are morally ill ill! 1 1 : A.' • I ■ \\\ \\\ I 10 Italian Phreniatric Society. T vicious, in whom I have never been able to discover any sign that would justify the diagnosis of epilepsy. I believe that moral insanity is absolutely not a sim- ulated form ; I believe that in a medico-legal discussion we could never find much difficulty in refuting the suspi- cion of simulation, regarding a morbid form which had indicated to us a moral insanity; it seems to me to be very difficult to assure ourselves of proof of simulation, for it requires many studies, many observat'.oiis and very close enquiries, before wc can establish it ; and I find that no form, or at least but very few phreniatric forms, pre- sent, in themselves, evidence so reliable for practice as moral insanity ; when we have present the means by which it may be discovered, and when we hold in view all the alterations manifested, it must be very diffi- cult of simulation. I now say frankly that it appears to me to be one of those forms which an individual would hardly select for simulation, because it is so vast, and one who is not a medical alienist would find it very diffi- cult to deceive an expert. Finally, I say that in order to establish the existence of a moral phrenosis, the means of deciding cannot be furnished unless by the full history of the individual and of the case, and from a precise recognition of a defective relation between the intellect and the affections, and above all from that incorrigibility to which Prof. Verga has justly alluded. I do not admit that degenerative characters suf- fice to give us an exact idea of moral insanity. I admit that these characters are often found in the unfortunates, who are morally diseased, but I here repeat what I have said of epilepsy. When moral insanity has been alleged to depend on one of these alterations which are said to form degene- rative personal character, in my estimation, it would cease to be a phrenopathia, and would become a nerv- ous form, like the majority of mental maladies, a nervous form which has its substratum in a physical alteration which we are well able to appreciate. This is my way r \ Moral Insanity. II • of viewing things, purely and simply in a practical order, because, I repeat it, a profound scientific discus- sion of moral insanity, in the strict sense of the word, with the means at present at our disposal, seems to me very difficult. , Verga. The courteous manner in which Dr. Michetti has directed his remarks to me, has taken from me all desire to reply to him, and all the more as I see that there is not any substantial difference between his opinions and my own. He holds that there are points of contact between moral insanity and reasoning mania; and I also have admitted that there are between the two forms of insanity those points of contact which always exist between a genus and a species. He would have moral insanity always congenital; I have admitted that it is only exceptionally acquired. He has shown that general paresis has characters quite different from moral insanity, and that the two should not be confounded ; I also declared that the moral insanity in many cases of gene- ral paralysis, simply constitutes the initial period, and that this passes off more or less promptly. I have there- fore reason tor congratulating myself, from seeing that almost along the whole line, in this grave question of moral insanity, I march in accord with him. He says that what I noted respecting change in the instinct" in paralytic phrenosis, cannot be regarded as moral insanity. Neither do 1 so regard it ; I said that it is the prelude of paralytic phrenosis, the initiation ; the malady is therefore still paralytic phrenosis; but in the mean time this initiation manifests itself in a perversion of the instincts. Now, what must I call this period, in naming it rightly? I call it an access of moral insanity ; it is one of those accesses which have been specially noted by Ikierre. Finally, another circumstance mentioned by Dr. Michetti is that relating to the simulation of moral insan- ity. He said that moral insanity could never be simu- lated. I believe he is right, but 1 may not have been n ? 12 Italian Phreniatric Society. fully understood, or perhaps I have not spoken clearly. By simulation I mean that the person asserts that he felt himself drawn, against his will, to do a certain act, whilst this is not true. This point being estab- lished and made clear, it seems to me we are in perfect accord. Morselli. Our conception of moral insanity cannot, in my humble opinion be enlightened otherwise than by the researches of criminal anthropology. Just as we owe to Professor Lombroso so many other discoveries, so are we indebted to him for the creation of the type of the natal delinquent ; now, whoever has followed the discussions which have occurred on the delinquent man, cannot fail to find an intimate relation, an analogy, and even an absolute identity, between what the anthropological school, now at last, call congenital delinquency, and what we must accept, in our classifications, under the name of moral insanity. This identification, it seems to me, throws light on the clinical conception of moral insanity ; it sweeps away half of the embarrassing questions of the prodromic moral insanity of other forms, it also, up to a certain point, sets aside the questions on the identity, insisted on by Prof. Lombroso, between epilepsy and moial insanity, an identity which, in unison with Dr. Michetti, I cannot accept. Were the question freed from these secondary problems, we could confront this clinical form (for the present I adopt the term, clinical^ but I shall after this better explain my idea) which we have to designate as moral insanity. There are certain states in which the moral sense is perverted, and these constitute a phenomenon altogether accessory in other forms of common mental alienation (for example, in epi- lepsy, mania, etc., etc.), but these do not at all constitute the type which we should have. It would be, to me at least, a deplorable confusion to conjoin a symptom such as perversion of the moral sense, accompanied by the actions which are exhibited in the first days of almost every acute mental disease, with that form, or morbid i •■' 5 Moral Insanity. ^' entity, which we should in our tables retain under the title of moral insanity. Moral insanity (and this I am constrained to say), for us, who hold and defend the ideas of the anthropologi- cal school, is not a disease, is not a morbid process ; it is a process which pertains to teratology, it is a teratolog- ical, not a morbid state, for there are not in it those characters which in pathology we term morbid; on the contrary, it is a special congenital state, an anomaly of development, an arrest in the development of the ethical sense ; but it is not at all a pathological form ; a morbid form in which we trace any lesions whatever. We may in course of time, discover some lesions of development, some anomalies, and researches of the criminal anthropo- logical school have already thrown light on the teratO' logical conception of these congenital forms of insanity, inasmuch as they show that there are individual varieties in the histological development of the nervous centres ; and the histological or the pathological genesis of moral insanities, being thus illuminated, ^it appears to me that the type of moral insanity is not at all that of a disease ; it is an anomaly of the mental development, which has its basis in a teramorphous, or a teratologic, development of the nervous centres and their functions. Evidently, for me at least, one-half of the harmful confusion between those perversions of moral sense, which are manifested in paralysis, etc., and moral insanity, is thus removed. In my opinion acquired moral insanity has no exist- ence; there will be a moral perversion which precedes- the outburst of the more salient phenomena of psychical alteration, but acquired moral insanity I do not under- stand, unless we should altogether modify the conception which we ough*^ to have of this teratological form. The researches of Lombroso, Ferri and others who have inaugurated the new era in criminal sociology, (the only school, we must speak the truth, which has the right to be so called is the Italian, because there is not any other, and it is the one on which the rest of the world I ; ! ; M^ Italian Phreniatric Society. has fixed its attention) have shown that moral insanity, considered hitherto as belonging to psychiatry, on the contrary belongs to sociology ; it is, if you will so have it, an atavic, anomalous, non-morbid, teratological type of the present human society, which ought to figure in the delineations of pathological psychology', not under- stood as psychiatry, but as a study of all the deviations which may be presented in the human mind. This conception, as I think, shows that this form must be absolutely congenital ; it clearly exposes the « rror of confounding it with those symptomatic forms of perversion of the moral sense, which have nothing to do with moral insanity ; and finally it leaves the question open, which has been propounded by Lombroso, as to the identity, or at least the very close afifinity, between moial insanity and epilepsy. Permit me to say a few words on this head, and I shall close. It is certain that there appear to be points of analogy, and the sagacious eye of Lombroso could not fail to see them; he saw that in some cases moral insanity was combined with epilepsy ; he next saw that epilepsy piesented a perversion of the moral sense, and this created in his mind the conception of identity. I am unable to admit it, because I do not, even etiologically see why one born with a teratology, a special embryology, should be epileptic. Admitting this, we shall find a con- tradiction in this very criminal anthropological school, and it consists in this : This school finds analogies between moral insanity, understood in the sense which I have stated, i. e., an abnormal teratological form, and the state of our progenitors, whether these were of infe- rior human race, or animals. Now this relation does not necessitate the fact that the inferior human races or ani- mals must have been epileptics. It is certain that epilepsy has always existed ; discoveries show that it existed even in the stone age, but this does not imply that when we find a congenital alteration of mental development from deficiency of the moral sense, this deficiency or anomaly ■ Moral Insanity. ij should be identified with a morbid form such as epilepsy. ; Epilepsy certainly gives origin to a morbid charac- ter, or if you would have it so, to a want of moral sense, but this is a co-phenomenon which is a natural part of the clinical picture of epilepsy. The same phenomenon is presented in other forms, for instance, in hysteria there is a perversion of the moral sense, — why then should we not identify hysteria with moral insanity ? In alcoholism also there is perversion of the moral sense ; we in gene- ral find it in all the forms of histological degeneration of the nervous system provoked by poisons which are infiltrated into the organism. Now it seems to me that it would be a very great confusion to link with the delir- ium of acts, anomalies, disturbances and perversions of the moral sense, those congenital anomalies which, accord- ing to the anthropological school, should represent alone the exclusive, unique type of the moral insanity which ought to be presented in our tables. Verga. I think I have heard it said that moral insanity is a teratological fact, a monstrosity. I concur in the maxim, because moral insanity is usually congenital ; but absolutely to exclude the possibility of moral insanity being developed in the course of life, and chiefly in early age, seems to me to be going too far. How would Prof. Morselli explain the cases of those individuals, who during all their boyhood and adolescence had always behaved admirably, and only in puberty had manifested a total upset in their afifections and tendencies, in conse- quence of which they have been called moral fools? I see that some admit a degeneratio juvenilis^ and this degeneration is in fact manifested only at the period of puberty. Well, admitting this, I cannot conceive why, unless as a mere conventionalism, we should constantly and necessarily understand by moral insanity a teratolog- ical fact. I beg for an explanation. Morselli. Prof. Verga has alluded to cases in which moral insanity had been developed at the period of ■ *i ■. ii;? lift ;? «6 Italian Phreniatric Society. puberty. I do not question his observances, but I do not know whether these cases really belong to moral insanity. If they have been cases which were observed in past times, when the conception of moral insanity was not so nice as it now is, I might have some doubts of the accuracy of the diagnosis ; if they have been cases recently observed, since a great revolution has taken place in the conception of moral insanity, especially through the researches of the criminal anthropological school, I confess I am ignorant of them. According to our views moral insanity is a congenital form ; this does not exclude cases in which moral insanity may follow some grave injury, that has fallen on the brain even during its early phases of development ; it has not been said that moral insanity must be hereditary, it may indeed be a purely embryonal, or a foetal form, it may be a form that is developed in the first years of life, but it suffices for us that the associate development of the fibres, the total development of the cells that constitute the web of the gray substance, the histo-genesis of the nervous development, has not been completed, — this is enough for us. We all know, as to puberty, that at this time of life development has not been completed I have referred to the researches of Flechsig ; we all know them, we know that at a certain time in life those paths of asso- ciation which constitute the heritage of all adult persons, have not yet been established ; it is then evident that in infancy, that is, in the period in which the greatest ferment takes place in the development of the nervous centres, there very well may be histological modifica- tions, not in the path'ological, but in the teratological sense of the term, for example, from injuries to the head, etc., and in this way we might explain those very rare cases, which may have been developed after the causes mentioned by Prof. Verga. But, I repeat it, if such cases belong to the time anterior to the concep- tion of moral insanity of which I have spoken, I would say, as we are now in cholera times, let them be put Moral Insanity. J7 in quarantine ; but if they belong to the posterior time, then let us know all about them, and we shall cheer- fully receive them, for it is our earnest purpose to dis- cover, as far as possible, the truth ; if this truth shall enlighten us and turn us back from the path we have been treading, all the ^better, we ^hall be happy to discover our errors ; but for the present, until we have felt assured of a complete diagnosis, derived from clinical observances, made with conceptions which we all can accept, we must doubt the theory that moral insanity should not be regarded as a congenital form. (The Congress now adjourned till the afternoon 20th September.) AFTERNOON SESSION. Dr. Brajon. If is known that all children {bambini — infants) have evil tendencies, instinctive perversions, and hence we see them strike, throw themselves on the floor, and exhibiting cruel instincts in maltreating and sometimes even in killing animals ; these tendencies are corrected by education. [Note bv Translator. If Dr. Brajon here spoke from observance of his own children, we pity both himself and his children. If he meant all Italian children, we decline to accept his draft on the bank of imagination, without substantial endorsation, and even then we shall insist on a very large discount, even larger than Prince Henry deducted from Falstaff's " men in buckram."] Further, we have the fact that many bad ones, who are placed in suitable institutions, have a tendency to crime. These, when so placed, and carefully educated, are often restored to society and the family, and become good citizens. But according to the teratological theory this change could not take place. If we admit this theory, no form of treat- ment would suffice to correct the perverted instincts. Now, if by education these results are obtained, it seems to ill' ''.I f|i Italian Phreniatric Society. me this theory cannot be wholly tenable, and therefore I have asked for some explanation. Finally, with regard to the affinity between epilepsy and moral insanity, I have met with many cases of moral lunatics who had brothers and relatives epileptic ; hence we see that the same mor- bificccause produces different effects ; in one of the degen- erates it presents itself under the form of moral insanity, and in another under that of epilepsy. This is what I wished to make known to the Congress. Morselli. As to the cases of furious mania compli- cated with moral insanity, I shall say that there is noth- ing extraordinary in the fact; it is not marvelous that moral lunatics may become subject to excesses of mania. We know that this is in accord with the doc- trines which I had the privilege of stating to the Congress this morning; it is in perfect accord with the theory by which we admit in paranoia the phenomena which we term episoidal. We know that epileptics con- stitute a group of individuals in close aflfiinity with that of the moral insane, and that the latter are subject to accesses of mania under an episoidal form. No one won- ders that in the moral insane also there are accesses of mania with fury, also of melancholy, and even in general paralysis, as has in some cases been verified. It is admitted, since the researches of Magnan, that several forms which have the symptoms of mania with fury, may be united with the common form of moral insanity, thus developing a morbid acute form under the aspect of mania. This should contribute to the confirma- tion of the doctrine which we hold, that is to say, there are individuals who are invalids, deformed, who may become subject to diseases just the same as those to which persons normally constituted are subject ; but in the early years these accesses will have special characters. My second observation is a confirmation of the doc- trine which I have stated : the researches of the anthro- pological school have demonstrated that there exist in children germs of moral insanity. But on this point I Moral Insanity. offer some remarks, I might almost say, criticisms. If we should call germs of moral insanity those phenomena which constitute a transient episode in the normal evolu- tion of the human sentiments, we might then say that children have also the germs of imbecility. We have facts which prove that some little children have as much intelligence as imbecile adults ; in the evolution of the affections, the sentiments, and the intellect, there are phases, and it is clear that the child passes through these phases, the education of social life, of the family, and of the surroundings, that operate so as to overturn the sentiments and affections, and then all are defaced. In those, on the contrary, in whom this anomaly of development is absent, and the organization of the uiervous system has been definitely settled, these germs are but transient. The doctrine of Lombroso on this point, must therefore be modified, at least in my humble opinion, in the way I have indicated, that is, if there are germs of moral insanity, we ought to regard these phenomena as only a transitory phase of development in the history of a normally constituted individual, but as permanent in those in whom the development of the nervous system is anomalous and incomplete. This furnishes the explana- tion of the third objection respecting the bad ones; it would be absurd and ridiculous to hold that education does no good ; we are the products of two factors, heredity, (that is atavism understood in the widest sense of the word,) and our surroundings; in a large number of indi- viduals heredity predominates; in a very small number the surroundings prevail over heredity ; the results depend on special circumstances; but is the problem modified by the fact that some of the bad ones have been successfully edu- cated? It remains now to be seen whether they are successfully educated ; Prof. Lombroso has profoundly studied the subject, but as regards reform of the bad ones, there still remains much to be said. We have an authority not to be suspected, Dr. Biffi, who is able to tell us what are the benefits of this education in the places in which the ii i: ii I 20 Italian Phreniatfic Society. small ones, wanting the moral sense, are confined ; in gen- eral little or nothing is achieved by that which the opti- mistic doctrine would lead us to expect. Finally, as to the fourth objection, relative to the hereditary affinity between epilepsy and moral insanity, there is nothing marvelous in the fact. We know that all forms of anomaly of development become combined, or they alternate ; we know that from persons who were affected with psycho-neurosis, there come some idiots, from their births, and alcoholists with degenerative forms. Nobody denies the theory of heredity, for without it I -could not comprehend the ideas of the modern school. Brajon. I have related the fact of an individual who, before he was afifected with moral insanity, had shown manifest mental alienation ; his moral insanity was developed only in consequence .of an access of furious mania, and his state has remained the same as it was at the outset. Venturi. It does not appear to me to be necessary that Morselli should enquire whether moral insanity exists from birth up to puberty, in order to show that it is always congenital. The conception of Lombroso, that between moral insanity and epilepsy there is a family affinity, is derived from the fact, that, according to the researches of Laseque, epilepsy usually appears between the ages of eight and eighteen years ; the child who is afterwards to become epileptic does not, before the age of eight, appear to be epileptic ; now, among the various forms of epilepsy, there may be also that of moral insanity, therefore the fact that it is always manifested in the age of puberty does not at all exclude the idea that this moral insanity has not a congenital basis. I have desired by these words to contribute support to the opinion of Lombroso, and at the same time to calm Morselli, and to assure him, that even though there may be no cases of moral insanity in infancy, this does not signify that moral insanity could never have a congenital basis. t 1 ) s ^ai f f wiww Moral Insanity. 21 . 1 :• ■■■%-. Buonomo, the President now left the chair, which was taken by the Vice-President. He spoke as follows : It seems to me that this dis- cussion on moral insanity is often conducted with ambi- guities of meaning ; we alienists, do not proceed according to the elementary principles which are unfolded in our science, in its serene, and I will say, altogether scientific field ; rather indeed we proceed jumpingly. To under- take the examination of a case of moral insanity, when we are questioned on the subject before the Courts of Assize, after the moral fool has arrived at crime and at the tribunal, and then to take this type of criminal char- acter and in it to display all our learning on the subject of moral insanity, all this, I say, constitutes an ambi- guity. To me it appears that in so doing we are abstract- ing a special case from our whole bundle of so many cases, which represent our conception of the moral dis- order of an individual ; because if by moral insanity we understand a disorder which is manifested more or less in the moral field, it will not be the degree of the disor- der that will indicate a different type, it will be, the nature of the disorder that will represent the type of the altera- tion with which we desire to occupy ourselves. One who rushes out, killing, ravishing and so forth, no one doubts is a moral madman ; but another who commits such offences as do not bring him under public notice, or such as escape judicial investigation, do ye believe that he is less a moral fool than he who committed murder and rape, and has been arraigned at the assizes ? Cer- tainly not. The proper conception of moral insanity is simply that it is a perversion of the moral sense ; magis- trates do not interrogate us on the general subject, in extenso ; they examine us as to the character of the case under their judgment, but we will view it thus only as a special case, as a single case of a whole series of moral disorders. If then we would begin to confine ourselves within the domain of our own science, without also considering its I n 22 Italian Phreniatric Society. ultimate applications to the legal code, perhaps some dis- cussions, which appear to be divergencies, might yet become elementary cognitions of our science, and per- haps there would be less disaccord. There are various moral disorders, and different degrees of these ; not only- are there different degrees, but the very same individual may have them in one single direction, and we may find one individual who is habitually, and very readily,, inclined to some delinquency or fault, whether such as- to bring him before the courts, or not. A person with such a disorder of his moral conceptions, when placed in a different position, may really appear to be a man of pure moral sense ; in one field a hero, but in another a wretch for the gallows, or certainly a man deserving of reproach in the forum of moral conscience ; and why ? Because we easily construct lumping groups of the so- called mental faculties, when each of such groups has only to be split up into so many several parts, which when closely regarded, impress each individual with a special importance. I therefore here repeat, begging pardon for so curious a phrase in this(!) hall, "before the judgment seat of God who will be justified?" I once heard this phrase, and it impressed me deeply, for many are the sins of morai sentiment which only the pure conscience can value justly ; outside the conscience of one who feels these sins, or of one who may fall into any transgression whatever, every thing in these moments appears limpid and clear, very different from what transpires in the un- fortunate one, who by the law of mental disturbance, commits an act which brings him to the scaffold. Moral insanity therefore, in general, in our scientific studies, not in those of legal appliance, is a disorder in the moral sentiments; and if, in these, disorders may arise, the passage therefrom to disorders of action is possible, and they are to be valued and judged of in relation to the degree of moral sense. Let us first ask : is it inevitable that a disordered \ Moral Insanity. 23 1 moral sentiment shall fatally have its expression in an act ? No. Sentiments and action are two different things, though they are c(Minected. In our studies we often say : when we have more facts than are wont to harmonize, as there may be in each part, so there may also be disorder in the law of connexion, succession. We may therefore have moral disorder without a responding immoral action, and vice versa, we may have an immoral act corresponding to any moral disorder. But to proceed more simply in my observations, I will say that moral insanity, or better, moral disorder, (for the term moral insanity gave place this morning to some serious observations by my friend Morselli), moral disorder, therefore say I, may consist in a disorder of the senti- ments, without those consequent fatal acts which make it manifest, or it may lead to subsequent acts which are more or less immoral. How comes this genesis of action, from the sentiments? Actions are accompanied more or less by the internal sentiment which is wont to be the decisive incentive to action, an incentive which springs from the ideas, the intellect. We may then have an intellect that was sound in its origin, but on which there have been impressed certain conceptions, judgments, beliefs and so on ; in other words we may have the con- ception of moral things and of immoral things, of justice and of injustice, of duty and of its opposite, but ideas do not rain down upon us haphazard from heaven, they come to us prepared, educated, from atavism ; hence a consequence which has at length become a fact known to all, that, is, that the moral sense is not that absolute, eternal sense, it has been usually styled, but on the con- trary it is the product of the scientific, educative, evolution of civilization. None of us would call immoral a person of a certain civilization and a certain epoch, who eats the flesh of his elders. None of us would call im- moral one who cohabits with his sister or his widowed mother, in another civilization and another epoch, and so on ; this is not immorality, it is the conception, it is the 24 Italian Phreniatfic Society, thought which prevails in that society and that epoch. And even nearer home, though we have not these classic examples, yet we have many examples of morality and immorality in the actions of those who live in a state of society different from that in which the others live; for though our society may boast of an ancient civilization and an ancient history, still it must deplore that dense and heavy stratum which, from antiqiuty, has lingered down to our modern civilization. When, for example, (and it pains me to adduce as an example, a bad feature of my own city of Naples, but if I cite Naples I do not desire that any of you should cite bad examples from his country ; yet, when the mask is taken off, every country is seen to have its plague spots in the order of ideas which I now announce,) when then, as I commenced to say, we have, low down, in a certain part of the city of Naples, into which the civil life, which is found in a higher order of society, has not yet penetrated, and when of this low stratum, people say, in a synthetic formula, there is born and there lives the camorra, look out for him, do you know what stands related to the intellectual life of his civilization ? Ofttimes he is a hero ; change the key to which this unfortunate beats time. If that note is struck to which the knife, or something more horrible responds, poor devil ! Did he but know that near by there is another key, from which is diffused the loveliness of the new civilization, and did he but strike the note aright you would call him a hero, whom before you regarded as a horror, a bestial man, or even worse. And why so ? Because ever since he was born, it has not been enough that we proclaim our more elevated society, and that we puff, and fling a ray of the light of civilization to him, for he has learned his own catechism, which has taught him that in the circle of his society, he who has recourse to force is , respected ; he is honored by his chums, when, on coming back in the night, he is able to detail those acts of prowess which we call infamous, but which, in i i7 t I ^ Moral Insanity. 25 his society, are the badge of honof. When he says, I have had the misfortune to be captured by the police force, (and forget not that he knows force only, he has not any idea of civil life) I have been seized by a man of the law, who is now conducting me handcuffed through the crowded streets of Naples. Now pray look at him, he fears not the jail, he walks with head erect, just as Poerio and Settembrini and so many others did, when in the like dilemma they went to the Assize Court, and next to the gallows. The difference is that Poerio and the others had a conception homogeneous with our civilization, but these camorisi have a concepton of honor and morality corresponding to an epoch very far distant from that of our blessed civilization. [^Note by translator. It is gratifying to find that the words, camorra and camoristo, do not appear in the Italian dictionaries now at hand ; they are Spanish, the nearest English (or American) equivalent would be roughs, or toughs, or bowie knife experts]. Gentlemen, ye should see these heroes : they have their cigar in the mouth, tliey .valk proudly, and when they reach the jail and meet their companions there, those who can narrate the greatest act of prowess, that is the most heinous outrage, are the most content; and when next he can say, " I will go back into society, and instead of the rank which I now have in the camorra, I shall mount to a higher," then are they satisfied, and this is exactly their career. Theirs is an intellect on which is impressed an idea different from that which civilization impresses on our minds ; the camoristo is immoral in the intellect not from disease in it, but a vicious saturation of his ideas, conceptions, the education he has had, and the beliefs he has acquired ; it is not a morbid disorder, it is with him a natural, physiological law. If the ni.i<,Mstrate asks us to account for these things, we, as psychological alienists, will reply to him ; let him judge, let those judge who have to administer the law, how far a nian's surroundings may draw him in one 26 Italian Phreniatric Society. direction or the other. Gentlemen, it is the idea which we should estimate. Consider for a little how the aspect of our own actions and of our own moral sense is transformed. If during the time of tyrannical governments, there were spies, and afterwards in the times of good government, we have such an abhorrence of spies, do you therefore believe that spies do not exist even now, in a state of society apparently superior? We no longer have the deaf spies of the times of tyr- anny, but they have the same moral vice that they had in the times when they played the part of spies ; the man- ner only, the external garb, is changed, and thus have we many would-be patriots whom we ought to condemn. Therefore I say, there is indeed a moral disorder in the intellect, not from disease, but from the reasons I have given. We have disorder in moral acts, which is purely of the intellect, but from intellectual disease, as, for example in reasoning madness. Our illustrious Presi- dent, Verga, said : " Moral insanity is a fact, it may be a case of reasoning madness, biit not ail reasoning madness is moral insanity." This is true, when there is a just, considerate and well-proportioned intelligence of things, and when things are taken in their proper substan- tiality and their proper qualities, each complete in itself, and the relations between things and ideas are also taken in just proportion, we never then reach reasoning mania; vice versa, when, with forms often very brilliant, and flashes of light which seem to emanate from genius, though in reality, from natural mental conditions, a subject is not embraced in that totality in which its essence consists; when, in the relation between things differing much from each other, one sole part in them suffices to establish a complete relation, (hence come those strange colossal, para- doxical forms) ; and when, as is popularly said, the mind is not square, and its brightness is not conjoined with due proportion and measure, we shall then have a form of moral insanity in which there is lucidity and genius, but there is a sad disconnection of the parts. Therefore from (r ?■ ' I I t I I /» Moral Insanity. 27 reasoning mania, there may proceed, as a logical conse- ■quence, errors in the sentiments and actions. And here I will say, that in reasoning mania the immoral acts which may result from it may be such as to bring the parties into the criminal courts, or not reaching this point, they may be of such a character as to render the authors of them unfit for society, and therefore deserving to be shunned ; for if permitted to enter they always do harm; they have felt evil contact and bad influences; they do not, it is true, commit offences legally criminal, but anti-civil ones, which disturb society; they calumniate and do all sorts of mischief The question here, in the differ- ence, is not as to essence, but as to degree ; and whence comes this difference ? It comes in both cases from the intellect. Some of these persons become forgers, others commit various offences ; the forms may be ever so various. Next to the intellect, I regard the sentiment; if it repre- sents a moving agency, differing from the others, in our mental organization, it is natural that, as we have had an alteration in the intellect and diverse parts of the same intellect, so we may have an alteration in the moral sense. Well then, since our sentiments are of so many sorts, it may happen that an individual may have disorder in certain sentiments, or there may be a want or a perversion of cer- tain sentiments, but not of them all ; sometimes indeed, the disorder actually consists in an excess of some sentiment ^vhich overrules the others, instead of keeping its own proper place. What happens then? Sometimes the senti- ments, though disordinate, are innocuous : for example, a person may not iiave a fine aesthetic sense ; again a person may have a disturbed sentiment, or some may be wanting, but this is not immorality, another may have the auditive sense deficient, or it may be absent, whilst our honorable colleague Vigna has it so sublime, that he is delighted when he can talk a whole night with Verdi. There are sentiments which have nothing to do with morality. It is necessary to study tiie sentiments separately, t 4 28 Italian Phreniatric Society. making each of them the object of observance by itself, and the relations which arise between them. Take a person in society, and a person studied apart from it, closely and profoundly ; there are some (and I know many examples) who, in society and in familiar conversations, pass for gentlemen, by an autono-masia {id. est, par complais- ance^, but if you could see one of these in the actions of his habitual life, and sound him deeply, you would say to yourselves : Is this person really a gentleman ? Are his sentiments in true accord with the moral law? are those which he expresses really his own, or does he fail, (who can tell why?) to manifest what is in his heart ? Here I may fitly repeat : " Before the judgment seat of God who will be justified ? " In fact, should you have a fair opportunity for dis- covering the whole of his conduct, you would be con- strained to admit that he was not the gentleman whom all had believed him to be. There is in him a moral disor- der, without manifestations of acts ; but then, is he less a moral fool than the other, who, with alterations in the moral sense, commits criminal acts ? Before the bar of science, the moral sense of both these persons will be judged as altered. Our sentiments are therefore distinct from our actions ; our ideas represent the energy which precedes action ; from the stimulus which our different sentiments and ideas produce on the motor centres, pro- ceed human actions which are at one time simple move- ments, and at another time, in one way or another, co-ordinate movements. But are all the centres, equally, and in the same manner, excitable in each of us ? Cer- tainly not. Halting even at that stage which does not overpass the limits of physiology, we may see one who stretches himself out like a lazy lubber, and again another who cannot be quiet, or stand still, for a moment : what does this signify ? it signifies a different excitability. And here I add that there may be not only a different excit- ability, according to different individuals, but also in one and the same individual a different excitability in the ^s I r ■ I ' 'J I Moral Insanity. 29 different motor centres ; we may have some one who, though slow in some movements, is very lively in some others, because the stimuli which reach some of his motor centres are more effective than those reaching others. The illustrious Verdi said, when talking pri- vately with the ever to be lamented Sella, in parliament, that he did not seek for sounds in order to compose music ; sometimes a sound gave to his mind the idea of a harmony all at once, or of a composition, and under this impression he wrote it out; let some other person hear a tune, and even' though he comprehends it, he will be content to say, it is very fine, I like it ; and he may name it, but it never in him awakes the idea of a complete harmony. What now may happen ? Disordered ideas and sen- timents may be found in a person who is but slightly excitable ; it is not likely that he will have to appear before the Assize Court; they may on the other hand, in a different person, be very exciting, and then, the first that is presented to his mind suffices, without time for reflecting, comparing or duly estimating, to produce, instantly, excitement in the motor centres of action. What then happens? Sometimes this excitement is held within those nearly physiological limits which constitute what is usually called the nervous temoerament of an individual, so that some distinguished persons reply to a courteous enquiry rudely, and presently beg our pardon. Sometimes, on the contrary, the excitability is morbid, and then according to the more or less excitable con- dition of the centres, which they have in asso- ciation, or each has in itself, we may have a differ- ent action. Then we have the epileptics; but who does not know that the epileptic is subject to terrible out- breaks of nervous movements, whether in the convulsive form (which is the ultimate stage), or, in explosions of grciit excitability, resulting in movements? It is there- fore but too true that we must find moral lunatics in the grt)up of the epileptics; or there may be epileptics of 30 Italian Phreniatric Society. every clinical, or as I might almost say, every somatic form of epilepsy ; or without the perfect characteristics of the clinical form, they may stand in close neighborhood with epilepsy, that is, they may present an augmenting excitability, which will afterwards reach the highest de- gree. I therefore very willingly accept the statement, that there is a great analogy between the violent acts of moral lunatics and those of epileptics, whether the latter may be complete epileptics or such as stand yet outside the portal of the last stage of the malady. But should we, for all this, confound moral insanity with epilepsy ? Not at all ; for in the first place moral insanity does not always reach those excesses of instan- taneous, violent acts which epilepsy presents; moral luna- tics often act quietly and with determination, as, for ex- ample, when one of them forges a name, or a public document, and so forth ; what see ye in such a case like the outbursts of the violence of epileptics? Nothing whatever ; another remark I would offer ; it is that among the perpetrators of violent acts there may be more moral lunatics, than there are among epileptics, or among those who have, as I would say, the epileptic constitution. Just as, after our studies of general pathology, we proceed to apply our general rules to individual clinical cases, so, when we may be called into the courts, should we apply the several parts of our science to any special case. No morbid type is so described that, in all its parts, it may be identified with each special case; in our interpretation of moral insanities, we must be guided by general pathology and psychiatric science. Now I hasten to close. 1 heard congenital and non-congenital insanity spoken of. Now, as for my- self, the general rule is that disorder of the moral senti- ments is congenital, but it is not always so ; at first it is moral disorder that leads to those immoral acts which belong not to pathology, but to sociology ; it is then very necessary that we should correctly understand what the teims congenital moral insanity ar J acquired moral in- cs5» t\ Moral Insanity. 31 "^sS* S ', sanity signify; it has been said that moral insanity does not appear in early youth, but that it comes afterwards ; this is natural, we know it; being congenital does not mean that the subjects of the malady even in utero, or from their first day of life, must have had the stigmata of insanity already imprinted on them; we understand that gradually during their development, the intensity of the affection and the proportional nutrition of the parts of the system may become altered. But can there be an acquired moral insanity ? Cer- tainly so. We can understand how this may happen. For example, after mania there remains, if not an active morbid process, yet an indelible alteration, a quasi cica- trice, from the nutritive disturbance that had preceded ; here we have an individual who has acquired a condition which, though no longer a morbid process, is j'et a sys- temic something in his organism, a quasi cicatrice, and this person becomes a moral lunatic. 1 beg pardon if I have talked too long, and now I stop. Tamburini. I desire only to call attention to one fact which has been cited by the distinguished Prof. Buonomo ; it is that of the relativity of insanity, the fact that acts, such as incest, etc., which are normal among savage and inferior races, appear now to us as immoral and criminal. This fact, it seems to me, is a proof of the atavic theory of moral insanity, because there is in the moral lunatic, the reproduction of acts which are in perfect harmony with the social constitution of savage races. But though we may accept the conception of the atavic nature of moral insanity, we cannot equally accept that conception which has been this morning expressed by Prof. Morselli respecting moral insanity, that is, that moral insanity is a fact which lies completely outside the field of psychiatry (as a fact exch'.sively teratological and not at all pathological) and that it is of a purely socio- logical order. I recognise the very great importance of moral insanity (and all with me recognise it) in the field W 32 Italian Phreniatric Society. of sociology, but I do not think it can be absolutely ac- cepted that moral insanity can be completely excluded from the field of psychiatric pathology. Let us take first of all those cases of moral insanity which are fully accepted and well known ; we shall find, in the majority of the well-known moral insane, whose histories have been recently detailed, anatomical degen- erative characters, and many functional facts, which are decidedly pathological, as, among others, that very high excitability to which Prof. Buonomo has just now alluded. The very fact of the great frequency of epilepsy among the moral insane, really proves the pathological nature of the affection. Finally also, the great frequency with which the congenital moral insane become afterwards the subjects of other maladies, (and I have recently reported one of these in treating of a typical case of moral insan- ity in a person who was often subject to accesses of mental change), this fact, I say, is a confirmation of the partly pathological nature of moral insanity. There is yet another observation. It is said : Moral insanity is an arrest of development, it is a teratological fact, but imbecility also, idiotism also, is an arrest of development ; these are teratological facts, accompanied by atavic characters, and why then do we not say that these facts have the right to be styled sociological? It appears to me indeed that it would be more correct (if we now admit moral insanity in congenital cases only) to abandon, as many of us do, the denomination moral insanity, and always to call these cases moral imbecility, or moral idiotism ; and so much the more as those anatomical and functional characters are conjoined with them, which ;\re also present in the idiot and the imbecile. Buonomo. I shall say only a few words. As regards atavism, first of all I shall say that it is quite unneces- sary to exaggerate its extent and influence ; but do not believe that atavism is the whole ; for example, I know that the experiment has been made of taking a child born of an unfortunate insane mother, and putting it «4(Sf» . , 4 Moral Insanity. 33 4 under education; it appears never to have attained an er""- cation corresponding to the state of our civilization ; ^ reached a certain point, and there its education stopped; but I do not know whether that child, if admitted into our company, would manifest the instinct of biting or eating us ; I believe there is much acquired in the im- mediate social customs ; I say this that we may keep our ideas always within their just limits. I have heard Prof. Tamburini make some observations on moral insanity, proposing to substitute for this term, moral idiotism or imbecility. I use the term which was written in the order of the day, in order to comprehend in one broad and generic denomination various cases, be- cause I have already said that the moral disorder may be a moral disorder in the sentiments alone, or a moral disorder accompanied by acts which amount to crime, and hence the great variety of forms. As to idiotism, or moral imbecilty, I would say, the question is rather to find a word still less significative, as has been done with that which is called mesmerism, somnambulism, hypnot- ism, exactly because there is not included in these words any theory ; but of this I do not wish to say more. Rather would I ask, is it a disease or not a disease ? Here is the discussion which has been raised by the honor- able Morselli. The facts may be compared to the grada- tion of light between one hemisphere and the other ; where disease ends, and where alteration begins, are things that remain a little uncertain, it is the dawn be- tween day and night. But I think these things are after all not very substantial. I have no more to say. Morselli. The remark which I would make responds in part to the observations of Prof. Tamburini. If we turn to the literature of moral insanity, we see that the greater part of it has been contributed by the physicians of prisons and by writers on prison subjects. The moral lunatics who enter asylums may be counted on the fingers. Everybody knows this ; on the contrary those who fill the houses of seclusion, the penal prisons and the jails. * k 34 Italian Phreniatric Society. constitute the immense majority of this sad class. This is evidently a practical reply to all the objections that can be made to the idea expressed by me this morning. The very rarity of moral insanity in asylums, and the evolution of social demands, in consequence of which our asylums in general admit not the moral insane, who pass into jails, serve to demonstrate the truth of the doc- trine of the criminal anthropological school. The moral lunatic is born a delinquent ; that is, individuals affected with moral insanity (or, if you prefer to modify the term), with congenital delinquency or a criminal psychosis con- stitute a special group, characterised by congenital defi- ciency of the moral sense. As respects the degenerative characters, they have not been studied by asylum alienists, but by those who have had the opportunity of studying them in prisons ; and among these investigators it gratifies me to name my friend Dr. Virgilio, who has studied it, not among the insane of his splendid asylum, but among the delinquents whom he had the opportunity of observing closely in his own city. The degenerative characters must be sought toi' \^ those individuals who neuro-pathologically deviate from the normal type. And here, as regards these characters, I feel obliged to say that confusion has often arisen ; all those characters which depart from the normal type have en masse been called degenerative. I think that on this point much might be said ; there are some deviations in the cranium which are not at all of a degenerative na- ture, but are pathological, for example plagiocephale (skull twisted sideways). At this point it is evident that we enter into the question whether moral insanity ought to be considered from a teratological or a pathological point of view. I insist on the opinion expressed by me this morning, that is, on considering moral insanity as a teratological fact, precisely as is imbecility. Moral insan- ity is not a disease, unless we designate as a disease a functional deviation of the moral organism, which has «^ 4 \- Moral Insanity, %% k4 ti 4 reached the fullness of its development; disease has characters different from those of infirmity ; an individual born blind or deaf, in consequence of arrest of develop- ment in the organs of sight or hearing, is not a diseased person, he is an infirm 9ne; he who is born devoid of the moral sense, because of an anomaly in the develop- ment of the nervous centres, which is yet unknown, but which may in course of time be discovered, is not a dis- eased person, he is an infirm one, a monster, or an anomaly. That, on this basis of deficiency, invalidity^ congenital weakness, atrophy of the nervous system, some pathological forms may be developed more readily than on a sounder foundation, we all know ; he who is born weak and infirm, and he who is born badly formed in consequence of an arrest of development, which happened in the embryological, foetal or infantile period, presents in greater number, and with more frequency, those patholog- ical characters which should on no account be confounded with the degenerative characters. Entertaining these views I would propose that we leave the question just where we found it. Nine years have now passed since the question of moral insanity was handed down from one congress to another — (certainly no trivial bequest) — and I see that we are now almost at the same point as when we started. He who accepts the doctrine of the anthropological school, by which moral insanity is regarded as purely a congenital debility, a teratological form of moral develop- ment, has already formed his conceptions, and he cer- tainly cannot recede from them so long as it is not clearly demonstrated that perversion of the moral sense is synonymous with deficiency of the moral sense. The ques- tion will be solved when medical alienists shall have entered the penal establishments, wherein moral lunatics reside, and when they shall there have studied them, and from an enormous number of facts they will be enabled to conclude that there is a class of persons, who, as the young school to which I have the honor of belonging. 36 Italian Phreniatric Society. has proved, are born, whether as the result of heredity, or other unknown cause, predisposed to a deficient devel- opment of the nervous centres. I believe that the question cannot be solved by any congress. Congress leaves our opinions as it finds them ; it cannot change the opinions of any one ; the same thing happens in parliaments, and still more in congresses, in which the discussion almost always turns on facts of personal observation. Until the experience of each shall have conglobated the experience of all our colleagues, we cannot change opinion; it is possible that a time may come when I shall change mine, and it is also possible that others also may change theirs, but at all events, it must be facts that will show who is right and who is wrong, it is from the conscientious and clinical study of cases that the solution of the problem will be reached. The discussion, which was suspended on the 20th of September, was resumed in the forenoon session of September 20th, when the champion of the anthropologi- ical criminal school, Lombrose, put in appearance and took the floor. He spoke as follows : " I ask pardon when I presume to speak, seeing that I am only a guest, and almost a stranger to the society; but it is imperative on me to speak, lest it might be said of me that / refused from coivardice. The subject treated of is one to which I have devoted a great part of my life, and if I should not speak when it is under discussion, it might be said that I have not the courage to do battle with the forces of the opponents here assembled " President. Oh never say that — Lombroso, and they have spoken with so much sense before me. There are two principal objections. With one of these (that of Michetti) I think I need not trouble you, because it is merely metaphysical, and these do not enter into the studies which should engage alienists. Next are the grave objections of our illustrious i vkr Moral Insanity. 37 1 \tr President, Senator Verga, who, strong in his own power- ful genius, has done as did Charles the Happy of Pied- mont, when, on returning to the throne, he erased all the names that had been inscribed in the interregnum of i6 years ; he has forgotton that from the time when he, the first in Italy, popularised the question of moral insanity, and with it faced the judges, who first ridiculed, and afterwards had to accept it, he has, I say, forgotten that since that time two generations have been born, one more robust than the other, among whom I rejoice to name Virgilio, our great patriarch, then Tamburini, Mor- selli, Tanzi, Frigerio, Ferri, (who has carried it into the field of jurisprudence in the university of this city), Krafft-Ebing, Kraopelin, Mendel and Sommer. To these authors, and in a small part to myself, are due the clinical and anatomical lines of moral insanity. Before they spoke out the judges used to say, " We also are capable of judging, without fail, whether the prisoner is a lunatic." I have advanced a step yet further in studying the functional anomalies by means of clinical methods, and the psychical and anatomical analogies by observations on delinquent man. If the conception of moral insanity has taken the field in science, it is due to two mono- graphs, one by Tamburini and the other by Morselli, who have delivered two very characteristic types (Sbroco and Grandi), on which it was easy to me and to some others to remodel all that they had sought out in born delin- quents ; and then a strange thing happened, which I must here relate, because such anecdotes end by convincing. I studied during 15 years in order to find the difference between the delinquent and the lunatic. In studying the characters of the delinquent I thought I found a differ- ence from the moral lunatic ; whet afterwards I found myself fronting the delineations furnished by Tamburini and Morselli, in their monographs, I saw that my own picture was a copy of theirs. I experienced some diffi- culty in making the comparison, because when two things *k;[ 38 Italiati Phreniatric Society. are identical they present no material differences ; this was one of the reasons why the clinical characters of moral insanity had to struggle so long, in order to gain admittance into the world. All the clinical characters of moral insanity are certainly not those of connate delin- quency ; for example, there Jiay be alcoholist moral fools, there may be moral fools with genius, and altruistic moral fools, in fact all sorts; among all these forms we have the criminal one, that is, the form of the born delinquent, which is exhibited in hospitals and prisons, and has char- acters that cannot be mistaken ; as, the big lower jaw, the outstretched ears, the projecting face, the retreating forehead, and above all, that which is most interesting, the very conspicuous clinical characters, which, I believe I have myself had the merit of bringing to light, and to me it seems strange that these should have been for- gotten in a discussion in which physicians spoke ; for example, the sensory obtuseness, analgesia, left-handed- ness, muscular agility, great development and robust form of the body, (which has been one of the greatest diffi- culties in the way of moral insanity in obtaining entrance into the minds of judges, as they cannot conceive how an apparently sound and robust individual can be dis- eased) ; another character which we found, with a certain prominence, was the precocious development of the person at 14 and 15 years of age, also the precocious sexual development, the sphygmographic insensibility, daltonism, etc. Mondo thinks that because we are much engaged with the skull, we have lost sight of the psychi- cal characters, but this is not the fact. The first thing which I would now demonstrate is that cruelty does not predominate in the insane criminal so much as impetu- osity, emotivity, an exaggerated outbreak and the con- trast between the various manifestations of the character ; men who on one clay are so good as to be benevolent even to animals, and will risk their own lives to save a cat, may next day see their own children dying of hun- ger whilst they take pleasure in torturing them, and eat 4 Moral Insanity, 39 ravenously themselves whilst their children are starving; these persons all have their good hours, but in the other forms of insanity these do not come ; this fact is very well known in prisons; another character is their great irascibility and its intermissions ; their intelligence is some- times in excess, and sometimes scanty, but it is always unequal and preoccupied with the present moment, and when it is absent it is substituted by cunning. I would here parenthetically say that I do not find myself in per- fect accord with my friend Morselli, (to whom I owe my warm thanks for his courageous defence of the criminal anthropological school), in the belief that moral insanity is altogether a teratological fact; there is in it a patholog- ical part; the scleroses, asymmetries, cardiac affections, etc., so frequent in these individuals, are pathological facts. We also admit that there are some forms of acquired moral insanity, for example, from typhoid fevers, wounds and alcoholism. I desire now to consider the grave objection of Prof. Buonomo. He said, if I am not mistaken; "you cannot calculate surrounding influences, you cannot calculate what individuals who become criminal, might, under other circumstances, have become heroes." But we have never denied this. We have always admitted that there is a class of delinquents who become such from surrounding influences; but let us well understand ourselves; this is not the deeply marked, teratological delinquency which we meet with in the delinquent born type ; on the con- trary it is that which we call the delinquency of occasion, which is indeed a born delinquency, but much less intense. In order better to explain myself, since there might here appear a great contradiction, I mention the fact, which we first stated in the midst of universal deri- sion, now however at an end, that the child is born a delinquent. We who arc always adorers of children fail to prcceive this ; it is necessary to study them intimately, profoundly, in order to see how soon they forget the mother after her death, how they forget benefits I! 40 Italian Phreniatric Society. ^^ received, how egotistic, envious, and cruel they are, to see how they divert themselves in plucking feathers out of birds, and inflicting a thousand other tortures on animals, — we must see all this in order to understand their delinquency ; but after the powerful out-wrenching effected by education, there comes an epoch, between 7 and 14 years of age, in which this born delinquent becomes a more or less normal person. But if he remains uneducated, then he who might have become an honest man, will be a criminal by habit and occasion, but much less ferocious and persistent than the born criminal. \Note by Translator. — In a former part of this discussion we had occasion to express our hesitation to accept, as ca- nonical, the assertion of Dr. Brajon, that all young children {bavibini) have evil tendencies, instinctive perversions, etc., etc. That Prof. Lombroso and he ever amused themselves in plucking living birds we venture not to believe, despite the fact that they are now " birds of the same feather." If they are right in their depictions of the moral (/. e- immoral) tendencies of childhood, how great must have been the error of that teacher who said, " Suffer the little children to come unto me, for of such is the Kingdom of Heaven ! " Will Professor Lombroso or Dr. Brajon have the goodness to inform us whether the little children (bambini) embraced by Jesus had been duly educated, before he embraced them, — that they had undergone that forte stortilatura which Prof. Lombroso deems indispensable to transform these bird pluckers into humane bipeds? He uses the generic term // bambino. Dr. Brajon is more explicit, though not more comprehensive ; his words are " tutti i bambini^' that is, the whole crowd, his own chil- dren. Prof. Lombroso's children, all the world's children ! Jesi s taught that " a good tree bringeth forth good frnjt." Italian mothers ! will ye not rebuke these men of Herod? Have ye hearts of flesh, or of stone?] But if he is really a moral lunatic, then no education avails, or it will give him merely a surface tinge. Which of us is aware that he was, in the early stages of his own de- t T I i Moral Insanity. 41 velopment, a reptile, or an insect ? Just so in moral insan- ity ; if the education is vigorous, and in every sense well directed ; and if it overpowers the germs of delinquency, who would any longer think of that embryonal - delin- quency, which was once his heritage ? we now call him not a born delinquent, but a pseudo-born delinquent. (This passage is very obscure ; it probably has been imperfectly reported, or erroneously printed.) " This does not contradict our theory ; quite the con- trary. We admit also another fact ; it is this, if the born delinquent has always advantages in favor of morality, and is never placed in positions that may draw him into immorality, in many cases delinquency will not be exhib- ited ; there are moral fools in the world and in families, whom no one recognises as such, because they are rich, because their learning and their polite manners conceal them ; but it is necessary to be their servants, in order to know the jeers and the harshness with which they repay good deeds ; we would require to be their intimate friends, or secretaries in order to know all the harm done by them ; in them education has covered their natal delinquency, and has led them into a form which society does not regard as criminal, but as an artifice or vice. There are, too, some, (as I have not a seat in parliament, I have no reserve, anil I can speak frankly), there are some diploma- tists and politicians, who owe their popular influence and their parliamentary position to their native delinquency, which has taken this form. The advocate Laschi and myself are studying political crime; we have been forced to admit that some part in revolutions is due to transformed native delinquency ; there are at present in Bulgaria and Servia ragamuffins who make a trade of politics; if they succeed in turning out a ministry, they may themselves become ministers ; they will then no longer be called n.itive delinquents, yet they will always be such in the opinion of alienists. Ihit I must return to the subject of the relation II. 42 Italian Phreniatric Society. between moral insanity and epilepsy; and here is another confession. I was a thousand miles from dreaming that epilepsy had any relation with congenital delinquency ; I found myself two or three times in contact, and I was not aware of them; I was studying the case of Misdea, in which 1 had for associate our illustrious colleague Bianchi, one of our real scientific notabilities, and although the case was one which might have awakened the mind of any one, it did not awaken mine ; I found that th re was a great analogy, but I did not discover a complete affinity, that affinity which I had found between moral insanity and native delinquency. One day I went to examine my statistics on median occipital fossas, for the purpose of using the figures in a work on which I was then engaged, and I found before me i6 per cent, of occipital median fossas in delinquents. I compared these figures with those of epileptics, and I found the very same proportion. This was as a ray of light projected into the darkness, and then I said to myself: "there rnust here be a relation," so I set to, to study the craniology of epileptics, — a labor in which I was pre- ceded by Amadei ; who may now afifirm that everything he has related on the craniology of epileptics exactly accords with what I found in delinquents. I must now request the congress to observe that in the exposition made by our distinguished colleague Fun- aioli, on nine skulls of epileptics, the type of the born delinquent is reproduced. I mention especially the num- bers 80, 92, 53 ; the osseous sclerosis is enormous, the parietal sinuses and the lower jaw are voluminous, the asymmetry is remarkable ; the weight of these bones is great ; and see how many other anomalies there are, for example the over-riding teeth and the whole series of anomilies that I had met with, which are of such a character as to render it impossible to deny the perfect identity. We had observed in moral lunatics the facial asymmetry, the twisted cranium, and the prominence of the frontal sinuses; well, we found just the same in 1 » I i t "3 Wf T I -1 t Moral Insanity. 43 epileptics, and in both all the other characters, as, the very large lower jaw, the inequality of the pupils, stra- bismus, the remarkable size of the body (we all know that many epileptics are very robust, their weight is equal to that of delinquents and sometimes even greater) ; then there are the sexual precocity, the tendency to alcoholic abuse, the great agility of the limbs, daltonism, left-hand- edness, the small frontal brain, and above all the anoma- lies in the moral character ; I need not tell alienists, for all know it, that the character of delinquent epileptics is so woful that it is necessary to keep them more isolated than others ; another fact common in both delinquents and epileptics, is, that whilst other insane persons will- ingly live apart from the rest, they love company, and they torment one another. Another characteristic fact, which we owe to Frigerio, Bianchi and Tonnini, is that not the head alone is asymmetrical, but likewise other parts. Tonnini has found also that there is a difiference of temperature in the two sides of the body, and of sen- sibility in them, so that they almost seem to be distinct halves ; I had never thought of this condition in epilep- tics when I noted that one of the salient characters of moral insanity was lateralism, or, so to speak, sensory left-handedness, that is, more sensibility on one side than on. the other, and signally so on the left ; the same fact obtained with regard to motility. Recalling to mind the facts recently stated by Abundo, of Naples, and Oserez- howski [Medic. Obosrenije, i88^), which exactly correspond to those found by Tonnini and Venturi, I observed that, in the same proportions, there was a diminution in the acoustic and visual sensibilities, both in epileptics and delinquents. I pass on now from the physical part, and I shall speak of the moral part only. These persons are very cruel, they frequently are cannibals ; we all know of cases of cannibalism in epileptics, e. g. that reported by Adri- ani, of one who bit the shoulder of a man, and wished to cat a child, after lie was captured. There are 44 Italian Phreniatfic Society. however some very good epileptics, but not very many, as Tonnini has shown ; and even the best of them are always mentally changed ; and as they are readily excited, they from time to time exaggerate ^things, and fall into excesses. Must I speak of causes ? Verily the causes are abso- lutely identical. It is true that among the moral causes fright contributes the greater proportion to epilepsy, but then we have alcoholism in the parents, whidh also gives so many delinquents and so many epileptics ; we have epilepsy in the parents themselves, which gives so many epileptics and so many moral fools ; and then also injuries to the head; many born delinquents have this injury, 26 to 28 per cent, of them, and this injury is also found in many cases, in which the epilepsy was not accompanied by the degenerative characters which I have mentioned. There is another fact, which has been recently made known by our colleague Morro, and confirmed by Dr. Ganger; it is that of the advanced age of the parents, but especially of the fathers, which contributes a remark- able number of epileptics and delinquents. Another fact not devoid of importance, and pretty well known, is the geographical distribution of epilepsy. Morselli and Sor- manni have constructed a geographical map of epilepsy, which has impressed on me the fact that some provinces which have the greatest number of epileptics, have also the greatest number of homicides ; I have had this map reconstructed by Dr. Rossi ; it is most accurate, and it has been illustrated by the statistics of the commissioner Bodio. Very well, I have found in 69 provinces only 23 exceptions to the law of proportion between the number of those committing homicide, rape and other violent acts, and the number of epileptics ; in other words, I have found that those provinces which had the greatest num- ber of epileptics had also the greatest number of homi- cides ; and those which had the least, had also the least number of homicides; Sondrio, Bergamo, Como and ■i' y f M- t Moral Insanity. 4S Porto Maurizio were exceptions, because cretinism there opens the door to a greater number of epileptics; Forli and Ravenna escaped merely because of error in their figures, for popular intelligenc is there very watchful, but crim- inally is in greater proportion than elsewhere. An anecdote may here be of service to me : some days ago, I was expressing to a prisoner of 21 years of age, my sur- prise that at so early an age he had already been seven times convicted ; his reply was " O, but I am from Forli ! '' You will now ask me, what conclusion do I wish you to draw from all this ? Is it that moral insanity is a motor epilepsy ? Here it is where the error begins. I reject the idea that the epileptoid, the born delinquent, is always an individual who writhes in convulsions (I bear in mind that I am speaking for the benefit of the public, 'who are unable to see epilepsy without convulsions, but when we use the word, we understand an irritation, fol- lowed by a discharge from certain cerebral zones which are especially designated epileptogenous) ; but when the zones outside the epileptogenous are unaffected, we no longer see the motor phenomenon ; we then have verti- goes, habitual crime, or moral insanity. I now repeat it, that when we speak of epilepsy, we do not mean merely convulsive epilepsy, we desire to say that since the field of epilepsy has, by the labors of numerous authors, been enlarged to such an extent as to embrace even a distress of breathing, or a racking head- pain, which arises suddenly, and has intermissions, in a degenerate individual, or one who has suffered an injury, etc., etc., suspicion of epilepsy is aroused, so that epilepsy has now attained an extraordinary number of forms and varieties, which were never before imagined ; in like man- ner, there is, as we think, a psychosis which is almost always congenital, sometimes acquired, for example, from typhoid, sunstroke, or other causes, though rarely, and it belongs to the great group of the epilepsies. With this we have now completed the edifice, or at k'iist h.ivc given the outlines for the completion of that 46 Italian Phreniatric Society. V edifice, on which we are attempting the reconstruction of the delinquent man, so far as we have found pathological and atavistic phenomena. It is unnecessary to demonstrate atavism in epilepsy; when the epileptic mews like a cat, barks as a dog, bites, drinks blood, creeps on all-fours and licks the dust, we have a reproduction of the phenom- ena, not only of savage races, but even of the lower animals. When, besides, we have other phenomena, such as asymmetry, tremor, daltonism, tactile obtusity, we no longer have atavistic, but pathological phenomena, and here we may comprehend the fact that moral insanity may, at the same time, be both an atavistic and a pathological phenomenon. Verga, A. I am rejoiced to find that in the main, if I have rightly understood. Prof Lombroso and I are in accord. If he had been present at our first discussion on the subject, he would have perceived that I reduced all forms of moral insanity to two. I said that in the first form the individual was without the moral sense ; he did not feel, he did not see what is just and what is unjust, what is right and what is wrong, what is lawful and what is unlawful; some call this moral daltonism, others call it moral imbecility, and others again congenital delinquency . These individuals do not know right and wrong, they do things without considering their importance, and they even wonder why others laugh at what they do, or blame them for it. Apropos to this, I remember a girl of good family, who was addicted to prostitution ; she came to me one day to complain of a cousin who had reproved her for it, whilst, as she said, she honestly gained her living. Here was a case of moral imbecility. I next admitted another form, in which the individual understands wrong; he knows he does wrong, and he deplores it; but there come over him certain eclipses, under which he is forced to do wrong, and cannot help it. The bad acts committed under this second form, I call cases of larvato epilepsy. Admitting these two forms, it appears to me that in i\% '' Moral Insanity. 47 great part I am in accord with Prof. Lombroso. That which appears to me important to decide, and which was the object of the discussion which was proposed in the Congress of Voghera, was the establishment of criteria enabling us to say : " In this case there is moral insanity, or in this other there is, on the contrary, simulated insan- ity." I do not allude to simulated insanity in the sense in which Michetti understood it, for that has no existence. It would be too easy to cheat justice, by saying that they were irresistibly dragged into crime ; lawyers would know too well how to play their game ; they would discover insanity in every culprit. What is to be done is to learn the characters by which we may be enabled to testify when there is moral insanity, and when there is not. It appears to me that they are to be found (at least so far as up to the present they can be established), in the fol- lowing three conditions, and here also I seem to be in accord with Lombroso. The first is the existence of cer- tain mental maladies in the parents; the second consists in the numerous degenerative characters in the individual; these characters may be atavic, or they may be particular, born with the individual, though not inherited ; and among these I admitted many of those characters which Lombroso has established, as, asymmetry of the face and the rest of the body, anomalies of the cranium, abasement of sensi- bility, nervous tics, convulsions, etc. Finally, a fact which should be well considered, is the complete want of rela- tion between the act and its cause, and the incorrigibility of the accused. It appears to me, that in these few ideas which I have expressed, or better to say, which I have repeated, for I before expressed them in another session, there is a great analogy with the manner of thinking exhibited by Prof. Lombroso. Tamburini. I have, with pleasure, heard, from the chief of the criminal anthropological school, confirmation of the conception upheld by me in another session, as to the pathological nature of moral insanity, when I made some 48 Italian Phreniatric Society. objections to Morselli ; exactly because the clinical char- acters which he so extensively related, are a confirmation of the pathological nature of this malady, which Morselli in a certain way excluded from the psychiatric field. It has also pleased me to hear that Prof. Lombroso does not insist, in a precise manner, on the conception of the absolute indentification of moral insanity with epilepsy, for though I fully accept the very luminous conception, which clears up so many facts, of the absolute identity between moral insanity and congenital delinquency, a conception of the very highest importance because also of its medico- legal bearings, yet, I cannot in like manner, accept that of a complete identity between moral insanity and congenital delinquency on one side, and epilepsy on the other. To me indeed identity between two states implies that there must be a correlation so absolute that what is verified in the one should be constantly verified in the other. This I find on comparing all the clinical cases of moral insanity, which have been described by alienists, as well as by medical legists, with the cases of congenital delinquency yet described by the criminal anthropologists; but I do not find the like in comparing the cases of moral insanity with those of epilepsy, and it really seems to me that Professor Lombroso this morning had reference to the analogy between moral insanity and epilepsy, rather than to an identity; I think we are all inclined to admit these analogies, but a perfect identity cannot be accepted. On the other hand, it is also to be observed that, taking cer- tain common characters, such as anomalies of the cranium and the face, inequality of the pupils, etc., many mental maladies might be identified among these, and very many diseases ought then to be founded in epilepsy ; thus, hys- teria, which in many cases coincides with moral insanity, might also be identified with epilepsy ; yesterday we heard a quasi identity between transitory mania and epilepsy spoken of; the rapti4s melancholicus will next have to be regarded as epilepsy. Biionomo. It has appeared to me that the question, as ,u Moral Insanity. 49 i s • ^ we have been treating it, is a practical one; the true expression of it should, as I think, be this : " is it, or is it not, true that certain individuals have perversion, disturb- ance, or disorder of the moral sentiments, apart from other mental defects?" Here is our first question. On one thing I think we are all agreed, viz., that there may exist in an individual, disorder of the moral sentiments, either from the lowness of these sentiments, as in imbecility, or from an excess in one of them over the others ; (in this latter case it does not seem to me that moral insanity should be called imbecility). This moral disorder is sometimes manifested in acts, and at other times it is not so manifested, but not for this reason is it a less real immorality of the sentiments, in accordance with the con- ception of it which we should hold. There may be many reasons for its non-manifestation in acts ; I, however con- fine myself to one of these reasons, which is, that between the ideas and sentiments of an individual, and the acts to which i.e abandons himself, there is a connexion, a cor- relation ; this connexion, this nervous passage between a centre of ideas and sentiments, and a centre of acts, may often be modified, interrupted, or disturbed, (this is very often observed), and then no action occurs, because the idea fails to stimulate to acts a centre that is but little excitable. There may be anot' er case; the centres of move- ments and acts may be very excitable, and then there may be a long series of degrees in the excitability, and delin- quency may result, which in this instance means the exist- ence of a moral disorder that displays itself in aggressive excesses. But to be a moral lunatic is it necessary that together with disorder of the moral sentiments there o should be excitation to movements, to actions, and th^.t this excitation should be as great as it is in epilepsy ? For my part I say no. There may be moral lunatics who do not properly belong to that form which impels an individual to commit such acts as bring the offender into the criminal court. When there is not a clinical epileptic 50 Italian Phreniatric Society. form (for if we do not trust to something clinical we shalU as Tamburini has before said, confound mental diseases- with epilepsy), — when, as I was saying, there is not a clinical epileptic form, but instead of this an epileptoid excitability, we have a moral lunatic who, instead of having unconscious impulses, catches the first image that crosses his mind; right or wrong he believes himself injured, right or wrong he believes himself .despised ; but there is a psychical reason, a moral reason, for which he ordinarily commits crime, differently from the true epileptic, who attacks and offends without any reason. The epileptic offender is not a moral lunatic, because, when explosion is given in that act, which is a phenonenon of epilepsy, he returns to himself, he has the moral sense, and he understands that he has done wrong; but an image which crossed his mind, sufficed that, suddenly, without first sub' mitting it to his judgment, and without confronting it with other ideas and sentiments, as a person in his natural moral and intellectual life would do, the explosion of his excitability took place, and he commited violence. But is such a person immoral? He is not immoral, he has not perversion of the moral sense. But there are others who do not see things as a man of our civilized epoch should regard them ; they know right and wrong, justice or injustice ; and then along with this moral disorder there is an excessive emotivity; any reason whatsoever sufifices that these individuals, being unable to counterpoise to the stimulus the moral sentiment, shall commit such aces as will bring them into the criminal courts. We have many examples ; individuals who are deliberate and obstinate forgers, others who, though possessing the highest intel- ligence, commit the most shameful acts; for example, Bacon, as intellectually estimated, a genius, yet became the accuser of his benefactor; a person such as he was who, with a powerful intellect, that might have ruled the world of politics, was yet the vilest of men, not only in the ingratitude which he showed towards his benefactor, but because he was really imbecile and vile in all his public Moral Insanity. 51 life ; will ye write him down among the epileptoids ? By no means ; he was not an epileptoid ; he acted calmly and without impulse, the excitability of an epileptoid. Might ye not, with very good right, call him a moral fool ? The honorable Lombroso has reminded me of one point, on which I must detain you a moment. Not only have I not designated . as a moral lunatic that person who is imbued by education with certain ideas of human act- tions, rather have I said that he is not immoral under a correct judgment of morality ; but he is immoral when contrasted with another class of citizens, he is immoral when confronted with the civilization of these times, but per se he is not immoral. For example, the camorrista of Naples says it is a point of honor, it is human dignity, to resist the public force, to attack it, to declare the war with two knives in the hand, and to go through it with- out even the aureole of an applauding public ; and when one of the two is left on the ground mortally wounded, and is carried to the hospital, if he is asked who has wounded him, he answers " I do not know, I was going about my own business, and some unknown one unex- pectedly wounded me ; " there is not a single instance of a wounded combatant denouncing his antagonist to the public authorities. Do ye know why? It is because he reasons thus ; " If I survive, revenge pertains to myself as a brave ; if I die, I should leave behind me the name of a coward, if I accuse any one." Now do ye believe that there is here immorality in the sense of perversion of the sentiments ? No, there is, instead, an intellective fact, it is the effect of the ideas which that individual has acquired respecting justice and injustice, honor and dishonor; I do not call him a lunatic. I go so far as to say, (and it is a bold saying), I do not even call him immoral, he is so only relatively. In like manner that one is not immoral in an absolute sense, who, in savage society, eats the flesh of his elders, (whether it is atavism or a thing acquired, is a question that does not concern me, the conception is It Italian Phreniatric Society. for me enough). It is late now, and we have other duties ; I therefore dot a full stop. Lombroso. On the whole, I see that we are in much closer accord than I had imagined. I shall add only a few words. The moral lunatic sometimes knows that he does wrong, but he has pleasure in doing it; this is what the father (papa) of Italian psychiatry appeared to me to say, if I am not mistaken, for I did not hear him very distinctly. To the degenerative characters we should add the clinical, especially the dullness of sensi- bility, the muscular agility, the left-handedness, the slow- ness of auditory and visual sensations, the emotivity, clinical characters which seem to pertain to these persons more than to others. We are in perfect accord, and I have pleasure in being able to salute my master, from whom I departed when I commenced these studies. As to my friend Tamburini, I have not well under- stood the opposition shown by him to my conception that moral insanity is a form of epilepsy; there are e. g. the head pain, the gluttony, and so many other forms which now have passed into the domain of epilepsy ; there is, above all, the epilepsia larvata, which passes over without convulsions ; there are very many special varieties in that great tree, out of which so many branches come, and the characters are on one part great emotivity, on the other bright intelligence, and even genius. Here Prof. Buonomo opposes to me the fact that many geni- uses have been moral fools. Certainly Bacon, Sterne and Foscolo were moral fools, but if we understand epilepsy as the phrenologists (modern) understand it (a discharge from the brain cortex), this confirms, it does not assail my theory. This foin, in those persons, was manifested in a discharge of creative genius, as Napoleon said; it is the work of a moment which vanishes, and it is some- times succeeded by amnesia ; Tasso, for example, often forgot what he had written. The majority of geniuses are moral fools (!), they are bad, for example, Napoleon, how much evil did not he to his friends? Tamburini ^ W WW h M i H I Moral Insanity. 53 U J asks for clinical characters ; I have not given them, because I wished to save time, but we all know them ; for example, the intermittences, irritability without cause, amnesia, vertigoes, tendency to laugh at everything, to burlesque everything, even the highest and most sacred tilings; these are characteristic of both the epileptic and the moral lunatic. I described only those anatomical characters of epileptics which are identical with those of born-delinquents. Examine the descriptions given by G. B. Verga, Frigerio and Tonnini, in that monograph which is a treasure, an immense treasure, and you will find that the characteristics of the moral lunatic overlie one another in their anatomical delineations of the epileptic. Let us but glance at the physiognomy ; thanks to Tamburini and Fiordispini who have presented to us those excellent photographs of moral lunatics ! Compare them with those which I have given in my book, as types of born-criminals, and you will see the perfect unity. Do not then accuse me of defect in the anatomical part ; it is that in which my work abounds, it is perhaps that in which I am unassailable. Tamburini thought to put before us a scarecrow, when he said, " so then the whole of psychiatry is put under the wings of epilepsy." First of all I begin, in defending myself, by saying that I am not the first nor the only one here ; Tonnini has gone beyond me ; he admits into epilepsy even some intermittent hallucinal maniacs. But I assure my friend Tamburini that I do not place among my epileptics idiots, cretins, melancholies, pellagrosi, monomaniacs, the maddish, the hysterical, the multitude of alcoholists, etc. I therefore leave an ample field open to psychiatry. Tamburini will agree with me that in doing so I do something of practical value. In fact when we appear before the judges, saying that such or such an individual is a born-delinquent, we encounter diffidence and incre- dulity ; but when, on the contrary, we conclude by saying "this man is an cpileptoid, he committed t'le offence just as another man might fall down in convulsions, and he 54 Italian Phreniatric Society. has the physiognomical, anatomical and clinical characters of an epileptic ; " then we do our work as clinicists and not as jurists ; this is the advantage ; by doing thus we place ourselves right, but by adopting half terms, phrases, psychological rather than clinical terms, we always find ourselves refuted both by the judges and the public. Prof. Buonomo has made objection to me, touching cer- tain crimes which cannot be ranked among the epilepsies, e. g. camorrism. I have always said that there are forms v/hich constitute the delinquency of occasion ; the meta- physicians and spiritualists believed that man is born good ; but which of us does not know that he is born to be bad? We aW^ know that he abounds more in evil than in good, above all in the period of childhood, and in the childhood of humanity ; well, should their innate tendencies not be wiped out, the man becomes a camorvist; if he finds more occasions for evil deeds than for good ones, you wili have the delinquent of occasion. •' But it seems to me that Prof. Buonomo made another objection with much ingenuity. He said : ' There are crimes which have no connection with impetuosity ; c. g. forgery ;* but it is necessary to study these persons, it is not easy for one who has not, as I have done, lived a long time among them, to judge of them, and to acquire complete knowledge of them ; these forgers are not forgers through their whole lives ; some days they flee from crime, but afterwards a time comes when they cannot avoid it, and then they fall in an intermittent cerebral discharge, like that of so many other forms, e. g. wounding and theft. There are thieves who, on leaving prison, swear they will steal no more ; they remain for a week without robbing, but there comes roi-nd a night on which they cannot go to *" Wf. all know It. ^^MaeDiif. He has no children. All my pretty ones?" " Did you gay all ? U, hell-kite-uU !" It !■ not to be wondered that un anthropolof^ist who had ipent so many years anions convicts, nhoiild lose all faith In innate human f(ood- neiB. it Is, howevor, a pity that Lombroso's sweeping miilediction called forth no rebuke; but the hour was late, and probably all were anxloiii for the cloie, and therefore unwlUinjif to provoke further elongation ol the dlscusilon. 3'. Moral Insanity. 55 4 sleep without robbing, so great with them is the neces- sity of doing wrong, I have had under me the case of an individual, who, before hanging himself, wrote to me the following letter : " The paper on which I write this has been stolen, the ink and the pen have been stolen, and the cord with which I will hang myself has been stolen." But I now repeat, even facts which appear to be devoid of emotion have it, for these individuals feel the need of doing evil ; and some will forge and some will steal. I c'ose with a fact which will be a sufficient reply to the objection of Buonomo. A Russian author, whose name I for- get, has recently related, in a book that is full of most valu- able facts, gathered in a sort of prison, that, in his district there is a kind of colony of smugglers. They are nearly all smugglers of alcohol ; they have everything to lose and nothing (in the end) to gain ; everything to lose, inasmuch at , if ^hcy are caught, they suffer five hundred strokes of the knc'i »:; the bare back ; nothing to gain, for even when the, ceed in defrauding the revenue the business does not pay ; but they were smugglers before and they con- tinue such afterwards ; they have to obey a sort of irresist- ible force ; and on this side, if not on all the others, of which I do not speak, because I have not studied them, this form enters the category of the epileptoids. Tamburitii. I have to say that I did not object against Prof. Lombroso any want of the anatomical characters <:ommon to epilepsy and congenital delinquency ; no, he has even brought to us a superabundance of them ; I merely wished to show that the community of these char- acters, between epilepsy and congenital delinquency, did not lead to a necessary identification of these two states; because it would otherwise be necessary to identify with them other mental diseases, which, having some characters in common, are yet essentially different. I will now say but a word in concluding, and it is this, if Prof Lombroso shall succeed in demonstrating that all the well ascertained cases of moral insanity present true epileptic characters, then I will fully concur in his opinion. * ;.