7. f THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES SCHOOL OF LAW GIFT OF TREATISE BY I. RAY, M. D. THIRD EDITION, WITH ADDITIONS. BOSTON: LITTLE, BROWN AND COMPANY. 1853. Entered according to Act of Congress, in the year 1853, by LITTLE, BROWN AND COMPANY, in the Clerk's Office of the District Court of the District of Massachusetts. T CAMBRIDGE: ALLEN AND FARNHAM, PRINTERS. PREFACE TO THE FIRST EDITION, FEW, probably, whose attention has not been particularly directed to the subject, are aware how far the condition of the law relative to insanity is behind the present state of our knowledge concerning that disease. While so much has been done, within a comparatively short period, to promote the comfort of the insane, and so much improvement has been effected in the methods of treating their disorder, as to have deprived it of half its terrors, it is both a curious and a melancholy fact, that so little has been accomplished towards regulating their personal and social rights, by more correct and enlightened principles of jurisprudence. While nations are vying with one another in the excellence of their public establishments for the accommodation of this unfor- tunate class of our fellow men, and physicians are every year publishing some instance of an unexampled proportion of cures, we remain perfectly satisfied with the wisdom of our predecessors in every thing relative to their legal relations. This, no doubt, is mainly the fault of medical men them- selves, who have neglected to obtain for the results of their researches, that influence on the law of insanity, which they have exerted on its pathology and therapeutics. In general treatises on legal medicine, this branch of it has always received a share of attention ; but the space allotted to it is altogether too limited to admit of those details which can 755989 IV PREFACE TO THE FIRST EDITION. alone be of any really useful service ; and it is one of those branches on which the author is usually the least qualified by his own experience, to throw any additional light. Insan- ity itself is an affection so obscure and perplexing, and the occasions have now become so frequent and important when its legal relations should be properly understood, that an ampler field of illustration and discussion is required for this purpose, than is afforded by a solitary chapter in works of this description. Notwithstanding the great prevalence of insanity in Great Britain, and the vast amount of property affected by legal regulations and decisions respecting it, yet the English lan- guage does not furnish a single work in which the various forms and degrees of mental derangement are treated in reference to their effect on the rights and duties of man. Dr. Haslam's tract on Medical Jurisprudence as it relates to Insanity, (1807,) which was- republished in this country in 1819 by Dr. Cooper, in a volume of tracts by various Eng- lish writers on different subjects of medical jurisprudence, though abounding in valuable reflections, is altogether too brief and general, to be of much practical service as a book of reference. Among a few other works more or less direct- ly concerned with this subject, or in which some points of it are particularly touched upon, the Inquiry Concerning the Indications of Insanity, (1830,) by Dr. Conolly, late Professor in the London University, is worthy of especial notice in this connection, for the remarkable ability and sound judg- ment with which all its views are conceived and supported. Though not entirely nor chiefly devoted to the legal relations of the insane, yet the medico-legal student will find his views of insanity enlarged and improved by a careful perusal of it ; and every physician will do well to ponder the sug- gestions contained in the chapter on the " Duties of medical PREFACE TO THE FIRST EDITION. V men when consulted concerning the state of a patient's mind." In the JUDGMENTS of Sir John Nicholl, (contained in Hag- gard, Phillimore and Addams's Reports) in the Ecclesiastical Courts, which in their jurisdiction of WILLS have frequent occasion to inquire into the effect of mental diseases on the powers of the mind, are also to be found, not only some masterly analyses of heterogeneous and conflicting evidence, but an acquaintance with the phenomena of insanity in its various forms, that would be creditable to the practical physician, and an application of it to the case under con- sideration, that satisfies the most cautious with the correct- ness of the decision. In Germany this branch of legal medicine has received a little more attention, and in a work, entitled, Die Psycologie in ihren Hauptamvendungen auf die Rechtspflege, (Psychology in its chief Applications to the Administration of Justice,) by J. C. Hoff bauer, a Doctor of Laws and Professor in the University of Halle, and published in 1809, we had, till quite recently, the only complete and methodical treatise on insanity in connection with its legal relations. It bears the impress of a philosophical mind accustomed to observe the mental operations when under the influence of disease ; it con- tains a happy analysis of some states of mental impairment ; its doctrines are generally correct, and in many instances in advance of his own, and even of our time. Hoffbauer, how- ever, not being a practical physician, was less disposed to con- sider insanity in its pathological than in its psychological rela- tions, and consequently has attached too little importance to its connection with physical causes, and to the classification and description of its different forms by means of which they may be recognized, and distinguished from one another. It is also too deeply imbued with the peculiar metaphysical subtleties in which his countrymen are so fond of indulging, VI PREFACE TO THE FIRST EDITION. to suit the taste or- convenience of the English reader. It has been translated into French by Dr. Chambeyron, with many valuable notes by Esquirol and Itard. In France, M. Georget has cultivated this field of inquiry with a success proportioned to his indefatigable zeal and diligence ; and his various writings will ever be resorted to by future inquirers, as they have been by the author of the present work, as to a fund of original and interesting infor- mation. Having long been devoted to the study of insanity, and especially to the observation of the manners and charac- ter of the insane, he was peculiarly well qualified to treat this subject in a spirit corresponding to the present condition of the science. His work entitled, Des Maladies mentales conside're'es dans leurs rapports avec la legislation civile et criminelle, (1827,) is an admirable manual, and though but a humble brochure, it yet abounds with valuable information, and is pervaded by sound and philosophical views. In his Examen medical des proces criminels des nommes Feldtman, Lger, Lecouffe, (1825,) and his Discussion medico-leg-ale, sur la Folie, (1826,) as well as a sequel to the last, entitled, Nouvelle discussion medico-legale sur la Folie, (1828,) he has collected accounts of numerous criminal trials in which insanity was pleaded in defence of the accused, and has taken the occasion to discuss the many important questions to which they give rise. In the course of these discussions there is scarcely a dark or disputed point in the whole range of the subject, which he has not examined with great ability ; and if he has not always settled them satisfactorily to the unprejudiced inquirer, he has at least afforded him the means of forming more clear and definite views. On becoming aware of the deficiency in our medical litera- ture, of works on insanity considered exclusively in its legal relations, it was the author's first thought to make a transla- PREFACE TO THE FIRST EDITION. Vli tion, either of Hoffbauer's or Georget's work, but consider- ing that the numerous notes which would be required in order to bring it up to the present state of the science, and adapt it to our own laws, would prove inconvenient and em- barrassing to the reader, besides not fully accomplishing the object, he was induced to abandon this project, and, as the only means of fairly developing the subject, to prepare an original work, original strictly in plan and in many of its general views only, for the materials have been necessarily drawn, in a great degree, from other sources than the author's own experience. The main object which he proposed to himself was, to establish the legal relations of the insane in conform- ity to the present state of our knowledge respecting their disease. In furtherance of this object, he has given a suc- cinct description of the different species of insanity, and the characters by which they are distinguished from one another, so that the professional student may have some means of recognizing them in practice ; and thence deducing, in regard to each, such legal consequences as seem warranted by an humane and enlightened consideration of all the facts. He is well aware that he has presented some views that will not, at first sight, meet with the cordial assent of all his readers. He can only say in justification, that they have appeared to him to be founded on well -observed, well-authenticated facts, and that as such, it was an imperative duty required by the claims of humanity and truth, to present them in the strong- est possible aspect. Before being condemned for substitut- ing visionary and speculative fancies, in the place of those maxims and practices which have come down to us on the authority of our ancestors, and been sanctioned by the ap- proval of all succeeding times, he hopes that the grounds on which those alleged fancies have been built, will be carefully, candidly, and dispassionately examined. Of the manifold Vlll PKEFACE TO THE FIRST EDITION. imperfections of his work, no one can be more sensible than the author himself ; but if it succeed in directing attention to the subject and putting others on the track of inquiry, it will, at the very least, have been followed by one beneficial result. March 20, 1838. PREFACE TO THE SECOND EDITION SINCE the publication of the first edition of this work, quite a number of contributions possessing various degrees of merit, have been made to the subject. Among those most deserving the attention of the professional inquirer, I would mention the following : The Medical Jurisprudence of Insanity, by J. M. Pagan, M. D., Lecturer on Medical Juris- prudence, Member of the Faculty of Physicians and Sur- geons of Glasgow, etc. London, 1840; On the effect of drunkenness upon criminal responsibility, etc., by Professor C. J. A. Mittermaier, translated from the German into the American Jurist, XXIII. 290; On the different forms of insanity in relation to jurisprudence, by J. C. Prichard, M. D., F. R. S. London, 1842 ; Report of the trial of D. McNaughtonfor the murder of Mr. Drummond, by Bousfield and Merrett. London, 1843 ; De la Folie dans ses rapports avec les questions medico-judiciares, par M. Marc ; (On insan- ity considered in its medico-judicial relations, by M. Marc). Paris, 1839. Among these, the work of Marc is preemi- nently valuable, for he was rarely qualified for the undertak- ing. During a long and brilliant professional career, insanity in its manifold relations occupied a large portion of his attention. He was in habits of intimacy with many of those physicians who were devoted to its study and treat- ment ; for twenty -five years he examined officially the mental X PREFACE TO THE SECOND EDITION. condition of applicants for admission into the private estab- lishments of the insane ; and in his quality of expert, he was often commissioned by the courts to examine, for judicial purposes, the mental condition of individuals. Although not a work of the highest philosophical order, yet the accuracy of its statements, the general correctness of its views, and its eminently practical character, render it exceedingly valuable to the medical jurist. From these sources as well as my own personal observations, I might have enlarged this edition with many striking cases, buf as I have quoted cases solely with the view of illustrating general principles, I have sought to multiply them no farther than seemed to be neces- sary for this purpose. Some additions have been made which, it is hoped, will increase the usefulness of the work, and some of the sections have been rearranged ; but except- ing these, no other except merely verbal changes have been introduced. May 1, 1844. PREFACE TO THE THIRD EDITION, FOR the last twenty years, no part of Medical Jurispru- dence has received so much attention, in one way and another, as that which relates to Insanity. During that period, the cases in which it has been discussed in Eng- lish and American courts, greatly outnumber the whole amount of those which had been previously recorded. In preparing the present edition of this work, therefore, it has formed no part of my purpose to notice all, or any consider- able number of such cases, but I have rather sought, by means of some additions prudently made, to indicate -the progress of the science, to supply important omissions, and to place some views in a stronger light. I take the opportunity to state, that an increased practical acquaintance with the sub- ject, while it has occasionally led me to more precision and accuracy of statement, has not weakened my belief in those doctrines which have been regarded as peculiar to this work. On the contrary, every year's experience has only strength- ened the conviction, that much of the common law relative to insanity, whatever other support it may have, has no foundation in the facts of science. Providence, March 1, 1853. CONTENTS. PRELIMINARY VIEWS CHAPTER I. MENTAL DISEASE IN GENERAL . . CHAPTER II. IDIOCY 73 CHAPTER HI. IMBECILITY 78 CHAPTER IV. LEGAL CONSEQUENCES OF MENTAL DEFICIENCY . . f . . 101 CHAPTER V. PATHOLOGY AND SYMPTOMS OF MANIA 129 CHAPTER VI. INTELLECTUAL MANIA 15"! Sec. I. General Intellectual Mania 151 Sec. H. Partial Intellectual Mania 158 CHAPTER VH. MORAL MANIA 166 Sec. I. General Moral Mania 168 Sec. H. Partial Moral Mania 189 B XIV CONTENTS. CHAPTER VHI. LEGAL CONSEQUENCES OP MANIA 234 Sec. I. Legal Consequences of Intellectual Mania . . . 235 Sec. II. Legal Consequences of Moral Mania .... 259 CHAPTER IX. DEMENTIA 291 CHAPTER X. LEGAL CONSEQUENCES OF DEMENTIA 299 CHAPTER XI. FEBRILE DELIRIUM 315 CHAPTER XH. LEGAL CONSEQUENCES OF DELIRIUM 320 CHAPTER XHI. DURATION AND CURABILITY OF MADNESS 326 CHAPTER XIV. LUCID INTERVALS 333 CHAPTER XV. SIMULATED INSANITY 349 CHAPTER XVI. CONCEALED INSANITY 380 CHAPTER XVH. EPILEPSY AND ITS LEGAL CONSEQUENCES 389 CHAPTER XVIH. SUICIDE 395 CONTEXTS. XV CHAPTER XIX. LEGAL CONSEQUENCES OF SUICIDE 404 CHAPTER XX. SOMNAMBULISM 408 CHAPTER XXL LEGAL CONSEQUENCES OF SOMNAMBULISM 415 CHAPTER XXH. SIMULATED SOMNAMBULISM 418 CHAPTER XXIII. EFFECT OF INSANITY ON EVIDENCE CHAPTER XXIV. DRUNKENNESS 435 CHAPTER XXV. LEGAL CONSEQUENCES OF DRUNKENNESS CHAPTER XXVI. INTERDICTION AND ISOLATION CHAPTER XXVH. DUTIES OF MEDICAL WITNESSES '. 503 MEDICAL JURISPRUDENCE INSANITY. PRELIMINARY VIEWS. STATUTES were framed and principles of law laid down, regulating the legal relations of the Insane, long before physicians had obtained any accurate notions respecting their malady ; and, as might naturally be supposed, error and injustice have been committed to an incalculable extent under the sacred name of law. The actual state of our knowledge of insanity, as well as of other diseases, so far from being what it has always heretofore been, is the accumulated result of the observations which, with more or less accuracy and fidelity, have been prosecuted through many centuries, under the guidance of a more or less inductive philosophy. In addition to the obstacles to the progress of knowledge respect- ing other diseases, there has been this also in regard to insanity, that, being considered as resulting from a direct exercise of Divine power and not from the operation of the ordinary laws of nature, arid thus associated with mysterious and supernatural phenomena confessedly above our compre- hension, inquiry has been discouraged at the very threshold, by the fear of presumption, or, at least, of fruitless labor. To this superstition we may look as the parent of many of the false and absurd notions that have prevailed relative to I 2 MEDICAL JURISPRUDENCE OF INSANITY. this disease, and especially of the reckless and inhuman treat- ment once universally bestowed on its unfortunate subjects. Instead of the kindness and care so usually manifested to- wards the sick, as if it were a natural right for them to receive it ; instead of the untiring vigilance, the soothing attention, the lively solicitude of relatives and friends; the patient, afflicted with the severest of diseases, and most of all depen- dent for the issue of his fate on others, received nothing but looks of loathing, was banished from all that was ever dear to him, and suffered to remain in his seclusion uncared for and forgotten. In those receptacles where living beings, bearing the image and superscription of men, were cut off from all the sympathies of fellow men, and were rapidly completing the ruin of their spiritual nature, there were scenes of bar- barity and moral desolation, which no force of language can adequately describe. The world owes an immense debt of gratitude to the celebrated Pinel who, with an ardor of phi- lanthropy that no discouragement could quench, and a courage that no apprehension of danger could daunt, suc- ceeded, at last, in removing the chains of the maniac, and establishing his claims to all the liberty and comfort which his malady had left him capable of enjoying. With the new aspect thus presented, of the moral and intellectual condition of this portion of our race, the medical jurisprudence of in- sanity became invested with an interest, that has led to its most important improvements. 2. In all civilized communities, ancient or modern, in- sanity has been regarded as exempting from the punishment of crime, and under some circumstances at least, as vitiating the civil acts of those who are affected with it. The only difficulty, or diversity of opinion, consists in determining who are really insane, in the meaning of the law, which has been content with merely laying down some general princi- ples, and leaving their application to the discretion of the judicial authorities. Inasmuch as the greatest possible vari- ety is presented by the mental phenomena in a state of health, it is obvious, that profound study and extensive ob- servation of the moral and intellectual nature of man can PRELIMINARY VIEWS. / alone prevent us from sometimes confounding them with the effects of disease. It would seem, therefore, an almost self-evident proposition, that a certain knowledge of the mind in its healthy state, is an essential preliminary to the attainment of correct ideas concerning its diseased manifes- tations. If, in addition to this, it is considered, that opinions on the nature of insanity, viewed solely in the light of a dis- ease, of a derangement of the physical structure, have been constantly changing for the better, it follows of course, that its legal relations, which should be determined in some measure by our views of its nature, ought to be modified by the progress of our knowledge. That much of the juris- prudence of insanity in times past, should bear marks of the crude and imperfect notions that have been entertained of its pathological character, is not to be wondered at ; but, it is a matter of surprise, that it should be adhered to, as if consecrated by age, long after it has ceased to be supported by the results of more extensive and better conducted inqui- ries. It is to be feared, that the principles laid down on this subject by legal authorities, have been viewed with too much of that reverence which is naturally felt for the opin- ions and practices of our ancestors ; and that innovations have been too much regarded, rather as the offspring of new-fangled theories, than of the steady advancement of medical science. In their zeal to uphold the wisdom of the past, from the fancied desecrations of reformers and theo- rists, the ministers of the law seem to have forgotten that, in respect to this subject, the real dignity and respectability of their profession is better upheld, by yielding to the im- provements of the times and thankfully receiving the truth from whatever quarter it may come, than by turning away with blind obstinacy from every thing that conflicts with long- established maxims and decisions. In the course of the review proposed to be taken of the principles that have regu- lated the civil and criminal responsibilities of the insane, the reader will have constant opportunity to witness the influ- ence of the spirit above condemned ; and be inclined, per- haps, to consider it as the source of that striking difference, 4 MEDICAL JURISPRUDENCE OF INSANITY. presented by the sciences of law and medicine, in the amount of knowledge they respectively evince on the subject of insanity. 3. Legislators and jurists have done little more, than merely to indicate some of the most obvious divisions of in- sanity, without undertaking anything like a systematic clas- sification of its various forms. In the Roman law, the in- sane, or dementes, are divided into two classes ; those whose understanding is weak or null, mente capti, and those who are restless and furious, furiosi. The French and Prussian codes make use of the terms demence,fureur, and imbecillite, without pretending to define them. The English common law originally recognized but two kinds of insanity, idiocy and lunacy, the subjects of which were designated by the term, non compotes mentis, which was used in a generic sense, and meant to embrace all who, from defect of under- standing, require the protection of the law. An occasional attempt has been made by jurists, to attach some definite ideas to these terms, and to point out the various descrip- tions of persons, to whom they may be applied. Lord Coke says, there are four kinds of men, who may be said to be non compotes mentis: 1. An idiot, who, from his nativity, by a perpetual infirmity is non compos ; 2. He that by sick- ness, grief, or other accident, wholly loseth his memory and understanding ; 3. A lunatic that hath sometimes his under- standing, and sometimes not, aliquando gaudet lucidis inter- vallis ; and therefore he is called non compos mentis, so long as he hath not understanding ; 4. He that by his own vicious act for a time depriveth himself of his memory and under- standing, as he that is drunken. 1 4. Nothing can show more plainly how imperfect were the notions of the early law-writers concerning insanity, than this classification of insane persons, and their attempts to define the several classes. An idiot is defined to be a per- son who cannot count or number twenty pence, or tell who was his father or mother, or how old he is, so as it 1 Coke's Littleton, 247 a. PRELIMINARY VIEWS. O appear that he hath no understanding of reason, what shall be for his profit or what shall be for his loss ; but if he have sufficient understanding to know and understand his letters, and to read by teaching or information, he is not an idiot. 1 Now the truth is, that many of those whose idiocy is unques- tionable, are capable of attaining the kind of knowledge herein specified, by means of the ordinary intercourse with men, or of special teaching. The entire loss of memory and understanding, attributed to the second class, is observed only as a sequel to madness or some other disease, or as the result of some powerful moral causes ; so that if this is to be considered an essential character of madness, by much the larger proportion of madmen will be altogether excluded from this classification ; for, instead of wholly losing their understanding, they are for the most part perfectly rational on some topics, and in some relations of life ; and a little effort is frequently necessary, in order to detect the fact of the understanding being at all impaired. Judging from the almost exclusive use of the term lunacy, and the frequent reference to lucid intervals, the intermittent character of mad- ness was either more common, some hundreds of years since, or, which is more probable, in consequence of the general belief in its connection with lunar influences, this intermission was imagined to occur far oftener than it really did. This certainly is a more reasonable explanation, than the idea that the course of nature has changed, so that lucid intervals, which were once of the most common occurrence in insanity, are now among its rarest phenomena. 5. Common sense and a tolerable share of the intelli- gence of the time, if fairly exercised, would probably prevent, in practice, any grossly improper application of these theo- retical principles ; but, in civil cases, the law, though not dis- posed to guage the exact measure of men's intellects, has sometimes insisted on technical distinctions, that have little foundation in nature or reason. Originally, commissions of lunacy were granted for the purpose of inquiring whether 1 1 Fitzherbert, Natura Brevium, 583, ed. 1652. 1* 6 MEDICAL JURISPRUDENCE OF INSANITY. the individual were either an idiot ex nativitate, or a lunatic, in Coke's meaning of the term, and, in consequence thereof, incapable of governing himself and managing his worldly affairs. The injustice of leaving beyond the protection of the law, that larger class of insane, who, though neither idiots nor lunatics, labor under more or less mental derangement, led to a change in the form of the writ, by which the phrase unsound mind was used for the purpose of embracing all others, who were considered proper objects of a commission. What is the precise meaning of this term, it is not easy to gather from the observations of various high legal authorities who have attempted to fix its meaning. It seems to be agreed, that it is not idiocy, nor lunacy, nor imbecility, but beyond this all unanimity is at an end. Lord Hardwicke held, that unsoundness of mind did not mean mere weakness of mind, but a depravity of reason or a want of it. 1 Lord Eldon once referred to the case of a person advanced in years, " whose mind was the mind of a child," and observed, that, " it was, therefore, in that sense, imbecility and inability to manage his affairs, which constituted unsoundness of mind." 2 The same high authority had observed, on a pre- vious occasion, that " the court had thought itself authorized to issue the commission de lunatico inquirendo, provided it is made out, that the party is unable to act with any proper and provident management ; liable to be robbed by any one ; under that imbecility of mind, not strictly insanity, but as to the mischief, calling for as much protection as actual insanity." 8 Mr. Amos, late professor of Medical Jurispru- dence in the London University, has said, that " the term unsoundness of mind, in the legal sense, seems to involve the idea of a morbid condition of intellect, or loss of reason, coupled with an incompetency of the person to manage his own affairs." 4 Whatever it may signify, it has always been insisted on, that the return of the commission must state the 1 Ex Parte Barnsley, 3 Atkyns's Reports, 168. 2 Haslam : Medical Jurisprudence as it relates to Insanity, 336. 8 8 Vesey's Eeports, 66. 4 London Medical Gazette, Vol. 8, p. 19. PRELIMINARY VIEWS. 7 incapacity or inability of the party to manage his affairs, to be evidence of its existence, in order that the party may have the protection of the law. If the jury are unwilling, from what they see, to infer the presence of a mental condition, to which the highest dignitaries of the law have declined fixing a precise, intelligible meaning, then the inquisition is quashed. The feelings of dread and disgust, with which madness has been generally contemplated, have often deter- red juries, acting under a commission, from returning a ver- dict of unsound mind, which has become equivalent to insanity; either from a disinclination to embarrass the family with an odious distinction, or because the individual was not really unsound in the popular acceptation of the term, though his mental faculties might have been so far enfeebled by old age, or sickness, or congenital causes, as to render him absolutely incapable of conducting himself or his affairs, a fact which they have sometimes returned. These attempts to change the ordinary course have never succeeded, the court having in every case required the verdict to be in the words of the inquisition, or in equipollent words. " It is settled," says Lord Eldon, " that if the jury find merely the incapacity of the party to manage his affairs, and will not infer from that and other circumstances unsoundness of mind, though the party may live where he is exposed to ruin every instant, yet upon that finding the commission cannot go on." 1 The consequence is, that the afflicted party must either forego the protection of the law, or fix upon his family a sort of stigma of the most disagreeable and onerous des- cription. When it is considered how many are the cases, where individuals are incapacitated from managing their affairs, simply from that impairment of the mind so common in old age, or mere defect of memory, the other powers remaining sound, it is a little surprising, that no effectual measures have been taken, to render the operation of the law less imperfect and unequal. It is not easy to see the ground of the extreme repugnance displayed by the English 1 19 Vesey's Reports, 286. 8 MEDICAL JURISPRUDENCE OF INSANITY. courts, towards any return that does not assert the mental unsoundness of the affected party, unless it may be some ob- stacle thereby thrown in the course of the subsequent pro- ceedings. The object of the commission is, to ascertain whether or not the party in question is incapable, by reason of mental infirmities, of governing himself and managing his affairs ; and if they so find him, it certainly is irrelevant to any useful purpose, to connect this inability as an effect with any particular kind of insanity, whether expressed in com- mon or technical language. Indeed, to require a jury to infer explicitly unsoundness of mind from inability to man- age affairs, which is of itself sufficient evidence of all the mental unsoundness that is required for practical purposes, and reject their return if they do not, would seem exceed- ingly puerile, were it not strictly professional. In ex parte Cranmer, 1 where the jury pronounced the party in their ver- dict, " so far debilitated in his mind as to be incapable of the general management of his affairs," Lord Chancellor Erskine gives some reasons for finding fault with the terms of the verdict, and directing the inquisition to be quashed. " The verdict," he says, " does not state distinctly, that he is inca- pable ; but that he is so far debilitated in his mind, that he is not equal to the general management of his affairs." The very word incapable, it is true, is not used, but the words "not equal" are surely of equivalent meaning; and it is not easy to conceive, how a clearer or stronger idea of a person's incapacity can be conveyed, than to pronounce him "not equal to the management of his affairs." " How can I tell," he asks, " what is ' so far debilitated in his mind that he is not equal to the general management of his affairs ?" ; He cer- tainly could not tell the precise quantity of mind left, but even if the party had been returned non compos and therefore unequal to the management of his affairs, it is not quite obvious, how any more definite notion on this point would have been conveyed. 2 1 12 Vesey's Reports, 406. 2 In a recent case, the inquisition was quashed by Lord Lyndhurst, be- cause the verdict of the jury said too much, instead of too litt e, viz. : " that PRELIMINARY VIEWS. 9 6. The business of the jury in these cases is, to ascer- tain whether the individual is mentally capable of managing his affairs; and this is a duty, which, generally speaking, they are able to perform with tolerable correctness. But what can be more irrelevant to the object in view, or more remote from the ordinary circle of their reflections, than the additional duty of deciding whether his mental impairment has gone far enough, to bear being designated by the techni- cal phraseology, unsoundness of mind ? When it is recol- lected, too, that the members of these juries are mostly unedu- cated men, and but few of them at all acquainted with the force of legal or medical distinctions, it cannot be supposed, that such a return is always the recorded opinion of unbias- ed, understanding minds. Indeed, the inconvenience and in- justice of this proceeding have been so strongly felt, as to have led to the repeated expression of a wish, that its defects were , remedied by the action of the legislature. That it should still continue in a country, where it is linked in with a system, whose foundations are in the very constitution of the government, is perhaps not strange ; but, that it should be used in some of our own States which are untrammelled by such considerations, is certainly an. anomaly in legislation. 7. This is not the only instance where the principles of common sense and common justice, which ought to regu- late the legal relations of the insane, have, with astonishing inconsistency, been strangely disregarded in the maxims of the common law. "While theoretically it requires that con- tracts, to be valid, should spring from a free and deliberate consent, it refuses to suffer the party himself to avoid them on the plea of lunacy, in accordance with an ancient maxim, that no man of full age shall be allowed to disable or stultify himself; though at the same time, it does allow his heirs, or other persons interested, to avail themselves of this privilege. 1 the party was not a lunatic, but partly from paralysis and partly from old age, his memory was so much impaired, as to render him incompetent to the man- agement of his affairs, and consequently that he was of unsound mind, and had been so for two years." In Re Holmes, 4 Russel's Chancery Reports, 182. 1 2 Blackstone, 295. 10 MEDICAL JURISPRUDENCE OF INSANITY. Thus, a person who recovers from a temporary insanity before the return of an inquisition, has no remedy at law or in equity for the most ruinous contracts that he may have entered into while in that condition, except on the ground of fraud, though, after his death, his heirs may have them set aside by establishing the fact of lunacy alone. Well may a distinguished jurist exclaim, that "it is matter of wonder and humiliation, how so absurd and mischievous a maxim could have found its way into any system of jurisprudence, professing to act on civilized beings." l It arose, no doubt, in part, from erroneous notions of the nature of insanity, and partly from apprehensions, not well founded, of the conse- quences, that might follow the admission of the plea of lunacy in avoidance of contracts. Within a few years, however, the English courts have almost entirely disregarded the ancient maxim, 2 and in this country, it has long since lost its author- ity altogether. 8 Indeed, there now seems to be a strong dis- position to run to the opposite extreme. We cannot but think that the ends of justice would be better obtained, if no general rule at all were adopted, and every case decided on its own merits. Where the insanity of one of the parties is perfectly well known to the other, or might have been so by the exercise of ordinary sagacity, a contract between them, except for the necessaries of life or comforts and luxuries suitable to his wealth or station, should obviously be held in- valid, because the insane party is deprived by the act of provi- dence of his natural share of discernment and foresight. It often happens, however, that a person's insanity is not general- ly known and is not very apparent, and, in such cases, if it can be proved, that the contract is a fair and reasonable one on the face of it, and was entered into in perfect honesty and good faith, he certainly should not be permitted to stultify himself, 1 Story, Commentaries on Equity Jurisprudence, 225. 2 Bagster v. Earl Portsmouth, Chitty on Contracts, 256 ; Gates v. Boen, 2 Strick. 1104. s 3 Day, 90, Webster v. Woodward; 15 Jolms. 503, Rice v. Peet; 5 Pick. 431, Mitchell v. Kingman. PRELIMINARY VIEWS. 11 in order to escape its performance. Neither does his death or interdiction so change the case, as to render it proper for his heirs or guardians to do that which he could not do for himself. Much as the law is bound to protect the interests of the insane, it is no less required to protect those who deal with them, unacquainted with their mental condition. It as often happens, that the same party suffers from the avoid- 1 ance of the contract, as that the insane or his heirs do from its validity ; and nothing can be more clearly unjust, than the application of a maxim or general rule that favors only the interests of the unsound party. 8. Though little of this pertinacious adherence to merely technical distinctions is observed, in the application of the law to criminal cases, yet there is much of the same respect for antiquated maxims, that have little else to recom- mend them but their antiquity, and are so much the more pernicious in their application, as the interests of property are of less importance than reputation and life. It by no means follows, that a person declared to be non compos by due process of law, is to be considered, on that account merely, to be irresponsible for his criminal acts. This is a question entirely distinct, and is determined upon very differ- ent views of the nature- of insanity, and of its effects on the operations of the mind ; and, here it is, that the lawyer en- croaches most on the domain of the physician. The first attempt to point out precisely those conditions of insanity, in which the civil and criminal responsibilities are unequally affected, was made by Lord Hale. " There is a partial insanity," says he, " and a total insanity. The former is either in respect to things, quoad hoc vel illud insanlre. Some persons that have a competent use of reason, in re- spect of some subjects, are yet under a particular dementia, in respect of some particular discourses, subjects, or applica- tions, or else it is partial in respect of degrees ; and this is the condition of very many, especially melancholy persons, who for the most part discover their defect in excessive fears and griefs, and yet are not wholly destitute of the use of reason ; and this partial insanity seems not to excuse them, 12 MEDICAL JURISPRUDENCE OP INSANITY. in the committing of any offence for its matter capital ; for, doubtless, most persons that are felons of themselves and others, are under a degree of partial insanity, when they commit these offences. It is very difficult to define the invisible line that divides perfect and partial insanity; but it must rest upon circumstances duly to be weighed and considered both by judge and jury, lest on the one side there be a kind of inhumanity towards the defects of human nature ; or, on the other side, too great an indulgence given to great crimes." 1 So strongly was this celebrated jurist possessed with the idea, that it is the strength and capa- city of the mind only that are affected by insanity, that he has actually founded upon it a test of criminal responsibility. " Such a person," says he, " as laboring under melancholy distempers, hath yet ordinarily as great understanding as ordinarily a child of fourteen years hath, is such a person as may be guilty of treason or felony." As if the only difference between sanity and insanity were precisely that which is made by difference of age, and as if there could be two things more unlike than the mind of a person "laboring under melancholy distempers," and that of a child fourteen years old. 9. The doctrines thus dogmatically laid down by Lord Hale, have exerted no inconsiderable influence on the judicial opinions of his successors ; and his high authority has often been invoked against the plea of insanity, whenever it has been urged by the voice of philanthropy and true science. If, too, in consequence of the common tendency of indul- gence in forced and unwarrantable constructions, whenever a point is to be gained, his principles have been made to mean far more than he ever designed, the fact impressively teaches the importance of clear and well-defined terms, in the expression of scientific truths, as well as of enlarged, practical information, relative to the subjects to which they belong. In the time of this eminent jurist, insanity was a much less frequent disease than it now is, and the popular notions concerning it were derived from the observation of 1 Pleas of the Crown, 30. PRELIMINARY VIEWS. 13 those wretched inmates of the mad-house, whom chains and stripes, cold and filth, had reduced to the stupidity of the idiot, or exasperated to the fury of a demon. Those nice shades of the disease in which the mind, without being wholly driven from its propriety, pertinaciously clings to some absurd delusion, were either regarded as something very different from real madness, or were too few, too far removed from the common gaze, and too soon converted by bad management into the more active forms of the disease, to enter much into the general idea entertained of madness. Could Lord Hale have contemplated the scenes presented by the lunatic asylums of our own times, we should undoubt- edly have received frpm him a very different doctrine, for the regulation of the decisions of after generations. 10. Judging from the few cases that have been reported, the course of practice in the English criminal courts has been in strict conformity to the principles laid down by Hale. For instance, in the trial of Arnold in 1723 for shooting at Lord Onslow, Mr. Justice Tracy observed, " that it is not every kind of frantic humor, or something unaccountable in a man's actions, that points him out to be such a madman, as is exempted from punishment: it must be a man that is totally deprived of his understanding and memory, and doth not know what he is doing, no more than an infant, than a brute, or a wild beast, such a one is never the object of pun- ishment." * This is but the echo of Lord Hale's doctrine, and the circumstances of the case show how faithfully the principles were applied. Arnold seems to have been of weak understanding from his birth, and to have led an idle, irregular, and disordered life, sometimes unequivocally mad, and at all times considered exceedingly strange and different from other people ; one witness describing him as a strange, sullen boy at school, such as he had never seen before. It was testified by his family and his neighbors, that for several years previous, they had considered and treated him as mad, occasionally if not always, although so little disposed to mis- 1 8 Hargrave's State Trials, 322. 2 14 MEDICAL JURISPRUDENCE OF INSANITY. chief, that he was suffered to be at large. Contrary to the wishes of his friends, he persisted in living alone in a house destitute of the ordinary conveniences ; was in the habit of lying about in barns and under hay -ricks ; would curse and swear to himself for hours together ; laugh and throw things about the house without any cause whatever, and was much disturbed in his sleep by fancied noises. Among other unfounded notions, he believed that Lord Onslow, who lived in his neighborhood, was the cause of all the tumults, disturb- ances, and wicked devices that happened in the country, and his thoughts were greatly occupied with this person. He was in the habit of declaring, that Lord Onslow sent his devils and imps into his room at night to disturb his rest, and that he constantly plagued and bewitched him, by getting into his belly or bosom, so that he could neither eat, drink, nor sleep, for him. He talked much of being plagued by the Bollies and Bolleroys ; he declared in prison it was better to die than live so miserably, and manifested no compunction for what he had done. Under the influence of these delu- sions, he shot at and wounded Lord Onslow. The proof of insanity was strong enough, but not that degree of it, which the jury considered sufficient to save him from the gallows, and he was accordingly sentenced to be hung. Lord Onslow himself, however, thought differently ; and, by means of his intercession, the sentence was not executed, and Arnold was continued in prison for life. It is clear, that the court recog- nized that class of madmen only, as exempted from the penal consequences of crime, whose reason is completely dethroned from her empire, and who are reduced to the condition of an infant, a brute, or a wild beast. If it be true, as the court said, that such are never the objects of punishment, though it neglected to state that they are never the objects of prosecu- tion, the converse must be equally true, that those not exactly in this condition can never avoid punishment on the plea of insanity. It appears, then, that the law at that time did not consider an insane person irresponsible for crime, in whom there remained the slightest vestige of rationality ; though it did then, and has ever since deprived him of the management PRELIMINARY VIEWS. 15 of himself and his affairs, and vitiates Ms civil acts, even when they have no relation to the delusions that spring from his madness. That the progress of science and general enlight- enment has produced no improvement of the law on this sub- ject, is abundantly shown in the strong declarations of Sir Vicary Gibbs, when attorney-general of England, on the trial of Bellingham, in 1812. " A man," says he, " may be deranged in his mind, his intellects may be insufficient for enabling him to conduct the common affairs of life, such as disposing of his property, or judging of the claims which his respective relations have upon him ; and if he be so, the administration of the country will take his affairs into their management, and appoint to him trustees ; but, at the same time, such a man is not discharged from his responsibility for criminal acts." x Lord Erskine had previously given the same doctrine the sanction of his authority, in his celebrated speech in defence of Hadfield. " I am bound," he says, " to admit that there is a wide distinction between civil and criminal cases. If, in the former, a man appears, upon the evidence, to be non compos mentis, the law avoids his act, though it cannot be traced or connected with the morbid imagination which constitutes his disease, and which may be extremely partial in its influence upon conduct ; but, to deliver a man from responsibility for crimes, above all, for crimes of great atrocity and wickedness, I am by no means prepared to apply this rule, however well established when property only is concerned." 11. That a person, whom the law prevents from manag- ing his own property, by reason of his mental impairment, should, in respect to criminal acts, be considered as possess- ing all the elements of responsibility, and placed on the same footing with men of the soundest and strongest minds, is a proposition so strange and startling, that few, uninfluenced by professional biases, can yield to it unhesitating assent, or loo^ upon it in any other light, than as belonging to that class of doctrines which, while they may be the perfection of 1 Collinson on Lunacy, 657. 16 MEDICAL JURISPRUDENCE OF INSANITY. reason to the initiated, appear to be the height of absurdity to every one else. Georget, an able French writer on the legal relations of the insane, in commenting on the speech of M. de Peyronnet who, in the trial of Papavoine, had adduced the passage above extracted from Lord Hale, in support of his own views, expresses his astonishment and indignation, that such a sentiment should ever have been uttered, least of all, quoted with approbation, in a French court of .justice, by the chief law-officer of the government. " Can we help won- dering," he exclaims, " at these sentiments of Lord Hale, who seems to make more account of property than life. No excuse for the unfortunate man who, in a paroxysm of mad- ness, commits a criminal offence, while civil acts are to be annulled, even when they have no relation to the insane impressions that might have influenced his conduct." l The language of the law, virtually addressed to the insane man, is, your reason is too much impaired to manage your pro- perty ; you are unable to distinguish between those measures, which would conduce to your profit and such as would end in your ruin, and therefore it is wisely taken altogether from your control; but if under the influence of one of those insane delusions that have rendered this step necessary, you should kill your neighbor, you will be supposed to have acted under the guidance of a sound reason ; you will be tried, con- victed, and executed like any common criminal whose under- standing has never been touched by madness. As for any physiological or psychological ground for this distinction between the legal consequences of the civil and criminal acts of an insane person, it is in vain to look for it. That the mind, when meditating a great crime, is less under the influ- ence of disease, and enjoys a more sound and vigorous exer- cise of its powers, than when making a contract, or a will, few, probably, will be hardy enough to affirm ; and yet the practice of the law virtually admits it. The difference, if there be any, would seem to be all the other way. In the disposal of property, the mind is engaged in what has per- 1 Discussion medico-legale sur la Folie, 8. PRELIMINARY VIEWS. 17 haps often exercised its thoughts ; the conditions and conse- quences of the transaction require no great mental exertion to be comprehended ; and there may be nothing in it, to deprive the mind of all the calmness and rationality of which it is capable. Now criminal acts, though abstractly wrong, may under certain circumstances become right and meritori- ous ; and if the strongest and acutest minds have sometimes been perplexed on this point, what shall we say of the crazy and distorted perceptions of him, whose reason shares a divi- ded empire with the propensities and passions ? Most mani- acs have a firm conviction that all they feel and think is true, just, and reasonable ; and nothing can shake their convictions. The contracts of the insane are, in many cases, declared to be invalid, and are set aside, in courts of equity, on the ground of fraud ; in accordance with an established principle, that the parties to a contract must be capable of giving their deliberate and rational consent, the power of doing which is destroyed by mental derangement. 1 In point of mental sound- ness they must be equal, and common justice requires, that the insane man, in his dealings with his fellow men, should be protected from the effect of his disorder. Even in the simplest transaction, it is supposed that the insane party may not be able to discern all the circumstances that may conduce to his advantage, and may not act as if his mind were perfectly sound. But it remains to be proved that, in the commission of a criminal offence, he has more clearly apprehended its abstract nature, its relations to the injured party, and its consequences to himself, than he would all the circumstances attending a contract ; if, therefore, he have not acted rationally, but under the influence of a disorderd mind, he ought to be no more responsible for the former than for the latter. 12. A distinction is also made between civil and criminal cases, in regard to evidence respecting the state of the party's mind. In the former, proof drawn from the nature of the act in question is sometimes paramount to all others, and, in the 1 Story's Commentaries on Equity Jurisprudence, 227. 2* 18 MEDICAL JURISPRUDENCE OF INSANITY. absence of others, admitted to be alone conclusive ; while, in the latter, to seek to prove the existence of insanity from the character of the act, would be viewed as nothing less than a begging of the question. " If a lunatic person," says Swin- burne, 1 " or one that is beside himself at sometimes but not continually, make his testament, and it is not known whether the same were made while he was of sound mind and memory or no, then in case the testament be so conceived, as thereby no argument of phrensy or folly can be gathered, it is to be presumed that the same was made during the time of his calm and clear intermissions, and so the testament shall be adjudged good, yea, although it cannot be proved that the testator useth to have any clear and quiet intermissions at all, yet, nevertheless, I suppose that if the testament be wisely and orderly framed, the same ought to be accepted for a law- ful testament." Sir John Nicholl has observed, that where there is no direct evidence of the time or, consequently, of the deceased's state of mind at the time, of the act done, recourse must be had to the usual mode of ascertaining it in such cases which is by looking at the act itself. " The agent is to be inferred rational, or the contrary, in such cases from the character broadly taken of his act." 2 So, on the other hand, " in the case of a person who is sometimes sane and sometimes insane, if there be in it a mixture of wisdom and folly, it is to be presumed that the same was made dur- ing the testator's phrensy, even if there be but one word sounding to folly." 8 If, then, testamentary dispositions that conflict with the natural distribution of property and the known and expressed intentions of the testator, yea, if they contain but one word " sounding to folly," are to be held as sufficient evidence of unsound mind, in doubtful cases, why, when an atrocious crime is shown to be motiveless, unnatural, 1 Of Testaments and Last Wills, Part II, Section 3. 2 1 Addam's Ecclesiastical Keports, 74, Scruby and Finch v, Fordham and others. See also 1 Phillimore's Reports, 90; 1 Dow's Reports, 178, for a recognition of the same principle. 8 Swinburne, Part H, 3, pi. 16. PEELIMINARY VIEWS. 19 in opposition to the habits, feelings, and principles of the whole past life, and unfollowed by any consciousness of guilt, should not this act be considered as equally strong proof of unsoundness of mind ? Why is it, that instead of being thus considered, it actually avails the accused nothing ; the charac- ter of the act, in the last resort, being too often explained, on the supposition of an inherent ferocity and thirst for blood, which no considerations can restrain; even in the face of totally different dispositions, indicated by the whole tenor of his life. 13. Notwithstanding that Lord Hale's doctrine was cited with approbation by M. de Peyronnet, ( 11), yet, by the French penal code, madness, without limit or condition, exempts from the punishment of criminal acts. The language of the law is, that " there is no crime nor offence when the accused was in a state of madness at the time of the action." l The existence of insanity once established, the accused is, by the spirit of the law, acquitted. This intention has some- times been near being defeated, in consequence of the great liberty allowed to French juries, in the construction of the phraseology of their verdict, in which they may declare, if they choose, not whether the accused was guilty or not guilty, sane or insane, but whether or not the act was committed voluntarily. 2 A verdict of this kind, in an instance men- tioned by Georget, led to a curious result, in the hands of men who were not indoctrinated in the subtleties of meta- physics. The fact of insanity having been given to the jury for decision, they returned that the accused acted voluntarily and with premeditation ; and, secondly, that he was insane at the time of committing the act. 3 This verdict, so consistent in reality, but so utterly contradictory in a legal sense, was received by the court and understood to mean, that the accused possessed the will of a madman, a merely animal 1 II n'y a ni crime ni delit lorsque le prevent! etait en e"tat de demence au temps de 1'action. Art. 64. 2 Special verdicts in criminal cases are quite common in France. 3 Des maladies mentales, 100. 20 MEDICAL JURISPRUDENCE OF INSANITY. will which excludes legal culpability. Had not the last question been raised, the accused, though mad, would have been condemned to death. 1 It seems evident, that the legis- lator, in framing that law, was impressed with the difficulty of drawing the line between general and partial insanity, and of estimating the quantity of reason left after the invasion of this disease, and therefore determined to avoid it altogether by recognizing but one kind of insanity. Though not pre- pared to acquiesce entirely in the dispositions of this enactment, yet it is infinitely preferable, with all its faults, to the English practice of requiring a number of men, who may have had very little education of any kind, and least of all, any very accurate notions of the influence of insanity on the operations of the mind, to sit in judgment on the measure of a man's understanding, and decide whether or not he had enough of reason left to discern the nature of the act he committed. True, mental unsoundness is not necessarily incompatible i It is one of those metaphysical subtleties, so prevalent on the subject of v insanity, that the acts of an insane mind are involuntary. It certainly can be of little practical consequence, what epithet is applied to the acts of a mind admitted to be insane ; though it seems to be an abuse of language, to call any act involuntary, which proceeds from a person's own free will. True, the exercise of the will may be greatly influenced by the condition of the mind, even to such an extent as to deprive a person of all criminal responsibility. But this does not necessarily prove the act to be involuntary, unless, for instance, every man, who commits a criminal act under the influence of strong passions, is considered as acting involuntarily. The objection to this distinc- tion is, that it is used as a test in the decision of doubtful cases, every one being left to decide, as he pleases, what acts are voluntary, and what invol- untary. A curious application of the distinction is made by Mr. Shelford, in his work on Lunatics, (Introduction, p. xlix.) when speaking of suicide. " The art with which the means are often prepared, and the time occupied in plan- ning them, seem to mark it [suicide] as an act of deliberate volition ; but the acts of an insane mind are involuntary, and not voluntary ; therefore, the question must always revert to what was the real condition of the mind when suicide was committed." If the preparation for the suicidal act be so indica- tive of that volition which is exercised by sound minds only, it is not very clear by what process of logic, from these two propositions would be drawn the conclusion, that the " question must always revert to what was the real condition of the mind when suicide was committed." PRELIMINARY VIEWS. 21 with crime, for we can conceive of cases, where the criminal act is beyond the sphere of the influence of the reigning delusion, and therefore, as far as that is concerned, the off- spring of a sound mind ; yet we must acknowledge the extreme difficulty of establishing this fact, and the caution with which we should proceed to a decision. 14. On the trial of Hadfield, for shooting at the king in Drury Lane theatre, in 1800, there occurred for the first time, in an English criminal court, anything like a thorough and enlightened discussion of insanity as connected with crime ; and the result was, that a fatal blow was given to the doc- trines of Lord Hale by Mr. Erskine who brought all the energies of his great mind to bear upon the elucidation of this subject. 1 In accordance with these doctrines, the attor- ney-general had told the jury, that to protect a person from criminal responsibility, there must be a total deprivation of memory and understanding. To this Mr. Erskine very justly replied, that if these expressions were meant to be taken in the literal sense of the words which however he did not deny " then no such madness ever existed in the world." This condition of mind is observed only in idiocy and fatuity, and its unhappy subjects are never made accountable to the laws. In proper madness, on the contrary, so far was there from being a total deprivation of memory and understanding, that " in all the cases that have filled Westminster Hall," said he, " with the most complicated considerations, the lunatics 1 One reason, why the criminal law of insanity has undergone so little improvement in England is, probably, that the accused, not having been allowed counsel to speak in their defence, except in trials for high treason, the officers of government have always been at liberty to put their own con- struction on the law, and urge it on the jury as the only correct one, without fear of being contradicted or gainsayed. Thus the old maxims have been repeated, year after year, and not being questioned, their correctness has remained undoubted, both in and out of the legal profession. Can any one doubt, that had those insane criminals who have been condemned within the last half century, been defended by an Erskine, many of them would have been acquitted, and a great advance made in the law of insanity, that would have prevented some of those exhibitions of presumptuous ignorance, which will one day be universally regarded with feelings of disgust and pity ? 22 MEDICAL JURISPKUDENCE OF INSANITY. and other insane persons who have been the subjects of them, have not only had memory in my sense of the expression they have not only had the most perfect knowledge and recollection of all the relations they stood in towards others, and of the acts and circumstances of their lives, but have, in general, been remarkable for subtlety and acuteness. Defects in their reasonings have seldom been traceable the disease consisting in the delusive sources of thought: all their deductions, within the scope of their malady, being founded on the immovable assumption of matters as realities, either without any foundation whatever, or so distorted and dis- figured by fancy, as to be nearly the same thing as their creation." Instead therefore of making that kind of insanity which would exempt from punishment to consist in the absence of any of the intellectual faculties, he lays down delusion as its true character, of which the criminal act in question must be its immediate unqualified offspring. 1 Here was a great step made in this branch of medical jurisprudence, and it might have been expected, that the victory thus gained over professional prejudices and time-honored errors, would be felt in all subsequent decisions. But, though the day has gone by, when such insanity only as is attended by total deprivation of memory and understanding, can be admitted in excuse for crime, the test offered by Erskine was altogether too simple and too philosophical, to be readily adopted by minds that delighted in subtleties and technicalities. 1 It is surprising and perfectly unaccountable that Mr. Erskine, in advert- ing to the case of Arnold, ( 10), should have declared, " that his counsel could not show, that any morbid delusion had overshadowed his understand- ing ! " If it were no delusion in Arnold to believe that Lord Onslow was the cause of all the turmoils and troubles in the country that he bewitched him in particular by getting into his belly and bosom, and sending his devils and imps into his room to prevent his rest ; it surely was none for Hadfield to imagine that he had constant intercourse with God that the world was about to come to an end and that he was to sacrifice himself for its salva- tion, by taking away the life of another. Either the able advocate, in his zeal for his client, must have egregiously deceived himself respecting the facts of Arnold's case, or have attached some ideas to delusion, which have never entered into the ordinary conceptions of that kind of belief. PRELIMINARY VIEWS. 23 15. In the case of Bellingham, for instance, 1 tried for the murder of the Hon. Spencer Percival in 1812, it appeared from the history of the accused, from his own account of the transactions that led to the fatal act, and from the testimony of several witnesses,' that he labored under many of those strange delusions that find a place only in the brain of a madman. His fixed belief that his own private grievances were national wrongs ; that his country's diplomatic agents in a foreign land neglected to hear his complaints and assist him in his troubles, though they had in reality done .more than could have reasonably been expected of them ; his con- viction, in which he was firm almost to the last, that his losses would be made good by the government, even after he had been repeatedly told, in consequence of repeated applica- tions in various quarters, that the government would not interfere in his affairs ; and his determination, on the failure of all other means to bring his affairs before the country, to effect this purpose by assassinating the head of the gov- ernment, by which he would have an opportunity of mak- ing a public statement of his grievances and obtaining a tri- umph, which he never doubted, over the attorney-general ; these were all delusions, as wild and strange as those of seven-eighths of the inmates of any lunatic asylum in the land. And so obvious were they, that though he had not the aid of an Erskine to press them upon the attention of the jury, and though he himself denied the imputation of insanity, the government, as if virtually acknowledging their existence, contended for his responsibility on very different grounds. As the various tests of this condition, commonly urged on such occasions, were dwelt upon with unusual earnestness and force, and with strong expressions of confidence in their value, it may be well to examine them critically, in order to ascertain to how much weight they are really entitled, in set- tling the question of criminal responsibility. 16. In the trial of Arnold, already noticed ( 10), the jury were directed to settle it in their own minds, whether 1 1 Collinson on Lunacy, 650. 24 MEDICAL JURISPRUDENCE OF INSANITY. the accused was capable of distinguishing right from wrong, good from evil, and if they concluded that he was, that they must return a verdict of guilty. In Bellingham's case, the attorney-general declared, " upon the authority of the first sages in the country, and upon the authority of the estab- lished law in all times, which law has never been questioned, that although a man may be incapable of conducting his own affairs, he may still be answerable for his criminal acts, if he possess a mind capable of distinguishing right from wrong." l Lord Chief Justice Mansfield who tried the case, echoed the * ' same doctrine in his charge to the jury. In speaking of a species of insanity, in which the patient fancies the existence of injury, and seeks an opportunity of gratifying revenge by some hostile act, he says, " if such a person were capable, in other respects, of distinguishing right from wrong, there was no excuse for any act of atrocity, which he might commit under this description of derangement." 2 Mr. Russell, in his work on criminal law, includes inability to distinguish right from wrong among the characters of that grade of insanity which exempts from the punishment of crime. 8 17. That the insane mind is not entirely deprived of this power of moral discernment, but on many subjects is perfectly rational and displays the exercise of a sound and well-balanced mind, is one of those facts now so well estab- lished, that to question it would only betray the height of ignorance and presumption. The first result, therefore, to which the doctrine leads, is, that no man can ever success- fully plead insanity in defence of crime, because it can be said of no one who would have occasion for such a defence, that he was unable in any case to distinguish right from wrong. To show the full merits of the question, however, it is necessary to examine more particularly, how far this 1 Collinson on Lunacy, 657. 2 This opinion was delivered scarcely a dozen years after the absurdity of its principles had been so happily exposed in a few words, by Mr. Erskine, on the trial of Hadfield. What a comment on the progress of improvement in the medical jurisprudence of insanity ! * 8 Russell on Crimes and Misdemeanors, 12. PRELIMINARY VIEWS. 25 moral sentiment is affected by, and what relation it bears to insanity. By that partial possession of the reasoning powers, which has been spoken of as being enjoyed by maniacs gene- rally, is meant to be implied the undiminished power of the mind, to contemplate some objects or ideas in their cus- tomary relations, among which are those pertaining to their right or wrong, their good or evil tendency; and it must comprise the whole of these relations, else the individual is not sane on these points. A person may regard his child with the feelings natural to the paternal bosom, at the very moment he believes himself commanded by a voice from heaven to sacrifice this child, in order to secure its eternal happiness, than which, of course, he could not accomplish a greater good. Our belief in a maniac's soundness, on certain subjects, is founded in part on the moral aspect in which he views those subjects ; for it would be folly to consider a per- son rational in reference to his parents and children, while he entertains the idea that it would be doing God service to kill them ; though he may talk rationally of their characters, dispositions, and habits of life, their chances of success in their occupations, their past circumstances, and the feel- ' ings of affection which he has always cherished towards them. Before, therefore, an individual can be accounted sane on a particular subject, it must appear that he regards it correctly, in all its relations to right and wrong. The slightest acquaintance with the insane will convince any one of the truth of this position. In no school of logic, in no assembly of the just, can we listen to closer and shrewder argumentation, to warmer exhortations to duty, to more glow- ing descriptions of the beauty of virtue, or more indignant denunciations of evil-doing, than in the hospitals and asy- lums for the insane. And yet many of these very people may make no secret of entertaining notions utterly subversive of all moral propriety; and, perhaps, are only waiting a favorable opportunity to execute some project of wild and cruel violence. The purest minds cannot express greater horror and loathing of various crimes than madmen often do, and from precisely the same causes. Their abstract concep- 3 26 MEDICAL JURISPRUDENCE OF INSANITY. tions of crime, not being perverted by the influence of dis- ease, present its hideous outlines as strongly defined, as they ever were in the healthiest condition ; and the disapprobation they express at the sight arises from sincere and honest con- victions. The particular criminal act, however, becomes divorced in their minds from its relations to crime in the abstract; and, being regarded only in connection with some favorite object which it may help to obtain, and which they see no reason to refrain from pursuing, is viewed, in fact, as of a highly laudable and meritorious nature. Herein, then, consists their insanity, not in preferring vice to virtue, in applauding crime and deriding justice, but in being unable to discern the essential identity of nature between a particu- lar crime and all other crimes, whereby they are led to approve what, in general terms, they have already con- demned. It is a fact, not calculated to increase our faith in the march of intellect, that the very trait peculiarly character- istic of insanity, has been seized upon as a conclusive proof of sanity in doubtful cases ; and thus the infirmity that enti- tles one to protection, is tortured into a good and sufficient reason for completing his ruin. 18. If this power of distinguishing right from wrong do really indicate soundness of mind, it may be justly com- plained, that the question of its existence is never agitated in any but criminal cases, while it certainly should be whenever the rights and liberties of the insane are to be invaded. If it is proper to make those who possess this power responsible for their criminal acts, how unjust and absurd is it to deprive them of their liberty, and seclude them from their customary scenes and enjoyments, before they have violated a single human law. Undoubtedly, this measure would be conducive to their good, by taking from them effectually the oppor- tunity of injuring the persons or property of themselves or others ; and so it would be for every other unprincipled and reckless individual who bids fair to be a pest to society. But if it is alleged, that the latter are morally free, and, therefore, are personally free, until the commission of some overt act, it may be replied, that the former, on the hypothesis of the law, PRELIMINARY VIEWS. 27 which makes moral freedom consist in the power of distin- guishing right from wrong, have the same claim to immunity from personal constraint. This preposterous distinction between civil and criminal cases, gives rise in practice to one of the most curious and startling inconsistencies that human legislation ever presented. While the mental impair- ment is yet slight, comparatively, and the patient is quiet and peaceable, the law considers him incapable of managing him- self or his worldly affairs, and provides him with a guardian and a place in the wards of a hospital ; but when the disorder has proceeded to such a height as to deprive the maniac of all moral restraint, and precipitate him on some deed of vio- lence, he is to be considered as most capable of perceiving moral distinctions, and, consequently, most responsible for his actions! 19. The qualifications with which some of the latest writers have promulgated this test of responsibility, encour- age the hope, that it will ere long be viewed in a very differ- ent aspect. A disposition to disregard the old landmarks on this point was manifested, not long since, by Lord Lynd- hurst, in the case of the King v. Orford, when he directed the jury to acquit the prisoner, if satisfied, " that he did not know, when he committed the act, what the effect of it, if fatal, would be with reference to the crime of murder ; " * in other words, they were to satisfy themselves, before acquit- ting him, that he did not know that the act would be essentially murder, that crime which in the abstract is equally abhorred by the sane and the insane. Still, how- i 5 Carrington and Payne, 168. The defendant, in this case, was tried for murder. It appeared that he entertained the notion, that the person whom he shot and many others were desirous of depriving him of his liberty, and had accordingly conspired together to accomplish their purpose, and, under the influence of this delusion, he would abuse people whom he met in the streets, though wholly unacquainted with them. In his pocket was found a paper purporting to be " a List of Hadleigh Conspirators against my Life," in which he had enrolled the names of the deceased and his family. Several medical witnesses who heard the evidence, deposed that the prisoner was affected with monomania. 28 MEDICAL JURISPRUDENCE OF INSANITY. ever, this is not sufficient, for he might, like Hadfield and many others, have recognized the wrong and illegality of the act, and been perfectly conscious of its consequences to himself, while he felt impelled to its execution by a voice from heaven, or by a strong conviction of certain great ends which it was to promote, and thus have acted the part, if the expression may be allowed, of an insane Abraham or Brutus. This principle, therefore, is far from being univer- sally applicable, though if it had been admitted in the case of Bellingham, it would have produced the acquittal of that unfortunate man. The criminal act which he committed was not viewed by him at all as one of murder, any more than the killing of a brute for the same purpose, but merely as a disagreeable though justifiable method of bringing his affairs before the country, and obtaining redress for his man- ifold wrongs and sufferings. And yet Lord Lyndhurst, in this very case, expressed his approbation of the doctrines laid down by Lord Chief Justice Mansfield on the trial of Bellingham, doctrines which he had found it necessary here to modify, in order that they might afford to an inno- cent man the protection to which he was entitled! Mr. Chitty seems inclined to proceed a step farther on this point. " The substantial question presented to the jury," he ob- serves, "is, whether, at the time the alleged criminal act was committed, the prisoner was incapable of judging between right and wrong, and did not then know he was committing an offence against the law of God and of na- ture." l By some late Scotch writers on criminal law, this test of responsibility has been disapproved of, in still more explicit terms. Baron Hume disposes of it in the following language : " Would he have answered on the question, that it is wrong to kill a fellow creature ? this is hardly to be considered a just criterion of such a state of mind as ought to make him answer to the law for his acts. Because a per- son may happen to answer in this way, who is yet so abso- lutely insane as to have lost all power of observation of facts, 1 Medical Jurisprudence, 354. PRELIMINARY VIEWS. 29 all discernment of the good or bad intentions of those who are about him, or even the knowledge of their persons. Besides, the question is put in another and a more special sense, as relative to the act done by the panel, and his know- ledge of the place in which he did it. Did he at that moment understand the evil of what he did ? Was he impressed with the consciousness of guilt and fear of punishment? it is then a pertinent and a material question, but one which cannot be rightly answered, without taking into considera- tion the whole circumstances of the situation. Every judg- ment in the matter of right and wrong supposes a case, or state of facts to which it applies. And though the person may have that vestige of reason which may enable him to answer in the general, that murder is a crime, yet if he can- not distinguish a friend from an enemy, or a benefit from an injury, but conceives every thing about him to be the reverse of what it really is, and mistakes the ideas of his fancy in that respect for realities, those remains of intellect are of no sort of service to him in the government of his actions, in enabling him to form a judgment as to what is right or wrong on any particular occasion." l From all this, Hume draws the broad conclusion, that the judgment of right and wrong ha nothing to do with the question of responsibility. This view of the subject is certainly liberal enough, and increases our regret, that it should be contrasted in a subsequent stage of his remarks, by one of those vague and senseless notions, that seem to have obtained a prescriptive place in the books on criminal law. " It is not to be understood," he continues, " that there is any privilege of mere weakness of intellect, or of a strange and moody humor, or of a crazy and capricious, or irregular temper and habit. None of these things either are, or ought to be law." When all these traits are observed in an individual, or any one of them in a remarkable degree, there is great reason to suspect the existence of insanity, and the most faithful means should be resorted to, in order to determine this fact. In the great majority of cases, the sus- 1 Commentaries on the Law of Scotland respecting Crimes, I, 36. 3* 30 MEDICAL JURISPRUDENCE OF INSANITY. picion will prove to be well founded, and the judgment of right and wrong on " particular occasions " to be completely perverted. These traits of character must not be considered as they too generally are, in and by themselves exclusively, and unconnected with the previous moral and intellectual habits of the individual, but as symptoms of a deviation from the normal condition of pathological changes in the action of the cerebral organism. When viewed in this light, they will be examined with the patience and intelligence neces- sary to establish, beyond doubt, the existence of that insanity of which they are the almost certain signs, instead of being hastily dismissed, as only the marks of an ill-governed, malicious temper. 20. Mr. Alison lays down the principle, that " to amount to a complete bar to punishment, the insanity, either at the time of committing the crime, or of the trial, must have been of such a kind as entirely deprived the accused of the use of reason, as applied to the act in question, and the knowledge that he was doing wrong in committing it." * This is all very clear and rational, but a subsequent remark shows, that in his struggle with the errors of the law, he had not com- pletely emancipated his mind from their binding influence. " Anything," he observes, " short of this complete alienation of reason, will be no defence ; and mere oddity of manner, or half-craziness of disposition, if unaccompanied by such an obscuring of the conscience, will not avail the prisoner." The idea that "anything short of complete alienation of reason will be no defence," is not only at variance with his previous qualification, that this loss of reason must be in reference "to the act in question," but is identically the doctrine of the last century, the fallacy of which was clearly exposed by Erskine in Hadfield's case. "What is precisely meant by such vague phraseology as " half-craziness of dispo- sition," it would be hardly worth while to inquire ; it is enough to say, that, taking the language in its most natural and obvious signification, the mental condition expressed by 1 Commentaries on the Law of Scotland, etc., 645. PRELIMINARY VIEWS. 31 it is one utterly unknown in metaphysics or medicine. Mr. Alison very justly disapproves of the law as laid down by Chief Justice Mansfield, in Bellingham's case, viz. ; that the prisoner was 'accountable, because he could distinguish good from evil, and knew that murder was a crime ; but his remark respecting it betrays an ignorance of insanity, that would be surprising were it not so common in discussions upon this subject. " On this case," says he, " it may be observed, that unquestionably the mere fancying a series of injuries to have been received will not serve as an excuse for murder, for this plain reason, that, supposing it true, that such injuries had been received, they would have furnished no excuse for the shedding of blood ; but, on the other hand, such an illusion as deprives the panel of the sense that what he did was wrong, amounts to legal insanity, though he was perfectly aware that murder in general was a crime ; and, therefore, the law appears to have been more correctly laid down, in the cases of Hadfield and Bowler, than in this instance." Whether the insane belief have reference to a matter of fact, or to views of right and wrong, it ought equally to be regarded as annulling legal responsibility. If a single step in the reasoning which leads to the commission of a criminal act be the offspring of insanity, the conclusion must necessarily be vitiated thereby. If this be the law by which maniacs are to be tried, few will escape punishment for criminal acts ; for, in by far the greater proportion, such acts have been com- mitted in consequence of a fancying of injuries received. One man kills his neighbor whom he insanely fancies to have joined a conspiracy to defraud him of his property or his liberty ; or for having insulted and exposed him to scorn and derision ; or for standing in the way of his attaining certain honors or estates ; yet the insanity is not to excuse him, unless it deprived him of the consciousness that he was doing a wrong act. The existence of the delusion is obvious and cannot be mistaken ; but what may be the views of the maniac respecting the moral character of the criminal acts which he commits under its influence, can never be exactly known ; and, therefore, they ought not to be made the crite- 32 MEDICAL JURISPRUDENCE OP INSANITY. rion of responsibility. Even if the party himself acknowl- edge that he knew he was doing wrong, the very fact of his insanity destroys the value of his confession which is no more entitled to notice than his most incoherent ravings. But it is known, that one of the most striking and character- istic effects of insanity on the mental operations is, to destroy the relations between end and means, between the object in view and the course necessary to pursue in order to obtain it, between, as in the cases just instanced, the fancied injury and the measure of punishment it deserves. It was in accordance with these views, that Lord Erskine pronounced delusion to be the true test of such insanity as exempts from punishment, and that the correctness of the principle was recognized by the Court. It is impossible, therefore, to divine why Mr. Alison should say, that the law was more correctly laid down in Hadfield's case, when it is in direct conflict with his own opinions. Thus, as if frightened by their own temerity in overthrowing one ancient landmark on the domain of error, it would seem as if these writers were anxious to compound with their fears, by adhering with unusual pertinacity to all the rest. The radical fault of this test of responsibility lies in the metaphysical error of always looking on right and wrong in the abstract, as things having a positive and independent existence, and not as they really are, mere terms expressing the relations that exist between actions and certain faculties of our moral nature. That they express the same relations in nearly all men, is because nearly all men possess the same faculties ; but when these faculties are absent, as in idiots, or when their action is perverted by disease, as in the insane, the relations of right and wrong are widely different. 21. Another trait, which has been greatly relied on as a criterion in doubtful cases, is the design or contrivance that has been manifested in the commission of the criminal act. That it should ever have been viewed in this light, is an additional proof, if more were wanting, of the deplorable ignorance that characterizes the jurisprudence of insanity; for the slightest practical acquaintance with the disease PRELIMINARY VIEWS. 33 would have prevented this pernicious mistake. The source of this error is probably to be found in the fact, "that, among the vulgar, some are for reckoning madmen, those only who are frantic or violent to some degree ; " l the vio- lence being supposed to preclude every attempt at design, or plan of. operations. In the trial of Bellingham, the attor- ney-general declared that, " if even insanity in all his other acts had been manifest, yet the systematic correctness, with which the prisoner contrived the murder, showed that he possessed a mind, at the time, capable of distinguishing right from wrong." 2 In Arnold's case ( 10), great stress was laid on the circumstances of his having purchased shot of a much larger size, than he usually did when he went out to shoot, with the design then formed of committing the mur- der he afterwards attempted. Mr. Russell 8 recognizes the correctness of the principle, and lays it down as part of the law of the land. If, however, the power of design is really not incompatible with the existence of insanity, this pre- tended test must be as fallacious as that already adverted to. What must be thought of the attainments of those learned authorities, in the study of madness, who see in the power of systematic design a disproof of the existence of insanity when, from the humblest menial in the service of a lunatic asylum, they might have heard of the ingenuity of contrivance and adroitness of execution, that preeminently characterize the plans of the insane? If the mind continues rational on some subjects, it is no more than what might be expected, that this rationality should embrace the power of design, since a person could not properly be called rational on any point, in regard to which he had lost his customary ability to form his plans and designs for the future. These view.s are abundantly confirmed by ev.ery day's observation. The sen- timent of cunning, too, which is necessary to the successful execution of one's projects, holds but a low place in the scale 1 Sir John Xicholl, in Dew v. Clark, 3 Addams's Reports, 441. 2 Collinson on Lunacy, 657. 3 Russell, on Crimes and Misdemeanors, 13. 34 MEDICAL JURISPRUDENCE OF INSANITY. of the mental faculties being a merely animal instinct and is oftentimes observed to be rendered more active by insanity, so as to require the utmost vigilance to detect and defeat' its wiles. One who is not practically acquainted with the habits of the insane, can scarcely conceive of the cunning which they will practise, when bent on accomplish- ing a favorite object. Those, for instance, whose madness takes a suicidal direction, are known to employ wonderful address in procuring and concealing the means of self-de- struction ; pretending to have seen the folly of their designs, and to have renounced them entirely, sending away their at- tendants after thus lulling them into security, and, when least expected, renewing their suicidal attempts. When desirous of leaving their confinement, also, the consummate tact with which they will set suspicion at rest, the forecast with which they make their preparations for escape, and the sagacity with which they choose the time ahd place of action, would do infinite credit to the conceptions of the most sound and intelligent minds. Mr. Haslam has related a case so strik- ingly illustrative of this trait, that it is well worth extracting in this connection. An Essex farmer, after having so well counterfeited recovery as to produce his liberation, and having been sent back, immediately became tranquil, and remon- strated on the injustice of his confinement. " Having once deceived me, he wished much that my opinion should be taken respecting the state of his intellects, and assured his friends that he would submit to my determination. I had taken care to be well prepared for this interview, by obtain- ing an accurate account of the manner in which he had con- ducted himself. At this examination, he managed himself with admirable address. He spoke of the treatment he had received from the persons under -whose care he was then placed, as most kind and fatherly : he also expressed himself as particularly fortunate in being under my care, and bestow- ed many handsome compliments on my skill in treating this disorder, and expatiated on my sagacity in perceiving the slightest tinges of insanity. When I wished him to explain v certain parts of his conduct, and particularly some extrava- PRELIMINARY VIEWS. 35 gant opinions, respecting certain persons and circumstances, he disclaimed all knowledge of such circumstances, and felt himself hurt that my mind should have been poisoned so much to his prejudice. He displayed equal subtlety on three other occasions when I visited him ; although, by protracting the conversation, he let fall sufficient to satisfy my mind that he was a madman. In a short time he was removed to the hospital, where he expressed great satisfaction in being under my inspection. The private madhouse, which he had for- merly so much commended, now became the subject of severe animadversion ; he said that he had there been treated with extreme cruelty, that he hacl been nearly starved, and eaten up by vermin of various descriptions. On inquiring of some convalescent patients, I found (as I had suspected) that I was as much the subject of abuse when absent, as any of his supposed enemies, although to my face he was cour- teous and respectful. More than a month had elapsed since his admission into the hospital, before he pressed me for my opinion ; probably confiding in his address, and hoping to deceive me. At length he appealed to my decision, and urged the correctness of his conduct during confinement as an argument for his liberation. But when I informed him of circumstances he supposed me unacquainted with, and assured him that he was a proper subject for the asylum which he then inhabited, he suddenly poured forth a torrent of abuse ; talked in the most incoherent manner ; insisted on the truth of what he formerly denied; breathed vengeance against his family and friends ; and became so outrageous that it was necessary to order him to be strictly confined. He continued in a state of unceasing fury for more than fifteen months." 1 Even the purely intellectual power of combining a series of acts that shall accomplish or eventuate in certain results, when properly carried into execution, seems to be not only less frequently involved in the mental derange- ment, but often to have received a preternatural degree of strength and activity. Pinel speaks of a maniac who endea- 1 Observations on Madness, 53. 36 MEDICAL JURISPRUDENCE OF INSANITY. vored to discover the perpetual motion, and, in the course of his attempts, constructed some very curious machines. Es- quirol has given the case of a mad general, who, though laboring under great mental excitement and disorder, con- ceived of an improvement in the construction of a military weapon, and made a drawing of the same. Having expres- sed a desire to have a model of it cast, and given his word of honor that he would go only to the founder's and return peaceably, he was permitted to go. He went on foot to the founder's, gave him the drawing, requested him to cast a model of it, and passed an hour in the shop, without the founder's once suspecting that he was dealing with a maniac. On leaving, he remarked that he would return in eight days, as he did, although a period of great excitement intervened during that time. On the second visit, he found the model executed, and gave an order for fifty thousand to be cast, which was the only circumstance that led the founder to sus- pect the general's disease. It is observed that the weapon thus improved was subsequently adopted in the army. 1 The plans which the brain of a maniac, who imagines himself a monarch, is perpetually hatching for the management of his kingdom, will bear to be compared with the political schemes of some rulers who are supposed to have the advantage of sanity on their side. 22. If, then, the knowledge of good and evil, of right and wrong, and the power of design, are to be considered as fallacious tests of responsibility, notwithstanding they have proved the death warrant of many a wretched maniac, let us come back to that proposed by Erskine delusion and see if that will bear a more rigid scrutiny, when viewed by the light of modern discovery. 2 Now, if it ,were a fact, that the 1 Des Maladies Mentales, JI. 190. 2 The use of this test of irresponsible insanity has been sanctioned by the high authority of Sir John Nicholl, in the case of Dew v. Clark, 3 Addams, 79. " The true criterion," says he, " the true test, of the absence or pre- sence of insanity, I take to be the absence or presence of what, used in a certain sense of it, is comprisable in a single term, namely, delusion." " In short, I look upon delusion in this sense of it, and insanity to be, almost, if not PRELIMINARY "VIEWS. 37 reason, or, to speak more definitely, the intellectual powers are exclusively liable to derangement, this test would be unobjectionable, and would furnish an easy and satisfactory clew to the elucidation of doubtful cases. 1 But it must not be forgotten, that the author of our being has also endowed us with certain moral faculties, comprising the various senti- ments, propensities, and affections which, like the intellect, being connected with the brain, are necessarily affected by pathological actions in that organism. The abnormal condi- tion thus produced may exert an astonishing influence on the conduct, changing the peaceable and retiring individual into a demon of fury, or, at the least, turning him from the calm and quiet of his lawful and innocent occupations, into a career of shameless dissipation and debauchery, while the intellectual perceptions seem to have lost none of their ordi- nary soundness and vigor. The existence of this form of insanity is now too well established, to be questioned by altogether, convertible terms." "On the contrary, in the absence of any such delusion, with whatever extravagances a supposed lunatic may be justly chargeable, and how like soever to a real madman he may either think or act on some one, or on all subjects ; still, in the absence, I repeat, of anything in the nature of delusion, so understood as above, the supposed lunatic is, in my judgment, not properly, or essentially insane." 1 Even Mr. Erskine himself has furnished an exception to his own rule, in a case he has related of a young woman indicted for murder, who was acquit- ted on the ground of insanity, though it was not pretended that she labored under ay delusion whatever. " It must be a consolation," he says, " to those who prosecuted her. that she was acquitted, as she is at this time in a most undoubted and deplorable state of insanity ; but I confess, if I had been upon the jury who tried her, I should have entertained great doubts and difficul- ties ; for, although this unhappy woman had before exhibited strong marks of insanity arising from grief and disappointment ; yet she acted upon facts and circumstances which had an existence, and which were calculated, upon the ordinary principles of human action, to produce the most violent resent- ment. l\Ir. Errington having just cast her off, and married another woman, or taken her under his protection, her jealousy was excited to such a pitch, as occasionally to overpower her understanding ; but when she went to Mr. Errington's house where she shot him, she went with the express and deliberate purpose of shooting him." " She did not act under a delusion, that he had deserted her when he had not, but took revenge upon him for an actual de- sertion." Erskine's Speeches. 4 38 MEDICAL JURISPRUDENCE OF INSANITY. those who have any scientific reputation to lose ; and though the proofs of this will be furnished in their proper place, it will, for the present, be supposed that the assent of the reader has been obtained without them. In this the most deplorable condition to which a human being can be reduced, where the wretched patient finds himself urged, perhaps, to the commission of every outrage, and though perfectly con- scious of what he is doing, unable to offer the slightest resis- tance to the overwhelming power that impels him, the respon- sibility is to be considered as not affected, because no delusion is present to disturb and distort the mental vision ! In short, the very character that renders this mental disorder more ter- rible than all others, is also that which is made to steel the heart against the claims of humanity in behalf of its misera- ble victim. 23. The doctrine of moral insanity has been as yet un- favorably received by judicial authorities, not certainly for want of sufficient facts to support it, but probably from that common tendency of the mind, to resist innovations upon old and generally received views. If, a quarter of a century ago, one of the highest law-officers of Great Britain pro- nounced the manifestation of " systematic correctness" of an action, to be a proof of sanity sufficient to render all others un- necessary, it is not surprising, that the idea of moral insanity has been considered by the legal profession, as having sprung from the teeming brains of medical theorists. In the fulness of this spirit, Mr. Chitty declares, that, " unless a jury should be satisfied that the mental faculties have been perverted, or, at least, the faculties of reason and judgment, it is believed, that the party subject to such a moral insanity, as it is term- ed, would not be protected from criminal punishment ; " l and in the trial of Howison for the murder of the widow Geddes, at King's Crammond, Scotland, two or three years since, moral insanity which was pleaded in his defence, was declar- ed by the court to be a " groundless theory," 2 Such opin- 1 1 Chitty, Medical Jurisprudence, 352. 2 Simpson on Homicidal Insanity, in a Treatise on Popular Education. Boston, 1834. PRELIMINAKY VIEWS. 39 ions, from quarters where a modest teachableness would have been more becoming than an arrogant contempt for the results of other men's inquiries, involuntarily suggest to the mind a comparison of their authors with the saintly persecu- tors of Galileo, who resolved by solemn statutes, that nature always had operated and always should operate in accord- ance with their views of propriety and truth. 24. It appears, then, that as a test of responsibility, delusion is no better than those before mentioned. The truth is, there is no single character which is not equally lia- ble to objection. Jurists who have been so anxious to obtain some definition of insanity, which shall furnish a rule for the determination of responsibility, should understand, that such a wish is chimerical from the very nature of things. Insanity is a disease, and, as is the case with all other dis- eases, the fact of its existence is never established by a single diagnostic symptom, but by the whole body of symptoms, no particular one of which is present in every case. To distin- guish the manifestations of health from those of disease, requires the exercise of special learning and judgment; and, if no one doubts this proposition, when stated in reference to the bowels, the lungs, the heart, the liver, the kidneys, etc., what sufficient or even plausible reason is there, why it should be doubted when predicated of the brain ? The func- tions of those organs proceed with the regularity and same- ness of clock-work, compared with the ever-varying and une- qual phenomena of this; and yet there are persons who assume a magisterial tone in writing or talking of the latter, who would defer to a tyro's judgment, in whatever concerns the others. If, when anxious to know all we can, respecting a disease of the lungs or stomach, we repair to those who have a high and well-founded reputation, in the pathology of these parts, why adopt the converse of this rule in regard to diseases of the brain ? No reasonable person would desire to set up an insuperable barrier between the domain of profes- sional knowledge and that of common sense and common information ; but it is not too much to insist, that facts estab- lished by men of undoubted competence and good faith, 40 MEDICAL JURISPRUDENCE OF INSANITY. should be rejected for better reasons than the charge of " groundless theory." 25. In the passage taken from Lord Hale ( 8), it will be observed, that he considers all crime to be the offspring of partial insanity, and the inference he meant should be drawn from it is, that partial insanity furnishes no excuse for crime. It is a curious fact, that many benevolent people, in their desire to palliate the sins of criminals, have inculcated the same principle, for the purpose of drawing from it a very different inference. Says the former: crime must be pun- ished ; but all crime proceeds from madness, therefore mad- ness furnishes no exemption from punishment. Say the lat- ter : madmen are not responsible for their criminal acts ; but madness is the source of all crime, therefore madmen and criminals are equally irresponsible and exempt from punish- ment. Which of these two precious specimens of human subtlety can claim the triumph of absurdity, it would not be easy to determine. Crime is not necessarily the result of madness, not even when perpetrated under the excitement of fierce and violent passions ; in the true sense of the word, it is never so, but is always actuated by motives ; insufficient it may be, but still rational motives, having reference to definite and real objects. The misfortune which the crimi- nal is going to avert, the interest which he is going to sub- serve, the revenge he is about to gratify, the insult or injury he is about to repay, are real injuries and insults and inter- ests, however much they may be exaggerated, or however dis- proportionately small they may be to the crime they provoke ; and, the ends to be obtained by the criminal act, are real and have an appreciable value. In the most violent trans- ports of passion, he never wholly loses his knowledge of the true relations of things. The person whom he considers his enemy, or the author of the insult, is really such, or at least, he has some ground for believing him such ; and with the absence of the object of his passion, disappears the inten- tion to offend. Violent passions may weaken the judgment, and diminish its power of control, but they do not vitiate the perceptions, nor deprive the mind of its powers of compari- PRELIMINARY VIEWS. 41 son. All this is very different in mental derangement. The causes which urge the insane to deeds of violence are gene- rally illusory the hallucinations of a diseased brain or they may act from no motive at all, solely in obedience to a blind impulse, with no end to obtain, nor wish to gratify. Madness, too, is more or less independent of the exciting causes that have given rise to it, and exists long after those causes have been removed, and after the paramount wish or object has been obtained. In short, madness is the result of a certain pathological condition of the brain, while the crimi- nal effects of violent passions merely indicate unusual strength of those passions, or a deficient education of those higher faculties that furnish the necessary restraint upon their power. It is admitted, that strong passions do deprive the individual of the power of calmly deliberating, and per- ceiving the terrible consequences of his fury ; and legislators have wisely distinguished homicide committed under their influence, from deliberate, premeditated homicide, by visiting it with a minor degree of punishment. In drunkenness the same effect is sometimes produced to such a degree as to amount to temporary insanity; but neither does this any more than strong passions exempt from all punishment; for the plain reason, that, in both cases, the impairment of moral liberty is the voluntary act of the individual himself, and must be imputed to him as a fault. If the remarks on this point may seem to be unnecessarily prolix, it can only be observed, by way of excuse, that where opinions are handed down, as they are in law, from one generation to another, they attain much the same kind of value that is possessed by established facts in natural science, and exert an influence that demands for them a degree of consideration which their intrinsic merits do not deserve. 26. Enough has been said, it is believed, to convince every unprejudiced reader that, in Great Britain, the law of insanity, especially that relative to criminal cases, is still loose, vacillating, and greatly behind the present state of our knowledge of that disease. If we carefully examine the cases tried within the last hundred years, as they are brought 4* 42 MEDICAL JURISPRUDENCE OF INSANITY. together in the various treatises on lunacy and on criminal law, the utmost respect for authority will not prevent us from observing the want of any definite principle as the ground of the difference of their results. Amid the mass of theoretical and discordant speculations on the psychological effects of insanity, and of crude and fanciful tests for detect- ing its presence, which these trials have elicited, the student who turns to them for the purpose of informing his mind on this branch of his profession, finds himself completely dis- heartened and bewildered. Instead of inquiring into the effect produced by the peculiar delusions of the accused on his ordinary conduct and conversation, and especially of their connection with the criminal act in question, the courts, in these cases, have been contented with laying down meta- physical dogmas on the consciousness of right and wrong, of good and evil, and the measure of understanding still pos- sessed by the accused. One principle after another has been successively abandoned and resumed, either with the strangest disregard of consistency, or the most extraordinary ignorance of previous decisions. Thus, the old maxim that insanity does not annul criminal responsibility in one who retains the power of distinguishing right from wrong, was abandoned in the case of Hadfield, reaffirmed in that of Bellingham, ( 15), again abandoned in the trial of Martin, 1 subsequently modi- fied by Lord Lyndhurst ( 19), and again, in the year 1837, a jury, holding in their hands the life of a fellow man, are told by Mr. Justice Park, that, as regards the effect of insanity on responsibility for crime, "it is merely necessary that the party should have sufficient knowledge and reason to dis- criminate between right and wrong" 2 Three years after- wards, on the trial of Oxford for shooting at the Queen, Lord Chief Justice Denman told the jury, " that the question for them to decide was, whether the prisoner was laboring under that species of insanity which satisfied them that he was 1 Report of the trial of Jonathan Martin for setting fire to the York Minster. 2 Trial of Greensmith, noticed in Medico- Chirurg. Review, v. 28. 86, N.a PRELIMINARY VIEWS. 43 quite unaware of the nature, character, and consequences of the act he was committing, or, in other words, whether he was under the influence of a diseased mind, and was really unconscious at the time he was committing the act, that it was a crime." l 27. In the spring of 1843, a Scotchman named Mc- Naughton, met in one of the streets of London, Mr. Drum- mond, the private secretary of Sir Robert Peel, and shot him dead with a pistol. For some time previous, he had enter- tained the delusion that he was pursued by enemies who followed him every where, blasting his fame, disturbing his peace, and filling him with intolerable inquietude ; and fan- cying his victim to be one of the crew, he determined to sacrifice him. His insanity was not obvious at sight, he had recently transacted business, he viewed some of his relations in their true light, and behaved with much propriety in the ordinary intercourse with men. He was defended by able and zealous counsel who brought before the jury the more sound and humane views of insanity which have resulted from modern inquiry, and the court readily favored his acquittal. The community, however, were far from being satisfied with this result, for it beheld only two facts in the case, a worthy man had been shot down in broad day, and without provocation, by one who could transact business, discourse correctly, and who showed no very obvious symp- toms of insanity. Participating in the popular feeling, the house of Lords propounded to the law-judges certain queries relative to the law of England on the subject of insanity as a defence in criminal actions. The queries implied a doubt of the correctness of the doctrine, that delusion, in and of itself alone, is necessarily an exculpatory plea, and seemed to suggest the idea that, to have this effect, it must be accompanied by some other mental disability. They were intended, no doubt, to obtain an authoritative exposition of the law that should settle its principles and regulate the future practice of courts. They wished, indeed, to obtain 1 9 Carrington & Paine, 525. 44 MEDICAL JURISPRUDENCE OF INSANITY. from the judges collectively what had eluded their grasp individually, a general expression of the law capable of embracing every possible case, and working injustice to none. We shall see whether the attempt of the judges fulfils this high object. 28. The first query is, " what is the law respecting alleged crimes committed by persons afflicted with insane delusions in respect of one or more particular subjects or per- sons ; as, for instance, where, at the time of the commission of the alleged crime, the accused knew he was acting con- trary to law, but did the act complained of with a view, under the influence of insane delusion, of redressing or avenging some supposed grievance or injury, or of producing some supposed public benefit ? " To this the judges reply that, assuming the inquiry " to be confined to those persons who labor under such partial delusions only, and are not in other respects insane, they are of the opinion, that notwithstanding the party accused did the act complained of, with a view, under the influence of insane delusion, of redressing or aveng- ing some supposed grievance or injury, or of producing some public benefit, he is nevertheless punishable, according to the nature of the crime committed, if he knew, at the time of committing such crime, that he was acting contrary to law, by which expression they understand their Lordships to mean, the law of the land." 29. Had the principle here laid down, been always strictly followed, it is very certain that many a one who has been acquitted on the ground of insanity, would have met the fate of ordinary criminals. Hadfield knew so far as a man in his condition may be said to know anything that in shooting at the king, he was doing an illegal act, because, when apprehended, he declared that his life was forfeited, and that he did the deed for this very purpose, in order that by his own death, he might fulfil some great end to which he fancied himself to have been called. The mental disability of the insane may be evinced, not in failing to recognize the illegality of their acts, but in considering themselves as ab- solved from the obligations of the law. An act which they PRELIMINAKY VIEWS. 45 know to be forbidden, they may feel constrained to commit by reasons that transcend all law. They move in a sphere beyond the reach of the ordinary motives of human conduct, and are a law unto themselves. It is certainly very unrea- sonable for any one to believe, that, to revenge a private grievance, or secure a public benefit, he may set aside all law and take any and every extreme measure that may seem to him necessary for the purpose. But shall we be guilty of the absurdity of expecting an insane person to act reasonably in reference to his delusions ? 30. The second and third queries are, " what are the proper questions to be submitted to the jury, when a person, alleged to be afflicted with insane delusion respecting one or more particular subjects or persons, is charged with the com- mission of a crime, (murder, for example,) and insanity is set up as a defence ? In what terms ought the question to be left to the jury, as to the prisoner's state of mind at the time when the act was committed ? " 31. The judges state that these two questions can be more conveniently answered together, and their reply is, that, " to establish a defence on the ground of insanity, it must be clearly proved, that at the time of committing the act, the party accused was laboring under such a defect of reason from disease of the mind, as not to know the nature and quality of the act he was doing, or, if he did know it, that he did not know he was doing what was wrong." They add, that the question of right and wrong should be put in reference to the particular act with which he is charged. 32. The principle of responsibility here laid down, man- ifestly conflicts with that promulgated in the answer to the first query. An insane person may do an act he knows to be contrary to law, because he thinks the peculiar circum- stances of the case render it right for him to disregard the law. We have just seen that Hadfield admitted that he had violated the law, but believed he was right in so doing, for the sake of the end which it would enable him to accomplish. Tried by the former test, he would have been convicted, while by the latter he would have been acquitted. Without 46 MEDICAL JURISPRUDENCE OF INSANITY. mentioning all the objections to which this test of responsi- bility is liable, it is enough to say that it furnishes no protec- tion to that large class of the insane who intertain no specific delusion, but act from momentary irresistible impulses, or diseased moral perceptions. 33. The fourth query is, " If a person, under an insane delusion as to existing facts, commits an offence in conse- quence thereof, is he thereby excused ? " To this the judges reply, that, on the assumption " that he labors under partial delusion only, and is not in other respects insane, he must be considered in the same situation as to responsibility, as if the facts, with respect to which the delusion exists, were real. For example, if under the influence of delusion, he supposes another man to be in the act of attempting to take away his life, and he kills that man, as he supposes, in self-defence, he would be exempt from punishment. If his delusion was, that the deceased had inflicted a serious injury to his character and fortune, and he killed him in revenge for such supposed injury, he would be liable to punishment." 34. Such a remarkable doctrine as this can have sprung from only the most deplorable ignorance of the mental opera- tions of the insane. If the insane person really believe that his neighbor is engaged in a conspiracy to take his life, he may anticipate the blow by killing him ; but if he merely believes that the said neighbor has inflicted a serious injury on his character or fortune, the law will not hold him guilt- less if he hurt a hair of his head ! This is certainly very plain, and it must be the fault of the lunatic, if he do not understand it. It is very reasonable, too, if insane men would but listen to reason. This doctrine of the English judges seems to be essentially that of Hoffbauer, who says that the acts of the accused should be judged, precisely as if he were really in the circumstances he imagined. That is, if he fan- cies there is a design to take his life, he may take life ; if he fancies that he is only insulted or railed at, he may insult or rail in turn ; if he fancies his neighbor is defrauding him, he may say hard things about him, (taking care to utter no matter libellous,) or bring against him a suit at law. This is PRELIMINARY VIEWS. 47 virtually saying to a man, " you are allowed to be insane ; the disease is a visitation of Providence, and you cannot help it ; but have a care how you manifest your insanity; there must be method in your madness. Having once adopted your delusion, all the subsequent steps connected with it, must be conformed to the strictest requirements of reason and propriety. If you are caught tripping in your logic ; if in the disturbance of your moral and intellectual perceptions you take a step for which a sane man would be punished, insanity will be no bar to your punishment. In short, having become fairly enveloped in the clouds of mental disorder, the law ex- pects you will move as discreetly and circumspectly as if the undimmed light of reason were shining upon your path." 35. The principle in question is not supported by our knowledge of the psychological effects of insanity, and can- not be followed out without working great injustice. Mc- Naughton did not suppose that Mr. Drummond nor any one else was seeking his life, but that his fancied enemies fol- lowed him about, traducing his reputation and disturbing his peace. There was no proof that he apprehended any deadly injury, and yet he was acquitted with the approbation of the judge, by whom this principle was not once mentioned, the very Chief Justice Tindall who read the answers of the judges to the Lords, and probably had the principal share in framing them. Oxford, too, who shot at the queen, did not imagine that he had sustained any personal wrong from her or any one else, but that killing the queen was necessary in order to accomplish some great public benefit. Yet he was acquitted with the approbation of the court, Lord Denman, who said nothing of this principle in his charge to the jury, though he joined in the reply to the queries of the Lords. 36. It is beyond our power to conceive how this prin- ciple can be reconciled with that conveyed in the reply to the second and third queries. Most if not all those lunatics who, like McNaughton, take life in order to revenge some suppos- ed injury to their character or fortune, have a strong belief that they are doing right. Nothing is more common than for the insane to be guilty of the utmost violence towards 48 MEDICAL JURISPRUDENCE OF INSANITY. persons from whom they fancy they have received only some trivial offence, while their views of law and right on this point, are so confused and perverted, that they might as well, for any good influence they exert, be obliterated altogether. And it is because their mental perceptions are so dull and distorted, that they do not proportion their measures of retal- liation by the same rules that govern sane men. But now, it seems, the state of the person's mind, the extent of the mor- bid influence of the disease over his perceptions of truth, and right, and propriety, and the degree to which it has consigned him to the dominion of delusion and passion, are no longer to be considered in settling the extent of his legal responsi- bility, we are to look only to his acts, and these are to be judged of as if committed by perfectly sane men. 37. In the debate which sprung up in the house of Lords, 1 on the occasion of McNaughton's trial, the distin- guished law-Lords Lyndhurst, Brougham. Cottenham, and Campbell, expressed their views on the general question, furnishing a signal illustration of the inconsistency and con- tradiction which we have charged upon the opinions of courts. Lyndhurst, in referring to the Hadfield case, quotes the following, as the exposition of the law made by Erskine and adopted by the Court. " When a man is laboring under a delusion, if you are satisfied that a delusion existed at the time of the committal of the offence that the act was done under its influence then he cannot be considered as guilty of any crime." Subsequently, he restates the principle in the following words of his own. " If the man who committed .a crime was insane at the time he committed it, that is to say, was laboring under such disease of the mind as not to know whether he were doing right or wrong, in that case, he was not a subject for a criminal trial." The fact is, that Erskine neither adopted nor approved the criterion furnished by knowing right from wrong. It is not once mentioned in the whole course of his speech on that occasion, for the simple reason that it was his design to establish a very 1 Hansard, 67. 714. PRELIMINAKY VIEWS. 49 different criterion, or test, a point of which the speaker seems to have had not the slightest conception. Lord Brougham said, " he could conceive the case of a human be- ing, of a weakly constituted mind, who might, by long brood- ing over real or fancied wrongs, work up so perverted a feeling of hatred against an individual, that danger migjit occur. He might not be deluded as to the actual existence of injuries he had received, but he might grievously and grossly exaggerate them, and they might so operate on a weakly framed mind and intellect as to produce crime. He could conceive that the Maker of that man, in his infinite mercy, having regard to the object of his creation, might deem him not an object for punishment. But that man was accountable to human tribunals in a totally different sense. Man punished crime for the purpose of practically deterring others from offend- ing by committing a repetition of the like act. It was in that sense only that he had any thing to do with the doctrine of accountable and not accountable. He could conceive a person whom Deity might not deem accountable, but who might be perfectly accountable to human laws." He thought that the later tests of responsibility, such as knowing good from evil, or what was proper or wicked, were not preferable to the old one, of knowing right from wrong ; and yet he immediately remarks, that sane people differ in their views of right and wrong, and though he knew what the learned judges meant by right and wrong, he was not sure that the public at large did, especially juries. He blamed the court - for refusing to postpone Bellingham's trial, in order that his friends might procure evidence respecting his mental con- dition. He says, " affidavits had been made of the prisoner's family having been tainted with insanity. Affidavits had been produced from those who had known him from infancy of his having been insane. Affidavits were offered, showing a prima facie case of mental alienation." But he adds with wonderful coolness, " no man doubted that the result of the trial would have been precisely the same, had the evidence been adduced." His Lordship cautions courts against urging the conviction of persons who entertain delusions, and yet 5 50 MEDICAL JURISPRUDENCE OF INSANITY. he approves of the conviction of Bellingham, of whose de- lusions he furnishes additional evidence not before published. He says, on the authority of Mr. Stephens and Mr. Wilber- force who saw him after the trial, that " Bellingham had no conception that he had done any thing wrong ; he lamented the death of 4 Mr. Percival ; spoke of him with the greatest respect, and even esteem for his character ; said that no man could more lament that such a thing should have befallen that gentleman, than he did ; that nothing could be more hard, both to his family and the public and society at large ; and that it was greatly to be lamented. ' Then,' he was asked, ' why did you do the deed ? ' ' O, do it,' he answered, ' that was perfectly inevitable ; there was no wrong at all in doing it ; he could not help that.' " Lords Lyndhurst and Brougham were of the opinion, that from the time of Had- field's case to the present day, the law had been laid down by successive courts, with great uniformity. Lord Campbell said of the same cases, that " there was a wide difference both in meaning and in' words, in their description of the law." He therefore thought that an authoritative statement of the law was desirable, though he had just before declared that "the law of England on this subject admitted of no altera- tion." To say that a thing is so correct as to admit of no alteration, and, in the next breath to add, that there is needed an authoritative statement of what that thing is, indi- cates a confusion of ideas not uncommon in discussions on this subject. 38. Nothing can more clearly show how completely the authoritative statement of the English judges has failed to accomplish its purpose, than the fact that in subsequent trials, the result seems to have been, as much as ever, a matter of accident or caprice, rather than of principles well-settled and clearly understood. Several have been convicted and execu- ted, in spite of the plea of insanity, in whom the manifesta- tions of disease were far more abundant than in some who were acquitted under the same plea. As they involve no new principle, it would be inconsistent with our present pur- pose, to bestow upon them a particular notice. A recent PRELIMINARY VIEWS. 51 writer who has given them some attention, thinks they indi- cate both uncertainty and injustice in the operation of the criminal law. " Either some individuals," he says, " are most improperly acquitted on the plea of insanity, or others are most unjustly executed." * A more correct expression of the actual fact, could not be made. We have no means of knowing, however, how far the verdict of the jury reflects the opinion of the court, and therefore must remain in doubt whether this remarkable want of uniformity is to be attributed to the growing independence of the former, or a more lenient construction of the principles which have hitherto governed the latter. Some of it is, probably^ owing to an increasing dis- position to heed the opinions of experts, and a commendable reluctance to convict a man declared by competent authority to be insane, merely on the strength of some metaphysical tests of responsibility laid down by the courts. 39. Notwithstanding the occasional instances of ameli- oration in the English law, the old principle that some insane men are proper objects of punishment, is as binding at this moment, as it was in the time of Lord Hale. It seems to be almost impossible for those who have not a professional knowledge of insanity, to view the subject in the true light. The popular feeling, mixed unquestionably with some truth, was strongly expressed by Lord Brougham, in the debate to which we have already referred. "If," says he, "the perpe- trator knew what he was doing, if he had taken his precau- tions to accomplish his purpose, if he knew, at the time of doing the desperate act, that it was forbidden by the law, that was his test of sanity ; he cared not what judge gave another test ; he should go to his grave in the belief that it was the real, sound, and consistent test." That some insane persons know very well, that, in committing their offences, they are guilty of a moral and legal wrong, and that they may be more or less deterred by the fear of punishment, are propositions that cannot be denied. The fallacy of which the courts are guilty, consists in supposing that these abstract ^ Taylor, Medical Jurisprudence, 3d Am. Ed. p. 642. 52 MEDICAL JURISPRUDENCE OF INSANITY. propositions may be safely applied to particular cases by means of certain criteria. It has been shown that these criteria are insufficient for the purpose, because .they do not cover the whole ground, and are, at the best, but a begging of the question. For admitting that the person knew that he was doing wrong and contrary to law, it remains to be proved that this knowledge embraces all the elements of responsibility. The real question at issue is, why, with this knowledge, he should commit acts incompatible with his natural character and disposition, and the only rational answer is to say, that the action of the mental powers is disturbed by the presence of disease. "Whatever degree of intelligence or self-control may be left, there still remains this disturbing element, the precise influence of which never can be safely estimated. It is a monstrous doctrine to put forth in a civilized age, that a man hitherto of irreproachable conduct and conversation, shall be punished for any criminal act he may commit, while ad- mitted to be laboring under a morbid condition, the tendency of which is to distort the moral perceptions and destroy the healthy balance of the mental faculties. Whether Belling- ham or McNaughton knew they. were doing an act for- bidden by the law, when they shot down unoffending men, in open day, is a question entirely irrelevant to the purpose. What we want to know is, whether they would have com- mitted the outrage, if they had not been prompted by delu- sions which were the effect of disease. To inflict upon such men the ordinary consequences of crime, is virtually to punish them for being diseased, and the utmost ingenuity of logic or metaphysics can make nothing else of it. Lord Brougham intimates that he had been much annoyed, if not frightened, by a class of persons with deranged intellects, who hover around the courts in search of redress for their real or fancied wrongs, and he believes that the fear of punishment is neces- sary in order to deter them from actual mischief. Now, in whatever aspect we consider the case, we can find no support for such a doctrine. The punishment of one insane person would not deter another insane person from committing a criminal act, for the simple reason that the latter, no't regard- PKELIMIXARY VIEWS. 53 i ng himself as insane, sees in it no application to him who, as he believes, is in a state of perfect health, pursuing a right and lawful object. He either thinks that his case is an ex- ception to the general rule, and that he is about to do some- thing that will receive universal approbation, or that he is bound by solemn obligation to do the act, whatever may be the consequences. The proper remedy for the evil is to be sought for in suitable measures of prevention, and spciety is guilty of a great wrong when it punishes the individual for the consequences of its own neglect. The management of the insane in hospitals where they are excited to behave with propriety by the promise of reward, and deterred from wrong doing by the fear of being deprived of some privilege or indulgence, is confidently appealed to in support of this idea. It is unquestionably the practice in such institutions to pre- sent to the insane motives for maintaining their self-control, but it is not the fact that when such motives fail to produce the end in view, they are punished. They are deprived of a privilege or indulgence, not as a punishment, but because they have shown themselves incapable of enjoying it. The anecdote is often related for the same purpose, respecting the conversation that occurred among the inmates of a lunatic asylum on the case of Martin who was then waiting his trial for setting fire to the York Minster. " He wili not be hanged," said one of them, " They cannot hang him, because he is mad he is one of ourselves." It is not very obvious how this anecdote which, by the way, has the appearance of a little embellishment, affords any support to the doctrine that some insane men should be punished, while others may be properly acquitted. If it indicates any thing on this point, it is that every insane man who commits a criminal act, even though he may escape from an asylum for the purpose, is a proper object of punishment. 40. Criminal trials, in which insanity was pleaded in de- fence, have been generally so little known beyond the place of their occurrence, that it is difficult to ascertain on what particular principles of the common law the decisions of American courts have been founded, though from all that 54 MEDICAL JURISPRUDENCE OF INSANITY. can be gathered, it appears that their practice, like that of the British, has been diverse and fluctuating. In the trial of Lawrence, at Washington, in 1835, for shooting at president Jackson, the jury were advised by the court to regulate their verdict by the principles laid down in the case of Hadfield, which had been stated to them by the district-attorney. 1 In I the case of Theodore Wilson, tried in York county, Maine, in 1836, for the murder of his wife in a paroxysm of insanity, " ( the court charged the jury that if they were satisfied the pris- /oner was not of sound memory and discretion at the time of committing the act, they were bound to return a verdict of acquittal. This is all that could be wished ; and considering that two highly respectable physicians had given their opin- ion in evidence that the prisoner had some consciousness of right and wrong, and that the attorney-general, though he admitted the existence of insanity in some degree, denied that it was of sufficient extent to exempt him from punish- ment, supporting his assertion on the authority of the lead- ing English cases relating to insanity, this decision indicates an advance in the criminal jurisprudence of insanity that does credit to the humanity and intelligence of that court. In the trial of Cory, for murdering Mrs. Nash, in New Hampshire, 1829, the court, Chief Justice Richardson, stated in his charge to the jury that the only question for them to settle was, whether he was of sane mind when the deed was done ? The same language was used by the same court on the trial of Prescott, for the murder of Mrs. Cochran, in 1834. On the trial of Rogers, in July, 1843, for the murder of Mr. Lincoln, in the State Prison of Massachusetts, the court, Chief Justice Shaw, charged the jury, that insanity or delusion is an excuse for crime, in two ways ; first, where it amounts to a firm belief that one is liable to lose his own life, or suffer some great bodily harm ; secondly, "where some violent outbreak occurs which, taken in connection with former acts, indicates 1 Niles's Eegister, vol. 48, p. 119. The principle adopted in Hadfield's case was, that a person is not responsible for whatever criminal act is com- mitted under the influence of delusion. PRELIMINARY VIEWS. 55 that the will was overborne. The questions for them to decide were, whether such a delusion existed in the mind of the accused ; whether he did the act under an insane but firm belief that the deceased was going to shut him up with some dangerous design, or not for a slight punishment; whether the facts indicate that the deed was done at a mo- ment when the delusion was uncontrollable. 1 On the trial of Abbot for killing his wife, in 1841, by the superior court of Connecticut, the jury was instructed to acquit the prisoner " if they found that, at the time of committing the act, he was insane had not sufficient understanding to distinguish right from wrong, and did not know that the murder of his wife was an offence against the laws of God and nature." 2 Similar language was used by the court on the trial of Mer- cer for the murder of Heberton, in New Jersey, April, 1843. 8 41. The frequency with which insanity is pleaded in defence of crime, the magnitude of its consequences to the parties concerned, and the perplexity in which the discussions it occasions involve the minds of judges and jurors, are am- ple reasons why the law relative to insanity should be simple and easily understood a result that can only be obtained by direct legislative enactments. It is time for the legislature to determine what, amid the mass of conflicting opinions on this subject, shall be the law of the land ; and thus no longer permit the lives and liberties of people to be suspended on the dicta of men, whose knowledge of insanity was exceed- ingly imperfect, and which have not even the merit of uni- formity and consistency. It may be well, therefore, to see what has been the legislation of various enlightened nations, in reference to this subject, inasmuch as it may furnish valua- ble hints for our own. In some, the legislator has been con- tented with indicating, by some popular, general phrase, that condition of mind which the judge may consider as freeing 1 MS. notes of prisoner's counsel, George Bemis, Esq. 2 MS. notes of Hon. H. M. Waite, one of the court, kindly furnished the author. 3 Dollar Newspaper, April 5, 1843. 56 MEDICAL JURISPRUDENCE OF INSANITY. from responsibility. The Bavarian code (1813) follows this course, as well as the code of Basle, promulgated in 1835. In the latter, we find the following words : " Minors, and those laboring under general mania, or haUucination, cannot be punished as criminals, nor, generally speaking, can any others be punished, who have committed a crime while de- prived of the use of their minds." Art. 2. Very nearly the same language is used in describing such as are exempted from punishment by reason of mental disorders, in the code of Turin, (1835) Art. 63, and in the proposed Hanoverian code, Art. 83. In other codes, general terms alone are used, in describing the mental condition of such as are irresponsi- ble. Thus, in the Saxon code, we find these words : | \ " Responsibility is annulled in persons who are deprived of the use of reason by mental disease." Art. 65. It is a suf- ficient objection to such enactments that, in any particular trial, no two persons could be found to agree respecting the practical application of such terms as, deprived of the use of reason, bereft of understanding, etc. ; and how many judges and juries would see, in the unfortunate monomaniac before them, who, though stained with the blood of a fellow man whom some wild delusion had prompted him to kill, is still correct and coherent in his discourse, staid and dignified in his demeanor, ready and shrewd in his replies, a being deprived of the use of his reason, or bereft of his understand- ing ? We have seen too often the deplorable failure of such general terms to protect the miserable subjects of disease, under the operation of the English common law, to recom- mend their use to the legislator. In some codes an attempt is made to avoid this objection to general terms, by mention- ing various mental diseases as illustrations of the meaning they are to convey. 1 Thus, the proposed Wurtemberg code contains the following provision : " An illegal act is exempt from punishment, if committed in a state of mind in which the use of reason is taken away ; to this state belong, chiefly, general mania, general and partial hallucination, entire imbe- 1 J. C. Mittennaier : De principle imputationis alienationum mentis, p. 24. PRELIMINARY VIEWS. 57 cility, and complete confusion of the senses, or understand- ing." Art. 91. In the code of the grand duchy of Hesse, propo- sed in 1836, we find the following provision : " By reason of their impaired responsibility, punishment cannot be inflicted on those who commit penal acts in a state of sleep, of som- nambulism, of general mania, of hallucination, of imbecility, or of any other mental disorder, which either takes away all consciousness respecting the act generally and its relation to penal law, or in conjunction with some peculiar bodily condi- tion, irresistibly impels him, while completely unconscious, to violent acts." Art. 29. In the code of the grand duchy of Ba- den, it is enacted as follows : " Responsibility is annulled in that condition, in which, either a consciousness of the crim- inality of the offence, or the free will of the offender is taken away." Art. 65. " To the condition which annuls responsi- bility on the strength of the 65th Art. belong chiefly, imbe- cility, hallucination, general mania, distraction, and complete confusion of the senses, or understanding." Art. 69. Some- what similar is the phraseology used by the code of Lucerne, in Switzerland. This method is liable to precisely the same objection as the former, for the difficulty will be as great in the one as in the other, of settling the exact meaning of the particular terms. Many a case will occur, that will not be unanimously referred to some one of the above-mentioned affections. To avoid the difficulties incumbent on the use of such terms, and to bring the wretched subjects of mental disease under the protection of the law, without discrimina- tion, the legislator has, in some instances, made the single fact of the presence of disease, sufficient to annul criminal responsibility. In Livingston's code, it is provided that " No act done by a person in a state of insanity can be punished as an offence." The revised statutes of the State of New York contain the same words. 1 The revised statutes of Ar- kansas provide that a lunatic, or insane person, without lucid intervals, shall not be found guilty of any crime or misde- meanor with which he may be charged. 2 The French penal 1 Vol. H. p. 697. 2 Revised Statutes of Arkansas, 236. ^ 58 MEDICAL JURISPRUDENCE OF INSANITY. code is equally simple. " There can be no crime nor offence, if the accused were in a state of madness at the time of the act." 1 If we insert after the word insanity, the following words, or any other condition of mind in which the person is involuntarily deprived of the consciousness of the true, nature of his acts, in order to protect him from the consequences of acts committed in a state of sleep or somnambulism, it may be doubted whether any other provision would better pro- mote the purposes of justice, than that of Livingston's code. Under this law, when strictly applied, if the existence of in- sanity is once established, the responsibility of the party is taken away ; and all nice discussions concerning the effect of this or that kind or degree of mental derangement, and the exact measure of reason that has been left or taken away, are thus effectually precluded. It cannot be denied that an in- sane person may be actually guilty of a criminal act, his in- sanity being* very partial, and the act not within the range of its operation, while by the letter of the law, he must be acquit- ted. The only way of avoiding this evil, would be to add something like the following ; provided, it can be proved that the act was not the offspring of the insanity. True, the fact of insanity would be left, as it now is, with the jury to decide ; but as they would no longer be puzzled with meta- physical distinctions between total and partial insanity, and engaged in nice estimates of the knowledge of good and evil, of right and wrong, and of the power of design possessed by the accused, their inquiries would be narrowed down to the single fact of mental impairment on a certain point a duty much less remote from the train of their ordinary habits and pursuits. Thus a great object would be gained, for the more that is provided by statute and the less that is left to judi- cial discretion, the greater is the benefit afforded by law. 42. As the conclusions of the jury, relative to the existence of insanity, must necessarily be founded on the testimony offered by the parties, it is a subject of the utmost importance, by whom and in what manner, this testimony 8 Art. 64. PRELIMINARY VIEWS. 59 shall be given. If the decision of this point were purely a matter of facts, the only duty of the jury would be to see that they were sufficient for the purpose, and proceeded from authentic sources ; but, on the contrary, it is a matter of inference to be drawn from certain data, and this is a duty for which our juries, as at present constituted, are manifestly unfit. That a body of men, taken promiscuously from the common walks of life, should be required to decide, whether or not certain opinions and facts in evidence prove derange- ment of mind, or, in other words, to decide a professional question of a most delicate nature and involving some of the highest interests of man, is an idea so preposterous that one finds it difficult, at first sight, to believe that it ever was seri- ously entertamed. Such, however, is made their business, and, in the performance of it, there is but one alternative for them to follow ; either to receive with the utmost defer- ence the opinions of those who have a professional acquaint- ance with the subject, or to slight them altogether, and rely solely on their own judgment of the facts. The latter course has sometimes been adopted, though no one, probably, per- sonally concerned in the issue of the case, would congratu- late himself on their choice, unless specially anxious to be- come a victim of ignorance and obstinacy. But, in the larger proportion of cases, the medical testimony, which is given in the shape of opinions, though rather an anomaly in evidence that courts have been sorely puzzled at times whether to ad- mit or reject, is mostly relied on, and determines the verdict of the jury. It is, perhaps, of little consequence, who testifies to a simple fact, that it requires only eyes to see, or ears to hear ; but it is all very different with the delivery of opinions that are to shape the final decision. As this requires an ex- ercise of judgment as well as observation, there ought to be some kind of qualification on the part of those who render such opinions, not required of one who testifies to mere facts. The understanding certainly is, that their habits, pursuits, and talents, have rendered them peculiarly competent for this high duty, for, in spite of the power of cross-examina- tion, these constitute the only pledge that can be had of its 60 MEDICAL JURISPRUDENCE OF INSANITY. correct and faithful performance. But as the law makes no exclusion, and the witnesses' stand is open to any one whom the parties may choose to call, it frequently happens, that the witness has nothing but his professional character to rely on, to give his opinions the authority they ought to possess. And even when he may have been preceded by the shadow of a great reputation, the jury may not know, nor be able to discover, how much of that reputation is a factitious one ; and, in consequence, may be induced to confide in opinions which, from a different quarter, they would have listened to with feelings of doubt and distrust. It is true, the law re- quires that such opinions should be founded on facts, but who is to decide whether the fact is a sufficient foundation for the opinion, or, indeed, has any relation to it at all ? 43. It is not enough, that the standing of the medical witness is deservedly high in his profession, unless it is found- ed on extraordinary knowledge and skill relative to the par- ticular disease, insanity. Lunatic asylums and retreats for the insane have so multiplied in our country, that patients of this class are almost entirely taken away from the management of the private physician, and consigned to the more skilful con- ductors of these institutions ; so that many a medical man may spend a life of full practice, without having been in- trusted with the care of a dozen insane persons. To such, therefore, a practical knowledge of the disease is out of the question, and thus the principal inducement is wanting, to become acquainted with the labors of those, who have in- joyed better opportunities. If a particular class of men only are thought capable of managing the treatment of the insane, it would seem to follow, as a matter of course, that such only are capable of giving opinions in judicial proceedings relative to insanity. True, in important cases, the testimony of one or more of this class is generally given ; but it may be con- tradicted by that of others utterly destitute of any knowledge of the subject on which they tender their opinions with arro- gant confidence, and the jury is seldom a proper tribunal for distinguishing the true from the false, and fixing on each its rightful value. An enlightened and conscientious jury, when PRELIMINARY VIEWS. 61 required to decide in a case of doubtful insanity, which is to determine the weal or woe of a fellow being, fully alive to the delicacy and responsibility of their situation, and of their own incompetence unaided by the counsels of others, will be satisfied with nothing less than the opinions of those who have possessed unusual opportunities for studying the char- acter and conduct of the insane, and have the qualities of mind necessary to enable them to profit by their observa- tions. If they are obliged to decide on professional subjects, it would seem but just, and the dictate of common sense, that they should have the benefit of the best professional advice. This, however, they do not always have ; and, consequently, the ends of justice are too often defeated by the high-sound- ing assumptions of ignorance and vanity. 44. It may, at first sight, be thought impossible to rem- edy this defect, without what would seem to be an engraft- ment upon our judicial system of practices not in perfect harmony with it; but the difficulty, after all, may not be found utterly intractable, if names are not allowed to usurp in our minds the place of things. Instead of the unqualified and irresponsible witnesses now too often brought forward to enlighten the minds of jurymen on medical subjects, it would be far better, if we had a class of men more or less like that of the experts l of the French, peculiarly fitted for 1 The term experts is used in the French law to designate certain persons, appointed in the course of a judicial proceeding, either by the court or by the agreement of the parties, to make inquiry under oath, in reference to certain facts, and to report thereon to the court They are not examined as wit- nesses ; nor have they the power of deciding the cause, like arbitrators ; their functions are more analogous to those of a master in chancery, according to our laws. The following extract from Pothier's Treatise on Civil Procedure (Part L chap. ILL art ILL I.) will give an idea of the functions of these officers. " The decision of a cause, frequently depends on some fact contested between the parties, which can only be established by a visit to the thing which makes the object of the contestation ; for example, the buyer of a horse brings a redhibitory action against the seller, to compel the latter to take back the horse, on account of some pretended defect, which the former alleges entitles him to a return ; if the seller denies the existence of the defect, this 6 62 MEDICAL JURISPRUDENCE OF INSANITY. the duty by a course of studies expressly directed to this end. They might be appointed by the government, in numbers adapted to the wants and circumstances of the population," and should be always ready, at the call of courts, to examine the health of criminals, draw up reports touching the same, and deliver opinions. When the courts see the minds of jurors perplexed and confounded by the contradictory opin- ions of medical witnesses, and with no means of satisfying themselves as to what is really true, it should be their duty to submit the accused to the examination of experts, who should report at a subsequent period. Something like this is often done in France and Germany, and ought to be provided for in the criminal procedure of every country. 1 Thus, in the case of Henriette Cornier, in Paris, for murder- ing a neighbor's child, November 4, 1825, the court, at the request of the prisoner's counsel, made shortly before the trial, which was ordered to take place February 27, 1826, appointed a committee of three distinguished physicians to report, after due examination, whether or not she was a fit fact, upon which the decision of the cause depends, can only be ascertained by an examination of the horse by experts ; and the judge, therefore, before rendering a definitive judgment, must order the animal to be examined by experts, who shall report whether he labors under the said defect or not. In like manner, if I make a bargain with a workman to do certain work upon a house, and when the latter demands the agreed price of me, I object that the work is badly done, and therefore not receivable, there must be an order for an examination by experts." 1 Fodere (De medicine legale, Tome I., Introd. p. xlii.) relates with the most naive astonishment, that, in a question of survivorship, arising out of the accouchement of Mrs. Fischer in England, the opinion of the celebrated Denman was rejected by a jury, that yielded implicit belief in the testimony of one Dallas, who was not a physician, and of two ignorant women, who spoke only from memory, after the expiration of fourteen years. Many readers may recollect, that, in the case of Donellan, tried in 1781, (see 2 Beck's Medical Jurisprudence, fifth edition, 563,) for the murder of Sir Theodosius Boughton, by poisoning, the opinions of three or four physicians, as unknown to fame as the science they professed to understand seems to have been unknown to them, far outweighed with the court that of John Hunter, though illustrated by his various learning, and supported by his repu- tation for unrivalled talents and original research. PRELIMINARY VIEWS. 63 subject for trial. Their reports not being satisfactory to the avocat-g^ne'ral (attorney-general), the trial, at his request, was postponed to another session, and the prisoner was again subjected to the examination of the committee, who reported three months afterwards. 1 What a contrast does this calm and deliberate inquiry present, to the indecent haste with which the legal proceedings were precipitated against Bel- lingham who committed his offence, was indicted, tried, hanged, and dissected, all within the space of eight days. In this case, there was a strong disinclination manifested by the court to listen to the plea of insanity ; as if it were a fiction set up by counsel, in the absence of any other ground of defence; and the earnest request of his counsel for a little delay, that he might obtain witnesses from the part of the country where the accused had lived and was well known, who would substantiate the fact of his insanity, of which there was already more than suspicion, was disregarded. Few, it is believed, at this period, unbiased by the political prejudices of the times, and examining the event as a point of history, will read the report of Bellingham's trial without being forced to the conclusion, that he was really mad, or, at the very least, that the little evidence which did appear rela- tive to his state of mind, was strong enough to have entitled him to a deliberate and thorough investigation of his case. Mr. Simpson, 2 after mentioning the case of Howison, who was tried and executed for the murder of the widow Geddes, in which the evidence of his insanity was so strong, that it is almost impossible to conceive what additional evidence could make it stronger, states, that " application was made without success to the secretary of state, by Howison's law-agent, for time to obtain further evidence of his insanity. To this that gentleman was emboldened, by receiving the concurring opinions of some of the first medical men in Edinburgh, who had not been cited, that even the evidence adduced on the trial was sufficient ; but that, when several post-judicial facts v 1 Georget, Discussion medico-legale sur la Folie, 71. 2 Homicidal Insanity, 222. 64 MEDICAL JURISPRUDENCE OF INSANITY. were added, there could be no doubt that the unhappy man was not a fit subject for punishment." Cases like these ought to convince us, that the feelings of horror and ven- geance excited by the bloody deeds of the insane, completely unfit the popular mind for a careful and impartial investiga- tion of the plea of insanity, and that the mental condition of the accused should be examined by men who have become fitted for such duties by a peculiar course of study and expe- rience. Is it necessary to go into a labored argument to prove that this method of determining the grave and delicate question of insanity must be infinitely more satisfactory, than that of summoning medical witnesses to the trial most of whom have but very imperfect notions of the disease, and probably have not had the least communication with the accused, and forcing out their evidence, amid the embar- rassment produced by the queries of ingenious counsel, bent on puzzling and distracting their minds ? If a physician, after listening to divers vague and rambling details concern- ing a person's ill-health, and looking at him across the apart- ment, without being permitted to address to him a single word, or lay a finger on his person, should then be required to say on his oath, whether or not the individual in question were laboring under inflammation of the lungs, bowels, or kidneys, he would scarcely restrain a smile at the stupidity which should expect a satisfactory answer. And yet, absurd and foolish as such a course would be considered in the ab- stract, it is the only one recognized by our laws, when the disease, whose existence is to be established, happens to be insanity. Besides, where mental derangement is suspected, there are many physical symptoms and numerous other cir- cumstances that cannot be investigated in an hour or a day, but require a course of diligent observation that may occupy weeks or months, before the suspicion can be confirmed or disproved. From these considerations, the general conclu- sion is, that in criminal cases where insanity is pleaded in defence, the ends of justice would be best promoted by the appointment of a special commission, consisting of men who possess a well-earned reputation in the knowledge and man- PRELIMINARY VIEWS. 65 agement of mental derangement, who should proceed to the examination of the accused with the coolness and impar- tiality proper to scientific inquiries. 1 45. To facilitate the inquiries of such a commission, there is needed some suitable provision for the examination of the accused. Indeed, with every disposition to arrive at the truth, it is generally impossible under the present arrange- ments. In jails, where prisoners accused of crime are con- fined, proper opportunities are not afforded for investigating their mental condition. In the few formal interviews to which the observation of the prisoner is confined, it may often hap- pen that the real condition of the mind will not be discovered. If really insane, he will be likely to control his movements, and to discourse and appear very differently from what he would when left to himself and unconscious of being ob- 1 It may be proper, perhaps, to inform the reader that the exclusive com- petence of medical men to give opinions, as experts, in cases of doubtful con- dition of mind, has, at different times, been warmly disputed. The celebra- ted Kant, by whom the dispute was begun, contended that such cases ought more properly to be submitted to the Philosophical Faculty. (Anthropologie 41.) His arguments were satisfactorily answered by Metzger, (Gerichtl. medic. Abhand. s. 74), Hcffbauer, (Die Psycologie in ihren Anwendungen aufdie Rechtspjlege, 1, not. 3,) and others, and the controversy was set at rest until the trial of Henriette Cornier, at Paris, which led to its revival with renewed vigor. Coste, a French physician, (Journ. univer. des Scien. med. t. 43, p. 53,) and Regnault, a Parisian advocate, who wrote a book on the sub- ject, (Du degree de competence des medicins dans les questions relatives aux alienation mentale, 1828,) have hotly contended that any tolerably sensible, well-informed man is as competent as a Pinel or an Esquirol, to form opin- ions for judicial purposes, relative to cases of doubtful condition of mind. The arguments or, more properly speaking, the assumptions and declama- tion of these writers, have been severely handled by their opponents, (Georget, NouveUe Discussion medico legate sur lafolie, p. 20; North Ameri- can Medical and Surgical Journal, April, 1828, p. 457; Friedreich, Hand- buch der gericht. Psychologic ; Leuret, Annals d' Hygiene, i. 281 ; Royer- Col- lard Journ. hebd ii. 181,) and the controversy may be considered as once more at rest, precisely where it was found. We have not thought it worth while to discuss this question, for the simple reason that the objections against receiving the opinions of physicians, as experts, are altogether founded in gross ignorance, misconception, and prejudice, without even a plausible show of support. 6* 66 MEDICAL JURISPRUDENCE OF INSANITY. served. Many insane, as we have already shown, manifest their aberration only under certain circumstances and on par- ticular occasions, and appear quite correct at all other times. Many, too, whose insanity is recognized by every body who knows them, never evince it in their discourse, but solely in their ways and habits. If, on the other hand, the prisoner is feigning insanity, he will summon all his powers to produce the requisite impression at these interviews which, being short and few, the difficulty of his task is much lessened. To ascertain satisfactorily the mental condition of a prisoner suspected of being insane, he should be placed where the expert may be able to see him often, and at times when he is not aware of being observed. His words, and acts, and movements, his manners and habits should be systematically watched, and a single day of such observation would often throw more light on the case than many formal interviews. We see no difficulty in so changing our modes of criminal procedure, that when the court shall be satisfied that there are reasonable doubts of the prisoner's sanity, it may be authorized to postpone the trial, and place him, in the mean time, in the charge of an expert for which our hospitals for the insane furnish a convenient and suitable opportunity whose report shall be received in evidence at the trial. This is substantially the course adopted in France, and nothing short of its adoption with us, will render the plea of insanity powerless for evil, and remove the suspicions of the community on this point. 46. If the above hasty review of the judicial opinions and practices that have hitherto prevailed relative to insanity, have left the impression, that this disease is as yet but imper- fectly understood, as well in the medical profession as out of it, an explanation of this fact may perhaps be demanded ; but as it would be hardly relevant to the present purpose to enter largely into a discussion of this point, nothing more will be attempted than merely to indicate what seems to have had the principal share in producing it. To explain the little progress, comparatively speaking, that has been made b^ medical men in the knowledge of insanity, it is too PRELIMINARY VIEWS. 67 much the fashion to allege, that they have neglected the study of mental philosophy, or that of mind in the healthy state, which is indispensable to correct notions on the disor- dered condition of mind. So far, however, is the fact here indicated from being true, generally, that one cannot hesitate to say, that the result in question has been owing to the un- due account that physicians have made of the popular phi- losophy of mind, in explaining the phenomena of insanity, and that they have failed in consequence of studying metaphysics too much instead of too little. While it is admitted that the knowledge of healthy structure and functions is necessary to a thorough understanding of diseased structure and functions, there is x every reason to believe, that the converse of the pro- position is equally true ; neither can be successfully studied independently of the other. In the prosecution of psycholog- ical science, this latter truth has been almost entirely disre- garded, and therefore it is, that we see the metaphysician looking for his facts and his theories in the healthy manifes- tations of the mind, and directed in his course solely by his own self-consciousness, while the student of insanity, after collect- ing his facts with commendable diligence and discrimination, amid the disorder and irregularity of disease, resorts to the theories of the former, for the purpose of generalizing his re- sults, instead of building upon them a philosophy of his own. Metaphysics, in its present condition, is utterly incompetent to furnish a satisfactory explanation of the phenomena of in- sanity, and a more deplorable waste of ingenuity can hardly be imagined, than is witnessed in the modern attempts to reconcile the facts of the one with the speculations of the other. In proof of the truth of these assertions, it is enough barely to mention, that the existence of monomania, as a distinct form of mental derangement, was denied, and de- clared to be a fiction of medical men, long after it had taken its place among the established truths of science ; because, probably, it was a condition of mind not described by meta- physical writers. All this, however, is in accordance with a well-known law of the human mind, which resists important innovations upon the common modes of thinking till long 68 MEDICAL JURISPRUDENCE OF INSANITY. after they shall have been required by the general progress of knowledge. The dominant philosophy has prevailed so long and so extensively, and has become so firmly rooted in men's minds that they who refuse to take it on trust and who seri- ously inquire into its foundations, and after finding them too narrow and imperfect, are bold enough to endeavor to remedy its defects by laying foundations of their own, are stigmatized as visionaries, and overwhelmed with ridicule and censure. The only metaphysical system of modern times which pro- fesses to be founded on the observation of nature, and which really does explain the phenomena of insanity with a clear- ness and versimilitude that strongly corroborate its proofs, was so far from being joyfully welcomed, that it is still con- fined to a sect, and is regarded, by the world at large, as one of those strange vagaries in which the human mind has sometimes loved to indulge. So true it is, that, in theory, all mankind are agreed in encouraging and applauding the hum- blest attempt to enlarge the sphere of our ideas, while, in practice, it often seems as if they were no less agreed to crush them by means of every weapon that wit, argument, and calumny can furnish. In the course of this work, the reader will have frequent occasions to see how the popular miscon- ceptions, which are too much adopted by professional men of the nature of various forms of mental derangement, have been produced and fostered by the current metaphysical doctrines, and thus may have some means of judging for him- self, how far the imperfect notions of insanity, that are yet prevalent, may be attributed to the cause above assigned. CHAPTER I. MENTAL DISEASES IN GENERAL. 47. CORRECT ideas of the pathology of insanity are not unessential to the progress of enlightened views respecting its legal relations. If it be considered as withdrawn from the influence of the common laws of nature in the produc- tion of disease, and attributed to the direct visitation of God ; if the existence of physical changes be overlooked or denied, and be referred exclusively to some mysterious affection of the immaterial spirit for its cause ; then is it in vain to hope, that such a condition can ever be the object of discriminating, salutary legislation. In the prevalence of such views in past times, however, we may look for the cause of much of the error and absurdity that pervade the law of insanity, and that are equally at variance with the principles of science and the dictates of humanity. It is an undoubted truth, that the manifestations of the intellect, and those of the sentiments, propensities, and passions, or generally, of the intellectual and affective powers, are connected with and dependent upon the brain. It follows, then, that abnormal conditions of these powers are equally connected with abnormal conditions of the brain ; but this is not merely a matter of inference. The dissections of many eminent observers, among whom it is enough to mention the names of Greding, Gall, and Spurz- heim, Calmeil, Foville, Falret, Bayle, Esquirol, and Georget, have placed it beyond a doubt; and no pathological fact is better established though its correctness was for a long while doubted than that deviations from the healthy struc- ture are generally presented in the brains of insane subjects. 70 MEDICAL JURISPRUDENCE OF INSANITY. In the few cases where such appearances have not been observed, it is justly concluded that death took place before the deviation was sufficiently great to be perceptible, a phenomenon not rare in affections of other organs. 48. These pathological changes are not sufficiently definite to admit of classification, or of practical applica- tion in the treatment of the various kinds of insanity. To us they are chiefly valuable, as showing the frequent liability to disease, either from excessive exertion or disuse of its own powers, or from its proneness to be affected by morbid irri- tations that radiate from other parts of the body. We learn from them, also, that changes of structure may proceed in the brain, as in other organs, to an incurable degree, without giv- ing rise to much, if any, very perceptible disturbance of its functions, until some striking and unexpected act leads the enlightened physician to suspect its existence, and draws down upon the unfortunate subject the restraints and penal- ties of the law. 49. A natural classification of the various forms of insanity, though of secondary importance in regard to its medical treatment, will be of eminent service to the legal inquirer, by enlarging his notions of its phenomena, and enabling him to discriminate, where discrimination is neces- sary to the attainment of important ends. The deplorable consequences of knowing but one kind of insanity, and of erecting that into a standard, whereby every other is to be compared and tested, are too common in the records of criminal jurisprudence ; and it is time that it were well understood, that the philosophy of such a method is no better than would be that of the physician who should recognize no diseases of the stomach, for instance, but such as proceeds from inflammation, and reject all others as anomalous and unworthy of attention. The various diseases included in the general term insanity, or mental derange- ment, may be conveniently arranged under two divisions, founded on two very different conditions of the brain ; the first being a want of its ordinary development, and the second, some lesion of its structure subsequent to its devel- MENTAL DISEASES IN GENERAL. 71 opment. In the former of these divisions, we have IDIOCY and IMBECILITY, differing from each other only in degree. The various affections embraced in the latter general divis- ion may be arranged under two subdivisions, MANIA and DEMENTIA, distinguished by the contrast they present in the energy and tone of the mental manifestations. Mania is characterized by unnatural exaltation or depression of the faculties, and may be confined to the intellectual or to the affective powers, or it may involve them both, and these powers may be generally or partially deranged. Dementia depends on a more or less complete enfeeblement of the faculties, and may be consecutive to injury of the brain, to mania, or to some other disease ; or it may be connected with the decay of old age. These divisions will be more con- veniently exhibited in the following tabular view. INSANITY. < Defective develop- ment of the facul- ties. Lesion of the facul- ties sub- sequent to their develop- ment. IDIOCY. IMBECILITY. MANIA. DEMENTIA. :1. Resulting from congenital defect. 2. Resulting from an obstacle to the development of the faculties, supervening in infancy. '1. Resulting from congenital defect. 2. Resulting from an obstacle to the development of the faculties, supervening in infancy. Intellectual. < 2 * Affective. ] ' General. Partial. General. Partial. 1. Consecutive to mania, or injuries of the brain. 2. Senile, peculiar to old age. 50. It is not pretended that any classification can be rigorously correct ; for such divisions have not been made by nature, and cannot be observed in practice. Diseases are naturally associated into some general groups only ; and if these be ascertained and brought into view, the great end of classification is accomplished. We shall* often find them running into one another, and be puzzled to assign to a particular disease its proper place; but since such is the 72 MEDICAL JURISPRUDENCE OF INSANITY. order of nature, we must make the most of the good it pre- sents, and remedy its evils in the best manner we can. The above arrangement, with the exception of some slight modi- fications, is that adopted by Esquirol, and has this advantage over some others, that it preserves the divisions made by nature, and will thus be serviceable to our present purpose. Several other conditions of mind in which moral freedom is impaired, will also be considered, though they cannot be strictly called insanity. CHAPTER II. IDIOCY. 51. IDIOCY is that condition of mind, in which the re- flective, and all or a part of the affective powers, are either entirely wanting, or are manifested to the slightest possible extent. As the organic defects on which idiocy depends, are various in kind and degree, and also as it regards the parts of the brain affected, we should be led to expect, what observation shows is actually the case, considerable variety in the manifestations of this condition. The individual may hardly rise to the level of some of the brutes, his movements being confined to the necessities of the automatic life ; or he may be capable of performing some useful services, of ex- ercising some talent, or of displaying some of the higher moral sentiments. In short, there is even more diversity in the characters of the idiotic and imbecile, than in those of the sound, and this truth must not be forgotten, if we would avoid -the flagrant error of regulating judicial decisions by rules, which, though perfectly correct in regard to one case or set of cases, may be wholly incorrect in regard to others. 52. No particular physical trait can be considered as inseparable from idiocy, although after the period of infancy, the physical organization never fails to give notice of its presence. In a small number of cases, the head presents no deviation from the normal form and size, but with this excep- tion, the head is either too large or too small ; the tables of the 7 - 74 MEDICAL JUBISPRUDENCE OF INSANITY. skull being thin and distended with water, or thick, indu- rated, and uneven. In the former class, the forehead, though prominent, is always depressed, and the posterior part of the head is apparently of the regular size, while the middle region is more or less distended, either laterally or upwards. In the latter class, the depression is equally destitute of uniformity. Sometimes it affects principally the superior and anterior parts of the head, producing a narrow and retreating fore- head ; in other instances, it affects the posterior or occipital parts, the occipital curve being reduced to an almost straight line ; in others, the lower parts of the skull are tolerably regular, while the upper appear to be diminished arid flat- tened ; in others, finally, the two sides of the skull are exceed- ingly unequal. In all these cases, the head is found, by measurement, below the ordinary size. The circumference, measured immediately over the orbitar arch and the most prominent part of the occiput, is fixed by Gall at between eleven and one third and fourteen and a half inches, the brain, consequently, equalling that of a new-born infant, that is, about one fourth, one fifth, or one sixth of the cerebral mass of an adult. The senses of idiots are more or less imperfect, if not entirely wanting. Some are blind, and in nearly all who see, the eye is either in constant motion, unable to fix its regards on any particular object, or unnaturally fixed and not easily changing its look from one point to another. Many are entirely deaf, and many more are incapable of listening. Many are mute, and many utter only wild, inarticulate cries. Some speak slowly and with difficulty, others tolerably well. The sense of touch frequently exhibits an excess or defect of sensibility. Many are incapable of perceiving odors, and have so little taste as to show no discrimination in their choice of food, swallowing whatever comes to hand. Their movements are constrained and awkward ; they walk badly, easily falling down ; and are constantly dropping whatever is placed in their hands. Sometimes the limbs are crooked and feeble, and limited in their motions. Idiots are often affected with rickets, epilepsy, scrofula, or paralysis, their whole phy- IDIOCY. 75 sical economy indicating a depraved and defective consti- tution. 53. In reasoning power, many idiots are below the brute. Unable to compare two ideas together, nothing leads them to act but the faint impressions of the moment, and these are often insufficient to induce them to gratify even their in- stinctive wants. It frequently happens, however, that some one or more of the intellectual faculties, always excepting the reflective, are manifested in more or less perfection. Among the moral sentiments, it is not uncommon to find self-esteem, love of approbation, religious veneration, and benevolence, bearing a prominent part, if not constituting the entire character, and thus producing a slight approxima- tion to humanity. Rush l speaks of one who was remarka- ble for kindness and affection, and spent his life in acts of benevolence, though he showed no one mark of reason. Dr. Combe 2 saw two who, though differing much in other re- spects, agreed in evincing a strong predilection for religious worship, and for listening to sermons and prayers. Some can recollect names, numbers, or historical facts ; some are capable of repeating what they have frequently heard ; others are able to sing a few airs, and even to play on musical instruments. Gall 3 saw one at Hamburgh, sixteen years old, who learned names, dates, numbers, history, and repeated them all mechanically, but was destitute of all power of com- bining and comparing his ideas, and was incapable of being engaged in any employment. Various propensities, such as the sexual feelings, cunning, and destructiveness, they often manifest in an inordinate degree of vigor and activity. 54. It has been reserved for our own times to prove, on a large scale, that these defective beings are not beyond the reach of education. Under the united efforts of science and philanthropy, the lowest have been raised some steps in the scale of being, and those less unhappily endowed have 1 Medical Inquiries. 2 Observations on Mental Derangement, 243. 3 Sur les Fonctions I. 193. 76 MEDICAL JURISPRUDENCE OF INSANITY. showed an improvement in their personal habits, in the number of their ideas, and their capacity for useful employ- ment, that would once have appeared quite incredible. It is not supposed that education can ever efface the distinction between them and ordinary men, but small as its results may be comparatively, they are enough to be of some medico- legal importance. 55. In that form of idiocy called cretinism, which is endemic in the Alps and some other mountainous countries, opportunities of observing its phenomena are offered on a grand scale. The difference in the degrees of this affection has led to its division into three classes, namely, cretinism, semi-cretinism, and cretinism of the third degree. In the first, life seems to be almost entirely automatic ; most of its subjects are unable to speak, their senses are dull, if not altogether wanting, and nothing but the most urgent calls of nature excite their attention. To good or to bad treatment they are equally insensible. The semi-cretins show some glimmering of a higher nature; they note what passes around ; they remember simple events ; and make use of language to express their wants. They are capable of little else, however, for they have no idea of numbers, and, though taught to repeat certain passages, they learn nothing of their meaning. The actions of those of the third kind indicate a still higher degree of intellect ; they have a stronger memory of events, and they learn to read and write, though with scarcely any conception of the purposes of either. Particular talents are often displayed by them in a very respectable degree. Music, drawing, painting machinery, etc., have each had its followers in a humble way, among these cretins. In the construction of some parts of a watch, they are often employed in Geneva, and their work is characterized by neat- ness. Others have executed drawings of some merit, and some have even studied several languages, in which their acquisitions were by no means insignificant; while others have even attempted poetry, though succeeding in nothing but the rhyme. Though, in all degrees of idiocy, the intel- IDIOCY. 77 lectual powers are so deficient as hardly to be recognized, and therefore these distinctions can be of little practical im- portance, yet they may serve to teach us how independent of one another are the various moral and intellectual faculties, and lead us to be cautious how we infer the soundness or capacity of the whole mind, from the perfection manifested by one or two of its faculties. CHAPTER III. IMBECILITY. 56. BY imbecility is meant an abnormal deficiency either in those faculties that acquaint us with the qualities and ordinary relations of things, or in those which furnish us with the moral motives that regulate our relations and con- duct towards our fellow men ; and frequently attended with excessive activity of one or more of the animal propensities. In imbecility the development of the moral and intellectual powers is arrested at an early period of existence. It differs from idiocy in the circumstance, that while in the latter there is an almost utter destitution of every thing like reason, the subjects of the former possess some intellectual capacity, though far less than is possessed by the great mass of man- kind. Imbeciles can never attain that degree of knowledge which is common among people of their own rank and opportunities, though it is very certain that they are not entirely unsusceptible of the influences of education. They are capable of forming a few simple ideas and of expressing them in language ; they have some memory and a sense of the conveniences and proprieties of life. Many of them learn to read, write, and count, and make some progress in music, though, for the most part, they are untaught and employed in the coarsest and rudest labors. Their moral and intellectual character presents the same infinite variety that is witnessed in the normal state of the mind. While some are changing their plans and resolutions with the fickleness of the winds, others have some favorite project which they are bent on accomplishing. While nothing can arrest the attention of IMBECILITY. 79 some for a moment, others pertinaciously retain some crotchet that occupies nearly all their thoughts. Some en- gage in certain occupations, and manage to take care of themselves and their property, though frequently obliged to resort to others for advice and assistance. They talk but little, and will answer questions correctly, provided they are not without the circle of their customary thoughts and habits, and are not required to follow a conversation. They are particularly deficient in forethought and in strong and dura- ble affections, and they generally labor under a certain unea- siness and restlessness of disposition that unfit them for steady employment. They are thus easily induced by bad men to assist in the execution of their criminal enterprises. It is also worthy of notice that the same physical imperfections and a tendency to the same diseases which accompany idiocy, are generally observed, though in a less degree, in imbecility. 57. Much as the moral and intellectual powers vary in the different cases, but little has been done towards distin- guishing the various degrees of imbecility, by a system of classification, though it must be obvious at first sight, that something of this kind is absolutely necessary before its legal relations can be determined with much correctness or con- sistency. Hoffbauer 1 alone has made an attempt to supply this want, and though perhaps not perfectly satisfactory, as might have been expected from the nature of the subject, yet it evinces such a correct appreciation of mental diversities, and so much ability in the analysis of deficient understand- ings, that it would be doing injustice to the subject, to neglect giving some account of his views in this place. 58. Mental deficiency is manifested under two different forms which Hoffbauer designates by the terms imbecility (Blodsinn), and stupidity (Dummheit). The former consists in a defect of the intensity, the latter in a defect of the ex- tensity, necessary to a sound and healthy mind. By intensity 1 Die Psychologic in ihren Hauptanwendungen auf die Rechtspflege, 26 46. 80 MEDICAL JURISPRUDENCE OF INSANITY. is meant the power of the mind to examine the data pre- sented to it by the senses, and therefrom to deduce correct judgments; by its extensity, the mind perceives and em- braces these data, and suffers none to escape, one, it may be added, is the reflective ; the other, the perceptive power. " In reference to the faculty of judgment, it may be ob- served, that the stupid person is more liable than the imbecile to form erroneous decisions; the latter experiences great difficulty in bringing himself to any conclusion. Secondly, the stupid person sometimes judges very correctly on subjects to which his attention has been strongly applied ; occasion- ally he surpasses, in this respect, those of superior intelligence. When he judges wrongly, it is through neglect of some of the considerations which ought to have formed the ground- work of his judgment, and he will say, in order to excuse himself, that ' he never should have dreamed of this or that circumstance.' To the imbecile, on the contrary, the most simple act of judgment is difficult. A lady, for instance, who said she was twenty-five years of age, and had been married six years, could not, after many efforts, tell how old she was at the period of her wedding ; at one time calling it twenty, at another, twenty-two. Thirdly, the stupid man may often be induced to correct his mistake ; some simple reason, or particular circumstance being suggested to him which leads to its detection. The imbecile man can scarcely rectify his errors, being unable sufficiently to concentrate his attention on any particular subject. Fourthly, the stupid man, in recovering from his error, frequently falls into the opposite extreme, passing from the blindest confidence to the most jealous distrust, because he views every subject on one side only, and is embarrassed by every complex idea. 59. " In relation also to memory, there is a decided difference between the stupid and the imbecile. The latter appear to be almost entirely deficient in this faculty, while the former recollect after a long interval of time, and with tolerable accuracy, ome insulated circumstances. 60. " Weakness of intellect is displayed in both these classes, when their defect is excessive, by a propensity to talk IMBECILITY. 81 to themselves. This is mostly observable when the individ- ual is alone, or supposes himself alone. In reality, we em- ploy words, not merely for purposes of intercourse, but as an instrument of thought ; and when the mind is morbidly enfeebled, the silent and unperceived, or mental employment of words is insufficient ; they must be repeated more or less audibly. This practice is not uncommon with imbecile and stupid people, but when in company, they generally perceive its incongruity and abstain from it. If, however, such indi- viduals talk to themselves, knowing that they are in the pre- sence of company, it is a proof of greater deficiency. 61. " Another distinction between the imbecile and the stupid person is, that the latter imagines himself equal, if not superior, to other men in intelligence ; whereas the former is sensible of his defect, and even exaggerates it. Hence results another difference between the stupid and the imbecile per- son. The former acts precipitately and without reflection ; the latter never can make up his mind, even on the simplest affair, from the fear that there may be consequences which he is incapable of foreseeing. The imbecile is frequently timid, and even misanthropic ; not only because he is con- scious of his deficiency, but because he has a disagreeable experience of the superiority of others. When this is the cause of his jealous distrust, we observe, first, that he reposes unlimited confidence in those whose benevolence he has ex- perienced ; secondly, that when his condition in society places him beyond the reach of injury, he has none of this mis- anthrophy of which we speak, and is at peace with all the world. The pusillanimity and misanthropy of the imbecile lead them to a species of devotion, if such it may be called ; for it is natural that, on seeing themselves repulsed, or ill- treated by men, they should apply to the deity for support, The stupid, more confident in themselves, fancy that they acquire merit by their devotions, or confer an honor on the divinity." 62. Hoffbauer, while he acknowledges the various and almost imperceptible shades of difference between one case of imbecility and another, has reduced its numberless grada- 82 MEDICAL JURISPRUDENCE OF INSANITY. tions to five degrees, and those of stupidity to three. To these, as described and explained by him, he looks for the means of a consistent and rational application of the legal principles that should regulate their civil and criminal rela- tions. " The first degree of imbecility manifests itself in the ina- bility to form a judgment respecting any new object, even when the necessary data are furnished, and the question is one which, in itself, presents no difficulties. In this degree of the affection, the individual can very well judge respecting objects to which he is daily accustomed, and in familiarity with which he may be said to have grown up. In the pur- suit of his daily concerns, he often shows a minute exactness that appears to him a matter of absolute necessity. His memory is very limited; not that he loses absolutely the remembrance of things, but because he cannot apply his recollections according to his wishes. He scrupulously observes whatever he thinks becoming in his situation, because he fears to offend by neglecting it. When he gives himself up to avarice, there is observed in him rather an ap- prehension of losing than a desire of accumulating. The propensity to talk to himself, and the species of devotion to which we have alluded, is seldom to be met with in this instance ; the former, because the routine of daily occupa- tions, above which the individual seldom raises himself, makes but small demands on his intelligence; the latter, because his infirmity is not so remarkable in ordinary society as to render it a subject of general observation, and entail upon him frequent annoyance, and thus make him feel the neces- sity of seeking support elsewhere. He is very subject to gusts of passion, which, nevertheless, are as easily appeased as they are excited." The description of the second degree of imbecility applies to the subjects of dementia, which will be considered in another place ; and it may therefore be omitted here. 63. " A person affected with imbecility in the third degree, is unfitted for all matters that require more than a mechanical mode of action; but he preserves sufficient in- IMBECILITY. 83 telligence to be aware of his weakness and of the intellectual superiority of others. "We may likewise remark in him that propensity to devotion and misanthropy of which we have spoken above. His mind is not completely inactive, although it cannot raise itself to any elevated views ; hence he has the propensity to talk to himself. He has not the power of seiz- ing an idea so clearly as to impress it on his mind ; hence a very marked defect of memory and a great propensity to pass rapidly from one topic to another. He is very irrita- ble and suspicious, fancies a design to insult him where it is impossible, because his state yet permits him to feel and resent injuries of which susceptibility those about him often take advantage in order to annoy him. 64. The fourth degree of imbecility is marked by a clouded state of the understanding and memory, with a great insensibility, which nevertheless leaves the patient a confused idea of his weakness. He eagerly seeks excitement by vari- ous stimuli." 65. The fifth degree of imbecility, as described by Hoff- bauer, corresponds to the last stage of dementia, or the fatuity which results from some cerebral diseases, and there- fore does not belong to this condition of mind according to the arrangement above adopted. 66. Stupidity, generally speaking, is a defect less severe than imbecility, according to the definition given of each. The slightest degree of imbecility, however, indicates an im- perfection of the intellectual powers, less severe than the greatest degree of stupidity. " In the first degree of stupidity, the individual is only incapable of judging and deciding, when it is necessary to weigh opposing motives. Then he feels his incapacity, and resorts to the intelligence of others, unless too proud, which often happens. If he acts absurdly, it is often because he applies to his actions a rule good in itself, but the application of which requires other considerations. 67. " The subject of the second degree of stupidity judges accurately and sometimes even promptly, respecting things by which he is habitually surrounded ; but he com- 84 MEDICAL JURISPRUDENCE OF INSANITY. mits serious errors whenever it is necessary to exert a certain vigor of judgment. He is embarrassed in any train of rea- soning, however simple it may be. His memory is, perhaps, faithful, but it is slow ; he cannot, without great difficulty, express a complex idea, if it is the result of his own reflec- tions, and has not been received from another. When his faculties have been somewhat developed by education, he is an obstinate partisan of any thing which is, as we say, good in theory, but useless in practice ; because he cannot observe the circumstances that distinguish particular cases, and ap- preciate them according to their just value. These two con- ditions are indispensable, however, to the proper application of general rules. 68. " In the highest degree of stupidity the individual cannot go beyond one single idea ; and he must completely lose that one before he can pass to another. Hence he is less capable of judging than the imbecile, because the comparison of several ideas is necessary to form a judgment. Individu- als who are affected with stupidity in the third degree, often express themselves in half-uttered words, return incessantly to the same subject, make known their ideas by sentences, short, incoherent, and unfinished, like children who can retain words but do not know how to connect them together ; they often express the subject and the attribute without connect- ing the one to the other by the affirmative or negative. If they wish to say, ' the rose is beautiful,' they will say, ' rose beautiful,' or only ' rose,' or ' beautiful,' according as the sub- ject or attribute strikes them most. Often they reverse the natural order of words, and say, for example, ' rose beautiful is ; ' and when they perceive an omission which they wish to repair, they become still more perplexed." 69. It does not need the high authority of Esquirol to convince us, that these distinctions are drawn with a minute- ness and show of accuracy that savor more of the labors of the closet than of the rigid and faithful observation of nature. This objection, however, which might not have been unsus- pected by the author himself, does not entirely destroy the utility of his attempt, so long as it is admitted to be an IMBECILITY. 85 approximation to the truth ; for, with all its defects, it estab- lishes the important fact that mental deficiency is distin- guished by various grades of intensity, instead of being invariably the same condition, and therefore that it cannot properly be always subjected to the same legal regulations. It is a material defect in the above descriptions, that the state of the moral faculties is seldom adverted to, though their deviations from the normal condition are no less strik- ing than those which the intellectual powers exhibit. What- ever may be their character, it is obvious that their ordinary relations to the intellect must be affected, and thus the idea is forced upon us, that, as accountable beings, the subjects of mental deficiency must be viewed in a very different light from that in which we are accustomed to regard those of sound and well-developed minds. The observations of Georget on the moral faculties of imbeciles, partially supply this defect in Hoffbauer's descriptions, and therefore are worthy of notice in this connection. 70. " In hospitals for the insane," says he, " there is always a certain number of imbeciles who do the coarser work of the house, or serve as domestics and assistants to the regular officers. They become sufficiently intelligent, at last, to perform their duties well, to sweep the courts, carry burdens, move machines, execute simple commissions, know the use of money, and procure various enjoyments. But they have no idea, or a very imperfect one, of society, laws, morality, courts and trials ; and though they may have the idea of property, they have no conception of the conse- quences of theft. They may have been taught to refrain from injuring others, but they are ignorant of what would be done to them if guilty of incendiarism or murder. Indeed, it is well known how common theft is among imbeciles and idiots, and for a very obvious reason. Some of them have no conception of property, nor of the distinctions of meum and tuum ; their conduct is actuated solely by the fear of punishment, when capable of experiencing this sentiment, and by their own desires. Others have some notions of prop- erty, but neither a sense of morality, nor a fear of punish- 8 86 MEDICAL JURISPRUDENCE OF INSANITY. ment furnishes motives sufficiently powerful to prevent them from stealing. The sentiment of cunning, too, may be very much developed, while the other faculties are more or less deficient. Among the lower orders of society are many imbeciles a little more intelligent than these, and not consid- ered as utterly devoid of understanding, who, nevertheless, have but vague and imperfect notions of social duties and of justice. They engage in occupations that require no great extent of intellect, and even in the simplest of the mechanic arts. If they do not pass among their acquaintances for imbeciles, they are at least regarded as singular beings with feeble understandings, and are teazed and tormented in innu- merable ways. Many of them, for want of some powerfully restraining motive, indulge in drinking, and become lazy, drunken, and dissipated, and finally fall into the hands of justice in greater numbers than is generally suspected. They steal adroitly, and hence are considered as very intelli- gent ; they recommence their offences the moment they are released from confinement, and thus are believed to be obstinately perverse ; they are violent and passionate, and the slightest motive is sufficient to plunge them into deeds of incendiarism and murder. Those who have strong sexual propensities, soon become guilty of outrages on female chas- tity. I have had occasion to see many examples of this class in prisons, who had been judicially decided to be rational, but whose demi-imbecility was manifest enough to me." 1 If this is a correct representation of the moral character of the lesser grades of imbecility and the accuracy and good faith of Georget are not to be doubted it may be easily imagined, without the help of further description, what it must be in the higher degrees. 71. By imbecility is ordinarily understood a deficiency of intellect ; but it has been seen above ( 56) that its signi- fication is here extended, in order to include that class of subjects in whom the mental defect consists in a great defi- 1 Discussion me'dico-legale sur la Folie, 140; and Des maladies mentales, conside're'es dans leurs rapports avec la legislation civile et criminelle, 8. IMBECILITY. 87 ciency, if not utter destitution of the higher moral faculties, the intellectual, perhaps, not being sensibly affected. The following case will illustrate this form of the disorder. E. S., aged thirty-four, who had been ten years an inmate of the Richmond Lunatic Asylum in Dublin, was brought before Mr. George Combe, during a visit to that institution, on the 20th of April, 1829, to be subjected, with several others, to a phrenological examination. A few months after, Dr. Crawford, the physician of the asylum, addressed a letter to Mr. Combe respecting this patient, from which the follow- ing description is taken. " You observe in your notes, ' I am surprised he was not executed before he became insane.' This would lead to the supposition that he had been afflicted with some form of insanity, in addition to a naturally depraved character. Such, however, is by no means the t case ; he never was different from what he now is ; he has never evinced the slightest mental incoherence on any one point, nor any kind of hallucination. It is one of those cases where there is great difficulty in drawing the line between extreme moral depravity and insanity, and in decid- ing at what point an individual should cease to be con- sidered as a responsible moral agent, and amenable to the laws. The governors and medical gentlemen of the asylum have often had doubts whether they were justified in keep- ing E. S. as a lunatic, thinking him a more fit subject for a Bridewell. He appears, however, so totally callous with regard to every moral principle and feeling so thoroughly unconscious of ever having done anything wrong so com- pletely destitute of all sense of shame or remorse when reproved for his vices or crimes and has proved himself utterly incorrigible throughout life, that it is almost certain that any jury before whom he might be brought would sat- isfy their doubts by returning him insane, which, in such a case, is the most humane line to pursue. He was dismissed several times from the asylum, and sent there the last time for attempting to poison his father; and it seems fit he siiould be kept there for life as a moral lunatic', but there has never been the lest symptom of diseased action of the brain, 88 MEDICAL JURISPRUDENCE OF INSANITY. which is the general concomitant of what is usually under- stood as insanity" 1 72. Nothing can be more certain than that this indi- vidual was denied by nature the possession of those moral faculties, the due development and exercise of which consti- tute an essential element of responsibility. By the aid of kind and intelligent friends, he was secluded from scenes in which he was unfitted to mingle ; but if, on the contrary, he had been suffered to go at large, with his animal propensities uncontrolled by the higher powers of our moral nature, and constantly meeting with opportunities for indulgence, what else could have been expected but some deed of violence that would have brought upon him the tender mercies of the law ? Dr. Crawford is altogether too sanguine in believing that a jury would have pronounced E. S. insane ; for the melan- choly termination of the cases above given, teaches how little we can here rely on the intelligence of courts and juries. Had he committed a capital crime, he would probably have been condemned and executed, while the intelligent and the educated, the philosopher and the man of the world, would, for the most part, have joined the unthinking populace, in thanking God, that a monster of wickedness had fallen beneath the arm of the law. 73. In a class of cases by no means unfrequent, this moral imbecility is particularly manifested in a morbid ac- tivity of the destructive propensity. An interesting case of this kind is related at length by Parent Duchatelet. 2 The subject of it was a little girl fourteen years old, who lived with her grandmother, a very respectable and religious woman, till the age of seven, when she returned to the charge of her parents. At this time, she is described as never playing, nor crying, nor laughing. She had been taught to read, sew, and knit, though quite averse to all instruction. Her mother being sick, she expressed regret that she was not dead, be- cause in that case she would inherit her mother's clothes 1 Edinburgh Phrenological Journal, vi. 147. 2 Annales d'Hygiene, vii. 173. IMBECILITY. 89 which she would alter so as to wear them herself. She de- clared that she would have killed her while sick if she could have evaded the observation of the attendants, and told her mother, who asked how she would have accomplished her purpose, that she would have plunged a poignard into her bosom. She said she was aware her father would put her in prison, but that would not deter her. A few months after- wards, on the occasion of the murder of a child, she told her mother that if she had killed her with a knife she would have got blood on her clothes, which would have led to discovery, and therefore she would have taken care to undress, before committing the act. Subsequently she said, she would use poison, in order to kill her mother. She frequently de- clared that she never loved her father, nor mother, nor grand- mother. It appears that from the age of four years she was addicted to the practice of self-abuse, and no precautions nor persuasions could deter her from this dreadful habit. Such was the moral state of this child, now eight years old, when she was examined by a commissary of the police, and sent to a con- vent. At the age of fourteen, she appears to have abandoned her murderous designs, but continued dejected and silent. 74. This form of insanity, which is above denominated moral imbecility, in order to distinguish it from that in which the intellect is affected, is not very rare in receptacles for the insane, and is more common in society than is generally sus- pected. It is seldom regarded in its true light, and when its subjects have occupied a high place in society, and thus been enabled to indulge more freely their mischievous pro- pensities, they have often been consigned by the historian to the eternal execrations of mankind. Count Charolais, brother of the duke de Bourbon Conde", whose sanguinary character has been commemorated by Lacretelle, was undoubtedly a case of this kind. He manifested an instinct of cruelty in the very sports of his childhood. He took a pleasure in tortur- ing animals, and committing the most ferocious acts of vio- lence against his domestics. He would stand at his window and shoot the artizans at work upon the neighboring build- ings, merely for the pleasure of seeing them tumble from the 8* 90 MEDICAL JURISPRUDENCE OF INSANITY. roofs and ladders. It is said that he loved to stain even his debaucheries with blood, and committed many murders from no motive of interest or anger. 1 Dr. Rush says that in the course of his life he had been consulted in three cases of moral imbecility ; and nothing can better express the true characters of their physiology, than his remark respecting them. " In all these cases," he observes, " there is probably an original defective organization in those parts of the body which are occupied by the moral faculties of the mind," 2 an explanation that will receive but little countenance in an age that derives its ideas of the mental phenomena from the exclusive observation of mind in a state of acknowledged health and vigor. To understand these cases properly, requires a knowledge of our moral and intellectual consti- tution, to be obtained only by a practical acquaintance with the innumerable phases of the mind, as presented in its vari- ous degrees of strength and weakness, of health and disease, amid all its transitions from brutish idiocy to the most com- manding intellect. 75. The prevalent error of looking at mind in the ab- stract, as a unique principle endowed with a certain apprecia- ble measure of strength and activity, has been the cause of much dispute and discrepancy of opinion, in cases where the acts of persons affected with Hoffbauer's first degree of im- becility, have been made the object of judicial investigation. One witness has observed a range and tenacity of memory which he could not square with his notions of mental weak- ness ; another, perhaps, has seen the party whose acts are in question conducting himself with the utmost propriety, and observing the social usages proper to his station, and this he has deemed incompatible with imbecility of mind; while another has heard him replying to questions on common- place subjects, readily and appropriately, and he also draws similar conclusions. On the other hand, he is seen engag- ing in occupations and amusements, and associating with company seemingly below the dignity of his age or station, 1 Histoire de France, ii. 59. 2 Diseases of the mind, 357. IMBECILITY. 91 by one who desires no -further proof of an imbecile mind; or he may be so extravagantly vain of some personal accom- plishments, as to impress another with the idea, that his un- derstanding has scarcely the strength of a child's. And it is worthy of notice, that oftentimes the very fact which fur- nishes undoubted proof of imbecility to one observer, conveys an unshaken conviction of mental soundness to another. Few, indeed, are capable of sounding the depths of another's intelligence, because few are aware of the necessity, or have the ability if they were, of scrutinizing, not one act or trait of character alone, but every intellectual manifestation as it appears in the conduct, conversation, and manners, as the only means of obtaining an insight into his real, mental ca- pacity. Scarcely a case comes up in which the understanding of an imbecile is judicially investigated, that does not furnish striking illustrations of this fact, as might be shown by numer- ous instances in point. The following, however, the first of which was adjudicated in 1832, may serve as examples. 76. " Miss Bagster was a young lady of fortune, and perpetrated a runaway-match with Mr. Newton. An appli- cation was made by her family to dissolve the marriage, on the ground that she was of unsound mind. The facts urged against her before the commissioners were, that she had been a violent, self-willed, and passionate child ; that this continued till she grew up ; that she was totally ignorant of arithmetic, and therefore incapable of taking care of her property ; that she had evinced a great fondness for matrimony, having engaged herself to several persons ; and that, in many respects, she evinced little of the delicacy becoming her sex. Dr. Suther- land had visited her four times, and came to the conclusion that she was incapable of taking care of herself or of her prop- erty. She had memory, but neither judgment nor reasoning power. Dr. Gordon did not consider her capacity to exceed that of a child of seven years of age. Several non-medical witnesses, who had known her from infancy, spoke of her extremely passionate, and occasionally indelicate conduct. On her examination, however, before the commissioners, her answers were pertinent and in a proper manner. No indeli- 92 MEDICAL JURISPRUDENCE OF INSANITY. cate remark escaped from her. Drs. Morrison and Haslam had both visited her, and were not disposed to consider her imbecile or idiotic. She confessed and lamented her igno- rance of arithmetic, but said that her grandfather sent excuses when she was at school, and begged that she might not be pressed. Her conversation generally impressed these gentle- men in a favorable manner as to her sanity. The jury brought in a verdict, that Miss Bagster had been of unsound mind since November 1, 1830, and the marriage was conse- quently dissolved." 1 77. There would seem to have been no doubt as to the existence of some degree of mental deficiency in this young lady ; the question was, whether it was constitutional, or merely the result of a neglected education and misplaced in- dulgences, and consequently capable of being remedied. In proof of its constitutional nature, we have the opinion of a respectable physician that she was incapable of taking care of herself or of her property ; and of another, that her ca- pacity did not exceed that of a child seven years old, which opinion is corroborated by the facts in evidence, that she was extremely passionate, and often indelicate in her conduct ; that her mind ran greatly upon matrimony ; and that she had not made the most ordinary attainments in knowledge. On the other hand, it appears that her education was unquestion- ably neglected ; that, before the commissioners, her answers were pertinent and in a proper manner ; and that two emi- nent physicians were not disposed to consider her idiotic or imbecile. It is obvious, that in cases like this, the opinions of the medical witnesses will depend very much, if not alto- gether, on the extent of their previous acquaintance with the manifestations of the mind, both in its normal and abnormal conditions. Hence it is that a trait by no means incompati- ble with imbecility was considered, in this case, as indicative of a proper soundness of mind. Persons laboring under far more imbecility than Miss Bagster, are capable, on occa- sions, of controlling themselves and concealing their more 1 1 Beck, Medical Jurisprudence, 579. IMBECILITY. 93 prominent faults to such a degree that a stranger finds it difficult to believe, that in point of understanding, they are much below the level of ordinary people. It should be recol- lected that imbecility is manifested in the conduct and man- ners, as well as the thoughts and language; and when it is considered that persons like Miss Bagster are confes- sedly of narrow understandings, and often of defective edu- cation, it could not be expected that strong indications of im- becility would be observed in their conversation alone. Her answers, it seems, were pertinent, and properly delivered, as they might well have been, if they related to things in which she was particularly interested, and were not beyond her powers of comprehension, and she still have been imbecile or stupid. In the description of the first degree of imbecility, already quoted ( 62), Hoffbauer expressly says that "the individual can very well judge respecting objects to which he is daily accustomed, and in familiarity with which he may be said to have grown up." It may be also added, that their answers are sometimes not only pertinent, but characterized by considerable pith and shrewdness. Miss Bagster's educa- tion was, no doubt, grossly neglected, but this circumstance could not have produced so much mental deficiency as to have impressed a careful and intelligent observer with the conviction that her capacity did not exceed that of a child seven years old. Neglected or vicious education is a cause of ignorance, but can never degrade the mind into a state of im- becility or stupidity, which are always either congenital or the effect of disease. Dr. Morrison indeed stated under oath, that he would undertake to teach her, in six months, arith- metic and the use of money, but his success would have been far from disproving the existence of imbecility. It is not doubted that in this condition of mind, there is some sucepti- bility of education, and the cases are not unfrequent where, in regard to one or two particular powers, the individual is quite on a level with his more happily-endowed fellow men. 1 1 I regret that the drift of these remarks on Miss Bagster's case has been entirely misunderstood. In a notice of this work in the British and Foreign 94 MEDICAL JURISPRUDENCE OP INSANITY. 78. In the case of Portsmouth v. Portsmouth, which was a suit of nullity of marriage, on the ground of the men- tal unsoundness (which was, in fact, imbecility in the first degree) of the husband, the Earl of Portsmouth, numerous facts were deposed to by witnesses, in proof that he pos- sessed a capacity and understanding fully equal to the ordi- nary transactions of life. It appeared that when at school he evinced a very good memory, and made respectable pro- ficiency in arithmetic and the languages; and that, after coming of age, he settled accounts with his agents ; attended public meetings and committees; prosecuted an offender, and was examined as a witness ; and that his friends had failed in making him the object of a commission of lunacy. In regard to 'these circumstances, the court, Sir John Nicholl, Medical Review (July, 1840), they are pronounced to be in contradiction with the views subsequently expressed in the chapter on Interdiction, and charged with favoring legal oppression. This case was quoted for the pur- pose of illustrating that discrepancy of opinion and irrelevancy of facts so often witnessed in medico-legal investigations of cases of mental imbecility which is the subject of the preceding paragraph. In the comments which follow, my object was merely to examine the value of certain evidence and show how far it proved or disproved mental imbecility generally. I contend that certain facts alleged in disproof of imbecility, are not incompatible with that condition, and it may be inferred, no doubt, from my remarks, that I con- sidered Miss B. as laboring under some degree of imbecility, a point which the reviewer himself admits. Whether the imbecility were of such a kind as to incapacitate her from being a party to the marriage contract, is a question very different from that of imbecility in the abstract, and one which I did not pretend to discuss. For any thing I have said to the contrary, it may have been the height of injustice to annul this marriage. What foundation, then, has the reviewer for his assertion, that the author " comes to the conclusion that the verdict was correct, and that this lady was really imbecile to a degree requiring legal interference ? " A closer examination of my remarks on this case would have satisfied the reviewer, I think, that they are nowise contra- dictory to the general principle prominently set forth in various parts of this work, that the legal consequences of the various forms of insanity, are to be determined by no general arbitrary rule, but always in reference to the particular act in question. I have since carefully read the report of this case in the Medical Gazette, vol. x., and have no hesitation in concluding that the verdict was correct, and that this lady was really imbecile to a degree requiring legal interference. IMBECILITY. 95 observed in substance, that the capacity for instruction and improvement is possessed even by the brute creation, and therefore did not of itself disprove the fact of imbecility; that when he appeared as a witness in a court of justice, it was only a simple fact he had to state, requiring little, if any thing, more than memory, and that his cross-examina- tion could require nothing more than the recollection of facts not any considerable exercise of the understanding and of the reasoning powers ; that his behavior in company, and his few observations on the state of the weather, horses, and farming, were not incompatible with great imbecility of mind, because, under the restraint produced by formal com- pany and by the sense of being observed, the more promi- nent features of imbecility would be shaded, and the indi- vidual might pass as possessing a considerable degree of understanding. On the contrary, it was satisfactorily proved that he had always been treated by his family as one of fee- ble capacity, and by a family-arrangement, he was married, when thirty-two years of age, to a lady of forty-seven, evi- dently for the purpose of saving him from improper con- nections, and obtaining for him suitable care and protection. It appeared that his servants were his play-fellows, and that he played all sorts of tricks with them ; that he was fond of driving a team, and that his wife so far indulged him, as to have a team of horses kept for his amusement as a toy and a plaything, with which he carted dung, timber, and hay ; that he had a propensity for bell-ringing, was fond of slaugh- tering cattle, and indulged in wanton cruelty towards man and beast, never expressing regret, but merely observing, " serves him right," on his own acts of cruelty. It also ap- peared that a medical man was taken into the family to assist in superintending the earl, and that he obtained com- plete ascendency over him, the mention of his name being sufficient to intimidate him and exact his obedience. This gentleman at last thought it prudent to deliver up his charge to the earl's trustees in London, one of whom, within one week after, married him to his own daughter. This mar- 96 MEDICAL JURISPRUDENCE OF INSANITY. riage was declared by the court null and void. 1 In the above statement a few facts only have been selected from a mass of evidence given by one hundred and twenty-four witnesses ; but this is sufficient to illustrate the general principle that proof of imbecility is not to be found in a few isolated facts, but in an investigation of the whole character and conduct of the party. 79. A similar diversity of views on the value of evidence respecting mental imbecility, was strikingly displayed in the Lispenard case which was finally decided in the New York Court of Errors in 1841. It arose out of the refusal of the Surrogate of New York to approve the will of Alice Lispen- ard, on the ground of mental incompetence. This woman was born in 1781 ; her father died in 1806, leaving her an an- nuity of $500 ; her brother died in 1808, leaving her, as one of his heirs at law, considerable property, and in 1834 she made her will, whereby she gave all her estate to A. L. Stew- art, her sister's husband, and appointed him sole executor. In 1836 she died. The probate of the will having been refused by the Surrogate, an appeal was made, first to the circuit Judge and from him to the Chancellor, both of whom sustained his decision. The case was then carried into the Court of Errors by which these decisions were overruled, and probate of the will decreed. It appeared in evidence that the devisor was always regarded by her family as mentally deficient, and that her father left her only an annuity of $500, because, as he states in his will, " it had pleased Almighty God that my daughter Alice should have such imbecility of mind as to render her incapable of managing or taking care of property." By several persons who lived or were intimate in the family, it was testified that she was washed, nursed, and put to bed 1 1 Haggard, 359. The reader who wishes to extend his inquiries farther, will find in the judgment of Sir John Nicholl, in Ingram v. Wyatt, 1 Hag- gard, 384, some excellent observations on the characters of imbecility, besides a masterly analysis of evidence relative to this condition, ranging through a life of seventy-four years. IMBECILITY. 97 the same as a child, until she was twenty-two years old ; that she had a vacant expression of countenance, and a silly laugh when spoken to ; that she dribbled at the mouth, had an awkward and unnatural carriage of the body, and a violent temper ; that she was not permitted to see company like the other children, but was kept out of sight ; that no one thought of entering into conversation with her ; and that all attempts to teach her beyond spelling short words of two syllables, were abandoned as impracticable. While at board, which was from 1817 to 1827, she was washed, dressed, and put to bed like a child ; cried when the children of the family refused to share their cake and candy with her ; ate her food vora- ciously ; would strike those around her when in a rage, which was not seldom ; and could not be taught the Lord's prayer. Although placed in the charge of a teacher in the house, she was found incapable of being taught to read, and forty years afterwards, when the attempt was renewed by her sister, it met with no better success. One .witness stated, that when six- teen or eighteen years of age, she preferred a sixpence to a dollar. Another could not teach her to distinguish a two shilling piece from a half dollar. Once she was found chok- ing a child six years old, until he was black in the face. In the selection of boarding-places she was never consulted, and it appeared that the families with whom she was placed, were in humble and narrow circumstances, without those conveniences and accommodations which she had a right to expect. Even when under the kind and judicious manage- ment of her sister, she submitted to be imprisoned in her room whenever it was ordered, and was frequently subjected to confinement as a punishment for misbehavior. On the other hand, it was stated that much of her deficiency might be attributed to the excessive indulgence of her parents, and especially to habits of intemperate drinking they had allowed her to contract. It appeared that she carried simple messages from one part of the establishment to another, and that she performed the duty of delivering out clothes for the wash, and soap, candles, starch, etc., to the servants. By her sister she was taught to perform some little offices about 9 98 MEDICAL JUKISPKUDENCE OF INSANITY. her own person and clothes, and to distinguish small pieces of money. Another witness had seen her washing cups and saucers. Another stated that when she wanted any thing she asked for it, and if medicine was given to her she would take it. On a very cold day when somebody was to be baptized, she said she would not be a baptist, to be baptized on such a day, and asked if they dipped them as they dip candles. She also told the witness that when her sister died, they put her into a coffin with a silver plate having her name and age upon it, and that when she (Alice) died, she would like to be put into such a coffin and laid in the same room. It was stated that while living in her brother's family, which was during the last fifteen years of her life, she had charge of the clothes that were sent to the wash, would give the neces- sary directions, and correct mistakes when they were re- turned ; that, she took charge of her own clothes, was very careful of them, and would send them to the sempstress if they needed repairing. In the absence of other members of the family, she would give directions to masons and carpen- ters employed in making repairs and alterations about the house, who obeyed her, and invariably found that her direc- tions were approved. She sent messages by the servants, kept an eye upon them, and reported their misconduct. She recognized persons whom she had known in her youth, but had not seen for many years, called them by name, made in- quiries respecting particular members of their families, and recurred to the scenes and amusements of her youth. She would inquire of visitors as to the health of particular mem- bers of their families with whom she was acquainted. Several other facts of similar importance were also related by the same witness. Another stated that when the children played school, Alice would act the mistress, and punish the others if they did not know their lesson. A clergyman who was somewhat acquainted with her, thought well of her under- standing, on the score of her religious attainments. " Her confession of guilt," he says, " might have implied a knowl- edge of the depravity of nature, the necessity of forgiveness, and the ability of God to forgive in any circumstances, IMBECILITY. 99 and might (when instruction had been received, as was the fact in her case) imply a knowledge of the atonement of Jesus Christ. Prayer is a means by which we receive the influence of the Holy Spirit ; and as she said she constantly prayed, it may naturally be inferred that it was for that influence." This opinion is hardly corroborated by the statement of another witness who said that when she read the Bible to her, "she would ask the meaning of Christ, and ask who Christ was. She would then turn round and laugh, and say, ' O, you devil ; ' and then would go down stairs laughing, and perhaps she would laugh till she got down to her room." A physician who was also one of the subscribing witnesses of the will, and had often conversed with the testator, thought her natural powers were sufficiently good for any transaction requiring memory or judgment; and that if her education had been carefully attended to, she would have become a highly useful member of society. On cross-examination, he stated that he did not regard her of ordinary understanding ; he believed her to be a weak woman, but whether capable of buying or selling, could not answer, not knowing that the duty was ever put upon her. Another physician, who enter- tained a similar opinion of her capacity, in answer to the question whether she could read, replied that he did not know and did not inquire ; he would have thought it an in- sult to ask her. It did not appear that she had any idea of the nature and extent of her property, or even called her brother-in-law, who had charge of it, to an account. Neither did it appear that she gave any instructions for the will which was prepared by the executor himself. At the time of the execution, however, and previously at different times, she declared her intention to give all her property to the executor, to the exclusion of all other members of the family. That there was great mental deficiency in this woman was not questioned, and it is not easy to perceive from the pub- lished statement of the evidence, how any one can believe that the will in question was her will, and not wholly and exclusively 'the will of the executor. If by means of any con- * 100 MEDICAL JURISPRUDENCE OF INSANITY. siderations, legal, medical, or psychological, the validity of such an act could be established, the decision of the court of appeals might be justified. It is worthy of especial notice that the ground of this decision was a technical construction of the phrase unsoundness of mind, if the views of the court were fairly represented by the two senators who expressed their opinions. The law of the State permits every male person eighteen years old, and every female (not married) sixteen years old, of sound mind and memory, to give and be- queath his or her personal estate by will or testament. Now, the mental deficiency of the testator, not being embraced in either of the kinds of unsoundness as defined by Coke ( 3), it follows that she was not incapacitated by law from mak- ing her testament. Her mind was weak but not unsound, and courts cannot measure the extent of people's understand- ing or capacities, however feeble they, may be without being positively unsound. 1 Such a distinction, however tolerable in the plea of an advocate laboring under the difficulties of a weak cause, could hardly have been expected in a judicial decision. 1 26 Wendell, 256. Stewart's executor vs. Lispenard. CHAPTER IV. LEGAL CONSEQUENCES OF MENTAL DEFICIENCY. 80. THE general principles that determine the legal relations of idiocy are so obvious, and the fact of its exis- tence so easily established, that little occasion has been afforded for doubt or diversity of opinion. The maxims of the law have sprung from the suggestions of common sense, and its provisions have equal reference to the best interests of its wretched subjects and of those who are about them. It may be- mentioned as a curious fact, however, that while the idiot is denied the enjoyment of most of the civil rights, he is quietly left by the constitutions of the several States of the union, in possession of one of those political rights, that of suffrage, the very essence of which is the deliberate and unbiased exercise of a rational will. How this anomaly has arisen, it is not easy to conceive. A natural jealousy of any attempt to encroach upon the popular right, might appre- hend evils to this institution in allowing the mental qualifica- tions of voters to be too closely scrutinized, but such fears could hardly have been expected in view of the unlimited control maintained by the law over the property and personal liberty of idiots. 81. The little indulgence shown to imbecility in crim- inal courts, sufficiently indicates that either the psychological nature of this condition of mind is very imperfectly under- stood, or the true ground on which the idea of responsibility reposes is not clearly perceived. Whichever it may be, it may no doubt be attributed to the prevalent habit of study- ing the moral and intellectual phenomena in sound and 9* 102 MEDICAL JURISPRUDENCE OF INSANITY. healthy minds only, without a suspicion, apparently, of the great modifications they present, when the development of the cerebral organism is interrupted by disease. It will be necessary, therefore, before coming to any positive conclu- sions relative to the legal accountability of imbeciles, to bring into view some considerations on this point, which have been too much, if not altogether, overlooked. 82. Our moral and intellectual constitution is con- structed in harmony with the external world on which it acts and by which it is acted upon ; the result of this mutual action being the happiness and spiritual advancement of an immortal being. Thus endowed with the powers of perform- ing the part allotted us, and placed in a situation suitable for exercising and- developing them, we become accountable for the manner in which they are used, to our Maker, under all circumstances ; to our fellow men, when the institutions of society are injured. All legal responsibility, therefore, is founded on this principle of adaptation, and ceases whenever either of its elements is taken away. The intellect must not only be sufficiently developed to acquaint the individual with the existence of external objects and with some of their relations to him, but the moral powers must be sound enough and strong enough to furnish each its specific incentives, to pursue that course of conduct which the intellect has already approved. It is nothing that the mind is competent to dis- cern some of the most ordinary relations of things, and is sensible of the impropriety of certain actions ; for so long as the individual is incapable, by defect of constitution, of feeling the influence of those hopes and fears and of all those senti- ments and affections that man naturally possesses, an essen- tial element of legal responsibility is wanting, and he is not fully accountable for his actions. 83. In the normal mind the idea of crime is associated with those of injury and wrong ; can we then impute crime where there is neither intention nor consciousness of wrong ? For want of the higher and nobler faculties, the actions of the imbecile are contemplated by him solely in relation to himself; not a thought enters his mind respecting their con- LEGAL CONSEQUENCES OF IMBECILITY. 103 sequences to others. For the same reason that he puts to death a brute, that of mere personal gratification, he mur- ders a fellow being, and is constitutionally unable to appre- ciate any difference in the moral character of the two actions. In the latter case, as in the former, he has a selfish object in view, and is restrained from pursuing his purpose by none of the considerations that actuate the sound and well-developed mind. The natural right of every one to the undisturbed possession of his own life, and the sentiment of wrong awakened by the infliction of injury, are things as far beyond the sphere of his contemplations, as the most difficult pro- blem in mathematics, and he merely feels the anknal im- pulse which to him has the strength of a natural right to appropriate to himself whatever will conduce to his momentary gratification. The thought of the wounds in- flicted on the friends and connections of his victim by his decease, cannot restrain him, because the feelings of benevo- lence and sympathy which they suppose, are utter strangers to his own bosom ; and it would be preposterous to expect him to be influenced by a regard to feelings which he never experienced himself. The sense of future accountability can- not restrain him, for the idea of an Almighty, All-seeing Being, ever witnessing his actions, is too confused and too limited in his mind, to present the slightest check to the in- dulgence of his caprices and passions. The fear of punish- ment cannot restrain him, because his intellect can discern no necessary connection between his crime and the penalty attached to it, even if he were aware of the existence of the penalty. To make such a person responsible for his actions to the same degree as one enjoying the full vigor and sound- ness of the higher faculties, is therefore manifestly unjust; because an essential element of responsibility is a power to refrain from evil-doing, which power is furnished by the exercise of those faculties that are but imperfectly, if at all, developed in the imbecile. The law looks only to the inten- tion, not to the amount of injury committed; and since there can be no criminal intention where there is no consciousness of wrong, it cannot properly reach those wretched objects, MEDICAL JURISPRUDENCE OP INSANITY. who, to use the expression of one of them, whose case will be shortly noticed, " can see no difference between killing an ox, and killing a man." 84. Many, it is true, find it hard to be convinced that one who labors under no delusion, and enjoys a certain de- gree, at least, of moral liberty, may still not be responsible for his criminal acts. They see, perhaps, that he has intelli- gence enough to perform the inferior kinds of employment, and feel assured that observation must have made him ac- quainted with the consequences of such acts, even though a stranger to that high moral power which instinctively teaches the distinctions of right and wrong. " He knew better," is their language, " and therefore justice requires his punish- ment." The error of this reasoning arises in the vulgar habit of estimating the strength and extent of the moral faculties by the ability to go through certain mechanical duties, and provide for the wants and exigencies of the present moment. Not only has this ability no connection with the moral senti- ments, but it is not even an index of the measure of intelli- gence ; any more than the skill of the bee or beaver in erect- ing their structures, is indicative of great intellectual re- sources. These degraded specimens of our race are not with- out the capacity of being educated in a limited degree ; and thus like those inferior animals which man has made con- ducive to his comfort, they are trained to perform some kinds of service with tolerable merit. This, however, no more proceeds from the kind of intelligence that discerns moral truth, than the isolated talent for music or construction not unfrequently met with in the complete idiot. 85. For the purpose of illustrating and confirming the above views, some account will now be given of a few criminal trials, the subjects of which seem to have been affect- ed with mental imbecility, stating very briefly the facts as they are found recorded, and accompanying them with such reflections as the particular circumstances of the case re- quire. They are well worth the consideration of every honest and unprejudiced inquirer, for he will find in them a kind of information which he can obtain from no other LEGAL CONSEQUENCES OF IMBECILITY. 105 quarter, and he will be able to see for himself, how little of true philosophy has presided over this department of crimi- nal jurisprudence. 86. In November, 1821, John Schmidt, aged 17, was tried at Metz for parricide. He had manifested, from an early age, a proneness to mischief and even cruelty. As soon as he was old enough to run in the streets, he would amuse himself by throwing stones into the rivulet, that ran through the village, in order to spatter and hurt the people who were passing by, many of whom were injured by him. They contented themselves, however, with charging his parents to take care of him, for he was even then considered to be mad. The first count in the indictment charged him with wound- ing on the head his sister-in-law, in one of their domestic quarrels. The second charged him with an attempt on the life of one of his cousins, whom he pushed into the water while fishing by the side of a pond, and then laughed at his struggles to extricate himself. When he finally succeeded, Schmidt approached him and asked if he were wet, and if the water had reached his skin ; the boy, to show that it had, opened his shirt, when Schmidt plunged a knife in his bosom. Happily, the wound was not severe. On the night of the parricide, the father was boiling pot- ashes. At four o'clock in the morning he called to his wife to come and assist him in lifting the kettle from the fire, but she refused and ordered John to go. John went in his shirt, and set the kettle on the floor, and while his father was bending over to stir the potashes, he struck him a blow with a hatchet lying near, that felled him senseless to the ground. He then ascended to the garret, where his brother and sister were sleeping, and severely wounded the latter with the hatchet. On being seized by his brother soon after, he asked to see his father, who had just expired ; and when gratified in this wish, he uttered these remarkable words : " Ah, my dear father, where are you now ? What will be- come of me ? You and my mother are the cause of my misfortunes. I predicted it long ago, and if you had brought 106 MEDICAL JURISPRUDENCE OF INSANITY. me up better, this would not have happened." When asked what had induced him to commit such an atrocious crime, he replied that the devil undoubtedly instigated him. He also declared that the itch, which he had taken from his sister-in-law, was repelled, and, in consequence, frequently occasioned a mental derangement and fits of fury which impelled him to sacrifice every thing. Several witnesses testified that he had always been remarkable for profound piety and religious habits. He confessed to his counsel that whenever he saw a cutting instrument, such as a hatchet, a knife, etc., he felt the strongest desire to seize it, and wound the first person that came in his way. His counsel unsuc- cessfully pleaded in his defence mental derangement, though Schmidt interrupted him by declaring that he was not mad. Shortly before the fatal hour, food was brought to him, but observing it to be meat, he refused to eat it, saying that in a few minutes it would be Friday. As he walked barefoot- ed to the place of execution, his confessor asked him if the pavement did not hurt him ? "I wish," he replied, they had made me walk on thorns." When he arrived at the scaffold, they cut off his hand, but he uttered not a word or a cry, and remained firm to the last. 87. Dr. Marechal, of Metz, who communicated this case, observes that he was struck with the smallness of the head, and its singular shape, and that on carefully examining his skull, he found the forehead very narrow and retreating, the sinciput tolerably high, and a marked prominence over the ears. He said it had the same shape as those of all the idiots mentioned by Pin el. 88. In Schmidt we have ample confirmation of the other indications of imbecility, in the physical structure which speaks a language that cannot deceive. If his cranium were shaped like those of the idiots described by Pinel, what better manifestations of mind or morals could have been expected from one thus stamped by nature with the impress of inferi- ority? This furnishes an explanation of his early indul- gence in brutal propensities, to such a degree, as to be re- garded mad ; and gives us a clew to the cause of his attempts LEGAL CONSEQUENCES OF IMBECILITY. 107 on life,,solely for the momentary gratification they afforded; of the motiveless and cold-blooded murder of his father ; and of that regard of religious observances which had no better foundation than the merest superstition. His inclination to kill on seeing a cutting instrument, shows some morbid action in the brain not uncommon in imbecility, which is also indicated by the paroxysms of fury in which he felt him- self urged on to indiscriminate slaughter. These vehement impulses, even the slight consciousness of wrong, denoted by his exclamation on seeing the corpse of his father, was totally unable to restrain ; and, by a process unknown to himself, and which he could only explain on the popular notion of the instigation of the devil, they would burst forth with fatal violence. His extraordinary proneness to mischief and cruelty, and the early age at which it began to appear, point distinctly to an original defect of constitution, which, though not attended by what is probably called mania, deprived him of all controlling influence over the purely animal propensities. Ferocity of disposition in imbeciles no more implies respon- sibility for criminal acts, than it does in the brutes ; and affords but an indifferent reason for ridding the world of their presence. To conclude, then, we cannot hesitate to believe with MM. Marechal and Georget, that Schmidt was one of those wretched beings who are disgraced by nature from their very birth, and whose vicious propensities are counter- balanced, neither by a sense of justice and morality, nor a fear of punishment. 89. Pierre Joseph Delepine, aged sixteen, was tried at Paris for eight different incendiary acts, committed in the Faubourg St. Antoine, in 1825. The first time, a bird, with burning tow dipped in spirits attached to its tail, was let loose in a garden adjoining that of the accused. At another time, August 17th, a fire broke out in the adjoining garden, two heaps of straw being burnt and a part of the wall destroyed. Three days afterwards, a grange belonging to Delepine's garden was burned, and three days after this, a cousin of his was awakened by a dense smoke, and soon discovered that a chest containing his effects was on fire. The next night, MEDICAL JURISPRUDENCE OF INSANITY. a person passing through the street, observed a heap of straw in flames at the farther end of the garden which laid on the street. He sprang over into the garden to render assistance, when Delepine and his family rose and finally extinguished the fire. While this was doing, a bucketful of burning charcoal was discovered in the garret, in time, however, to be extinguished. In the morning of the 7th September, a piece of burning canvas was found in a wood-closet under the staircase ; and Delepine, who expressed his astonish- ment, helped to extinguish the flames. Soon after, there was found under the two mattresses in his sister's room, a handful of burning flax by which the bed-furniture had been already set on fire, and some was also discovered in his own chamber, placed under his pillow, and an hour or two after- wards, a heap of straw in a neighboring garden was observed to be on fire. He was also charged with having committed several thefts. 90. On the trial, his father stated that the prisoner's intellectual faculties were not what might have been ex- pected from one of his age ; and, in support of his assertion, he adduced the nature of the criminal acts themselves, and the absence of sufficient motives to excite him to so many attempts, both against his own family, and people who were indifferent to him. He also produced a certificate signed by nine of his neighbors, which purported that Delepine's thoughts and feelings were frequently in a disordered con- dition; that he would often wander in his conduct and conversation ; that he would sometimes strip himself naked and run like a madman through his father's garden ; that they heard his parents say that in the January previous, he attempted to hang himself, and sometime after, to jump into a well. It appears from the evidence that he led an irregular life, was jealous of his brothers and sisters, and caused his father much uneasiness. At various times he had stolen from his parents, and it was for having stolen a horse that he met in the street, without its owner, that he was first arrested by the police. 91. On his trial, Delepine replied to the questions put LEGAL CONSEQUENCES OF IMBECILITY. 109 to him with calmness ; his countenance was devoid of ex- pression and presented a picture of stupidity. He denied the facts charged in the indictment, and could not conceive how they happened. The newspapers described him as having a low forehead; and all the witnesses who had an opportunity of knowing, agreed in believing that there was some singular defect in his mental organization. His mother testified that for some time previous his parents had had occasion to reprove him for his conduct, and that they had 'intended to seclude him. She said he was odd, addicted to the strangest tricks, and, in short, showed that " there was something wrong about his head," though he was not mad nor idiotic. This testimony of the mother was confirmed by that of eight or nine other witnesses, who agreed in repre- senting him as having been always very odd and strange in his conduct, and addicted to mischief, though not mad, nor, properly speaking, idiotic. He was, notwithstanding, con- victed, and condemned to death ; but he heard the sentence as unmoved as he had continued to be during the trial. 92. In a memoir addressed to the king by his counsel, M. Cleveau, he is described as being " weak in body, his face pale, his eye dull, and his mind infirm ; as manifesting no disposition for employment, wrapped in silence, and subject to convulsive agitations. He was in the habit of shunning his companions, and when he did incline to join them, he proposed only the most frightful sports. Once, in the middle of the night, he placed baskets on his head, wrapped himself in his bed-clothes, and ran through the garden, uttering the most fearful bowlings. On one occasion he kindled a fire in a stove with thirty crackers, and though covered with the ruins, he was not astonished at the result. After the trial, while in prison and in irons, and under the eyes of his keepers, he contrived to place burning coals in his bed, and then laid down upon it while actually on fire. It cannot be doubted that he is enslaved by a passion for conflagrations, incessantly haunted by images of flames, cinders, and ruins, and would not mind perishing himself, provided he could enjoy the sight of them, in the act. He belongs to that 10 110 MEDICAL JURISPRUDENCE OF INSANITY. class of wretched beings who are doomed from the cradle ; who live without motives, and are cut off without under- standing why." In consequence of this memorial, his pun- ishment was commuted for that of imprisonment for life. $ 93. While in prison he amused himself with scribbling his name in every variety of form on the copy of the indict- ment that was left with him ; by writing on it unmeaning or disconnected words, or words formed by letters put together at random ; by drawing on it grotesque figures, and changing the letters in such a manner that some parts of it could scarcely be read. Thus, the words, " Acte d'accusation contre Joseph Delepine," were changed in the following manner; Dacte deaccusationiss contre Josephu Delapine; and the first page is filled with ink-spots, and detached and insignificant words, such as, Marieux, meche, a mosire non, daceuler, mosieurje dit, bonjour a monsieur lent" etc. " Can it be conceived," says Georget, " that a person who is con- scious of the enormity of his crime, and who cannot be with- out some anxiety respecting the result of his trial, should be absorbed in such puerilities ? that he should read such grave charges, not only without a single emotion of horror, but even with the most perfect indifference, and use the paper containing them for his amusement? Such conduct not only displays insensibility, which is not rare in hardened criminals, but betokens the mind of a child; and in a lad of sixteen, indicates stupidity, silliness, and imbecility." The physical characters attributed to Delepine, and his manners, as described by those who were in the habit of frequently seeing him, clearly indicate a natural deficiency of his moral powers; but though his crimes were the acts of a child five or six years old, his imbecility alone may not be sufficient to account for the particular form his offences assumed. It must be borne in mind that imbecili ty, as in other abnormal conditions, there is not only deficiency and irregularity, but also a great tendency to diseased cerebral action, manifesting itself in excessive uncontrollable indulgence of some one or more propensities. In Delepine, it assumed the form of that monomania which consists in a morbid impulse, which the LEGAL CONSEQUENCES OF IMBECILITY. , 111 higher powers cannot restrain, to acts of incendiarism. That the incendiary acts of Delepine arose from diseased action in the brain, and not from mere love of mischief, is abundantly proved by the slightest examination of their nature. To let loose a bird with burning tow attached to it, without know- ing or caring where it would alight, is what, perhaps, might have been expected from a low and simple, .though sound mind, deliberately bent on mischief; but certainly, nothing less than genuine, unequivocal insanity, can account for his setting his own bed on fire, and then calmly lying down upon it. If, too, he had been actuated by malice or a pure love of mischief, it is absurd to suppose that he would have chosen his own home for its objects, and thus deliber- ately endeavored to deprive himself of a shelter, as .well as those on whom he depended. In short, the fact of imbecility, combined with mania, is so plainly written on the history of this singular case, that it would be hopeless, by any- addi- tional comments, to make it more clear to those who cannot read it for themselves. 1 94. Abraham Prescott was tried at Concord, ; New Hampshire, in September, 1834, for the murder of Mrs. Sally Cochran. 2 On the morning of June 23d, 1833, he left home with the deceased, who was the wife of his employer, for the purpose of picking strawberries in a neighboring pasture. An hour and a half afterwards, the family heard a whining, moaning sound in the barn, which was found to proceed from Prescott, who, on being asked what was the matter with him, said that " he had struck Sally [Mrs. Cochran] with a stake and killed her." He then went with them and showed them the body, which they found had been dragged a little distance from the place where the murder was committed, 1 The facts in the above cases are taken from Georget's "work, already referred to, entitled, Discussion medico-legale sur la Folie, 130, 144. 2 The facts of this case are derived from the report of the trial, published at Concord, in 1834, and from an article in the Boston Statesman of January 9th, 1836, entitled " Execution of Abraham Prescott." 112 MEDICAL JURISPRUDENCE OF INSANITY. and concealed among some bushes. On his way thither he asked the husband if he would hang him ; he showed no dis- position to escape, though not arrested till several hours after- wards, and slept soundly the succeeding night. He was eighteen years old, had lived three years in Mr. Cochran's family, by which he had been always kindly treated, and his conduct had been uniformly correct and satisfactory. No misunderstanding had occurred between him and any other member of the family, and they reposed unlimited confidence in his fidelity and attachment, though on one occasion it was strongly tried. On the 6th of January, 1833, that is, about six months previously, he arose in the night, procured an axe from the shed, went to the bed where Mr. and Mrs. Cochran were sleeping, and struck each of them some severe blows on the side of the head, which left them senseless. He then went to an adjoining room where Mr. Cochran's mother slept, and told her, he " believed he had killed Mr. and Mrs. Cochran." They recovered, however, and warmly repelled every suspicion of the truth of his own statement that he had committed the act in his sleep, unconsciously, though he had never been known to walk in his sleep before. For several months after the murder, he continued to explain his conduct in regard to it, by saying that while in the pas- ture he had the toothache, that he sat down on a stump, and fell asleep, and that was the last he knew, until he found he had killed Mrs. Cochran. On being much pressed by the coroner and warden to confess the whole truth, for they did not believe that he acted without a motive, and assured by them that he would stand a better chance of being pardoned if he confessed, he told these officers, that he made an insult- ing proposal to Mrs. Cochran, which she resented, and threat- ened to tell her husband of and get him punished ; that he supposed he should have to go to prison, and thinking he would rather be hanged than go there, he took up a stake and killed her. Subsequently, he stated that he did not make such proposals to Mrs. Cochran, and uniformly denied that he had ever so confessed ; but declared that the coroner LEGAL CONSEQUENCES OF IMBECILITY. 113 and warden had troubled him so much that he did not know what he told them. To the keeper of the jail and the clergy- men who visited him, he invariably stated, "that he attempt- ed to kill Mr. Cochran and his wife, in January, 1833, in order to get possession of their property ; and that when he found he had not despatched them, he feigned that he had been asleep when he did it. In June, his intentions were, first to kill Mrs. Cochran in the hollow, and then call down Mr. Cochran and kill him." 95. His counsel set up in defence the plea of homici- dal insanity, which they supported by quoting numerous cases of this disorder, and citing the opinions of high medi- cal authorities and witnesses ; and, in short, nothing was omitted by them that could help to render the defence satis- factory to the jury. Chief Justice Richardson, in his charge, strongly inclined to the belief of his insanity, and observed that if the prisoner " had been all the time sane, his conduct had certainly been most extraordinary. And on the other hand, if he had been otherwise than sane, it was a most ex- traordinary case of insanity." 96. There certainly are strong reasons for believing that Prescott was utterly unconscious of what he was doing when he murdered Mrs. Cochran, but, on the contrary, a careful examination of all the circumstances of the case presents us with still stronger reasons for thinking that he did know well enough what he was doing. It appears perfectly evident that he belonged to that wretched class of men, in whom mental deficiency is accompanied by more or less perversion of the moral faculties. Upon any other than this view of his mental condition, it is impossible to furnish a satisfactory explanation of his conduct and the circumstances attending it. His original statement that he was unconscious when he committed the murder, is opposed by his subsequent confes- sions that he was actuated by certain motives ; so that we are presented, in the outset, with the very unusual case of a criminal defended on the ground of insanity, who denies that he was insane, and furnishes rational motives for his conduct. There is good ground for believing that his last confession 10* 114 MEDICAL JURISPRUDENCE OF INSANITY. was the true one, first, because he could have had no reason then for inculpating himself falsely, while, on the other hand, the hope of escaping punishment was a sufficient reason for his fabricating the story which he told at first ; and, secondly, because it furnished the same motive for the attempt to kill in January, and this establishes a consistent and satisfactory relation between these two acts. To remove the only doubt in his favor, that of his sanity, and confess a fictitious motive for his conduct, is of itself, considering the circumstances of the case, strongly indicative of mental imbecility. We are obliged, therefore, to believe that he was actuated by a motive, and that this motive was a desire of gain ; and nothing can more strongly show the imbecility of his mind than the means which he took to obtain his object. It seems that the idea haunted his mind that the death of the Cochrans would put him in possession of their property ; and with this view, " he thought," as he said, " a thousand times of killing them along through the fall, before the attempt on their lives in January." When asked if he did not know that the prop- erty would descend to the children, he replied, " that he knew it would so descend, but he did not think of it at that moment." In fact he was not even the most distantly rela- ted to the Cochrans, and had no reason whatever for sup- posing that they had made testamentary dispositions in his favor. His imbecility is also strikingly manifested in the feebleness of spirit and want of resolution which character- ized his criminal attempts. He kills, as he supposes, both husband and wife in their bed ; but when he returns to their room and finds them still living, instead of completing his work by an additional blow, as the cool assassin would have done, he goes and arouses the rest of the family and the neighbors, and tells them what he has done. Again, instead of taking an opportunity when both his victims might be finished together, with some shade of secrecy, he despatches one in open day, almost within call of help, intending to trust to his chance of overpowering the other under similar circumstances. The latter part of this plan that of call- ing Mr. Cochran and killing him he abandons the mo- LEGAL CONSEQUENCES OF IMBECILITY. 115 ment he has murdered the wife ; and seems then for the first time to have thought of concealing the body and his own share in the bloody act. This purpose, too, he but half performs, and finally goes and discloses the whole transac- tion to the very person most interested in knowing it. Such conduct is perfectly inexplicable on the supposition of his possessing a soundly-acting mind ; but it is a fair specimen of that vacillation of purpose, feebleness of resolution, and capriciousness of design, which are among the most com- mon features of imbecility. Had he belonged to the class of ordinary criminals, he certainly, after obtaining the ob- ject he had in view in committing the murder, would either have fled, or taken some means of turning suspicion from ' himself and provided for his escape in this last resort. But he was an imbecile, and because he was an imbecile, he immediately proclaims his own agency in the act, relying for his safety on the very suspicious excuse of being uncon- scious of what he -was doing, an excuse which, at best, would not have saved him from much tedious, perhaps perpetual confinement, and the ineffaceable stigma of hav- ing murdered a fellow being. Even the motive he assigned to the coroner and warden, and on which the attorney-gene- ral rested the burden of his argument against him, supposing it were actually the true one, would only strengthen this view of his mental condition ; for none but an imbecile or an idiot would ever have imagined that he would be sent to jail for offering an insulting proposal to a woman, or would have preferred hanging to temporary imprisonment, and then added murder to insult for the purpose of obtaining his preference. Nothing that appears in what is said of him during his confinement, gives any higher idea of his moral and intellectual powers. The utmost efforts of zealous and judicious clergymen failed to impress him with a sense of his awful situation, or inspire him, in the least degree, with those cheering hopes which even the most abandoned crim- inals often entertain. This did not arise from a spirit of bravado, nor from the utter recklessness sometimes mani- fested by the hardened victims of the law ; but from stupid 116 MEDICAL JURISPRUDENCE OF INSANITY. indifference, or sheer inability to comprehend the simple truths of religion, or imagine any thing beyond the present worse than the annoyances to which he was subjected. In short, so obvious was his imbecility, that the writer, from whose statement the foregoing account is partly taken, ob- serves that " no one who has had any intercourse with Pres- cott has come to the conclusion that he is or has been insane, but they all consider him to have been deficient in intellect or common sense. 1 The signs of imbecility were not want- ing even in his physical constitution. A medical witness, who had been physician of a private asylum for the insane for fifteen years, speaking of his appearance at the bar, said, " the motion of his eye is idiotic, dull, lazy, indifferent ; no appearance of fear or anxiety in his countenance. I noticed no agitation, nor anxiety in the prisoner during the examina- tion of the first two government witnesses." It is also worthy of notice, that insanity had been a common disease in the Prescott family ; that his mother was fifty-six years old when he was born, and his father but one year younger ; and that the prisoner, when a child, had a scrofulous or rickety affection, for which they used cold bathing and some external remedies. Stronger predisposing causes of imbe- cility than these, when combined, do not exist. 2 1 It is true, that one -witness, with whom the accused lived a year and a half pi-evi^us to living with the Cochrans, described him as " intelligent," and another, who had been acquainted with him from a child, said, " he was as intelligent as boys in general ; " but when we bear in mind how ill-quali- fied most persons are to estimate the intellectual capacity of others, and that with them intelligence generally means only manual skill, or a tolerable apt- ness in performing the coarser labors of the farm and the work-shop, we shall place little reliance on these representations, more especially, too, as they are not sustained by other testimony. The keeper of the jail and his wife, who seem to have been particularly interested in him, and to have had con- siderable intercourse with him, both testified that they considered him " not as intelligent as boys in general." 2 Before dismissing this case, it is gratifying to be able to add, that the knowledge of the phenomena of insanity in its various forms, evinced by the court and by the counsel for the prisoner, and the general correctness of their notions, were exceedingly creditable to them, and present a remarkable LEGAL CONSEQUENCES OF IMBECILITY. 117 Such are the reasons that induce the belief, that Prescott was a subject of imbecility, not mania, that he belonged to that unfortunate class described by Georget ( 55) who know no other incentive than the gratification of animal passion ; and who are restrained from evil-doing by no higher sentiment than the fear of punishment. This conse- quence he certainly should have been made to suffer in a limited degree ; but to mete it out to him in the same meas- ure that is bestowed on ordinary criminals, was manifestly contrary to the principles of natural justice. 97. On the 14th of May, 1833, a young man, John Barclay, was executed at Glasgow, for the murder of Samuel Neilson, for whom he had previously shown some affection. He took from him three one-pound notes and a watch, to obtain possession of which seems to have been the cause of the murder. So little sense had he of having done wrong, or of his own situation, that he hovered about almost with- out disguise, and, while going to spend part of the money with the first person he spoke to, he dropped first one and then another note at his feet, as a child would have done. He was devoid of natural affection, and evinced no sorrow for what had happened. When questioned, he said he could see no difference between killing a man, and killing an ox, except that he " would never hear him fiddle again ; " and so little did he know of the nature of the watch, that he regarded it as an animal, and when it stopped from not having been wound up, believed it had died of cold from the glass being broken. His only idea of God was, that he was a muckle horse. He had no idea of time, and did not know the number of days in a week. So obvious was Barclay's mental deficiency, that the court of justiciary before whom he was brought, declined proceeding to his trial till it was decided by medical evidence, that he was a fit subject for trial. In his parish, he was familiarly known as " daft Jock contrast to the crude and narrow views so commonly taken by men in similar situations, who yet have had far ampler means of obtaining information on this branch of medical jurisprudence. 118 MEDICAL JURISPRUDENCE OF INSANITY. Barclay ; " and the clergyman, who knew him well, " always regarded him as imbecile, and had never been able to give him any religious instruction, and did not consider him a responsible being." Notwithstanding the fact that Barclay's weakness of mind was recognized by all parties from the judge downwards, and that the jury strongly recommended him to mercy on that account, he was condemned and exe- cuted. 1 It appears that much stress was laid on Barclay's knowing right from wrong, as affording indisputable proof of his being a moral agent. The reader may judge for himself, how extensive and accurate must have been the notions on this point, of one who thought a watch was a live creature, and who could see no difference between killing an ox and killing a man. In the above case the imbecility was congenital, and re- sulted from an imperfect development of the cerebral organ- ism. In the following, it was the effect of disease, perverting the normal action of the brain. 98. Louis Lecouffe, aged twenty-four years, was tried at Paris, llth December, 1823, for the murder of a woman whom he robbed of a quantity of plate. It appears that he was an epileptic from infancy ; and those who were in the habit of associating with him always regarded him as an idiot or fool. He had some disease of the head when very young. At fifteen, he showed manifest signs of insanity ; and affirmed that God, from time to time, came to visit him. His mother whom he strongly accused, and seriously com- promised by his disclosures, declared, even while she stigma- tized him as a monster and a villain, that he had always been in bad health, and hardly ever in possession of his senses. At his first examination he denied the charge, but subsequently he confessed, for the following reason. He stated that on the preceding night, while still awake, the spirit of his father appeared to him, with an angel at his right hand, and commanded him to confess his crime ; that God immediately after, placed his hand upon his heart, and 1 Edinburgh Phrenological Journal, x. 33. LEGAL CONSEQUENCES OF IMBECILITY. 119 said to him, " I pardon thee," and ordered him to confess every thing within three days. It appears that his mother, of whom he stood greatly in awe, had refused her consent to a marriage he was anxious to contract ; that she refused him again on another occasion, and, according to his confession, she long teased him to commit the murder and robbery, and decided his resolution by promising no longer to oppose his marriage. The plate was pawned for two hundred and thirty francs, of which his mother gave him only forty to defray the expenses of his marriage* He declared that his victim was fond of him, and that he deserved her good will by having rendered her many little services. On being confronted with his mother, he did not retract his assertions, but only showed some hesitation, saying he was not himself, and experienced a violent nervous attack. He said, next day, that if placed' again in the presence of his mother, he would be unable to answer for himself; that she would give him the lie, and he would not have firmness enough to main- tain the truth. Her unbounded influence and authority over him, which were deposed to by several witnesses, were such, that he did whatever she ordered him, and absolutely de- prived himself of every thing to support her, giving her all his earnings, without daring to retain a single sous. The keeper of the prison testified that he talked incoherently, and that he seemed idiotical and weak-minded. The chief keeper said, that he had often seen the accused with haggard looks, and eyes filled with tears, complaining of headache, but without manifesting any true derangement of mind. During the trial he had very frequent violent attacks of con- vulsions, and he stated that when he felt vexed, a kind of flame or flash passed before his eyes. 1 99. The facts here related may seem to some, to estab- lish the imbecility, or mania, or both, of Lecouffe, beyond a reasonable doubt; but not so thought the court or jury, and, accordingly, he was condemned and executed with his mother. Certainly, nothing short of great weakness of mind 1 Georget, Examen des proces crim. 120 MEDICAL JURISPRUDENCE OF INSANITY. can account for the entire submission of a man twenty-four years old to the despotic rule of his mother, to whom he yielded the last sous of his earnings, sacrificed his matrimo- nial scheme, on which he was strongly bent, and from whom he received only forty of the two hundred and thirty francs, for which, at her instigation, he had murdered his benefactress. That this mental weakness amounted to im- becility, is satisfactorily proved by the fear and convulsive agitations which he experienced when brought into her pres- ence ; by the common, opinion of those who were in the habit of associating with him ; and by the well-known effects of this disease on the understanding of its subjects. If Le- couffe, after suffering the disease his whole life, had still possessed a sound mind, it would have been a fact almost, if not altogether, without a parallel ; but that he did not escape its " deteriorating effects, is abundantly proved by the evidence adduced. Occasionally, his mental affection took the form of proper mania, as was indicated by the wildness and disorder of his looks, by talking incoherently to himself, by his groanings and mournful cries in the night, observed by one of the witnesses, by his nocturnal apparitions, and by the testimony of his own mother, that he was almost never in possession of his senses. 100. Against all this array of evidence, the advocate- general had nothing to offer but the idle declamation usually resorted to on such occasions. The attempts of the prison- er's counsel to establish the existence of imbecility and ma- ma, he reprobated in the severest terms, as dangerous to society, subversive of social order, destructive of morality and religion, and affording a direct encouragement to crime. It forms no part of the plan of this work to show the utter groundlessness of these assertions ; and they are mentioned here, merely that the reader may see what powerful consider- ations succeeded in invalidating the evidence in favor of Lecouffe, and consigning him to an ignominious end. 101. If the principles above laid down ( 69, 70, 74,) are not entirely incorrect, it follows that the persons whose cases have been related, were not fit subjects for criminal LEGAL CONSEQUENCES OP IMBECILITY. 121 punishment at least, not that of death. The usual treat- ment of such offenders, it is to be feared, is prompted more by prejudice and excited feelings, than by enlarged views of human nature and of the ends of criminal jurisprudence. While the public feeling has become too refined to tolerate the infliction of blows and stripes on the imbecile and the mad in the institutions where they are confined, and is inclined to discountenance altogether the idea of punishment as applied to the insane, it can still be gratified by gazing on the dying agonies of a being unable to comprehend the connection between his crime and the penalty attached to it, and utterly insensible of the nature of his awful situation. The voice of reason and humanity which speaks successfully in the first instance, is, in the last, drowned by the more imperious tones of prejudice and passion. When imbeciles are convicted on a charge of great criminal offences, the only rational course to be pursued with them, is that of perpetual confinement, which at once secures society from their future aggressions, and is most conducive to their mental and bodily welfare. 102. It has been already mentioned ( 69,) as an essen- tial defect in Hoffbauer's description of the various grades of imbecility and stupidity, that he has almost entirely left out of view the state of the moral faculties, an omission that is fatal to the value of the principles which he lays down relative to the legal consequences of this mental condition in connection with crime. The ground above taken ( 69, 70,) obliges us to consider the principle he has adopted, of gradu- ating criminal responsibility by the strength and extent of the intellect alone, as exceedingly partial and unjust in its operation. The only conditions of culpability which he recognizes are, first, a knowledge that the act is contrary to law ; and, secondly, that the act is precisely the one pro- hibited by the law. In the first degree of imbecility for in the third all legal culpability is annulled the absence of these conditions may be alleged in excuse ; but only, first, when the violated law neither forms a part of those general relations which concern the offender in common with 11 122 MEDICAL JURISPRUDENCE OF INSANITY. other members of society, nor belongs to his own particular condition or circumstances ; and, secondly, when the action forbidden by the law is not contrary to the law of nature. Accordingly, he considers " that inattention or absence of mind, want of foresight, etc. are not to be received in excuse when they have regard to objects universally known, as to fire, or to those which are familiarly used by the imbecile, as the tools, etc. of his profession. In all other instances his* fault loses the degree of culpability that belongs to it, in abstractor according to the expression of jurists. This is also the case when the act is the result of sudden anger or fear, to which weak persons are prone. 1 103. In determining the civil responsibilities and rela- tions of the imbecile, Hoffbauer's descriptions are not so unsuitable for practical application ; as these must chiefly be determined by the condition of the intellect alone. As his observations, however, have reference in a great measure to the legal regulations of his own country, they will be noticed no farther than merely to state his opinion that when imbecility reaches, or approaches the third degree, the party can no longer be considered capable of taking care of his property, or of bequeathing it by will. 104. No cases subjected to legal inquiry are more calcu- lated to puzzle the understandings of courts and juries, to mock the wisdom of the learned, and baffle the acuteness of the shrewd, than those connected with questions of imbe- cility. Much of the difficulty consists, no doubt, in a want of that practical tact which is obtained by experience, in unravelling their intricacies, and of that knowledge of the psychological nature of this condition of mind, which directs the attention exclusively to the real question at issue, and abstracts whatever is extraneous, or without any direct bear- ing on its merits. It is impossible to specify any particular rules for ascertaining the mental capacity of imbecile per- sons ; for circumstances, always proper to be taken into the account, are constantly varying with each individual case. 1 Op. cit sup. 55. LEGAL CONSEQUENCES OF B1BECILITY. 123 The education of the party, the sphere of life in which he has moved, his capacity of acquirement, his exposure to improper influences, and especially the nature of the act in question, are points which require a close and thorough consideration. In questions of interdiction which present the greatest difficulty, some overt acts of extravagance or indiscretion generally appear in evidence, when the party is really incapable of managing his affairs, which will remove the doubts that a direct investigation of his intelligence and capacity may have left behind. It ought to be considered as a general rule, that when no acts of this kind have been committed, notwithstanding the management of his property has been entirely in his own hands, beyond the control of others, the party ought not to be interdicted on the score of imbecility. In all cases it will be indispensably necessary, as Mr. Haslam advises, to investigate his comprehension of numbers, without which the nature of property cannot be understood. But the assertion of this writer, that " if a per- son were capable of enumerating progressively to the number ten, and knew the force and value of the separate units, he would be fully competent to the management of property," 1 is by no means to be admitted as true ; for it is very cer- tain that a large proportion of those whose mental capacity is unquestionably inadequate to the management of prop- erty, have, nevertheless, these arithmetical acquirements. Cases, even, are occasionally met with of imbeciles who possess surprising powers of calculation, but have not the competency of children to manage pecuniary affairs of any extent. No doubt the converse of the proposition, in refer- ence to people of doubtful capacity, comes nearer the truth. When there exists this inability of comprehending the value of numbers, the individual ought to be considered, in all questions of property, as legally non compos mentis, notwith- standing we might hesitate to adopt this conclusion, after an investigation of his intellectual capacity in regard to the 1 Medical Jurisprudence, as it relates to Insanity, 347. 124 MEDICAL JURISPRUDENCE OF INSANITY. general nature and relations of property and business trans- actions. 105. Imbeciles in the third degree are evidently inca- pable of making wills ; but not necessarily so, HofFbauer thinks, 1 are imbeciles in the first degree, even when subjected to a curator. The purpose of this guardianship is to protect them from the damage they might do themselves if left with the administration of their affairs, and to prevent them from entering into engagements which they would find it impos- sible to perform. But as testamentary dispositions depend on a single arrangement, and one which the testator may have taken time to think upon and mature, they do not require the same degree of intelligence as the administration of property, and therefore the validity of a will ought not to be considered as necessarily incompatible with the interdiction of the testator. As a general principle, the correctness of Hoffbauer's doctrine may be admitted, because it places no arbitrary restriction on the exercise of* a natural right, the abuse of which can be sufficiently prevented by judicial interference ; and because, if it be rejected, we may have the curious spectacle of a person debarred from having any voice in the final disposition of his property, in an act which really comes within the reach of his understanding, while in the management of his property, a judicious com- mittee is constantly paying all the deference to his wishes and suggestions which their reasonableness deserves. It cannot be denied that the nature and consequences of a testament may be sufficiently understood by many an imbe- cile who is utterly incapable of discerning the complicated relations that are involved in the management of property. For this reason it is said that, "if a man be of a mean understanding, neither of the wise sort, nor of the foolish, but indifferent as it were, betwixt a wise man and a fool, yea, though he rather incline to the foolish sort, so that for his dull capacity he might worthily be called grossum caput, 1 Op. cit. sup. 73. LEGAL CONSEQUENCES OF IMBECILITY. 125 a dull pate or a dunce ; such a one is not prohibited to make a testament." * Nothing can be more natural than that he should be attached to those who have rendered him impor- tant services, and perhaps have well-founded claims on his bounty ; and if anxious to leave some substantial token of his regard, no legal impediment ought to prevent him from bequeathing them a reasonable portion of his property. The danger anticipated from such an exercise of the testamentary power, is probably more imaginary than real ; for it can hardly be conceived that testamentary dispositions, which turn the descent of property altogether from its natural chan- nels, to heap it up in the lap of a stranger or a favorite, would not be attended by appearances of fraud or circumvention, that would inevitably destroy their validity. All that is required to establish the wills of people of weak under- standings is that they should have been capable of compre- hending their nature and effect, 2 a point entirely indepen- dent of the accidental circumstance of interdiction. Much injustice, therefore, might be committed by depriving ah 1 interdicted imbeciles of the testamentary power, compared with which the temporary inconvenience that would arise from the absence of any statutory provisions on the subject, is hardly to be mentioned. Of course, the slightest appear- ance of interference, or improper influence, should be closely scrutinized, and as much less evidence required to substan- tiate its existence, as the party is more likely to have been affected by it. The propriety of the practice here advocated was recognized on the 14th of February, 1808, by the Royal Court of Aix, who confirmed the will of the Sieur Beau- quaire, a person of weak understanding (though at the time of making it he was under the surveillance of a curator) ; for the reasons that the dispositions of the will were rational, and that the mind of the testator was capable f under- standing them, though too weak to be intrusted with the management of his property. 8 The French tribunals, ac- 1 Swinburne on Wills, part 2, s. 4. 2 Shelford on Lunacy, 275. 3 Sirey, Recueil gen. des lois et des arrcts. viii. 315. In coining to this 11* 126 MEDICAL JURISPRUDENCE OF INSANITY. cording to Georget, have ever shown themselves the pro- tectors of the right of making wills, taking into consideration the mental condition of the testator and the dispositions of the will itself. 106. It would seem to be reasonable that the validity of the contracts of imbecile persons not under guardianship, should be determined by the same principles, as that of their wills. This, however, is not the doctrine of the law, which does not recognize imbecility as a form of insanity. What- ever may be the nature or magnitude of the contract, the question at law is one, not of capacity or incapacity, but of soundness or unsoundness of mind; and on this question, the law " makes no distinction between important and com- mon affairs, large or small property." 1 Courts of law have always refused to invalidate the contracts of imbeciles and others of weak understanding, and courts of equity have declined to interfere, except on the ground of fraud. 2 There is this strong objection to this doctrine, that we have no rule, and cannot have in the nature of things, by which the ques- tion of compos or non compos can be uniformly determined ; for one court or jury, for instance, may range through the whole life and conversation of the party, while another may think itself obliged not to go beyond the particular act in question. A surer and safer principle is, that if the imbecile person is capable of comprehending the nature of the particular act, then has he all the capacity which the decision, the Court considered the testator to be one of those persons whose case is contemplated in the following article (499) of the Civil Code, in which the power of making a will is not mentioned among the civil acts, which they are rendered unable to perform. " In rejecting a petition for interdiction, the court may, nevertheless, if circumstances require, decree that the defend- ant is henceforth incapable of appearing in suits, of making contracts, of borrowing, receiving payment for debts or giving a discharge, alienating or pledging his property, without the aid of a council which shall be appointed in the same judgment." 1 4 Dane's Abridgment, 561. This point is discussed at some length, in Jackson v. King, 4 Co wen, 207. 2 1 Story, Commentaries on Equity, 238. LEGAL CONSEQUENCES OF IMBECILITY. 127 case requires, and the act should be established; and vice versa. Indeed, whether the question be one of capacity or soundness, regard must always be had to the nature of the subject to which the mind is applied, and the utmost respect for technical rules and definitions cannot prevent us from being governed by this rule, in the majority of cases. Noth- ing can be more unjust than to infer imbecility in general, from facts that establish its existence merely in regard to cer- tain subjects or relations. No one imagines a general or a statesman to be necessarily non compos, because the one may have shown himself incapable of conducting a campaign, and the other of controlling the destinies of an empire. And nothing can be more absurd, as well as unjust, than to con- clude that because a weak-minded person can be- shown to have acted shrewdly in small and familiar matters, he must possess a legal capacity for the transaction of the most im- portant and complicated affairs. Many an imbecile is per- fectly competent to purchase the necessaries of life, or make contracts relative to personal service, who could not be trusted with the disposal of an estate, or with making an investment of money. We cannot help concluding, there- fore, that the universal application of the rule, compos or non compos, is repugnant to the most obvious principles of justice. 107. Imbeciles in the third degree, and others of what- ever grade under interdiction, are legally incapable of con- tracting marriage, for since they are presumed to be incapa- ble of transacting business of the smallest amount, they must be equally so of becoming a party to a contract which is not only to affect their pecuniary interests, but their whole future happiness and comfort. When, however, the mental defi- ciency has not been sufficient to provoke interdiction, though plain enough to be generally recognized, it, very properly, constitutes no legal impediment to marriage, but on proof of fraud or circumvention, the marriage has been pronounced by the courts, null and void. 1 It is obvious that no general 1 1 Haggard Ecc. Rep. 355. Portsmouth v. Portsmouth ; Miss Bagster's case, Ante, 76. 128 MEDICAL JURISPRUDENCE OF INSANITY. rule can be applied to all such cases, for while marriage might conduce to the interests of each party in one case ; in another, it might be equally ruinous to the interests of one or both parties. Every case should be judged on its own merits, and only annulled when the mind of either party is proved to have been operated on by improper influences. CHAPTER V. PATHOLOGY AND SYMPTOMS OF MANIA. 108. WHILE medical literature is far from being defi- cient in works on Insanity considered as one of the most serious maladies to which man is liable, the popular notions respecting it are peculiarly loose and incorrect. As these, however, are the source of many of the faults in the jurispru- dence relating to this affection, it is necessary to enter some- what into its medical history, and to discuss points which might seem, at first sight, to be of an exclusively professional nature, but a proper understanding of which is absolutely necessary to save us from gross mistakes on this subject. Certainly no greater absurdity can be imagined than that of fixing the legal relations of persons in a particular state of mind, while entertaining the most imperfect notions of what that state really is, unless it may be that of pertinaciously clinging to those notions and discouraging every attempt to correct them, after the progress of scientific knowledge has shown them to be erroneous. Before describing the phe- nomena of mania, it should be distinctly understood that it is, first, a disease of the brain ; and, secondly, that in its vari- ous grades and forms, it observes the same laws as diseases of other organs. The importance of these propositions makes it proper to state the grounds on which they rest ; for until they are clearly recognized and appreciated, it will be in vain to expect any improvements in the medical jurisprudence of insanity. 109. I. Mania arises from a morbid affection of the brain. The progress of pathological anatomy during the 130 MEDICAL JURISPRUDENCE OF INSANITY. present century, has established this fact beyond the reach of a reasonable doubt. It can hardly be necessary at the present time, to prove the fact of the dependence of the mind on the brain for its external manifestations, that, in short, the brain is the material organ of the intellectual and affective powers. Whatever opinion may be entertained of the nature of the mind, it is generally admitted at least by all enlight- ened physiologists that it must of necessity be put in con- nection with matter, and that the brain is the part of the body by means of which this connection is effected. Little as we know beyond this single fact, it is enough to warrant the inference that derangement of the structure, or of the vital actions of the brain, must be followed by abnormal mani- festations of the mind ; and, consequently, that the presence of the effect indicates the existence of the cause. Whether the morbid action arises in the digestive, or some other sys- tem, and is reflected thence to the brain by means of the nervous sympathies, or arises primarily in the brain, the soundness of the above principle is equally untouched. This leads us to the source of the hesitation that has been evinced by pathologists to consider the brain as the seat of insanity. 110. From the fact that organic lesions are not always discoverable after death in the brains of the subjects of in- sanity, it has been inferred that the brain is not the seat of this disease ; though, if this fact were true, it being also true that no other organ in the body invariably presents marks of organic derangement in insanity, the only legiti- mate inference would have been, that, in some cases, it is impossible to discover such lesions by any means in our power. The strangest theoretical error which this apparent soundness of the brain in some cases has occasioned, is that of denying the existence erf any material affection at all, and attributing the disease entirely to an affection of the imma- terial principle. If the same pathological principles had guided men's reasoning respecting this disease, that they have applied to the investigation of others, this error would never have been committed. It will scarcely be contended, at the present day at least, that the structural changes, found PATHOLOGY AND SYMPTOMS OF MANIA. 131 after death from any disease, are the primary cause of the disturbances manifested by symptoms during life ; or that if the interior could be inspected at the beginning of the disease, any of these structural changes would be discovered. It is now a well-recognized principle, that such changes must be preceded by some change in the vital actions of the part where they occur. This vital change is now generally ex- pressed by the term irritation, and nothing is implied by it relative to the nature of this change, more than an exaltation of action. Irritation, then, is the initial stage of disease, the first in the chain of events, of which disorganization is the last, and, of course, nothing can be more unphilosophical than to attribute disturbances of function, exclusively to any structural changes that may take place during the progress of these successive stages. The departure from the normal course of vital action, which is probably as unexceptionable a definition of irritation as can be given, is sufficient to derange the functions of the part in which it occurs, without producing any visible change in its appearance ; and hence, we may oftentimes explore the dead body with the utmost minuteness and skill, without being enabled to infer from any thing we find, an adequate cause of death. Before this can be found, the initial stage must have continued more or less time ; and though it always tends to pass into the subse- quent stages, yet death may take place from various causes, before they are developed and before a trace of their existence can be detected. 111. There is this peculiarity in the pathology of insan- ity, that while the irritation deranges the mental functions so as to be manifest to every observer, its sympathetic effects upon the rest of the system are so slight that they contribute but little, comparatively, by their reaction, to develop the stage of inflammation. The consequence is, that cerebral irritation, sufficient to produce insanity, may endure for years, and death occur at last from other causes, without our being able to discover any morbid appearances. Thus their exist- ence, instead of being essential to the disease, is entirely the result of accidental circumstances. The probability of find- 132 MEDICAL JURISPRUDENCE OF INSANITY. ing inflammation or any of its products, will depend on the duration of the disease, and the share which it had in caus- ing the death of the patient. If it have existed for a short time only, or death have been occasioned by some other cause, examination will be likely to disclose no traces of mor- bid action ; but, on the contrary, if it have been of long stand- ing and have killed the patient by the constitutional disturb- ances it has produced, they will generally be found more or less abundantly. From not properly attending to these con- siderations, pathologists have been led into an egregious error by the absence of morbid changes, no less a one than that of denying the disease to be an affection of matter, and jumping at the absurd conclusion, that it is the spiritual principle alone that suffers. 112. It is not now denied, however, that the traces of disease, when they do occur, are oftener found in the brain than in any other organ ; nor that, in a very large propor- tion of the whole number of cases, the brain actually does show evident marks of having been diseased. And when we bear in mind the limited knowledge of the cerebral structure which pathologists have possessed till quite lately, and, consequently, the difficulty they must have experienced in detecting changes from the healthy condition, it may well be concluded that the absence of these changes might be attributed, in not a few instances, to the fault of the inquirer rather than to the nature of the disease. Certain it is, that as we have become better acquainted with the anatomy of the brain and with its sensible qualities, and been more thorough and persevering in our examinations, the rarer it has become to find a case of insanity presenting no organic changes after death. The very same observers who once could find nothing satisfactory in their pathological re- searches in the brains of the insane, have changed their views, as their field of observation has enlarged, and their acquaintance with the whole subject has been increased with time and practice, so that some have examined hundreds of subjects without finding one entirely free from some appre- ciable change. PATHOLOGY AND SYMPTOMS OF MANIA. 133 113. II. Insanity observes the same pathological laws as other diseases. Notwithstanding the air of mystery which ignorance and superstition have thrown around this disease, it cannot be said to present any thing very strange or pecu- liar ; nor are the discussions concerning it involved in the obscurity which is generally imagined. It arises from a mor- bid affection of organic matter, and is just as much, and no more, an event of special providence, as other diseases ; and to attribute it to the visitation of God in a peculiar sense, is a questionable proof of true piety as well as of sound phi- losophy. It follows the same course of incubation, develop- ment, and termination in cure or death, as other diseases ; sometimes lying dormant for months or even years, obscure to others, and, perhaps, unsuspected by the patient himself; at others, suddenly breaking out with little premonition of its approach ; and again, after being repeatedly warded off by precautions and remedies, finally establishing itself in its clearest forms ; just as consumption, for instance, sometimes begins its ravages so slowly and insidiously as to be percep- tible only to the most practised observer, for years together, while in another class of patients, it proceeds from the begin- ning with a progress as rapid as it is painfully manifest. But its presence no one thinks of denying in the former case, merely because its victim enjoys a certain degree of health and activity, though it would be no greater error than to deny the existence of insanity while the operations of the mind are not so deeply disturbed as to be perceptible to the casual observer. When fully developed, too, it may, like other diseases, give rise to severe constitutional disturbance, or it may scarcely affect the system at large ; as inflamma- tion of the digestive organs may occasion fever and intolera- ble pain, or lead its victim slowly to the grave, hardly aware of its presence, and in the enjoyment of comparative health. Like other diseases, insanity is made the object of remedial treatment, and often yields to judicious administration of* medicines, a sufficient proof of its material origin, for though the rationale of the operation of bathing, bleeding, and digitalis, is perfectly obvious in cerebral disease, it is not 12 134 MEDICAL JURISPRUDENCE OF INSANITY. so clear how they restore the spiritual principle to its natural vigor. It may proceed through its successive stages with a severity ever increasing to the end, or, like many other affec- tions of the nervous system, its progress may be interrupted by periods, more or less long, of relaxation of its ordinary force, from a mere abatement of the constitutional excite- ment and mental extravagance, to complete intermission of the disease, when the patient is apparently restored to all his original soundness. In its causes, also, insanity is under the dominion of no extraordinary pathological laws. It never arises in a mysterious way, as if abstracted from the ordinary relations of cause and effect, as it would do, were it an affec- tion of an immaterial principle ; but its origin may be readily accounted for in the same way as that of other diseases. Whether proceeding from hereditary predisposition, or ma- ternal influences during gestation ; from the cerebral irrita- tion produced by disease in other parts, or by external inju- ries ; from excessive or deficient exercise of the mind ; from great predominance or indulgence of some faculties with a small endowment or neglect of the rest ; from improper or insufficient nourishment or air; from the unbridled license of the passions ; or the habitual use of intoxicating drinks ; we see the influence of causes precisely analogous to those which give rise to other diseases. Mania also furnishes an illustration of a well known pathological law, in its tendency to be affected by remedies, in proportion to the recency of its attack, a fact which is totally inexplicable on the sup- position of the mind itself being idiopathically diseased. In common with other diseases it is benefited by proper air and exercise, cheerful conversation, friendly sympathy and atten- tion, and employments which furnish a healthful play to the actions of the whole system, and abstract the patient from the contemplation of his own condition. In short, through- out the whole history of mania, in its various forms, we clearly discover the evidence of a bodily disease, of a suffering organ; and in not a fact respecting it can we dis- cover any thing anomalous or at variance with the principles of diseased action. If this truth be steadily borne in mind, PATHOLOGY AND SYMPTOMS OF MANIA. 135 it will be a faithful light to our steps ; and no one at all acquainted with the subject, can question the importance of the influence which it will exert on judicial investigations. 114. Mania, then, being a disease and governed by the same pathological laws as other diseases, it will be incum- bent on us to give some account of its symptoms; and, since we consider a well-settled conviction of the above views as having an important bearing on the course of legal decisions, no further reason will be necessary for going more fully into this part of the subject, than at first blush might seem proper for our purpose. So closely are soundness and unsoundness of mind allied, that we are met at the outset by the difficulty already hinted at, of discriminating in some cases between mental manifestations modified by disease, and those that are peculiar, though natural to the individual. Madness is not indicated so much by any particular extrava- gance of thought or feeling, as by a well-marked change of character, or departure from the ordinary habits of thinking, feeling, and acting, without any adequate external cause. To lay down, therefore, any particular definition of mania founded on symptoms, and to consider every person mad who may happen to come within the range of its application, might induce the ridiculous consequence of making a large portion of mankind of unsound mind. Some men's ordinary habits so closely resemble the behavior of the mad, that a stranger would be easily deceived ; as in the opposite case, where the confirmed monomaniac, by carefully abstaining from the mention of his hallucinations, has the semblance of a perfectly rational man. Hence, when the sanity of an individual is in question, instead of comparing him with a fancied standard of mental soundness, as is too commonly the custom, his natural character should be diligently investi- gated, in order to determine whether the apparent indication of madness is not merely the result of the ordinary and healthy constitution of the faculties. In a word, he is to be compared with himself, not with others, and if there have been no departure from his ordinary manifestations, he is to be judged sane ; although it cannot be denied that striking \ 136 MEDICAL JURISPRUDENCE OF INSANITY. peculiarities of character, such as amount to eccentricity, furnish strong ground of suspicion of predisposition to madness. 115. For the first announcement of this great princi- ple, that, in doubtful cases, the mind of the supposed lunatic should be compared with his own when in its natural, habitual state, we are indebted to the late Dr. Gooch, 1 though it has been since developed and illustrated with an ability worthy of its importance, by Dr. Andrew Combe. If the truths contained in the following extract are faithfully considered by the medical student, he may be spared many an awkward mistake, which he might otherwise have com- mitted, and may save many a sound and worthy individual from incalculable pain and annoyance. " In investigating the nature of insanity, the first caution to be observed is, not to confound disorders of mental functions with natural quali- ties, which sometimes strongly resemble them. Many men in the full enjoyment of health are remarkable for peculiari- ties and idiosyncrasies of thought and feeling, which con- trast strongly with the general tone and usages of society ; but they are not on that account to be held as insane, be- cause the singularity for which they are distinguished is with them a natural quality, and not the product of disease ; and, from the very unlikeness of their manifestations to the modes of feeling and acting of other men, such persons are, in common language, said to be eccentric. It is true that, on the principle already explained, of excess in size of some organs over the rest being favorable to the production of insanity, eccentricity involves, all other things being equal, a greater than usual susceptibility to mental derangement; but still it is not mere strangeness of conduct or singularity of mind which constitutes its presence. It is the prolonged departure, without an adequate external cause, from the state of feeling and modes of thinking usual to the individual when in health, that is the true feature of disorder in mind; and the London Quarterly Review, XLII. 355. PATHOLOGY AND SYMPTOMS OF MANIA. 137 degree at which this disorder ought to be held as constitut- ing insanity, is a question of another kind, on which we can scarcely hope for unanimity of sentiment and opinion. Let the disorder, however, be ascertained to be morbid in its nature, and the chief point is secured, viz., a firm basis for an accurate diagnosis; because it is impossible that such derangement can occur unless in consequence of, or in con- nection with, a morbid condition of the organ of mind; and thus the abstract mental states, which are justly held to indicate lunacy in one, may, in another, speaking relatively to health, be the strongest proofs of perfect soundness of mind. A brusque, rough manner, which is natural to one person, indicates nothing but mental health in him ; but if another individual, who has always been remarkable for a deferential deportment and habitual politeness, lays these qualities aside, and without provocation or other adequate cause, assumes the unpolished forwardness of the former, we may justly infer, that his mind is either already deranged or on the point of becoming so. Or, if a person who has been noted all his life for prudence, steadiness, regularity, and sobriety, suddenly becomes, without any adequate change in his external situation, rash, unsettled, and dissi- pated in his habits, or vice versa, every one recognizes at once these changes, accompanied as they then are by bodily symptoms, as evidences of the presence of disease affecting the mind, through the instrumentality of its organs. It is, therefore, I repeat, not the abstract act or feeling which con- stitutes a symptom ; it is the departure from the natural and healthy character, temper, and habits, that gives it this meaning; and, in judging of a man's sanity, it is consequently as essen- tial to know what his habitual manifestations were, as what his present symptoms are." 1 116. Mania, under whatever form it may appear, is generally preceded, except when produced by injuries or moral shocks, by a change in the natural condition desig- 1 Observations on Mental Derangement, 196. 12* 138 MEDICAL JURISPRUDENCE OF INSANITY. nated by writers as the period of incubation. In the follow- ing paragraphs by Georget, we have a most accurate and graphic description of this state. " Sometimes," says he, " the action of the cause is strong and rapid ; at other times, more moderate and slow. In the first case, madness breaks out at the end of some hours or some days, after a state of anxiety and uneasiness, with headache, sleeplessness, agita- tion, or depression, and threatening of cerebral congestion ; the patient begins to babble, cry, sing, and becomes agitated and wild. He is then often taken for a person in a state of intoxication, and the mistake becomes apparent only after examining the previous circumstances and the duration of the malady. In the other case, thought only becomes affected gradually, and often very slowly ; the patient is generally conscious of some disorder in his intellectual faculties ; he is beset by new and odd notions, and by unusual inclinations ; he feels himself changing in his affections ; but, at the same time, he preserves a consciousness of his condition, is vexed at it, and tries to conceal it ; he continues his occupations as much as he can ; and lastly, as many people do in the first stage of intoxication, he makes every effort to appear reason- able. Meantime his health continues to give way, and he either sleeps less or loses sleep altogether ; the appetite di- minishes or disappears ; sometimes digestion is difficult, and constipation supervenes ; embonpoint decreases, the features alter, the monthly discharge becomes irregular, weak, and at last is suspended. At the same time, there is observed something unusual and even extraordinary in the tastes of the patient, in his habits, his affections, his character, and aptitude for business ; if he was gay and communicative, he becomes sad, morose, and averse to society, ; if he was orderly and economical, he becomes confused and prodigal ; if he had long abstained from the pleasures of love, he becomes the victim of insatiable desires, and either seeks to associate with the other sex, or has recourse to disgraceful practices ; if he was moderate in his political and religious opinions, he passes to an extreme exaggeration in both ; if he was open and candid, he becomes suspicious and jealous ; if a wife, PATHOLOGY AND SYMPTOMS OF MANIA. 139 she regards her husband and children with indifference ; the merchant neglects his business ; tears and laughter succeed each other without apparent motive ; the exterior of candor and modesty gives place to an air of conceit and assurance, which, especially in women, astonishes us. But all these phenomena are less prominent than they may appear to be here, and unless the individual have been insane before, no one may suspect the nature of the ailment which torments him ; all the questions put to him lead to no results, except that of fatiguing and giving him pain, for the ignorance that prevails relative to madness leads the friends to indulge in offensive insinuations, and to charge him with frivolous accusations, from not perceiving that he is under the in- fluence of disease, and not of reason. Sometimes the appetite either remains entire, or is speedily recovered, as well as digestion, nutrition, etc., and it is in these circum- stances that the conduct of the patient gives rise to a host of interpretations on the part of his relatives and the public." 117. " This period of incubation of mental alienation, during which the true state of the patient is generally mis- understood, or not appreciated, may last a long time. Pinel relates, that a man who believed his wife to have been ill only six months, the period of the invasion of furious de- lirium, admitted, after a multiplicity of questions, that the disease must have been going on fifteen years. The same author mentions elsewhere, that in several instanced, the maniacal or melancholic state, has begun four, six, ten, or even fifteen or twenty years previously. It is often easy to go back months, or years, in this way ; and we finally dis- cover that circumstances, taken for causes by the friends, are frequently only the consequences of unobserved disease. In fact, it often happens at that period of the malady, that a slight contradiction, or paroxysm of anger, or some cause equally insignificant to a person in good health, provokes the immediate and complete subversion of reason, and gives rise to mistakes as to its true cause and duration." 1 1 Dictionnaire de Medecine, art. Folie. 140 MEDICAL JURISPRUDENCE OF INSANITY. 118. Sooner or later this disorder of the cerebral func- tions becomes of a more obvious and positive character. The struggle between the convictions of his sounder reason, and the impulses of this new condition ceases, and the patient, instead of contending any longer against the ap- proaches of disease, or of concealing his thoughts, now believes in their reality, and openly and strenuously avows them, except when induced by powerful reasons to pursue a contrary course. The governing principle in the mind is gone ; ideas and perceptions occur in the utmost confusion and rapidity, and are connected by unnatural and incon- gruous relations. The attention is constantly wandering from one idea or object to another ; external impressions have lost their ordinary power, being overlooked or disre- garded amid the turmoil that prevails within. The indi- vidual is excited to action by strange and extraordinary motives, or by impulses that he finds himself unable to resist. His passions are easily aroused, and almost instantly reach their maximum of strength and activity. The higher affec- tions are dormant, while all his relations to his fellow men are viewed through a medium of fear, suspicion, jealousy, and distrust. His friends and relatives especially, are objects of his suspicions, and nothing can induce him to view them in any other light, than as enemies to his moral and physical welfare. Maniacs, when they recover, sometimes remember all thfe scenes and occurrences of their disorder. They can tell what they saw, heard, and felt, and explain the motives that governed their conduct. In some cases, however, the exercise of memory seems to be more or less suspended during the active stage of the disease, and the patient may recover his senses, like one awakening from a deep sleep, unconscious of the lapse of time, and every thing that has happened. 119. The symptoms of physical derangement are also striking and numerous. A febrile excitement pervades the system. The pulse is accelerated, the eye has a wild and glassy look, the sensations have become either more acute or more obscure, besides being frequently erroneous, and the PATHOLOGY AND SYMPTOMS OF MANIA. 141 patient sometimes complains of pain in the head, sense of weight, giddiness, ringing in the ears. The countenance greatly changes, and though varying differently in the differ- ent forms of insanity, yet in all it generally bears the expres- sion of physical pain, or mental disquiet. A singular insen- sibility to external impressions is often witnessed in this stage of mania, by means of which, exposure to intense cold, heat, hunger, and thirst, is borne to a wonderful degree, with- out producing uneasiness, or even consciousness of the fact. The muscular power is sometimes inordinately developed, the waking moments being a scene of almost constant rest- lessness and agitation ; while at others, there is an equally unnatural sluggishness and indisposition to move about. Hunger and thirst are seldom unaffected, the patient either taking immense quantities of food, or scarcely sufficient to supply the wants of nature. The maniacal patient sleeps less, and his slumbers are disturbed by frightful dreams. 120. Although the course of a maniacal attack is ordi- narily such as is represented above, yet sometimes, especially on the application of a powerfully exciting cause, it breaks out suddenly and terminates in death or recovery within ten or fifteen days. When cases of this description are sub- jected to judicial inquiry, it is often I difficult to satisfy a jury of the genuineness of the disease. The proofs, though suffi- cient for those who are much conversant with insanity, are very far from striking others with equal force. Most cases of transitory mania belong to that form of the disease to be described hereafter, under the name of homicidal mono- mania, and are supposed to be unaccompanied by delusion, or other intellectual disturbance. There is a smaller class, however, characterized by violence and confusion of mind, the patient being apparently under the dominion of some exclusive and overpowering idea. Their medico-legal impor- tance renders no apology necessary for introducing several of these cases. 121. A syphilitic patient having recovered from his dis- order, was about to quit the hospital, when suddenly, with- out the least premonition, he began to vociferate, and destroy 142 MEDICAL JURISPRUDENCE OF INSANITY. the furniture of his room. He stripped off all his clothes, tore out his hair, beat his head against the walls, and tried to bite and strike all who approached him. He seemed to be ex- cessively frightened, as if pursued by somebody who sought to take his life. His pulse was hard and quick, his body was covered with a cold sweat, he frothed at the mouth, and trembled violently. In the course of a couple of hours, he came to himself. He then said he had experienced a similar attack four or five years before, but could assign ho cause for either of them. 1 A sober and industrious shoemaker arose early one morn- ing, to go to his work, when his wife was struck by his inco- herent discourse and wild looks. He seized a knife and rushed upon her, when the neighbors seized him and pre- vented any damage. His face was red, pulse frequent and rather full, body covered with sweat, his eyes flashed, and his look was wild. About noon, he became calm, and slept. In the evening, he had recovered his faculties, but had no idea of what had happened to him. A young man laid down one evening in good health. Some persons entering the room, he threw at them whatever he could lay his hands upon, until he fell back upon his bed exhausted with fatigue. \ He sang, cursed, and tried to get at his sword. He knew nobody. His face was not red, nor his head hot ; but his eyes were wild, and his pulse rather full. The next day he had not the least recollection of what had occurred. A tailor of sober and industrious habits, after returning one morning from a walk, sat down, refused to eat, then suddenly began to upset every thing in the room, and finally rushed upon his wife, when the neighbors came in. The next day he had no recollection of the occurrence. 2 A young Irish laborer, on his way from Stonington to Prov- idence, R. L, went into a farmer's house towards nightfall, got some bread and milk, and went to bed. In the course of 1 Jahn, in Berlin Med. Gazette, No. 23, 1834. 2 These cases are from Marc. II. 511. PATHOLOGY AND SYMPTOMS OP MANIA. 143 an hour or two, he came down, half-dressed, into the kitchen where the family still were, talking wildly, and as if appre- hending some harm. On being prevented from going out, he rushed through the window, though closed, demolishing it entirely, ran down to a neighboring factory village, quite naked, and was there secured. Towards morning he began to come to his senses, and in the course of the day, had com- pletely recovered, with a partial recollection of what had hap- pened. He had never been so affected before. 122. In the two following cases, yet fresh in the public mind, we have examples of transitory mental disturbance, apparently of a maniacal character. The* evidence is not so satisfactory as would have been the results of the observation of persons specially acquainted with insanity. It was suf- ficient, however, to deter the jury from a conviction, and in the absence of other evidence, we are obliged to share the conclusions of the jury. In March, 1843, Mercer was tried by the court of oyer and terminer of New Jersey, for the murder of Heberton, on the 10th of February previous. He was defended by his counsel on the plea of insanity, and acquitted, though it does not appear that the acquittal was on this ground. We shall only notice such facts, which appeared in evidence, as have any bearing on Mercer's mental condition. On the 8th of February he was informed of the seduction of his sister, a young, simple-minded girl, by Heberton, a practised libertine. The communication made a powerful impression upon his feelings, attended with manifestations of the highest mental excitement. During the greater part of the day, he was strongly agitated crying and cursing sitting still and silent for a minute or two, and then violently striding through the room insisting on calling his father to come and shoot his sister, who had ruined and disgraced them all declaring that he would go and kill her himself, and abusing his friends for keeping him in the room. He did not seem to understand or appreciate any thing that was said to him, nor know what he himself said or did. On being told that the law could not hold Heberton, he became quite furious and wild. 144 MEDICAL JURISPRUDENCE OF INSANITY. His face had a mottled appearance, and his eyes were wild and staring. He complained that his head was burning, and bound around it a wet handkerchief. This conduct con- tinued in the evening. Of his condition during the next day we hear nothing from the witnesses, until late in the evening, when he accosted the captain of the watch, in an oyster-cellar, and without any previous acquaintance with him, insisted on telling him the whole story of his sister's disgrace. He said his sister was crazy, his father was crazy, his mother was crazy, and they were all ruined. He imag- ined that some trunks he saw in the street were Heberton's, and wished to watch them, lest he might elude him. His manner was wild, and his countenance haggard. He called for food and drink, but scarcely tasted of either. Another witness, who saw him the same evening, described his man- ner as being very wild and agitated. He said somebody was running away with his sister. On the 10th he passed by an acquaintance without seeming to notice him ; on meeting him a second time and being addressed, he looked with a vacant stare, turned and walked away in a wild and hurried manner. Another witness saw him walking up and down the street, his face red on one side and white on the other, looking wild and agitated. Witness spoke to him about some business Mercer and his son had together, hoping thereby to call his attention, but his answers were quite strange and irrelevant. He spoke of men with whom he had no acquaintance. While walking in the streets he frequently changed his course, and looked around anxiously, as if ex- pecting to see some one. That evening he shot Heberton, while sitting in his carriage in the ferry-boat. He immedi- ately confessed the act, and made no attempt to escape. Soon after he asked several different persons for a fiddle, that he might have a dance. During the coroner's inquest the same night, he sat resting his head on his arms over the back of a chair, recognizing no one. In the night, he said his sister was in the insane asylum. Shortly after his com- mittal he was visited by a physician who had been previ- ously acquainted with him. By him, Mercer was considered PATHOLOGY AND SYMPTOMS OF MANIA. 145 insane on the strength of the following facts. His face was flushed, his eye wild and wandering, his manner restless, his conversation was incoherent and rambling, and he miscalled persons and things, (this fact was testified to by several other witnesses). For two or three days he complained of a pain in his head, and was much constipated. Essentially the same was the testimony of two other witnesses (not medical), one of whom thought he was not quite himself, till the 18th. 1 123. The nature of the exciting cause in this case, ren- ders it not very strange that Mercer should have become in- sane, and the circumstances above related, touching his appear- ance, furnish no light proof that such was actually the fact. It certainly is not very far from the ordinary line of occurrences, that a high-spirited, nervous young man, suddenly hearing of the ruin of a beloved sister, should be completely over- whelmed and driven from his propriety, that reason should depart, and the passions rage with intense excitement. Why the disease should have run its course so rapidly, we know not. It is a common opinion, however, that this character of short duration is oftener witnessed in cases which, like this, have been attended by some dreadful deed of violence. Unquestionably, Mercer was in a towering passion, and to a certain degree, at least, he acted as if under its influence. But a storm of passion seldom, if ever, continues three or four days together. After the first outbreak, which spends its fury in a few hours, the mind settles down into a state of fixed, decided determination, forming its plans, and steadily and consistently pursuing them. How different from this was Mercer's case ! At no time, between hearing of his sister's infamy and revenging her wrongs, did he act with calmness, deliberation, and coherence. That he was under a high degree of mental excitement, is undeniable ; that he had also lost his reason, or, in scientific language, was laboring under a patho- logical irritation of the brain, is shown by some facts that cannot well be explained upon any other ground. To talk 1 The Dollar Newspaper. 13 146 MEDICAL JURISPRUDENCE OP INSANITY. wildly and incoherently, to imagine that a pile of trunks he happened to see in the streets were Herberton's ; that his family were all crazy, and his sister in a hospital ; to be con- stantly miscalling persons and things ; to talk familiarly of men whom he did not know ; to return irrelevant answers to questions on business, and, finally, after accomplishing the terrible act of revenge, to call for a fiddle that he might have a dance, these things are strongly indicative of insanity. In a large portion of cases recently attacked, which come in- to hospitals for the insane, the proofs of insanity are not more strong and abundant than they were in Mercer's case. Very often the disease is evinced, not so much by any particular word or act, as by incoherent and disjointed discourse, and by a course of conduct and demeanor at variance with the natural character of the individual. In this case, too, if the testimony may be relied upon, there were delusions, and these, if genuine, can only spring from insanity. . 124. Very similar to the above, in many of its features, was the case of Wood, who was tried for the murder of his daughter, the 30th of September. 1839, in Philadelphia. It appears from the testimony, that Wood, who was a confec- tioner, and considered an upright, industrious man, had for the last fifteen years suffered much from diseases of a nervous character, such as neuralgia, dyspepsia, and constipation, and exhibited much mental irritability. About a year before this event, while making some alterations in his house, he inter- fered with his workmen in a very unreasonable manner, fre- quently rubbing his hands together, and exclaiming he was ruined. Just before the event, he went to New York, where he was disposed to make some strange business arrangements; but suddenly left the city, neglecting to pay his board and to meet an engagement with a person whom he had engaged to see. On the 27th of September, he heard of the marriage of his daughter with a man whom he regarded as a great villain, and was much agitated by the communication. He walked the room in great distress, crying and moaning, and exclaim- ing that he was a lost, ruined man. He then shut up his shop and went running through the streets. When he returned PATHOLOGY AND SYMPTOMS OP MANIA. 147 home, he refused for half an hour to sit down, and when he did, he kept moving his head backwards and forwards. So strangely did he appear, that his neighbors requested his wife to remove his razors, and offered to watch him through the night. In the middle of the night he ordered his wife to go to the front window and call his daughter by name, for he heard her in the street crying to get in. On the 23th, he was very importunate to see his daughter, who had not been at home since her marriage. When she appeared, he raised his hands, uttered a wild scream, and fell down in a sort of fit, gnashing his teeth, and appearing to be in a great agony. He manifested no anger towards her, but treated her with his usual affection, and, on parting, they kissed each other, fh the afternoon he went into the streets, looking wild and agitated, as the day before. A colored man whom he knew, he requested to come to his house the next day, though it was Sunday, as he was to entertain a large party. In the night he arose, went to his daughter's room, laid his head down by the side of hers, crying violently and manifesting the most intense fondness for her. On the 29th, he was met in the street, walking rapidly along, by his family physician, who, noticing his strange conduct, beckoned him to come to him, but he merely put up his hand, made a rapid motion with it, turned round and went in the opposite direction. On the morning of the 30th he appeared quite weak, and drank two or three glasses of brandy. While his wife and a man-ser- vant were talking in the kitchen about confining him, he pro- ceeded to his daughter's chamber and shot her dead with a pistol. He made no attempt to escape, and confessed that he was the murderer, sauntering about the room apparently quite unconcerned. Shortly he laid down upon a bed and moaned heavily. When told that his daughter was dead, he expressed himself as satisfied ; said he should not long sur- vive ; and requested to be buried in the same grave. He then described the manner in which he had accomplished the bloody act. It appeared also, that he was a kind, amiable man, very fond of his children, not intemperate, nor accus- tomed to drink spirituous liquors at all, and that on the 27th, 148 MEDICAL JURISPRUDENCE OF INSANITY. 28th, 29th, he took no food, except a very little on the even- ing of the 29th. On his mental condition subsequently, the testimony throws no light. He was acquitted on the ground of insanity. 1 125. This case differs from Mercer's in the important fact that, for some time previous, Wood had been laboring under a certain degree of mental impairment, and was appar- ently on the verge of insanity. In this state he hears of the marriage of his daughter, which, in his mind, was equivalent to her ruin and the dishonour of himself and family. Over- powered by the shock, his nervous system becomes violently agitated, and reason soon ceases to control his movements. In this state of bewilderment and confusion, he wanders about, without aim or object, till at last, when the powers of nature are about to yield from pure exhaustion, impelled by no passion, and actuated by no rational motive, he takes the life of his beloved child. That he did not act from passion, is evident from the fact that he had evinced no anger towards her, but, on the contrary, had shown the strongest affection. The only passion which could have actuated him at that moment was revenge, and in that case, the object of his fury would have been the daughter's husband. It may be sup- posed, perhaps, that the bloody deed was perpetrated under the influence of the liquor he drank ; or, at any rate, that it would not otherwise have been done. This, no doubt, is possible, but the true question at issue is, whether or not he was insane for two or three days previous to the criminal act. If he were, then the intoxication was the effect of insanity, and he was no more accountable for the former than for the latter. A fondness of strong drinks is a not uncommon ac- companiment of mania, and a person may drink while insane, who never drank before. The conditions of this case were all favorable to the production of insanity, a highly irritable, nervous temperament, a morbid apprehension of coming ills, and a powerfully exciting cause of the disease. Where is the wonder, then, that Wood should have become insane, 1 Spirit of the Times, Philadelphia. PATHOLOGY AND SYMPTOMS OF MANIA. 149 and while so, that he should have committed any imagina- ble folly or crime ? 126. The mental disorders are, of course, as numerous and various as the mental constitutions of the insane them- selves ; and to consider any particular association of them as characteristic of the state of mind called mania, would be only to blend things together that have no uniform nor necessary relations to one another ; and would convey no more really valuable information, than it would to marshal forth every symptom that has at any time been observed in the countless disorders of digestion, as the symptoms of diseased stomach. The only use which the physician makes of the latter is to refer them as they occur, to some particular derangement of that organ, and thus establish the ground for an appropriate and efficient treatment. There is no reason, why the same process should not be pursued in mania ; and it is because a different one has been followed, that the common notions of this disease are so loose and incorrect, as not only to be of little service in judicial discus- sions, but absolutely in the way of arriving at just and phi- losophical conclusions. To furnish any light on the subject, it would be our duty to analyze the various phenomena of mania, associate them by some natural relations, and refer them, as far as our knowledge will permit, to particular facul- ties. It is proposed, therefore, following this idea as closely as possible, to consider mania as affecting either the intellec- tual, or the affective faculties ; meaning by the former, those which make us acquainted with the existence and qualities of external objects and the relations of cause and effect, and conduct us to the knowledge of general truths ; and by the latter, those' sentiments, propensities, and passions necessary to man as a social and accountable being. It is not intended to convey the idea that mania is invariably confined to one or the other of these two divisions of our faculties ; for though they may sometimes be separately affected, the one present- ing a chaos of tumult and disorder, while the other appa- rently retains its wonted soundness and vigor, yet more frequently, they are both involved in the general derange- 13* 150 MEDICAL JURISPRUDENCE OF INSANITY. ment. But unless we study these disorders separately, and recognize their independent existence, and this effect it is the tendency of the above classification to produce, we never shall be able to refer them to their true source, nor dis- cover their respective influence over the mental manifes- tations. CHAPTER VI. INTELLECTUAL MANIA. I 127. INTELLECTUAL MANIA is characterized by certain hallucinations or delusions, 1 in which the patient is impressed with the reality of facts or events that have never occurred, and acts more or less in accordance with such belief; or having adopted some notion not altogether unfounded, carries it to an extravagant and absurd extent. It may be general, involving all or the most of the operations of the understanding ; or partial, being confined to a particular idea, or train of ideas. SECTION I. General Intellectual Mania. 128. The general description of mania is equally appli- cable to the acute state of this, and sometimes of other forms of the disease. It is not generally till after the excitement has somewhat subsided, that the distinctive features of each become very manifest. In this stage of general intellectual 1 These terms, though they have long held a place in medical language, have always been used with remarkable diversity and vagueness of meaning. Without troubling the reader with an array of nosological definitions, it will be sufficient to say, that in this treatise, the former is used as a general desig- nation of all those notions which are indicative of derangement of the reflec- tive, as the latter is of the perceptive powers. 152 MEDICAL JURISPRUDENCE OF INSANITY. mania, many glimpses of natural soundness may be discov- ered amid the intellectual disorder. 1 Questions on indifferent subjects may be appropriately answered ; many of the pa- tient's relations to surrounding circumstances may still be perceived ; and no little acuteness and ingenuity are often manifested in accommodating the real and true to the delu- sions under which he labors. The difficulty is to fix the attention on a particular point, the mind constantly running from one idea to another, or absorbed in the thoughts which happen, for the moment, to predominate over every other. 129. In the present state of our knowledge of the mental constitution, it is not strange to find considerable diversity of opinion respecting the nature or cause of hallucinations of the senses ; yet, in a medico-legal point of view, it is impor- tant that they should be correctly understood. Hoffbauer 2 says that they consist in a vicious relation between the im- agination and the senses, in consequence of which the patient mistakes the creations of the one for objects really perceived by the others. Esquirol, not entirely satisfied with this ex- planation, divides them into two classes, termed by him, illusive sensations, and hallucinations. 8 The first arise in the senses, as when a maniac mistakes a window for a door, passes through it and is precipitated to the ground ; or takes the clouds which he sees in the sky for contending armies ; or believes his legs are made of glass ; or his head turned round. In all these instances, the error refers to the real impression which is ill-perceived ; there is an error of sensa- tion, a vicious relation between the sense which actually perceives and the intellect which judges falsely of the exter- nal object. In the second, on the contrary, the senses have no share ; the imagination alone is exalted ; the brain is exclusively the seat of the disturbance ; the patient mistak- ing the creations of his imagination for objects actually present to his senses. He sees images and apparitions amid the thickest darkness ; hears sounds and voices in the most 1 Pinel, Traite" sur 1' alienation mentale, 142, 148. 2 Op. cit sup. 84. 8 Idem, 82, note. GENERAL INTELLECTUAL MANIA. 153 perfect silence ; and smells odors in the absence of all odor- ous bodies. This distinction does not seem to be well sup- ported. That the functions of the senses are sometimes greatly perverted, there can be no question ; but it needs more evidence than we yet have, to prove that such per- versions bear much if any part in producing these illusions ; more especially as Esquirol admits, that, in what he terms hallucinations, an exalted imagination is sufficient of itself to produce a very similar effect. In old age, where, in con- sequence of the decay of the senses, wrong impressions are being constantly received, they nevertheless give rise to none of these delusions. When the hero of Cerventes did battle with the sheep and the windmills, it will not be con- tended that he was laboring under any special optical in- firmity which conveyed false impressions of outward objects, because on most occasions, the action of his senses was un- dquivocally sound. Ready as he was to mistake a company of peaceable shepherds for the creations of his disordered intellect, he never imagined Sancho to be any other than his faithful squire, for the reason that his reflective faculties were not so far subverted as to be incapable of any healthy action. Besides, if erroneous sensation has any thing to do with producing these illusions, we must go the length of asserting, that at such times all the senses are disordered, or deny that the errors of one may be corrected by the others. It is not so strange that vision should sometimes be so affected as to deceive a person with the idea that his legs are made of glass or butter, but it certainly is very strange, that on such occasions, the other senses should all return equally false impressions ; the touch being unable to distinguish the feel of flesh and blood, and the hearing the sound produced by striking them, while they retain this power in regard to every other part of the body. These illusions appear to result from a morbid excitement of the perceptive faculties, whereby they are stimulated by outward impressions to in- voluntary and irresistible activity, while a coexistent impair- ment of the reflective faculties prevents them from being considered as illusions and not actual realities. The physi- 154 MEDICAL JURISPRUDENCE OF INSANITY. cian will not unfrequently hear a patient complaining of seeing colors of the utmost beauty and variety of combina- tion passing and repassing before his eyes, or forms of ob- jects of every possible description, whether his eyes be open or shut, the room dark or light. His understanding being sound, he is not deceived, but believes them to be what they actually are, merely illusions ; but if, on the contrary, it were unsound, then these illusions would be taken for realities, and he would conduct accordingly. Ben Jonson would keep awake an entire night, gazing at armies of Turks and Tar- tars, Carthaginians and Romans contending around his great toe; in which amusement there is no evidence of mania, but merely of a morbid activity of the internal per- ceptive organs. The apparitions of Nicolai of Berlin, and others of a similar kind, arose, no doubt, from the same cause. Indeed unnatural excitement of these organs in in- sanity is sometimes so obvious and well-marked, as to be immediately recognized and properly understood. Rush gives the case of a young woman who delighted her visitors with her efforts in singing and poetry, though previously she had never manifested any talent for either ; and the author once attended an insane patient of feeble intellect and defect- ive education, who occupied much of her time in making verses, though she had not shown the slightest trace of such a power before the invasion of her disease. The faculty of construction, too, is occasionally heightened to a wonderful degree. Pinel speaks of a maniac who believed he had dis- covered the perpetual motion ; and in the course of his re- searches he constructed some very ingenious machines. The common and essential element, then, in the production of hallucinations and illusive sensations, is an impairment of the reflective faculties accompanied by morbid activity of the perceptive faculties. The only real difference between them is, that in the latter, the morbid activity of the percep- tive faculties requires to be excited by outward impressions, while in the former, this effect is produced by the remem- brance of past impressions, a distinction that can be of but little if any importance, in judicial investigations. We GENERAL INTELLECTUAL MANIA. 155 have been thus particular in showing the true origin of hal- lucinations, that any mistake arising from wrong views of their nature might be avoided, an event not altogether beyond the limits of possibility, for one instance has come to our own knowledge, where it was attempted, in a court of justice in a neighboring State, to measure the extent of the insanity by the comparative number of the senses supposed to be deranged in the hallucination. 130. Hallucinations of the senses occur in a large pro- portion of maniacs. In the early stage of acute mania they are generally numerous and changing, and somewhat masked by the more conspicuous symptoms. In chronic mania they are more simple, uniform, and obvious. Occasionally, how- ever, this rule is reversed, the hallucinations being very dis- tinct and vivid from the beginning of the disease. And it should be borne in mind, that when it is the predominant feature of the mental disorder, the patient is disposed to conceal it from others as long as he retains sufficient control over his thoughts. A little strangeness of demeanor may, for months, be the only perceptible deviation from the natu- ral condition, the reason, in the mean while, struggling with the suggestions of the hallucinated sense, till it finally yields, and the patient, in obedience to some voice or vision, commits a sudden and fearful act of violence. In the still- ness of night they are more common and often more vivid than during the day. For the most part their occurrence is irrespective of times and seasons, and whether in solitude, in the church, in the gay assembly, in the midst of animated conversation, in the pursuit of pleasure or of business, the attention may be arrested at once, and the whole soul en- grossed by the powerful appeal to the senses. When the patient describes his hallucinations, there is a remarkable air of sincerity and frankness in his manner, which no art of simulation can successfully imitate. 131. To determine exactly what mental impairment it is which is essential to insanity, metaphysicians and physi- ologists have long and anxiously labored with hardly the shadow of success. The various definitions and explana- 156 MEDICAL JURISPRUDENCE OF INSANITY. . tions to which their inquiries have given rise, display some ingenuity, but would scarcely be worth considering in this place, were they not capable of an injurious application in judicial investigations. It has been said that insanity con- sists essentially in diseased perception, that this is the common attribute of its various kinds and degrees. We have seen above, however, that in a state of perfect mental soundness, the perceptions may be deeply disordered, inso- much as to give rise to strange and most extraordinary im- pressions, while many a madman may be found who evinces no one single error of perception. The doctrine that in- sanity consists in false judgments, conveys no more satisfac- tory notion of its essential characters, for though there most certainly is false judgment in every case of insanity, it is far from being confined to this condition of the mind. Every one is occasionally guilty of some gross error of judgment on which he may reason accurately and arrive at specious con- clusions, without being considered at the time madder than his neighbors. Locke, as if strongly impressed with the curi- ous fact of the coexistence of absurd fancies with the power of reasoning smartly and pertinently to a certain extent, which is occasionally observed in the insane, remarked that they did not seem to have lost the faculty of reasoning, " but having joined together some ideas very wrongly, they mis- take them for truths, and they err as men do that argue right from wrong principles." * If Locke had possessed any prac- tical acquaintance with insanity, if he had even spent an hour in a well-managed hospital for the insane, he never would have adopted this opinion, for nothing can be farther from the truth, than the idea that generally madmen reason correctly from wrong premises. The lady who imagined that a tooth which a dentist had removed, had slipped from his fingers and, stuck in her throat, and insisted that she could not swallow a morsel, while she ate and drank heartily, was as wrong in her conclusion as she was in her premises ; and the man who, like Bellingham, imagines that the gov- 1 On the Human Understanding, Book II. ch. xi. 13. GENERAL INTELLECTUAL MANIA. 157 ernment has been culpably negligent of his private interests, and thence proceeds to take the life of a person whom he believes to be perfectly innocent, in order that he may have an opportunity of bringing his affairs before the country, errs in every stage of his reasoning. Indeed, it is matter of com- mon observation, that maniacs display their insanity, not more in the delusions which they entertain, than in the course they pursue in order to accomplish their objects. The last and most ably-supported speculation on this subject is that of Dr. Conolly, who makes insanity to consist in " the im- pairment of any one or more of the faculties of the mind, accompanied with, or inducing a defect in the comparing faculty." l There can be no doubt that this power of compari- son is often, perhaps generally, affected in insanity ; but it may be questioned whether this author has not referred many phenomena to this faculty of the mind, which more properly belong to some other. And even when the mental disturb- ance does unquestionably flow from defect in the comparing power, it would seem as if this defect were but the conse- quence of one affecting more deeply the secret springs of thought. It is said that the celebrated Pascal sometimes believed that he was near the brink of a fearful precipice, and that his attendants, to allay his apprehension of falling down it, were accustomed to place a chair near him, in the direc- tion of the supposed precipice. " He then compared what was done with what appeared to him," says Dr. Conolly, " and drew the just conclusion, that a chair could not stand upon air, beyond the brink of a precipice, and that he was not therefore in real danger." " Whenever the comparison could be made," he adds, " the delusion yet remaining, he was not sane on the subject of the precipice." 2 Now it can- not be denied that in both instances, Pascal saw the chair, and was sensible that it was in the direction of the precipice, and that the real difference between them was, that in the 1 Indications of Insanity, 300. 2 Idem, 316. 14 MEDICAL JURISPRUDENCE OF INSANITY. former he could, in the latter he could not, draw the just con- clusion that a chair could not stand upon air. It is evident that, in this case at least, and there is much reason to believe the fact is a general one the faculty of the mind primitive- ly affected was that which recognizes the relations of cause and effect. We might multiply examples of this fondness for definitions, but enough has been said on this point, to con- vince the student of legal medicine how barren of all practical benefit such speculations are, and to place him on his guard against their admission in judicial investigations, as tests, or criteria of insanity. 132. It is not to be understood that, in this form of mania, the derangement is confined to the intellectual fac- ulties, the moral continuing to be exercised with their ordi- nary soundness. On the contrary, the moral faculties sel- dom escape its influence ; and one of the earliest symptoms of the disease is an unaccountable change in the patient's social and domestic feelings. He becomes indifferent to those whom he loved the most ; the mother thinks no longer of her children, or regards them with loathing ; the child forgets his parents ; the husband is insensible to the endearments of his wife ; and love, attachment, and friendship are replaced by hatred, jealousy, and indifference. These traits, however, are not so prominent as the intellectual disorders, (except in the earliest stage of the disease) and besides, are very different from those which characterize that form of mental derange- ment to be presently described under the title of moral mania. * SECTION II. Partial Intellectual Mania. 133. By the ancients this form of the disease was called MELANCHOLIA, on the supposition that it was always attended by dejection of mind and gloomy ideas. This term was used and so understood by modern writers, till Esquirol PARTIAL INTELLECTUAL MANIA. 159 proved its improper application by showing that the ideas are not always gloomy, but frequently of a gay and cheerful nature. He substituted the term MONOMANIA, which is now in general use ; arid though possessing a more correct and definite signification, it embraces, besides the cases which come under the present division, a class that will be treated of under a different head. Still, for convenience' sake, the use of the term will be continued, with the understanding that it always refers to that form of insanity which is the im- mediate subject of discussion. 134. Monomania is often described as a derangement of any one or few of the intellectual faculties, but incorrectly, upon our views of the constitution of those faculties, many of which may be simultaneously deranged by the action of disease, without necessarily producing insanity. This point has been already established, when speaking of those affec- tions of the perceptive faculties which give rise to apparitions, and change, to appearance, the outward qualities of objects. ( 129.) A multitude of cases are recorded, in which the faculty of language too has been wholly or partially lost, while the soundness of the reasoning powers remained unimpaired ; indeed there is not a single perceptive faculty whose functions have not been sometimes obliterated or diminished, without being accompanied by insane delusion. It is evident that before a person can be insane, partially or generally^, the mental faculty or faculties must be deranged, by which we discern the relations of things, and arrive at the knowledge of general truths. 135. The most simple form of this disorder is that in which the patient has imbibed some single notion contradic- tory to common sense and to his own experience, and which seems to be, and sometimes no doubt really is, attended by errors of sensation. Thus, thousands have believed their legs were made of glass, or that snakes, fish, or eels had taken up their abode in their stomach or bowels. In many such cases the hallucination is excited and maintained by impressions propagated from diseased parts, the presence of which has been revealed by dissection after death. Esquirol, in a 160 MEDICAL JURISPRUDENCE OF INSANITY. memoir read before the institute, 1 a few years since, has re- lated numerous cases in proof of this proposition, among which is that of a woman who insisted she was pregnant with the devil, in whose womb there was found, after death, a mass of hydatids ; of another, in the Salpetri^re, who imagined that a regiment of soldiers lay concealed in her belly, and that she could feel them struggling and fighting. with each other; and of another, who believed that the apostles and evangelists had taken up their abode in her bowels and were occasion- ally visited by the pope and the patriarchs of the Old Testa- ment, in both of whom, the intestines were found agglu- tinated together in consequence of chronic peritonitis. That these hallucinations are not always connected with corporeal impressions of this kind, seems to be proved by the fact, that they are sometimes dissipated by the skilful application of arguments, or mano3uvres, by which the patients are made to believe themselves cured of their complaint. The story of the " Turned Head," in the " Diary of a Physician," ludicrous as it is, is scarcely a caricature of the truth ; and one of M. Manry's patients, who, after thinking himself cured of a ser- pent in his bowels by means of a pretended surgical opera- tion, suddenly took up the idea, that the creature had left its ova behind ready to be hatched into a brood of young ones, was again restored by the dexterous reply of his physician, that the snake was a male. 2 In this class of cases, the mind is not observed to have lost any of its original vigor, and its soundness on every other topic remains unimpaired, though there unquestionably does exist some derangement in the reflective faculties. 136. In another class of cases, the monomania takes a little wider range, involving a train of .morbid ideas, instead of being limited to a single point. The patient imbibes some notion connected with the various relations of persons, events, time, space, resistance, etc., of the most absurd and unfounded nature, and endeavors, in some measure, to regu- 1 Des Maladies Mentales, ii. 211213. 2 Medico-Chirurgical Review, N. S. xxi. 524. PARTIAL INTELLECTUAL MANIA. 161 late his conduct accordingly; though, in most respects, it is grossly inconsistent with his delusion. It is certainly not one of the least curious phenomena of our mental constitu- tion, that these hallucinations will sometimes continue for years together, unaffected by time, and proceeding parallel, as it were, with the most sound and healthy operations of the mind, though more often, the predominant idea instead of enduring in this manner is frequently changing, one in- sane notion disappearing to give place to another and another. Rush says that he knew one clergyman and had heard of another, who were deranged at all times, except when they ascended the pulpit, where they discovered, in their prayers and sermons, all the usual marks of a sound and correct mind ; and he speaks of a judge who was rational and sen- sible upon the bench, but constantly insane when off it. 1 The celebrated case of the Rev. Simon Browne is another remarkable instance of this kind. For many years before his death, he entertained the belief that "he had lost his rational soul," though during that time he evinced great ability both in his ordinary conversation and in his writings. Having discontinued all public or private worship, he ex- plained to his friends, that " he had fallen under the sensible displeasure of God, who had caused his rational soul gradu- ally to perish, and left him only an Minimal life in common with brutes ; that it was therefore profane in him to pray, and incongruous to be present at the prayers of others." In a book of some merit which he dedicated to the queen he speaks of himself as " once a man ; and of some little name ; but of no worth, as his present unparalleled case makes but too manifest ; for, by the immediate hand of an avenging God, his very thinking substance has for more than seventeen years been wasting away, till it is wholly perished out of him, if it be not utterly come to nothing." 2 137. The operations of the understanding, even on subjects connected with the insane belief, are sometimes not 1 On Diseases of the Mind, 204. 2 An account of this case may be found in the Gentleman's Magazine, 1 762. 14* 162 MEDICAL JURISPRUDENCE OP INSANITY. impaired in an appreciable degree ; on the contrary, we are occasionally struck with the acuteness of the reasoning power displayed by monomaniacs. Muratori relates the case of a Jesuit, named Sgambari, who believed himself a cardinal, and claimed to be addressed by the title of emi- nence. A friend was anxious to convince him of his error, and obtained a patient hearing of his remarks. When he had finished, the madman replied ; " either you consider me in- sane or rational ; on the latter supposition, you do me injus- tice by your remonstrances; on the former, I hardly know which is the most mad, I, for believing myself a cardinal, or you, for thinking to cure a madman by such reasonings." 1 138. Though monomaniacs are generally ready enough to declare their predominant idea, yet when sufficient induce- ment exists, such as interest, fear -of ridicule, etc., they will occasionally conceal it ; and this, too, without the occurrence of a lucid interval, and while they believe in its reality as firmly as ever. Chambeyron, the French translator of Hoff- bauer's treatise, speaks of " a woman who on her admission to the Salpetriere told one of the overseers, ' that she was an apostle, and that Louis XVIII. had remembered her in his will.' " " The next day," says he, " at my visit, I asked her reasons for entering the hospital. ' If I tell you,' said she, * you will think me madv' On my protesting to the contrary, however, she replied, ' well I am remembered in the will of Louis XVIII.' Of the other notion whose absurdity was more palpable, she said not a word. Now [a few days after] she denies that she ever entertained either notion, though her conduct and coversation prove that she still believes them both." Some cases of a similar kind are also related in Erskine's speech in the defence of Hadfield. Georget speaks of a lady who thought she was deprived of the power of sen- sation, and professed to feel neither fatigue nor the ordinary wants of nature, comparing herself to a machine moved by springs. Believing she never should recover, she made several attempts at suicide ; at times she was greatly agi- 1 Hoffbauer, Op. cit. sup. 86, note. PARTIAL INTELLECTUAL MANIA. 163 tated, and abused her female companion. And yet this lady received visits, and sometimes passed whole evenings with persons of her acquaintance without manifesting the slightest disorder in her mental faculties. 1 139. It has just been stated, ( 129) that any one of the perceptive faculties might be disordered, without any derangement of the reflective or reasoning powers. The true nature of these cases is generally quite obvious, but as those in which the faculty of language is affected, might, by the careless or incompetent observer, be mistaken for insanity, they require a particular notice in this place. It is a curious, though well-established fact, instances of which are related numerous enough to fill a volume, that the faculty of language, of the power of representing thoughts by appropriate articu- late or written signs, may be utterly or partially lost, the other mental powers remaining sound. This disorder either arises from slight congestion in the brain, or is the sequel of traumatic or pathological lesions of this organ, especially of apoplexy. The patient is observed to be more or less inca- pable of communicating his thoughts and feelings by spoken or written language, the words appearing to be arbitrary signs totally unconnected with ideas. When a word is pronounced slowly and distinctly, he may be able to repeat it once or twice, seldom oftener, or he may be unable to articulate at all. In some cases the power -of language is soon and completely regained; in some, a slight stammer- ing or hesitancy is observed, as long as they live ; while in a few the power never spontaneously returns, the person being obliged to learn to read and write, as if he had never known how before. Mr. Hood relates a case 2 in which the patient, a blacksmith, lost the memory of all words except yes and no, while he comprehended distinctly whatever was said to him. Though able to understand what was read to him from a book, he could not himself read. When a name was pro- nounced, he would repeat it once or twice, but before he 1 Nouvelle discussion medico, leg. 23. 2 Phrenological Transactions, 255. 164 MEDICAL JURISPRUDENCE OP INSANITY. could do it a third time, it was utterly gone. Within a few days of the first attack, he would go to his shop and attend to his workmen, but though he lived three years afterwards, his power of language though much improved, was always greatly impaired. Another case has been related l where the patient received an injury on the head by falling from a coach-box, one effect of which was the loss of the use of all language, but the "word oui. In other respects his mind was entirely sound. In some cases, this loss of the memory of words is confined to common and proper nouns. This hap- pened to the celebrated naturalist Broussonnet who entirely recovered from an attack of apoplexy, except that he could never after utter nor write the names of persons or things, though other parts of speech were at his command in abun- dance. When he wished to designate an individual, he described his figure, his qualities, and occupation. He recognized the name at once, when pointed out to him in a book, though it never would occur spontaneously to his memory. 2 In other cases of this kind, the patient is observed to have forgotten every thing but substantives. One is mentioned whose " apprehension of the use and importance of substantives was keen 'and unimpaired, but he could not succeed in perceiving the modifying influence of articles, adjectives, or adverbs. Of verbs he had a very imperfect recollection." 8 Esquirol had a patient who recollected no words but substantives, and but few of them, using generally abstract terms corresponding to states of the mind, the ordinary events of life, etc., but not indicating the objects by which he was surrounded, or those presented to his senses. Thus when asked how he was, he would reply : " malheur, injustice, audacite", courage, piete", mort." 8 140. In the simplest form of monomania, the under- standing appears to be, and probably is, tolerably sound on all subjects but those connected with the hallucination. 1 Jour, de la Soc. Phrenol. no. 2, art. 5. 2 Cuvier, Eloges historiques, i. 341. 8 W. A. F. Browne. Edin. Phrenol. Jour. viii. 415. * Idem. PARTIAL INTELLECTUAL MANIA. 165 When, however, the disorder is more complicated, involving a longer train of morbid ideas, we have the high authority of Georget for believing, that though the patient may reason on many subjects unconnected with the particular illusion on which the insanity turns, the understanding is more exten- sively deranged, than is generally suspected. If we could follow these people to the privacy of their own dwellings, narrowly observe their intercourse with their friends and neighbors, and converse with them on the subjects nearest to their thoughts, we should generally detect some perversity of feeling or action, altogether foreign to the ordinary character. Cases illustrative of this remark will frequently occur to the reader in the course of this work ; and it is not necessary to insist on the importance of this fact in estimating the degree of criminal responsibility remaining in monomaniacs. It is a fact that must never be forgotten, that the phenomena of insanity do not lie on the surface, any more than those of other diseases, but oftentimes can be discovered only by means of close and patient examination. CHAPTER VII. MORAL MANIA. 141. THUS far mania has been considered as affecting the intellectual faculties only; but a more serious error on this subject can scarcely be committed, than that of limiting its influence to them. It will not be denied that the propen- sities and sentiments are also integral portions of our mental constitution ; and no enlightened physiologist can doubt that their manifestations are dependent on the cerebral organism. Here, then, we have the only essential conditions of insanity, a material structure connected with mental manifesta- tions ; and until it is satisfactorily proved that this structure enjoys a perfect immunity from morbid action, we are bound to believe that it is liable to disease, and, consequently, that the affective, as well as intellectual faculties are subject to derangement. In fact, it has always been observed, that insanity as often affects the moral, as it does the intellectual perceptions. In many cases there is evinced some moral obliquity quite unnatural to the individual, a loss of his ordi- nary interests in the relations of father, son, husband, or brother, long before a single word escapes from his lips, " sounding to folly." Through the course of the disease, the moral and intellectual impairments proceed pari passu, while the return of the affections to their natural channels, is one of the strongest indications of approaching recovery. Such being the fact, it ought not to be a matter of surprise, that in some cases the aberration should be confined to the moral impairment, the intellectual, if there be any, being too slight to be easily discerned. MOKAL MANIA. 167 142. To moral mania, as a distinct form of the disease, the attention of the profession was first directed by the celebrated Pinel in the beginning of the present century. Previously to that time it was a matter of universal belief, that insanity is always accompanied by derangement of the reasoning powers, and a recognition of this fact entered into every definition of the disease. Participating in the common belief, he found, to his great surprise, on resuming his researches at the Bi- cetre that there were many maniacs who betrayed no lesion whatever of the understanding, but were under the dominion of instinctive and abstract fury, as if the affective faculties alone had sustained injury. This form of mental disorder he designated as manie sans delire. The examples which he gives, being chiefly characterized by violent anger and unbounded fury, by no means furnished suitable illustrations of the affection now styled moral insanity, though they do illustrate a particular form of that disorder. This defect, however, has been amply supplied by the researches of others, which have made us acquainted with a great number and variety of cases, in which the affective faculties, either singly or collectively, were deranged, independently of any appreciable lesion of the intellect. The reality and impor- tance of this distinction which thus establishes two classes of mania, is now generally acknowledged by practical observers, among whom it is sufficient to mention Esquirol, Georget, Gall, Marc, Rush, Reil, Hoffbauer, Andrew Combe, Conolly, and Prichard, though some of them are inclined to doubt whether the integrity of the understanding is so fully pre- served in moral mania, as Pinel believed. Still, its apparent soundness, and the difficulty, at least, of establishing the existence of any intellectual derangement, while the moral powers are unequivocally and deeply deranged, render it no less important in its legal relations, than if the understanding were unequivocally affected. It is defined by Prichard, who has strongly insisted on the necessity of assigning it a more distinct and conspicuous place, than it has hitherto received, as " consisting in a morbid perversion of the natural feelings, affections, inclinations, temper, habits, and moral dispositions, MEDICAL JURISPRUDENCE OP INSANITY. without any notable lesion of the intellect or knowing and reasoning faculties, and particularly without any maniacal hallucination." 1 It will be convenient, even if not scientifi- cally precise, to consider it under two divisions, according as it is general or partial. SECTION I. General Moral Mania. 143. One form of this condition is thus vividly des- cribed by Prichard. " There are many individuals living at large, and not entirely separated from society, who, are affect- ed in a certain degree by this modification of insanity. They are reputed persons of singular, wayward, and eccentric char- acter. An attentive observer may often recognize something remarkable in their manner of existence, which leads him to entertain doubts of their entire sanity, and circumstances are sometimes discovered on inquiry which assist in determining his opinion. In many instances it is found that there is an hereditary tendency to madness in the family, or that seve- ral relatives of the person affected have labored under dis- eases of the brain. The individual himself is discovered in a former period of life to have sustained an attack of mad- ness of a decided character. His temper and dispositions are found on inquiry to have undergone a change ; to be not what they were previously to a certain time ; he has become an altered man ; and this difference has perhaps been noted from the period when he sustained some reverse of fortune, which deeply affected him, or since the loss of some beloved relative. In other instances, the alteration in his character has ensued immediately on some severe shock which his bodily constitution has undergone. This has either been a disorder affecting the head, a slight attack of paralysis, a fit of epilepsy, or some fever or inflammatory disorder, which 1 Cyclop. Prac. Med. HI. 826. GENERAL MORAL MANIA. 169 has produced a perceptible change in the habitual state of the constitution. In some cases the alteration in temper and habits has been gradual and imperceptible, and it seems only to have consisted in an exaltation or increase of peculiarities which were always more or less natural or habitual." " Indi- viduals laboring under this disorder are capable of reasoning or supporting an argument on any subject within their sphere of knowledge that may be presented to them, and they often display great ingenuity in giving reasons for their eccentric conduct, and in accounting for and justifying the state of moral feeling under which they appear to exist. In one sense, indeed, their intellectual faculties may be termed unsound, but it is the same sense in which persons under the influence of strong passions may be generally said to have their judgment warped, and the sane or healthy exercise of then* understandings impeded. They think and act under the influence of strongly excited feelings, and a person sane is under such circumstances proverbially liable to error both in judgment and conduct." 1 It was this class of persons, un- doubtedly, that suggested the following description in a work published in the beginning of the present century. " Among the varities of maniacs met with in medical practice, there is one, which, though by no means rare, has been little noticed by writers on this subject: I refer to those cases in which the individuals perform most of the common duties of life with propriety, and some of them, indeed, with scrupulous exact- ness, who exhibit no strongly marked features of either tem- perament, no traits of superior or defective mental endowment, but yet take violent antipathies, harbor unjust suspicions, in- dulge strong propensities, affect singularity in dress, gait r and phraseology ; are proud, conceited, and ostentatious ; easily excited and with difficulty appeased ; dead to sensi- bility, delicacy, and refinement ; obstinately riveted to the most absurd opinions ; prone to controversy, and yet incapable of reasoning ; always the hero of their own tale, using hyper- bolic, high-flown language to express the most simple ideas, 1 Op. cit sup. p. 826. 15 170 MEDICAL JURISPRUDENCE OF INSANITY. accompanied by unnatural gesticulation, inordinate action, and frequently by the most alarming expression of counte- nance. On some occasions they suspect sinister intentions on the most trivial grounds ; on others are a prey to fear and a dread from the most ridiculous and imaginary sources ; now embracing every opportunity of exhibiting romantic courage and feats of hardihood, then indulging themselves in all man- ner of excesses. Persons of this description, to the casual observer, might appear actuated by a bad heart, but the ex- perienced physician knows it is the head which is defective. They seem as if constantly affected by a greater or less de- gree of stimulation from intoxicating liquors, while the expression of countenance furnishes an infallible proof of mental disease. If subjected to moral restraint, or a medical regimen, they yield with reluctance to the means proposed, and generally refuse and resist, on the ground that such means are unnecessary where no disease exists ; and when, by the system adopted, they are so far recovered, as to be enabled to suppress the exhibition of the former peculiarities, and are again fit to be restored to society, the physician, and those friends who put them under the physician's care, are generally ever after objects of enmity and frequently of revenge." l 144. Heinroth and Hoffbauer both recognize a form of mental alienation consisting exclusively of morbid excitement of the passions and feelings. " It is clear," says the latter, " that mania may exist uncomplicated with mental delusion ; it is in fact only a kind of moral exaltation (tollheit), a state in which the reason has lost its empire over the passions and the actions by which they are manifested, to such a degree that the individual can neither repress the former, nor abstain from the latter. It does not follow that he may not be in possession of his senses and even his usual intelligence, since, in order to resist the impulses of the passions, it is not suffi- cient that the reason should impart its counsels ; we must have the necessary power to obey them. The maniac may 1 Cox, J. M., Practical Observations on Insanity. London, 1804. GENERAL MORAL MANIA. 171 judge correctly of his actions without being in a condition to repress his passions, and to abstain from the acts of violence to which they impel him." * Subsequently he observes, that when mania proceeds from inordinate passions, "its more immediate cause lies in the physical temperament, or in cer- tain moral affections which induce frequent occasions of anger. In every other respect, the maniac may be master of his propensities and the actions to which they lead ; he may judge and act rationally. He is irrational only in his par- oxysms of fury, and then his errors of judgment are rather the effect than the cause of his furious transports." 2 145. There is another very common and well-marked form of insanity, the manifestations of which are chiefly confined to the moral sentiments. Its characteristic feature is that of excitement alternating with depression, the two conditions varying considerably, in different cases, in point of intensity, and also as well as the intervening interval in point of duration. The general tAits of the first-mentioned condition, are an unusual flow of spirits, great self-confidence, sanguine anticipations of the future, restlessness both of body and mind, and untiring loquacity. Usually, these traits are only strong enough at first to modify the ordinary char- acter of the individual, without raising the slightest sus- picion, and not uncommonly giving the impression that the person has been indulging too freely in drink. Sooner or later, they become more strikingly developed, and exert an unmistakable influence upon the conduct and discourse. He engages in enterprises, moral, social, or commercial, either manifestly beyond his means, or in one way or another, inappropriate to his condition. Especially is he bent on speculation, and nothing comes amiss capable of gratifying this passion. Whether it be a farm or a ship, a mill-privilege or a city lot, a parcel of trumpery jewelry, or the odds and ends of a twopenny auction, he is equally ready to buy, and equally sanguine of getting a good bargain. He is con- stantly yielding to some new fancy, and ardently prosecuting 1 Op. cit. sup. 122. 2 Ibid. 126. 172 MEDICAL JURISPRUDENCE OF INSANITY. some of the countless schemes that swarm in his teeming brain. He frequents company either above or below his own grade, while perhaps he amazes and mortifies his friends, by the levity of his manners, if not the laxity of his morals. His movements are abrupt, rapid, and unseasonable. He is fond of taking long journeys, and horse-flesh suffers under his hands. He sleeps much less than he usually does, and is fond of being up at night, roaming about the house or neigh- borhood. He is always ready with plausible reasons for his strangest conduct sufficient to silence, if not to satisfy any troublesome inquirer, while his discourse is entirely free from delusion, or obvious incoherence. With all this there is generally an utter disregard of the feelings of others, an impe- rious and even tyrannical deportment towards those who are dependent upon him, and a disposition to trample upon all domestic conveniences and proprieties. The slightest attempt to restrain or control his movements, or even to administer advice, is met by the fiercest hostility, and any intimation of mental infirmity provokes his hottest wrath. 146. To this the state of depression presents a complete contrast, every trait here mentioned being replaced by its opposite. Seldom speaking except when spoken to, and apparently absorbed in his own gloomy reflections, he is silent and quiet in the midst of company, and as if over- whelmed by a sense of inability, he reluctantly engages in any occupation beyond the most ordinary routine, and often is scarcely persuaded to perform the most necessary duties. All nature without and within him is shrouded in gloom, a terrible evil seems to be impending over him, the future reveals not a single gleam of hope, and were he called on to lay down his life, he would hardly hesitate to obey. His conduct during the excited state is now viewed in its true light, and is the subject of bitter reflections. He wonders that he should have done such things, and, in some instances, begs his friends to keep him in future from similar exhibi- tions by seasonable measures of restraint. With the mental dejection there is often some bodily ailment, and he loses both flesh and strength. Either this or a total paralysis of GENERAL MORAL MANIA. 173 the will may keep him in bed much of the time, and inca- pacitate him for the slightest effort. 147. In point of duration the two states are generally equal as compared with each other in the same case, though varying in different cases, from one month to a couple of years. In point of severity, too, they are subject to the same rule. The excitement may be confined to an unusual flow of spirits, to an increase of self-confidence, and a fondness of self-magnification, while the patient attends to his ordi- nary duties, evincing no loss of his usual intelligence and discretion. Or it may be manifested by boisterous and vio- lent conduct, by a disposition to engage in foolish enterprises, and an utter abandonment of all regular and appropriate employment. So, too, the state of depression may vary from what passes merely for low spirits, to the most profound and painful melancholy, attended with the keenest distress and disposing to suicidal attempts. 148. The interval between these two conditions, when the individual appears to be perfectly rational and natural, also presents the same kind of uniformity, in the same case, and the same kind of diversity in different cases. In many, and perhaps the majority of cases, it has no appreciable duration as a distinct condition, the periods of excitement and depression passing into each other, with scarcely an interval between. In others it may continue as long, or even longer, than either of these states, although, as is more fre- quently the case, it is considerably shorter. Generally, the lucid interval follows the excitement and precedes the de- pression, but sometimes the excitement passes abruptly into depression, and this more gradually is followed by the lucid interval. 149. Another feature worthy of notice, is that the dura- tion of these several states occasionally changes, in the same individual. In one case that came under observation, they gradually changed within four or five years, from one month to eight or ten. Generally, the longer the duration of the excitement and depression, the less prominent and dis- tinct is the lucid interval. 15* 174 MEDICAL JURISPRUDENCE OF INSANITY. 150. This form of mental disease, when the periodicity is once fairly established, is peculiarly intractable to treat- ment, and may continue for years ; but then it finally as- sumes a more continuous and uniform character, until its original phasis entirely disappears. 151. The contrast often presented in moral mania be- tween the state of the intellectual and that of the moral faculties, is one of its most striking features. These patients can reason logically and acutely on any subject within their knowledge, and extol the beauties of virtue, while their con- duct is filled with acts of folly, and at war with every princi- ple of moral propriety. Their moral nature seems to have undergone an entire revolution. The sentiments of truth, honor, honesty, benevolence, purity, have given place to men- dacity, dishonesty, obscenity, and selfishness, and all sense of shame and self-control have disappeared, while the intellect has lost none of its usual power to argue, convince, please, and charm. We once asked a patient who was constantly saying or doing something to annoy or disturb others, while his intellect was apparently as free from delusion or any other impairment as ever, whether, in committing his aggres- sive acts, he felt constrained by an irresistible impulse, con- trary to his convictions of right, or was not aware, at the moment, that he was doing wrong. His reply should sink deep into the hearts of those who legislate for, or sit in judg- ment on the insane. " I neither acted from an irresistible impulse, nor upon the belief that I was doing right. I knew perfectly well I was doing wrong, and I might have refrained if I had pleased. I did thus and so, because I loved to do it. It gave me an indescribable pleasure to do wrong." Yet this man when well, is kind and benevolent, and in his whole walk and conversation a model of propriety. 152. In nothing, however, is the intellectual soundness more strikingly evinced than in the ingenuity with which these persons endeavor to explain the folly and absurdity of their acts, and reconcile them to the ordinary rules of human action. By denying entirely some alleged circumstances in a particular transaction, adding a little to one and subtracting GENERAL MORAL MANIA. - a little from another, and giving a peculiar coloring to the whole, they will convince the unguarded observer that there is some mistake about the matter, that they acted precisely as any one else would under similar circumstances, and that they are the victims of misrepresentation and unkindness. 153. There is, unquestionably, a great tendency in this affection to pass into intellectual mania, which we have seen is no less strongly characterized by moral perversities than by hallucinations ; and Georget actually describes it as be- longing to the initiatory stage or incubation of the latter dis- order. Without stopping to discuss the correctness of this view, the fact that it may continue for an indefinite length of time and become the object of judicial investigation, gives it incalculable importance in a medico-legal point of view, and entitles it to a prominent place in a work like the present. 154. The form of mental disorder which we are now considering, has been so little noticed by writers until quite recently, while an ample knowledge of its phenomena is es- sential to the correct administration of justice, that no farther apology is needed for illustrating it with several examples collected from the observations of others. The first is re- lated by Pinel as belonging to his manie sans delire. " An only son of a weak and indulgent mother was encouraged in the gratification of every caprice and passion of which an untutored and violent temper was susceptible. The impetii- osity of his disposition increased with his years. The money with which he was lavishly supplied removed every obstacle to the indulgence of his wild desires. Every in- stance of opposition or resistance roused him to acts of fury. He assaulted his adversaries with the audacity of a savage ; sought to reign by force, and was perpetually embroiled in disputes and quarrels. If a dog, a horse, or any other animal offended him, he instantly put it to death. If ever he went to a fete or any other public meeting, he was sure to excite such tumults and quarrels as terminated in actual pugilistic encounters, and he generally left the scene with a bloody nose. This wayward youth, however, when unmoved by 176 MEDICAL JURISPRUDENCE OF INSANITY. passions, possessed a perfectly sound judgment. When he became of age, he succeeded to the possession of an exten- sive domain. He proved himself fully competent to the management of his estate, as well as to the discharge of his relative duties, and he even distinguished himself by acts of beneficence and compassion. Wounds, law-suits, and pecu- niary compensations were generally the consequences of his unhappy propensity to quarrel. But an act of notoriety put an end to his . career of violence. Enraged with a woman who had used offensive language to him, he precipitated her into a well. Prosecution was commenced against him ; and on the deposition of a great many witnesses who gave evidence to his furious deportment, he was condemned to perpetual confinement in the Bicetre." * In this instance there was something more than the unrestrained indulgence of strong passions, though, no doubt, the passions of this person were naturally remarkably strong and active; the understanding, though sound, was incapable of restraining their impulses, for the reason that they were excited by disease, and, therefore, beyond its control. The constant ex- citement of passions already too much developed by means of a vicious education, led to that condition of mind in which the healthy balance of the affective and intellectual faculties is destroyed, in other words, to moral mania. A case of a very similar character to this, and to which the rank of the person and the disastrous results of the affection have given a melancholy preeminence over all others in the medico-legal history of the disease, is that of Earl Ferrers, who was exe- cuted in 1760, for the murder of his steward. It differs from the above in exhibiting a more advanced stage of the disease, and in more distinctly revealing its approximation to intellectual mania by the unfounded notions which the patient had imbibed. Though his reasoning powers were sound and his conversation rational, he imagined that his relatives had formed a conspiracy against him in which his victim was an accomplice ; and his conduct in many respects 1 Sur 1' Alienation Mentale, 156, 159. GENERAL MORAL MANIA. 177 was so wild and strange, as to excite in those who were in the habit of meeting him, a suspicion, and even conviction of his insanity. 1 155. The following case which came under the obser- vation of the writer, strikingly exhibits the prominent fea- tures of moral mania. This person, while yet a youth, had several paroxysms of mental disorder, which were accompa- nied by such a spirit of violence and mischief, as to require his close confinement at home. He got married, however, went into the back settlements, and, by means of his industry and energy, he accumulated some property, while he was respected for his many virtues. Every two or three years he had an attack of his mental disorder, when he neglected his usual employments, launched into speculations of every kind, and projected schemes for making money. He talked loud and fast, became irritable and despotic, impatient of contradiction and easily offended. At the same time, he conceived a high idea of his religious attainments, and fre- quented religious meetings where he was distinguished by the fervor of his exhortations and prayers. Finally, having squandered the most of his property, and treated his wife quite roughly, she had him placed in a hospital. He came in breathing out threatenings and slaughter against all who had any hand in the measure, while he explained, with great plausibility, every incident which had been represented as indicative of insanity. He continued to be wild and turbu- lent, and was a perpetual source of strife and trouble. His principal employment was to make mischief, by fomenting troubles between fellow-patients, disaffecting them towards the physicians and attendants, and, in one way 05 another, annoying every-body around him. He set at nought every i A report of Earl Ferrers's trial may be found in Hargrave's State Trials, and it is noticed at considerable length in Smollet's Continuation of Hume's History of England. Some valuable comments on this case, are contained in Combe's Observations on Mental Derangement, 204, to which every reader is referred, who is more anxious to enlighten his rnind by correct facts and philosophical views, than to confirm his errors and gratify his prejudices by obstinately shutting his eyes against the progress of scientific improvement. 178 MEDICAL JURISPRUDENCE OF INSANITY. rule of propriety, while incessantly charging others with mis- behavior, and representing himself as an object of persecution and abuse. From cursing and swearing, it was an easy transition to praying ; and, whether entertaining others with coarse and vulgar talk, or a strain of religious discourse calculated to deceive the very elect, he seemed to be equally pleased. He stole whatever he could lay his hands upon, and hoarded all kinds of worthless things. In the course of four or five months, his natural character began to return, and in two or three more he went home quite restored. In about two years, he was again attacked, and again was placed in the hospital. 156. The following case from Metzger is cited by Hoffbauer, who observes that the patient labored under no delusion, properly speaking, but was only not master of his actions. A Russian colonel came to Konigsberg to receive an inheritance, and committed there so many acts of violence, that he was summoned before the ,tribunal of justice. His conduct before the magistrates was equally unreasonable. He had become so much an object of dread at Konigsberg, that nobody would execute any commission for him, the very chimney-sweepers required a guard if sent to sweep his chimneys. At last, after several complaints made against him, he was arrested because he had threatened to stab his landlord with a pitchfork for demanding his rent, and pursued him with that intent. " In going into the prison," says Metzger, " I saw an old man with white hair, of a respect- able appearance, who received me politely. I first inquired concerning his health. ' I am ill, through old age,' he replied, ' and tormented with gout, with the stone, and with the scurvy, evils for which I can have no remedy.' He desired to know who had sent me to see him ; I told him it was the tribunal. 'I ought to be judged,' he replied, 'by a French tribunal,' and he pretended that I should find proof of what he said in a writing which he forced me to take. At last I informed him of the reason of his arrest. His eyes then sparkled, and he said in French, with much volubility, that GENERAL MORAL MANIA. 179 M. M. and were his mortal enemies ; that they had several times tried to ruin him ; that he had expe- rienced much injustice and opposition on the part of the tribunal ; and that they had disposed, as they pleased, of his brother's inheritance. Being asked what were his occupa- tions, he replied, ' that he was, as every honest man should be, free and content, even in prison ; that he amused himself with poetry, and copied verses relating to his situation.' " l 157. The following cases are taken from Prichard. " I. K., a farmer, several of whose relatives had been the subjects of mental derangement, was a man of sober and domestic habits, and frugal and steady in his conduct, until about his forty-fifth year, when his disposition appeared to have become suddenly changed in a manner which excited the surprise of his friends and neighbors, and occasioned grief and vexation in his family. He became wild, excitable, thoughtless, full of schemes and absurd projects. He would set out and make long journeys into distant parts of the country to purchase cattle and farming-stock, of which he had no means of disposing ; he bought a number of carriages, hired an expensive house ready furnished, which had been inhabited by a person much above his rank, and was unsuit- able to his condition ; he was irascible and impetuous, quar- relled with his neighbors, and committed an assault upon the clergyman of the parish, for which he was indicted and bound to take his trial. At length his wife became con- vinced that he was mad, and made application for his confinement in a lunatic asylum, which was consequently effected. The medical practitioners who examined him were convinced of his insanity, by comparing his late wild habits and unaccountable conduct with the former tenor of his life, taking into consideration the tendency to disease which was known to prevail in his family. The change in his char- acter alone had produced a full conviction of his madness in his friends and relatives. When questioned as to the motives which induced him to some of his late proceedings, he gave 1 Op. cit. sup. 126. MEDICAL JURISPRUDENCE OF INSANITY. clear and distinct replies, and assigned, with great ingenuity, some plausible reason for almost every part of his conduct." 158. " Abraham B., a working tradesman of industri- ous and sober habits, conducted himself with propriety until about forty-six years of age, and had accumulated a con- siderable property from the fruits of his exertions. About that period he lost his wife, and after her death became more and more penurious. At length he denied himself the comforts, and in a great measure, the necessaries of life, and became half-starved and diseased ; his body was emaciated and beset with scaly eruptions. Mr. S., a gentleman who had long known him, hearing of the condition into which he had sunk, sent a medical practitioner to visit him, by whose advice B. was removed from a miserable dirty lodging to a lunatic asylum. Mr. S., who w r as present on the occasion, observed that Abraham B., previously to his quitting the room in which he had immured himself, kept his eyes fixed on an old trunk in the corner of the apartment. This was afterwards emptied of its contents, and in it were found, in the midst of various articles, dirty bank-notes, which had been thrown into it apparently at different times to the value of more than a thousand pounds. Abraham B., after his removal to an asy- lum where he had wholesome food and exercise, soon began to recover from his bodily infirmities, and at length became anxious to be at large. The writer of this article visited him and conversed with him for some time, in order to ascertain his mental condition. He betrayed no sign of intellectual delusion, nor did it appear that any thing of that description had ever been a part of his complaint. His replies to ques- tions were rational according to the extent of his natural capacity. He was determined to go and manage his prop- erty, and get a wife who should take care of him. In a few days after his release he was married to a servant belonging to the lunatic asylum where he had been confined. His new wife found after some months that it was impossible to endure the strange conduct of her husband, and after various expedi- ents, brought him back to tfie asylum, with a certificate from a medical man, who had examined him and declared him to GENERAL MORAL MANIA. 181 be insane. He still remains in confinement, and his derange- ment is now more complete than formerly, as it plainly in- volves his intellect." l 159. These are no uncommon instances of that con- dition of mind so often mistaken for any thing rather than what it really is mental derangement. Its true nature was here recognized by intelligent practitioners who looked beyond the circle of a definition, and might have been re- cognized, perhaps, by others of narrower views, in a calm investigation for therapeutical purposes ; but, amid the excite- ment produced by great criminal acts, and the struggles be- tween knowledge and ignorance, truth and prejudice, that spring up in judicial investigations, how seldom, alas, has it been discerned. The following cases in which this perver- sion of the moral faculties was accompanied in its latter stages, by some delusions, furnishes a striking illustration of this form of disease, as well as its intimate connection with intellectual mania. 160. Col. M. was a man of superior intellectual powers, and moved in the higher walks of society. He was a lawyer by profession, and was appointed District Attorney in one of the South-western States by President Jackson whom he had previously served in a military capacity. Towards the me- ridian of life, his conduct became so disorderly and boister- ous, that he was often confined in jails or hospitals for the insane. On one of these occasions he cut off his nose, and subsequently came to Boston in order to have it replaced by Dr. J. Mason Warren, by means of the rhinoplastic operation which proved quite successful. While in Boston he made the acquaintance of Dr. Bell of the McLean Asylum, for the purpose, as he declared, of getting his aid in obtaining redress for the wrongs he had sustained, in being placed under guardianship, and confined in jails and hospitals, his object being not to retaliate, but to protect his future reputation. The Dr. has kindly furnished such particulars of his case as came to his knowledge from various sources. " I inferred 1 Op. cit sup. 831. 16 182 MEDICAL JURISPRUDENCE OF INSANITY. that he was naturally of a proud, arrogant, and extravagant spirit which was kept in check, while she lived, by the discre- tion of his wife. He was sensual, but not intemperate until his nervous system had become excited. His peculiar theory was, that while he admitted that he had held and, towards the last of my interview, avowed that he then held certain fan- ciful notions which we might term delusions, if we pleased, still they were such as did not interfere with his right to en- tire liberty of action. ' For instance,' said he, ' I feel that I am cousin to the Duke of Wellington and to Napoleon. It seems ridiculous. I can't make it out by any kind of proof. I even laugh at it. But still, I dwell upon it as a reality. It concerns nobody else. It has in it no dangerous element. Why, then, should I be interfered with for harboring a delu- sion, if you choose to call it so, no more absurd than a thou- sand religious sects feel themselves happy in resting upon.' He would often argue thus : ' I protest against being called insane on account of my ideas. For my actions I am accountable. I never yet claimed I never will claim immunity as an irresponsible being. I will permit no one to set up such a defence for me. Try me by the laws of the land and the strict rules of evidence, and I will abide by the result, as a good citizen, but I must have opportunity to argue my own cause, and examine the witnesses brought against me.' " He had often been arrested for assault and battery, but always continued to beat the complainants, by his familiarity with legal proceedings, and by his quick perception of whatever made for or against himself. If, in his best estate he had been counsel for another party, he could not have managed the case better than he did his own. However wild, extrava- gant, and boisterous at hotels and such places, of which he was the terror, as soon as he was in the atmosphere of a court of justice, he became calm, dignified, and respectful, but tenacious to the last degree. For example, when carried before the police-judge in New York, on a warrant, the print- ed form of which had been in use for twenty years, setting forth that in consequence of insanity ' or otherwise,' he was GENERAL MORAL MANIA. 183 dangerous to be at large, he, at once, advocated successfully his constitutional right to have the offence set forth specifi- cally and precisely. " He had most carefully considered the extent of his rights, the precise amount of force justifiable in ejecting an un- welcome guest, or, what was a more common event, in resist- ing an ejectment; the obligation of inn-holders to receive ap- plicants, and the value of proving the first blow in defence of assaults. On one occasion, thinking the hack-men and cab-men of New York were insolent and exacting in regard to the right of way, he armed himself with a heavy whip, took a good witness by his side, and drove through Broad- way in a strong carriage, running against every charioteer who failed to give him his exact half of the road. This of course produced a collision of tongues as well as wheels. His peculiarly sarcastic language tempted a touch of the whip from some of his opponents, and upon this, our hero turned to and thrashed them within an inch of their lives. They appealed to the courts, but his witness soon and truly proved the aggression on them. " While in the Pennsylvania hospital for the insane, and again, I believe, while in the jail in Washington, he got dis- charged by means of a writ of habeas corpus which he was allowed to sue out. When thus brought before the court, he argued his case upon the settled legal doctrine, that an ability to distinguish right from wrong is the sole test of sanity. Of course, no judge did or could hesitate in opinion, that a gentleman who was able to make an elegant and an astute argument on the nature, origin, and protection of the rights of the subject, could, by any means, be within the category of individuals intellectually incapable of discriminating be- tween right and wrong. In fact, processes of detention as a lunatic, held, in his case, only until he could get before some tribunal. And yet when thus turned loose upon society, he was a passionate, dangerous lunatic. When hard pushed by evidence of extravagant and boisterous conduct, he would attribute the fact to his having unfortunately taken a little too much wine, (which was probably true to some extent,) MEDICAL JURISPRUDENCE OF INSANITY. comprehending perfectly that an offence of that kind would be followed by a much lighter consequence a mere fine, in fact than seclusion as a lunatic. When the self-mutila- tion was alluded to, he would most frankly attribute it to his ignorance of physiological laws, and allege that his lost organ being covered with blotches and carbuncles, he cut it off', absurdly supposing that nature had a renewing power, as in the growth of the hair. " After he became so wild in his conduct in Boston, as to be a universal annoyance, I advised his friends in Missouri to place him under care as a lunatic. They replied that the thing was impracticable ; that no institution had been found able to hold him, and they would not arouse his vindictive feelings by any farther trials of that sort. His intemperate habits increased, and his delusions became more palpable, yet without affecting his intellectual power. The idea returned, that parts of his face, if removed, would grow again, and he cut out the cicatrix on his forehead whence the nasal flap had been taken. Fortunately, death stepped in at this point, and removed a man whose fate was so melan- choly, for under all the ravages of mental disease, there were traces of noble sentiments and lofty aspirations." 161. There is another form of moral insanity deeply interesting in its medico-legal relations, that has been almost entirely overlooked. It is a fact "well-established in this country at least, that masturbation, or self-pollution is a pro- lific cause of mental derangement in young subjects. It deserves our especial attention for the reason, that although the intellect finally suffers deeply and rapidly, yet in its ini- tiatory stage, the moral and affective powers may be seri- ously perverted, while the conduct and conversation of the individual may be outwardly marked by his usual propriety. Long before any intellectual aberration is observed, and while the patient is merely moody and reserved, his mind may be tortured by fears and suspicions that mar his peace and sometimes lead him to acts of violence. Dr. Bell, the accomplished physician of the McLean Asylum, Massa- chusetts, observes that he knew " a pious, intelligent student, GENERAL MORAL MANIA. 185 pursuing his daily avocations to the satisfaction of his friends and instructors, who nightly slept with a weapon under his pillow to protect himself from an attack from one whom he had scarcely seen, and to whom he had never spoken ; and when convinced of his delusion by proofs so overpowering that his mind was obliged to acknowledge its assent, he merely transferred his suspicions to another equally innocent individual." Had this young man met the object of his suspicions and shot him dead, how few could have been brought to believe that he acted under the influence of in- sanity, and was consequently irresponsible! How feeble would have been any evidence of his insanity but such as had reference expressly to the particular form under which he was laboring ! Such a case as this should make a strong impression on the mind of the medical jurist. When an act of violence is committed by a young subject without any apparent motive, and without any obvious signs of insanity, it should always be ascertained, if possible, whether he has been addicted to masturbation, and whether he has shown any of those changes of temper and habit which generally accompany the incipient stage of this form of mental derangement. If it appear that he has practised this vice, and especially if he have also manifested its usual moral effects, then is there strong ground for believing that his mind was possessed by a delusion which farther inquiry may bring to light. This form of disease is not yet, perhaps, sufficiently understood, to warrant us in furnishing an exact detail of its phenomena. Reference must be had to the opinions of those who have had opportunities of observing it, and to the few valuable contributions that have been made to the subject. 1 162. A very common feature of moral mania, as has been already stated, is a deep perversion of the social affec- 1 An Hour's Conference with Fathers and Sons in relation to a common and fatal Indulgence of Youth. By L. V. Bell, M. D., Superintendent of the McLean Asylum, 1840. Hints to the Young, in relation to Health of Body and Mind. By S. Woodward, M. D., Superintendent of the Mass. Lun. Hospital. See also Dr. Bell's last Report, (1843), pp. 39, 40. 16* 186 MEDICAL JURISPRUDENCE OF INSANITY. tions, whereby the feelings of kindness and attachment that flow from the relations of father, husband, and child, are replaced by a perpetual inclination to tease, worry, and em- bitter the existence of others. The ordinary scene of its manifestations is the patient's own domestic circle, the peace and happiness of which are effectually destroyed by the out- breakings of his ungovernable temper, and even by acts of brutal ferocity. Frederic William of Prussia, father of Fred- eric the Great, undoubtedly labored under this form of moral mania ; and it furnishes a satisfactory explanation of his brutal treatment of his son and his utter disregard of the feelings or comfort of any other member of his family. About a dozen years before his death, his health gave way under his constant debauches in drunkenness, he became hypochondriacal, and redoubled his usual religious austeri- ties. He forbade his family to talk of any subject but reli- gion, read them daily sermons, and compelled them to sing, punishing with the utmost severity any inattention to these exercises. The prince and his eldest sister soon began to attract a disproportionate share of his hostility. He obliged them to eat and drink unwholesome or nauseous articles, and would even spit in their dishes, addressing them only in the language of invective, and at times endeavoring to strike them with his crutch. About this time he attempted to strangle himself, and would have accomplished his design, had not the queen come to his assistance. His brutality towards the prince at last arrived to such a pitch, that he, one morning, seized him by the collar as he entered his bed- chamber, and began beating him with a cane in the crudest manner, till obliged to desist from pure exhaustion. On another occasion, shortly after, he seized his son by the hair and threw him on the ground, beating him till he was tired, when he dragged him to a window apparently for the pur- pose of throwing him out. A servant, hearing the cries of the prince, came to his assistance, and delivered him from his hands. Not satisfied with treating him in this barbarous manner, he endeavored, though unsuccessfully, by a similar course of conduct, to make him sign an act renouncing his GENEKAL MORAL MANIA. 187 claim to the succession of the Prussian throne, in favor of his brother. To obtain this end, though in a different man- ner, he connived at the prince's attempts to escape from his tyranny, in order that he might procure from a court-martial a sentence of death, and this even he was anxious to antici- pate, by endeavoring to run him through the body with his sword. Not succeeding in procuring his death by judicial proceedings, he kept him in confinement, and turned all his thoughts towards converting him to Christianity. At this time, we first find mention of any delusion connected with his son, though it probably existed before. In his correspond- ence with the chaplain to whom he had intrusted the charge of converting the prince, he speaks of him as one who had committed many and heinous sins against God and the king, as having a hardened heart and being in the fangs of satan. Even after he became satisfied with the repentance of the prince, he showed no disposition to relax the severities of his confinement. He was kept in a miserable room, deprived of all the comforts and many of the necessaries of life, denied the use of pens, ink, and paper, and allowed scarcely food enough to prevent starvation. His treatment of the princess was no less barbarous. She was also confined, and every effort used to make her situation thoroughly wretched, and though, after a few years, he relaxed his persecution of his children, the general tenor of his conduct towards his family and others, evinced little improvement in his disorder, till the day of his death. 1 163. There can be little doubt that the affection above described, is far more common in the ordinary walks of society, than is generally imagined. .It is so imperfectly understood, however, that those singular freaks of conduct and whimsical notions which would unquestionably subject a person to the imputation of insanity, were there the slight- est aberration of reason, are set down to eccentricity of tem- per, or inherently vicious dispositions. The suspicion that 1 Lord Dover's Life of Frederic IT. King of Prussia, vol. 1, B. 1, chap. 2, 3, 4, 5, 6, 7. 188 MEDICAL JURISPRUDENCE OF INSANITY. they spring from insanity, is immediately dispelled by calling to mind the general correctness of his views, and the steadi- iness and sagacity with which he pursues his daily avoca- tions. And so intimately connected are the ideas of insanity and delusion in the common mind, that it requires no little courage and confidence on the part of the practitioner who ventures, in a given case, to declare the existence of the former, independently of the latter. The consequences of these erroneous views are often strikingly and painfully exhibited, when a person thus affected becomes the object of a legal procedure. While he may be described by one, as acute and methodical in his business, and rational in his discourse, and believed to be perfectly sane ; another will testify to the strangest freaks that ever a madman played, and thence deduce the conviction of his insanity ; while one represents him as social and kindly in his disposition, ready to assist and oblige, and to accommodate himself to the varying humors of those about him, it will be testified by another, that in his domestic relations, his former cheerful- ness has given way to gloom and moroseness, that equa- nimity of temper has been replaced by frequent gusts of pas- sion, and that the warm affections, which spring from the relations of parent and child, husband and wife, have been transformed into indifference or hate. These are the cases that confound the wise and defy the scrutiny of the skilful, while they tempt the superficial and conceited to betray their ignorance, under the delusion of superior penetration ; which tarnish many a professional reputation, and expose even the pretensions of true science to popular mockery and derision. 1 1 Many striking cases of moral mania might have been related which have come under the author's own observation, but as this could not be done without giving pain, probably, to the patients themselves or their friends, it was deemed advisable to draw entirely from foreign sources. PARTIAL MORAL MANIA. 189 SECTION II. Partial Moral Mania. 164. In this form of insanity, the derangement is con- fined to one or a few of the affective faculties, the rest of the moral and intellectual constitution preserving its ordinary integrity. An exaltation of the vital forces in any part of the cerebral organism, must necessarily be followed by in- creased activity and energy in the manifestations of the fac- ulty connected with it, and which may even be carried to such a pitch as to be beyond the control of any other power, like the working of a blind, instinctive impulse. Accord- ingly, we see the faculty thus affected, prompting the indi- vidual to action by a kind of instinctive irresistibility, and while he retains the most perfect consciousness of the im- propriety and even enormity of his conduct, he deliberately and perseveringly pursues it. With no extraordinary temp- tations to sin, but on the contrary, with every inducement to refrain from it, and apparently in the full possession of his reason, he commits a crime whose motives are equally inex- plicable to himself and to others. The ends of justice re- quire that this class of cases should be viewed in their true light ; and while it is not denied that their similarity to other cases in which mental unsoundness is never supposed to have existed, renders such a view difficult, yet this very difficulty is a fresh reason for extending our inquiries and increasing our information. In the account now to be given of partial moral mania, those forms of it only will be noticed which have the most important legal relations. 165. Instances of an irresistible propensity to steal, unaccompanied by any intellectual alienation, are related on good authority, and are by no means rare. " There are persons," says Dr. Hush, "who are moral to the highest degree as to certain duties, but who, nevertheless, live under the influence of some one vice. In one instance, a woman 190 MEDICAL JURISPRUDENCE OF INSANITY. was exemplary in her obedience to every command of the moral law, except one, she could not refrain from stealing. What made this vice more remarkable was, that she was in easy circumstances, and not addicted to extravagance in any thing. Such was the propensity to this vice, that when she could lay her hands on nothing more valuable, she would often at the table of a friend, fill her pockets secretly with bread. She both confessed and lamented her crime." l Cases like this are so common, that they must have come within the personal knowledge of every reader who has seen much of the world, so that it will be unnecessary to mention them more particularly. 2 It would be difficult to prove directly, that this propensity, continuing as it does during a whole life, and in a state of apparently perfect health, is, notwith- standing, a consequence of diseased or abnormal action in the brain, but the presumptive evidence in favor of this explanation is certainly strong. First, it is very often ob- served in abnormal conformations of the head, and accom- panied by an imbecile condition of the understanding. Gall and Spurzheim saw in the prison of Berne a boy twelve years old, who could never refrain from stealing. He is described as " ill-organized and rickety." At Haina they were shown an obstinate robber whom no corporal punish- ment could correct. He appeared about sixteen years of age, though he was in fact twenty-six ; his head was round, and about the size of a child's one year old. He was also deaf and dumb, a common accompaniment of mental imbe- cility. An instructive case has been lately recorded, in which this propensity seemed to be the result of a rickety and scrofulous constitution. 8 Secondly, this propensity to steal is not unfrequently observed in undoubted mania. Pinel says it is a matter of common observation, that some mani- acs who, in their lucid intervals, are justly considered models of probity, cannot refrain from stealing and cheating during 1 Medical Inquiries and Observations, 1. 2 In Gall's large work, On the Functions of the Brain, iv. 131, Boston edition, the reader will find a considerable number of these cases related. 8 Phrenological Journal, x. 459. PAKTIAL MORAL MANIA. 191 the paroxysm. 1 Gall mentions the case of two citizens of Vienna, who, on becoming insane, were distinguished in the hospital for an extraordinary propensity to steal, though previously they had lived irreproachable lives. They wan- dered over the house from morning to night, picking up whatever they could lay their hands upon, straw, rags, clothes, wood, etc., which they carefully concealed in their room. 2 A propensity to theft is recognized by Prichard, as being often a feature of moral mania, and, sometimes, the leading if not the sole character of the disease, and he men- tions a lunatic who would never eat his food, unless he had previously stolen it, and accordingly his keeper was obliged to put it into some corner within his reach, in order that he might discover and take it furtively. 8 Thirdly, it has been known to follow diseases or injuries of the brain, and there- fore to be dependent on morbid action. Acrel mentions the case of a young man, who after receiving a severe w r ound on the temple, for which he was trepanned, manifested an invincible propensity to steal, which was quite contrary to his ordinary disposition. After committing several larcenies, he was imprisoned, and would have been punished according to law, had not Acrel declared him insane, and attributed his unfortunate propensity to a disorder of the brain. In the Journal de Paris, March 29th, 1816, appeared the following paragraph : " An ex-commissary of police at Toulouse, Beau- Conseil, has just been condemned to eight years confinement and hard labor, and to the pillory, for having, while in office, stolen some pieces of plate from an inn. The accused per- sisted to the last in an odd kind of defence ; he did not deny the crime, but attributed it to mental derangement produced by wounds he had received at Marseilles in 1815." 4 The late Dr. Smith, of New Haven, Connecticut, once observed a similar effect consecutive to an attack/ of typhus fever. " One patient in particular, who had been extremely sick with this disease, after his recovery, had a strong propensity 1 Op. cit sup. 132. 2 Ibid. iv. 131. 3 Ibid. 829. * Quoted by Gall in Ibid. 141. 192 MEDICAL JURISPRUDENCE OF INSANITY. to steal, and did in effect take some articles of clothing from a young man to whom he was under great obligations for the care which he had taken of him during his sickness. He at length stole a horse and some money, was detected and punished. I took some pains to inquire into the young man's former character, and found it good, and that his family were respectable." 1 Fourthly, this propensity to steal is sometimes followed by general mania. Foderd relates the case of a female servant in his own family, who could not help stealing secretly from himself and others, articles, even of a trifling value ; though she was intelligent, modest, and religious, and was all the while conscious of and admitted the turpitude of her actions. He placed her in a hospital, considering her insane, and after apparent restoration and a long trial, he again took her into his service. Gradually, in spite of herself, the instinct again mastered her, and in the midst of an incessant struggle between her vicious propen- sity on the one hand and a conscientious horror of her con- dition on the other, she was suddenly attacked with mania, and died in one of its paroxysms. 2 Fifthly, this propensity is sometimes produced by certain physiological changes in the animal economy. Gall met with four examples of wo- men who, when pregnant, were violently impelled to steal, though perfectly upright at other times. Friedreich gives the case of a pregnant woman who, otherwise perfectly honest and respectable, suddenly conceived a violent longing for some apples from a particular orchard, two or three miles distant. Notwithstanding the entreaties of her parents and husband not to risk her character and health, and their promises to procure the apples for her in the morning, she started off in company with her husband, at nine o'clock of a cold September night, and was detected by the owner in the act of stealing the apples. She was tried and convicted of theft, but subsequently a medical commission was ap- pointed by the supreme court to examine and report upon 1 Medical and Surgical Memoirs, 62. 2 Traite de medicine legale, i. 237. PARTIAL MORAL MANIA. 193 her case. Their inquiries resulted in the opinion that she was not morally free, and consequently not legally respon- sible while under the influence of those desires peculiar to preg- nancy ; adding that if Eve had been in the condition of the accused, when she plucked the forbidden fruit from the tree, the curse of original sin would never have fallen on the race. 1 165. An inordinate propensity to lying is also of no uncommon occurrence in society ; and most of the readers of this work have probably met with instances of it in people whose morals in other respects were irreproachable, and whose education had not been neglected. The maxim of Jeremy Bentham, that it is easier for men to speak the truth, and therefore they are more inclined to do so than to utter falsehood, seems, in them, to be completely reversed, for they find nothing more difficult than to tell the truth. In repeating a story which they have heard from others, they are sure to embellish it with exaggerations and additions, till it can scarcely be recognized, and are never known to tell the same story twice alike. Not even is the slightest groundwork of truth necessary, in order to call forth the inventions of their perverted minds ; for they as often flow spontaneously, in the greatest profusion, as when based on some little foundation in fact. This propensity seems to result from an inability to tell the truth, rather than from any other cause ; as it can be traced to no adequate motive, and is often indulged when truth would serve the interests of the individual better. Like that last mentioned, it is liable to degenerate into unequivocal mania, of which it is sometimes a preliminary symptom, and is also quite a com- mon feature in this disease, a circumstance which Rush considers as proof of its physical origin. 166. We are not prepared to go the length of referring all the instances of these two propensities thus manifested, to the influence of disease, but they cannot all be attributed to faults of education, to evil example, or to innate depravity, without doing violence to the testimony of every day's ex- 1 Handbuch der gericht. Psychologic, 691. 17 194 MEDICAL JUKISPRUDENCE OF INSANITY. perience. It may be difficult no doubt, in many cases, to distinguish them in respect to their physical or moral origin, but the distinction is no less real on that account; the same principles are to guide us that regulate our decision in ques- tions touching any other form of insanity ; and if common sense and professional intelligence preside over our delibera- tions, the final judgment will not often be wrong. Where the propensity to steal is manifested in a person whose moral character has previously been irreproachable, and whose social position and pecuniary means render indul- gence in this vice peculiarly degrading and unnecessary, his plea of having committed the larceny while deprived, in a measure, of his moral liberty, deserves to be respectfully considered. If the object stolen is of trifling value, or inca- pable of being turned to any purpose of use or ornament ; if the offence have been preceded by others of a similar kind ; and especially if, in addition to these circumstances, the individual be a woman in a state of pregnancy, there can scarcely be a doubt that the plea should be admitted. We must not overlook the fact, however, that objects which are utterly valueless to some men, are exceedingly prized by others ; and it is a lamentable truth that some persons, in their eagerness to get possession of certain objects that gratify a favorite passion or taste, seem to lose sight all at once of the ordinary distinctions of meum and tuum. A cele- brated anatomist of irreproachable character was so anxious to enrich his cabinet with a valuable specimen of patho- logical anatomy which had smitten his fancy, that he actu- ally directed one of his pupils to visit the place and steal it for him. The commission, however, was not executed. " If the larceny had been attempted only," says Marc, who relates the anecdote, and was himself the pupil charged with the com- mission, " and the attempt had been discovered, neither the professor or the pupil could have been deemed excusable." * 167. Morbid activity of the sexual propensity is un- fortunately of such common occurrence, that it has been 1 Marc, de la Folie, etc. ii. 259. PARTIAL MORAL MANIA. 195 generally noticed by medical writers, though its medico- legal importance has never been so strongly felt as it de- serves. This affection, in a state of the most unbridled excitement, filling the mind with a crowd of voluptuous images, and ever hurrying its victim to acts of the grossest licentiousness, though without any lesion of the intellectual powers, is now known and described by the name of aidol- omania. We cannot convey a better notion of the phe- nomena of this disorder, than by quoting a few examples from Gall, by whom it was first extensively observed and its true nature discovered. Its milder forms and early stages, when not beyond the control of medical and moral treat- ment, are illustrated in the following cases. 168. "A robust and plethoric young man came to reside in Vienna. Having no liaisons, he was unusually continent, and was soon attacked with erotic mania." Gall, pursuing the treatment indicated by his peculiar views of the origin of the disease, succeeded in restoring him in a few days to perfect health. 169. " A well educated, clever young man, who, from his infancy almost, had felt strong erotic impulses, suc- ceeded in controlling them to a certain extent, by means of equally strong devotional feelings. After his situation per- mitted him to indulge without constraint in the pleasures of love, he soon made the fearful discovery, that it was often difficult for him to withdraw his mind from the voluptuous images that haunted it, and fix it on the important and even urgent concerns of his business. His whole being was absorbed in sensuality." He obtained relief by an assiduous pursuit of scientific objects, and by finding out new occupa- tions. 170. " A very intelligent lady was tormented, like the subject of the last-mentioned case, from infancy, with the most inordinate desires. Her excellent education alone saved her from the rash indulgences to which her tempera- ment so violently urged her. Arrived at maturity, she abandoned herself to the gratification of her desires, but this only increased their intensity. Frequently, she saw herself 196 MEDICAL JURISPRUDENCE OF INSANITY. on the verge of madness, and in despair, she left her house and the city, and took refuge with her mother who resided in the country, where the absence of objects to excite desire, the greater severity of manners and the culture of a garden, prevented the explosion of the disease. After having changed her residence for that of a large city, she was, after a while, threatened with a relapse, and again she took refuge with her mother. On her return to Paris, she came to me, and complained like a woman in perfect despair. ' Everywhere,' she exclaimed, ' I see nothing but the most lascivious images ; the demon of lust unremittedly pursues me, at the table, and even in my sleep. I am an object of disgust to myself, and feel that I can no longer escape either madness or death.' " 1 171. In the following cases, the mind was finally over- whelmed by the force of this frightful propensity, and sunk into complete aYid violent madness. " A man had lived many years in a happy and fruitful union, and had acquired by his industry a respectable fortune. After having retired from business and led an idle life, his predominant propen- sity gradually obtained the mastery over him, and he yielded to his desires, to such a degree, that, though still in posses- sion of his reason, he looked on every woman as a victim destined to gratify his sensual appetite. The moment he perceived a female from his window, he announced to his wife and daughters, with an air of the utmost delight, the bliss that awaited him. Finally, this partial mania degene- rated into general mania, and shortly after, he died in an insane hospital at Vienna." 2 172. Pinel has related a very similar case. " A man had creditably filled his place in society till his fiftieth year. He was then smitten with an immoderate passion for vene- real pleasures ; he frequented places of debauchery, where he gave himself up to the utmost excesses ; and then re- turned to the society of his friends, to paint the charms of pure and spotless love." His disorder gradually increased ; 1 Sur les Fonctions, iii. 317-319. 2 Op. cit. sup. iii. 320. PARTIAL MORAL MANIA. 197 his seclusion became necessary ; and he soon became a victim of furious mania. Many more cases like these might be quoted, particu- larly from the writings of Esquirol, Georget, and Marc, but the above are sufficient to illustrate a truth as generally recognized as any other in pathology, and to convince the most skeptical mind, that if insanity, or, in more explicit terms, morbid action in the brain inducing a deprivation of moral liberty, ever exists, it does in what is called aidoio- mania. 173. A morbid propensity to incendiarism, or pyro- mania, as it has been termed, where the person, though other- wise rational, is borne on by an irresistible power, to the commission of this crime, has received the attention of medi- cal jurists in Europe, by most of whom it has been regarded as a distinct form of insanity, annulling responsibility for the acts to which it leads. Numerous cases have been related, and their medico-legal relations amply discussed by Platner, 1 Vogel, 2 Masius, 3 Henke, 4 Gall, 5 Marc, 6 Friedreich, 7 and others. In a few of these cases the morbid propensity is excited by the ordinary causes of insanity ; in a larger class, it is excited by that constitutional disturbance which often accompanies the menstrual periods ; but in the largest class of all, it occurs at the age of puberty, and seems to be connected with retarded evolution of the sexual organs. The case of Maria Franc, quoted by Gall from a German journal, who was executed for house-burning, may be referred to the first class. She was a peasant of little education, and, in consequence of an unhappy marriage, had abandoned herself to habits of in- temperate drinking. In this state a fire occurred in which she had no share. " From the moment she witnessed this 1 Quasstiones Medicinae Forensis, 1824. 2 Beitr. zur gerichtsarztl Lehere d. Zurechnungsfahigkeit, p. 10. 1825. 8 System der gerichtlichen Arzneykunde fiir Rechtsgelehrte, 1818. 4 Abhandl. gerichtl. Medic, iii. 1824. 5 Sur les Fonctions, iv. 157-160. 6 Annales D'Hygiene, x. 357. 7 Handbuch der gericht. Psychologie, 393-435. 17* 198 MEDICAL JURISPRUDENCE OP INSANITY. fearful sight, she felt a desire to fire houses, which, whenever she had drunk a few coppers' worth of spirit, was converted in- to an irresistible impulse. She could give no other reason, nor show any other motive for firing so many houses than this impulse which drove her to it. Notwithstanding the fear, the terror, and the repentance she felt in every instance, she went and did it afresh." In other respects her mind was sound. Within five years she fired twelve houses, and was arrested on the thirteenth attempt. 1 174. Among numerous other cases of this kind that have been reported, we have room for only two more. Eve Schebomska, twenty-two years of age, was guilty of four incendiary acts, to which she said she was impelled by an inward agitation that tormented her. This agitation which, however, did not prevent her from performing her domestic labors, was greatly augmented, according to the testimony of her mistress, when she had been some time without seeing her lover. 2 A peasant girl, named Kalinovska, seven- teen years of age, while returning from a dance, where she had got quite heated, was suddenly seized with a desire to burn a building. She struggled with the desire for three days, when she yielded, and she declared that on seeing the flames burst out she experienced a joy such as she had never felt before. 8 175. In the following cases the incendiary propensity was excited by disordered menstruation, accompanied in some of them by other pathological conditions. A servant girl, named Weber, aged twenty-two years, committed three incendiary acts. Her mistress had observed that she was sad ; that she would frequently seem as if buried in thought, and would cry out in her sleep. It appeared in evidence that she had had a disease two years before, that was accompanied by violent pains in the head, disordered circulation, insensi- bility, and epileptic fits ; and that since then menstruation had ceased. 4 The servant girl of a peasant, seventeen years old, 1 Op. cit. sup. iv. 158. 2 Klein. Annalen, xvi. 141. 8 Ibid. B. xii. 53. * Ibid. B. xiii. 131. PARTIAL MORAL MANIA. 199 that had been guilty of two incendiary acts, declared that she was constantly beset by an inward voice that com- manded her to burn and then destroy herself. The first fire she regarded with calmness and even pleasure. The second time, she gave the alarm herself, and immediately after tried to hang herself. She had never manifested any mental dis- order, but from her fourth year she had been subject to spasms which finally degenerated into epileptic fits that were unusually violent whenever they coincided with the menstrual period. A very severe fit occurred but a few days previous to the second incendiary act. The faculty of Leipzig, who were consulted respecting the case, terminate their report with saying, that " in consideration of the physical state of the accused, they do not consider it probable, that, at the periods w r hen she committed the incendiary acts, she enjoyed the free use of her mental faculties." l 176. The following examples of the last class of cases will show the nature of the exciting causes of the incendiary impulse, and the physical imperfections of its subjects. " A servant girl was committed for two incendiary attempts on the premises of her master, in a German village, in 1830. On her examination before the magistrate she denied the charge, but subsequently confessed it while in prison. She assigned no reason for her conduct, acknowledged that she had been well treated by her employers, and they expressed themselves perfectly satisfied with her. It appeared in evi- dence that she was in her twentieth year ; that she had never menstruated; that since her thirteenth year, she had 'fre- quently had epileptic fits, two of which occurred on the day these attempts were made, one in the interval between them, the other after the last; and that for several days subsequent- ly she had two fits daily in prison. It also appeared that she had been guilty of other incendiary acts when in the service of a different family. On one occasion she declared " that she felt badly, and that when she felt so, she knew not what she did." The physicians by whom she was examined, and 1 Plainer, Op. cit sup. P. ii. 200 MEDICAL JURISPRUDENCE OF INSANITY. who made reports to the proper authorities, stated that she was quiet in her demeanor, betraying no indication of a malicious disposition, inclined to talk to herself, and, in regard to mental capacity, obviously stupid and dull. They concluded that she was not responsible for criminal acts, and that those she was charged with proceeded from an incendi- ary impulse which was a consequence of " interrupted phy- sical evolution." She was accordingly released by the court. Under appropriate treatment the menses were soon establish- ed, after which she had no return of her epilepsy, nor her pyromania. 1 A girl, fifteen years old, named Graborkwa, while suffer- ing from nostalgia, or homesickness, made two incendiary attempts in order that she might be able to leave the service of her employers. She stated that from the moment she entered their service, she was unceasingly beset by the de- sire of burning buildings. It seemed as if a shade that was constantly before her, impelled her to acts of incendiarism. It appeared that she had long suffered violent pains in her head, and had never menstruated. 2 A servant girl, seventeen years old, was guilty of incen- diarism, for the purpose, as she stated, of being sent back to her parents. She exhibited no sign of mental derange- ment, though of very limited capacity. She was unusually short in stature, the sexual organs showed no signs of devel- opment, and the menses had never appeared. 8 177. That the evolution of the sexual functions is very often attended by more or less constitutional disturbance, especially in the female sex, is now a well-established physi- ological truth. The shock seems to be felt chiefly by the nervous system, which experiences almost every form of irritation, varying in severity from the slightest hysteric symptoms, to tetanus, St. Vitus's dance, and epilepsy. And when we bear in mind, also, that general mania is sometimes produced by this great physiological change, it cannot be 1 Neues Archiv dps Criminalrechts. xiv. 393. 2 Klein, Annalen, xii. 126. 3 Plainer, Op. cit. sup. xv. PAETIAL MORAL MANIA. 201 deemed an extraordinary fact that partial mania, exciting to acts of incendiarism or murder, should be one of its effects. Still we would not be understood as favoring the opinion that every youth between the age of twelve and fifteen, guilty of incendiarism, is a subject of pyromania. The general principle of the power of the change in question to produce this disorder, is not alone sufficient. It is neces- sary to trace the connection between them in the particular case, and unless this can be done, we have no right to claim the benefit of the general truth. To aid us in the investiga- tion of this point, it will be well to bear in mind the follow- ing considerations, laid down by Henke, 1 and adopted by Marc, in his excellent paper on this disorder. 2 178. 1. To proye the existence of pyromania, pro- duced by the sexual evolution, the age should correspond with that of puberty, which is between twelve and fifteen. Sometimes, however, it may occur, especially in females, as early as the eleventh or tenth year, and, therefore, if the symptoms are well marked, we have a right to attribute them to this cause. 2. There should be present symptoms of irregular develop- ment ; of marked critical movements, by means of which nature seeks to complete the evolution. These general signs are, either a rapid increase of stature, or a less growth and sexual development then is common at the age of the individual ; an unusual lassitude and sense of weight and pain in the limbs ; glandular swellings ; cutaneous erup- tions, etc. 3. If, within a short time of the incendiary act, there are symptoms of development in the sexual organs, such as efforts of menstruation in girls, they deserve the greatest attention. They will strongly confirm the conclusions that might be drawn from the other symptoms, that the work of evolution disturbed the functions of the brain. Any irregu- 1 Op. cit. sup. 2 Considerations medico-legales sur la monomania et particulierement sur la monomania incendiaire. Annales D'Hygiene, x. 357-473. 202 MEDICAL JURISPRUDENCE OF INSANITY. larity whatever of the menstrual discharge, is a fact of the greatest importance in determining the mental condition of incendiary girls. 4. Symptoms of disturbance in the circulating system, such as irregularity of the pulse, determination of blood to the head, pains in the head, vertigo, stupor, a sense of op- pression and distress in the chest, are indicative in young subjects of an arrest or disturbance of the development of the sexual functions, and therefore require attention. 5. For the same reason, symptoms of disturbance in the nervous system, such as trembling, involuntary motions of the muscles, spasms and convulsions of every kind, even to epilepsy, are no less worthy of attention. 6. Even in the absence of all other symptoms, derange- ment of the intellectual or moral powers would be strong proof, in these cases, of the existence of pyromania. Of the two, the latter is far the more common, and is indicated by a change in the moral character. The patient is sometimes irascible, quarrelsome ; at others, sad, silent, and weeping without the slightest motive. He seems to be buried in a profound revery, and suddenly starts up in a fright, cries out in his sleep, etc. These symptoms may have disappeared and reappeared, or degenerated at last, into intellectual mania. 7. The absence of positive symptoms of mental disorder, as well as the presence of those which appear to show that the reason is sound, is not incompatible with the loss of moral liberty. The remarks of Marc on this point deserve to be quoted in full. " Even when, previously to the incen- diary act, they have shown no evident trace of mental aliena- tion, and been capable of attending to their customary du- ties ; when, on their examinations, they have answered per- tinently to questions addressed to them ; when they have avowed that they were influenced by a desire of revenge ; we cannot conclude with certainty, that they were in posses- sion of all their moral liberty, and that, consequently, they should incur the full penalty of the crime. These unfortu- nates may be governed by a single fixed idea, not discovered PARTIAL MORAL MANIA. 203 till after the execution of the criminal act. Pyromania re- sulting from a pathological cause, may increase in severity, as this cause itself is aggravated, and suddenly be converted into an irresistible propensity, immediately followed by its gratification." 1 179. If the above considerations are carefully pondered by the medical jurist, he will be in little danger of mistake, in determining the question whether or not the incendiary act is excited by a pathological condition of the nervous system, incident to the evolution of the sexual functions. If it be decided in the affirmative, the acquittal of the accused should follow as a matter of course, though it might not square with the technical definitions of insanity, and the usual subtleties respecting moral liberty and freedom of the will. In the north of Germany, where pyromania in young subjects is remarkably frequent, the court is generally gov- erned by the opinions of the medical experts, and thus the accused escapes the ignominious fate which is almost inevi- table wherever the spirit of the English common law pre- vails. 180. The last and most important form of moral mania that will be noticed, consists in a morbid activity of the propensity to destroy; where the individual, without provo- cation or any other rational motive, apparently in the full possession of his reason, and oftentimes, in spite of his most strenuous efforts to the contrary, imbrues his hands in the blood of others ; oftener than otherwise, of the partner of his bosom, of the children of his affections, of those, in short, who are most dear and cherished around him. The facts here alluded to are of painful frequency, and the gross mis- understanding of their true nature, almost universally preva- lent, excepting among a few in the higher walks of the pro- fessions, leads to equally painful results. In the absence of any pathological explanation of this horrid phenomenon, the mind seeks in vain, among secondary causes, for a rational mode of accounting for it, and is content to resort to 2 Op. cit sup. 457. 204 MEDICAL JURISPRUDENCE OF INSANITY. that time-honored solution of all the mysteries of human delinquency, the instigation of the devil. Of the double homicide to which this affection gives rise, there can be no question which is most to be deplored, for, shocking as it is for one bearing the image of his Maker to take the life of a fellow-being with brutal ferocity, how shall we characterize the deliberate perpetration of the same deed, under the sanction of law and of the popular approbation ? We trust, however, that the ample researches of writers of unques- tionable veracity and ability, which are now just reaching the attention of the legal profession, will be soon followed by a conviction of past errors, and a more rational adminis- tration of the criminal law. For the purpose of contributing to this object, it will be necessary to bring fully before the reader the results of these researches, and, in view of the importance of the subject, to risk the charge of prolixity by the number and length of the quotations. 181. The form of disease now under consideration was first distinctly described by Pinel ; and though its existence as a distinct form of monomania was for a long time after doubted, it has subsequently been admitted by the principal writers on insanity ; by Gall and Spurzheim, Esquirol, 1 Geor- get, Marc, Andral, Orfila, and Broussais in France ; by Co- nolly, Combe, and Prichard in England; by Hoffbauer, Platner, Ethmuller, Henke, and Friedreich in Germany ; by Otto of Copenhagen ; and by Rush in this country. It has received the various appellations of monomanie-homicide, monomanie-meurtriere, melancholie-homicide, homicidal insan- ity, instinctive monomania. Esquirol, in his valuable memoir,' first published in the shape of a note in the French transla- tion of HofFbauer's work, observes that homicidal insanity, or monomanie-homicide, as he terms it, presents two distinct 1 It is worthy of mention, that though Esquirol, in liis article Manie, in the Did. Med. Sci., expressed his disbelief in the existence of homicidal insanity unconnected with other mental alienation, he has since not only retracted his opinion, but has published the very best contribution to our knowledge of the subject. PARTIAL MORAL MANIA. 205 forms, in one of which the monomoniac is always influenced by avowed motives more or less irrational, and is generally regarded as mad; in the other, there are no motives ac- knowledged, nor to be discerned, the individual being im- pelled by a blind, irresistible impulse. It is with the latter only that we are concerned, for the other is clearly a form of partial intellectual mania ; but as this division has not been strictly made by nature, cases often occurring that do not clearly come under either category, the subject will be better elucidated by noticing all the forms of this affection, and seeing how intimately they are connected together. 182. In the first group of cases we have the simplest form of homicidal insanity, that in which the desire to destroy life is not only prompted by no motive whatever, and solely by a violent impulse, but without any appreciable disorder of mind or body. " In a respectable house in Germany, the mother of the family returning home one day, met a servant, against whom she had no cause of complaint, in the greatest agitation ; she begged to speak with her mistress alone, threw herself upon her knees, and entreated that she might be sent out of the house. Her mistress, astonished, inquired the reason, and learned that whenever this unhappy servant undressed the lady's child, she was struck by the whiteness of its flesh and experienced the almost irresistible desire to tear it in pieces. She felt afraid that she could not resist the impulse, and preferred to leave the house." " This circumstance," says the narrator, " occurred in the family of Baron Humboldt, and this illustrious person permitted me to add his testimony." 1 183. " A young lady who had been placed in a maison de sante, experienced homicidal desires, for which she could assign no motive. She was rational on every subject, and whenever she felt the approach of this dreadful propensity, she shed tears, entreated to have the strait-waiscoat put on and to be carefully guarded, till the paroxysm, which some- times lasted several days, had passed." 2 1 Marc, consultation medico-legale, pour H. Cornier, p. 52. 2 Idem. 18 206 MEDICAL JURISPRUDENCE OF INSANITY. 184. " M. R., a distinguished chemist and a poet, of a naturally mild and sociable disposition, committed himself a prisoner in one of the maisons de sante of the faubourg St. Antoine. Tormented by the desire of killing, he prostrated himself at the foot of the altar, and implored the divine assistance to deliver him from such an atrocious propensity, of the cause of which he could give no account. When he felt that he was likely to yield to the violence of this inclina- tion, he hastened to the head of the establishment, and requested him to tie his thumbs together with a ribbon. This slight ligature was sufficient to calm the unhappy R., who subsequently endeavored to kill one of his friends, and finally perished in a fit of maniacal fury." 1 185. The following case is recorded by Gall, who derived it from a German paper of April 13th, 1820. " A carrier, belonging to the bailiwick of Frendenstadt, who had quitted his family in perfect health, was suddenly attacked by a paroxysm of furious madness, on the route between Aalen and Gemunde. His first insane act was to shut him- self up in the stable with his three horses, to which he gave no fodder ; and when departing he harnessed only two of his horses, accompanying the carriage, mounted on the other. At Moglengen he abused a woman ; at Unterbobingen, he alighted, and walked before his horses with a hatchet in his hand. On the route between the last place and Hussenhofen, the first person he met with was a woman whom he struck several times with his hatchet, and left her lying in a ditch by the road side. Next, he encountered a lad thirteen years old whose head he split open ; and shortly after, he split the skull of a man, thirty years old, and scattered his brains in the road ; and after hacking the body, he left his hatchet and carriage, and thus unarmed proceeded towards Hus- senhofen. He met two Jews on the road, whom he attacked, but who, after a short struggle, escaped him. Near Hus- senhofen, he assaulted a peasant who screamed till several persons came to his aid, who secured the maniac and carried 1 Marc, op. cit 65. PARTIAL MORAL MANIA. 207 him to Gemunde. They afterwards led him to the bodies of his victims, when he observed, ' It is not I, but my bad spirit, that has committed these murders.'" 1 186. William Brown was executed at Maidstone, Eng- land, in 1812, for strangling a child whom he accidentally met one morning while walking in the country. He took up the body and laid it on some steps, and then went and told what he had done, requesting to be taken into custody. On the trial, he said he had never seen the child before, had no malice against it, and could assign no motive for the dreadful act. He bore an exemplary character, and had never been suspected of being insane. 2 It is needless to say that he was hanged. 187. A country gentleman, enjoying good health and easy circumstances, consulted Esquirol in regard to his singular and unhappy condition. He related that he had read the indictment of Henriette Cornier, which, however, did not very strongly excite his attention. In the course of the night he suddenly awoke with the thought of killing his wife who was lying beside him. He left his wife's bed for a time, but within three weeks the same idea seized upon his mind three times, and always in the night. During the day, considerable exercise and occupation preserved him from this fearful inclination. He evinced not the slightest mental disorder ; his business was prosperous ; he had never experienced any domestic chagrins ; and he had no cause of complaint or jealousy in regard to his wife whom he loved, and with whom he never had had the least disagreement. With the exception of a light headache occasionally, he had always been well and free from pain. He is sad and troubled about his condition, and has quitted his wife for fear least he might yield to the force of his desire. 8 188. In most cases of homicidal insanity the presence 1 Sur les Fonctions, etc. iv. 103. 2 Knapp and Baldwin's Newgate Callender, iv. 80. a Des Maladies Mentales, ii. 830. 208 MEDICAL JTJKISPRUDENCE OF INSANITY. of some physical or moral disorder may be detected ; and though none is mentioned in those above related, there is reason to suppose that it might have been ascertained by a more thorough examination. It is a curious Tact, however, that homicidal desires of the intensest kind will sometimes flit through the mind, while the individual, though capable of judging of his feelings, is unconscious of being otherwise then perfectly well. Marc, the distinguished medical jurist, relates, that passing over a bridge in Paris one day, he observed' a lad sitting on the parapet of the bridge, eating his breakfast, when he was seized with an almost irresistible desire to push him over into the river. The idea was but a flash, but it filled him with such horror, that he rapidly crossed over to the opposite trottoir, and got out of the way as quick as possible. Talma, the actor, also assured him, on hearing the story, that he had experienced the same pro- pensity under very similar circumstances. 1 In the following group of cases the homicidal fit was obviously accompanied or preceded by disease or physical disorder of some kind. 189. The following case is related by Gall, who ob- tained it from Dr. Zimmermann of Krumback. " A peasant, born at Krumback, Swabia, who never enjoyed very good health, twenty-seven years old, and unmarried, had been subject from his ninth year to frequent epileptic fits. Two years ago, his disease changed its character without any apparent cause, and ever since, instead of a fit of epilepsy, this man has been attacked with an irresistible inclination to commit murder. He felt the approach of the fit many hours, and sometimes a whole day, before its invasion, and from the commencement of this presentiment, he begged to be secured and chained that he might not commit some dread- ful deed. ' When the fit comes on,' says he, ' I feel under a necessity to kill, even if it were a child.' His parents, whom he tenderly loved, would be the first victims of this murder- ous propensity. ' My mother,' he cries out with a frightful 1 Marc. De la Folie, etc. ii. 478. PARTIAL MORAL MANIA. 209 voice, ' save yourself, or I must kill you.' Before the fit he complains of being exceedingly sleepy, without being able to sleep ; he feels depressed, and experiences slight twitchings of the limbs. During the fit, he preserves his consciousness, and knows perfectly well that in committing a murder, he is guilty of an atrocious crime. When he is disabled from doing injury, he makes the most frightful contortions and grimaces, singing or talking in rhyme. The fit lasts from one to two days. When it is over, he cries out, ' Now unbind me. Alas! I have cruelly suffered, but I rejoice that I have killed nobody.' " 1 190. On the fifteenth February, 1826, Jacques Mounin, after many acts of violence and fury, escaped from his family who wished to restrain him, scaled the walls of seve- ral adjoining properties, and took to the fields, without shoes, hat, or weapons of any kind. His flight having excited considerable alarm, as after some epileptic attacks he had formerly given many signs of a blind fury, the local authori- ties were informed, and several persons despatched after him as quickly as possible. On arriving at a field, where many laborers were at work at a distance from one another, Mou- nin first threatened a man who was driving a cart, and imme- diately after pursued Joseph Faucher and pelted him with stones. The latter having escaped, he then approached an old man almost blind, named Mayet, whom he knocked down and killed by beating on the head with a large stone. He next attacked a man who was digging at a little distance, and killed him with a spade. A few minutes afterwards he met Propheti on horseback, whom he struck down with stones, but was obliged to leave him in consequence of the cries of his victim. He then chased some children who saved themselves by hard running, but he overtook a man at work and slew him. On being questioned during his confinement, Mounin said he well recollected having killed the three men, and especially one, a relative of his own, whom he greatly regretted ; he added that in his paroxysms 1 Gall, op. cit iv. 104. 18* 210 MEDICAL JURISPRUDENCE OF INSANITY. of phrensy he saw nothing but flames, and that blood was then most delightful to his sight. At the end of a few days' imprisonment, he seemed to have entirely recovered his reason, but subsequently he relapsed. The court declined trying him, under the conviction that he was insane while committing the murders above mentioned. 1 191. " Frederick Jensen, a workman, thirty-seven years old, had for some time suffered from fits of giddiness, which always obliged him to seize hold of the nearest objects. In the spring of 1828, he lost a beloved daughter, which afflicted him very much. The state of his health was nevertheless perfect in mind as well as in body, when he, one day (Sun- day, 28th September, 1828) after dinner, told his wife that he would take a walk with his son, a boy ten years old. He did so, and went with him to the green which encircles the citadel. When he came there, he now relates, ' a strange confusion came over me ; ' it appeared like a matter of ab- solute necessity to him to drown his son and himself in the waters at the citadel. Quite unconscious of what he was doing, he ran towards the water with the boy in his hand. A man, surprised at his behavior, stopped him there, took the boy from him, and tried to persuade him to leave the water; but he became angry, and answered that he intended to take a waHc, and asked, ' whether any body had a right to forbid him to do so ? ' The man left him, but took the boy along with him. An hour afterwards he was taken out of the water, into which he had thrown himself, and taken to prison. As he still showed symptoms of in- sanity, he was bled and purged, and two days after, was brought into the hospital, and committed to the care of my friend, Dr. Wendt, who has perfectly cured him, and who kindly afforded me the opportunity to see and to speak with him. He now very quietly* tells the whole event himself, but is not able to explain the cause of the suddenly rising desire to kill himself and the boy whom he loved heartily. This cause is only to be sought in congestion of blood to the brain, 1 Georget, Discussion medico-legale, etc. 153. PARTIAL MORAL MANIA. 211 the same which before had caused his giddiness; and whether we adopt an organ of destructiveness in the brain or not, it is to be assumed that the propensity to kill himself and the son arose from a morbid excitation of a certain part of the brain. The disposition to congestion originated from a fall he suffered on the head in 1820." 1 192. Another curious form of homicidal insanity oc- curs in women, and seems to be connected with those changes in the system produced by parturition, menstrua- tion, and lactation. It is a little remarkable that with few exceptions, the victim selected by the patient is always her own, or some other young child. Among several cases which Esquirol has related at length, are the two following, which are abridged from his memoir. 193. Madam N., whom Esquirol received into his hos- pital, and whom he describes as being perfectly rational in her conversation and conduct, and of a mild, affable, and industrious disposition, very calmly related to him the cir- cumstances connected with a strong inclination she felt to kill her child. After her last accouchement, fourteen months before, she had several hysterical fits, and was much troubled with pains in the head, stomach, and bowels; with vertigo, and ringing in the ears. These mostly disappeared, but she then became exceedingly capricious in her temper and affec- tions, being alternately gay and sad, confiding and jealous, resolute and weak. In this condition, she heard of the mur- der committed by Henriette Cornier, when she was imme- diately seized with the idea of killing her infant, and one day when her child entered the room, she felt the most violent de- sire to assassinate it. ' I repelled the idea,' said she, ' and coolly inquired of myself, why I should conceive such cruel designs what could put them into my imagination ? I could find no answer. The same desire returned ; I feebly resisted it, was overcome, and proceeded to consummate the crime. A new effort arrested my steps, I raised the knife .to my own throat, saying to myself, better perish yourself, bad woman.' 1 Dr. Otto, in the Edinburgh Phrenological Journal, vi. 611. 212 MEDICAL JURISPRUDENCE OF INSANITY. When asked the cause of these evil thoughts, she replied, that something behind her back urged her on. During the first fortnight of her stay in the hospital, she was afflicted by a return of the physical disturbances with which she was at first attacked, but at the end of six weeks w T as so much better, in consequence of a proper medical treatment, that she received her husband and child with joy, and lavished on the latter the tenderest caresses. Suddenly she perceived a cutting instrument, and was seized with the desire of snatching it up and committing two murders at once, a thought which she suppressed only by flying from the room. The symptoms of physical disturbance now again made their appearance, during which she was informed that her child was sick, and while extremely distressed and weeping at the news, ' she felt a violent desire,' to use her own expres- sion, 'to stab or stifle it in her arms.' After about three months' residence at the hospital, she went away restored, and continued well. 1 194. A girl fourteen years old, of strong constitution and difficult temper, enjoyed apparently good health, though she had not menstruated. Once a month she complained of pain in the head, her eyes were red, she was irascible, gloomy, and restless ; every thing went wrong with her, and she was particularly inclined to dispute with her mother who was always the object of her threats and abuse ; and finally she became most violently angry, sometimes attempt- ing her own life and sometimes her mother's. When the fit arrived to this degree, the blood escaped from her mouth, nose, or eyes ; she wept and trembled ; the extremities be- came cold, and affected with convulsive pains ; and her mind was filled with distress. The fit, which altogether con- tinued one or two days, being over, she recovered her affec- tion for her mother, and asked her forgiveness. She did not recollect all the circumstances of these fits, and denied with feelings of surprise and regret some of the particulars which were related to her. At the age of sixteen years, these fits 1 Des Malad. Ment. ii. 821. PARTIAL MORAL MANIA. 213 of anger were often replaced by hysteric convulsions ; the disease diminished progressively, but did not cease till she was seventeen years old, when the menses appeared. She afterwards married, and became an excellent mother. 1 195. Almira Brixey was a maid-servant in a respectable English family, and one day, in the spring of 1845, while the nurse was out of the room, she obtained a knife from the kitchen and cut the throat of her master's infant child. She then went down stairs and told what she had done, inquiring with some anxiety whether she would be hanged or trans- ported. No delusions were detected, nor had she manifested any other mental peculiarity except some violence of temper about trivial matters, a short time before. She had expressed a little dissatisfaction with her share of her mistress's cast-off dresses, but beyond this, there did not appear to be a shadow of a motive. There was some proof, though not very definite, that she. had labored under some menstrual disorders. She was acquitted and sent to Bethlehem hospital. 196. Esquirol relates another case communicated to him by Dr. Barbier of Amiens, which will be briefly noticed. This lady, Marguerite Molliens, twenty-four years old, had suffered for three years past pains in the epigastrium, and right side of the abdomen ; headache, vertigo, noise in the ears, disturbance of vision, palpitation of the heart, con- strictions of the throat, and trembling of the limbs. Her first child, which lived but three months, she loved and deeply regretted. Nine months ago she had another child. On the fifth day of her confinement she heard of Cornier's case, and was so deeply impressed with the story that her thoughts dwelt upon it, and from that moment she feared lest she also might be similarly tempted. In spite of all her efforts, she gradually familiarized herself with the idea of killing her child. One day while dressing it, the thought of murdering it seized upon her mind and became a violent desire. She turned around, and perceiving a kitchen-knife on a table near her, her arm was involuntarily carried towards it. She saw 1 Idem. ii. 814. 214 MEDICAL JURISPRUDENCE OF INSANITY. that she could no longer control herself, and cried out for assistance. The neighbors came in and she soon became calm. Shortly after she was separated from her child and sent to a hospital, where she finally recovered. It is worthy of note that when the pains in the head and epigastrium, from which she suffered greatly in the hospital, were worst, then the bad thoughts appeared to be most imperious. 1 197. Dr. Otto, of Copenhagen, relates that a female, who was received into a lying-in-hospital of which he was physician, requested a private conference with him previ- ously to her accouchement. She appeared to be in great agitation and embarrassment, and earnestly begged of him that she might not be left in the same chamber with other women and their infants, as it would be utterly impossible for her to resist the propensity she felt to destroy the latter. Her request was granted and she was carefully watched. Her delivery was easy, and the child was kept from her and afterwards sent to her mother. The young woman on leav- ing the hospital went into service, and would not return to her mother's, lest she might be tempted to destroy her infant. She declared that the sight of a very young infant kindled up an irresistible propensity to destroy its life. This woman was a peasant who had been seduced, but had never led a dissolute life, nor was in any way of corrupt manners. She had not been reproached, nor ill-treated by her parents, during pregnancy, nor was there the least cause for anxiety on account of the child, as her mother had engaged to pro- vide for it. She entered into the service of a clergyman, and enjoyed good health. Sometime afterwards she in- formed the doctor that she had lost nearly all propensity to infanticide. 2 198. The next case is recorded by Dr. Michu. " A country woman, twenty-four years of age, of a bilious, san- guine temperament, of simple and regular habits, but re- served and sullen manners, had been ten days confined 1 DCS Malad. Mcnt. ii. 825. 2 Medico-Chirurgical Review, O. S. xiii. 4 1. PARTIAL MORAL MANIA. 215 with her first child, when suddenly having her eyes fixed upon it, she was seized with the desire of strangling it. This idea made her shudder ; she carried the infant to its cradle, and went out in order to get rid of so horrid a thought. The cries of the little being who required nourish- ment, recalled her to the house ; she experienced still more strongly the impulse to destroy it. She hastened away again haunted by the dread of committing a crime so horri- ble ; she raised her eyes to heaven, went to the church and prayed. The whole day was passed by this unhappy mother in a constant struggle between the desire of taking away the life of her infant and the dread of yielding to the impulse. She concealed her agitation until evening, when her confes- sor, a respectable old man, was the first to receive her confi- dence. He soothed her feelings, and counselled her to have medical assistance. ' When we arrived at her house,' says Michu, ' she appeared gloomy and depressed, and ashamed of her situation.' Being reminded of the tenderness due from a mother to her child, she replied ; ' I know how much a mother ought to love her child ; but if I do not love mine, it does not depend upon me.' She soon after recovered, the infant, in the meantime, having been removed from her sight." 1 199. Gall says he knew a woman, then twenty-six years old, who had experienced, especially at the menstrual periods, inexpressible torture, and the fearful temptation to destroy herself, and to kill her husband and children, who were exceedingly dear to her. She shuddered with terror, as she described the struggle that took place within her between her sense of duty and of religion, and the impulse that urged her to this atrocious act. For a long time, she dared not bathe her youngest child, because an internal voice constantly said to her, ' let him slip, let him slip.' Fre- quently she had hardly the strength and time to throw away a knife which she was tempted to plunge into her own breast and her children's. Whenever she entered the chamber of her 1 Memoire sur la monomanie-homicide, 99. 216 MEDICAL JURISPRUDENCE OF INSANITY. children, or husband, and found them asleep, she was instant ly possessed with the desire of killing them. Sometimes she precipitately shut behind her the door of their chamber and threw away the key, to remove the possibility of returning to them during the night, if she should fail to resist this infernal temptation." 1 200. In another class of cases, the exciting cause of the homicidal propensity is of a moral nature, operating upon some peculiar physical predisposition, and sometimes followed by more or less physical disturbance. Instead of being urged on by a sudden, imperious impulse to kill, the subjects of this form of the affection, after suffering for a certain period much gloom of mind and depression of spirits, feel as if bound by a sense of necessity to destroy life, and proceed to the fulfilment of their destiny with the utmost calmness and deliberation. So reluctant have courts and juries usually been to receive the plea of insanity in defence of crime, deliberately planned and executed by a mind in which no derangement of intellect has ever been perceived, that it is of the greatest importance that the nature of these cases should not be misunderstood. They are of not unfre- quent occurrence, and are often attended by such horrid, heart-rending circumstances, that nothing but the plainest and strongest conviction of their true character can ever save their subjects from the last penalty of the law. The near affinity of this form of the affection to those already described will be manifest, upon a careful consideration of the few cases here given. 201. The following is related by Dr. Otto of a surgeon who had served in several campaigns against the French. " He always appeared of a lively and cheerful disposition, till certain pecuniary matters ruffled his temper and made him thoughtful and melancholy. He was now frequently observed to be studying the scriptures, and reciting passages from the bible. He was happily married, and had four children. One morning he summoned his wife and chil- 1 Op. cit. sup. iv. 110. PARTIAL MORAL MANIA. 217 dren into the court of the house, and there informed them that it was his intention to kill them all, and afterwards himself. He descanted coolly on the propriety of homicide, and told his wife she must first be a spectator of the destruction of her children, and then her own turn would come. The woman appears to have possessed great presence of mind, and acted with great prudence on such a trying occasion. She entirely coincided in the justness of her husband's sen- timents, and cheerfully agreed to the proposed tragedy. But she appeared suddenly to recollect that it would be proper for herself, as well as the children, to confess and take the sacrament previous to their appearing before their final judge, a ceremony which would necessarily require seve- ral days' preparation. The monomaniac replied that this was a reasonable and proper procedure ; but, in the mean- time, it would be absolutely necessary that he took some person's life that day. With this purpose in view, he in- stantly set off for Salzbourg. His wife, having placed the children in security, made the best of her way to the above- mentioned town, and went directly to professor O., the friend of her husband, for advice. The monomaniac had already been there, and not finding the professor at home, had gone away. The woman now recollected and told the professor, that her husband had threatened his life for some imagi- nary slight; but, at that time, she thought he was in jest. About mid-day the monomaniac came back to the professor's residence, and appeared quite calm and peaceable. The pro- fessor invited him to go and see the hospital of the town where he had a curious dissection to make, and they sat down to take some refreshments before proceeding- thither. At this repast, the monomaniac informed his host that he had lately been most immoderately disposed to commit homicide, and that he had actually murdered a peasant that morning on his way to town. He confessed, also, that he had entered a coffee-house for the purpose of committing a second act of this kind, but had been diverted from his purpose. The murder of the peasant was a fiction, as was afterwards proved. The professor now turned the discourse to other subjects, 19 218 MEDICAL JURISPRUDENCE OF INSANITY. and on all other topics the monomaniac was perfectly ra- tional. They now set off for the hospital, and in their way thither the monomaniac met with an old acquaintance and fellow-campaigner. While they were greeting each other, the monomaniac suddenly struck his friend a violent blow on the pit of the stomach, exclaiming in a burst of laughter, that he had done it for him, as he had hit the coeliac plexus. The professor reprimanded him in strong terms for this dishonora- ble and cruel act, at which the monomaniac was much sur- prised, and informed his preceptor that he was irresistibly led to commit homicide, and cared not who was the victim of this propensity. The professor now asked him, somewhat tauntingly, if he had not a design against his life. The mon- omaniac acknowledged it ; but added that he had sufficient control over himself to prevent the destruction of his benefac- tor. The professor took his arm and they proceeded to the hospital, where the monomaniac was immediately confined. He almost instantly became furiously maniacal, and in a few months after died." 1 202. Gall quotes an account of Catherine Hansterin, who, in consequence of being detected in a petty theft which was reported to her husband, a man of harsh and austere manners, of whom she stood greatly in fear on account of his cruel treatment of her, became exceedingly melancholy and depressed. After suffering much and long from her cruel husband, she determined to leave him, and accordingly de- parted, taking her infant two and a half months old, and her little girl who had declared she would rather die than be left behind with her father. " The thought which this reply brought to her mind, the distress that afflicted her, the fear of what would happen to her children in case of her death, and at the same time, her ardent desire to terminate her own existence ; all these united, gave rise to the barbarous design of drowning her two children. Having arrived at the bank of the Danube, she made her little girl kneel down and pray God for a good death. She then placed the 1 Medico-Chirurgical Review, xlii. 446. PARTIAL MORAL MANIA. 219 infant in the hands of her sister, blessed them both, and mak- ing the sign of the cross, pushed them into the river. This done, she returned to the village and told what had passed." 1 203. Dr. Otto has published the case of Peter Neilsen, a joiner, aged forty-seven years, who drowned four of his seven children. He appears to have experienced some mis- fortunes, but was not in positive want of the necessaries of life at the moment when he committed the horrid deed. Many persons who conversed with him on the same day both before and after the transaction, testified that Tie was not intoxicated, nor the least agitated in mind. He was, on the contrary, placid and tranquil. No domestic altercations, of any moment, had occurred, but he was disconcerted at not readily getting a new lodging on being turned out of that which he previously occupied. His love to his children was testified to by all. He confessed that the idea of kill- ing his children came into his head on the morning of the day that he put the idea into execution, and that the impulse was quite irresistible. He determined to drown the three younger boys and spare the daughter who was older. But she insisted on accompanying her father and brothers in the walk he proposed, and though he endeavored to persuade her to return, she would not. He averred that his motive for destroying the boys was the fear of not being able to main- tain them ; whereas he would have spared the girl, not be- cause he loved her more, but because she was better able to maintain herself. Having arrived at a turf-pit he first em- braced his children, and then pushed them all into the water. He stood by unmoved, and saw them struggle and sink. He then returned quietly to the town and told what he had done He was then led back to the turf-pit, and beheld the dead bodies of his children without evincing any emotion. For a moment he wept, when he saw the bodies opened (for the purpose of medico-legal proof of the kind of death), but soon regained his tranquillity. He affirmed that he did not des- troy his offspring in order to procure happiness for them in i Op. cit. iv. 152. 220 MEDICAL JURISPRUDENCE OF INSANITY. heaven, nor from any desire to be put to death himself, as he wished to live. 1 204. The case of Henriette Cornier, which occurred in Paris a few years since, has, in consequence of the imposing weight of medical opinions that were delivered on her trial, and of the discussions to which it gave rise in the various shapes of reports, newspaper criticisms, and elaborate treatises from some of the most distinguished physicians of that capital, contributed, more than any other single event, to advance our knowledge of homicidal insanity. A case so celebrated deserves a particular notice here. The facts as related below are contained in the indictment (acte d> accusa- tion}^ which is given at length by Georget in his account of the trial. 2 205. Henriette Cornier, a female servant aged twenty- seven years, was of a mild and lively disposition, full of gaiety, and remarkably fond of children. In the month of June, 1825, a singular change was observed in her character ; she became silent, melancholy, absorbed in reverie, and finally sank into a kind of stupor. She was dismissed from her place, but her friends could obtain from her no account of the causes of her mental dejection. In the month of Sep- tember she made an attempt to commit suicide, but was prevented. In the following October she entered into the service of dame Fournier, but there she still presented the melancholy and desponding disposition. Dame Fournier observed her peculiar dejection, and endeavored in vain to ascertain its cause ; the girl would talk only of her misfor- tune in losing her parents at an early age, and of the bad treatment she received from her guardian. On the 4th of November, her conduct not having been previously different from what it usually was, she suddenly conceived and im- mediately executed the act for which she was committed. 206. About noon her mistress went out to walk, having told Cornier to prepare dinner at the usual hour, and to go to 1 Edinburgh Phrenological Journal, v. 87. a Discussion medico-legale, 70. PARTIAL MORAL MANIA. 221 a neighboring shop kept by dame Belon, to buy some cheese. She had frequently gone to this shop, and had always mani- fested great fondness for Belon's little girl, a beautiful child nineteen months old. On this day she displayed her usual fondness for it, and persuaded its mother who at first was rather unwilling, to let her take it out to walk. Cornier then hastened back to her mistress's house with the child, and laying it across her own bed, severed its head from its body with a large kitchen knife. She subsequently declared that while executing this horrid deed, she felt no particular emo- tion neither of pleasure, nor of pain. Shortly after, she said, the sight of the horrible spectacle before her eyes brought her to herself, and she expressed some emotions of fear, but they were of short duration. At the end of two hours, during which time she had remained chiefly in her own chamber, dame Belon came and inquired for her child, from the bottom of the staircase. " Your child is dead," said Henriette. The mother, who at first thought she was only in jest, soon became alarmed, and pushed forward into the chamber, where she witnessed the bloody sight of the mutilated fragments of her child. At that moment, Cornier snatched up the head of the murdered child, and threw it into the street, from the open window. The mother rushed out of the house, struck with horror. An alarm was raised; the father of the child and the officers of justice with a crowd of persons entered the room. Henriette was found sitting on a chair near the body of the child, gazing at it, with the bloody knife by her, her hands and clothes covered with blood. She made no attempt to escape, nor to deny the crime ; she con- fessed all the circumstances, even her premeditated design, and the perfidy of her caresses, which had persuaded the unhappy mother to intrust her with the child. It was found impossible to excite in her the slightest emotion of remorse or grief ; to all that was said, she replied, with indifference, " I intended to kill the child." When closely and earnestly interrogated, as to her motives for committing this dreadful act, she replied that she had no particular reason for it ; that the idea had taken possession of her mind, and that she was 19* 222 MEDICAL JURISPRUDENCE OF INSANITY. destined to do it. When asked why she threw the head into the street, she answered that it was for the purpose of attract- ing public attention, so that people might come up to her chamber and see that she alone was guilty. The nature of her extraordinary replies, the want of motives for such an atrocious deed, the absence of every kind of emotion, and the state of stupor in which she remained, fixed the attention of the medical men who were called in, and impressed them with the belief that she was mad. On the examination before the magistrate, she confirmed the above statements respecting her mental condition, adding, among other things, that she had been unhappily married seven years before ; that she attempted to drown herself " because she was ennuied at changing her place of service so often ; " that she knew her crime deserved death, and she desired it. 207. She was tried for the first time, on the 27th of February, 1826. She then appeared to be in a state of great nervous irritation ; her limbs trembled ; her eyes were fixed ; and her understanding was dull and stupid. A few days previous, the court, at the request of her counsel, appointed a medical commission consisting of Adelon, Esquirol, and LeVeille*, to examine the accused and all the documents of the case, and report on her " present moral state." Accord- ingly they reported that they were unable to detect any sign or proof of mental derangement; but added that it is ex- tremely difficult in some cases, to establish the existence of insanity, it requiring a long intimacy with the individual and numerous opportunities of watching him under every variety of circumstance, none of which they had possessed in this case. In fine, they reported that though they could not adduce any positive proof of her insanity, yet they were equally unable to pronounce her sane. 208. This report not being satisfactory, the trial was postponed to another session, and the prisoner was sent to the Salpe"triere to be observed by the above-named physi- cians. After recapitulating their observations, which were continued three months, they came to the following con- clusions : " first, that during the whole time Cornier was PARTIAL MORAL MANIA. 223 under examination, from the 25th of February to the 3d of June, they had observed in regard to her moral state great mental dejection, extreme dulness of mind, and profound chagrin ; secondly, that the present situation of Cornier sufficiently explains her moral state, and thus does not of itself indicate mental alienation either general or partial." They also added that it was due to the cause of justice and to their own conscience, to declare that their judgment of her actual moral condition could not be considered final, if it were proved, as stated in the acte d* accusation, that long before the 4th of November, the character and habits had changed ; that she had become sad, gloomy, silent, and rest- less ; for then that which might be attributed to her present situation, could be only the continuation of a melancholy state that had existed for a year. 1 Cornier was again brought to trial on the 24th of June, and the jury returned a verdict of guilty of " committing homicide voluntarily, but not with premeditation ; " 2 and ac- cordingly she was sentenced to hard labor for life. 209. Sometimes the individual confesses a motive for the homicidal act, which is rational and well founded, but altogether inadequate to lead to such an action in a sound mind. There are seldom wanting other circumstances in the previous conduct, conversation, or bodily health, to con- firm and establish beyond a reasonable doubt the presence 1 Georget justly observes that the meaning of the committee would have been better expressed in the following language. " The present moral state of Henriette Cornier is doubtful. It may be the result either of a painful moral affection, or of melancholy ; which it really is, the nature of the prior circumstances must decide. If, several months before the 4th of November, her character had changed ; if she became sad and gloomy without cause ; if she had a motiveless propensity to suicide ; and, finally, if the homicide she committed was without cause, and under the circumstances related in the acte Alienation Mentale, 130. 228 MEDICAL JURISPRUDENCE OF INSANITY. " Captain James Purington, of Augusta, Maine, a rich, independent farmer, of steady, domestic habits, dark com- plexion, grave countenance, reserved in company, never looking in the face of persons he addressed, obstinate in his opinions, though he frequently changed his religious notions voluntarily, died a decided believer in universal sal- vation, often expressed anticipation of the moment when his family would be happy, and sometimes how happy he should be if they should die at once. He was very avaricious, and elated or depressed as his affairs were prosperous or adverse. In August, 1805, he moved to a new farm which he rapidly improved. He seemed happy till within a few weeks of his death. The uncommon drought depressed him greatly, lest his family should suffer for want of bread, and his cattle starve. On Sunday, the 6th of July, 1806, Mrs. Purington and the eldest daughter being at church, the second daughter saw her father writing a letter which he, perceiving that he had been overlooked, attempted to hide. She asked him what he had been writing. He said, " nothing," and asked for his butcher-knife, saying he wanted to sharpen it. Hav- ing made it very sharp, he stood before the glass and seemed preparing to cut his throat. His daughter, terrified, cried, 'what are you doing?' He calmly said, 'nothing;' and laid the knife away. This was told to his wife ; she searched for the letter and found it. [It was addressed to his brother, and stated that he was about going a long journey, and directed him to take charge of his children.] On the 7th of July, at dinner-time, he found his wife sitting in the barn weeping ; she disclosed the cause ; he said he did not intend suicide ; but he had a presentiment his death was near. Towards the close of the following day, he ground the axe ; when the fam- ily went to bed, he was reading the bible ; it was found open on the table at Ezekiel, chap. ix. On the 9th of July, at two o'clock in the morning, his eldest son alarmed the neighbors ; they found Capt. Purington lying on his face, his two sons aged five and eight in bed, with their throats cut ; the razor on the table by his side, the axe near ; in the next room, Mrs. Purington, aged forty-four, in bed, her head almost severed PARTIAL MORAL MANIA. 229 from the body; near her, on the floor, a daughter murdered, ten years old ; in the other room in bed, a daughter aged nineteen, most dreadfully butchered ; the second, aged fifteen, most desperately wounded, reclining her head on the infant, eighteen months old, whose throat was cut. The eldest son was wounded, when Capt. Purington attacked and dreadfully mangled the second, twelve years old, who attempted to escape ; Capt. Purington did not speak a word." 1 2 216. The various forms of homicidal insanity have thus been illustrated, by selecting a few cases only, from a mass that would fill a considerable volume. 8 Now, however these cases may differ from one another, whether the indi- vidual has succumbed to the propensity to kill after .a long struggle with his better nature, or has yielded to it at once and instantaneously ; whether harassed by previous disease of body or despondency of mind, or apparently in sound health and with a cheerful disposition ; whether his passions have been tamed by the discipline of a good education, or allowed to seek their gratification' without restraint; they all, except the last two, possess one feature in common, the irresistible, motiveless impulse to destroy life. Before enter- ing upon any discussion relative to the nature of these forms of insanity, it may be well to consider the following analysis of their most important features. 217. I. In nearly all, the criminal act has been pre- ceded, either by some well-marked disturbance of the health, originating in the head, digestive system, or uterus, or by an irritable, gloomy, dejected, or melancholy state, in short, by 1 Parkman : Elustrations of Insanity. 2 Perhaps the most extraordinary case on record of homicidal insanity accompanied by delusion, is one related by Mr. Scoresby, the Arctic navi- gator, and copied into Waldie's Circulating Library, vol. xii. p. 258, where the captain of a British vessel on the passage from St. Andrews, N. B. to Ireland, succeeded in getting his crew into his power, and murdering them all in detail, excepting one, who escaped into the hold desperately wounded. 3 They who are desirous of extending their acquaintance with this class of cases, will find the later ones which have appeared in the English courts, noticed in Taylor's Medical Jurisprudence. 20 230 MEDICAL JURISPRUDENCE OF INSANITY. many of the symptoms of the incubation of mania. The ab- sence of particulars in some of the cases we find recorded, leaves us in doubt how general this change really is ; but a careful examination would, no doubt, often, if not always, show its existence where, apparently, it has never taken place. , II. , The impulse to destroy is powerfully excited by the sight of murderous weapons, by favorable opportunities of accomplishing the act, by contradiction, disgust, or some other equally trivial and even imaginary circumstance. III. The victims of the homicidal monomaniac are mostly either entirely unknown or indifferent to him, or they are among his most loved and cherished objects ; and it is remarkable how often they are children, and especially his own offspring. IV. While the greater number deplore the terrible pro- pensity by which they are controlled, and beg to be subjected to restraint, a few diligently conceal it, or if they avow it, declare their murderous designs, and form divers schemes for putting them in execution, testifying no sentiment of remorse or grief. V. The most of them having gratified their propensity to kill, voluntarily confess the act and quietly give themselves up to the proper authorities ; a very few only and these, to an intelligent observer, show the strongest indications of insanity fly, and persist in denying the act. VI. While the criminal act itself is, in some instances, the only indication of insanity, the individual appearing rational, as far as can be learned, both before and after the act ; in others, it is followed or preceded, or both, by strange be- havior, if not open and decided insanity. VII. Some plead insanity in defence of their conduct, or an entire ignorance of what they did ; others deny that they labored under any such condition, and at most acknowledge only a perturbation of mind. 218. Apart from the obvious similarity of all these cases to those where the murderous propensity coexists with delusions, as in the last two, the circumstances under PARTIAL MORAL MANIA. 231 which the homicidal act is perpetrated, furnish strong ground for believing, that they depend on mental alienation in some form or other ; so different are these circumstances from those which attend the commission of crime. In homicidal insanity, murder is committed without any motive whatever strictly deserving the name; or at most, with one totally inadequate to produce the act in a sane mind. On the contrary, murder is never criminally committed without some motive adequate to the purpose in the mind that is actuated by it, and with an obvious reference to the ill-fated victim. Thus, the motive may be theft, or the advancement of any personal interest, in which case it will be found that the victim had or was supposed to have property, or was an obstacle to the designs or expectations of another. Or it may be revenge, and then the injury, real or imaginary, will be found to have been received by the murderer from the object of his wrath. In short, with the criminal, murder is always a means for accomplishing some selfish object, and is frequently accompanied by some other crime ; whereas, with the homicidal monomaniac, murder is the only object in view, and is never accompanied by any other improper act. 219. The homicidal monomaniac, after gratifying his bloody desires, testifies neither remorse, nor repentance, nor satisfaction, and if judicially condemned, perhaps acknowl- edges the justice of the sentence. The criminal either denies or confesses his guilt ; if the latter, he either humbly sues for mercy, or glories in his crimes, and leaves the world cursing his judges, and with his last breath exclaiming against the injustice of his fate. The criminal never sheds more blood than is necessary for the attainment of his object ; the homicidal monomaniac often sacrifices all within his reach to the cravings of his murderous propensity. The criminal lays plans for the execution of his designs ; time, place, and weapons are all suited to his purpose ; and when successful, he either flies from the scene of his enor- mities, or makes every effort to avoid discovery. The homi- cidal monomaniac, on the contrary, for the most part, con- 232 ' MEDICAL JURISPRUDENCE OF INSANITY. suits none of the usual conveniences of crime ; he falls upon the object of his fury, oftentimes without the most proper means for accomplishing his purpose ; and perhaps in the presence of a multitude, as if expressly to court observa- tion ; and then voluntarily surrenders himself to the con- stituted authorities. When, as is sometimes the case, he does prepare the means, and calmly and deliberately executes his project, his subsequent conduct is still the same as in the former instance. The criminal often has accomplices, and generally vicious associates ; the homicidal monomaniac has neither. The acts of homicidal insanity are generally, perhaps always, preceded by some striking peculiarities in the conduct or character of the individual, strongly contrasting with his natural manifestations ; while those of the criminal are in correspondence with the tenor of his past history or character. In homicidal insanity, a man murders his wife, children, or others to whom he is tenderly attached ; this the criminal never does, unless to gratify some evil passion, or gain some other selfish end, too obvious to be overlooked on the slight- est investigation. 220. A stronger contrast than is presented, in every respect, between the homicidal act of the real criminal and that of the monomaniac, can hardly be imagined ; and yet we are obliged to acknowledge that men of learning and intelligence have been often unable or unwilling to perceive it, though, undoubtedly, the number of such is fast diminish- ing. Much of the unwillingness manifested by jurors to abide by the result to which the above distinctions would necessarily lead them, arises from those feelings of horror and indignation excited by the perpetration of cold-blooded murders, which incapacitate them from discriminating with their usual acuteness between the various causes and motives of human action. Besides, notwithstanding the great simi- larity, for the most part, between these cases, one will occasionally occur, where, from defect of information, no little knowledge of insanity and of human nature is required to find one's way through the mists of doubt and obscurity PARTIAL MORAL MANIA. 233 in which it is involved. When, therefore, as in the case of jurors generally, the mind is not fitted by any of this prepara- tion so necessary to a successful investigation of difficult cases, it seizes only on some of the most obvious, though perhaps least important points which they present, and of course the verdict will often be deplorably at variance with the dictates of true science. 20* CHAPTER VIII. LEGAL CONSEQUENCES OF MANIA. 221. MAN being destined for the social condition, has received from the author of his being the faculties necessary for discovering and understanding his relations to his fellow men, and possesses the liberty, to a certain extent, of regu- lating his conduct agreeably or directly opposed to their suggestions. For the manner in which this power is used he is morally responsible, the elements of responsibility always being the original capacity, the healthy action, and the cultivation of the moral and intellectual faculties, the measure of the former being in proportion to the degree in which the latter are possessed. In legal responsibility, the last element above mentioned is not admitted, and the first to a very limited extent only, the second alone being absolute- ly essential. The relation of original incapacity to legal responsibility has already been discussed, when treating of MENTAL DEFICIENCY ; that of cerebral disease now comes up for consideration. 222.. The influence of this condition on responsibility will obviously be proportioned to its severity and the extent of its action ; and though we cannot hope to become ac- quainted with all its grades, there is no reason why we may not be able to recognize and identify some of the more common and prominent. If men had agreed to receive some particular analysis and arrangement of the affective and intellectual faculties, and to assign to each a portion of the brain as its material organ, we might then, by studying the derangements of each faculty, ascertain, in some measure, how far they affect the actions of one another. But as no LEGAL CONSEQUENCES OP INTELLECTUAL MANIA. 235 such unanimity exists, we can only consider, as we have in a preceding chapter, the observations that have been made on the derangement of a few particular faculties, and form our opinions relative to their influence, by the general tenor of human experience. SECTION I. Legal Consequences of Intellectual Mania. 223. The common law relating to insanity, as before intimated, is open to censure, not so much on account of the manner in which it modifies the civil and criminal re- sponsibilities of the lunatic, as of the looseness, inconsis- tency, and incorrectness of the principles on which the fact of the existence of the disease is judicially established. The disabilities it imposes on this unfortunate class of our fellow men are founded in the most humane and enlightened views, and have for their object the promotion of their highest wel- fare. To incapacitate a person from making contracts, bequeathing property, and performing other civil acts, who has lost his natural power of discerning and judging, who mistakes one thing for another, and misapprehends his rela- tions to those around him, is the greatest mercy he could receive, instead of being an arbitrary restriction of his rights. 224. In opposition to that principle of the common law, which makes the lunatic who commits a trespass on the per- sons or property of others, amenable in damages to be re- covered by a civil action, 1 Hoffbauer declares, that if the patient is " so deranged that he is no longer master of his actions, he is under no responsibility, nor obliged to make reparation for injuries." l He gives no reason for this opin- ion, and we are unable to see how it can be even plausibly supported. To the maniac, who, when restored to his 1 Weaver v. Ward, Hobart's Reports, 134. Butterly v. Darling, Com. Pleas, New York ; Nat. Intelligencer, March 30, 1841. 2 Op. cit 131. 236 MEDICAL JURISPRUDENCE OF INSANITY. senses, discovers that during his derangement he has com- mitted an injury to his neighbor's property, indemnity for which will strip him of his own possessions and reduce him to absolute beggary, his recovery must seem indeed like escaping from one evil only to encounter a greater. Such a possible consequence of madness, it is certainly painful to think of; but as the damage is produced and must be borne by one party or the other, we cannot hesitate to say which it should be ; for though it may be hard for a person thus to suffer for actions committed while utterly unconscious of their nature, it would manifestly be the height of injustice to make another suffer, who was equally innocent and perhaps equally unconscious of the act. 225. There is one operation of the common law, how- ever, which is justly a cause of complaint, namely, that by which lunatics, even when under guardianship, are subject to be imprisoned like others, in default of satisfying a civil exe- cution obtained against them ; * because, whether such im- prisonment be considered as a penal or a merely coercive measure, it is altogether inapplicable to the insane. It can- not coerce one who has no control over his own property, and whose mental condition is supposed to be such that he is unable to see any relation between the means and the end ; and to punish a person for what he himself had no agency whatever in doing, is a violation of the first princi- ples of justice. To incarcerate some madmen in a common jail would, in all probability, aggravate their disorder, and if the confinement were protracted to the extent which the law would allow, render it utterly incurable. 226. The civil disabilities above-mentioned are not in- curred by every one laboring under mental derangement ; the measure of insanity necessary to produce this effect, or in legal phrase, the fact of the party's being compos or non com- pos mentis, is a question to be submitted to judicial investi- gation, the result of which will depend on the views of indi- viduals relative to the effect of insanity on the mental opera- 1 Shelford on Lunacy, 407 ; Ex parte Leighton, 14 Mass. Rep. 207. LEGAL CONSEQUENCES OF INTELLECTUAL MANIA. 237 tions, and to the respect due to opinions and decisions already promulgated. General intellectual mania, as we have represented it, should be followed, to the fullest extent, by the legal consequences of insanity ; but partial intellect- ual mania does not necessarily render a person non compos, or so impaired in mind as to be no longer legally responsi- ble for his acts, any more than every disease of the lungs or stomach prevents a patient from attending to his ordinary affairs, and enjoying a certain measure of health. The question when mania invalidates a person's civil acts and annuls criminal responsibility, and when it does not affect his liability in these respects, has occasioned considerable discussion, and is certainly the most delicate and important that the whole range of this subject embraces. No general principles concerning it are to be found in the common law except lord Male's ( 8), and cases seem to have been decided with but little reference to one another, according to the med- ical or legal views which happened at the time to possess the minds of the court and jury. As insanity has become better known, decisions have occasionally been more correct, but as the prevalence of these improvements has not been universal, this branch of jurisprudence has often retrograded, and thus the mind of the inquirer is confused by an array of opinions diametrically opposed. Correct general principles on this subject, therefore, are yet to be established ; and in further- ance of this object, we shall endeavor to lay down such legal consequences of partial intellectual mania, as seem to be warranted by correct medical knowledge of insanity, and by enlightened principles of justice. 227. We see some persons managing their affairs with their ordinary shrewdness and discretion, evincing no extra- ordinary exaltation of feeling or fancy, and on all but one or a few points, in the perfect enjoyment of their reason. It has been elsewhere remarked ( 136), that strange as it may appear, it is no less true, that notwithstanding the serious derangement of the reasoning power which a person must have experienced, who entertains the strange fancies that sometimes find their way into the mind, it may still be exer- 238 MEDICAL JURISPRUDENCE OF INSANITY. cised on all other subjects, so far as we can see, with no diminution of its natural soundness. The celebrated Pascal believed at times that he was sitting on the brink of a preci- pice over which he was momentarily in danger of falling, and a German professor of law, mentioned by Hoff bauer, thought the freemasons were leagued against him, while he dis- charged the duties of his chair with his usual ability ; and numberless are the instances of worthy people who have imagined their heads turned round, or their limbs made of butter or glass, who nevertheless manage their concerns with their ordinary shrewdness. No one, however, following the dictates of his own judgment, would seriously propose to invalidate such of these men's acts as manifestly have no reference to the crotchets they have imbibed. To deprive them of the management of their affairs, under the show of affording them protection, would be to inflict a certain and a serious injury, for the purpose of preventing a much smaller one that might never occur. The principle that we would inculcate is, that monomania invalidates a civil act only when such act comes within the circle of the diseased opera- tions of the mind. 228. It is not to be understood, however, that in every case of partial mania we have only to ascertain the insane delusion, and then decide whether or not the act in question could have come within the range of its influence. In many instances the delusion is frequently changing, in which case, it is not only difficult to determine how far it may have been connected with any particular act, but the mind in respect to other operations, has lost its original soundness, to such a degree that it cannot be trusted in the transaction of impor- tant affairs. Still, this is not a sufficient reason against apply- ing the general principle where it can be done without fear of mistake. In doubtful instances we must be governed by the circumstances of the case, arid this course, with all its objections, seems far more rational than the practice of uni- versal disqualification. 229. The validity of a marriage contracted in a state of partial mania, is not to be determined exactly upon the LEGAL CONSEQUENCES OF INTELLECTUAL MANIA. 239 above principles. Here it is not sufficient to consider merely the connection of the delusion with the idea of being mar- ried, nor should we form any conclusion in favor of the capacity of the deranged party, from the propriety with which he conducts himself during the ceremony. The mere joining of hands and uttering the usual responses are things not worth considering ; it is the new relations which the mar- ried state creates, the new responsibilities which it imposes, that should fix our attention, as the only points in regard to which the question of capacity can be properly agitated. In" other contracts, all the conditions and circumstances may be definite and brought into view at once, and the capacity of the mind to comprehend them determined with comparative facility. In the contract of marriage, on the contrary, there is nothing definite or certain ; the obligations which it imposes do not admit of being measured and discussed; they are of an abstract kind, and constantly varying with every new scene and condition of life. With these views we are obliged to dissent from the principle laid down by the Supreme Judicial Court of Massachusetts, in a case of libel for divorce for insanity of the wife at the time of the mar- riage, that " the fact of the party's being able to go through the marriage ceremony with propriety, was primd facie evi- dence." 1 If by making the contract is meant merely the giving of consent and the execution of certain forms, then indeed the fact of the party's going through the ceremony with propriety may be some evidence of sufficient under- standing to make it ; but if the expression includes the slight- est idea of the nature of the relations and duties that follow, or even of the bonds and settlements that sometimes accom- pany it, then the fact here mentioned is no evidence at ah 1 of sufficient capacity. Sir John Nicholl, looking at the subject in a different light, has very properly said, that "going through the ceremony was not sufficient to establish the capacity of the party ; and that foolish, crazy persons might be instructed to go through the formality of the ceremony, 1 4 Pickering's Reports, 32. 240 MEDICAL JURISPRUDENCE OF INSANITY. though wholly incapable of understanding the marriage con- tract." 1 In a similar case, Lord Stowell, then Sir William Scott, had previously observed, on the fact given in evidence that the party " had manifested perfect propriety of behav- iour," during the ceremony, " that much stress was not to be laid on that circumstance; as persons, in that state, will nevertheless often pursue a favorite purpose, with the com- posure and regularity of apparently sound minds." 2 230. Within a few years, a class of cases has made its appearance, exceedingly embarrassing to the medical jurist. The woman, after preparing for a union to which her head and heart had apparently fully consented, and going through the marriage ceremony with the utmost pro- priety, manifesting all the while nothing unusual in her deportment, immediately after imbibes an insuperable aver- sion towards her husband, shuns his company, and perhaps refuses to live with him. In some of the cases, other singu- larities of conduct soon appear, one after another, till at last the woman becomes a subject of unequivocal insanity. In others, however, this strong repugnance towards the husband continues to be the principal, if not the only symptom, of mental disorder, but so closely do they resemble the former in other respects, that we can have no hesitation in regarding them as merely varieties of the same affection. The patho- logical character of these cases seems to be sufficiently obvi- ous. From some cause or other, the patient has been affected with a cerebral irritation not sufficient to disturb the men- tal manifestations, and which, under favorable circumstances might have entirely disappeared. In this condition, marriage, with the crowd of new thoughts and feelings with which it is preceded, operates as a powerfully exciting cause, and under its influence the pathological affection is completely devel- oped. It is not strange, certainly, that marriage should occasionally find a female brain in this morbid condition ; nor that, in case of such a conjunction, the result here mentioned 1 Browning v. Read, 2 Phillimore's Eccl. Rep. 69. 2 Turner v. Meyers, 1 Hagg. Con. Rep. 414. LEGAL CONSEQUENCES OF INTELLECTUAL MANIA. 241 should follow. The legal relations of these cases are not so satisfactorily settled. In some of them, a close scrutiny of the conduct and condition previous to marriage, may detect indubitable signs of insanity ; while in others no such signs ,can be discovered, though subsequently the mental disorder may have become no less obvious. Now, are we prepared to make a distinction between them ? to grant divorce in one class, and refuse it in the other ? This, no doubt, would be highly convenient, but we are not sure that it would be strict- ly just. While we see not how legal relief can be withheld in the former class, yet in regard to the latter, we recoil from the idea of depriving a woman of her protection and support, at the very moment when the severest of earthly calamities has overtaken her, merely on the strength of what we may call a pathological abstraction. How these cases have been regarded by the courts, we have had no means of ascer- taining. 231. The principles that should regulate the legal rela- tions of the partially insane are few and simple. While they should be left in possession of every civil right that they are not clearly incapable of exercising, they should be subjected to the performance of no duties involving the interests or comfort of individuals, which may be equally well discharged by others. In the former instance we continue the enjoy- ment of a right that has never been abused ; in the latter, we refrain from imposing duties 011 people who may not be qualified to perform them. We cannot, therefore, agree with Hoffbauer, that a monomaniac should be allowed to manage the affairs of another, or be appointed to the office of guar- dian, however much we might be inclined to respect the va- lidity of his civil acts. In some instances it is impossible to know or to conjecture, beforehand, how the predominant idea in his mind may be affected by his connection with persons and things that have hitherto been foreign to his thoughts ; while in others, it is far within the range of probability that the consequences will be ruinous to himself and others. Here, for example, is a man who has long believed that he has an eel in his stomach, but on no other point has he mani- 21 242 MEDICAL JURISPRUDENCE OF INSANITY. fested the slightest mental impairment. If a monomaniac is ever a suitable person to manage the % affairs of another, it would seem, at first thought, that this one certainly is ; yet nothing would be more injudicious than to intrust him with any such duty, for in all probability, though perfectly upright in his dealings, he would be irresistibly impelled to dissipate the property of others, as he always has his own earnings, in constant joumeyings from one empiric to another, in purchas- ing medicines, and consulting physicians, for the purpose of getting relieved from his fancied tormenter. This exclusion, as Chambeyron, the French translator of Hoffbauer, justly remarks, does the monomaniac no wrong; it frees him from a great responsibility, and prevents dangers, possible at least, either to the ward or to him. 232. The above views, though not yet distinctly re- ceived in courts, are countenanced by many distinguished physicians and jurists. Hoffbauer supports them to the fullest extent; Esquirol sanctions them, by interposing no word of disapprobation ; Georget admits them in application to civil cases ; and Paris and Fonblanque have explicitly recognized their correctness in the following passage. " When a man suffers under a partial derangement of intellect, and on one point only, it would be unjust to invalidate acts which were totally distinct from, and uninfluenced by this so limited insanity ; but if the act done bear a strict and evident reference to the existing mental delusion, we cannot see why the law should not also interpose a limited protection, and still less why courts of equity, which in their ordinary jurisdiction relieve against mistake, should deny their aid in such cases." l 233. Mr. Evans, the translator of Pothier's Treatise on Obligations, expresses an opinion on this subject, no less positive and precise. " I cannot but think," he says, " that a mental disorder operating on partial subjects, should, with regard to those subjects, be attended with the same effects as a total deprivation of reason ; and that on the other hand, 1 1 Medical Jurisprudence, 302. LEGAL CONSEQUENCES OF INTELLECTUAL MANIA. 243 such a partial disorder, operating only upon particular sub- jects, should not, in its legal effects, have an influence more extensive than the subjects to which it applies ; and that every question should be reduced to the point, whether the act under consideration proceeded from a mind fully capable, in respect of that act, of exercising free, sound, and discrimi- nating judgment ; but in case the infirmity is established to exist, the tendency of it to direct or fetter the operations of the mind should be in general regarded as sufficient presump- tive evidence, without requiring a direct and positive proof of its actual operation." 1 234. It has been already remarked, that the practice of the English courts in regard to partial insanity has been regulated by no settled principles. Of the truth of this remark we have a striking illustration in Greenwood's case, which is so often cited. Mr. Greenwood was bred to the bar, and acted as chairman at the quarter sessions, but becoming diseased, and receiving in a fever a draught from the hand of his brother, the delirium, taking its ground then, connected itself with that idea; and he considered his brother as having given him a potion, with a view to destroy him. He recovered in all other respects, but that morbid image never departed ; and that idea appeared con- nected with the will by which he disinherited his brother. Nevertheless, it was considered so necessary to have some precise rule, that, though a verdict had been obtained in the common pleas against the will, the judge strongly advised the jury to find the other way, and they did accordingly find in favor of the will. Farther proceedings took place after- wards, and concluded in a compromise. 2 No one. would be hardy enough to affirm that Greenwood's mind was perfectly rational and sound, and as his insanity displayed itself on all topics relating to his brother, every act involving this broth- er's interests, to go no farther, ought consequently to have been invalidated. A plainer case cannot well be imagined. 1 2 Pothier on Obligations, Appendix, 24. 2 Lord Eldon, in White v. Wilson, 13 Vesey's Reports, 88. 244 MEDICAL JURISPRUDENCE OF INSANITY. 235. More enlarged and correct views prevailed in the able and elaborate judgment delivered by Sir John Nicholl, in the case of Dew v. Clark, 1 where the existence of partial mania is recognized, and the necessity is strongly inculcated of bearing in mind the fact of its partial operation on the understanding, while determining its influence on the civil acts of the individual. The point at issue was the validity of the will of one Scott, (who left personal property amount- ing nearly to X40,000,) in which he bequeathed the com- plainant who was his daughter and only child, a life-interest in a small portion of his estate, the most of which was devised to his nephew. The object of inquiry was, whether the extraordinary conduct and feelings of the deceased towards his daughter had any real cause, or was solely the offspring of delusion in a disordered mind ; and to this end an unparalleled mass of evidence was offered by each party. It was proved by the nephews, that the testator had con- siderable practice as a surgeon and medical electrician from 1785 to 1820, and that at all times down to the latter period when he had a paralytic stroke, he managed the whole of his pecuniary and professional affairs in a rational manner, and rationally conducted all manner of business. They admitted that he was a man of an irritable and violent temper ; of great pride and conceit ; very precise in all his domestic and other arrangements ; very impatient of contradiction, and imbued with high notions of parental authority. They represented him to have entertained rigid notions of the total and absolute depravity of human nature and of the neces- sity of sensible conversion, and contended that all the singularities of his conduct could be attributed to his pe- culiar disposition and belief, without resorting to insanity for an explanation. By the daughter, it was shown, by a body of evidence that placed the fact beyond the shadow of a reasonable doubt, that from an early period of her life, he manifested an insane aversion towards her. It ap- pears that he was in the habit of describing her, even to per- 1 3 Addams's Reports, 79. LEGAL CONSEQUENCES OF INTELLECTUAL MANIA. 245 sons with whom he was not intimately acquainted, as sullen, perverse, obstinate, and given to lying ; as a fiend, a monster, a very devil, the special property of satan ; and charging her with vices, of which it was impossible that a girl of her age could be guilty. The peculiar and unequalled depravity of his child, her vices, obstinacy, and profligacy were topics on which he was constantly dwelling, and his general deport- ment towards her not only negatived all idea of natural affection, but betrayed a most fiend-like temper. His man- ner towards her was fiery and terrific ; the instant she ap- peared, his eye flashed with rage and scorn, and he spurned her from him as he would a reptile. He compelled her to do the most menial offices, such as sweeping the rooms, scouring the grates, washing the linen and the dishes ; to live in the kitchen and be sparingly fed. He once stripped her naked, when ten or eleven years old, tied her to a bed-post, and after flogging her severely with a large rod intertwisted with brass wire, rubbed her back with brine. Repeatedly, and on the most trivial occasions, he struck her with his clinched fists, cut her flesh with a horsewhip, tore out her hair, and once aimed at her a blow with some weapon which indented a mahogany table, and which must have killed her, had she not avoided it. Now it was abundantly proved that there existed no real cause whatever for this strange antipathy, but that the daughter was of an amiable, obliging, and docile disposition, that she had always shown a great filial affec- tion for her father, that she conducted at home and abroad with the utmost propriety and decorum, that she was a person of strictly moral and religious habits, and was so considered and known to be by the friends of the deceased and others of high reputation and character. The court, in making up its decision, declared that the question at issue was, " not whether the deceased's insanity in certain other particulars, as proved by the daughter, should have the effect of defeating a will, generally-, of the deceased, or even this identical will, but whether his insanity, on the subject of his daughter, should have the effect of defeating, not so much 21* 246 MEDICAL JURISPRUDENCE OF INSANITY. any will (a will generally) of the deceased, as this identical will." Accordingly, considering it proved that the will was the direct, unqualified offspring of that morbid delusion con- cerning the daughter, thus put into act and energy, it was pronounced to be null and void in law. In this decision we see the prevalence of those more correct and profound views of insanity, which have resulted from the inquiries of the last few years. 236. ^he same principle had been previously laid down in the following case which was adjudicated in Kentucky, in 1822. George Moore made his will in April, 1822, and shortly after died. It was the validity of this will which was the point at issue. About twenty-four years previous to his death, he had a dangerous fever, during which he imbibed a strong antipathy towards his brothers, imagining that they in- tended to destroy or injure him, though they attended him throughout his illness, and never furnished the slightest foun- dation for his belief, this antipathy continued to the day of his death, with a single exception, when he made a will in their favor, but afterwards cancelled it. When asked by one of the witnesses why he disinherited his brothers he became violently excited, and declared that they had endeavored to get his estate before his death. The court, in its decision, observe, that " he cannot be accounted a free agent in making his will, so far as his relatives are concerned, although free as to the rest of the world. But however free he may have been as to other objects, the conclusion is irresistible, that this peculiar defect of intellect did influence his acts in making his will, and for this cause it ought not to be sustained. It is not only this groundless hatred or malice to his brethren that ought to affect his will, but also his fears of them, which he expressed during his last illness, conceiving that they were attempting to get away his estate before his death, or that they were lying in wait to shoot him, while on other subjects he spoke rationally ; all of which are strong evidences of a derangement in one department of his mind, unaccounta- ble indeed, but directly influencing and operating upon the LEGAL CONSEQUENCES OF INTELLECTUAL MANIA. 247 act which is now claimed as the final disposition of the estate." 1 237. Esquirol has related a case of a very similar kind, where a person conceived an antipathy against his brothers, sisters, and other relatives, who, he believed, were seeking to destroy him. Under the influence of this delusion he made testamentary dispositions, and Esquirol being consulted respecting their validity, gave it as his opinion that the tes- tator was laboring under insanity. 2 238. On the other hand testamentary dispositions which are founded on motives that might be supposed to govern a sane mind, and present, on their face, no indications of insanity, have not been disturbed, though the mind were confessedly laboring under some degree of derangement. The following case was decided in strict accordance with this principle. At a session of the supreme court of Massachusetts, in Worcester county, April, 1843, the probate of a will was contested on the ground of the insanity of the testator who had bequeathed the most of his property to a nephew, though having children of his own. It appeared in evidence, on the one hand, that the testator, when under the immediate influence of strong drink, to which he was intemperately addicted, manifested some aberration of mind, and for seve- ral years before his death had persisted in the declaration that his children were not legitimate, as he had never been mar- ried to their mother. On the other hand, it appeared, that his only son was intemperate, and neglected and abused his parents; that his daughter, her husband and children also neglected him ; and that for many years, there was no inter- course among the various members of the family. The nephew had always maintained friendly relations with the testator and ministered to his wants and infirmities. Al- though he had lived with the mother of his children, as hus- band and wife, forty-nine years, yet no certificate or record 1 Johnson v. Moore's heirs, 1 Little's Reports, 371. 2 Annales d" Hygiene Publique, iii. 370. 248 MEDICAL JURISPRUDENCE OF INSANITY. of the marriage could be found, and it did not appear very improbable that the marriage ceremony had never been per- formed. He had always managed his property which was of considerable amount, prudently and intelligently, and the will was properly drawn and executed, giving good reasons also for its bequests. In short, it was a rational act, ration- ally done, and was established by the verdict of the jury. 1 239. Lord Brougham, however, has laid down the doc- trine, that in civil cases, partial insanity should have the same legal consequences, as the general form of the disease. The idea of partial unsoundness, in the common acceptation, is incompatible, he thinks, with the unity and individuality of the mind. If the mind were an aggregate of several facul- ties, one or more of them might certainly become unsound, while the rest remained unaffected, and it would be very proper to consider the acts of the individual, in reference to this point. But if the mind is indivisible, we are unable to limit exactly the operation of any unsoundness by which it is affected. Delusion, as long as it exists, whether much or lit- tle under control, is a* manifestation of insanity, and hence no confidence can be placed in the acts or any act of a diseased mind, however apparently rational that act may appear to be, or may in reality be, because we have no security that the lurking delusion, the real unsoundness does not mingle itself with, or occasion the act. Hence, if a person believing him- self to be Emperor of Germany, should make his will, and we were quite convinced that, had any one spoken of the German diet, or abused the German emperor, the testator's delusion would have at once broken forth, then we must pro- nounce the will void, be it rational and efficacious in every respect as any disposition of property could be. Now, the true issue in the case, which does not seem to be very clearly apprehended by his Lordship, is, whether or not the admit- ted unsoundness did influence the testamentary dispositions, i For the facts in this case I am indebted to Dr. S. B. Woodward, Super- intendent of the Massachusetts Lunatic Hospital, who gave his testimony on the trial, as an expert. LEGAL CONSEQUENCES OF INTELLECTUAL MANIA. 249 and on this point evidence is sought in the character of the will itself. The attentive reader will not fail to see the lamentable inconsistency of the doctrine here put forth, with that which the same person has promulgated in regard to criminal cases. ( 37, 39.) 1 240. In criminal as well as civil cases, it is important to consider the operation of the predominant idea, and its influence on the act in question. There certainly is no rea- son why a person should be held responsible for a criminal act that springs from a delusion which would be sufficient to invalidate any civil act to which it might give rise. A mono- maniac's sense of the fitness of things is not different when he signs a ruinous contract, or makes a will, from what it is when he commits a criminal deed. If the inability to discern the true relations of things is the ground on which the for- mer are invalidated, it ought equally to annul criminal respon- sibility ; unless it can be shown that the abstract conceptions of the nature and consequences of crime are never affected in insanity, or are compatible with a degree of mental soundness that would incapacitate a person from buying a house or sell- ing a lot of land. It is yet a disputed point, however, whether partial mania should have the full legal effect of in- sanity, in criminal cases. By Hoffbauer, Fodere, and some other writers, it is contended that the same principle which determines the effect of mania in civil, should also determine its effect in criminal cases ; that is, that criminal responsi- bility should be annulled only when the act comes within the range of the diseased operations of the mind. In favor of this view, it has been urged, that the connection of the mor- bid delusion with the criminal act, is generally very direct, and not easily mistaken. A remote and circuitous associa- tion of the predominant idea with the deed in question, presents fair ground for suspicion, because the farther the thoughts of the monomaniac wander from the object of his delusion, the less are they affected by its influence. If a man who imagines his legs are made of glass, should see another ap- 1 Amer. Jour, of Insanity, vi. 308. 250 MEDICAL JURISPRUDENCE OF INSANITY. preaching him with a stick for the purpose of breaking them, he could not help resisting even to bloodshed, in what would be to him an act of self-defence, but it would require a very peculiar concatenation of circumstances to warrant us in con- sidering a rape or theft as the offspring of this hallucination, because the idea of these acts would carry the thoughts far beyond the reach of its influence. 241. Against these views it is objected, that it is not always easy to trace the connection between the predomi- nant idea and the criminal act. The links that connect the thoughts which rise successively in the sound mind, defy all our penetration, and the few laws we have established are totally inapplicable to the associations of the insane mind No one will be bold enough to affirm that a certain idea can- not possibly be connected with a certain other idea, in a healthy state of the mind, least of all when it is disordered by disease ; so that the existence of partial insanity once established, it is for no human tribunal arbitrarily to circum- scribe the circle of its diseased operations. We must re- member also that sometimes the predominant idea is fre- quently changing, and at others, is obstinately concealed by the patient, and not ascertained till after his restoration to health. 242. Is it true that the insane judge of their relations to persons and things not immediately connected with their delusions, with ordinary clearness and accuracy ? Does the cloud that settles over one portion of their mental horizon, throw no shadow over the rest of it ? This question involves a matter of fact, and must be decided solely on the testi- mony of those who have had abundant opportunities of ob- serving the insane, of learning their habits, their modes of thinking and feeling, their motives and impulses. It is un- questionably true that a person partially insane may, to a certain extent, be quite rational in his conduct and conversa- tion, but the same is equally true of those who are regarded as wholly insane. Let a stranger spend an hour or two in the galleries of an asylum, observing the manners of the in- mates, and watching them while engaged in their labors, LEGAL CONSEQUENCES OF INTELLECTUAL MANIA. 251 amusements, and conversation, and distinguish, if he can, the wholly from the partially insane. If this limited power of speaking and acting correctly does not invalidate the plea of insanity as it regards the one class, why should it as it regards the other? Touching this phenomenon there are two facts which should be duly considered, in forming our opinion of its relation to legal responsibility. In the first place, this apparent rationality of the insane is usually mani- fested in connection with matters, to them of secondary con- sequence, not calculated to excite much interest, nor to task any moral or intellectual faculty ; but the moment their at- tention is engaged with topics of an opposite character, we perceive the influence of disease. A word, a look, by some bond of association, may touch a discordant string, and this individual, before so calm, so cool and rational, launches into a strain of absurdities, or explodes in a storm of passion. While the sea is smooth and the winds light, reason easily guides the helm which is wrenched from its grasp by the first breeze that ruffles the surface. The transition from the ap- parently sane to the insane, is perfectly obvious when we see the exciting ^cause, and the patient gives audible expres- sion to his thoughts. But because we do not learn these intermediate steps, as they often are not manifested by any sensible marks, does it follow that the final act to which they lead, is entirely free from the taint of insanity ? This is undoubtedly possible, but since we can never prove the fact, and the other event is highly probable, we are bound to abide by the known general rule and not the doubtful excep- tion. The more one sees of mental disorder, the more, we apprehend, is he disposed to believe that this integrity of some of the functions in partial insanity, is rather apparent than real, that the disease, however limited, seldom, if ever, fails to irradiate its morbific influence to a greater or less extentt A little acquaintance with monomaniacs almost always brings to light certain peculiarities in their modes of thinking or acting, or certain inequalities of temper which they did not manifest previous to their disease. So latent is this effect sometimes, that it will evade the closest observa- 252 MEDICAL JURISPRUDENCE OF INSANITY. tion, until a suitable opportunity occurs for its development. In this respect, it seems to follow a common law of our men- tal constitution whose faculties require a certain combination of /circumstances to arouse them into activity, and develop them in all their energy and power. How often do we find patients who, while enjoying the quiet, seclusion, and kind- ness of an asylum, are correct in their deportment, circum- spect in their ways, punctual in their outgoings and incom- ings, courteous and obliging in their manners ; but, restored to the bosom of their families, become overbearing, conten- tious, and irascible, destroying the peace and threatening the lives of those who should be most dear to them. In most monomaniacs so far indeed as our experience goes, the fact is without an exception we see, as it regards their estimates of men and things, less intellectual discernment and a lower tone of moral feeling than they manifested in their sound and healthy condition. Who that has been much conversant with the insane, has not been surprised at times, to hear persons who have always talked sensibly and discreetly except on their weak points, unexpectedly giving utterance to sentiments that betray a radical perversion of their moral perceptions ? Is all this to go for nothing in settling the measure of their legal responsibility ? 243. We ought also to bear in mind a fact too much overlooked, that much of the ordinary working of the mind, whether sane or insane, becomes somewhat instinctive and mechanical, and goes on, if not entirely independent of the exercise of the reasoning powers, certainly without their close and active supervision. In hospitals for the insane, this phenomenon is sometimes witnessed in a very remarka- ble degree. There we see men whose understandings are a complete wreck, every day uttering certain mere common- places of conversation, performing certain acts, and continu- ing certain habits which to a stranger would convey the im- pression that their mental disorder is very partial in its ope- ration. How often do we see patients in that state of fatuity which is the sequel of long continued insanity, playing at draughts, or performing on some musical instrument with a LEGAL CONSEQUENCES OF INTELLECTUAL MANIA. 253 very creditable degree of skill. In accordance, therefore, with this law of our intellectual being, an insane person may be quite rational in some respects, simply because his under- standing has nothing to do with it. He thinks and acts me- chanically. But let him be tried on something th'at requires a fresh and active exercise of thought ; something that requires control of his feelings, and then we shall see how feeble is the dominion of reason. It would be strange indeed, contrary to all our analogies of morbid action, if a disease so serious as to completely distort the perceptions and pervert the evidence of the senses on some points, should leave all the other mental operations perfectly intact. 244. The views here objected to have found a strong opponent in Georget, whose practical knowledge of the subject and acknowledged acuteness in observing the manners of the insane, entitle his opinions to great consideration, if not to entire belief. The following observations of his should never be forgotten in forming conclusions on this disputed point. " In conversing," says he, " with patients on topics foreign to their morbid delusions, you will generally find no difference between them and other people. They not only deal in common-place notions, but are capable of appreciating new facts and trains of reasoning. Still more, they retain their sense of good and evil, right and wrong, and of social usages, to such a degree, that whenever they come together, forget- ting their moral sufferings and delusions, they conduct, as they otherwise would, inquiring with interest for one another's health, and maintaining the ordinary observances of society. They have special reasons even for regarding themselves with a degree of complacency; since, for the most part, they believe that they are victims of arbitrary measures, fraudu- lent contrivances, and projects of vengeance or cupidity, and thus they sympathize with one another in their common mis- fortunes. Accordingly, the inmates of lunatic asylums are rarely known to commit those reprehensible acts which are regarded as crimes when dictated by sound reason, though the most of them enjoy considerable freedom. They often 22 254 MEDICAL JURISPRUDENCE OF INSANITY. talk very sensibly of their interests, and some even manage their property perfectly well." " Those patients who are insane on one point, only more or less limited, may have experienced some severe moral disorders which influence the conduct and actions of the individual, without materially injuring his judgment. Those who conduct themselves so well in the asylum, in the midst of strangers with whom they have no relations, and against whom they have conceived no prejudice nor cause of com- plaint, and in quiet submission to the rule of the house, are no sooner at liberty, in the bosom of their families, than their conduct becomes insupportable ; they are irritated by the slightest contradiction, abusing and threatening those who address to them the slightest observation, and working themselves up to the most intolerable excesses. And whether the reprehensible acts they then commit are really foreign to the predominant idea or not, ought we to m,ake a being responsible for them whose moral nature is so deeply affect- ed ? " 1 These facts, it cannot be denied, furnish strong ground for the remark with which Georget closes his obser- vations on this point, namely, that if, in following the rule that partial mania excludes the idea of culpability, "the moralist and the criminal judge run the risk of committing injustice by sparing a really guilty person, certainly, the op- posite course would lead them into still greater errors." 245. Hoffbauer has not only limited the exculpatory effects of partial mania to the acts which clearly come within its influence, but has laid down the principle that in the criminal jurisprudence of this condition, the predominant idea should be considered as true ; that is, that the acts of the patient should be judged as if he had really been in the circumstances he imagined himself to be when they were committed. The same view was maintained by chief justice Shaw, of Massachusetts, in the recent case of Rogers. It is based on the common, but erroneous notion, that insane 1 Discussion medico-legale BUT la Folie, 10, 14. LEGAL CONSEQUENCES OF INTELLECTUAL MANIA. 255 people always reason correctly from wrong premises, and therefore it is inapplicable to the numerous instances where the premises and inferences are all equally wrong. If a per- son imagines he heard the voice of God commanding him to immolate his only child, and he accordingly obeys, it may be said indeed that he is not responsible for the bloody deed, because it would have been perfectly proper, had he really heard the command ; but are we to be told, that if he had killed his neighbor for a fancied petty injury, he is not to be absolved from punishment, because the act would have been highly criminal, even though he might have really received the injury ? In cases like the latter, the insanity manifests itself, not only in the fancied injury, but in the dispropor- tionate punishment which is inflicted upon the offender. Nothing in regard to insanity is better established than the fact, that when the mind is possessed by a delusion, the con- clusions it may adopt are as likely to be absurd as logical and wise. The character of the conclusion, so far as we are con- cerned, is an accidental feature in the case, and therefore nothing can be more unphilosophical or unjust, than to make it the criterion of legal responsibility. Two men in affluent circumstances imagine that they are coming" to want, and the belief fills them with the keenest distress. To all appear- ance they are both equally insane, equally diseased in body, and equally wretched. The one denies himself and family the necessities of life, and they are indebted for their continued existence to the charities of others. The other slaughters his family and attempts to kill himself. Upon the principle in question, the latter is held guilty of murder, while the former is held to be irresponsible for his conduct. The turn which the delusion takes decides the question of guilty or not guilty. Hadfield's motive for shooting at the king was, that certain great ends might be attained by his own execu- tion which he supposed would follow. Lawrence, who attempted to take the life of President Jackson, imagined that his victim stood in the way of his obtaining certain imaginary estates. These men were tried and acquitted, and the public voice has abundantly comfirmed the correct- 256 MEDICAL JURISPRUDENCE OF INSANITY. ness of the verdict. Judged however, by Hoffbauer's prin- ciple, they must have been deemed fully responsible for their acts, and so must a large portion of those lunatics who, for their bloody deeds, have been consigned to the hospital, instead of the gallows. The meaning of the principle is, that when a person who is admitted to be insane, inflicts an injury which, in the judgment of a benevolent man, is dis- proportioned to the provocation, the surplus injury is to be attributed to passion, or some bad motive, and the lunatic must be punished accordingly. The tinsoundness of such views, it might be supposed, would have been shown by the most superficial knowledge of insanity. When a person is so insane as to imagine that another is disturbing his peace by spells and incantations, is it strange that at the same time, his notions of right and wrong should be so confused, that he thinks himself justified in sacrificing his disturber ? It certainly would be far more strange although it is not denied that this is sometimes the case if a person, after adopting a gross delusion, should reason respecting it with all the clearness and sagacity of a sound mind. 246. It is a great mistake to suppose, as this principle does, that the insane generally act from well defined, tangible motives or reasons. Some unquestionably do, while it is just as certain that some do not. It is often impossible for them to give a clear and consistent reason for their conduct. Their discourse on this point is vague, obscure, and contra- dictory. From want of sufficient steadiness or concentra- tion of mind, or both, they find it difficult to express or explain their ideas, and for a similar reason, probably, they are singularly unstable and changing in their views. They may utter certain propositions, and may give their assent to others, but can we believe that, laboring under the deficien- cies here indicated, their perceptions have that degree of clearness and accuracy which is essential to the idea of understanding and knowledge ? The law asks whether the party knew that the act he committed was wrong, or contrary to law, etc., implying that the reflective powers of such a person are not essentially changed, but only conduct to LEGAL CONSEQUENCES OF INTELLECTUAL MANIA. 257 unsound conclusions. The fact is, however, that seldom, if ever, do the insane, before committing acts of violence, reflect calmly on the subject, view it in its different relations, and thus deliberately form the simple, intelligible conclusion, that the act they meditate, is right. The notions which flit through their minds are too vague and disjointed to be prop- erly called knowledge, although they may use that term themselves in speaking their views. Were it otherwise, why should they, on recovery, regard the whole aspect of the sub- ject in a very different light, and be as much astonished as others to find what they have said and done ? The truth is, they act -from impulse and sudden suggestions, without being very conscious at the time of what they are doing, or if they are, without being able to explain their conduct even to their own satisfaction. Many of those who attempt suicide are unable to assign any thing like a reason for the act. They contemplate it but a moment, perhaps, before proceeding to carry the idea into execution, and then sincerely rejoice that they were prevented from succeeding. Homicidal acts are often unquestionably committed by the insane, in a similar state of mind. In general mania, especially the early stage, the mind is filled with vague fears, suspicions, jealousy, and distrust, and the thoughts are sadly confused. The patient believes that enemies encompass him around, bent on de* stroying his reputation or his life. With no special plan in view, he arms himslf with swords and pistols, and accident or some unaccountable caprice finally determines the victim. The poor maniac can no more give a reason for his selection, than he can for the groundless fears that besiege his mind. It is a fact that should be duly pondered by those who would adopt the principle we are now contending against, that very often, maniacs, upon recovery, have but a shadowy recollec- tion of the violence they may have committed, though at the time, they may have discoursed about it with some degree of coherence and pertinency. 247. Another mistake often made on this subject, is sufficient to vitiate any conclusions formed under its influ- ence, relative to moral responsibility. This mistake is to 22* 258 MEDICAL JURISPRUDENCE OF INSANITY. regard th,e operations of the insane mind as governed by the same laws of association, as those of the sane mind. Their motives are weighed in the same balance, they are sup- posed to be equally affected by the same moral considera- tions, and their conclusions are expected to be equally logical. Such views of the mental operations in insanity are not warranted by our knowledge of the disease. Noth- ing can be more unsafe than to infer, from certain notions or plans an insane person may have, the line of conduct or the speculative conclusions he may adopt. It is a fact which every one, much conversant with the insane, must have recognized, that their mental operations are marked by a kind of confusion that finds its analogy only in dreaming. And this is the case, not only with the wild and raving, but to a degree with those whose insanity is apparently confined within a narrow circle, and who would not be readily recognized to be insane, by the world at large. A man was once placed in the hospital under our care, who con- tinued so calm and quiet, so correct in his deportment, so gentlemanly in his manners, and so intelligent and rational in his discourse, that, for some time, we were puzzled to discover why he should have been sent to us, not having then received an exact history of his case. It finally ap- peared that he believed his wife had been unfaithful to him, and that the idea gave him much uneasiness. When reminded of the unsullied reputation of his wife, and the improbability of some of the incidents he related, he always replied, that he must believe what he saw with his own eyes, and then he would give a minute account of the cir- cumstances which, if he had really witnessed them, set the question at rest. For several weeks he exhibited the same quiet and correct demeanor, performing divers services about the house, and obtaining the favorable regards of all around him. At last, he became rather silent and sad, and after a day or two, he was observed to weep much. This continued for three or four days, when he resumed his usual cheerful- ness, declaring that his views had undergone a great change, and that some things appeared to him in a very different LEGAL CONSEQUENCES OF MORAL MANIA. 259 light. His whole belief about his wife's infidelity, he said, was a delusion, and never had the slightest foundation in fact. All the things which he thought he saw, now appeared to him like a dream, and he could give no other account of them. In dreaming and in insanity there is the same firm conviction of the reality of false impressions, the same patches of coherence and consistency, the same embroilment of the thoughts, the same absurdity in the conclusions, and on recovery the patient often feels as if just awoke from a dream, wondering how he could have had such thoughts and done such acts. 1 With what propriety then can we deem the insane responsible for any of the views they may adopt ? SECTION II. Legal Consequences of Moral Mania. 248. General moral mania furnishes good ground for invalidating civil acts, for notwithstanding the apparent in- tegrity of the intellectual powers, it is probable that their x operation is influenced to a greater or less extent, by a derangement of the moral powers. The mutual independ- ence of these two portions of our spiritual nature is not absolute and unconditional, but is always liable to be affected by the operation of the organic laws. The animal economy 1 This character of insanity is admirably represented by Shakspeare, whose delineations of this disease are marked by his usual fidelity to nature. Lear, on suddenly recovering, knows not, at first, where he is, or where he has been ; he scarcely recognizes his own friends, and almost doubts his own identity. " Pray, do not mock me. I am a foolish, fond old man, Fourscore and upwards ; and to deal plainly, I fear I am not in my perfect mind. Methinks I should know you, and know this man ; Yet I am doubtful ; for I am mainly ignorant What place this is ; and all the skill I have Remembers not these garments ; nor I know not Where I did lodge last night." 260 MEDICAL JURISPRUDENCE OF INSANITY. is a whole ; no part of it can exist without the rest, nor be injured or abstracted without marring the energy or harmony of the whole system ; and though each part is so far inde- pendent of the others as to contribute its distinct share in the production of the general result, even sometimes when sur- rounded by the ravages of disease, yet the general law is, that disease in one part modifies more or less the action of all the rest, and especially of those connected with it by contiguity or by resemblance of function. Nature has estab- lished a certain adaptation of the moral and intellectual faculties to one another, leading to that harmony of action which puts them in proper relation to external things, and we can scarcely conceive of any disturbance of their equili- brium, that will not more or less impair the general result. Amid the chaos of the sentiments and passions produced by moral mania, the power of the intellect must necessarily suf- fer, and instead of accurately examining and weighing the suggestions of the moral powers, it is influenced by motives which may be rational enough, but which would never have been adopted in a perfectly healthy state. It is hard to con- ceive, indeed, that with an understanding technically sound, the relations of a person should be viewed in an entirely dif- ferent light, the circle of his rights and duties broken and dis- torted, and his conduct turned into a course altogether foreign to that of his ordinary habits and pursuits. Notwithstanding the correctness of his conversation, and his plausible reasons for his singular conduct, a strict scrutiny of his actions, if not his words, will convince us that in particular cases, his notions of right and wrong are obscured and perverted, and that his own social position is viewed through a medium which gives a false coloring to its whole aspect. Now, though such a person may not be governed by any blind, irresistible impulse, yet to judge his acts by the standard of sanity, and attribute to them the same legal consequences as to those of sane men, would be clearly unjust, because their real tendency is not and cannot be perceived by him. Not that his abstract notions of the nature of crime are at all al- tered, for they are not, but the real character of his acts being LEGAL CONSEQUENCES OF MORAL MANIA. 261 misconceived, he does not associate them with their ordinary moral relations. No fear of punishment restrains him from criminal acts, for if not totally unconscious of violating any penal laws, he thinks he is acting for an end that sanc- tifies the means, and therefore the great end of punish- ment, the prevention of crime, is wholly lost in his case. If there were no other reason for withholding punishment in cases of moral mania, this alone would be sufficient, that the fear of it, which with others is a powerful preven- tive of crime, or at least is supposed to be, in the most popular theories of criminal law, does not and cannot exert its restraining influence on the mind. No one would think of attributing moral guilt to Earl Ferrers for entertaining the insane idea that his steward was a villain conspiring with the the earl's relatives against his comfort and interests ( 154) ; why then should it be charged to him as a crime, that, amid the tumult of his passions disturbing the healthy exercise of his understanding, he acted on this belief and made himself the avenger of his own wrongs ? Each delusion was alike the offspring of the same derangement, and it is unjust and un- philosophical to regard one with indifference as the crotchet of a madman, and be moved with horror at the other and visit it with the utmost penalty of the law, as the act of a brutal murderer. 249. Liberty of will and of action is absolutely essen- tial to criminal responsibility. Culpability supposes not only a clear perception of the consequences of criminal acts, but the liberty, unembarrassed by disease, of the active powers which nature has given us, of pursuing that course which is the result of the free choice of the intellectual faculties. It is one of those wise provisions in the arrangement of things, that the power of perceiving the good and the evil, is never unassociated with that of obtaining the one and avoiding the other. When, therefore, disease has brought upon an indi- vidual the very opposite condition, enlightened jurisprudence will hold out to him its protection, instead of crushing him as a sacrifice to violated justice. That the subject of homicidal insanity is not a free agent, in the proper sense of the term, 262 MEDICAL JURISPRUDENCE OF INSANITY. is a truth that must not be obscured by theoretical notions of the nature of insanity, nor by apprehensions of injurious consequences from its admission. Amid the rapid and tumultuous succession of feelings that rush into his mind, the reflective powers are paralyzed, and his movements are solely the result of a blind, automatic impulse with which the reason has as little to do, as with the movements of a new-born infant. That the notions of right and wrong continue unimpaired under these circumstances, proves only the partial operation of the disease ; but in the internal strug- gle that takes place between the affective and intellectual powers, the former have the advantage of being raised to their maximum of energy by the excitement of disease, which, on the other hand, rather tends to diminish the activity of the latter. We have seen that generally after the fatal act has been accomplished, and the violence of the paroxysm sub- sided, the monomaniac has gone and delivered himself into the hands of justice, as if, overwhelmed with horror at the enormity of his action, he either considered his own life the only compensation he could offer in return ; or, it may be, felt that the presence of his fellow men, though it would seal his own fate, would be a welcome relief from the crushing agony of his own spirit. It is not to be wondered at, however, if occasionally, the tide of feeling takes a different course, and the murderer is prompted to avoid what he cannot help think- ing to be the just consequence of his act, by flying from the bloody scene, and even denying his agency in it altogether. Considering the diversity of habits, sentiments, and education, uniformity in an unessential phenomenon like this, is not to 'be expected. That flying from pursuit indicates a conscious- ness of having committed a reprehensible act, and also a fear of punishment, is not denied, but it has never been contended that the opposite course implies the absence of all ideas of this kind from the mind of the homicidal monomaniac. The real point at issue is, whether the fear of punishment or even the consciousness of wrong doing destroys the supposition of insanity, and this is settled by the well-known fact that the inmates of lunatic asylums, after having committed some LEGAL CONSEQUENCES OF MORAL MANIA. 263 reprehensible acts, will often persist in denying their agency in them, in order to avoid the reprimand or privation which they know would follow their conviction. If insane persons have any rational ideas at all, and it is not denied that they have, it is not strange that they sometimes are conscious of the penal consequences of their acts, and use the intelligence of a brute in order to avoid them. Besides, in moral insanity the intellectual faculties are supposed not to be impaired, and when the fury of the paroxysm which has borne him on, in spite of every attempt at resistance, has subsided, the homi- cidal monomaniac returns, in some degree at least, to his or- dinary habit of thinking and feeling. He regrets the havoc he has made, foresees its disgraceful consequences to himself, shudders at the sight, and flies, like the most hardened crimi- nal, to avoid them. 250. In medical science, it is dangerous to reason against facts. Now we have an immense mass of cases related by men of unquestionable competence and veracity, where people are irresistibly impelled to the commission of criminal acts while fully conscious of their nature and con- sequences ; and the force of these facts must be overcome by something more than angry declamation against visionary theories and ill-judged humanity. They are not fictions invented by medical men (as was rather broadly charged upon them in some of the late trials in France,) for the pur- pose of puzzling juries and defeating the ends of justice, but plain, unvarnished facts as they occurred in nature ; and to set them aside without a thorough investigation, as unworthy of influencing our decisions, indicates any thing rather than that spirit of sober and indefatigable inquiry which should characterize the science of jurisprudence. We need have no fear that the truth on this subject will not finally prevail, but the interests of humanity require that this event should take place speedily. \ 251. The distinction between crimes and the effects of homicidal monomania is too well founded to be set aside by mere declamation, or appeals to popular prejudices, as it has repeatedly been in courts of justice. On the trial of Papa- 264 MEDICAL JURISPRUDENCE OF INSANITY. voine for the murder of two young children near Paris, in 1823, the advocate-general, in reply to the counsel of the prisoner who had pleaded homicidal insanity in his defence, declared that Papavoine committed the crime, in order " to gratify an inveterate hatred against his fellow men, trans- formed at first, into a weariness of his own life, and subse- quently into an instinct of ferocity and a thirst of blood. Embittered by his unhappy condition, excited by a sense of his sufferings and misfortunes, irritated by the happiness of others which awakened in him only ideas of fury, and drove him into seclusion which increased the perversity of his depraved propensities, he arrived at that pitch of brutal depravity where destruction became a necessity, and the sight of blood a horrible delight. His hateful affections, after being long restrained, finally burst forth and raised in his bosom a necessity of killing, which, like a young tiger, he sought to gratify." 1 That beings in human shape have lived who delighted in the shedding of blood, and found a pas- time in beholding the dying agonies of their victims, is a melancholy fact too well established by the Neros and Ca- ligulas of history. For such we have no disposition to urge the plea of insanity, for though we are willing to believe them to have been unhappily constituted, we have no evi- dence that they labored under cerebral disease, and they certainly exhibited none of its phenomena. Motives, the very slightest no doubt, generally existed for even their most horrid atrocities, and even when they were entirely wanting, there was still a conformity of their bloody deeds with the whole tenor of their natural character. They followed the bent of their dispositions as manifested from childhood, glorying in their preeminent wickedness, and rendered familiar with crime by habit ; and though conscience might have slumbered, or opposed but a feeble resistance to the force of their passions, yet it was not perverted by diseased action so as to be blind to the existence of moral distinctions. In homicidal insanity, on the contrary, every thing is dlffer- 1 Georget. Examen des proces criminelles. LEGAL CONSEQUENCES OF MORAL MANIA. 265 ent. The criminal act for which its subject is called to an account, is the result of a strong and, perhaps, sudden im- pulse, opposed to his natural habits, and generally preceded or followed by some derangement of the healthy actions of the brain or other organ. The advocate-general himself represented Papavoine, " as having been noted for his un- social disposition, for avoiding his fellow laborers, for walk- ing in retired, solitary places, appearing to be much absorbed in the vapors of a black melancholy." This is not a picture of those human fiends to whom he would assimilate Papa- voine, but it is a faithful one of a mind over which the clouds of insanity are beginning to gather. Where is the similarity between this man, who, with a character for probity and in a fit of melancholy, is irresistibly hurried to the commission of a horrible deed, and those wretches who, hardened by a life of crime, commit their enormities with perfect delibera- tion and consciousness of their nature. 252. It has been also urged that the subjects of homi- cidal insanity are, no less than criminals, injurious to society, the safety of which implicitly requires their extermination, upon the same principle that we do not hesitate to destroy a dog that has been so unfortunate as to go mad. Sane or insane, criminal or not, such monsters should be cut off from the face of the earth, and it is a misplaced humanity to re- serve them for a different fate. Such language might have been expected from people who are moved only by the feelings that are immediately raised by the sight of appalling crimes, but it is an humiliating truth that the opinions of those who are in the habit of discriminating between various shades of guilt, and of canvassing motives, are too often but an echo to the popular voice. If the old custom of smother- ing under a feather bed the miserable victims of hydropho- bia, be now considered as a specimen of the most revolting barbarity, we cannot see why the punishment of insane offenders should be regarded under a more favorable aspect. Society has a right to protect itself against the aggressions of the dangerously insane ; but unnecessary severity in its protective measures often defeats the very purpose in view, 23 266 MEDICAL JURISPRUDENCE OP INSANITY. and indicates a want of humanity and intellectual enlight- enment. While confinement in prisons and hospitals fur- nishes all the restraint which the necessity of their case requires, it is idle to urge the infliction of death as the only means by which society can be effectually shielded from a repetition of their terrible enormities. 1 253. One of the principal objects of punishment should be to deter from the commission of crime, by impressing the mind with ideas of physical and moral suffering as its certain consequence ; and whenever it is found to produce a very different effect, it is the part of enlightened legislation to devise some other means of prevention. Nothing can be more absurd than to inflict the very punishment which the delusion of the monomaniac often impels him to seek, to put him to death, who voluntarily surrenders himself, and imploringly beseeches it as the only object he had at heart in perpetrating a horrid crime. What is it but converting a dreadful punishment into the dearest boon that earth can offer ? In religious monomania, it is not uncommon for the patient to believe that the joys of heaven are in store for him, and, under the excitement of this insane idea, to murder a fellow creature, in order that he may the sooner enter on their fruition. To execute one of this class, is to perpetuate an evil which needs only a change of penal consequences to be effectually remedied. A kind of delusion has sometimes prevailed, in certain parts of Europe, which persuades its un- fortunate subjects that eternal happiness can be gained by being executed for the murder of some innocent person. The idea is that suicide being itself a sin, will not be followed by the happiness they seek, but that murder, though a greater crime, can be repented of before the time of execution. This delusion prevailed epidemically in Denmark, during 1 It must not be forgotten that when a person charged with a capital crime, is acquitted on the ground of insanity, though admitted to be the author of the crime, it is rendered obligatory on the court in England by stat. 89 and 40 Geo. III. c. 94, and by similar provisions in most of the United States, to order him into confinement. LEGAL CONSEQUENCES OF MORAL MANIA. 267 the middle of the last century, and to avoid sending an un- prepared person out of the world, the victim generally selected was a child. Death, of course, was no punishment in this case, and at last, the king issued an ordinance direct- ing that the guilty should be branded on the forehead with a hot iron and whipped, and be imprisoned for life, with hard labor. Every year, on the anniversary of their crime,' they were to be whipped. 1 Lord Dover, in his life of Frederic, relates that such was the severity of discipline to which the Prussian troops at Potsdam were subjected, that many wished for death to finish their intolerable sufferings, and murdered children whom they had enticed within their power, in order to obtain from justice the stroke they dared not inflict upon themselves. 2 Abolish capital punishment in such cases and the delusion will disappear with it ; continue it, and no one can tell when the latter will end. 254. Not only is the moral effect of punishment totally lost when inflicted on the subjects of homicidal insanity, since it does not deter other madmen from committing similar acts, but by a curious law of morbid action, the very publicity obtained for them, by the trial and execution of the actors, leads to their repetition to an almost incredible extent. At a sitting of the Royal Academy of Medicine in Paris, August 8th, 1826, Esquirol stated that since the trial of Henriette Cornier, which occurred not two months before, he had become acquainted with six instances of a parallel nature. Among these was a Protestant minister who became affected with the desire of destroying a favorite child. He struggled against this terrible inclination for fifteen days, but was at last driven to the attempt on his child's life, in which he fortunately failed. Several other physicians, on the same occasion, bore similar testimony relative to the effect of that trial, and the newspapers about that period teemed with cases of child-murder which had originated in the same way. 255. It should not be forgotten, that well-grounded suspicion that the homicidal act, thus punished, was the 1 London Quarterly Review, xii. 219. 2 i. 321. 268 MEDICAL JURISPRUDENCE OF INSANITY. \ result of physical disease, instead of moral depravity, is so horrid as to excite, in whatever mind it arises, feelings of distrust and jealousy, towards the law and its ministers, infinitely more to be dreaded than the occasional acquittal of a supposititious maniac. When, on the contrary, the dis- tinction is carefully made between the acts of a sound and those of an unsound mind, and a decision in doubtful cases is dispassionately and deliberately formed upon every species of evidence calculated to throw light upon it, the mind is impressed with a new sense of the wisdom and majesty of the laws, and with a feeling of security under their discrimi- nating operation. The numerous trials for witchcraft in a former age, and the occasional condemnation of a maniac in the present, have done more to lessen men's respect for the laws, than all its overruled decisions have to weaken their confidence in its certainty. Insanity is a disease, before the prospect of which the stoutest heart may quail ; but how much more appalling is it made by the reflection, that in some wild paroxysm, it may be followed by legal conse- quences that will consign its unhappy subject to an igno- minious death. In cases of simulated madness, the purposes of justice are more fully answered by receiving and examin- ing all the evidence and patiently showing its value and bear- ings, and thus laying open the imposition to the conviction of all, than by repelling the plea with idle declamation on its injurious tendency. Not only does the criminal obtain his deserts, by such a course, but the most cunning device of his ingenuity is seen to be baffled, and the plea that should ever shield innocence from destruction is ineffectually urged to protect the guilty. Every murmur at the injustice of the sentence is hushed, all scruples are removed and all fears are dissipated, that a fellow being has been sacrificed, whose only crime was the misfortune of laboring under disease of the brain. Besides, what if amid the obscurity in which a case may sometimes be involved, a guilty person do escape, though this event must be of very rare occurrence, is it not a maxim in legal practice that it is better for ten guilty persons to escape punishment than for one innocent person LEGAL CONSEQUENCES OF MORAL MANIA. 269 to suffer ? And though he escape the sentence of the law, yet society is perfectly secure from the effects of mistake, because the very plea by which he obtains his acquittal, consigns him to confinement and surveillance. 256. In those cases where there are some but not per- fectly satisfactory indications of insanity, the trial or sen- tence should be postponed, in order that opportunity may be afforded to those who are properly qualified, for observing the state of the prisoner's mind. Where the moral powers have become so deranged as to lead to criminal acts, with- out, however, any perceptible impairment of the intellect, time only is necessary, in the greater proportion of cases, to furnish indubitable evidence of mental derangement. And whatever may be the result, the ends of justice are not defeated by waiting a few months, while the scruples of the over humane are removed, and the acquiescence of the ministers of the law in measures calculated to establish innocence rather than guilt, gains for them a confidence and respect that the conviction of guilt never can. Many instances might be mentioned where the accused, whose insanity was doubtful on trial, has, during the confinement subsequent to his acquittal on a criminal prosecution, become most manifestly insane. Hadfield, who was tried for shooting at the king, and acquitted on the ground of insanity, though during the trial he displayed no indications of disordered mind, spent the remainder of his life in Bethlem hospital, and for thirty years showed scarcely any signs of mental aliena- tion, except once, when suddenly and without any known cause, he became so furious that they were obliged to chain him in his room. This paroxysm lasted but a short time, when he recovered his ordinary state of health. l 257. Another reason for delay is, that insanity is some- times so completely veiled from observation, as never to be suspected even by the most intimate associates of the patient. An instructive case is related by Georget, in which the existence of insanity, though of several years duration, 1 Billard, quoted by Georget in Nouv. discuss, med. leg. 71. 23* 270 MEDICAL JURISPKUDENCE OF INSANITY. was not recognized till after the death of the subject. The circumstances were briefly these. Bertet, a revenue officer, exercised the duties of his office for three years, in the manu- factory of MM. Ador and Bonnaire, at Vaugirard, where he was only noticed for his unaccommodating disposition, melancholy temperament, and fondness for seclusion. One day while M. Ador was conversing with some of the work- men, he was requested by Bertet to affix his signature to cer- tain papers. He proceeded to his room for this purpose, and while in the act of writing, was shot dead by Bertet, who immediately afterwards blew out his own brains. Among his papers were found several addressed to the advocate-general, bearing the most singular titles, such as my last reflections, my last sighs, in which he declared that he had been poisoned several years before, and gave a minute account of the numerous remedies he had ineffectually used, insisting at the same time that his head was not turned, that he acted delibe- rately, and giving very coherent reasons to prove it. He announced that four victims were required, namely, the two heads of the establishment, a woman who was living in it, and his old housekeeper, and that in case he should be con- tented with one, he would leave to justice the charge of obtaining the others. Some of these papers he finishes with saying, " To-day my pains are less acute, I feel better, my vengeance is retarded," or " my pains are renewed with them my thoughts of vengeance." Among other wild fancies, he made a description of the funeral monument to be raised to one of his victims, which was to be a gibbet covered with figures of instruments of punishment. He also described his own funeral procession. He wished the four corners of the pall to be carried by the four persons above- mentioned, in case he should not have sacrificed them ; that the advocate-general should follow the cortege ; and that when it reached the cemetery, the latter should prepare a large ditch in which they should first cast him, Bertet, and then the four pall-bearers. In another paper, he said he designed for each of his victims two gilt balls, as an emblem of their ambition and thirst of gold, and some pulverized LEGAL CONSEQUENCES OF MORAL MAXIA. 271 cantharides, as an image of the torments which he suffered. Bertet had never shown any signs of mental alienation in his official letters and reports. He was sometimes abstracted and loved to be alone, but his disposition, in this respect, had been of long standing, and seemed to be owing to the state of his health, of which he was constantly complaining, though judging from his exterior, he seemed to be well enough. He had always discharged the duties of his office satisfactorily, and, by his own solicitation, had just before obtained a more profitable place. Had not Bertet recorded his insane fancies, but, failing in his suicidal attempt, had been brought to trial for the murder of M. Ador, the plea of insanity would have fallen on the most incredulous ears, and he would have paid the last penalty of the law. In a state of confinement and seclusion, however, nothing but time would have been necessary to reveal the true nature of his case. 258. Homicidal monomania presents us with one of those remarkable phenomena, the existence of which men are slow to believe, long after the evidence in its favor has accumulated to such an extent as to render incredulity any thing but a virtue. The facts themselves cannot be denied, and the various methods of explaining them on the hypo- thesis of a sound understanding, though every phase of human character and every spring of human action have been resorted to for the purpose, are little calculated to diminish the confidence of impartial minds in the correctness of the abo.ve views. Strongly impressed as we are with their im- portance, we may have devoted more attention to the objec- tions that have been urged against them, than they really deserve ; we shall, therefore, say but little more on this part of the subject. Against Georget's proposition relative to the homicide committed by Henriette Cornier, that " an act so atrocious, so contrary to human nature, committed without interest, without passion, opposed to the natural character of the individual, is evidently an act of madness ; " * it has been 1 Discussion medico-legale sur la Folie, 126. 272 MEDICAL JURISPRUDENCE OF INSANITY. seriously objected that though we may be unable to discover motives, yet this is not a positive proof that there actually are no motives. We do not hesitate to say that sometimes the character of the act itself furnishes sufficient evidence of its having been prompted by insanity, even when the closest investigation of the bodily and mental condition of the party fails to detect other proofs of its existence. A man named Greensmith was tried and convicted in England in 1837, for the murder of his four children. It appeared in evidence that he was a kind father, and a sober, industrious man ; that he took affectionate leave of his children before he destroyed them, and again before he finally left them ; that he calmly and deliberately strangled them one after the other, and evinced neither fear, nor repentance, nor mental agitation. The motive he assigned for the act was, that he thought it would be better for him and for his family that he should destroy his children and be executed for the act, than let them go to the workhouse. Stronger evidence of insanity than such conduct furnishes, could not be had. The judge and jury, however, thought otherwise, although they had, besides, the testimony of an eminent physician of a lunatic asylum, who stated his belief, as the result of his observation of the accused, that he was laboring under insane delusion, and that the act was the direct offspring of that delusion. Does the man, who like Hadfield imagines that he is to be sacrificed for the salvation of the world, and to that end shoots at the king, or he who murders his neighbor in the belief that his victim and others are conspiring against his life, ( 10,) evince a more extensive derangement of the mental powers, than this poor creature who destroys his dear offspring in the imaginary apprehension of coming want ? It seems as if nothing but the most slavish and puerile regard for techni- calities, could so blind one to the clearest manifestation of truth as to lead him to return an affirmative to this question. 259. By those who delight not in metaphysical subtle- ties, a more summary, if not more philosophical, explanation of homicidal monomania has been furnished in the idea that it is to be attributed to an instinct of ferocity ; to unnatural LEGAL CONSEQUENCES OF MORAL MANIA. 273 depravity of character; to a radical perversity. That such qualities do exist as the too common result of a defective con- stitution, or a vicious education, is proved by the testimony of every day's experience, even if we had not the best author- ity for believing that the heart may be " desperately wicked." But even where they exist to the fullest extent, the actions to which they prompt have always some immediate motive, slight as it may be, of pleasure sought, or pain avoided ; or if they .can claim no higher title than that of instinct^ it is one of no sudden, transitory character, but a constant and con- sistent portion of the constitution. It is an anomalous in- stinct that manifests itself but once or twice in a person's life ; and therefore, we cannot, without indulging in the most unwarrantable use of language, apply this term to those un- controllable, abnormal influences that lead to acts of fury and destruction. What resemblance can we detect between the Domitians and Neros of history, and the Papavoines and Corniers, whose terrible acts have been commemorated in the records of criminal jurisprudence ? In the former, this instinct of ferocity appeared in their earliest youth ; it im- parted a zest to every amusement, and excited ingenuity to contrive new means for heightening the agonies of the wretched victims of their displeasure. In the latter, the char- acter was mild and peaceable, and their days were spent in the quiet and creditable discharge of the duties belonging to their station, till a cloud of melancholy enveloped their minds, and under its shadow they perpetrated a single deed, at the very thought of which they would have previously shuddered with horror. In short, all our knowledge of human nature, all our experience of the past, force us to the conclusion, that " the presence of mental alienation should be admitted in him who commits a homicide without positive interest, without criminal motives, and without a reasonable passion." 260. After what has been said on the subject of homi- cidal monomania, it will be scarcely necessary to enter into particulars relative to the legal consequences of the other forms of partial moral mania. Completely annulling, as we believe they do, all moral responsibility for acts committed 274 MEDICAL JURISPRUDENCE OF INSANITY. under their influence, the law can rightfully inflict no pun- ishment on their unfortunate subjects, though it should adopt every measure of precaution that the interests of society require. To punish the thief and the incendiary for acts which are the result of disease, is not only unjust, but it serves to aggravate their disorder, and to prepare them, when their term of punishment has closed, for renewing their depre- dations on society with increased perseverance. The proper course to pursue with this class of offenders, when brought into courts of justice, is to place them, or obtain a guaranty from their friends that they shall be placed, where judicious medical treatment will be used for the purpose of restoring their moral powers to a sounder condition, and where they will be secluded from society until this end shall be accomplished. 261. If the doctrines here laid down relative to moral insanity and its legal consequences are correct, it would seem to follow as a matter of course, that they should exert their legitimate influence on judicial decisions. Neverthe- less, it is contended, and that too by some who do not question the truth of these doctrines, that they ought not to have this practical effect, for the reason that insanity would thereby be made the ground of defence in criminal actions, to a most pernicious extent. Stated in the plainest and strongest terms, the objection is, that if these doctrines should be recognized in our courts of justice, and suffered to influence their decisions, almost every criminal would resort to a defence, the tendency of which is invariably to puzzle and distract the minds of the jury, and to produce the acquittal of many a wretch, who would first hear the men- tion of his own derangement from the lips of ingenious counsel. Now, even if we were disposed to accord to this objection all the foundation that is claimed for it, it would not seem to warrant the inference that is drawn from it. Are we to take from the maniac the defence which the law of nature secures to him, because it may sometimes be offered by those who use it as a means of deception ? Are the innocent to be made to suffer for the devices of the guilty ? To avoid this cruel injustice, therefore, without at LEGAL CONSEQUENCES OF MORAL MANIA. 275 the same time inflicting a positive evil on society, we would deduce from this objection an inference of a totally different kind. It is, to let the right of the accused party to make his defence be cumbered with no restrictions, expressed or implied ; to let the plea of insanity, if he choose to make it, be attentively listened to, the facts urged in its support closely scrutinized, the accused carefully and dispassionately examined, and his character and history investigated. If this duty be performed as it should be, and always may be, the case will seldom happen, when the truth will not be established to the satisfaction of every unprejudiced mind. If the accused be really insane, we have the satisfaction of reflecting, that an enlightened investigation of his case has saved an innocent person from an ignominious fate, while on the other hand, if he be simulating insanity, every doubt will be dissipated as to the justice of his sentence, and the conviction will be strengthened in the popular mind, that the law will prevail over every false pretence, and expose the guilty even in their most secret refuge. 1 262. In the form of moral insanity characterized by altef- 1 The following remark of chief justice Parker of N. H., shows that this objection is not confirmed by the experience of, at least, one practical lawyer, the value of whose testimony on this, or any other point, need not be indica- ted by any comment of mine. " There are, undoubtedly, instances in which this kind of defence is attempted from the mere conviction that nothing else can avail, cases in which the advocate forgets the high duty to which he is called, and excites a prejudice against the case of others, by attempting to procure the escape of a criminal under this false pretence ; but such cases are truly rare, and usually unsuccessful." Charge to the grand jury of Mer- rimack county, N. H., 1838, quoted in 20 American Jurist, 457. Dr. Bell, the Superintendent of the McLean Asylum, Massachusetts, states, " that for one real criminal acquitted on the score of insanity, there have been a dozen maniacs executed for their criminal acts." Dr. Woodward, Superintendent of the Massachusetts Lunatic Hospital, says, " of all the cases that have come to my knowledge, and I have examined the subject with interest for many years, I have known but a single instance in which an individual arraigned for murder, and found not guilty by reason of insanity, has not afterwards shown unequivocal symptoms of insanity in the jails or hospitals where he has been confined ; and I regret to say that quite a. number who have been exe- cuted, have shown as clear evidence of insanity as any of these." 276 MEDICAL JURISPRUDENCE OF INSANITY. nate excitement and depression, ( 145,) the patient is strongly disposed to buy and sell, which fact joined with equal eagerness on the part of others to take advantage of it, frequently make their civil transactions the subject of litigation. In these cases there are so many points to be considered, that it is often difficult to arrive at satisfactory conclusions. It is to be settled, and perhaps on very meagre evidence, whether the transaction occurred during the lucid interval ; or if it occurred during the period either of excitement or of depression, whether the mental affection were sufficiently grave to obscure the perceptions or weaken the judgment, and if so, whether the other party took advantage of this infirmity to obtain more favorable terms than he otherwise would. It is also to be considered, that although the con- tracts of these persons may be fair enough independently regarded, yet their number and extent may be so far beyond their means, as to prove highly inconvenient, if not ruinous. The following account of a suit arising out of one of this class of contracts, will give a better idea of the various ques- tions which they open as well as the principles of law appli- cable to them, than any general discussion. 263. At a session of the Supreme Judicial Court of Massachusetts, at Northampton, August, 1848, a suit was brought by the guardian of Josiah Allis, against Billings and others, for the purpose of annulling a contract made several years previous, whereby the plaintiff conveyed to the defend- ants his interest in certain mills, on the ground that the for- mer was then insane and that the latter were guilty of fraud. It appeared in evidence that Allis, then about fifty years old, and the son of a farmer, was attacked in 1819 with mania, under the form of high though not furious excitement. He recovered, apparently, in the course of two or three months, but every year since, had been visited by a similar attack which was invariably followed by a period of depression, and this by a period of apparent restoration to his natural condi- tion. In 1822 he married his first wife by whom he had two daughters now married. In 1829 his father died, leaving him executor of his will and residuary legatee to nearly all LEGAL CONSEQUENCES OF MORAL MANIA. 277 his property. In 1833 his wife died. In March, 1834, he made a contract with Bodwell, the husband of his only sis- ter, whereby the latter was induced to move upon Allis's farm, and maintain him and his family. At the end of a year this contract was dissolved by mutual consent. On March 21st, 1834, he made a contract for the sale of the mills which it was the object of this suit to avoid. For his interest in the property, being one-half, he received $4000, and a release from certain unsettled claims which, he sup- posed, might amount to $500. In this year his mother died. In March, 1835, he sold his homestead for $4,600, with the expectation of receiving $500 more. In the fall of the next year he married his second wife. In November, 1842, his oldest daughter, and the next year his other daughter, were married. In 1843 he commenced a suit against the pur- chaser of his homestead, for avoidance of the contract. He obtained a verdict, but subsequent law proceedings were instituted, and the matter was still pending. In the latter part of 1843, he was placed under guardianship. On July 6th, 1844, he was sent to the Worcester lunatic hospital, where he stayed six weeks. Bearing these incidents and dates in mind, we shall more easily understand the evidence respecting his mental condi- tion, every particular of which is here faithfully given. 264. It was abundantly proved by the evidence, that Allis was a subject of periodical insanity, each attack being char- acterized by a turn of excitement and depression, an interval intervening between the attacks, quite free from both. They occurred every year. At most there was but one year in which their occurrence was called in question. It appears that the excited turns usually commenced in the middle, or latter part of summer, continuing from one to three months. While under their influence, he was noisy, boisterous, and talkative. The various other manifestations of this condition, as related by the witnesses, were, for the most part, referred to particular attacks, and were probably confined to them. In this manner, it was stated, that he would drive about rap- idly and carelessly, shouting and hallooing ; that he indulged 24 278 MEDICAL JURISPRUDENCE OF INSANITY. in wild and incoherent expressions, and was observed ram- bling about without hat, coat, or shoes. At different times, too, he entertained some strange fancies which were not far from being real delusions. He professed to be able to walk on the water; to catch a person's breath in his teeth; to have command of angels ; to tame a ferocious woodchuck by looking in his eye ; and to hold up through a storm a whole broadside of a house frame which they were raising. At times he had great fears of thieves and devils, and would carry about a double-barrelled gun to protect himself. Once he spoke of these devils as brushing by him at an evening meeting. At another, he thought a fellow boarder at the hotel had been robbed of a large sum. With two or three exceptions, the excitement was never so high as to require his confinement to the house, nor did it always prevent him from managing his affairs. It was said he was inclined to make purchases, generally of fancy articles quite unsuitable to his condition, but only one or two instances were related, of his indulging in foolish speculations, and those were of trifling amount. 265. Depression immediately succeeded the excitement, . and continued until spring. Once it was spoken of as dis- appearing in March ; and at another time, in April. This also seems to have varied in severity. At one time, he is described as being still, sitting in company for hours without saying a word, shy, and avoiding his friends. In many of the depressed turns he was filled with vague fears and appre- hensions, thought he was coming to want, and was disposed to suicide. In others, he was able to attend to his customary business. 266. His daughters testified that within their recollec- tion, (then respectively 25 and 23 years old,) he had never been otherwise than excited or depressed ; yet it was abun- dantly shown by a cloud of witnesses who were in the habit of seeing him, every day or two, for many years, that there were well-marked intervals between his attacks, when he was apparently free from excitement or depression. It was their concurrent testimony, that in these intervals, his manners LEGAL CONSEQUENCES OF MORAL MANIA. 279 were natural and proper, his conduct and conversation cor- rect, and nothing in either to arrest the observation of others. He managed the farm, both before and after his father's death, with no very obvious lack of prudence and intelligence, and creditably discharged the duties of a parent, husband, and citizen. Various business transactions of his at one time or another, were described by the witnesses as having been per- formed with at least ordinary discretion and sagacity ; and those who had these dealings with him observed nothing strange or unusual in his appearance. He hired and paid his workmen, bought and sold his cattle, procured the necessary supplies of food and clothing for his family, placed his chil- dren at school away from home and paid the bills for their board and tuition, married twice, bought and sold real estate, lent money, received payments, obtained discounts at the Bank, and once, (in 1832,) was chosen by the parish as its agent for disposing of some lands. In all these transac- tions, the defendants undertook to show, that he evinced an ordinary share of shrewdness and intelligence ; and in regard to many of them, certainly, this was the fact. Instances were mentioned of his giving too much for his purchases, and of buying some things which he did not need, but nearly, if not quite all, these transactions occurred when he was con- fessedly in his excited state. One of them, which occurred in the spring of 1842, referred to the purchase of an old shop for a needy neighbor, and \vas first related in such a manner, as to convey the impression that it was deeply tinctured with folly. The testimony of the neighbor himself, however, presented the matter in a very different light. It appeared that he owned a lot of land, very near Allis's house, which it had been proposed to purchase for a burying-place for the use of the town. AUis being loath to have a burying-place so near him, suggested to the witness, that he had better put up a house on it. " I replied," said the latter, " that I had no funds, and then he offered to assist me. The next morning he came and proposed to buy for me a certain old shop near by, which might be made into a house, and could be obtained, he thought, for $100." He succeeded in getting it for $90, 280 MEDICAL JURISPRUDENCE OF INSANITY. and had it removed to the lot in question, but failed to sup- ply the funds necessary for converting it into a house. Thus the land was not sold for a burying-place, and he did no more than was necessary to defeat the project. Many of the witnesses who had dealings with him, and spoke of him as evincing nothing strange or unusual in his manner, and appearing like other men, had seen him in his excited and depressed states, and declared that in them, he had appeared very differently. Instances of excitement were related, which apparently occurred while in his rational or lucid intervals, but they were transitory, and seemed to have been caused by sudden provocations, or some other special causes. In this connection it is proper to state, that following the custom of the times, he frequently, if not excessively, used ardent spirits ; and it was testified that drinking always excited him. 267. The evidence respecting Allis's mental condition about the time of the transaction in question, requires par- ticular attention. In August, 1833, he went on a pleasure excursion to Saratoga, stayed two or three weeks, and came back highly excited. In September he bought a piece of land of his nephew ; he attended auctions, and was disposed to bid off every thing that was sold. In that month or the next he went abroad to purchase cattle, for the purpose of fattening them. He was disposed, says a witness, to give whatever was asked, and actually did pay high prices. He said, when he returned home, that he had got them for a song. In October, his wife died ; she was sick when he left home to buy cattle, and he told a young man who lived with him, that if she died, he must procure a coffin. Soon after, he became depressed ; was troubled at finding he had bought more cattle than he had the means of feeding, and solicited his brother-in-law to help him out of his troubles. A witness who took some of the cattle to keep for him, said that Allis applied to him and made the bargain. He was to keep them from 25th of November to the early part of February, at $1.17 per pair, Allis furnishing grain, and witness hay. " He came often," said the witness, " to see the cattle ; talked about them LEGAL CONSEQUENCES OF MORAL MANIA. 281 as other men do ; appeared, in all respects, like other men. Said he would pay when he got returns, and did pay in the course of two or three weeks. I saw nothing like excitement or depression." In March, 1834, he conversed with a witness about the mills ; said they were not profitable ; that there was always something to be done on them, and that he thought of selling them. He said he had been offered $4000 for his part, and asked witness's opinion about the price. The wit- ness observed nothing wild or incoherent in his manner ; he was as usual when about his business. In March, if not before, he began to negotiate the arrangement with his brother-in-law, referred to in the beginning of this notice, which ended in a contract whereby the latter was to receive all Allis's real estate excepting the mills, and which was val- ued at between $8000 and $9000, maintaining him and his daughters, and giving the latter $2000 each. His reasons for this step were, as appears from the evidence, that by the death of his wife, he was left with two young children, and an aged mother sick ; that he was unable to get any suitable person to take charge of his family ; and if his brother-in-law should prove a gainer by the arrangement, it would only turn a portion of his father's property into his sister's family. The brother-in-law went in March, and said he thought Allis con- tinued depressed until the first of April, but soon went out to work with him, and appeared to be in his natural condi- tion during the summer. He also consulted with his brother respecting the sale of the mills ; told him what was offered and his reasons for selling. 268. The evidence respecting the character of the act, inasmuch as it will affect our estimate of his mental capaci- ty, remains to be considered. He felt perplexed by his busi- ness and overburdened with cares. His brother, with whom he often spoke of his intention to sell the mills, told him it would be a judicious step and relieve him of care. Both this witness and another whom he consulted, expressed their satisfaction with the price. The fact of his being indebted to the defendants to the amount of $500, or indeed to any amount, was neither proved nor disproved. If not so in- 24* ' 282 MEDICAL JURISPRUDENCE OF INSANITY. debted, then he received at the rate of $8000 for the whole property ; otherwise at the rate of $9000. A few witnesses rated the mills at $10,000, in 1834; one at $12,000. A larger number fixed their value at $6000 ; at this sum, they were assessed on the tax book of the town that year. 269. Dr. Lee, assistant physician, of the lunatic hospi- tal at Worcester, testified that Allis entered that institution July 6th, 1844 ; that he was highly excited, and continued so four days ; that this excitement, then, rather rapidly passed into depression, in which state he continued as long as he remained, which was six weeks. His opinion upon the evi- dence was, that the fact of periodical insanity was established, but not that of occasional sanity. He was satisfied of Allis's insanity in the spring of 1834. Dr. Woodward, late super- intendent of the hospital at Worcester, coincided with Dr. Lee in the opinion that Allis had no lucid intervals, and must have been insane in the spring of 1834. Buying and selling, he thought, no proof, one way or the other, because insane men are capable of doing certain business. He admitted, however, that, if Allis on his return from the hospital, had talked with his family on the subject of his will, and had set down coolly and deliberately and made a proper will, the presumption would have been in its favor. The author testifi- ed that in his opinion the existence of lucid intervals was abun- dantly proved ; that in these intervals he was as capable of transacting business as a person ever is in a lucid interval, and that the contract in question was made in one of them. It should be stated in this connection, that the first two medical witnesses had heard none of the defendants' wit- nesses, and not all of the plaintiff's ; while the latter had heard all of the plaintiff's, and most of the defendants' wit- nesses. 270. The charge of the court (Mr. Justice Dewey) to the jury, contained some instructions that deserve the attention of the medical jurist. The jury were told that the precise point of inquiry for them was the state of Allis's mind on the 21st of March, 1834, and that his previous and subsequent states were only important as elucidating that inquiry. It was also stated LEGAL CONSEQUENCES OF MORAL MANIA. 283 that acts done in a lucid interval, will be sustained by the law, and that the question of fraud is of little weight, except as connected with that of sanity and of the consideration. In regard to the burden of proof, the ordinary doctrine was given, viz., that if insanity is alleged, it must be proved ; that if habitual insanity be proved, the party who contends that the act was done in a lucid interval must prove it ; that if a party exhibits only temporary ebullitions of insanity, he cannot be presumed to be always insane. The court also instructed the jury that Allis must have had sufficient capa- city to judge of the character and value of the property sold, and the law required no more. On the point of affirmation, the court said, that the contract was not void, but merely voidable, and therefore capable of ratification, and that, though it were the act of an insane man, it might stand if confirmed. If Allis, therefore, after recovering his reason, having in his recollection and knowledge the nature, extent, and time of the contract, and all the circumstances before his mind ; recognized the sale by permitting possession on the part of the defendants ; receiving instalments on the notes given for the purchase money ; knowing it to be the consideration of the sale of his part of the mills, he would be bound by it. The jury returned a verdict for the defendants, and thus the contract was not disturbed. 271. In this case the plaintiff claimed relief on the ground of his own insanity and the fraud of the other party, and the defendants undertook to prove that neither allega- tion was true. Indeed, the whole course of the proceedings showed that neither party regarded these two points as inde- pendent of each other, and not inseparably involved in the question of the merits of the case. The plaintiff disclaimed any desire to avail himself of his insanity ; whether sane or insane, he was willing the contract should stand, if a fair price had been paid for the property ; and yet the burden of his testimony had reference to his mental condition. The defendants, on the other hand, while they endeavored to establish his competency, were equally careful to show that 284 MEDICAL JURISPRUDENCE OF INSANITY. they had paid the full value of the property. It was well understood that the stronger the proof of incompetency, the easier it would be to prove the fraud ; and vice versa. 272. It was not denied that Allis was insane a portion of every year ; nor was it denied, except by his daughters, that for a portion of every year, he showed no very obvious manifestations of disease, and was apparently, at least, in his natural condition of mind. The question was whether these restorations were real, and not apparent merely ; a complete intermission of the disease, a lucid interval, as it is somewhat technically called, or only a transitory remission in the severity of the symptoms. The difference of opinion on this point between the medical witnesses, may be ac- counted for, perhaps, in the fact, that they formed their judgment upon different data. Taking the evidence of both parties together, it is difficult to conceive of stronger proof than it furnished, that Allis's periodical restorations fairly amounted to what are called lucid intervals. The states of excitement and depression were scarcely more strongly testi- fied to, than an interval which was marked by neither. Many of the same persons who observed him in the former states, also observed him in the latter, and were struck by the contrast they exhibited. If, then, for months together, he was neither excited nor depressed, and entertained no delusions, wherein was he insane? When we consider, too, that he resumed his customary duties, and appeared to his friends and neighbors to be like himself, it may be doubted whether we have, in a great majority of cases, more satisfactory proof of recovery. 273. The disbelief of two of the experts in his sanity, seemed to be a matter of inference, rather than of direct proof. The intervals were so short compared with the duration and frequency of the attacks, that there was hardly sufficient time, they thought, for the mind to have been restored to a state of sanity. If by sanity they meant the restoration of the mind to a state of perfect health, such as those enjoy who have never been insane, no one would be disposed to disagree with them. We are not aware, however, that the LEGAL CONSEQUENCES OF MORAL MANIA. 285 lucid interval as understood by medical authorities, implies exactly such a restoration as that. Without canvassing the various definitions that have been given of this state, it is enough that they agree that the individual clearly and cor- rectly recognizes his true conditions and relations, all delu- sions having vanished, and the affections returned to their natural current. This does not imply that he has recovered the original vigor of his mind and his capacity for transact- ing unusual or important business, with his original prompti- tude and correctness. Indeed, a degree of restoration like this, is possessed by few patients who are discharged from our hos- pitals as recovered. To prove the occurrence of a lucid inter- val, it seems hardly reasonable to require evidence of a degree of capacity which can only be predicated of a mind that, for years, has enjoyed complete exemption from disease. Dr. Woodward declared, as has already been observed, that buying and selling, even with a certain degree of shrewdness, was no proof of sanity, as such transactions are often performed by the inmates of asylums. The fact thus broadly stated, is un- doubtedly true, and we do not recollect any particular transac- tion of Allis which might not be performed by some unequivocally insane persons. But the question of sanity or competence cannot be settled by reference to a single act, except perhaps as regards that particular act. A broader view of the individual is necessary for this purpose. If he buys and sells for months together ; if he manages his affairs with prudence; if no delusions possess his mind; if to his friends and neighbors he seems to have regained his natural char- acter; if, in short, the indications of sanity appear in his general habit and not merely in a particular act, he must be regarded as sane. It is because the very reverse of this is true, that the inmate of the asylum is deemed to be insane, though he may occasionally do a very shrewd thing. He is, perhaps, the prey of delusions, or his affections are grossly perverted, or his shattered understanding needs the constant support and guidance of sounder minds. To meet every instance of shrewd transaction by the assertion that many 286 MEDICAL JURISPRUDENCE OF INSANITY. persons of unquestioned insanity do the same things, can only produce a confusion of ideas. There is another fact of the deepest significance in this connection. Year after year he had been seen by his father, under whose roof he lived, stricken down by annual attacks of insanity. And yet by this father who knew his mental infirmities better than any one else, he was made the executor of his will, and residuary legatee of the burden of his estate, amounting to nearly $20,000. What stronger evidence could we have, that for a large part of every year, he enjoyed his ordinary health and competence ? Besides, are his two marriages to be regarded as having no bearing on the question of his mental condi- tion ? Had he no lucid intervals when they were con- tracted ? 274. The admission that Allis had lucid intervals, does not necessarily settle the question of his sanity or compe- tence. True, the general doctrine of the law, whatever may be its practice, is, that in the lucid interval the individual is fully himself again, and restored to all his privileges and responsibilities. This implies that the mind is restored to a degree of integrity which the present state of our pathologi- cal knowledge on the subject fails to establish. For common purposes and ordinary occasions, it may be abundantly ade- quate, but the weakness and irritability which are induced by numerous and frequent attacks, unfit it for extraordinary efforts. So long as the individual confines himself to the beaten track of his customary thoughts and pursuits, he shows no want of capacity ; but let him embark in new un- dertakings, assume responsibilities of unusual magnitude, or be subjected to provocations peculiarly calculated to try his power of self-control, and his mind is very liable to be led astray. He may rightly appreciate the value of his property and manage it very judiciously, and yet be far more easily overreached by dishonest men, than if he had never been insane. To regard all persons in a lucid interval as either completely responsible or irresponsible for their civil or criminal acts, would be manifestly unjust. A better rule LEGAL CONSEQUENCES OF MORAL MANIA. 287 would be to permit them the exercise of all legal rights, and protect them from the fraudulent practices of those who would take advantage of their infirmity. 275. Admitting the general fact that Allis had lucid intervals, the next question was whether the period when the contract for the sale of the property was made, was embraced in one of them. By two witnesses he was described as being depressed as late as April, when he began to manifest his natural condition. Allis's case was not of that kind in which the transitions are very rapid and abrupt, a single day or night dividing the different states from each other. The change was slower, and it was impossible 1,o fix upon a particular day as that on which the depression completely passed away, and the individual resumed his natural charac- ter. If the plaintiff were lying in the deepest shadow of despondency, as he undoubtedly had been at times, then of course, no one would contend that he was in a lucid interval. If on the other hand, the cloud had fairly rolled away from his understanding, though his animal spirits had not quite risen to their natural buoyancy, it certainly does admit of a question whether he may not be correctly said, for any prac- tical purpose, to have been in a lucid interval. 276. It remains, then, to be ascertained whether, on the 21st of March, 1834, he was suffering under a degree of depres- sion sufficiently severe to exert a controlling influence over his views and calculations. On this point, the testimony of the man who kept his cattle for him, and of the other witnesses with whom he conversed respecting his projected sale of the mills, is conclusive. They saw nothing in him like excite- ment or depression, and thought his manifestations were natural. The only controlling influence which this depres- sion could exert over the contract, was supposed to arise from the feeling of poverty by which it was accompanied. Two witnesses testified that during the winter he felt poor, but no particulars respecting the feeling were given, and it did not appear whether it continued into March. Even admitting that it did, we have no reason to believe that it affected his estimates of the value of property ; nor do we 288 MEDICAL JURISPRUDENCE OF INSANITY. see why it should have induced him to sell at a less price than he otherwise would. Presumptively it would seem as if the poorer he felt, the more he would endeavor to get. It is difficult, however, to see any connection at all between this feeling and the sale of the mills. Converting his mills into promissory notes would make him no richer, nor remove in any degree the feeling of poverty. Considering, therefore, that he was admitted by the plaintiff's witnesses to have come out of his depressed state by the first of April ; that other witnesses saw nothing unnatural in his appearance weeks previously ; and that this morbid feeling, if it existed at all, must have been very slight, the lucid interval may be fairly said to have embraced the 21st of March. 277. Another and a conclusive proof that the contract was made in a lucid interval, is to be found in the various affirmations, as the lawyers call them, by which it was recog- nized. Year after year, until 1841, he continued to receive the annual interest and instalments upon his notes, in the month of June ; and neither then, nor at any other time during those seven years, did he complain that he had made the contract when he was not aware exactly of what he was doing ; or that the defendants had taken advantage of his morbid feeling of poverty, to obtain the property at an inade- quate price. The effect of this fact can be avoided only by denying that he enjoyed a single lucid moment subsequent to March, 1834, and this would hardly be thought of. 278. None of these facts are necessarily incompatible with fraud on the part of the defendants, because it is safe to presume that in the lucid interval, the mind is deprived of some of its original vigor, and in consequence thereof, the individual may be made the dupe of dishonest and designing men. Acts performed in this state, therefore, should be viewed with the utmost jealousy, and much less evidence of fraud should be necessary to annul them, than if the mental soundness had never been called in question. Leaving out of view the amount of Allis's indebtedness to the defendants, in regard to which, however, there was no direct evidence at all, the contract was singularly clear from suspicious circum- LEGAL CONSEQUENCES OF MORAL MAXIA. 289 stances. Allis was desirous of selling the mills, because he regarded them as a source of trouble and vexation. Had his mind been in a perfectly healthy condition, they probably would not have been regarded in this light, but the fact was no less real, nor did it furnish a less rational motive for the transaction. It certainly was not a very strange thing that a person who was in a state of excitement or depression a considerable portion of every year, should come to the con- clusion that his interests would be promoted by having this property in some other shape. His brother-in-law, who was probably more capable than any one else of advising him, thought it a judicious step. Under different circumstances, it might have been otherwise. Had his health been good, or had he been under guardianship, the mill property might have been rendered more profitable, than its value invested in any other way. Here the case was very different sufficiently so to account for the different course which Allis pursued. 279. There was nothing in the nature of the contract that required an extraordinary mental effort. He had always been acquainted with the mills ; they were partly owned by him- self, as they had been by his father before him ; with their expenses and earnings he was perfectly familiar ; the condition of the buildings was obvious ; mills had been bought and sold in the vicinity, and thus he was furnished with an addi- tional means of comparison for judging of the value of his own ; in short, it was a species of property with the value and nature of which he must have been perfectly well acquainted. Neither was the idea of selling them a sudden one. He had contemplated the sale for some time previous, mentioned his intentions to his friends, and deliberately exe- cuted the contract for the transfer of the property. On the part of the defendants, so far as the evidence indicated, the transaction was an open and an honest one. The alterna- tive before them was, either to allow a stranger to come into the joint ownership, or to purchase Allis's half themselves. It seems that the price they offered was an average of the different estimates made of the value of the property four- 25 290 MEDICAL JURISPRUDENCE OF INSANITY. teen years afterwards. The negotiation was not done in a corner. Allis took ample time to consider the matter, con- versed with and received the advice of his friends on the subject, deliberately consummated the bargain, and for seven years continued to affirm it by receiving the annual pay- ments on the notes. CHAPTER IX. DEMENTIA. 280. THIS form of insanity is attended by a general enfeeblement of the moral and intellectual faculties which were originally sound and well-developed, in consequence of age or disease, and is characterized by forgetfulness of the past, indifference to the present and future, and a certain childishness of disposition. The apparent similarity of this state to that of imbecility or idiocy, renders it necessary that they should be accurately distinguished ; for nothing could be more improper or unjust, than to view them merely as different shades of the same mental condition. Idiocy and the higher degrees of imbecility are congenital or nearly so, and consist in a destitution of powers that were never pos- sessed. Little or nothing is remembered, because little or nothing has left any impression upon the mind, and no advance is made in knowledge, because the faculties neces- sary for obtaining it have never existed. The proprieties and decencies of life are unobserved, for the simple reason that their moral relations have never been discerned, and their in- difference to the most pressing wants is to be attributed to the absence of the most common instincts of our nature. The idiot is restless, uneasy, and inattentive, because the faculties that direct the attention, and draw from its applica- tion valuable results, have been utterly denied. In idiocy and imbecility the manners and conversation strongly resem- ble those of childhood ; in dementia they never lose the im- press of manhood, however disjointed and absurd they may be. The former appear at an early age of life ; the latter never takes place till after the age of puberty, except occasionally as a sequel of wounds or diseases of the head, 292 MEDICAL JURISPRUDENCE OF INSANITY. and generally increases with time, from the slightest possible impairment of mental energy to the most complete fatuity. In dementia the past is forgotten, or but indistinctly and un- connectedly brought up to the mind ; the attention wanders from one thing to another ; the affairs of the present possess no interest; and the moral and social affections are inac- tive, because the faculties, in consequence of pathological changes in the brain, have fallen into a state of inertia that prevents their ordinary manifestations. The whole condition betrays the existence, not of physical imperfection, but of physical weakness, (many of the bodily functions also fre- quently being enfeebled,) and consequently it may sometimes be cured, or temporarily relieved. When once firmly seated, it is not incompatible with length of years ; and after death, we may find, on examination, lesions of structure, or diminu- tions of size, which are accidental, the result of diseased action, and not original malconformations. The above comparison of mental deficiency with dementia shows, that they depend on two very different conditions of the brain, and consequently must display very different moral and intel- lectual manifestations ; from which we are warranted in in- ferring that in regard to their medico-legal relations, they can- not properly be placed on the same ground. 281. Dementia is distinguished from general mania, the only other affection with which it is liable to be con- founded, by characters that cannot mislead the least practised observer. The latter arises from an exaltation of vital power, from a morbid excess of activity, by which the cere- bral functions are not only changed from their healthy con- dition, but are performed with unusual force and rapidity. The maniac is irrational from an inability to discern the ordinary characters and relations of things, amid the mass of ideas that crowd upon his mind in mingled confusion ; while in dementia, the reasoning faculty is impaired by a loss of its original strength, whereby it not only mistakes the nature of things, but is unable, from want of power, to rise to the con- templation of general truths. The reasoning of the maniac does not so much fail in the force and logic of its arguments, DEMEXTIA. 293 as in the incorrectness of its assumptions ; but in dementia the attempt to reason is prevented by the paucity of ideas, and that feebleness of the perceptive powers, in consequence of which they do not faithfully represent the impressions received from without. In mania, when the memory fails, it is because new ideas have crowded into the mind, and are mingled up and confounded with the past ; in dementia the same effect is produced by an obliteration of past impressions as soon as they are made, from a want of sufficient power to retain them. In the former, the mental operations are char- acterized by hurry and confusion ; in the latter, by extreme slowness and frequent apparent suspension of the thinking process. In the former, the habits and affections undergo a great change, the conduct becoming strange and inconsistent from the beginning, and the persons and things that once pleased and interested, viewed with indifference or aversion. In the latter, the moral habits and natural feelings, so far as they are manifested at all, lose none of their ordinary charac- ter. The temper may be more irritable, but the moral disposi- tion evinces none of that perversity which characterizes mania. 282. In dementia the mind is susceptible of only feeble and transitory impressions, and manifests but little reflection even upon these. They come and go without leaving any trace of their presence behind them. The attention is inca- pable of more than a momentary effort, one idea succeeding another with but little connection or coherence. The mind has lost the power of comparison, and abstract ideas are utterly beyond its grasp. The memory is peculiarly weak, events the most recent and most nearly connected with the individual being rapidly forgotten. The language of the demented is not only incoherent, but they are much inclined to repeat insulated words and phrases without the slightest meaning. " It seems," says Esquirol, " as if they were lis- tening to imaginary tales which they repeat in obedience to an involuntary or automatic impulse excited by their old habits or fortuitous associations with actual impressions." ] 1 Maladies Mentales, ii. 220. 25* 294 MEDICAL JURISPRUDENCE OF INSANITY. The mind is often occupied by hallucinations which con- tinue a longer or shorter time, and disappear to be succeeded by others. The useful or ornamental arts which they may have practised with skill and followed with ardor, and the various other employments of life, seem to be utterly forgot- ten as if they had never been thought of. Their time is spent either in moving about with restless activity, or pass- ing days, weeks, or months, in the same spot, in utter vacuity of thought or purpose ; in pouring forth an incessant flow of words at the top of their voice, or uttering low, muttering sounds, consisting of scarcely articulate words and broken phrases ; in singing, crying, or laughing. 283. Though often irascible and self-willed, their anger is momentary, and thus they readily yield to the direction of others. The moral powers, in fact, seem to be possessed of too little energy to maintain resolution, or cherish the pas- sions. Their feebleness of purpose and passive obedience to the will of others, strikingly contrast with the pertinacity and savage fury often evinced by the maniac. . With the remem- brance of their friends and former employments, there also disappears all trace of the social and domestic affections. All interest in the concerns of others is lost ; and family, friends, and relations are viewed with the indifference of per- fect strangers, and nothing is able to awaken an emotion of pleasure or pain. 284. The derangement of the intellectual powers is sometimes indicated by remarkable changes of the counte- nance. The skin is pale, dry, and wrinkled ; the eyes sunken, dull, and moistened with tears ; the pupils dilated ; the look uncertain and wandering ; the cheeks hollow and emaciated; and the whole face destitute of expression, and indicative of decay. The organic functions suffer but little ; the appetite for food is so great that the patient seems to be constantly eating, and the quantity consumed is enormous. Affections of the nervous system, however, particularly paralysis, are not unfrequent complications of dementia. 285. The above description is applicable to dementia only when fully developed and before it has passed into the DEMENTIA. 295 state of fatuity in which it often terminates. This form of insanity appears under two different degrees of severity, which are designated as acute and chronic. The former is a sequel of temporary errors of regimen, of fevers, hemorrhages, metastases, suppression of customary evacuations, and the debilitating treatment of mania. It differs from the latter in being more rapid in its progress, and in its successive stages not being so well distinguished from one another. It is readily cured by regimen, exercise, bathing, tonics, anti- spasmodics, or simply by removing the exciting cause. It sometimes terminates in an explosion of acute mania, which then becomes critical. 286. Chronic dementia is a sequel of mania (of which it is the usual termination) when life continues long enough, of apoplexy, epilepsy, masturbation, and drunkenness ; or it may occur idiopathically, and then it usually accompanies old age. This form of the disorder, or senile dementia, is so often the subject of medico-legal inquiries, especially in con- nection with wills, that it deserves particular attention. Senile dementia, it must be recollected, is something more than that mere loss of mental power which results from the natural decay of the faculties ; it is attended with those pathological changes also which are essential to the production of insani- ty. The mind is not only feeble, but it is deranged. Were it not so, every old man would labor under a certain degree of dementia. The first symptom which indicates the ap- proach of this affection, is generally an impairment of the memory of recent occurrences. The events of early life have lost none of their distinctness, while recent impressions are feebly made, and in a short time mostly forgotten. While the visits of his friends are forgotten beyond the day or week they are made, the patient may talk of their former inter- views, and relate the most trivial details concerning them. From this weakness of memory seems to arise, oftentimes, the first appearance of mental alienation. The patient for- getting the intermediate ideas, the connection between those he does remember, and that order and filiation of them necessary to sound reasoning, are destroyed ; and hence those 296 MEDICAL JURISPRUDENCE OF INSANITY. gaps in his ideas, and those inconsistencies of conduct which convey the impression of mental derangement. Coincident with the failure of the memory, or very shortly afterwards, there is a diminution of the ordinary ability of recognizing external objects, which arises not so much from weakness of the organs of sensation, as of the organs of perception within. That is, the impressions of sound, light, touch, etc., are well enough received, but the qualities of form, size, weight, color, etc., are imperfectly discerned. Objects not very different are mistaken for one another, from an inability to perceive at the first sight the qualities that distinguish them, though the individual may recognize his mistake when it is pointed out to him. 287. Thus far there is nothing that can properly be called mental derangement ; the pathological changes in the brain have only occasioned a diminution of the natural power and activity of the mind. The first symptom indicative of derangement (and it is the next which is observed), is a degree of incoherence in the ideas, like that of dreams. It may not appear for days or weeks together, or only on certain occa- sions. The above symptoms increase in intensity more or less rapidly till complete dementia is produced, when all the moral and intellectual powers are involved in this state of decay and derangement. The memory of recent impres- sions fades away as fast as they are formed, and the past is beheld with considerable indistinctness and confusion, though events and acquaintances of early life are not yet forgotten. The patient is often at a loss to know where he is, or thinks himself at home when in another house, and wonders why he is not engaged in his usual occupations. Places, times, and circumstances are forgotten, or incorrectly remembered. His friends are not easily distinguished; morning, noon, and evening, yesterday and to-morrow are being constantly blended together ; and he will get up in the night, mistake the light of candles for that of day, and persist in calling it morning. Objects the most dissimilar are mistaken for one another, and consequently his notions are often the most grotesque and absurd. The intellect gradually becomes DEMENTIA. 297 incapable of discerning the relations of cause and effect, and of comparing ideas together ; in short, any thing like an effort of reflection is beyond its powers. The person is unable to follow the conversation, unless it be of the simplest ideas, and particularly addressed to him. 288. Although such is the ordinary course of senile dementia, it sometimes begins with a general nervous excite- ment, accompanied by an excitement of some particular function which is exerted with a new and unaccustomed energy that deceives the old man and imposes on his friends. Thus, some are irritated by the slightest circumstances, and are very active and ready to undertake any thing. Others experience venereal desires that have been long since ex- tinguished, exciting them to conduct directly contrary to their ordinary habits. Others who had previously been temperate and sober, manifest an appetite for high-seasoned dishes and intoxicating drinks. These symptoms of excitement, how- ever, are soon succeeded by those of dementia, and the transi- tion is sometimes quite sudden, especially when the patient is restrained from gratifying his unreasonable desires. 289. The same decay which the bodily powers exhibit as they proceed to their natural termination in death, is always participated by the mental ; but it sometimes happens that the latter are irretrievably affected long before the former have shown any symptoms of faltering in their course. The causes of this inversion of the natural order of decay, so far as they are external, are to be found probably in the great irregularity of exercise, both of kind and duration, to which the brain is subjected by the habits and wants of a highly civilized condition, whereby its healthy elasticity and vigor are so impaired, that it needs only the first touch of decay to lose forever the nicely adjusted balance of its faculties. The transition from the greatest mental exertion to the most tedi- ous inactivity, from the various phases of excitement to the irksome sameness of ennui, from the stimulus afforded by the performance of a thousand duties, and the glow that is constantly kindled by the hopes of the future, to the mo- notony too often occasioned by the loss of business, friends, 298 MEDICAL JURISPRUDENCE OP INSANITY. and the cares of long-accustomed pursuits, is of such fre- quent occurrence, that every thing like regular and proper exercise which is as indispensable to the health of the brain as it is to that of every other organ, is but imperfectly prac- tised by a large proportion of men. 290. In the later periods of life, and particularly if the constitution be weakened by sickness or dissipation any exertion of the mind far beyond its power to sustain, is liable to be rapidly followed by a state of dementia. The same effect is produced when after many years of unremit- ting attention to certain pursuits, the mind is suddenly de- prived of the objects on which it rested, and thrown upon itself to furnish the means of excitement in the declining years of life, when novelty presents no allurements, and the circle of earthly prospects is being constantly narrowed. Take an individual from the stir and bustle of a city resi- dence ; from the unceasing strife of competition in the pur- suit of wealth or honor ; throw down the goal on which for years his eye has rested, though ever receding from his grasp; place him in the country, at a distance from familiar faces and scenes ; and unless his mind be informed with various knowledge, or warmed by an interest in the moral concerns of his fellow men around him, it will sink into that state of inactivity so favorable for the operation of the predisposing causes of this disease. 291. It must not be supposed that old age is subject to no other kind of insanity than that of dementia, for mania, even of the severest description, is not uncommon at this period, and the importance of distinguishing between them, in a legal point of view, must be immediately obvious. Not only may the mind remain competent to the discharge of some of the civil duties of life, in mania, but there is always a prospect of its restoration to health. The charac- teristic symptoms, as well as the exciting causes that we have described above, if carefully observed, will generally prevent us from committing the serious mistake of confound- ing them together, as is too often done, with scarcely a thought o"f the impropriety of the practice. CHAPTER X. LEGAL CONSEQUENCES OF DEMENTIA. 292. IN its last stages, dementia does not differ, of course, in respect to its legal relations, from general intellectual mania. It is only while the mind is in its transition-state, if we may use the expression, passing from its sound and natural condition to the enfeeblement and total extinction of its reflective powers and the entire change may occupy months and years in its progress that its legal capacity is ever called in question. The successive steps of this disorder are so gradual and oftentimes affect the powers so unequally, that it is not strange that so much diversity of opinion should arise respecting the capacity of the mind which is the subject of it, or that groundless suspicion of improper influ- ence should be so frequently excited. It must be considered, too, as a circumstance calculated to favor this effect, that the judgment is debarred from forming an unbiased decision, by suggestions of interest or jealousy which leads it to see lapses of the mind that would otherwise have appeared to be nothing more than that natural loss of energy, suffered by the mind as it " draws near to its eternal home." Most people, too, are so little accustomed to observe and analyze the mental phenomena, and so little acquainted with the physiological laws that govern their manifestations, that cir- cumstances are often adduced as indications of unequivocal insanity, which only evince some normal peculiarities of the senile understanding. They need only to be put on the pro- per bias, to confound the natural decay of the mental facul- ties with that derangement that depends exclusively on patho- logical affections ; so strongly do they resemble each other to 300 MEDICAL JURISPRUDENCE OP INSANITY. the superficial observer. By how many would Bichat's beautiful picture of the closing scenes of old age, be mistaken to represent the defaced and shattered temple that has been prostrated by the touch of disease. " Seated near the fire and concentrated within himself, a stranger to every thing without him, he passes his days there, deprived of desire, of passion, and sensation ; speaking little, because he is deter- mined by nothing to break his silence, yet happy in feeling that he still exists, when almost every other sentiment is gone." 1 Far greater, then, must be the necessity of caution in distinguishing between such degrees of capacity as exist in the early and those of the later stages of dementia, and where, too, the causes of error are so much more numerous. The deafness that generally accompanies the early stages, disables the individual from participating in or listening to the conversation of those around him, and thus gives to his countenance an expression of dulness and stupidity that might easily mislead one not particularly acquainted with him, while in fact he needs only to be properly addressed, to display a mind that has not yet ceased to think with some degree of accuracy and vigor. The latter fact, however, will be known only to his intimate friends, while the former is conveyed to the mass of common observers who are always ready to decide upon a person's mental capacity, from an occasional glimpse of his manner, or a few remarks on the most ordinary topics. 293. A judge is seldom required to decide questions of more delicacy, questions that demand such nice and cau- tious balancing of evidence, such penetration into motives and biases, such a profound knowledge of the mental mani- festations as affected by disease, than those of mental capacity in old age, where the mind is confessedly laboring under some kind or degree of impairment. The standard by which witnesses' opinions are formed in such cases is so different, and the pertinacity with which each one clings to his own conclusions, in proportion generally to his igno- 1 Sur la Vie et le Mort, pt. 1, c. x. LEGAL CONSEQUENCES OF DEMENTIA. 301 ranee of the subject, is so strong, that nothing but a great display of the above-mentioned qualities will enable the judge to perform his duty with credit to himself, and satis- faction to others. Unless he can state the grounds of his opinions, they are no better than surmises, and "he fails of accomplishing one of the most desirable objects of the law that of establishing and confirming the popular confidence in its decisions. Difficult as this duty is, it will be very much lightened by attending to some of those points which can always be ascertained, and which have an important bearing on the question at issue. 294. Though some of the perceptive powers may pre- serve their wonted activity through the whole of the disease ; yet it is in these that the disorder is first manifested, and that long before the higher powers of the understanding have materially suffered. The memory of persons, things, and dates, and especially of recent impressions, is exceedingly treacherous, and so striking is this impairment to those unaccustomed to look beneath the surface of appearances, that when they find they are not recognized, though once well enough known ; that past events and the actors engaged in them, are either forgotten, or singularly entangled and con- fused ; and that a certain listlessness and absence of mind takes the place of former animation and attentiveness ; they summarily conclude that for all business purposes, the patient is utterly incapacitated. The impressions produced by a single short interview have no chance of being corrected by subsequent opportunities, or by more philosophical observa- tions, and the final opinion is adopted and authoritatively propounded, that the individual in question did not possess legal capacity. If he take no part in the conversation, and appear scarcely to know what is passing around him, we are not to draw unfavorable conclusions relative to his mental condition, until we ascertain, if possible, that there are no peculiar reasons why he should remain silent and alone, and that he is no longer capable of pursuing a train of thought of some length and complexity. If he have forgotten the names and circumstances of those qnce familiar, but whom 26 302 MEDICAL JURISPRUDENCE OF INSANITY. he has not been in the habit of seeing recently, it does not follow that he has also forgotten those whose relations to him have kept them within the sphere of his daily observa- tion, and made them the objects of his thoughts. An old servant or tenant whose countenance may not have been seen for weeks or months, is not to be compared in this re- spect, with the near relative who is frequently in his com- pany, and always regarded with feelings of interest and affection. However certain it may be that he has lost all sense of the ordinary proprieties of life, it needs farther evi- dence to prove that the persons and interests, which have been always nearest to his heart and connected with the great purposes of his life, have utterly faded from his mind. The evidence of those, therefore, who are qualified both by their habits of intimacy with the person whose mental capa- city is in question, and by their intelligence and education, to appreciate the changes his mind may have undergone, is far more to be relied on, than that of people of a different description, who make up their opinion hastily from a few casual and perhaps trivial circumstances. The great point to be determined is, not whether he was apt to forget the names of people in whom he felt no particular interest, nor the dates of events which concerned him little, but whether in conversation about his affairs, his friends and relatives, he evinced sufficient knowledge of both, to be able to dis- pose of the former with a sound and untrammeled judgment. It is a fact that many of those old men who appear so stupid, and who astonish the stranger by the singularities of their conduct, need only to have their attention fairly fixed on their property, their business, or their family, to understand them perfectly well, and to display their sagacity in the re- marks they make. In the case of Kindleside v. Harrison, 1 which we shall briefly notice, in illustration of these remarks, the reader may obtain a better idea than can otherwise be conveyed, of the kind of evidence generally produced in cases of senile dementia, and derive instruction and high intellec- 1 2 Phillimore's Reports, 449. LEGAL CONSEQUENCES OF DEMENTIA. 303 tual gratification from the clearness and ability with.which it is sifted and stamped with its proper value, in the judg- ment of the court, Sir John Nicholl. 295. The points contested in this case were four codi- cils to the will of an old gentleman, on the ground that at the time of making them, he was incapable, by reason of mental decay, of understanding their nature and effect. It was testified by some of the servants of his brother, who lived at a little distance from him, and by those of the lady with whom he, the deceased, resided, that during the two or three years within which the codicils were made, he fre- quently did not know people with whom he had previously been well acquainted, without being told who they were ; that he would go about the house and garden looking around, and appearing not to know what he was about. On one occasion, he not only did not recognize a certain person, but could not be made to understand who he was, and it was testified by a very different kind of witness, that the deceased asked him how old was witness's father, (though he had been dead sixteen years and had been his partner in business,) and soon after, he inquired of the witness after his health, as if he were addressing another person. Several other similar lapses of memory and various appearances of childishness in his conduct, were also revealed by the evidence, amply suf- ficient, no doubt, to induce superficial observers to believe that he was mentally incapacitated from disposing of prop- erty. It appeared, however, that he was in the habit of giv- ing, in favor of his brother's butler, drafts accurately signed and filled up ; that at Christmas time, he gave the servants Christmas boxes and the usual amount of money, and enter- ed the sums in his account book ; that he received a farmer's bills for corn and paid them with drafts on his banker which he wrote himself, going through the whole business correctly, and that he docketed the bills and receipts on the back with the name of the person to whom paid, and the amount of the bill, making corresponding entries also in his private account book ; that he signed twenty drafts, at least, one morning for payment of his brother's debts, without instruction or assist- 304 MEDICAL JURISPRUDENCE OF INSANITY. ance, subscribing his own name as executor of his brother ; that he would detect errors in the casting up of other peo- ple's accounts ; that he discharged his physician's bills cor- rectly ; and, in short, that he managed his affairs, and that prudently and correctly, to the last. It was also testified that it was his practice to read aloud to the family the psalms and lessons of the day ; that he was fond of a little fun, and played at whist remarkably well. That a person might have done all this and yet been unsound in mind, is certainly not impossible ; but it was far beyond the power of a mind so broken up by old age and the invasion of disease as to be incapable of altering testamentary dispositions previously made. This consideration, and the fact that the circum- stances of the case furnished abundant reasons for the altera- tion, induced the court to decide in favor of the capacity of the testator. 296. In this country, where such cases are decided by juries who are not responsible for their decisions, we some- times meet with extraordinary verdicts. The case of Dennet and wife v. Dow, Executor, recently decided in Maine, after a protracted litigation, is calculated to excite serious reflec- tions in the minds of all who are accustomed to regard the testamentary act as too sacred to be disturbed by any other than the clearest evidence of incompetency. It appears that Stephen Neal, who died in December, 1836, aged seventy- four years, left a will, dated 29th of October, 1835, in which his nephew John Neal, was made residuary legatee to nearly the whole of his property. From the decree of the probate judge approving this will, an appeal was entered by the nat- ural heirs, (the daughter of the testator and her husband) and tried before the supreme court in November, 1838 ; and again, in consequence of a successful application for a new trial, in December, 1840, the verdict being, in each trial, against the will, on the ground of insanity. Before noticing the evi- dence relative to his mental condition, it will be better to mention some acts in which the testator was a party con- cerned. April 15th, 1834, he was placed under guardianship, as being non compos, but the application which was made by LEGAL CONSEQUENCES OF DEMENTIA. 305 some prominent members of the Society of Friends, to which he also belonged, was accompanied by a written request from him that the measure might be taken, and no inquiry was made into his mental condition. The guardian having taken him home to his own house, and observed him closely for several months, came to the conclusion that he was not unsound, and on his setting forth the facts, the letters of guardianship were revoked, September, 1834. In November, 1834, he conveyed to the appellants divers stocks and por- tions of real estate, amounting to about one half of his whole property. In December, 1834, he made a will which was found after his death uncancelled, in which he constituted the Society of Friends in Portland residuary legatee of nearly all his remaining property. In July, 1835, the Friends, by their committee, applied to have him placed under guardianship on the ground of his being non compos mentis. This application having been dismissed in October, 1835, it was immediately renewed, and again dismissed December 2d, 1835. On the 29th of October, 1835, he made the will in dispute, agreeing essentially with the other just mentioned, excepting the clause respecting the residuary legatee, in which John Neal is substituted for the Society of Friends. In February, 1836, his last illness commenced ; he was placed under guardianship upon application of the Friends, 25th of April, 1836, and died in December of the same year. 297. As the evidence touching the mental condition of the testator, was unusually multifarious, rambling, and inap- propriate, we must confine ourselves to those facts which have any real connection with this point. 1 In favor of his mental capacity, it was testified by the person who drew up 1 For these I am indebted to the notes of the Courts (Mr. Justice Shep- ley on the first trial, and Chief Justice Weston, on the last,) which were politely submitted to my inspection by those gentlemen. As the evidence at the two trials was essentially the same, except that some additional facts came out at the last, J have made no distinction between it, only using those notes in which it is most fully reported. As the verdicts were alike, there seems to be no impropriety in this course. I have given every fact which had any bearing on the state of the testator's mind. 26* 306 MEDICAL JURISPRUDENCE OF INSANITY. the will, that he did it from a draft originally in testator's hand- writing ; that they had considerable conversation about the items ; and that he had no doubt of his entire competency. One of the subscribing witnesses, who was also a neighbor and in the habit of doing business with him, had no doubt of his competency. While under the first guardianship and during the year 1835, he made bargains and contracts of various kinds, such as for sale of land, for board, for rent with his tenants, for services, etc., all of which appeared to be shrewd and, well-considered. The woman with whom he boarded a few weeks, immediately after the first guardian- ship was discharged, testified that he used to purchase for the table, he keeping an account and she also ; and that when they settled, she found him exact to a cent, and very close. The accounts with his tenants were entered in a little memorandum -book, addition and subtraction made, credits given, etc. After making a contract for board in November, 1834, by which he was to provide the fuel, he struck out the word firewood, and inserted " coal, to be delivered at the wharf," in order to save the charge of truckage. In July, 1835, when land speculations were rife, he refused an offer of two thousand six hundred dollars, and half profits, for a lot of land, preferring two thousand eight hundred dollars, part in cash, and the balance secured by mortgage. It appears, too, that the purchaser, having soon after sold the land for five thousand dollars, induced the testator to change the papers, and receive from the last purchaser notes amounting to three thousand five hundred dollars, secured by a mortgage on the land. He showed uncommon watchfulness about security, insisting upon the purchaser's wife signing a relinquishment of dower in the mortgage, until satisfied by legal inquiry that it was not necessary. He insisted, too, upon having the deed carried down at night and recorded, lest possibly an attachment might be slipped in, as he had known such a case. On being assured of the purchaser's solvency, he gave up the point, and waited until the next morning. Hiring a man to dig his potatoes by the bushel in October, 1834, and finding that he made more than day's wages, he insisted on LEGAL CONSEQUENCES OP DEMENTIA. 307 changing the bargain and paying him by the day. Another witness who had known him for fifty years, met him one day while under the first guardianship, and the testator began to converse about the value of stocks and the comparative value of bank and insurance stocks, observing that he owned both, and thought the former safer, though the latter might be more profitable. Neither then nor afterwards, for he was in the habit of meeting testator frequently at his son's house, did he observe any thing in him to lead him to suspect that the testator was unsounS or incompetent. One of his nieces often saw him during the summers of 1833, '34, and '35. At one time he fenced their land-lots which were contiguous ; bought boards, used her old posts to save expense, and kept the accounts. He also bought trees, gave her some, and directed her how to plant them. An architect conversed with him several times about some houses he was building for his nephew in 1835, and showed him plans with which he was pleased, though he criticised them, and suggested some sen- sible alterations in the manner of laying the stone. In the autumn of 1834, he bargained with a witness for some stones to be used in making a cellar drain ; and conversed very sensibly on the different kinds and qualities of stone and the manner of splitting them. About this time he con- versed with considerable acuteness respecting a young child's memory. The child knew its aunt, he said, not because he remembered her countenance, but because she resembled his mother ; and when it was objected that the resemblance was not very strong, he replied that the child might perceive it though an adult might not, and that probably the resem- blance was in the sound of their voices, rather than their features. This child died in September, 1835, and for some time afterwards, he frequently spoke of it, and with feelings of affection. It appears that until his last sickness, he always immediately recognized his friends and acquaint- ances, and manifested an interest in their welfare. 298. To show that the will was a rational act, as well as rationally done, a memorandum book was produced, con- taining, in the handwriting of the first guardian, a schedule 308 MEDICAL JURISPRUDENCE OP INSANITY. of the property he had .conveyed to his children, and beneath it, in his own hand, and subscribed with his name, he ex- pressed the design not to give them any thing more, saying, " he had amply provided them with the means of a comfort- able subsistence, provided that they exercise proper industry and economy ; and without these all my property could not suffice them, which, therefore, I have thought proper to dis- pose of in another manner." He expressed the same views in conversation with different witnesses. It also appeared that he was not on good terms with his children, from whom he had received, or at least thought he had received, much unkind treatment. As reasons for altering his testamentary dispositions, we have the two attempts of the Friends to place him under guardianship, which, of course, were as little calculated to secure his regard for them, as the treat- ment of his children was to increase his affection for them. It also appeared in evidence that the Society had " dealt with his wife," and turned her out of meeting, on the representa- tions of his own daughter. 299. On the other hand, in proof of his incompetency, it was testified by one of the subscribing witnesses, that he " did not think him of sound mind," though he could give no other reason for his opinion than " the appearance of the man." He could state no facts nor conversation evincing unsoundness of mind, though before and after the execution of the will, the testator was in the habit of buying groceries at his shop. He also admitted that the testator "always appeared to know what he was about." The remaining sub- scribing witness " did not consider him so sound as it was desirable he should be in such an important transaction," though he admitted that " he was pretty close in making a bargain, and_was a saving, prudent man in his calculations." He told stories and conversed correctly on old affairs, but on recent transactions, was not so connected. This witness also mentioned some other facts indicative, in his opinion, of mental unsoundness, which will be presently noticed. In July, 1835, he offered to the city treasurer, in payment of his taxes, a scrap of paper, apparently a bill of purchases, LEGAL CONSEQUENCES OF DEMENTIA. 309 and insisted that it was as good as money, and would be taken at the bank. But it appeared that he had received a check upon a bank, but his sight being poor, and his specta- cles missing, he had mistaken for it something of no import- ance. One evening he entered a house next his own and sat down, but he discovered the mistake himself the moment he heard a strange voice. Once when the meeting for worship was over, and the business meeting had begun, he asked, in a loud whisper, an old friend of his who dealt in wool, what he gave for wool then. On being answered that he should wait till after meeting before talking on such subjects, he nodded assent and was silent. Several times he went out of his house without his hat, and in one or two instances, he inquired the way to a house or street with which he had been previously well acquainted, and then started off in an opposite direction. Some of the entries in the memorandum- book were repeated, but they were all correct to a cent. Once, in 1833, after paying the balance of an account, he entirely forgot it in fifteen or twenty minutes, and when reminded of it, said, I am forgetful ; and in 1835, he would ask the same question several times in succession, without being aware that it had been asked and answered. Once he undertook to write a deed (a business he was accustomed to,) boggled over, and finally gave it up. Then he took another blank, got confused, and the witness had to write it himself. In 1834, when the witness carried to him money to pay a note, he had forgotten the note entirely, was unable to find it, and requested the witness to write a receipt for him to sign. The money he undertook to count, but merely tum- bled it over, and laid it down, when the witness counted it over to him, bill by bill. On purchasing things at the shops, he would take his change without counting it. It was testi- fied that when at table he required his food to be cut up for him ; that he would attempt to spread cheese on his bread, mistaking it for butter ; would pour his tea into a cup-plate instead of a saucer ; and put his sugar into the plate. A stray cow coming into the yard, he said it was one he had lately bought. Asked a witness if his mother's shed was 310 MEDICAL JURISPRUDENCE OF INSANITY. much injured in the storm, alluding to his aunt's shed, which had been blown down. He spoke of having some chairs and tables in a town at some distance, and wanted the wit- ness to ask the stage-driver to bring them down, as he might, a part at a time. One witness testified that in the autumn of 1835, after the execution of the will, he rode out with him at a little distance from town ; that he seemed lost did not know where he was, even when he got to his son's tanyard ; that he would rave about his children and their ill-treatment of him, and then go to see them and be cheerful with them, make no complaints, and come away happy. He admitted, however, that they drove around by an unusual road, and that on returning, while yet at a little distance from town, testator asked where they were, when he replied, pointing over the bridge to Dennet's tanyard, " Don't thee know that place ? That is Oliver's tanyard." He spoke of certain property as his, after he had sold it. A female witness, who lived in the same house with him in the autumn of 1835, said that he could not dress himself unassisted ; that she had seen him try to put on his wife's stays ; that he used to bring bits of paper and ask her to sew them together, calling it dividing his property ; that he talked of being buried at the head of his bed ; that he called patching windows, tailor- ing ; and that he made up a fire on the floor and filled the room with smoke. It appeared, however, that being large, clumsy, and wearing a loose wrapper, he was sometimes embarrassed in putting on his pantaloons ; that his wife's stays were in fact a flannel waist much resembling the flan- nel waistcoat he always wore ; that the bits of paper he had sewed together were, on one occasion at least, vouchers of his guardian's accounts, which he had stitched through and through, in order to preserve them ; that he had strips of paper sewed together and used for a measure ; that the hearth was very large, and one leg of one andiron stood off the hearth on the floor. There was evidence of a want of cleanliness, and neglect of the decencies of life, indicative of mental unsoundness. He was seen in the street with the flap of his pantaloons wholly or partly down, and he some- LEGAL CONSEQUENCES OF DEMENTIA. 311 times disregarded the calls of nature, "or attended to them in improper places. It was testified, however, in explanation of these facts, that his hands being swollen and clumsy, and the button-holes of his pantaloons much worn, he had some difficulty in buttoning and in keeping them buttoned ; that the uncleanliness was not habitual, but limited to occasions when he was suffering from diarrho3a, and that other instances of impropriety, which had been alleged, occurred during his last illness, when his mental unsoundness was admitted by the other party. It also appeared that he was somewhat in- temperate in the use of spirituous liquors. 300. No one, at all acquainted with the habits of old age and with the effect of senile dementia on the mind, can entertain a doubt of the testator's competency to make his will. True, he was more forgetful of the present than of the past ; he frequently forgot what he had just before said or done ; and he sometimes disregarded the common observances of life. All this, however, may be said of multitudes of old men whose competency for any business is never questioned by those who know them best. However weak may have been fhe mind of this old man, he still was acquainted with the value of property, especially of his own ; he recognized his relatives and friends ; was always aware of the exact nature of their relations towards him, and of their respective claims on his bounty ; he still was capable of feeling the sting of filial ingratitude, and of being actuated by motives of ordinary prudence and discretion. If his mind were not sufficiently vigorous to engage in contracts and speculations of large magnitude, it was none the less able to bequeath his property, the kind and amount of which he perfectly under- stood, to relatives and friends whom he still recognized and loved. The will was a rational act, rationally done, and there was not a tittle of evidence to show that the testator was under improper influences. 301. The court, at each trial, refrained from any com- ments on the evidence relating to the testator's mental con- dition, and the jury were left to their own unenlightened and unassisted deliberations. There were peculiar reasons, per- 312 MEDICAL JURISPRUDENCE OF INSANITY. haps, for taking this course, in the present case, but we may be allowed to question its propriety as a general rule of prac- tice. In cases like these, which are characterized by the abundance and discrepancy of the evidence, it needs a cool, tenacious, and intelligent mind to recapitulate this evidence ; to sift, to analyze, weigh, and finally stamp it with its proper value. The jury,* it is true, are sole judges of the facts, and if the question here were, whether certain facts offered in evidence were true or false, not a remark might be required of the court. But since they have to do with a very different question, that is, whether these facts warrant certain infer- ences relative to mental capacity, they are unable to answer it correctly, we apprehend, without the light that is derived from superior penetration and attainments. The knowledge necessary for this purpose is of a technical kind, which a jury cannot be expected to possess, and the very abundance of the evidence is calculated to fill their minds with uncertainty and confusion. If they can hear the opinions of experts of persons who have given especial attention to this branch of knowledge respecting the precise value of all these facts considered in relation to the point they are designed to establish, then indeed they would be in a condition to form conclusions of their own. But since this is not always practicable, 1 are they to be left to float about on a sea of conjecture, without star or compass to guide their course ? Must a jury, not one of whom, perhaps, ever observed a case of insanity, or even studied the operations of the sane mind, take upon themselves to say that certain facts do, or do not 1 Nothing can more strongly illustrate the necessity of some such measure as we have suggested, ( 44) than a fact that occurred in this case. The ap- pellees were desirous that the evidence relating to the testator's mental con- dition, should be heard by some one particularly acquainted with the subject of insanity, who might testify, on the strength of such knowledge, whether the evidence showed him to have been incapable of making a valid will. The attendance of such a witness could not be obtained, for one of the gentlemen applied to and they were the nearest resided at a distance of 120, and > another of 250 miles. Had it been otherwise, we might not have seen the most sacred of legal acts annulled on the most trivial grounds. LEGAL CONSEQUENCES OF DEMENTIA. 313 prove the presence of testamentary capacity ; in other words, to decide upon professional questions of acknowledged diffi- culty ? The really intelligent and conscientious juror, dis- tracted by an appalling mass of evidence, much of which is irrelevant and contradictory, which he may try in vain to unravel and arrange, and puzzled by questions he never con- sidered before, will and ought to look to the court for assist- ance. 302. The principle laid down by the court, at the first trial, that a disposing mind means " so much mind and mem- ory as would enable him to transact common business with that intelligence which belongs to the weakest class of sound minds," may be theoretically correct, but it seems to be of too abstract a nature to be practically applied by jurors. To compare one mind with another of different calibre, is a task for which they are altogether unfitted by their previous tastes, habits, and studies. Justice merely requires that the strength of the mind should be equal to the purpose to which it is applied. If this simple principle be distinctly presented to the minds of the jury, there are few so dull as to be unable to give it a practical application. It is not only reasonable, but it has the merit of having been repeatedly recognized in courts of law, until it has now obtained all the force of estab- lished authority. " He may not have sufficient strength of memory and vigor of intellect, to make and to digest all the parts of a contract, and yet be competent to direct the distri- bution of his property by will." 1 "A man may be capable of making a will, and yet incapable of making a contract, or to manage his estate." 2 303. We are to bear in mind, however, that testamen- tary dispositions generally imply an exercise of memory. 1 Stevens and wife v. Vancleve, 4 Wash. C. C. R. 262. 2 Harrison v. Rowan, 3 Wash. C. C. R. 580. Nowhere has the subject of testamentary capacity been treated with so much good sense and regard to scientific truth, as in the charges of the court from which the above quotations are made. With the progress of sound views on this subject, the correctness of the principles there laid down will only be the more firmly established. 27 314 MEDICAL JURISPRUDENCE OF INSANITY. The mind must be able to bring up before it scenes and per- sons connected with the past as well as the present, for with- out such ability, persons may be overlooked who would other- wise have held a prominent place in the act, and transactions forgotten which might naturally be supposed to have an effect upon its dispositions. A will which makes no men- tion of relatives who had a natural claim on the bounty of the testator, and in regard to whom, he apparently enter- tained only the kindest feelings, creates a suspicion that his memory was at fault, and unless the fact is satisfactorily explained, a strong presumption is raised against the validity of the will. Many old men who have begun to lose their faculties, have a passion for making wills, and so far as the form is concerned, they are able to do it correctly, but they are often governed by the whim of the moment rather than any definite views of the claims which others may have upon them, and not having them brought to their notice by any one else, they are liable to overlook them unintentionally. CHAPTER XI. FEBRILE DELIRIUM. 304. CEREBRAL affection, of some kind or other, we have considered as essential to the existence of insanity as constituting in fact the whole disease ; but there is another form of mental derangement of very common occurrence, in which the cerebral affection is only an accidental symp- tom of severe disease in the brain or some other organ. The functions of the brain are disturbed in each, but they differ so widely in their causes, progress, and termination, that the propriety of distinguishing them from each other for medico-legal, as well as therapeutical purposes, is uni- versally recognized. Few diseases terminate in death with- out presenting at some period or other of their progress, but more particularly towards their close, more or less disturb- ance of the mental faculties ; organic diseases of the brain, especially acute inflammation of its membranes and its periphery, are generally accompanied with delirium ; and it is sometimes a symptom of acute disease in other organs, in consequence of the cerebral irritation which they sympa- thetically produce. It is seldom entirely absent in fevers of any severity, and is readily determined by inflammations of the mucous and serous membranes, particularly of the ali- mentary canal. In inflammation of the lungs, liver, spleen, and kidneys, it appears only towards the last period of the disease when it is approaching a fatal termination. Surgical operations, too, that prove fatal, are ordinarily attended at last with delirium. In chronic diseases, such as cancer, dropsy, consumption, the mind is seldom impaired, except that occasionally, during the final struggle, it wanders over 316 MEDICAL JURISPRUDENCE OF INSANITY. the mingled and broken images of the past. Delirium is also produced by intoxicating agents, when it simulates mania more perfectly than when it arises from other causes; but this form of the affection will be discussed in a different place. 305. Delirium sometimes occurs suddenly, but gene- rally comes on gradually, and is preceded by premonitory symptoms, such as pain or throbbing in the head, heat of the scalp, and flushing of the cheeks. Its first appearance is manifested by a propensity of the patient to talk during sleep, and a momentary forgetfulness of his situation and of things about him, on waking from it. After being fully aroused, however, and his senses collected, the mind is com- paratively clear and tranquil, till the next slumber, when the same scene is repeated. Gradually, the mental disorder becomes more intense, and the intervals between its returns of shorter duration, until they are scarcely, or not at all perceptible. The patient lies on his back, his eyes, if open, presenting a dull and listless look, and is almost constantly talking to himself in a low, muttering tone. Regardless of persons or things around him, and scarcely capable of recog- nizing them when aroused by his attendants, his mind retires within itself to dwell upon the scenes and events of the past, which glide before it in wild and disorderly array, while the tongue feebly records the varying impressions, in the form of disjointed, incoherent discourse, or of senseless rhapsody. In the delirium which occurs towards the end of chronic diseases, the discourse is often more coherent and continuous, though the mind is no less absorbed in its own reveries. As the dis- order advances, the voice becomes more indistinct, the fingers are constantly picking at the bed-clothes, the evacuations are passed insensibly, and the patient is incapable of being aroused to any farther effort of attention. In some cases, delirium is attended with a greater degree of nervous and vascular excitement which more or less modifies the above- mentioned symptoms. The eyes are open, dry, and blood- shot, intently gazing into vacancy, as if fixed on some object which is really present to the mind of the patient; the skin is hotter and drier; and he is more restless and intractable. FEBRILE DELIRIUM. 317 He talks more loudly, occasionally breaking out into cries and vociferations, and tosses about in bed, frequently en- deavoring to get up, though without any particular object in view. 306. While delirium thus shuts out all ideas and images connected with the present, it sometimes revives the impres- sions of the past, which had seemed long before to have been consigned to utter oblivion, in a manner unknown in a state of health. A case once occurred in St. Thomas's hos- pital, of a patient who, when he began to rally, after a con- siderable injury of the head, spoke a language that nobody could understand, but which was, at last, ascertained to be Welsh. It appeared that he was a Welshman, and had been from his native country about thirty years, during which period he had entirely forgotten his native tongue, and acquired the English language. But when he recovered from the accident, he had forgotten the language he had been so long and recently in the habit of speaking, and acquired that which he had originally learned and lost. 1 Dr. Rush mentions, among many other similar instances, that the old Swedes of Philadelphia, when on their death-beds, would always pray in their native tongue, though they had not spoken it for fifty or sixty years, and had probably for- gotten it before they were sick. 2 307. When delirium, or more properly speaking the disease on which it depends, proves fatal, it usually passes into coma. Occasionally, however, it disappears some days or hours before death, and leaves the mind in possession of its natural soundness. Though enfeebled by disease, and therefore incapable of much exertion of his faculties, the patient is rational and intelligent, recognizes perfectly well his relations to others, and on familiar subjects, can arrange his ideas without dictation or guidance. 308. So closely does delirium resemble mania to the casual observer, and so important is it that they should be 1 Tupper's Inquiry into Gall's System, 35. 2 On Diseases of the Mind, 282. 27* 318 MEDICAL JURISPRUDENCE OF INSANITY. distinguished from each other, that it may be well to indicate some of the most common and prominent features of each. In mania, the patient recognizes persons and things, and is perfectly conscious of and remembers what is passing around him. In delirium, he can seldom distinguish one person or thing from another, and, as if fully occupied with the images that crowd upon his memory, gives no attention to those that are presented from without. In delirium, there is an entire abolition of the reasoning power ; there is no attempt at reasoning at all ; the ideas are all and equally insane ; no single train of thought escapes the morbid influence, nor does a single operation of the mind reveal a glimpse of its natural vigor and acuteness. In mania, however false and absurd the ideas may be, we are never at a loss to discover patches of coherence, and some semblance of logical se- quence in the discourse. The patient still reasons, though he reasons incorrectly. In mania, the muscular power is not perceptibly diminished, and the individual moves about with his ordinary ability. Delirium is invariably attended with great muscular debility ; the patient is confined to his bed, and is capable of only a momentary effort of exertion. In mania, sensation is not necessarily impaired, and in most instances, the maniac sees, hears, and feels with all his natural acuteness. In delirium, sensation is greatly im- paired, and this avenue to the understanding seems to be entirely closed. In mania, many of the bodily functions are undisturbed, and the appearance of the patient might not, at first sight, convey the impression of disease. In delirium, every function suffers, and the whole aspect of the patient is indicative of disease. Mania exists alone and independent of any other disorder, while delirium is only an unessential symptom of some other disease. Being a symptom only, the latter maintains certain relations with the disease on which it depends ; it is relieved when that is relieved, and is aggravated when that increases in severity. Mania, though it undoubtedly tends to shorten life, is not immediately dan- gerous, whereas the disease on which delirium depends, speedily terminates in death, or restoration to health. Mania FEBRILE DELIRIUM. 319 seldom occurs till after the age of puberty ; delirium attacks all periods alike, from early childhood to extreme old age. It must be borne in mind, however, that the above distinctive features are not always present. A form of mania is oc- casionally seen, in which the mental aberrations and some of the physical symptoms are remarkably like those of delirium. CHAPTER XII. LEGAL CONSEQUENCES OF DELIRIUM. 309. TESTAMENTARY dispositions made during the inter- vals of febrile delirium, are often contested on the ground of incapacity, especially where there is any suspicion, real or pretended, of improper influence on the testator's mind. These cases are sometimes very embarrassing, and it is im- possible to come to a conclusion upon the direct evidence respecting the state of mind ; nothing more can be attained than an approximation to correctness, by a careful investiga- tion of the attending circumstances. When the delirium accompanies only the daily exacerbations of the fever, and disappears with them, there can be no doubt of the mind's being in a suitable condition, during the intervals, for devis- ing property, but not for transacting other business of im- portance. The existence of delirium at any period of a disease will be sufficient to throw suspicion on any contracts entered into during such disease ; and unless it can be shown that the delirium was but an occasional symptom and of short duration when it occurred, and that the mind of the patient at other times was perfectly calm and rational, their validity is liable to be destroyed. When these two conditions are reversed, that of delirium being the habitual, and the lucid intervals the occasional state, the mind may have sufficient capacity to make a will ; but, certainly, no other civil act which it might perform ought to be held valid, for the same reason that the acts of imbeciles are avoided. Georget, however, does not hesitate to express his belief, that under these circumstances, the reason is not so restored that the patient can be declared capable even of making a will, and we readily admit that it is often questionable whether the LEGAL CONSEQUENCES OF DELIRIUM. 321 mind is sufficiently steady and collected to comprehend the relations of property, or appreciate the claims of kindred and friends. A case related by Dr. Woodward, the superin- tendent of the Massachusetts Lunatic Ayslum, while giving his evidence in court on one occasion, strongly confirms the correctness of Georget's views. A legal gentleman, in the course of an acute pneumonic affection, began to have slight delirium on waking in the morning, but it was observed at no other time. About this time he remarked to his physicians that if they considered him in danger, he wished to know it, as he was desirous of altering his will, which he had previ- ously made. Though not considering him to be in much danger, they approved of the plan, and the alteration was made. A few months after his recovery, he accidentally met with the will among his papers, but had no recollection of having made it, and was v much surprised and dissatisfied with its dispositions, for they did great injustice to two of his sons. Still we would not make the disqualification univer- sal, for cases not unfrequently happen in which, after days of constant delirium, reason for a while resumes her dominion and the patient converses with his accustomed fluency and wisdom, describing his feelings, giving directions to his family, and alluding to the past with a clearness and accuracy that leaves no doubt on the minds of those around him, of his perfect sanity. A safer practice probably would be, to be governed in our decision of this point by the circumstances that attend the making of the will, the previous intentions of the testator, and the nature of his disease. 1 310. The law requires that in this affection, as in mania, the occurrence of lucid intervals should be proved beyond a reasonable doubt, but as delirium is merely an adventitious symptom, and not, like mania, the habitual state of the patient, it will be satisfied with much less proof in the for- 1 It must be recollected that the question is, not whether the mind pos- sesses its ordinary soundness and vigor, for we know it is always enfeebled, but whether it retains what may be called a testamentary capacity. See ante 105, 294. 322 MEDICAL JURISPRUDENCE OP INSANITY. mer than in the latter affection. Sir John Nicholl has very justly observed, that " in cases of permanent, proper insanity, the proof of a lucid interval is a matter of extreme difficulty, and for this among other reasons, namely ; that the patient so affected is not unfrequently rational to all outward .appear- ance, without any real abatement of his malady ; so that in truth and substance, he is just as insane in his apparently rational, as he is in his visible raving fits. But the apparently rational intervals of persons merely delirious, for the most part, are really such. Delirium is a fluctuating state of mind, created by temporary excitement; in the absence of which, to be ascertained by the appearance of the patient, the patient is, most commonly, really sane. Hence, as also indeed, from their greater presumed frequency in most in- stances in cases of delirium, the probabilities, a priori, in favor of a lucid interval, are infinitely stronger in a case of delirium, than in one of permanent proper insanity ; and the difficulty of proving a lucid interval is less, in the same exact proporti9n, in the former, than it is in the latter case, and has always been so held by this court." 1 311. ,In the case from which the above passage is taken, the testatrix, a widow lady, died of some acute dis- ease after an illness of about ten days, during the two or three last of which she was more or less delirious. Her will was made on the evening of the day preceding her death, and its validity was opposed on the ground that she did not possess a testamentary capacity at the time of its execution. The evidence of the two consulting physicians who visited her about four o'clock, which was but a few hours prior to the execution of the will, was decidedly unfavorable to her testamentary capacity. One considered it " doubtful whether she was capable of making a will or not ; his opinion rather 1 Judgment in Brogden v. Brown, 2 Addams's Rep. 441. If the reader is desirous of extending his knowledge of this subject, he will be well rewarded for a careful perusal of this and the following cases, in which the luminous expositions of Sir John Nicholl cannot fail to please and convince : Evans v. Knight, 1 Addams, 229 ; Lemann v. Bonsall, ibid. 383. LEGAL CONSEQUENCES OF DELIRIUM. 323 was that she was not." He saw her once or twice after- wards, when she was " quite delirious and clearly incapable." The other physicians who saw her- at four o'clock, conceived her " quite incapable of any complicated act; undoubtedly of any thing that required fixed attention, or any exercise of mental faculty." The attending physician, however, attribu- ted the delirium to the paroxysms of severe pain suffered by the deceased, it being scarcely perceptible when these were absent, and believed that in the intervals she had perfect capacity. It appeared, too, that the will, which had been prepared from instructions just before received from her, was read over to the deceased, placed before her while she was sitting up in bed, and subscribed by her in the usual form with a dash below. The validity of the will was established. 312. In another case, the testator who died on Friday, the 24th of April, of an attack of pneumonia, during the latter stages of which he had considerable delirium, made his testamentary dispositions on the 21st. One of the physicians deposed that when he saw the deceased on the 21st, " he was not in a state of sound mind, memory, and understanding, or capable of doing any act requiring the exercise of thought, judgment, and reflection." Another, who saw him for the first and only time on the 23d, thought it was extremely " improbable that the deceased should have been free from wandering and mental affection, on a day so shortly before he saw him, as the 21st." It appeared, on the other hand, that he gave instructions for a will without any suggestions whatever from the solicitor who reduced them to writing, and that after they were read to him, he approved and sub- scribed them. It was also deposed by other witnesses, that when the solicitor came, and while giving him instructions, he appeared rational and conducted with propriety. The court pronounced in favor of the deceased's testamentary capacity. 1 313. In cases where the validity of testamentary dis- positions is impugned on the ground of mental incapacity 1 Evans v. Knight and Moore, 1 Addams, 229. 324 MEDICAL JURISPRUDENCE OF INSANITY. produced by delirium, or indeed by any other disorder, it is the practice of the English ecclesiastical courts, not to con- fine their attention exclusively to the evidence directly relat- ing to the mental condition of the testator, but to consider all the circumstances connected with the testamentary act ; for the object is not so much to settle the question of sound- ness and unsoundness in general, as it is in reference to that particular act. The principle is and it is one that is well- grounded in the common experience of men that a person may be capable of testamentary acts, while technically and really unsound, and incapable of doing other acts requiring much reflection and deliberation. This principle is particu- larly applicable in cases of delirium where the transitions from a state of senseless raving to that in which the mind is calm, perfectly rational, and conscious of its condition, are very rapid, and where in the lucid interval, the mind, though weak, is clear and unclouded by any of those peculiar views or notions which often characterize the lucid intervals in mania. Accordingly, the testamentary capacity is to be de- termined, in a great measure, by the nature of the act itself. If it be agreeable to instructions or declarations previously expressed, when unquestionably sound in mind ; if it be con- sonant to the general tenor of his affections ; if it be consist- ent and coherent, one part with another ; and if it have been obtained by the exercise of no improper influence ; it will be established, even though the medical evidence may throw strong doubts on the capacity of the testator. On the con- trary, when these conditions are absent, or are replaced by others of an opposite description, it will as generally be an- nulled, however plain and positive may be the evidence in favor of his capacity. 1 1 In illustration of these remarks the reader is referred to Cook v. Goude and Bennet, 1 Haggard, 577; King and Thwaits v. Farley, ibid. 502; Waters v. Hewlett, 3 Haggard, 790 ; Bird v. Bird, 2 Haggard, 142; Martin v. Wotton, 1 Lee's Eccl. Rep. 130; Bittleston by her guardian v. Clark, 2 Lee, 229 ; Marsh v. Tyrrel, 2 Haggard's Eccl. Rep. 84 ; Hoby v. Hoby 1 Haggard, 146. LEGAL CONSEQUENCES OF DELIRIUM. 325 314. In some affections of the head, and they may be primary or sympathetic, the patient lies in a comatose state from which he may be aroused, when he will recognize per- sons and answer questions correctly respecting his feelings, but drop asleep again as soon as they cease to excite him. That the mind is much embarrassed certainly cannot be doubted, and it is well known that when the patient recovers, he has, ordinarily, very little idea of what passed at those times ; indeed, he is generally unconscious of every thing he either said or did. It would be a bold assertion to say that the mind, under these circumstances, is legally capable of making testamentary dispositions, and they ought, therefore, to receive no favor from courts. In cases of injury to the head, it is not uncommon for the patient (after rallying from its immediate effects) to answer questions rationally, to appear collected and intelligent, in short to have fully recovered his senses, though he may subsequently declare/ that he is utterly unconscious of what were his acts, thought, or feelings at that time. Few, even among medical men, who observe a person under such circumstances, would have any hesitation in expressing their belief in his testamentary capacity, though the event would show that they had labored under a serious error. 28 CHAPTER XIII. DURATION AND CURABILITY OF MADNESS. 315. WITH the exception of that kind of dementia that occurs at other periods of life than that of old age, mania is the only form of insanity that admits of a cure ; and though its duration is various, the probability of this event is almost entirely destroyed within a comparatively short space of time. This is abundantly evident from the statistics of mad- ness that have been published from time to time by the heads of various lunatic establishments. Esquirol concludes, on data furnished by the returns of the principal French and English hospitals, that the absolute number of recoveries from madness is about one in three ; and also that the num- ber of recoveries varies in different establishments, from one in four, to one in two or two and a half of the whole number of persons affected. Prichard regards this computation of recoveries as much below what really takes place under favorable circumstances, and the reports of American hospi- tals confirm the correctness of his opinion. Such, however, is the imperfection of statistics on this subject, that we can speak with but little confidence respecting the proportion of recoveries. We only know that in cases subjected to judicious treatment soon after the attack, recovery takes place in the proportion of six or eight to ten ; while in those which have continued a couple of years, there is little pros- pect of recovery. Pinel, in a memoir presented to the Insti- tute in 1800, was led to conclude from a selection of cases expressly chosen for this purpose, that a greater number of recoveries takes place in the first month than in any succeed- ing one, and that the mean time of the duration of the dis- DURATION AND CURABILITY OF MADNESS. 327 ease when cured, is between five and six months. Esquirol, however, gives a table of recoveries at the Salpetriere during ten years, which shows a little longer term to insanity. Out of two thousand and five patients, twelve hundred and twenty-three were cured, viz., six hundred and four during the first year ; four hundred and ninety-seven in the second ; eighty-six in the third ; and forty-one in the seven succeeding years; from which it appears that eleven twelfths of the number of cures is obtained within the first two years ; that the mean duration of cases cured is a little short of one year ; and that after the third year, the probability of a cure is scarcely more than one in thirty. M. Desportes states, from observations made at the Bicetre and Salpetriere, that of the whole number of recoveries in 1822, 1823, and 1824, seven hundred and forty-six took place in the first year, and one hun- dred and eighteen only from the second to the seventh year. 1 316. Recovery from insanity generally takes place gradually, though occasionally the disease may suddenly disappear on the occurrence of certain moral or physical impressions. Pinel relates the case of a literary gentleman who, in a paroxysm of suicidal mania resolved to go and jump into the river. On arriving at the bridge, he was at- tacked by robbers, against whom he defended himself vigor- ously, beat them off, forgot the purpose of his excursion, and returned home cured. Dr. Rush relates that one of his patients, for whom he had recommended gentle exercise on horseback, was suddenly cured in consequence of the fright experienced from her horse running away in one of her excur- sions. He was stopped by a gate, and when her attendants came up they found her entirely restored to reason. Several other cases of recovery are related, produced by a similar cause. Esquirol speaks of having cured a girl at once, by the terror she experienced at the sight of the actual cautery which he was about to apply. He also mentions the case of a girl who, after being insane ten years, suddenly ran to her mother's bed, exclaiming, as she embraced her, " Mother, 1 Esquirol, Des nial. ment. i. 94. 328 MEDICAL JURISPRUDENCE OF INSANITY. mother, I am well." She had become insane in consequence of a suppression of the menses which at last made their ap- pearance on the evening preceding her cure. Prichard states that several instances of sudden cure from the same cause, have occurred in some of the English hospitals. Insanity has been sometimes cured by an attack of fever. A number of maniacs were once cured, in the Pennsylvania hospital, by a malignant fever which appeared in that establishment. Direct appeals to the reasoning power have sometimes been followed by immediate recovery. Pinel relates the case of a watchmaker who became deranged, and believed that he had been guillotined, and that in consequence of the mixing of the heads of other victims, his own had been replaced by another. When the miracle of St. Denis was mentioned, who carried his head under his arm and kissed it as he went, he contended for the possibility of the fact, by appealing to his own case, when one of his companions burst into a loud laugh, saying, " What a fool you are ; how could St. Denis kiss his own head ? was it with his heel ? " The absurdity of the idea struck his mind, and he never after spoke of the misplacement. Dr. Cox speaks of a patient who believed that he was the Holy Ghost. Another asked him, " Are there two Holy Ghosts ? how can you be the Holy Ghost and I be so too ? " He appeared surprised, and after pausing awhile said, " But are you the Holy Ghost ? " and when the other replied, " Did you not know that I was ? " he answered, " I did not know it before ; then I cannot be the Holy Ghost." 1 It is probable that in nearly if not quite all these cases of sud- den recovery by means of mental impressions, the disease was declining, and that its termination was hastened only by these impressions. 317. Partial intellectual mania is said to be cured with much more difficulty than general mania, and the latter is more easily cured when the sequel of some violent cause, than when it has come on gradually from some steadily con- tinued influence. Among the circumstances favorable to 1 Spurzheim on Insanity, 294. DURATION AND CURABILITY OF MADNESS. 329 recovery may be mentioned a constitution not greatly de- bilitated by excesses of any kind, good moral and intellectual education, the absence of hereditary predisposition, and an early medical treatment 318. The above facts and considerations will furnish the data, on which the physician is to form an opinion relative to the duration and curability of any given case of insanity. While in very many cases incurability is almost certain, and there can be no hesitation in certifying the same, there are none in regard to which we can predict a certain re- covery. The utmost we can say in the most favorable cases is, that the patient will probably recover, and the physician cannot be too cautious how he commits his own reputation and the interests and happiness of others by the expression of hasty and positive opinions. 1 Idiocy, imbecility, and senile dementia admit neither of cure nor amelioration, and when mania is of more than two years' standing, and especially if other circumstances are not favorable, it may be safely said there is but little hope of cure, but never that the case is beyond all hope. It should be borne in mind that persons, after years of insanity, have sometimes recovered their reason shortly before death. 319. An important feature of insanity in a medico- legal point of view, is its tendency to relapse during con- valescence, and to recurrence after being perfectly cured. The general rule is, that a brain which has once been the seat of the maniacal action is far more liable to its recur- rence, than one which has not. Many recover the full strength and activity of their mental faculties, but the ma- jority, Prichard thinks, are curable only to a certain extent. " They remain," says Esquirol, " in such a state of suscep- tibility that the slightest causes give rise to relapses, and they only preserve their sanity by continuing to live in a house 1 If proof be required of the propriety of this warning, the reader will find a memorable one, in TVraxaU's (Posthumous Memoirs) lively description of the contradictory statements and dogmatic assertions into which the medical attendants of George HI. were betrayed by party zeal, and which resulted in the confusion and disgrace of some respectable physicians. 28* 330 MEDICAL JURISPRUDENCE OF INSANITY. where no mental agitation or inquietude, no unfortunate con- tingency is likely to fall to their lot, and throw them back to their former state. There are other individuals whose facul- ties have sustained such a shock, that they are never capable of returning to the sphere which they had held in society. They are perfectly rational, but have not sufficient mental capacity to become again military officers, to conduct com- mercial affairs, or to fulfil the duties belonging to their appointments." * The proportion of cases in which insanity is recurrent, is estimated by writers at from one tenth to one sixth ; Esquirol estimates it at one twentieth. In those cases where the mind 'on recovery regains its usual capability, this disposition to recurrence is by no means so strong, as when it is left in a weak and irritable state, and it diminishes with the length of the interval after the recovery. This feature of insanity should ever be borne in mind by the physician, when required to give his opinion on the propriety of removing the interdiction of an insane person, who is apparently restored to health. He should seriously consider the risk that he runs, by entering again on the busy scenes of life, and endur- ing the anxiety and excitement attendant 011 the manage- ment of his affairs, of renewing that cerebral irritation which the quiet and repose of seclusion have temporarily subdued. In criminal cases, also, it should lead to a thorough and candid investigation of the plea of insanity urged in defence of those who have previously suffered from it, and it should be satisfactorily settled whether or not the circumstances attending the criminal act were likely to reproduce that pathological condition on which insanity depends. If it should prove that they were of that nature, and that the individual had but recently recovered from an attack of insanity, then it would indicate a confidence that springs from some other source than a just appreciation of the phenomenon of insanity under consideration, to presume, nevertheless, the continuance of mental soundness and, consequently, of moral responsibility. 1 Des maladies mentales, i. 96. DURATION AND CURABILITY OF MADNESS. 331 320. We are also to bear in mind, that a considerable number recover only to a certain point. They recover so far as to be free from all delusions, to maintain unremitting self- control, and transact their customary business correctly and shrewdly, but never regain confidence in those who favored their confinement or restraint, though their part in it was prompted by kindness and managed discreetly and consider- ately. This state of feeling varies from tacit distrust and aversion, to a deep malignity that leads to violence and litigation. Having regained all their natural shrewdness, they have no difficulty in enlisting the sympathies of those and they constitute the greater part of mankind who are ever ready to yield their faith to any statement that is uttered with a certain plausibility of manner. Whether actuated by a kind of pride that refuses to acknowledge that they have been the subjects of so humbling an infirmity as insanity, or an obscurity in their recollections of the past, that leads them to mingle the real and imaginary, and confound the scenes with the cause of their suffering, they persist in referring the mental tortures they endured, to the measures that were meant for their mitigation, and attributing their various discomforts to the cruelty or neglect of others, rather than to the disordered condition of their own minds. Even when they fail to convince the world that they were never insane, for of this fact there may have been too many witnesses, they often leave the impression that they have been unjustly, if not cruelly dealt with. 1 321. It has been already remarked that in most in- 1 A memorable case of this description memorable for the success which followed the representations of the patient, and the utter groundlessness of the charges which he brought occurred but two or three years ago, in Philadelphia. A man named Hinchman who was placed in the Friends' Asylum for the insane in Frankford, because, as the evidence showed beyond a doubt, he was violently and dangerously insane, brought an action of con- spiracy against every individual the least concerned in the measure, his mother, sister, cousins, the sheriff', a passing traveller, the physicians of the Asylum and the physician who signed the certificate, and others, and he succeeded in obtaining heavy damages. 332 MEDICAL JURISPRUDENCE OF INSANITY. stances, recovery takes place gradually, and is completed only after a period, more or less long, of convalescence. Nothing, therefore, can be more chimerical than the idea of fixing on any precise moment when all disease has departed and perfect health is established ; and yet this is what we are called upon to do when required to determine, as we some- times are in criminal cases, at what time the accused began to be responsible. To contend that a convalescent maniac may be irresponsible one day and responsible the next, would be no less absurd than to say to one recovering from inflammation of the lungs, that, as he valued his life, he must not leave his room to-day, though to-morrow he might safely expose him- self to the severest inclemency of the weather ; and to believe that the former is perfectly sound, because laboring under no hallucination and attacked by no fits of fury, would be as erroneous, as to consider the respiratory functions of the latter sound and vigorous, because we hear no cough and see no difficulty of breathing. The time that has elapsed since the unequivocal insanity of the accused, is therefore an im- portant element in the determination of his mental sound- ness. Just as exposure to bad weather, a week after an attack of inflammation of lungs had begun to subside, would be more likely to reproduce the disease, than it would a month afterwards ; so the longer the time since an attack of insanity has been apparently cured, the less likely is the cere- bral irritation to be renewed by sudden provocations or other causes that tend to produce it. Ample time must be allowed to cover the period of convalescence, and if it be difficult to fix upon the exact duration of this state, so much greater the necessity of caution in determining the responsibility of the accused. Here it is often a merit to doubt, and justice requires that the accused should have the benefit of our doubts. CHAPTER XIV. LUCID INTERVALS. 322. IT is well known that many diseases especially of the class called nervous observe a law of periodicity which is not uncommon in the actions of the animal econo- my. One effect of this curious law consists in an intermis- sion of the outward manifestations of the disease, so com- plete as to bear the appearance of a perfect cure, and this, in the present state of our knowledge, is all that we can, with certainty, say of it. As to the change that takes place in the organic condition of the part affected, during the inter- mission, we can at best hazard nothing more than a rude conjecture. We have no warrant for believing that the pathological affection itself entirely disappears with the symptoms that arise from it, and perhaps never shall have, until we are able to explain why, after such disappearance, the tendency of the disease to return at certain intervals should still remain; or, in other words, wherein the final, perfect cure differs from the temporary intermission. But in view of the established fact that organic disease often exists without producing its ordinary symptoms, or revealing itself by any appreciable signs, it seems the more probable suppo- sition, that the pathological condition of the affected organs does not disappear entirely during the intermission, but continues with perhaps a modified intensity. 323. The slightest examination will convince us, that in the most complete intermission of any disease that affects the whole system to some extent, the patient is far from enjoying sound health, or free from every indication of morbid action. A greater contrast in the matter of health, can scarcely be presented in the same individual, than 334 MEDICAL JURISPRUDENCE OF INSANITY. that between the paroxysm and the intermission of a quotidian fever; yet none will say, after the former has passed off, and the patient is no longer shaking with cold nor parched with he5,t, but is able to arise and give some attention to his duties, that he is entirely well. Better, no doubt, he is ; but his mind is weak, his stomach declines its once favorite food, a little exertion overcomes him, a cer- tain malaise not easily described, pervades his whole system, and which, though not excessively painful, is something very different from the buoyant sensation of health. We are therefore bound to believe, that the disease still exists, though its external aspect has changed. And here it may be as well to remark, that we must riot be led by an abuse of language to attribute that to the disease to the pathologi- cal condition which belongs only to one of its symptoms. When the epileptic, a few days after one of his frightful con- vulsions, appears to have regained his customary health, no intelligent physician imagines that the proximate cause of this disturbance has vanished with the fit, leaving the organ it affected as sound as ever. The fit itself which is a mere symptom, is indeed of periodical occurrence, but the patho- logical condition on which it depends, continues, slowly and surely though imperceptibly, to undermine the powers of the constitution. The general expression of all our knowledge on the subject of the intermission of diseases is, then, that certain pathological conditions give rise, among other phe- nomena, to some that disappear for a time, only to recur after an interval of more or less duration. 324. That insanity, or rather mania, is one of the dis- eases that are subject to this law of periodicity, in some respects, is universally admitted ; but to what extent the law operates, is a point on which there is much diversity of opinion. There are few cases in which we may not observe various periods in their course, when the severity of the symptoms is greatly alleviated; when calmness takes the place of fury, and a quiet and sober demeanor succeeds to noisy and restless agitation ; when reason, driven from her throne, seems to be retracing her steps and struggling for her DURATION AND CURABILITY OF MADNESS. 335 lost dominion. In all this, however, there is nothing differ- ent from what occurs in many, if not the greater proportion of chronic diseases. In mania, but in no other form of in- sanity, this abatement of the severity of the symptoms may amount to a complete intermission, when the patient is con- scious of his true condition, converses rationally, and admits his having been insane. But that the intermissions of mania are ever so complete, that the mind is restored to its original integrity, would seem scarcely probable, from the fact, that the very seat of the pathological changes is the material organ on which the manifestations of the mental phenomena depend. For if the mind be rendered as sound as before the attack, it necessarily follows that the brain is equally restored, since in point of health they stand to each other in the rela- tion of cause and effect. But as there is no proof that such is the case, and as the supposition is not supported by what we do know of pathological actions, we have no right, at present, to conclude that the physical condition on which mania depends is entirely removed during the intermission. We are thus led to scrutinize a little more closely these peri- odical restorations of the insane mind, or lucid intervals, as they are called, in order to ascertain if possible, what is the actual state of the mind at these times. But before doing this, it will be proper to show what is understood in law by lucid intervals, as explained by eminent legal authorities. 325. D'Aguesseau, in his pleading in the case of the Abb d' Orleans, says, " It must not be a superficial tran- quillity, a shadow of repose, but on the contrary a profound tranquillity, a real repose ; it must be, not a mere ray of reason, which only makes its absence more apparent when it is gone. not a flash of lightning, which pierces through the darkness only to render it more gloomy and dismal, not a glimmering, which joins the night to the day ; but a per- fect light, a lively and continued lustre, a full and entire day interposed between the two separate nights, of the fury which precedes and follows it ; and, to use another image, it is not a deceitful and faithless stillness which follows or 336 MEDICAL JURISPRUDENCE OF INSANITY. forebodes a storm, but a sure and steadfast tranquillity for a time, a real calm, a perfect serenity ; in fine, without look- ing for so many metaphors to represent our idea, it must be not a mere diminution, a remission of the complaint, but a kind of temporary cure, an intermission so clearly marked, as in every respect to resemble the restoration of health." l 326. Many years after, Lord Thurlow, in the court of chancery, thus stated his views of the condition of mind necessary to constitute a lucid interval. " By a perfect in- terval, I do not mean a cooler moment, an abatement of pain or violence, or of a higher state of torture, a mind relieved from excessive pressure ; but an interval in which the mind, having thrown off the disease, had recovered its general habit." 2 327. Here, then, is the lucid interval as clearly and mi- nutely described, as a profusion of words and metaphors could do it, and as such it was believed by these authorities, no doubt, to have a real existence. In the early periods of the English law, the doctrine of lucid intervals was univer- sally admitted, and they seem to have been considered not a rare, but a very common phenomenon of mental derange- ment. Indeed, judging from the frequent mention made of them in all discussions on the subject, and from the fact that idiocy and lunacy which latter was considered, as its name would lead us to suspect, to be of an intermittent na- ture constituted, for a long time, the only division of mental diseases, it will not perhaps be too strong an expres- sion to say, that they were viewed as an essential feature of mania. This, however, was in the infancy of medical science, before the phenomena of mania which, until re- cently, has always been less understood than other diseases were thoroughly and accurately observed, and the men whose ideas we have just quoted had no practical acquaint- ance with the disorder whose phases they so vividly de- 1 Pothier on Obligations, by Evans, Appendix, 579. 2 Attorney-General v. Parnther, 3 Brown's Ch. Cases, 234. LUCID INTERVALS. 337 scribed. Before adopting their views, then, it will be pro- per to inquire how far they are supported by the investiga- tions of modern medical science. 328. While the doctrine of lucid intervals, as ex- plained by the language above quoted, is upheld by scarcely a single eminent name in the medical profession, we find that their existence is either denied altogether, or they are regarded as being only a remission, instead of an intermis- sion of the disease ; an abatement of the severity of the symptoms, not a temporary cure. Mr. Haslam who is no mean authority on any question connected with insanity, emphatically declares, that, " as a constant observer of this disease for more than twenty-five years, I cannot affirm that the lunatics, with whom I have had daily intercourse, have manifested alternations of insanity and reason. They may at intervals become more tranquil, and less disposed to obtrude their distempered fancies into notice. For a time their minds may be less active, and the succession of their thoughts consequently more deliberate ; they may endeavor to effect some desirable purpose, and artfully conceal their real opinions, but they have not abandoned, nor renounced their distempered notions. It is as unnecessary to repeat that a few coherent sentences do not constitute the sanity of the intellect ; as that the sounding of one or two notes of a keyed instrument could ascertain it to be in tune." 1 329. Strong as this testimony is, and true, no doubt, as the result of an individual's experience, it cannot be denied that others, whose opportunities have not been less than Mr. Haslam's, have distinctly recognized the existence of inter- vals, when the patient not only becomes more tranquil and reserved, but is conscious of having been mad, and perceives the folly of the delusions that have engrossed his thoughts. But so far are they from attributing to the mind, during their occurrence, that degree of soundness which is contended for in the passages above quoted, that they have taken great care to inculcate a very different doctrine. " The mania," says 1 Medical Jurisprudence, as it relates to Insanity, 224. 29 338 MEDICAL JURISPRUDENCE OF INSANITY. Foderd, " which is accompanied by fury, is very often periodi- cal ; that is, as if granting an occasional truce to the patient, it appears only at certain epochs, between which he enjoys all his reason, and seems to conduct and judge in all respects like other men, if we except in regard to certain ideas the thought of which may at any time occasion a fresh par- oxysm." 1 330. Georget, while he speaks of lucid intervals " as returns to reason," is careful to add, that, " in this state, patients frequently experience some degree of malaise, of some disturbance of their ideas, and weakness of mind, which prevents them from fixing their attention, for any length of time, on a particular subject; from engaging in reading, writing, or attending to their affairs." 2 331. " There are few cases of mania or melancholy," says Dr. Reid, " where the light of reason does not now and then shine out between the clouds. In fevers of the mind as well as those of the body, there occur frequent intermis- sions. But the mere interruption of a disorder is not to be mistaken for its cure, or its ultimate conclusion. Little stress ought to be laid upon those occasional and uncertain disentanglements of intellect, in which the patient is for a time only, extricated from the labyrinth of his morbid hallu- cinations. Madmen may show, at starts, more sense than ordinary men." f 332. Dr. Combe, in one of the most philosophical treatises on Insanity, which the present century has pro- duced, expresses similar views in the most explicit and forcible language. " But however calm and rational the patient may appear to be, during the lucid intervals, as they are called, and while enjoying the quietude of domestic society, or the limited range of a well regulated asylum, it must never be supposed, that he is in as perfect possession of his senses, as if he had never been ill. In ordinary cir- 1 De Mddecine Le"gale, i. 205, 140. 2 Des Maladies Mentales, 46. 8 Essays on Hypochondriacal and other Nervous affections: 21st Essay. LUCID INTERVALS. 339 cumstances and under ordinary excitement, his perceptions may be accurate, and his judgment perfectly sound ; but a degree of irritability of brain remains behind, which renders him unable to withstand any unusual emotion, any sudden provocation, or any unexpected and pressing emergency. Were not this the case, it is manifest that he would not be more liable to a fresh paroxysm, than if he had never been attacked. And the opposite is notoriously the fact; for relapses are always to be dreaded, not only after a lucid interval, but even after perfect recovery. And it is but just as well as proper to keep this in mind, as it has too often happened, that the lunatic has been visited with the heaviest responsibility, for acts committed during such an interval, which, previous to the first attack of the disease, he would have shrunk from with horror." l 333. With the views of these distinguished observers before us, what are we to think of the doctrine, that in the lucid intervals the mind is restored to its natural strength and soundness ; that it is capable of as great intellectual exertions, and of holding as tight a rein over the passions ; that it is as able to resist foreign influence and to act on its own determinations, with its ordinary prudence and forecast ; that " having thrown off the disease, it has recovered its gene- ral habit," or that it has undergone a "temporary cure?" Sounder patho.logy was never written, than is contained in the extract from Dr. Combe, and no physician, who has been much conversant with the insane, will be disposed to ques- tion its correctness. Foder goes a step farther and hazards a theory which is plausible, at least, to explain the pathologi- cal causes that produce this alternation of paroxysms and lucid intervals. The former state, he considers, is attended by an excessive plethora of the blood-vessels of the brain, and the latter by a relaxed, atonic condition of these vessels, which is an effect of their previous forcible distension. In this condition they are liable to be suddenly engorged by exciting causes, such as intemperance in eating or drinking, 1 Observations on Mental Derangement, 241. 340 MEDICAL JURISPRUDENCE OF INSANITY. anger, violent exercise, insolation, etc. ; or in consequence of a certain predisposition of constitution. 1 Indeed, it is well known, that the return of the paroxysms is often retarded by regulated diet, bleeding, quiet, seclusion, kind treatment, and the absence of the above-named stimuli. It is thus shown, conclusively, that in every lucid interval, there remains some unsoundness of the material organ of the mind, which may be designated generally as a morbid irritability, which, on the application of the slightest exciting cause, may produce an outbreak of mania in all its original severity. 334. The principle of law, which holds the civil re- sponsibilities of the insane to be unimpaired during the lucid interval, we are willing to admit, is generally correct. It should be the duty of courts, however, to view their acts done at such times with the most watchful jealousy, because their minds, though left free from all delusion, are neverthe- less weak and irritable, and they may be easily induced by the arts of unprincipled men, to enter into transactions, the folly of which would have been obvious enough to them before they began to be insane. Although inclined to be- lieve that the restoration of the mind during the lucid inter- val is far from being so perfect, as it is represented by the legal authorities above quoted, yet we do not hesitate to say, that the proof of its occurrence should be as strong, as they require it. D'Aguesseau, in continuation of the remarks above quoted, declares, that, " as it is impossible to judge in a moment of the quality of an interval, it is requisite that there should be a sufficient length of time for giving a perfect assur- ance of the temporary reestablishment of reason, which it is not possible to define in general, and which depends upon the different kinds of fury, but it is certain there must be a time and a considerable time." Lord Thurlow, also, on the same occasion which elicited his views of the nature of the lucid interval, says, that "the evidence in support of the allegation of a lucid interval, after derangement at any period has been established, should be as strong and demonstrative 1 De Medicine Legale, i. 208, 140. LUCID INTERVALS. 341 of such fact, as where the object of the proof is to establish derangement. 1 The evidence in such a case, applying to stated intervals, ought to go to the state and habit of ^he person, and not to the accidental interview of an individual, or to the degree of self-possession in any particular act." It may be well to inquire how far these views are sustained by- subsequent decisions. 335. In law and equity courts there seems to have been little disposition, in civil cases, to question their cor- rectness. 2 In the ecclesiastical courts, however, there has 1 It appears from a note in 1 Beck's Med. Juris. 586, that Lord Eldon dis- sented from this proposition, and thus stated his objections to it to Lord Thur- low himself. " I have seen you exercising the duties of lord chancellor with ample sufficiency of mind and understanding, and with the greatest ability. Now if Providence should afflict you with a fever, which should have the effect of taking away that sanity of mind for a considerable time, (for it does not signify whether it is the disease insanity, or a fever that makes you in- sane,) would any one say, that it required such very strong evidence to show that your mind was restored to the power of performing such an act as making a will, an act, to the performance of which a person of ordinary intelligence is competent ? " We are not informed how this objection struck Lord Thur- low, but we trust that no reader of the present work will be at a loss to per- ceive its weakness for a moment. It does signify every thing, whether it is the disease insanity or a fever that makes one insane, for the delirium of fever is but a casual symptom of that disease, and, together with the pathological con- dition that gave rise to it, is presumed to disappear with the main disorder on which it depends. This is the ordinary course of nature. On the contrary, mental alienation is the essential, the pathognomic, and, oftentimes, the only clearly discernible symptom of mania, and its disappearance furnishes the only intimation perhaps that we have of the cure of this disease. Thus our means of deciding this point being so small, we are necessarily led to require stronger evidence of their certainty, than of the restoration of the mind in fever, because the latter is confirmed by a multitude of symptoms. Recovery from an attack of fever is a phenomenon, that any one can see, but not such is recovery from an attack of mania ; because, though the insane delusions or conduct by which it was manifested may disappear, it remains to be deter- mined in every case, whether they are not purposely concealed from observa- tion, or proper opportunity has been offered to the patient to bring them forward. Just as the existence of mania requires stronger proof than that of the delirium of fever, so does recover)' from the former require stronger proof than recovery from the latter. 8 See Hdl v. Warren, 9 Vesey ; exparte Holyland, 11 Vesey. 29* 342 MEDICAL JURISPKUDENCE OP INSANITY. occurred some discrepancy of opinion, both as to the exact nature of the lucid interval, and the kind of proof required to establish its existence. In a commendable respect for the sacred character 'of testamentary acts, they have assumed considerable latitude, and, no doubt, very properly, in their construction of lucid intervals ; but occasionally they have gone farther than even the truths of pathology will warrant. 336. In Cartwright v. Cartwright, 1 the deceased, a sin- gle woman, made her will on the 14th of August, 1775, which will was contested on the ground of the insanity of the testator. " It was proved in general," says the court, " that her habit and condition of body, and her manner, for several months before the date of the will, was that of a person afflicted with many of the worst symptoms of that dreadful disease, and continued so certainly after making the will." It appears from the evidence, that for some time previous to the date of the will, she was very importunate for the use of pen, ink, and paper, which, however, were withheld from her by the direction of her physician, Dr. Battie, who was eminent for his knowledge and treatment of mental disorders. Her importunity continuing, he at length consented, in order to quiet and pacify her, that she might have them, observing that it did not signify what she might write, as she was not fit to make a proper use of pen, ink, and paper. These being carried to her, her hands, which had been constantly tied, were loosed, and she sat down to a bureau to write. Her attendants, who were watching her outside the door, saw her write on several pieces of paper in succession, which she tore up and threw into the grate, walk- ing up and down the room in a wild and ferocious manner, and muttering to herself. After one or two hours spent in this manner, she finally succeeded in writing a will that suited her, though it occupied but a few lines. Such are the facts that have any bearing on the point at issue. It was decided by the court, Sir William Wynne, that she had a lucid interval while making the will, the validity of which 1 1 Phillimore's Reports, 90. LUCID INTERVALS. 343 was consequently established. The grounds of this decision were, that the will made a natural and consistent distribu- tion of her property, and, in short, that it was " a rational act rationally done ; " hence it was to be inferred, that her mind was visited by a lucid interval, at the moment of making it. For, says the court, " I think the strongest and best proof, that can arise as to a lucid interval, is that which arises from the act itself; that I look upon as the thing to be first ex- amined, and if it can be proved and established, that it is a rational act rationally done, the whole case is proved." It seems to have occurred to the court, that some catenation must be made out between such an act and a lucid interval ; and it being in evidence, that, at times, she would converse rationally, we have the following deductions therefrom. " If she could converse rationally, that is a lucid interval; and that she did so and had lucid intervals, I think is completely established." The fact is, that the court, throughout its whole judgment, confounded testamentary capacity with a lucid interval, without once seeming to be aware that though the will might be a rational act, and, therefore, perhaps valid, it by no means followed, that a lucid interval had taken place. What it considered as such here scarcely amounted to the kind of remission described by Mr. Haslam .( 328,) for not a single fact appears in the evidence, from which we can infer any alteration whatever in the state of her disease. True, the court thought that her reason had returned, be- cause, though released from the confinement of a strait- waistcoat, and trusted with a candle, she did no mischief and did not abuse her liberty ; but such things would have little weight with medical men, especially at the present day. Nothing indeed can be more chimerical, because so utterly contradicted by all that we know of insanity, than this idea of a lucid interval of a few minutes' duration suddenly inter- posed amid years of mania, and as suddenly disappearing. 1 1 Its consequences seem to render it as pernicious as it is absurd. In the trial of Hadfield for shooting at the king, Lord Kenyon, after admitting that he was insane both before and after the act, and that it was improbable he had recovered his senses in the interim, declared, that " were they to run 344 MEDICAL JURISPRUDENCE OF INSANITY. The point particularly insisted upon by the judge is, that she would sometimes converse rationally, as indeed most insane people do. " If," he says, " she had particular subjects or topics in her mind, and at such times would converse ra- tionally upon them, and when those topics were out of her mind would fly into outrages of frenzy and extravagance, does that all show that at the former time she was deprived of rational capacity?" He does not seem to be aware, that madmen are every day doing rational acts, and that it would not be surprising if wills should sometimes be found among the number. 1 337. We have no fault to find with the principle of law which makes these wills valid, but we would have the ground on which such validity is established, distinctly understood to be the character of the act, not the condition of the tes- tator's mind ; and if, in the above case, the court had been contented with proving the will to be a rational act, and thence inferring testamentary capacity, there would have been nothing to complain of. It is important that on sub- jects like medical jurisprudence, language should be used with strict adherence to its original and proper signification ; and therefore when a lucid interval is defined by competent authority to be a " temporary cure " of the disease, a re- covery of the mind's general habit, the occurrence of which must be proved by the " state and habit," of th,e person, observed during a sufficient length of time, we have to com- plain, that the term is applied by others to a mere remission in the violence of the symptoms, which lasts but a few min- utes, and is proved by a single coherent act. 338. The construction here put upon the lucid interval, not only conflicts with the opinions of the eminent authori- ties we have quoted, but has not been countenanced by sub- sequent decisions even in the ecclesiastical courts. In a into nicety, proof might be demanded of his insanity, at the precise moment when the act was committed ! " as if such proof were not utterly beyond the reach of human means. 1 It will be observed that the views of the court in this case, are fully in accordance with the law as laid down by Swinburne. See 12. LUCID INTERVALS. 345 recent case, where the testamentary acts of an insane per- son were propounded by the executors who endeavored to prove the occurrence of a lucid interval at the time of their execution, the court, Sir John Nicholl, decided that the proof was not sufficient, though it was unquestionably stronger than in the case of Cartwright v. Cartwright. The surgeon of the testator who saw him once within the period a little more than ten months that included the two wills in question, and commenced a frequent at- tendance on him between two and three months afterwards, deposed, that on none of these occasions did he exhibit any symptoms of insanity, but " conducted himself, and talked and discoursed in a rational manner, and was in the full possession of his mental faculties." The solicitor who took the instructions for the last will, considered him of sound mind, and deposed that neither of the witnesses treated him as a person of deranged intellect or of unsound mind. In the testamentary dispositions themselves, there was nothing to negative the idea of the most perfect sound- ness of mind. In view of the fact, however, that the testa- tor was so deranged that he was attended by a keeper from a lunatic asylum, till within a few months of the date of the first will, and frequently manifested absurd delusions during the period including both wills, the above proof was not con- sidered as sufficient for the purpose, reasoning upon the general principles of insanity. " It is clear," said the court, " that persons essentially insane may be calm, may do acts, hold conversations, and even pass in general society as per- fectly sane. It often requires close examination by persons skilled in the disorder, to discover and ascertain whether or not the mental derangement is removed, and the mind again become perfectly sound. When there is calmness, when there is rationality on ordinary subjects, those who see the party usually conclude that his recovery is perfect Where there is not actual recovery, and a return to the management of himself and his concerns by the unfortunate individual, the proof of a lucid interval is extremely diffi- 346 MEDICAL JURISPRUDENCE OP INSANITY. cult." l Whatever confidence the civil law may repose in the evidence furnished by the character of the testamentary act touching the mental condition of the testator, it is distinctly enough inculcated in the above quotations, that such evi- dence is not necessarily to prevail over that which is drawn from his daily walk and conversation. When, however, sanity is confessedly doubtful merely, then " the agent is to be inferred rational, from the character broadly taken of his act." 1 339. It has been admitted, that, with certain reserva- tions, the civil responsibilities of the insane are unimpaired during the lucid interval, because the mind is sufficiently restored to enable the individual to act with tolerable discre- tion in his civil relations. In respect to crime, however, the matter is altogether different, for reasons that will not be without their force, we trust, to those who have attentively considered the proceeding remarks. These reasons are, that the crimes which are alleged to have been committed in a lucid interval, are generally the result of the momentary excitement produced by sudden provocations; that these provocations put an end to the temporary cure, by immedi- ately reproducing that pathological condition of the brain called irritation, and that this irritation is the essential cause of mental derangement which absolves- from all the legal consequences of crime. The conclusion is, therefore, that we ought never perhaps to convict for a crime committed dur- ing the lucid interval, because there is every probability, that the individual was under the influence of that cerebral irrita- tion which makes a man insane. The difference between a person in the lucid interval and one who has never been insane, on which we particularly insist, is, that while in the 1 Groom and Thomas v. Thomas and Thomas, 2 Ilagg. Eccl. Hep. 433 : In White v. Driver, 1 Phillimore, 84, however, a lucid interval was held to be established, on much less proof than was offered in the above case, though far more certainly than was admitted in Cartwright v. Cartwright. 1 Scruby and Finch v. Fordham, 1 Addams, Ecc. 11. 74. LUCID INTERVALS. 347 latter provocations stimulate the passion to the highest degree of which they are capable in a state of health, though still more or less under his control, they produce in the former a pathological change which deprives him of every thing like moral liberty. It is scarcely necessary to do more than barely state these views, since their correctness seems to have been universally recognized in practice, not a single case hav- ing occurred, so far as can be ascertained, where a person has been convicted of crime committed during a lucid interval. Burdened as the criminal law is with false princi- ples on the subject of insanity, the time has gone by when juries will return a verdict of guilty against one who is admitted to have been insane, within a short period of time before the criminal act with which he is charged. 1 340. We shall be careful not to confound the period intervening between the perfect cure of one attack of insanity and the occurrence of another attack, with a lucid interval. The renewal of the disease does not prove that it never has been cured, for in this respect, insanity follows the same pathological laws, as gout, rheumatism, colic, or any other disease. True, persons who have experienced repeated attacks of insanity, generally labor under a certain irritability of the nervous system, which should lead us to be cautious in form- ing opinions relative to their moral liberty under particular circumstances. Whether the absence of the disease arise 1 We have been so long accustomed to the severity that characterizes the spirit of the English criminal law, that we look with no little jealousy on any attempt to circumscribe the range of its operation. In Germany, however, where no such influence is felt, more humane and scientific views on the subject of responsibility during the lucid interval have found distinguished supporters. " The state of the mind during the lucid interval is such," says Dr. Friedreich, " that a circumstance which would have passed unnoticed at any other time, here excites the individual to violent, illegal acts." " Who can positively decide whether the criminal act really happened during a lucid interval, or was the result of a paroxysm prematurely provoked by some internal or external cause of excitement, (for during the lucid interval, the susceptibility to excitement is greatly increased,) and which paroxysm might not have occurred at all without such provocation." Ueber Zurechnung im lucido intervallo, Neues Archiv des Criminalrechts, xiv. 268. 348 MEDICAL JURISPRUDENCE OF INSANITY. from a lucid interval, or a complete cure, the occurrence of certain exciting causes equally exposes the patient to a renewed attack of the disease in all its original severity. Whenever, therefore, the criminal acts of one subject to repeated attacks of insanity, are called in question, and it appears that the accused was under the influence of violent or harassing moral emotions, such as anger,- grief, or sense of responsibility ; or of certain physiological conditions, such as menstruation, lactation, or the repulsion of other diseases ; or exposed to the noxious influence of certain physical agents, such as insolation, deprivation of sleep, or blows on the head, we are justified in considering him as not having been morally free at the time when the act was committed. If, on the other hand, there appear to have been no causes of this kind in operation,, and the usual signs of insanity were not present, and especially if the act obviously serves some interest of the accused, we can hardly avoid the conclusion, that he is responsible for his criminal acts. CHAPTER XV. SIMULATED INSANITY. 341. THE supposed insurmountable difficulty of dis- tinguishing between feigned and real insanity has conduced, probably more than all other causes together, to bind the legal profession to the most rigid construction and applica- tion of the common law relative to this disease, and is always put forward in objection to the more humane doctrines that have been inculcated in the present work. That some diffi- culty has been experienced, and given rise to much per- plexity and mistake, cannot be denied; but it is to be considered, whether it has not arisen, less from the obscurity of the subject, than from the imperfect means that have been generally applied to its elucidation. The opinions of phy- sicians, which are ordinarily taken in doubtful cases, have been received with a deference that was warranted more by general professional reputation, than by superior knowledge of this particular disease. The treatment of insanity is now so much confined to the heads of extensive establishments in which its subjects are congregated, that opportunities for studying it are comparatively limited in ordinary practice, so that a physician may be justly celebrated in the knowledge and treatment of other diseases, and at the same time be poorly qualified to decide upon questions relative to insanity, especially when every effort is made to perplex and mys- tify -his mind. This truth cannot be disguised, and though physicians are frequently unwilling to believe it, and are dis- posed to act on the popular notion that all medical subjects are equally familiar to them, this is no reason why courts and juries should ever forget it. Nothing, indeed, requires a 30 350 MEDICAL JURISPRUDENCE OP INSANITY. severer exercise of a physician's knowledge and tact, than a case of simulated insanity ; but the same might be said with quite as much truth, of other diseases that men have been led to feign, but which, nevertheless, are every day investi- gated and understood. 342. The workings of an insane mind such as attract the popular notice are apparently so confused and dis- cordant, so wild and unnatural, as to have given rise to the notion as prevalent as it is unfounded, that insanity may be easily imitated. The method that is in madness, the con- stant and consistent reference to the predominant idea, which the practised observer detects amid the greatest irregularity of conduct and language, is one of those essential features in certain forms of the disease, which is generally overlooked, or at least very unsuccessfully imitated. Those who have been longest acquainted with the manners of the insane, and whose practical acquaintance with the disease furnishes the most satisfactory guaranty of the correctness of their opinions, assure us that insanity is not easily feigned, and consequently that no attempt at imposition can long escape the efforts of one properly qualified to expose it. Georget does not believe, "that a person who has not made the insane a subject of study, can simulate madness so as to deceive a physician well acquainted with the disease." x Mr. Haslam declares, that, " to sustain the character of a parox- ysm of active insanity, would require a continuity of exertion beyond the power of a sane person." 2 Dr. Conolly affirms, " that he can hardly imagine a case which would be proof against an efficient system of observation." 8 Another writer, while admitting that attempts to deceive are some- times successful, on account of the imperfect knowledge of the operations of the mind in health and disease possessed by medical men in general, observes, however, that when we consider the " very peculiar complex phenomena which 1 Des Maladies Mentales, 60. 2 Medical Jurisprudence as it relates to Insanity, 322. 8 Inquiry concerning the indications of Insanity, 467. SIMULATED INSANITY. 351 characterize true madness, and reflect on the general igno- rance of those who attempt to imitate them, we have no right to expect such a finished picture as could impose on persons well acquainted with the real disease." 1 With such authority before us, to urge as an objection against the free admission of insanity in excuse for crime, the extreme diffi- culty of detecting attempts to feign it, can no longer be any thing more than the plea of ignorance or indolence. The only effect such difficulty should have on the minds of those who are to form their opinions by the evidence they hear, should be to impress them with a stronger sense of the necessity of an intimate, practical acquaintance with insanity on the part of the medical witness, and convince them that without this qualification, the testimony of the physician is but little better than that of any one else. We shall now notice those features of insanity the knowledge of which, either from their not being generally obvious, or not easily simulated, will enable us to distinguish the reality from the imitation ; and as general mania is oftener chosen than any other form of mental derangement, for the purpose of decep- tion, we shall begin with that. 343. The grand fault committed by impostors is, that in their anxiety to produce an imitation that shall deceive, they overdo the character they assume, and present nothing but a clumsy caricature. The representations of mania put forth in the works of novelists and poets, with a few such admirable exceptions as the Lear and Hamlet of Shakspeare, are, of all their attempts to copy nature, the least like their model. If, then, men of education, who may have had some opportunities for observing the disease, have after all so imperfect a picture of its phenomena in their mind, what success could be expected from the attempts of persons who, for the most part, assume their task upon the spur of the occasion with little preparation, and who have derived all then* ideas of madness from a casual visit to an insane hospital, or from observing the manoeuvres of 1 Cyclopaedia of Practical Medicine: Article, Feigned Diseases, 146. 352 MEDICAL JURISPRUDENCE OF INSANITY. some roving maniac ? With such, insanity is but another name for wildness, fury, and unlimited irregularity, and consequently under the thin disguise they assume, there can readily be detected a constant effort to impress on the beholder the conviction they are anxious to produce by the mere force of noise and disorder. The really mad, except in the acute stage of the disease, are, generally speaking, not readily recognized as such by a stranger, and they retain so much of the rational as to require an effort to detect the impairment of their faculties. In feigned cases, all this is very different ; the person is determined that his derangement shall not be overlooked for want of numerous and obvious manifestations of its existence. Under this impression, the impostor is constantly guilty of some word or act grossly in- consistent with real insanity, and affording an easy clew to the truth of the case. 344. Generally speaking, after the acute stage has passed off, a maniac has no difficulty in remembering his friends and acquaintances, the places he has been accus- tomed to frequent, names, dates, and events, and the occur- rences of his life. The ordinary relations of things are, with some exceptions, as easily and clearly perceived as ever, and his discrimination of character seems to be marked by his usual shrewdness. His replies to questions, though they may sometimes indicate delusion or extravagant notions, generally have some relation to the subject, and show that it has occupied his attention. Now a person simulating mania will frequently deny all knowledge of men or things, with whom he has always been familiar, especially when- ever he imagines that such ignorance, if believed, may be considered as a proof of his innocence. The very names, dates, and transactions, with which he has been most lately and intimately conversant, he will, for the same reason, refuse to remember, while the real madman will seldom, if ever, forget them, in whatever shapes they may appear to his mind, or with whatever delusions they may be connected. His distorted perceptions may transform his humble dwelling into a princely castle, and the people about him into generals SIMULATED INSANITY. 353 and courtiers ready to execute his slightest orders ; but he will never deny that he has an abode, nor forget the existence or names of those whose station and duties he has so entire- ly mistaken. Grant his premises, and oftentimes nothing can be urged against the conclusions df the madman's rea- soning ; but in simulated madness, the common error is to imagine that nothing must be remembered correctly, and that the more inconsistent and absurd the discourse, the better is the attempt at deception sustained. In simulated madness there is also a certain hesitation and appearance of premedi- tation in the succession of ideas, however incoherent, very different from the abruptness and rapidity, with which in real madness the train of thought is changed. This, of itself, is sufficient, in the majority of cases, to reveal the deception to the practised observer of insanity. In simulated mania, the impostor, when requested to repeat his disordered ideas, will generally do it correctly, as if anxious that none of his ravings should escape attention, or be forgotten ; while the genuine patient will be apt to wander from the track, or intro- duce ideas that had not presented themselves before. The following case, which we find in one of Georget's works, will furnish an appropriate illustration of the foregoing remarks, and give an insight into the devices of imposture, to be obtained only from examples. 345. " Jean-Pierre, aged forty -three years, formerly a notary, was brought before the court of assizes of Paris, on the 21st February, 1824, accused of crimes and misconduct, in which cunning and bad faith had been prominently con- spicuous. He had already been condemned for forgery ; and was now accused of forgery, swindling, and incendiarism. When examined after his arrest, he answered with precision every question that was put to him. But about a month after, he would no longer explain himself, talked incoherently, and finally gave way to acts of fury, breaking and destroying every thing that came in his way, and throwing the furniture out of the window. At the suggestion of the medical men who were called to examine him, Jean-Pierre was sent to 30* 354 MEDICAL JURISPRUDENCE OF INSANITY. the Bicetre, to be more closely observed. There he became acquainted with another pretended lunatic, accused also of forgery and swindling, and retained in that house for the same purpose, that of being observed by the physicians. One night a violent fire broke out at the Bicetre, in three different places at once, in one of the buildings occupied by the insane, which circumstance led to the suspicion that the fire was the effect of malice. The next day it was discovered that the two supposed madmen had disappeared. Jean- Pierre hid himself in Paris in a house where his wife was employed, and where he was again arrested. Immediately on his escape from the Bicetre, he wrote a very sensible letter to one of his friends ; but scarcely had he been taken when he again assumed the character of a madman. From the indictment, it appears that the person who ran away at the same time with Jean-Pierre, confessed that they had formed the plan of escaping in company, and that they had profited by the occurrence of the fire to put it into execution. He also said that Jean-Pierre had made him swear to reveal nothing ; and he seems to have told as a secret to one of the officers of La Force, that the fire was the work of Jean- Pierre. " All the witnesses, who had had any transactions with, or known any thing of the accused before his arrest, deposed that he always seemed to them rational enough, and even very intelligent in business. One of the prisoners in La Force, who occasionally met and talked with Jean-Pierre, declared that his conversation was often veny incoherent, and that in some of the phases of the moon, his mind was much excited. But these observations were made after the arrest of the accused. It was his conduct at the trial, how- ever, which, more than any thing else, proved that the mad- ness of Jean-Pierre was only assumed ; for there is, perhaps, not one of his answers that would have been given by a madman. The following are a few of them. " Q. How old are you? A. Twenty-six years [he was forty-three]. SIMULATED INSANITY. 355 " Q. Have you ever had any business with Messrs. Pel- lene and Desgranges [two of his dupes] ? A. I do n't know them. " Q. Do you acknowledge the pretended notarial deed which you gave this witness ? A. I do not understand this. " Q. You have acknowledged this deed before the com- missary of police ? A. It is possible. " Q. Why, the day of your arrest, did you tear up the bill for three thousand eight hundred francs? A. I don't re- collect. " Q. You stated in your previous examinations, that it was because the bill had been paid. A. It is possible. " As to many other of his own depositions the accused answered, in like manner, that he did not recollect any thing about them. " Q. Do you know this witness [the portress of the house he lived in] ? A. I do n't know that woman. " Q. Can you point out any person who was confined in La Force with you, and who can give any account of your then state of mind ? A. I do n't understand this. " Q. You made your escape from the Bicetre ? A. Was you there ? " Q. At what hour did you escape ? A. At one o'clock three o'clock. / " Q. What road did you take ? A. That of Meaux en Brie. [He took that of Normandy.] " Q. Can you tell us who set the Bicetre on fire ? A. I do not know what you mean. " Q. You wrote a letter to Captain Froyoff the day after your escape from the Bicetre ? A. I did not write that letter. [It was his own handwriting.] " When charged with setting fire to the Bicetre, Jean- Pierre uttered the most horrid imprecations, and incessantly interrupted his counsel and the advocate-general in their pleadings, with contradictions, ridiculous remarks, and curses." l 1 Archives general de Med. viii. 182. 356 MEDICAL JURISPRUDENCE OF INSANITY. 346. In commenting on this case, Georget observes, that " among those madmen who have not entirely lost their senses, and Jean-Pierre is not one of this kind, probably not one will be found who would mistake the persons with whom he has been connected, who would not understand what a notarial act is, who would have forgotten his actions, who would not know what was meant when a memorable event was recalled to him, and who would make such sin- gular answers as those we have quoted. The latter appear as so many contradictions to those who are accustomed to observe the insane. When people have completely lost their reason, they either do not reply to questions at all, or branch off to subjects that have no relation to the questions address- ed to them. I have seen patients whose understanding was reduced to a few isolated sensations, and who recognized their parents and friends, and called them by name. Some, it is true, can recognize nobody, but they certainly would not have returned all the answers above-mentioned, and their mental disorder would have been otherwise characterized." 3 347. The change that takes place in the moral charac- ter of the insane, in their affections and desires, furnishes an excellent test of the genuineness of any particular case, inas- much as this fact hardly enters into the popular notions of this disease. Perhaps no character of mania, general or partial, is more common than that inversion of feeling, which is manifested in reference to every person or thing that comes within the circle of the domestic and friendly relations. The feelings of the parent, child, and spouse, seem to be completely eradicated, while family loses its ties, home its endearments, and friends their kind and soothing influence. Suspicion takes the place of confiding trust; jealousy, of love ; and fierce and hostile demeanor, of grace and suavity of manner. As the severity of the disease abates, the cur- rent of the affections begins to resume its ordinary direction, and no indication of improvement is more to be relied on, than manifestations of regard for those to whom they are 1 Des Maladies Mentales, 61. SIMULATED INSANITY. 357 bound by ties of intimacy or relationship. The impostor is seldom aware of these facts, and generally evinces no settled diminution of his attachment to his family or friends. He does not scruple to show his ordinary fondness for his chil- dren or parents, or if he happen to be aware of the trait of insanity here described, and has suppressed all such displays, the first menace of injury to these objects of his regard, is sufficient to tear away his disguise, and disclose the rational and affectionate man. In the conspiracies and hostile plans that constantly perplex the madman's brain, his intimate friends bear the most prominent part, while the impostor always pitches upon those as the disturbers of his peace, with whom he has had some previous disagreement, or at least, no particular intimacy. 348. In real, general mania there is usually more or less insensibility to the ordinary proprieties and decencies of life, insomuch that sometimes those who "were formerly noted for the purity of their manners, freely indulge in obscene lan- guage and filthy practices. Indeed, it seldom happens that in general mania the patient preserves the natural propriety of his conversation and manners ; and this departure from the ordinary character will go far to distinguish the real from the simulated disease. 349. If, as we have endeavored to prove elsewhere, mania arises from cerebral disorder, we might reasonably expect to find it giving rise to physical disturbances of more or less moment, and, accordingly, in most cases, it actually is manifested by various pathological symptoms which no device of imposture can ever imitate. To say nothing of the wildness of the eye, and a certain strangeness of expres- sion, as easily recognized when once impressed on the mind, as it is difficult to describe, there is some degree of febrile action which it requires no very labored examination to discover. The pulse will generally be found more frequent than in health, and when this increased frequency is observed in doubtful cases, it will furnish a strong collateral proof of the genuineness of the mental disorder. In the case of a crimi- nal condemned to be executed who was suspected of feign- 358 MEDICAL JURISPRUDENCE OF INSANITY. ing madness, the opinion of the late Dr. Rush was requested, and when that critical observer of disease found the pulse twenty beats more frequent than in the natural state, he decided, chiefly on the strength of this fact, that the prisoner was really mad, 1 and such he finally proved to be beyond a doubt. Of course, it is not to be understood that whenever the pulse remains at the natural standard, the plea of mad- ness is fictitious, nor vice versa ; it is mentioned merely as a valuable means in connection with others, of arriving at correct conclusions in doubtful cases. 350. Sleeplessness, which is so common in mania, is another of those symptoms, the presence of which may furnish conclusive proof of real insanity, and though its absence would hardly warrant the contrary conclusion, it would certainly produce strong suspicions, and thus give additional weight to less prominent symptoms. In real mania, the patient will be days and even a week without sleep, while the simulator, if aware of this feature of the disease, will be observed, when faithfully watched, not to protract his sleeplessness to any thing like the period which it commonly remains in the real disease. In fact, in spite of all his efforts, sound sleep will invariably overtake him before the second or third day. Impostors almost always attempt to imitate the nocturnal restlessness and disorder of maniacs, but the imitation is as different from the reality, as the occasional disturbance by sound slumbers can make it, a difference which it would require but little watching to establish. 351. Perhaps there is nothing which of itself furnishes a better test in doubtful cases, than the manner of their inva- sion. Well-marked, real mania seldom occurs suddenly, but is preceded, as has been elsewhere noticed, by a course of preliminary symptoms which occupy a period of more or less duration, and which, though they do not always suggest to the beholder the suspicion of derangement, will, when the disease has become indubitably established, be recollected as 1 Introductory Lectures, 369. SIMULATED INSANITY. 359 having appeared strange and unaccountable. In simulated insanity, on the contrary, the invasion is as sudden as is most frequently the occasion that leads to it. The simulator being unaware of the progressive nature of the invasion, suddenly, in the midst of health, startles his attendants by an outbreak of the most extravagantly wild and furious conduct, while the minutest inquiries will fail to establish the previous existence of any precursory symptoms. No instance of strange, or eccentric conduct or language, not the slightest departure from the individual's natural thoughts and affections, or manner of manifesting them, nor any indications of bodily derangement, will have been observed by those who were about his person. When, therefore, the disease has come on in this manner, it may be safely concluded, if there be any other the least ground of suspicion, that the case is one of simulation. 352. When other tests fail, the habits and constitutional peculiarities of the individual may sometimes furnish us with valuable information. If, for instance, the person have in- dulged in intemperate drinking, the occurrence of mental derangement would be no unnatural sequel to the sudden abstinence from intoxicating drinks to which prisoners are generally subjected. If insanity have been a disease of his family, more especially if it have been manifested in former periods of his life, when there existed no motive for decep- tion, there must be additional evidence strong enough to counterbalance the presumption drawn from this fact, to induce the belief that the case is one of simulation. When, too, the person is well known to possess an irritable, nervous temperament, inordinately excited by moral or physical causes, this fact will very justly raise a bias in his favor, and lead us to require so much additional weight in the proofs of deception ; and its force will be strengthened by the consider- ation, that the circumstances in which he has been recently placed, are of the very kind most calculated to produce the effect to which he is thus predisposed. 353. In real mania there is always an extreme irrita- bility of temper which makes the person impatient of the 360 MEDICAL JURISPRUDENCE OF INSANITY. least contradiction, and is constantly breaking out into furious gusts of passion, as sudden as the apparent causes are inadequate to account for them. This feature of mania is not easily imitated, and nothing less than long personal observation of the insane, joined with no inconsiderable powers of mimicry, would enable the simulator to arrive at even an approximation to the reality. When, therefore, the pretended madman maintains his temper under various little aftmoyances and contradictions, or only displays a clumsily- enacted passion, it may be pretty safely concluded that he is feigning the disease. 354. Generally, persons feigning mania, lack the bold, unflinching look of real maniacs ; they never look the physi- cian steadily in the face, nor allow him to fix their eye ; and on being accused, their change of countenance plainly betrays that they are conscious of the nature of the charge. Dr. Hennen speaks of an instance where a person feigning mad- ness, confessed that he could not support the inquiring glance of the physician who examined him. 1 355. It is a well-known fact that in real madness, the system becomes singularly insensible to the power of certain medicines particularly emetics, drastic purgatives, and opi- um. A dose of the last article, which would not procure a moment's sleep to a real maniac, would completely over- power the simulator, and in doubtful cases the result of this experiment should be entitled to considerable weight. The same may also be said of experiments on the effect of other narcotics. 356. Partial insanity, in consequence of the superior difficulty of the attempt, is much less frequently simulated, and with a much smaller degree of success, than the general form of the disease. Those who undertake it " are deficient," says Haslam, " in the presiding principle, the ruling delusion, the unfounded aversions, and causeless attachments which characterize insanity, they are unable to mimic the solemn dignity of characteristic madness, nor recur to those asso- 1 Principles of Military Surgery, 364. SIMULATED INSANITY. 361 ciations which mark this disorder ; and they will want the peculiarity of look which so strongly impresses an experienced observer." i The mental and physical peculiarities of partial mania are of a kind that do not obtrude themselves on the observation, and instead of loudly proclaiming the presence of a crazed condition, and soliciting the attention of the beholder, some investigation is required before they are dis- covered. All this is contrary to the purposes of the simula- tor, which require that an immediate and powerful impres- sion should be made on those in whose charge he is placed. If, however, in consequence of ignorance or presumption, these difficulties are unknown or under-estimated, and the task of simulating partial madness is assumed, we have only to bear in mind the characteristic features of the affection, to detect the counterfeit almost at a glance. In real mono- mania the patient seldom troubles himself to make the sub- ject of his delusion square with other notions with which it has more or less relation, and the spectator wonders that he can possibly help observing the inconsistency of his ideas, and that when pointed out to him, he should seem to be indif- ferent to or unaware of this fact. In the simulator, on the contrary, the experienced physician will detect an unceasing endeavor to soften down the palpable absurdity of his delu- sions, or reconcile them with correct and rational notions. This too obvious anxiety to produce an impression, strongly contrasts with the reserve and indifference of the real dis- order, and will, of itself, furnish almost conclusive proof of sim- ulation. In partial mania, the subject of the delusion, though it may frequently change, completely occupies the mind for a longer or shorter period, and the patient's discourse, when he wanders, will always have some relation to it. When this form of the disease is simulated, the delusions are not only frequently changing, but when questioned concerning them, the person is more likely than not to shape his answer without any reference to the subject, and embrace the oppor- tunity to introduce a new insane idea. Nothing irritates a 1 Medical Jurisprudence as it relates to Insanity, 323. 31 362 MEDICAL JURISPRUDENCE OF INSANITY. monomaniac more than to be called insane. He stoutly repels the idea, and maintains the reality and correctness of his delusions. The simulator, on the contrary, will be but little inclined to discourage a belief which it is his great object to produce. " A real monomaniac," says Marc, "is strongly prejudiced -in favor of his opinions, the slightest contradiction excites his temper, while the simulator readily overlooks this essential point in his part, if the contradiction be skilfully managed. The taciturnity peculiar to the real subject of monomania, frequently leaves simulators at fault, since the complaints of the latter, when sure of being seen or heard, and their repugnance at dwelling in solitude, are not met with, or at least, not in the same degree, in the others." 1 In addition to these characteristics of this form of mental derangement, it may be remarked that many of the peculiarities diagnostic of general mania, are often so of partial mania, such as sleeplessness, insensibility to opium, and irritability of temper. According to Marc, monomania that is not characterized by sad, or at least serious ideas, has seldom, if ever, led to criminal acts. 357. Idiocy and imbecility are sometimes simulated, and the imitation would be very likely to deceive those not practically acquainted with these mental affections; but the history of the individual and his physical constitution furnish such conclusive proof of the imposture, that the attempt is less successful than when the other forms of insanity are selected for simulation. In genuine cases, if the affection be congenital, the history of the patient or form of the head will establish this fact. If it have occurred at an after period of life, the circumstances that have occasioned it may be learned from the acquaintances of the patient. If the form of the head present nothing abnormal, it is to be supposed that the mental deficiency, if there be any in reality, is of the acquired kind, so that if the person pretends to have been from birth in his present condition, this of itself would be presumptive proof of imposition. If, however, he is capable 1 Diet. Med. Sci. Article, Alienes. SIMULATED INSANITY. 363 of referring his mental deficiency to the influence of any par- ticular adventitious causes, the practitioner can determine for himself, in a certain measure, how far these alleged causes could have contributed to produce the condition in question. If they appear to be plainly and palpably inadequate, he has a right to conclude that the person is acting the part of an impostor. It sometimes happens that the simulator has had frequent opportunities of observing the manners of an idiot or imbecile, and possessing some powers of mimicry, is able to give a pretty faithful copy of the example he has studied. But there is a stupid, vacant cast of countenance in these affections, which it is difficult, if not impossible to imitate well enough to deceive one much conversant with this class of beings. Full as difficult is it to imitate the unfixed, un- certain, expressionless look, and the frequently and abruptly fluctuating train of their ideas. Zacchias offers as a test of idiocy, the pusillanimous and submissive character of its subjects, but it is now well known that most idiots are liable, on provocation, to gusts of furious, brutal passion, as transient as they are sudden. Imbecility presents such a diversity of mental deficiency both in kind and degree, that the simulation of it will baffle the scrutiny of the observer, who is not prepared for his task by a considerable acquaint- ance with the phenomena of the imbecile mind. In the first degree of real imbecility there is a singular mixture of stupid- ity and shrewdness, in the fraudulent imitation of which, the vigilant observer may discover proofs of simulation. He will find that on points directly involving the interest of the simulator, the latter will display the full endowment of the shrewdness compatible with this condition, while he reserves his stupidity for occasions where his own interests are not particularly concerned. In replying to the questions put to him, he will be careful, amid all his display of imbecility, to say nothing likely to favor a belief of his guilt in the matter which has led him to assume the part of an impostor. What he says is intended to leave an impression favorable to his innocence, and this effect he will endeavor to produce as far as he dares. When, therefore, the person replies to inquiries 364 MEDICAL JURISPRUDENCE OF INSANITY. in such a manner as to criminate himself, it may be pretty safely concluded that the imbecility is genuine ; and though the converse of this rule may not be equally true, yet if the whole tenor of his replies has an exculpatory turn, strong ground of suspicion at least is afforded, that all is not right. Imbecility in the first degree will seldom be counterfeited, however, from the simple fact, that the real affection seldom annuls the criminal responsibilities of those who are ac- knowledged to be its subjects. 358. Senile dementia may be simulated by aged per- sons, but it is so imperfectly known as a distinct form of insanity, that its peculiar features would probably be mingled with those of general and partial mania, and thus lead to an easy detection. If the physician will steadily bear in mind that senile dementia is essentially characterized by deficiency of mental excitement, he will not be long in arriving at the truth in doubtful cases, for the simulator will inevitably indulge in hallucinations, and perform physical movements indicative of excessive mental excitement. The principal points that distinguish this affection from mania may be briefly recapitulated. In senile dementia, the delusions are based on some previous event of life, and though irrational, are not always absurd. The memory decays, first, relative to recent events, and finally, to every thing it had previously stored up. The senses lose their acuteness ; the power of recognizing persons, places, and things, fails at last, and has gone forever ; and one looks in vain for the least exertion of thought. The whole conduct and language are indicative of complete childishness; and in this second childhood, the necessity of vigilance to prevent the miserable patient from injuring himself or others, is no less imperative than in the first. In mania, the delusions are generally absurd as well as irrational ; the memory manifests no decay, except perhaps on subjects that relate to the predominant idea ; the strength and accuracy of the senses are unimpaired; persons and things are as readily recognized as ever; and occasionally the mind flashes forth with more than its usual power and vividness. At times the character assumes its natural manli- SIMULATED INSANITY. ^365 ness and dignity, and the individual conducts with a pro- priety and discretion scarcely to be distinguished from those of perfect soundness of mind. Bearing in mind these char- acteristic differences which are so little known to any but medical men, we cannot be easily deceived by the best-man- aged attempt at simulating senile dementia. 359. It has been already stated, ( 286,) that the other forms of dementia are usually the sequel of mania, or other disorders of the nervous system. It must be borne in mind, that the previous disorder is sometimes so mild, so obscure, and so short in its duration, as to be entirely overlooked. AYlien this is the case, the dementia that supervenes is viewed with suspicion, and, unless sufficient time is allowed for its development, it may frequently be mistaken for the effect of" simulation. The following case looks like one of this kind, though nothing but farther observation and per- haps more information respecting his previous history, could place its true nature beyond the reach of doubt. " I was, a few years ago, requested to see a man confined in gaol for the crime of cutting off his wife's head. This man had made no attempt to deny the deed, or to escape the conse- quences. For some time after he was taken to prison, his conduct was quiet, and on common subjects he would talk in a common way with his fellow-prisoners. When he was asked about the murder, and reminded that he would cer- tainly be hanged for it, he always said he did not know that he had done any harm. After being confined five or six weeks, he occasionally showed a disposition to be violent; and, on one occasion, put a handkerchief round his neck as if he intended to hang himself. Subsequently he became taciturn, and his demeanor changed to that of an imbecile person, which it was at the time of my seeing him. He wore a woollen cap, which he had taken from one of the other prisoners, and carried a piece of wood about with him, which he represented, by signs, to be his sword; for he would not speak, nor answer any questions ; only breaking silence now and then by repeating the word ' cabbage,' with- out any kind of meaning. He had buttons and other com- 31* 366 MEDICAL JURISPRUDENCE OF INSANITY. mon trinkets tied round his wrist ; and he had made a great many attempts to walk out of the hospital of the prison, in which he was lodged. When a watch or any shining sub- stance was shown to him, he would assume an idiotic smile, and begin to dance." 1 360. The narrator of this case suspected that the man " was playing a part," though he admits that u the nature of his crime, and his conduct after committing it, went far to support the idea of his insanity, and that his insanity might have been coming on some time before the murder." He remarks, as one ground of his suspicions, that " the mixed character of his mental disorder, and the rapid super- vention of idiocy [dementia] on a quiet form of insanity, in a man of thirty-five, seemed to be unusual circumstances." Such circumstances are certainly not very common, but nevertheless, they have been observed. Esquirol recognizes a form of dementia which is complicated more or less with monomania, and distinctly alternating with it. He remarks of a patient whose case he relates, that " though apparently insensible to whatever was passing around him, he still was not entirely deprived of intelligence, and he had great strength of will." 2 The case of Pechot, adjudi- cated in France within three or four years, was a striking instance of the rapid supervention of dementia on a quiet form of insanity, though the patient was older, it is true, than Dr. Conolly's. Between the time of the commission of the murder in April, for which he was indicted, and that of his trial in the following November, he was frequently observed and examined by a medical commission appointed for the purpose of ascertaining the exact condition of his mind. During the early part of this period, he merely ap- peared to be deeply dejected, and the commission reported that it was impossible for them to say that his understanding was nowise impaired. At the time of the trial, however, dementia was plainly visible, and then one of the commission 1 Conolly, Indications of Insanity, 455. 2 Des Maladies Men. ii. 228. SIMULATED INSANITY. 367 stated, that during the first examination, Pechot was un- doubtedly in a state of profound melancholy, of which the present dementia was the natural sequel. It also appeared from the evidence, that for some time previous to the mur- der, his mind was considerably disordered. 1 The other cir- cumstances which raised the suspicion of simulation in the above case, were, that though he would not answer ques- tions, he heard and understood them, that " although he never looked directly at any one, he was, in reality, very watch- ful of their movements, even when distant from him," and that " he always made a sudden run toward the door when anybody opened it to go out." In regard to the last circum- stance, we can only say, that it is often seen in every form of insanity ; and as it regards the others, it may be sufficient to observe, that the committee, in speaking of Pechot's condi- tion a few days after the murder, stated that he was very re- luctant to answer questions, and that " his eye was constantly on the watch, the slightest noise, the least gesture instantly attracting his attention." 361. Homicidal insanity, when the fact of its existence shall be generally recognized, will, undoubtedly, be often falsely pleaded in excuse for crime, and the task imposed on the physician in such cases, will be sometimes a difficult and a delicate one. The characteristic and distinctive features of this affection have been elsewhere stated ( 217,) and it is to a knowledge of them we are to look for the means of detect- ing its counterfeits ; and though our investigation may oc- casionally result only in doubt and uncertainty, yet, generally speaking, when rightly conducted, it will lead us to the truth. 362. Insanity, characterized by hysteric symptoms, was simulated not long since in the McLean Asylum, Massa- chusetts, and, considering the youth of the subject, the appar- ent want of motive, and the severity of the symptoms, it was somewhat curious. The lad, thirteen years old, had fallen on his head about two years and a half previous to admission, 1 Annales D'Hygiene Publique, No. 35. The article is condensed in 22 American Jurist, 27. 368 MEDICAL JURISPRUDENCE OF INSANITY. and ever since that period, had exhibited some anomalous symptoms of disease, which had been referred by his phy- sicians to derangement of the digestive organs. For the few last months the symptoms were more severe and decided. He refused food for long periods, had spasms, laid with his eyes, fixed and legs drawn up, would hold his breath and strike. On admission to the asylum, he presented the ap- pearance of a sickly, emaciated boy under puberty, unable to stand, exhausted by suffering, breathing quick, and pass- ing his evacuations in bed. Every few minutes he had a frightful spasm, commencing with a convulsive shaking of the head, pawing of the hands, and turned-up eyes. Soon his hands would vibrate against his sides and chest; his countenance would be dreadfully distorted, and then would commence a horrid scream that might be heard over the whole premises. In this condition, with occasional remis- sions, and the addition, at one time, of diarrhosa, he remained for about a month, when the imposture which had been sus- pected, was detected. Being watched through a hole in a blanket hung before his window, he was observed to jump up and stride about his room as actively as anybody, but at the slightest noise, resuming his old position, screaming and groaning. Dr. Bell, finally burst in upon him before he could regain his bed, chided him for his deceit, and bade him walk into the hall. " The spell is broken," says the record, " the feeble knees are made strong, the convulsed and dis- torted visage is calm and smooth, and the young deceiver goes forth erect, clothed, and in his right mind." 363. Besides a knowledge of the symptoms of insan- ity, which will enable the physician to detect its simulation, his own ingenuity may often contrive some plan for outwit- ting the pretender, and entrapping him in his own toils. To perform the part of an insane person, carrying through its numerous and complicated phases, requires an endowment of the imitative powers, seldom bestowed on any, least of all, on those who would have occasion to use it for such pur- poses, so that the measure of ingenuity by which it is main- tained, is scarcely ever a match for the devices which a SIMULATED INSANITY. 369 shrewd and vigilant physician has always at hand. In the case of a girl feigning mania, Foder informed the keeper, in her presence, that if she were not better the next day, he should apply a hot iron between her shoulders. This im- mediately produced a decided amendment. There is related the case of a sailor, whose simulated madness was mani- fested by a vehement desire to throw himself overboard, which, after being prevented for some time, he was at last permitted to do ; immediately on reaching the water, how- ever, he swam vigorously and called loudly for a boat. 1 A device frequently resorted to, is to mention in the hearing of the person some symptom of madness which is easily imi- tated, as not being present ; at a subsequent examination, if the disease is feigned, this symptom will certainly be observ- ed, whether it is or is not a symptom of madness. In some cases, it would be perfectly proper to adopt the suggestion of Marc, to intoxicate him slightly, when, if he be playing a part, he will be likely to forget it, and appear in his real colors. In the English naval and military service, where the medical officer is often called on to deal with feigned insan- ity, punishment is much resorted to, 2 on the principle, prob- ably, that if the affection be counterfeited, it will be more efficacious than any thing else in restoring the impostor to his right mind ; and if real, it will do good by acting as a power- ful derivative. If the latter part of the alternative were true, nothing certainly could be more proper than sound flagella- tion ; but if any thing, more surely than another, will push a case of mental derangement beyond the reach of curative means, it is corporal punishment. The misery thus produced is poorly compensated by the detection of a few cases of im- posture. In the following case, however, where something like this kind of treatment was used, it would undoubtedly have been very proper had the disorder actually existed ; and as it may serve as a guide to the practitioner in similar in- stances, a brief notice of it may not be out of place in this connection. i Cyclop. Pract. Med. Article, Feigned Diseases. a Idem. 370 MEDICAL JURISPRUDENCE OF INSANITY. 364. Jean Gerard, a bold villain, murdered a woman at Lyons in 1829. Immediately after being arrested, he ceased to speak altogether, and appeared to be in a state of fatuity. He laid nearly motionless in his bed, and when food was brought, his attendants raised him up, and it was given to him in that position. His hearing also seemed to be 'affected. The physicians who were directed to examine him, concluded that if this were' actually what it appeared to be, a paralysis of the nerves of the tongue and ear, the actual cautery applied to the soles of the feet, would be a proper remedy. It being used, however, for several days, without any success, it was agreed to apply it to the neck. For two days no effect was produced; but on the third, while preparations were making for its application, Gerard evinced some signs of repugnance to it, and after some urg- ing, he spoke, declaring his innocence of the crime of which he was charged. His simulation was thus exposed. 1 365. When required to examine and report upon cases of suspected simulation, the medical man cannot be too cau- tious in arriving at his final decision. The judgment is not to be determined by any single symptom, however striking, but every pathological indication, every possible motive to action, in short, the whole moral, intellectual, and physical history of the individual should be faithfully studied, before we venture to make up our final opinion. Especially should we try to ascertain from the acquaintances of the individual, whether he has evinced mimic powers to any extent, and has ever had an opportunity to observe the man- ners and discourse of the insane. The mimic power neces- sary to produce a clever imitation of insanity of any kind, can hardly be supposed to have laid all his life unexercised and unknown, and still less could it be supposed that this power might be so great as to render any personal observa- tion of the disease unnecessary. Ample time for the investi- gation should be demanded, and unless it be granted, the physician would be justified in declining altogether the duty 1 Annales D'Hygiene Publique, ii. 392. SIMULATED INSANITY. 371 assigned him. Opportunities must be provided of observing the simulator, when, thinking himself not watched, he throws off the guise he has assumed, (which he will do at such times,) and returns to his own proper character. The phy- sician should never forget, however, the extreme perseverance and vigilance with which these people manage thei/ imposi- tions, and not be too easily induced to regard them favorably in consequence of the results which such opportunities may sometimes furnish ; for they will" often suppose they are watched at times when they have no means of knowing whether they are so or not. Foder speaks of a girl, un- doubtedly a simulator, who committed every kind of inde- cency in her cell ; and another case is related of some French prisoners of war, who carried " their simulation to so exquisite a height, as to eat their own excrement, even when shut up in their cells, suspecting that they might be over- looked." 1 In suspected cases, therefore, the persons should be strictly, and as far as possible, secretly watched, in order" that in their moments of forgetfulness or a sense of security, they may be seen laying aside their false colors, and sudden- ly assuming their natural manners. That this will happen sooner or later in every case, there cannot be a doubt, for the mind will instinctively seek relief from the painful exertion and sense of restraint, rendered necessary by an elaborate attempt at deception, by throwing off the disguise that has been adopted, and again returning to its natural condition. Again we caution the practitioner not to be in haste to form his opinion, but to wait long and patiently, for opportunities that may shed new light on the difficulties before him. 366. The importance of the last suggestion is strongly exemplified in the following case, related by Professor Mon- teggia, and translated from the Italian by Marc. We have taken the liberty to abridge somewhat the original narrative. In 1792, a criminal who was confined in the prison of St. Ange, in the province of Lodi, became insane soon after hearing that he had been betrayed by his accomplices. The 1 Cyclop. Pract Med. Article, Feigned Diseases. 372 MEDICAL JURISPRUDENCE OF INSANITY. physicians of the place who were required to examine him, came to the conclusion that he was feigning madness, though they did not express strong confidence in their opinion. From their report, his disorder seems to have been of rather a quiet form. To any question whatever, he merely uttered the words, book, priest, crown, crucifix. Sometimes he seemed, by the motions of his mouth and tongue,, desirous of replying to questions, but finally repeated, with a smile, the usual words. Their reasons for considering him to be feign- ing, were, that the disease appeared suddenly, without any premonition, and was accompanied by irregular symptoms, sometimes appearing to be a melancholy, attended by wan- dering, sometimes a cheerful mania, and sometimes a com- plete dementia. It appears that he was noisy at night and quiet by day; that he scattered his food about; that he never sighed ; and that he never fixed his eye on any partic- ular object. The physicians, in speaking to one another in his hearing, of these four circumstances, observed, for the purpose of entrapping him, that if just the contrary had hap- pened, they must necessarily have concluded that he was insane. It was soon after observed that he was quiet at night, no longer scattered his food, and did sigh. He seemed reluctant to have his pulse felt, for whenever this was done, he would keep his arm and fingers constantly in motion, though before perfectly at rest. The physicians also said in his presence, that his disorder would certainly be improved by a blister to the neck. At this time he was mute, but shortly after the application, he began to repeat the old words book, croum, etc. In July, 1793, he was ordered by the court to be trans- ferred to the prison at Milan, and Prof. M. was requested to examine him and ascertain his mental condition. At this time he appeared to be in a demented, imbecile state, and there was a kind of oddity and apparent affectation in his manners, which at first strongly favored the suspicion of simulation. Though attentive to what was passing around him, he seemed to shrink from observation, and averted his eye the moment it met that of another. When called, he SIMULATED INSANITY. 373 certainly heard the voice, and would start to go in the direc- tion of the sound, but instead of advancing directly, he would wander about the room. He never spoke ; the only sound he uttered was a kind of whistle, like that made by the wind blowing through a keyhole. He was singularly fond of bright and beautiful objects, viewing and touching them with an air of great interest. He collected various trifles of which he was quite fond. He never was com- pletely quiet, but was constantly in motion, or making some gesture. He was never observed to sleep ; while in bed he was continually moving his legs, or some other part of his body, or playing with a rag which he would put upon his eyes or mouth, or twine around his fingers. He loved to put it over the eyes or mouth of others, and then retiring a few steps, would look at them with a smiling air, and utter a sound expressive of gratification. He would frequently caress those about him, and pinch their cheeks in a friendly manner. He could neither dress nor undress himself alone ; being used to eat out of crockery plates, he would refuse food brought to him in any other kind of ware. He would sometimes hide his bread in his bed, and think no more of it. He never seemed to desire, nor to seek for food, though he ate with avidity when he was hungry. Sometimes, instead of eating his soup out of the plate, he would turn it out on the floor, and then take it up with a spoon. He was much an- noyed if made to remain long in any one place. When they brought towards him a mirror, he would spit at it, refuse to look at it, and*be made quite angry if they persist- ed in putting it under his eyes. When teased in this man- ner, he exerted extraordinary strength. When pinched, he appeared not to feel it, and he was seen to take up live coals in his hands, without showing any sign of pain. When his attention was directed to figures on the wall, made by candle- light, he would run as if to catch them in his hands, and express his disappointment by beating his head with his fist. He would never drink wine, but the moment he tasted it, he would spit it out with a strong expression of displeasure. Though inclined to believe, from the examination so far, 32 374 MEDICAL JURISPKUDENCE OF INSANITY. that the disorder was real and not feigned, yet considering the suspicions of the physicians of St. Ange, some decisive test seemed to be required that would unmask the simula- tion, if it existed, beyond all doubt. Wine being out of the question, six grains of opium was given him in his soup, but it produced no effect whatever. A few days afterwards he again took six grains of opium, in the morning, and this pro- ducing no effect at the end of six hours, six more grains, from a different parcel, was given him. In the evening he appear- ed as usual. A cracker was fired near him while his eye was turned in another direction, to see if the unexpected ex- plosion would surprise him at all ; but it did not, nor did another that was exploded under his shirt. He passed the night as usual, without sleep. No change was observed in him the next morning, but in the evening, he appeared a little uneasy and looked towards the windows, as if frightened. He went to bed, and about one o'clock in the morning, he raised himself up, heaved some deep sighs, and at last cried out, " My God, I am dying." The physician who was im- mediately summoned, found him quiet and talking rationally, without any sign of madness. He said, upon inquiry, that he had no idea of what had taken place; he believed, or seemed to believe, that he was still in the prison of St. Ange ; and demanded a confessor and an officer of justice, that he might be judicially interrogated. He added, that there had seemed to be persons at the windows, who told him that they had given him poisoned soup in order to kill him. He complained of nausea, though his pufse was natural, and his countenance calm and unaltered. The next day he ate well, and continued to conduct well and appear perfectly rational as long as he remained in the prison, after which he was lost sight of. The narrator of the case concludes that the crimi- nal was really insane, and that he was suddenly cured by the opium ; because if he had been feigning, and were finally induced to throw off the mask from the fear of actu- ally dying from the effects of opium, it is not very clear why the first dose had no effect. 367. Marc, in commenting on the above case, observes, SIMULATED INSANITY. 375 " that the reasons which induced the physicians of St. Ange to suspect simulation, may be easily disposed of. Their opinion is founded, first, on the irregularity of the signs of madness ; but this fact appears to me by no means to have been established. I see in this patient, so far as the imper- fect description enables me to judge, a maniac laboring under a cheerful form of mania, characterized by restlessness and nocturnal noise, followed by a remission with depression and true dementia. Such a complication, however, is frequently observed in maniacs. The circumstance of the patient's being noisy at night, and quiet by day, is rather in favor of the reality of the derangement, than otherwise. Is it proba- ble, indeed, that a simulator would choose the time when the imperious want of sleep is most strongly felt, to feign an attack of mania which he could just as well feign during the day, and sleep, at least, a portion of the night ? Besides, those who lived with the prisoner, and even the keepers of the prison of Milan, declared that he had never been seen to sleep, and during the day, was so restless as to be constantly changing his position. It seems to me impossible for a simulator to persist in this manner, and, therefore, I believe that such a complete and long-continued absence of sleep is alone sufficient to prove the reality of the mental perturba- tion." The sudden invasion of the insanity, he does not regard as a proof of simulation, because this fact, though rare, is not without examples. The oddities of demeanor also, are characteristic of dementia, and could not be coun- terfeited for any length of time. But the effect of opium was enough to destroy any remaining suspicion of simula- tion. If he had been simulating, there does not appear to have been a sufficient reason for ceasing when he did. The return of reason was preceded by a hallucination of the sense of hearing ; but it is not probable, says Marc, that an Italian bandit could have been so thoroughly acquainted with mental disease, as to have thought of using such a stratagem. 368. A remarkably embarrassing case has been published by Dr. Parchappe, physician of the asylum at Rouen, who 376 MEDICAL JURISPRUDENCE OF INSANITY. was directed by the court to investigate the mental condition of the prisoner, and who, for that purpose, was allowed, as is the custom in France, to examine the evidence given at the preliminary trial. From this it appears, that on the 8th of April, 1845, a man named Lambert was bitten in the hand by a dog that was generally considered to be mad. The same day the wound was cauterized with the actual cautery. The next day he started for Nibas to find some one who could cure him, but stopped at Eu and consulted a lawyer from whom he got a secret remedy for hydrophobia. On the llth he returned home, having been, during all this period, very anxious and abstracted, saying that he was lost. About one o'clock in the morning of Sunday, the 13th, he was heard howling' in his room. The persons who went to him found him calm. He told them that he had perspired and trembled ; that this was the first paroxysm of hydro- phobia ; that he must go directly to Nibas to get cured, as he might be then, but that after the third paroxysm, there could be no help for him. That day he went again to Eu, but the lawyer declined giving him a remedy, and told him he was more likely to be crazy than hydrophobic. The following night he did not go to bed, because, as he said, if he should lie down, a paroxysm would come on. On the 14th, about five o'clock in the morning, he came into the house [he slepi^ over the stables] for the purpose of getting a purse of money, to carry into the fields. He sought for money in every direction, and then displayed it on the kitchen table, singing, laughing, and dancing. He committed these extravagances till noontime, when his mistress ordered him to go to work, which he refused to do. She then told him that, since he would not work, he might quit her service. He replied that it was necessary for him to be quiet that afternoon. He did not dine, but for two or three hours kept repeating that he had money, but it was a great misfortune, because he had stolen it from Dorothy, an old servant of the family, and would have his throat cut for it. In the morning he had had an altercation with his mistress because she had refused him the use of a horse, and called her an old tiger. SIMULATED INSANITY. 377 About half-past two he had collected some money, and by way of preventing him from carrying it away, his mistress struck him with a little walking-stick. Lambert wrested the stick from her, threw her upon the floor, and then went to the kitchen, saying : " This is not the thing ; I want the hatchet ; I must kill her." With this weapon he returned to her room, and, having frightened away her maid, killed her by repeated blows on the head. In about ten minutes he went into the street, with the hatchet on his shoulder, pursu- ing every one who came in sight, and crying out, " long live the king, my fortune is made." He overtook a woman, and killed her with two strokes of the hatchet. On approaching another person, he said, "fear not, I do not mean to kill you ; " but he raised the hatchet as if to strike him. Pres- ently, he was shot down and secured, but a quarter of an hour after, he begged to be released, because he had eight more to kill. A witness told him he deserved to be shot, when he replied, " shoot." He appeared calm, and spoke in his ordinary tone. On his way to prison, he uttered cries, and tried to get away. He said to a witness, "that if he died without killing him, he should not die content." " Why," he said, " should he regret having killed his mistress ; if he had taken her money, it was only to give it away in charity, which she never would do herself. Here, too, he cried, " long live the king ; Jesus, my God ; rny fortune is made." At nine o'clock he arrived at the prison, where he tried to kick one of the witnesses. Here he soon became taciturn and abstracted, and refused food. Shortly after, he slept. On the 15th he was abstracted and dull, and seemed to be surprised when told of the cause of his arrest and of his wounds. He cursed any one who would harm so good a mistress as his. When examined by the magistrate, he pro- fessed not to know that he had been wounded, nor where he was, and denied having killed his mistress. " When was it? " said he ; " I have not killed her. If I did, I was mad? Why should I have killed her? People do not kill without a motive." He denied having killed the other woman. " If I did," said he, " I do not remember it." On the 18th, he 32* 378 MEDICAL JURISPRUDENCE OF INSANITY. recognized the hatchet, but denied all knowledge of the mur- ders. He recollected nothing since Sunday. From the 14th of April to the 6th of June, the physician who visited him every day, was unable to discover a single symptom of mental disorder, or of hydrophobia. The prisoner constantly declared that he had no recollection of the murders imputed to him. On the 6th of August, he was visited by Dr. Par- chappe who found him with every appearance of good health, except that he walked with a little difficulty and had a sad expression of countenance. He denied all knowledge of the murders, and of other events subsequent to Sunday, as before stated. He was conscious of his situation, and shed tears. On the 12th of August, visited again, with the same result. In regard to Lambert's mental condition, it is obvious that he was either insane or feigning insanity ; and if insane, he must' have been laboring under hydrophobia, or ordinary mania. The motiveless character of the acts, the circum- stances of atrocity by which they were marked, and the previous good reputation of the prisoner, are at variance with the supposition of intentional crime, in which fact alone could be found any motive for his feigning insanity. We are, therefore, led to the conclusion that he must have been laboring under some form of mental disorder, either hydrophobia or mania. Although, from the time he was bitten, until the murder, he was evidently suffering with strong apprehensions of hydrophobia, yet, as Dr. Parchappe well observes, he exhibited at no time, a single diagnostic symptom of that disease. His mental disorder must have been a form of acute mania of which his excessive appre- hensions of the consequences of the bite, were a powerfully exciting cause. To this idea which obtained complete pos- session of his mind, may be attributed the howling on Sun- day, the fact which furnishes the strongest suspicion of simulafton. It is more likely to have arisen in this manner, than to have been put forth as the only symptom of an affec- tion which is marked by so many and such well known traits. By some, the very brief duration of the attack may SIMULATED INSANITY. 379 be regarded as a sufficient objection to this hypothesis. This is certainly an unusual feature of mania, yet its occurrence has been too often witnessed to be considered as problem- atical, ( 120). Dr. Parchappe is most embarrassed by the complete unconsciousness of Lambert for a period of forty- eight hours, a fact which he conceives to be entirely unsup- ported by our knowledge of the disease. " In mania and the kindred forms of mental disorder unaccompanied by fever," he says, " the memory is preserved during the disease. . . . After the return of reason, the insane, remember all they have said and done and thought." He concludes, therefore, that, although the prisoner had actually suffered an attack of mania, he simulated this unconsciousness when he came to himself, in order the better to escape responsibility for his acts. Without disputing this hypothesis which may possi- bly be correct, we are not quite satisfied of the necessity of resorting to it at all, for our own observations do not lead us to agree with Dr. Parchappe, as to the matter of fact. We think we have occasionally met with a case not marked by any febrile movement, in which, after recovery, a certain period was a complete blank in the mind. 1 a " Annales med. psyco. viii. 228. CHAPTER X VI. CONCEALED INSANITY. 369. IT sometimes happens, that when maniacs have learned what notions of theirs are accounted insane by oth- ers, and have understanding enough left to appreciate the legal consequences of their mental condition, they endea- vor to conceal it, for the purpose of avoiding those conse- quences. If the address and ingenuity which they then mani- fest have occasionally succeeded in baffling the scrutiny of the most practised experts, it is not strange that common observers should have been frequently deceived, and that some of the medical profession even, with a knowledge of this fact before their eyes, should have been outwitted by their manoeuvres. When it is considered that the insanity of many consists in a few insane notions which do not, to appearance, affect their general conduct and conversation, the difficulty of concealing it, by professing to have renoun- ced their belief in these notions, is perhaps not greater than that which attends the accomplishment of most of their designs. Their task, too, is materially lessened, it is to be recollected, by the prevalent error, that madness is insepa- rable from boisterous behavior and complete disorder of the ideas. At the commencement of the French Revolution, when the mob broke into the lunatic hospitals, for the pur- pose of liberating those among their inmates whom they sup- posed to be unjustly confined, one man recounted his wrongs so clearly and connectedly, that he was deemed at once to be a victim of oppression, and ordered to be released. The use he made of his liberty soon convinced these enlightened champions of their race, that those who put him in confine- CONCEALED INSANITY. 381 ment, had, what they themselves had not, some reason for their measures. 1 Lord Eldon once related, that after repeated conferences and much conversation with a lunatic, he was persuaded of the soundness of his understanding, and pre- vailed on Lord Thurlow to supersede the commission. The lunatic, calling immediately afterwards on his counsel to thank him for his exertions, convinced him in five minutes, that the worst thing he could have done for his client, was to get rid of the commission. 2 In another place ( 21) will be found a case which well illustrates the adroitness and per- severance, with which maniacs will sometimes conceal their mental derangement. 370. In England and in this country, the choice of the means for proving the existence of insanity when concealed, is left to individual sagacity. This, no doubt is sufficient, where great practical acquaintance with insanity readily sug- gests the course best adapted to each particular case ; but the great majority of medical men will feel the need of some system or order of proceeding, that will simplify their in- quiries, and render them more efficient. The French arrange their means into three general divisions or classes, which are made use of, each in succession, when the preceding class has failed of its object. They are called the interrogatory, the continued observation, and the inquest, and as no better arrangement has ever been offered, it may be well to describe it ; and it may be added in passing, that it would materially conduce to our success in inquiries of this kind, if they were always pursued in the course here indicated. 371. Interrogatory. The interrogatory embraces only those means of information, which are applicable in a per- sonal interview with the patient. After learning generally his moral and intellectual character, his education and habits of living, the duration and nature of his mental delusion, (if they can be ascertained from his acquaintances,) and the state of his relations to others, and after observing the expression 1 Pinel, Sur Alienation mentale, 159. 2 Ex parte Holyland, 11 Yesey's Reports, 11. 382 MEDICAL JUBISPRUDENCE OF INSANITY. of his countenance, his demeanor and general appearance, we may proceed to a direct examination of his case. In the first place, it is necessary to lull his suspicions and remove his distrust, as far as possible, by a free and courteous deport- ment, and an air of kindness and unaffected interest in his welfare. He should then be engaged in conversation, which should lead him by easy and imperceptible transitions to the particular subject on which it is alleged his mind is deranged ; and the manner in which he treats it should be carefully ob- served, for if he be really insane on that point, he will pro- bably avow it ; while if he is not so, he will take the oppor- tunity to declare his disbelief in the notions imputed to him, and bring forward various considerations to support the truth of his assertions. He should be led to speak of his relatives and friends, especially if they have taken any part in provok- ing his interdiction, or otherwise interfered in his affairs, and here he will need all his self-control to restrain himself from the angry and revengeful feelings which he entertains to- wards them. When confined in hospitals or other lunatic establishments, we should not fail to ask how they like their situation, and what they think of their companions ; for Georget observes, that many, even of those the least derang- ed, are such poor observers, or have so little penetration, that they are ignorant of the nature of their abode, and the char- acter of those around them. When the mental disorder is that of imbecility or dementia, we must not confine our ques- tions to the simple topics of their present condition or feel- ings, for they may be able to answer them clearly and ration- ally, though subjects requiring a little more reflection or ex- ertion of memory, may be far beyond their comprehension. It not unfrequently happens that the mental deficiency affects the faculties of the mind unequally, degrading some to the scale of idiocy, and leaving others in a state of tolerable strength and development. When, therefore, the capacity of the mind is in question, whether for interdiction or any other purpose, we must not fail to test the soundness of all the fac- ulties, by inquiries relative to the objects with which they are respectively concerned, since, if satisfied with a partial ex- CONCEALED INSANITY. 383 animation, we may grossly deceive ourselves and injure the interests of others. True, this requires a knowledge of the mental constitution not possessed by every one charged with this kind of investigation ; but the deficiency, common as it is, proves nothing against the importance of this knowledge. 372. The importance of the above suggestions is strikingly shown by the case of a young man, B , noticed by Dr. Abercombie, 1 and Dr. Combe, 2 which occa- sioned much trouble and litigation to the parties concerned. This person was educated for the church, and had made such proficiency in the study of Latin and Greek, that, for several years, he acted as a tutor in these languages. He also displayed great keenness and adroitness in driving a bargain. When, however, his mind was directed to those studies and topics which require the exercise of the higher powers of the intellect, he was found so deficient that he utterly failed in his second examination before the presby- tery, in which his reasoning powers were tasked, though the first, which was in the languages, he passed successfully and creditably. It was found, too, that he was incapable of comprehending the relations of business, or even performing the ordinary duties of life. Accordingly, it appeared in the course of the law-proceedings, that those witnesses who knew him only as a linguist or a purchaser, did not hesitate to pronounce him a capable, clever man ; while those who had business transactions with him that called his reflective powers into action, had no doubt whatever of his imbecility. 373. There are few points in regard to which the medi- cal jurist will find it more important to possess correct notions, than the value of the interrogatory as a means of establishing the existence of insanity. In the English courts of chancery, it has been common, especially of late years, to appoint a committee of physicians to examine the party whose mental condition is supposed to require the interference of the court, and thus their report, deciding as it virtually does, questions of liberty and property, becomes an instru- 1 On the Intellectual Powers, 276. 2 On Mental Derangement, 244. 384 MEDICAL. JURISPRUDENCE OF INSANITY. ment of much good or much harm. It is a curious and a mor- tifying fact, that, not unfrequently, different committees have thus examined the same individual, and arrived at opposite results. If they had been composed of persons selected rather on account of professional eminence generally, than for their knowledge of insanity, unanimity of opinion could hardly have been expected ; but in fact we always observe among them the names of men whose lives have been devot- ed to this special department of the profession. 1 Of course, an honest difference of opinion occasionally, is no mat- ter of surprise ; but when it becomes so common as it has of late years, we are forced to the conclusion that there is a prevalent mistake touching the precise value of the method employed for obtaining the requisite object. 374. There are cases, unquestionably, where the insan- ity of the party would be clearly exposed by means of the interrogatory; but the converse of the proposition is not equally true. In a large proportion of the cases which re- quire such investigation, the interrogatory must prove utterly incompetent for this purpose. If the patient entertain delu- sions, he may have learned enough of the consequences of avowing them, to keep them to himself in the presence of those who, he well knows, have approached him for the very purpose of drawing them out and turning them to his detri- ment. If, too, the examiners possess no clew to his delu- sions, they have no means of provoking him to utter them, 1 In the celebrated case of Dyce Sombre (London Morning Post, Feb. 26, 1849 and seq.) which was in the court of chancery from 1842 to 1849, a com- mittee of French physicians, not entirely unknown to fame, reported that the party was of sound mind. Shortly after, a committee of two English phy- sicians reported that he was unsound, and incapable of managing his estate. Two or three years after, the same committee, with the addition of two others, examined him again and found no change in his mental condition. Two months after, another English committee of six physicians, examined him, and reported in the strongest terms that he was of sound mind, and ca- pable of managing his property. In the case of Mrs. Gumming (Times, Jan. 8, 1852 and seq.) there was the same lamentable difference between the conclusions to which two medical committees arrived, both bearing the names of men eminent for their knowledge of insanity. CONCEALED INSANITY. 385 and hence he passes for being sound simply because the chord which is out of tune, has not been touched. Another and a more common reason why the interrogatory should fail, is, that the patient's unsoundness may not manifest itself in delusions, but in gross improprieties of behavior, in fool- ish and absurd transactions, and the extravagance of all his anticipations. Conversation furnishes no occasion for the display of his mental disorder ; but let him go into the world, the master of his own movements, heeding no will but his own, and every day would furnish additional evidence of his in- capacity to manage himself or his affairs. Any one who visits a hospital for the insane, may find, at every turn, a patient who converses intelligently and discreetly, and neither in discourse nor behavior, displays a single trace of insanity. Whoever has not met with such cases, can have had but little practical acquaintance with the insane. A woman once came under our care who was reported to have had several previous at- tacks, but beyond this the history of the case happened to be exceedingly imperfect. For three months her whole dis- course and demeanor were without fault or blemish. She was calm and quiet in her ways, affable and intelligent, and exerted a healthy influence upon those around her. In regard to her own case, she complained that she should be banished from society, and especially from that of a young and beloved daughter who was thus cast upon the mercy of strangers, and for no other reason, as she said, but the superior force of a tyrannical husband. She then would launch into long and circumstantial accounts of the sufferings she had experi- enced, by poverty, sickness, and every species of privation, in consequence of his habitual intemperance. He finally crowned his iniquities two or three years before, by shutting her up in a hospital for the insane. Now all this might or might not have been true. We had no means of deciding. But when she added as a great secret, not to be told to all, that he employed a man to go to the hospital, every day, and beat her soundly with a stick, there was certainly strong rea- son to suspect a delusion. Towards the end of the above- named period, she became agitated and irritable, and finally 33 386 MEDICAL JURISPRUDENCE OF INSANITY. raved. In this condition she continued about six months, when she began to improve quite rapidly, and in the course of a month or two, went home, entirely restored, with her husband whose conduct, she then admitted, had always been most exemplary. Had this woman been submitted to the examination of a committee of physicians, they would unquestionably have reported her as being of sound mind and an unsuitable subject for confinement. 375. When delusions or other indications of insanity, of equivalent value, have been detected by competent ob- servers, we cannot understand why their existence should be denied by other observers, merely because they have failed to detect them. To prove a negative under any circum- stances, is no easy matter, but to prove it in the face of an affirmative, requires a course of protracted and varied observa- tion, aided by strong professional sagacity, very different from the hasty examinations we usually witness. Especial- ly should we be cautious in cases of moral insanity, where the very incidents which, viewed precisely as they occurred, furnish indubitable proofs of disease, may be so easily repre- sented by a little false coloring, in a totally different light. Had this caution been duly observed, the world would prob- ably have been spared some of those disagreements which are little calculated to advance its confidence in medical opinions. 376. Continued observation. A systematic course of observations continued for some time, may establish the fact of insanity in doubtful cases, after several personal in- terviews have completely failed. Opportunities, therefore, should be demanded for visiting the patient freely and fre- quently ; for watching him at times when he supposes himself unobserved; and for exercising a general surveiUance over his conduct and conversation. Those about him should be enjoined to watch his movements, and he should often, but cautiously, be led to speak of the motives of those who are anxious to prove his insanity. It often happens, too, that those who are most successful in concealing every indication of disordered mind, in their conversation, will betray themselves the moment they commit their thoughts to paper. They CONCEALED INSANITY. 387 should be induced, therefore, to write letters to their friends, describing their present situation, and to prepare statements of their wrongs and grievances, and thus we may be readily furnished with instances of incoherence and folly, which the patient had self-command enough to withhold, when put on his guard by questions which he knows well enough are designed to entrap him. " The rapid transitions and odd unions of discordant subjects, the relations of things which have not happened, and could not have happened, are in many cases very remarkable ; and a forgetfulness of common modes of spelling, or of the arrangement of the letters of words well known, will be evinced by maniacs who have been well educated, and who would commit no such mistakes but for their malady." 1 377. Inquest. When the above means fail, our inqui- ries must take a wider range and be directed to the previous history of the. patient, as made known to us by the testimony of friends and relatives, and those who have been connected with him in business, or had any other good opportunity of becoming acquainted with his mental condition. " The In- quest" says Georget, " consists in collecting information respecting the patient's condition before and after the pre- sumed disease, and the causes suspected to have impaired his mind. For this purpose we consult his writings, and recur to the testimony of those who have been about him and conversed with him ; who have been able to observe him closely and to witness his insane actions and irrational discourse. We should be particularly careful, however, to require of witnesses facts rather than opinions. 2 We should ascertain if madness be a disease of the family ; if he have already evinced a degree of singularity in his moral and intellectual character, or exaltation of any kind ; if he have been exposed to the influence of powerful causes, such as chagrins, severe and repeated crosses, reverses of fortune, etc. ; if, without any real motive, he has manifested any 1 Connolly: Inquiry concerning the Indications of Insanity, 469. 2 See Hathorne u. King, 8 Mass. Reports, 371. 388 MEDICAL JURISPRUDENCE OF INSANITY. change of his habits, tastes, or affections ; in short, we should inquire into all those circumstances which so frequently pre- cede the development of the disease." * We are to look into his business transactions, his management of family affairs, his conduct in the domestic and social relations, and the part he has taken in public scenes and duties. His letters and written communications should be closely scrutinized, espe- cially those that have any reference to the state of his health, or to the legal measures that have been taken against him, for here we may meet with incoherent and foolish ideas, that we have found nowhere else. In short, no source of information likely to enlighten us on the subject of the patient's mental condition, should be suffered to go unexplored. If the means thus indicated are faithfully used if the whole life of the individual have passed in review before us, and after all, we are unable to prove the patient's insanity beyond a doubt, we are bound to conclude that his mind is sound, or at least, that he is not a proper subject for legal interference. This conclusion will be no less proper, even though we still enter- tain some doubt of his mental soundness, for if he have suf- ficient self-control and penetration to enable him to conceal his mental impairments and conduct himself rationally, but little harm will probably arise from leaving him at present to his own discretion. 1 Des Maladies Mentales, 57. CHAPTER XVII. EPILEPSY AND ITS LEGAL CONSEQUENCES. 378. EPILEPSY is a nervous disease characterized by paroxysms of insensibility, unconsciousness, and convulsions. These vary in severity, from that of a simple vertigo, continu- ing for a few seconds and scarcely discernible by others, to that of a most distressful convulsive fit enduring from five to fifteen minutes. They may recur twice or thrice a day for several days together, or once a week, month, or year. They sometimes occur without warning, but as often perhaps they are preceded by symptoms indicative of disturbance of the nervous functions ; such as, giddiness, pain of the head, drowsiness, frightful dreams, hallucinations of sight or of hearing, vigilance, irritability of temper. So distressing is the condition of many epileptics, says Esquirol, previous to the paroxysm, that they endeavor to hasten its access, and for this purpose resort to spirituous drinks. The cessation of the paroxysm is followed by somnolence, pain in the head, and a sense of weakness. The recurrence of the fits is determined by whatever disturbs the general health, more especially by derangements of those organs in which the series of morbid phenomena takes its origin. Anger, fright, or any strong moral emotion is very liable to produce a paroxysm. A soldier, in mounting a breach, was frightened into a fit of epilepsy by the bursting of a bomb-shell near him. He was soon cured, but at sight of the place, twenty years afterwards, he was thrown into a fit. 1 379. Epilepsy seldom continues for any length of time without destroying the natural soundness of the mind, ren- dering the patient listless and forgetful, indisposed and un- 1 Esquirol, Des Malad. Ment i. 297. 33* 390 MEDICAL JURISPRUDENCE OP INSANITY. able to think for himself, yielding without any will of his own to every outward influence, and finally sinking into hopeless fatuity, or becoming incurably maniacal. Esquirol states that of three hundred and thirty-nine epileptics in the SalpetriSre, twelve were monomaniacs ; sixty-four were mani- acal, of whom thirty-four were furious ; one hundred and forty-five were imbecile or demented, of whom one hundred and twenty-nine were so only immediately after the fit ; eight were idiots ; fifty were habitually rational, but with loss of memory, exaltation of the ideas, sometimes a temporary delirium and a tendency to dementia ; sixty had no derange- ment of intellect, but were very irritable, irascible, obstinate, capricious, and eccentric. 1 380. From this statement it appears, that of the one hundred and forty-five imbecile or demented epileptics, all but sixteen were so only immediately after the fit, and that this was also the case with three of the thirty-four who were furious. This is a fact of no little importance in a medico- legal point of view, and should never be lost sight of in judicial investigations of the mental condition of epileptics. The maniacal fury of these patients is of the wildest and blindest kind which nothing can tame, the individual acting automatically as it were, and in a state of unconsciousness. It may continue for minutes, hours, or days. The dementia which is the form of mental derangement to which epileptics are most liable after the fit, is characterized by intellectual stupor and moral depression, in which, however, they have sufficient energy, under some circumstances, to commit acts of violence, of which they retain only an imperfect recollec- tion when they recover. Another direct, though temporary effect of the epileptic fit, is to leave the mind in a morbidly irritable condition, in which the slightest provocation will derange it entirely. Sometimes this irritability is accom- panied by a sense of anxiety, distrust, jealousy, and un- founded fear, and sometimes by great activity of the lower propensities. 1 Ibid, i. 284. EPILEPSY AND ITS LEGAL CONSEQUENCES. 391 381. To determine exactly the mental condition of an epileptic at the moment of his committing a criminal act, is often a difficult task. It may have taken place in the absence of any observer, in a fit of fury that rapidly passed away, and which, perhaps, may not have followed any previ- ous paroxysm ; or the accused, though subject to the disease, may not have recently suffered an attack, and may have appeared perfectly rational to those around him. The sus- picion that the accused was deprived of his moral liberty when committirfg the criminal act, would be strengthened, if the paroxysms had been recently frequent and severe ; if one had shortly preceded or succeeded the act ; if he had been habitually subject to mental irritability, or other symptoms of nervous disorder; and by those circumstances generally which would lead to the same conclusion, were the supposed disease a form of moral mania, instead of epilepsy. ( 217.) Cases of this kind should be closely scrutinized, and where the accused has been undeniably subject to epilepsy, he should have the benefit of every reasonable doubt that may arise respecting his sanity. Less than this common human- ity could not ask ; more even has sometimes been granted under the operation of milder codes than the English com- mon law. 382. In the following case, the criminal act was the' result of that morbid irritability which sometimes succeeds the paroxysms, Joachim Hoewe, twenty-nine years old, had been an epileptic since his sixth year. Since the age of puberty, the disease had become aggravated, and latterly had attacked him once in three weeks. He was long in recover- ing from the effects of the fits, being troubled with pain in the head and vertigo, and manifesting strong aversion to food, though never furious or insane. In July, 1826, after an hour's walk, he experienced a fit, and in the course of the three next days, he had several, appearing all the while to be quite unconscious, and refusing nourishment. On the third day he arose from his bed, and went down into the yard, where he met with a son of his brother ten years old, and a daughter of a relative to whom he was attached, eleven 392 MEDICAL JURISPRUDENCE OF INSANITY. years old. The boy asked him if he did not wish to eat. The patient made no reply, but struck at him, when the children ran off. He followed them, overtook the girl, knocked her down, and catching up a hatchet from the ground, frac- tured her skull in several places, when the neighbors rushed in, and, after considerable resistance, overpowered him. He now remained quiet, till they proceeded to carry him to the magistrate, when he broke out into violent expressions of" hatred against his fellow-townsmen. In prison he layed two days in a state of unconsciousness, took no nourishment, and had a fit. On the third day his reason returned ; he ex- pressed some interest in his friends, complained bitterly of his sufferings, but had no recollection of what had occurred. The question having been put to the medical expert, (by whom the case was reported,) whether the accused was in a responsible condition of mind when he committed the mur- der, it was answered in the negative, for the following reasons. Unlike real criminals, he had no definite purpose in view, and did not fly, after having committed the act. The mental condition of epileptics just before and after the fit, is usually very peculiar, and for many years, medical jurists have not been in the habit of considering an epileptic as deserving of punishment for any offence he might commit within three days before or after a fit. Among the exciting causes of his fits at the time in question, and of the criminal act, the reporter mentioned the exercise and heat of the weather to which the accused had been exposed, and the inquiry of the child whether he would eat, which, on account of his morbid aversion to food, excited him, in his uncon- scious and irritable condition, to expend his fury on the nearest object. Two months after, he died in a fit. 1 383. Epilepsy is often accompanied by imbecility, con- genital or acquired, and by disordered appetites and propen- sities. Although its immediate effect on the mind, in these cases, may not be so definite and prominent as in others, yet it is no less effectual in weakening and perverting its facul- 1 Jahn in Henke's Zeitschrift. 1827, iv. 282. EPILEPSY AND ITS LEGAL CONSEQUENCES. 393 ties. The medical jurist should preserve himself from the common error of viewing these bad propensities as indicative of a depraved and sin-loving character, instead of being the result of an abnormal condition of the nervous system. The following case from an old writer, will illustrate this form of the disorder. C. F. Oppel, sixteen years old, twice set fire to the royal stable in Saxony, once in April, and again in May, 1725. The fire was discovered before much damage was done, and the second time, he extinguished it himself. It appeared in evidence that he had always manifested a good and peaceable disposition ; that from childhood, he had always been troubled, especially in the summer time, with bleeding from the nose ; that when ten years old, he hacl an attack of scarlet fever ; and that about a year before the in- cendiary attempts, he began to suffer from epilepsy, the par- oxysms of which were light at first, but gradually increased in severity. Four weeks before the fire he had a fit, and two days after he had another, and they continued for some time to be very frequent and severe. The reasons which he him- self gave for the act were, that when he had been drinking, he felt strongly impelled to commit incendiary acts, and that on this occasion, he also hoped to save something from the fire, with which he might buy drink, instead of being obliged to ask his mother for money. It appeared that his father was an epileptic, and addicted to drinking. The physician who was directed to inquire whether the accused was in per- fect possession of his reason when he committed the offence, reported that he was not, and had been of unsound mind from childhood. The reasons offered in support of his opinion though remarkably correct for the time, will not all bear a critical examination now, and therefore it will not be worth our while to state them at length. The fact that he might have inherited a depraved constitution which was still more weakened by the accession of a severe nervous disease, is sufficient to warrant the suspicion that his mind may have been a prey to morbid impulses which, when under the influ- ence of drink, he would find it difficult to resist. The fact that, shortly before and after the offence, he had suffered 394 MEDICAL JURISPRUDENCE OF INSANITY. from epilepsy, furnishes a presumption that, however ra- tional he may have appeared, his mind was far from being in a sound and healthy condition. True, he alleged as his motive, the gratification of an appetite, but it does not ap- pear that the appetite existed till after the invasion of the epilepsy. 1 1 Troppaneger, decis. med. forens. 1735, quoted in Henke's Abhandlung, iv. 25, 2te Aufl. CHAPTER XVIII. SUICIDE. 384. AT the present day, the subject of suicide is deprived of much of the medico-legal importance which it once possessed. Still, however, as questions occasionally come up in which dispositions of property are made to de- pend on the judicial views that are formed respecting its relations to mental derangement, it is highly proper that mistakes should not be committed from a want of correct notions of its nature. With all the light on the subject which the researches of modern inquirers have elicited, many probably are yet unable to answer understandingly the ques- tion so often started, whether suicide is always or ever the result of insanity. It may be proper, therefore, to lay before the reader the present state of our knowledge on this subject, in order that he may have the materials for forming correct and well-grounded opinions respecting it. 385. To the healthy and well-balanced mind, suicide appears so strange and unaccountable a phenomenon, that many distinguished writers have inconsiderately regarded it as, in all cases, the effect of mental derangement ; while, by many others, it has, with still less reason, been viewed as always the act of a sound, rational mind. Neither of these views can be supported by an impartial consideration of all the facts, and the truth probably lies between the two ex- tremes. Suicides may be divided into two classes, founded upon the different causes or circumstances by which they are actuated. The first includes those who have deliberately committed the act from the force of moral motives alone; the second, those who have been affected with some patho- 396 MEDICAL JUKISPRUDENCE OF INSANITY. logical condition of the brain, excited or not by moral mo- tives. 386. If it be considered, that life is not the only nor per- haps the best gift we have received from the author of our be- ing, it ought not to appear strange that men should sometimes be willing to relinquish it for the sake of securing a good, or avoiding an evil. We know well enough that life is not so dear that it will not be readily sacrificed, when all that makes it worth retaining is taken away. The intrepid Roman chose rather to fall on his own sword, than survive the liber- ties of his country or live an ignominious life ; and reverses of fortune, which hurl men from the pinnacles of wealth or power, or the certain prospect of infamy and the world's scorn, are no very inadequate motives for terminating one's existence. In these cases, the person, no doubt, may act from error of judgment, and thus be guilty of foolish and stupid conduct, but we have no right to confound such error with unsoundness of mind. Inasmuch as the prospect before him may be such that it will appear to his mind more painful to live than to die, it is not to be wondered at, if, for want of courage to bear up against the ills that threaten to over- whelm him, and battle it to the last, he should prefer the latter ; for, after all, the choice might indicate less folly than that which often characterizes the conduct of men. True, the motive may seem sometimes totally inadequate to lead to such a determination, when in reality it may be the only and sufficient motive ; and this, probably, must always con- tinue to be one of the mysterious facts in our constitution, that the termination of our existence, from which we instinct- ively shrink with feelings of horror, should so often be volun- tarily hastened from the most trivial and insignificant motives. No doubt the mental disturbance is always great, but the same may be affirmed of all cases where crime is committed under the excitement of strong passions, and, therefore, is in itself no proof of insanity. It cannot be denied, however, that the cases are comparatively few in regard to which it would be safe to affirm, that the excitement of the organic action of the brain and nervous system, which accompanies SUICIDE. 397 this perturbation of mind, had not transcended the limits of health and passed into real pathological irritation. Among these few we can have no hesitation in placing the case of the pair of youths, noticed by Mrs. Trollope, who, after dining sumptuously at a fashionable restaurant at the ex- pense of their entertainer, went to their lodgings, and suffoca- ted themselves together in the same bed ; * or that of suicidal clubs, the members of which bind themselves to die by their own hands within an appointed time. Men who, with cul- tivated intellects and refined passions, entertain only the meanest conceptions of the great moral purposes of life, may be ready to terminate their existence the moment it ceases to impart its usual zest to sensual gratification. Here, self-de- struction is obviously not the effect of physical disease, but of moral depravity. But how are we to account for those in- stances of juvenile suicide so often recorded, where the dreadful propensity is excited by the most trivial causes ? Burrows speaks of a girl, but little over ten years of age, who, on being reproved for some trifling indiscretion, cried and sobbed bitterly, went up stairs and hung herself in a pair of cotton braces ; and of another, eleven years old, who drowned herself for fear of simple correction. 2 A French journal has lately reported the case of a boy twelve years old, who hung himself by fastening his handkerchief to a nail in the wall, and passing a loop of it around his neck, for no other reason, than because he had been shut up in his room and allowed only dry bread, as a punishment for breaking his father's watch. Another case is related of a boy eleven years old, who killed himself because reproved by his father ; and several more of a similar description are also recorded. 8 In these cases, the moral causes seem altogether inadequate to excite the suicidal propensity, without first producing some serious physical disturbance, for here are none of those 1 Paris and the Parisians. 2 Commentaries on Insanity, 440. 8 Medico-Chirurgical Review, N. S. xxvii. 21. 34 398 MEDICAL JDKISPRUDENCE OF INSANITY. motives for self-destruction which have just been mentioned as influencing the adult mind. 387. That suicide is often committed under the im- pulse of mental derangement, even when mental derange- ment would not otherwise have been suspected, is a doc- trine that was long since taught by some medical writers, and has been confirmed beyond the shadow of a doubt, by the researches of recent inquirers. The propensity to suicide connected with an obviously melancholy disposition, is now universally recognized as a form of monomania, for its symp- toms are plainly indicative of cerebral derangement. These patients labor under a constant melancholy, conjuring up the darkest prospects, and presaging nothing but evil fortune. They have been guilty of some sin, real or imaginary, which they believe to be of the most heinous nature, and thence- forth there is no more happiness nor comfort in the world for them. They imagine their friends are constantly watching their movements and engaged in machinations against them, or silently neglecting and despising them; at one time, morose and taciturn ; at another, uttering the most bitter complaints, weeping and traversing the room, as if in ex- treme mental anguish. If their thoughts take a religious turn, they imagine they have committed the unpardonable sin, that their prayers are rejected, that the Saviour turns away his face from their sight, and that the miseries of the damned are to be their everlasting portion. This unquiet and melancholy mood will occasionally give way to short periods of comparative cheerfulness, when the clouds seem to be breaking away, and the individual approximating to his natural character. Their nervous system is weak and irritable, the circulation is quickened, the digestion more or less impaired, the secretions, especially the biliary, more or less deficient, or vitiated, and the mind is incapable of con- tinued exertion. After this state has continued for some time, the mental derangement becomes more prominent, and the wretched victim begins to see visions and hear strange voices, and believes that he has communications from supe- SUICIDE. 399 rior beings. All this time the idea of self-destruction is fre- quently if not constantly before the mind, and unless the patient be narrowly watched, he will finally succeed, after various attempts, in accomplishing his purpose. 388. The suicidal propensity here described, is univer- sally attributed to pathological causes ; but there is, besides, a large class of cases, in which no insanity of mind or body has been observed or suspected, though we have good rea- son to believe its existence. That one may be so harassed with the ills of life, as to deem it best to rid himself at once of both, is not perhaps very strange ; but when a person, apparently in good health, and surrounded with every thing that can make life dear to him, deliberately destroys himself without any visible cause, no balancing of motives nor scru- tiny of private circumstances can satisfactorily explain it, and we are obliged to consider it as a form of partial moral mania. Within a few years past, the attention of the medi- cal profession has been directed to this subject, and their researches have abundantly established the fact, that the efficient cause is some pathological change, or physical pecu- liarity, not in every case easily defined or understood, but none the less certain on that account. 389. Sometimes this monomania is attended appa- rently by no physical or moral disorder, the individual being driven by mere impulse to self-destruction, without being able to assign any reason therefor, real or imaginary. He feels that he is urged on by an impulse he can neither account for nor resist, deplores his sad condition, and beseecrles his friends to protect him from himself. In another class of cases, some powerful physical or moral impression only is needed, to call the suicidal propensity into fatal activity. The wonderful effect of mental influences on diseases of the bodily organs, is so common a fact, that we have no rational ground for disbelieving a similar kind of agency in the pro- duction of this phenomenon. The distinguished accoucheur who attended the princess Charlotte in her fatal confinement, observed a pair of pistols in the room to which he had retired for repose, the sight of which was sufficient, to a mind 400 MEDICAL JURISPRUDENCE OF INSANITY. harassed by long and anxious attendance, and overwhelmed, as it were, by the responsibilities of his situation, to provoke a desire which he may never have felt before to die by his own hands. The case of Sir Samuel Romilly who com- mitted suicide immediately after sustaining a severe domes- tic bereavement, strongly shows how far the propensity to commit this act is beyond the control of moral principle or Christian virtue, even when, as it was with him, previously contemplated and conditionally determined upon. 390. It is a remarkable fact, that in many cases of attempted suicide, the individual, after recovery, has no re- collection, or at most, but a faint and shadowy one, of the fact itself, and believes it upon the testimony of others. And yet he may have evinced considerable forethought and ingenuity in preparing the means, and when detected in the attempt, have conversed about it calmly and pertinently. It seems to be analogous to that loss of recollection in regard to homicide, or other violent acts committed in acute mania, often evinced by patients after recovery. The fact strongly shows us what deep and serious disorder may pervade the mind, while outwardly all is calm and regular. 391. Among the features which ally the propensity to suicide with ordinary mania, is that of its hereditary dispo- sition. Dr. Gall knew several families in which the suicidal propensity prevailed through several generations. Among the cases he mentions, is the following very remarkable one. " The Sieur Ganthier, the owner of various houses built without the barriers of Paris, to be used as entrepots of goods, left seven children, and a fortune of about two millions of francs, to be divided among them. All re- mained at Paris or in the neighborhood, and preserved their patrimony ; some even increased it by commercial specu- lations. None of them met with any real misfortunes, but all enjoyed good health, a competency, and general esteem. All, however, were possessed with a rage for suicide, and all seven succumbed to it within the space of thirty or forty years. Some hanged, some drowned themselves, and others blew out their brains. One of the first two had invited six- SUICIDE. 401 teen persons to dine with him one Sunday. The company collected, the dinner was served, and the guests were at the table. The master of the house was called, but did not answer, he was found hanging in the garret. Scarcely an hour before, he was quietly giving orders to the servants, and chatting with his friends. The last, the owner of a house in the rue de Richelieu, having raised his house two stories, be- came frightened at the expense, imagined himself ruined, and was anxious to kill himself. Thrice they prevented him, but soon after, he was found dead, shot by a pistol. The estate, after all the debts were paid, amounted to three hundred thousand francs, and he might have been forty-five years old at the time of his death. " In the family of M. N. * * *, the great-grandfather, the grandfather, and the father committed suicide." 1 392. Falret, whose researches have thrown much light on this affection, believes that it is more disposed to be heredi- tary than any other kind of insanity. He saw a mother and her daughter attacked with suicidal melancholy, and the grandmother of the latter was at Charenton for the same cause. An individual, he says, committed suicide in Paris ; his brother who came to attend the funeral, cried out on seeing the body " What fatality ! My father and uncle both destroyed themselves ; my brother has imitated their exam- ple ; and twenty times during my journey hither, I thought of throwing myself into the Seine." 2 393. Gall also relates the case of a dyer of a very taciturn humor, who had five sons and a daughter. The eldest son, after being settled in a prosperous business, with a family around him, succeeded, after many attempts, in killing himself by jumping from the third story of his house. The second son who was rather taciturn, had some domestic troubles, lost part of his fortune at play, and strangled him- self at the age of thirty-five. The third threw himself from the window into his garden, but did not hurt himself ; he pretended he was trying to fly. The fourth tried one day 1 Sur les fonctions, iv. 345. 2 Sur la Hypochondria et Suicide. 34* 402 MEDICAL JURISPRUDENCE OF INSANITY. to fire a pistol down his throat, but was prevented. The fifth was of a bilious, melancholy temperament, quiet, and de- voted to business ; he and his sister showed no signs of being affected with their brother's malady. One of their cousins committed suicide. 1 394. Like other kinds of mental derangement, the suicidal propensity undergoes occasional exacerbations, from the influence of the seasons, periodical congestions, etc. The patient, perhaps, may have thrown off some of the gloom which overshadowed his mind, resumed a portion of his ordinary cheerfulness and interest in his affairs, courted the company of his friends, and thus excited strong expecta- tions of a perfect cure, when suddenly his malady breaks out afresh ; the sentiments are again perverted, the judgment disturbed, his breast torn with anguish and despair, and the utmost watchfulness is necessary to prevent him from accom- plishing his fatal designs. 395. Another trait which the suicidal propensity pos- sesses in common with some nervous diseases, though not insanity, is its disposition to prevail epidemically, as it were, in consequence of that law of our constitution, not well un- derstood, called sympathy. It is a matter of common obser- vation, that the occurrence of one case of suicide is followed, oftener than not, by one or more in the same community. In a sitting of the Academy of Medicine at Paris a few years since, it was mentioned by M. Costel that a soldier at the Hotel des Invalids having hanged himself on a post, his example was followed in a short time by twelve other in- valids, and that by removing this fatal post, the suicidal epidemic was arrested. It is related that thirteen hundred people destroyed themselves in Versailles in 1793 ; and that in, one year, 1506, sixty perished by their own hands in Rouen. 2 396. The analogies, thus presented between the suici- dal propensity and insanity or other nervous diseases in its symptoms, are also strengthened by the pathological changes 1 Op. cit. sup. iv. 350. 2 Burrows's Commentaries on Insanity, 438. SUICIDE. 403 observed after death. In the larger proportion of instances where examination is made, the brain or abdominal viscera are found to have suffered organic lesions, more or less ex- tensive, which, when confined to the latter, have affected the mind by sympathetic irritation. Even in those cases where the fatal act was preceded by no indications of dis- ease or other symptoms that excited suspicions that the individual was tired of life, dissection has often revealed the most serious disease, which must have existed for some time previous to death. True, the most careful dissection will sometimes fail of revealing the slightest deviation from the healthy structure, and it is not necessary to the support of the above views of the nature of this affection, that it always should. For here, as in mania, sometimes the pathological change may not have gone beyond its primary stage, that of simple irritation, which is not appreciable to the senses, but the existence of which we are bound to believe on the strength of the symptoms. CHAPTER XIX. LEGAL CONSEQUENCES OF SUICIDE. 397. BY the common law of England, a felo de se forfeited all chattels, real or personal, which he had in his own right, and various other property, and his will became void as to personal property. 1 Such severity has been gen- erally avoided by the almost universal practice of coroners' juries to return an inquest of insanity. At present, the fact of suicide has no other importance, than what it derives from its connection with the mental derangement which may be supposed to have given rise to it. Courts would very justly refuse to consider it as sufficient proof of insanity, in the absence of other proofs, because it might have been the act of a rational mind, and because, too, if it really had sprung from insanity, the delusion might have been so circumscribed, as not to have perverted the judgment in regard to testa- mentary dispositions and other civil acts. The principle adopted in the ecclesiastical courts is, that in cases of doubt- ful sanity, among which those of suicide must always be ranged, the validity of the individual's testament must be determined solely by the character of that instrument itself. Here is an inherent difficulty that courts will never be very anxious to encounter, and that is, to determine the exact con- nection of suicide with insanity supposing the latter to be admitted in point of time. When this act is the only proof we have of mental derangement, we are left without the means of ascertaining when this condition began to exist or to disappear, and consequently nothing can be more 1 Blackstone's Commentaries, iv. 190. LEGAL CONSEQUENCES OF SUICIDE. 405 difficult than to decide within what time, either before or after the suicidal attempt, the individual can be pronounced insane. It not uncommonly happens, that a person kills himself, or makes the attempt, shortly after making his will, when the question requires a judicial decision, whether or not the insanity which led to the fatal act existed at the time of making the will. The practice has usually been, if there were no other evidence of unsound mind, either in his con- duct or conversation, or in the testamentary dispositions them- selves, not to impeach the testator's sanity. In a certain case it was held by Sir John Nicholl, that where there was no evidence of insanity at the time of giving instructions for a will, the commission of suicide three days afterwards did not invalidate the will, by raising an inference of previous derangement. 1 Chief Justice Parker, of Massachusetts, also held that suicide committed fifteen days after the date of the person's will, was not sufficient, in the absence of other evi- dence, to prove him insane and thus invalidate the will, on account of the difficulty we have just mentioned. 2 398. Even where the suicidal act is unquestionably the effect of insanity, it does not necessarily follow that a will prepared within a short time of it, is invalid ; for it may be that the insanity was of a limited kind not involving ideas of property or relations. A gentleman made his will a few hours after an unsuccessful attempt on his life, and intrusted it to the charge of a person with the injunction that he should produce it after his death. After some months' treatment he got better, and promised never again to attempt to shorten his life. For three years he kept his promise, and showed no signs of mental derangement, but it does not appear of what 1 Burrows v. Burrows, 1 Haggard's Eccl. Reports, 109. 2 His language was, that, " even if the act itself, [suicide,] should be con- sidered as proof demonstrative that the reasoning faculty was disturbed at the time of its commission, the difficulty of ascertaining with precision the very inception of derangement, weakens its force in relation to any ante- cedent act." Brooks and others v. Barret and others, 7 Pickering's Re- ports, 94. 406 MEDICAL JURISPRUDENCE OF INSANITY. disease he died. 1 The dispositions of the will were reason- able ; but since it was undoubtedly made during the insanity of the testator, it could not be deemed valid on the principles of the common law. When we consider, however, that it was a rational act, and that the testator suffered it to remain unaltered during the three years that he was free from disease, we are bound to believe that it expressed his true, deliberate intentions ; and being such, we ought to be cautious how we adopt a principle that would have defeated them. 399. Generally, then, if the unreasonableness of the will itself raises a suspicion of the testator's sanity, the act of suicide within a short time will always be strongly confirma- tory of it, and, in connection with attending circumstances, may, in some instances, turn suspicion into conviction. There will be little danger of going wrong in any cases of this kind, if we are willing to be governed in our decisions by the principles of equity and common sense, rather than by technical distinctions and antiquated maxims. If the will be a rational act rationally done, a suicidal act or attempt ought not to invalidate it, because the presumption is, either, that the will was made before the mind became impaired, or that the derangement was of a kind that did not prevent the judgment from using its ordinary discretion in the final dis- position of property. If, on the contrary, it be an unreason- able act, and especially if it be contrary to the previously expressed intentions of the testator, then the act of suicide will be in itself strong proof, that the mind was impaired at the time of making the will. 400. It sometimes happens that two persons desirous of dying, agree to kill each other, while the plan succeeds but in part, and one survives. In this case, how is the survivor to be treated ? We do not know that any trial for this offence has ever taken place in this country or England, but in all prob- ability it would be viewed by the light of the common law, as nothing short of manslaughter. In the milder spirit of German jurisprudence, Professor Mittermaier thinks that the 1 Georget, Des Maladies Mentales, 114. LEGAL CONSEQUENCES OP SUICIDE. 407 survivor would not be a fit object of punishment ; but whether because he considers his responsibility as annulled, or that the act is not criminal, he does not state. 1 However, it cannot be denied that an agreement to commit mutual homicide, ought to be regarded as but questionable evidence of insanity, and therefore should receive no favor on that ground alone. 1 De principio imputationis alienationum mentis in jure criminali recte constituendo. p. 26. Heidi. 1838. CHAPTER XX. SOMNAMBULISM. 401. WHETHER this condition is really any thing more than a cooperation of the voluntary muscles with the thoughts which occupy the mind during sleep, is a point very far from being settled among physiologists. While to some, the exer- cise of the natural faculties alone seems to be sufficient to explain its phenomena, others have deemed it necessary to suppose, that some new and extraordinary powers of sensa- tion are concerned in its production, though unable to convey a very clear idea of their nature or mode of operation. With- out discussing this question here, our purpose will be an- swered, by inquiring how far the natural faculties are exer- cised during its continuance, and thus ascertaining, as well as may be, in what respect it differs from the sleeping and the waking states. 402. Not only is the power of locomotion enjoyed, as the etymology of the term signifies, but the voluntary mus- cles are capable of executing motions of the most delicate kind. Thus, the somnambulist will walk securely on the edge of a precipice, saddle his horse and ride off at a gallop, walk on stilts over a swollen torrent, practise airs on a musi- cal instrument ; in short, he may read, write, run, leap, climb, and swim, as well as, and sometimes even better, than when fully awake. 403. The extent, to which vision is exercised, differs in different cases. In one class of cases, it is very certain that the somnambulist does not use his eyes in the various opera- tions which he performs. Negretti, an Italian servant, whose celebrated history is related by two different physicians, would rise in his sleep, go into the dining-room, spread a SOMNAMBULISM. 409 table for dinner, and place himself behind a chair with a plate in his hand, as if waiting on his master. When in a place with which he was not perfectly acquainted, he was embarras- sed in his proceedings, and felt about him with his hands ; and sometimes he struck himself against the wall, and was severely injured. He sometimes carried about with him a candle as if to give him light, but when it was taken away and a bottle put in its place, he failed to perceive the differ- ence. 1 Galen says of himself, that he once walked about a whole night in his sleep, till awakened by stumbling against a stone which laid in his way. Here, it appears that the long continued habit of performing certain operations enabled the individual, with the aid of feeling alone, to repeat them in his sleep. 404. At other times, objects are clearly discerned, but the imagination transforms them into those with which the mind happens, at the moment, to be engaged. Thus, a som- nambulist described by Hoffman, who dreamed he was about going on a journey, strided across the sill of an open win- dow, kicking with his heels, and exerting his voice, as if he supposed himself riding on his horse. 405. In other instances again, things are done, in which vision, or an analogous power, is unquestionably exercised. Castelli, whose case which is one of the most remarkable, is related by Francesco Soave, 2 was, one night, found translat- ing Italian into French, and observed to look for the words in a dictionary. His light having gone out, he found himself in the dark, groped about for a candle, and went into the kitchen to light it. He would also get up, and go into his master's shop, and weigh out medicines for supposed cus- tomers. When some one had altered the marks which he had placed in a book he was reading, he noticed the change and was puzzled, saying, " Bel piacere di sempre togliermi i segni." Another somnambulist, a priest, whose case was pub- lished in the French Encyclopedic, would arise from his bed 1 Muratori : della forza della Fantazia Umana. 2 Biflessioni sopra il Somnambolismo. 35 410 MEDICAL JURISPRUDENCE OF INSANITY. and compose sermons, reading over every page when finished, and erasing and correcting with the utmost accuracy. On one occasion, after writing " ce divine enfant," he erased the word " divine," and wrote " adorable " over it. Perceiving that ce could not stand before the last word, he altered it to cetj by inserting after it a t. He would also write music with the greatest accuracy. 406. In another class of cases, there seems to be no reasonable ground for doubting, that the power of vision is manifested to an almost incredible extent. Jane Rider, whose curious history was published a few years since, was able, in a dark room, to make out the date of coins, the figures of which were nearly obliterated, and to read the motto of a seal which others had been unable to decipher by the light of a lamp. With her eyes covered by several folds of handkerchief, she could still read and write as if nothing intervened, and play at backgammon understandingly. 407. It appears that the eyes of somnambulists are sometimes closed while walking about, and perhaps always so when they first get up, though by one writer they are described as being sometimes half open. In some of the cases which have been alluded to, the eyes were observed to be open and staring. 408. The senses of hearing and of taste present as many different modifications as that of sight. The sound of persons' voices talking loud in his presence may be un- perceived by the somnambulist, and that of a trumpet no better heard, unless put close to his ears ; in other cases, very faint sounds may be heard at considerable distances. Negretti did not distinguish between strongly seasoned cabbage, and some salad he had prepared. He drank water instead of wine which he had asked for, and snuffed ground coffee instead of snuff. By other somnambulists, however, such deceptions have been instantly detected. Generally, som- nambulists take but little notice of what is passing around them, unless it is naturally connected with the subject of their thoughts, or specially obtruded on their attention ; and then the perceptions will be associated more or less cohe- SOMNAMBULISM. 411 rently with their thoughts. Jane Rider would take part in the conversation, and never mistake the nature of outward objects ; while others have been no less accurate and acute in some of their remarks, though unconscious of the presence of other persons. These facts show a strong analogy between somnambulism and dreaming. It is well known that a per- son, who will hear and reply to questions addressed to him relative to the subject he is dreaming about, may not notice nor be aware of loud sounds made near him. The differ- ence in the sensorial powers of different somnambulists, probably indicates merely a difference in the degree to which this peculiar condition is carried. Where it is but little removed from that of ordinary dreaming, the sense of feeling alone, in a limited measure, is added to the locomotive power ; when still farther removed, the senses of sight and hearing come into play, though but partially exercised ; and when displayed to its utmost extent, they enjoy a range and nicety of perception, not witnessed in the ordinary state, and hardly explicable in the present state of our knowledge. 409. There is another form of this affection, called ecstasis or cataleptic somnambulism, from its being conjoined with a kind of catalepsy, in which the walking and other active employments are replaced by what appears to be a deep, quiet sleep, while the patient converses with fluency and spirit, and exercises the mental faculties with activity and acuteness. Both in this and the former kind, the person generally loses all recollection of whatever transpires during the paroxysms, though it may be revived in a subsequent paroxysm. In some cases that have been related, the mem- ory during the paroxysms embraced only the thoughts and occurrences of those periods ; those of the lucid intervals being as entirely forgotten, as those of the paroxysms were, after they had subsided. 410. It now scarcely admits of a doubt, that somnam- bulism results from some morbid condition in the system, involving, primarily or secondarily, the cerebral organism. We see that its lighter forms are but a slight modification of dreaming, which is universally admitted to be very much 412 MEDICAL JURISPRUDENCE OF INSANITY. influenced by the state of the corporeal functions, and which in certain disorders, is produced in a very troublesome degree. The analogy of ecstasis to hysteria and epilepsy with which it is often conjoined, is too strong to escape the most cursory observation, not merely in its phenomena, but in its curability by the use of remedial means. Indeed, these affections are known to pass into each other by fre- quent and rapid transitions, and to possess a strong common relation to insanity. The attacks of cataleptic somnambu- lism are invariably preceded by derangements of the general health, in females, of the uterine functions especially, and their recurrence is prevented by the methods of treat- ment, which are found most successful in those affections with which it is pathologically related. The more active forms of sleep-walking, seldom, if ever exist, except in con- nection with those habits or conditions that deteriorate the general health. Intemperate drinking is said to be among the causes that produce it; and an observer of Negretti's case attributed the disorder to his immoderate fondness of wine. A plethoric condition of the vessels of the head is also a strong predisposing cause of it ; and in proof of this, Muratori relates that he was assured by a physician, that nothing but having his hair cut off once in a couple of months, saved him from being a somnambulist. Its heredi- tary character, which, like the same trait in insanity, we may fairly conclude depends on morbid conditions, also indicates its physical origin ; and the same inference may be drawn from the influence of age and sex in its production. The cataleptic form of the disorder appears chiefly in females before the last critical period ; while the other is as much con- fined to males, in whom it mostly appears in childhood and the early periods of manhood, seldom in old age. 411. In the somnambulist, either the perceptive organs are inordinately excited, and thus he is led to mistake in- ward for outward sensations ; or the perceptions, if correct, are misapprehended by some obliquity of the reflective powers ; in some instances probably, both these events take place. He talks, moves, and acts, unconscious of his real SOMNAMBULISM. 413 condition, and of nearly all his external relations. The ideal images that are brought before the mind are mingled and confounded with the real objects of sense, and the con- duct is regulated accordingly. Psychologically considered, then, somnambulism appears to be not very remote from mania, the difference consisting in some circumstances con- nected with the causes that give rise to the derangement of the faculties. In the latter, the pathological affection of the brain is continuous ; in the former, it appears only during sleep, by which its effects are greatly modified. When the maniac finds himself restored to health, he looks on the period of his derangement as on a dream crowded with gro- tesque images, heterogeneous associations, and ever-changing scenes. So the somnambulist, on awaking, is conscious only of having been in a dream, the events of which have left a more or less vivid impression on his memory. 412. In somnambulism, as well as in mania, intellect- ual powers are sometimes evinced, that are altogether un- known in the waking state. Jane Rider would sing cor- rectly, though she had never learned to sing, nor been known to sing when awake, and would play at backgammon with considerable skill, though she had never learned the game in the waking state. She also exhibited a power of imitating the manners and language of people, while she had never evinced the slightest trace of this power when awake. 413. Like the maniac, too, the sleep-walker's senti- ments and propensities are often included in the same circle of morbid action, in which the operations of the under- standing are involved. The case of a Carthusian monk is related, who, while awake, was remarkable for his sim- plicity, candor, and probity ; but unfortunately, almost every night walkecj in his sleep, and like the fabled Penelope, undid all the good actions for which he was so celebrated by day. On such occasions, he was a thief, a robber, and a plunderer of the dead. A case of a pious clergyman is somewhere described, who in his fits of somnambulism would steal and secrete whatever he could lay his hands upon, and on one occasion, he even plundered his own 35* 414 MEDICAL JURISPRUDENCE OF INSANITY. church. In a case of somnambulism which occurred a few years since in Maine, there was a strong disposition to com- mit suicide. The paroxysms appeared every night, and watchers were required, as if the somnambulist had been laboring under an acute disease. He always attempted to escape from his keepers, and having succeeded one night, an outcry was heard from a neighboring pasture, and he was found suspended by a rope from the limb of a high tree. Fortunately, he had attached the rope to his feet instead of his neck, and consequently was but little injured. CHAPTER XXI. LEGAL CONSEQUENCES OF SOMNAMBULISM. 414. SOMNAMBULISM may sometimes incapacitate a person from the proper performance of the duties and en- gagements of his situation, and then unquestionably it may impair the validity of contracts and other civil acts to which he is a party. By rendering him troublesome, mischievous, and even dangerous, it furnishes good ground for annulling contracts of service, whether it existed previously and was concealed, or had made its appearance at a later date. Whether it should be considered a sufficient defence of breach of promise of marriage, or a valid reason for divorce when concealed from one of the parties previous to the marriage, are questions which do not properly admit of a general answer. Since its evils may be in some, of the lightest, in others, of the most serious description, each par- ticular case ought, in justice, to be decided solely on its own merits, reference being had to the amount of injury as com- pared with the magnitude of the obligation sought to be avoided. If studiously concealed or denied, when its avowal would have undoubtedly prevented the other party from entering into a contract, the latter ought to be enabled to set aside his own obligations on the ground of fraud. 415. As the somnambulist does not enjoy the free and rational exercise of his understanding, and is more or less unconscious of his outward relations, none of his acts dur- ing the paroxysms, can rightfully be imputed to him as crimes. HofFbauer places him on the same footing with one who labors under hallucinations, except that the former is not fully excused, if, knowing his infirmity, he has not 416 MEDICAL JURISPRUDENCE OF INSANITY. taken every possible means to prevent injurious consequences to others. Both law and equity, too, would undoubtedly hold him liable, as they would the maniac, for injury com- mitted to the property of others, though as to what extent this power would be exercised, we have no means of form- ing an opinion. Hoffbauer suggests as a reason for not re- garding the criminal actions of the somnambulist with too much indulgence, that they have probably originated, if not in premeditation, at least in the deep and deliberate attention which the mind has given to the subject when awake. This is, no doubt, the case in many instances, p,nd if men were to be punished for their meditations, the suggestion would be not without its weight ; but as such is not the law, it is not very obvious how this fact can affect the legal conse- quences of somnambulism. Fodere*, too, comes to the con- clusion that the acts of a/ somnambulist, instead of resulting from mental delusion, are more independent than any others, because they are the free and unconstrained expression of his waking thoughts and designs, and therefore that they are not altogether excusable. He seems to have forgotten that by no human law are men responsible for their secret thoughts, but only for their words and acts. To these only does it look, and if they are found to have proceeded from a mind not in the full possession of its powers, they must be excused without the slightest reference to the former. And as it cannot be denied that they are sometimes excited by unfounded delusions that have no affinity with the natural character and purposes of the individual, every sentiment of justice cries out against ever regarding them in a criminal light. Georget quotes from an anonymous work a curious instance of somnambulism in a monk, which was related to the author by the prior of the convent who witnessed it him- self. Late one evening, this somnambulist entered the room of the prior, his eyes open but fixed, his features contracted into a frown, and with a knife in his hand. He walked straight up to the bed, as if to ascertain if the prior were there, and then gave three stabs which penetrated the bed- clothes and a mat which served the purpose of a mattress. LEGAL CONSEQUENCES OF SOMNAMBULISM. 417 He then returned, his features relaxed, and an air of satis- faction on his countenance. The next day, the prior asked him what he had dreamed about the preceding night. The* monk confessed, that having dreamed that his mother had been murdered by the prior, and that her spirit had appeared to him and cried for vengeance, he was transported with fury at the sight, and ran directly to stab her assassin. Shortly after, he awoke, covered with perspiration, and re- joiced to find that it was only a dream. 1 A similar case is also related of two individuals who, finding themselves out over night in a place infested with robbers, one engaged to watch while the other slept, but the former, falling asleep and dreaming of being pursued, shot his friend through the heart. 1 Des Maladies Mentales, 127. CHAPTER XXII SIMULATED SOMNAMBULISM. 416. THIS disorder may be simulated, first, by those who have, at other times, really experienced its attacks; secondly, by those who have not at any time. The motive may be, either to do something which the individual would not otherwise dare to attempt, or to avoid the punishment of an action which is alleged to have been committed in one of its paroxysms. The difference, however, in the difficulty of proof, is not so great, as at first sight might be appre- hended ; for, since the mind is generally unconscious of what passes during the paroxysm, the somnambulist possesses but little advantage over others, from his experience, in feigning this affection. He will be no less at fault in respect to those little traits which mark the difference between the real and feigned attacks, as well as the more important phenomena. When, however, it is admitted that the person has been sub- ject to its attacks, this fact certainly furnishes a presumption of its reality in doubtful cases, which diminishes the strength of the evidence which the alleged case requires. 417. When the feigned paroxysm is witnessed by others who are capable of describing minutely what they saw, a comparison of his conversation and acts with those observed in real paroxysms, may furnish us with a clew to the true nature of the act imputed to him ; for it is scarcely possible that, if feigning, he will not be caught tripping in some of his manoeuvres. A curious case is quoted by Hoffbauer from an old writer, where nothing was wanting but a tole- rable knowledge of the state of the mental faculties in som- nambulism, to expose the deception. An old ropemaker SIMULATED SOMNAMBULISM 419 frequently fell into a profound sleep in the midst of his oc- cupation, whether sitting or standing, or walking in the street, when he would begin to repeat, by means of words and. gestures, every thing he had been doing during the day, from his prayer in the morning till the very moment of his falling asleep. If taken while walking abroad, he would pursue his course just as if he had been awake, avoiding persons and things which might harm him. The story was related as one of. genuine somnambulism, though there were two circum- stances in it sufficient to have exposed the deception. In the first place, to repeat the transactions of the day in this man- ner, is contrary to what we know of somnambulists who do only what they have premeditated, or what has strongly engaged their attention. Secondly, this man acted a double, and consequently a deceptive part. He first repeated what he had done during the day, and then went on with what he was in the act of doing when the paroxysm took him. The ruse was finally discovered. The man professed himself cured, as soon as a physician charged with examining his case proposed to bandage his eyes, to see if he would then be able to perform those actions which had excited so much surprise. No doubt can remain of the genuineness of the attack, if the person perform feats which he would not dare to do when awake, unless which would hardly be possible he has systematically concealed his skill and abilities ; the converse of the proposition, however, cannot be equally true. It will also be a strong confirmation of the evidence in favor of its reality, if the physical symptoms we have mentioned, as sometimes attending the somnambulic disposition, are shown to have been present. But it generally happens that the somnambulist walks unwitnessed, and must rest the proof of his mental condition on his own testimony and the cir- cumstances of the case. The full burden of proof mani- festly devolves on him, and if he fail of establishing it satis- factorily, he must suffer the consequence. There can be no other rule ; for once acquit a criminal on the score of som- nambulism which is imperfectly or at best but plausibly proved, and it will soon become a favorite excuse for crime, whenever 420 MEDICAL JURISPRUDENCE OF INSANITY. the offender possesses the requisite address for maintaining the deception. Among the proofs, however, necessary to establish this defence, a prominent place should be claimed for those drawn from the nature of the criminal act itself. If this be manifestly contrary to the known character and disposition of the accused, and especially if it can be shown that he could have entertained no motive for injuring the other party, but little else beyond a straight story and an open air of sincerity ought to be required to establish the truth of his own assertions. CHAPTER XXIII. EFFECT OF INSANITY ON EVIDENCE. 418. THE insane are disqualified by law 1 from appear- ing as witnesses in courts of justice, their incompetence being inferred from their mental unsoundness. The fact of incompetence to testify, however, is not necessarily connected with that of insanity, and it would be far more correct to consider the former an independent fact to be established by a distinct order of proofs. The truth is, an analogy, in a medico-legal sense, has been too hastily assumed, between the act of testifying, and that of performing business con- tracts or other civil acts, and, in consequence, it has shared with them in the same sentence of disqualification, without an attempt to ascertain the kind and degree of intellectual power which they respectively require. The practice of including them in the same category, is certainly not favored by the present state of our knowledge of insanity, nor does it approve itself to the common sense of mankind. To see what foundation in nature this rule of law really has, we shall proceed to inquire how far the competency of a witness is actually impaired by the different forms of insanity. 419. According to Hoffbauer, before a witness can be deemed competent, it is necessary that his senses should be sufficiently sound to take cognizance of the facts to which he testifies ; that their impressions should have been really what he believes they were ; that his testimony should coincide with his belief; and lastly, that he should be able to convey to others his own ideas, without fear of being misinterpreted. i Thomas's Coke's Littleton, 489; Livingston v. Keirsted, 10 Johnson's Reports, 362. 36 422 MEDICAL JURISPRUDENCE OF INSANITY. These conditions, it may be added, constitute the capacity of a witness, and wherever they are present, his evidence should be received, without agitating the question of his mental unsoundness which is not absolutely incompatible with their existence. 1 420. The higher degrees of imbecility must of course disqualify a witness, but its less aggravated forms may not, under all circumstances, have this effect. His senses may-be acute enough to see and to hear what he deposes to ; no illusions may obtrude and mingle with their impressions ; and his memory may be retentive enough, provided too long a space of time do not intervene between the occurrence of the facts and his deposition concerning them, to bear them in mind till revealed by judicial investigation. The facts to which he testifies must be of the simplest kind, requiring the smallest perceptive effort to seize and appreciate, and so intelligible to the meanest understanding, that the memory can easily retain them. If the details are too numerous and complicated, and especially if they include words or actions not familiar with or analogous to his own ordinary experi- ence ; or if they happened at too remote a period, they become confused and entangled in his mind, and many of them fade from it altogether, while some important members of the series may not have been attended to at all. Hence, the evidence of imbeciles may present many a contradiction and hiatus of which they may be perfectly unconscious them- selves, and which it would be wrong to attribute to inten- tional omissions, or a wish to deceive. If we bear in mind, too, that these persons are easily embarrassed, it might naturally be expected that the presence of spectators, the perplexing questions of counsel, and the formalities of a trial, would so disorder their ideas, as to make their testi- 1 The third condition above-mentioned, may not at first sight appear to be connected with capacity ; but if the reader will refer to the observations ( 165) on a class of people, who, in consequence of some natural defect or organic disease, are incapable of telling the truth, even when most conducive to their own interests,, he will be convinced of the propriety of placing it in this connection. . EFFECT OF INSANITY ON EVIDENCE. 423 mony appear to those unacquainted with their mental defi- ciency, like the most impudent trifling or downright men- dacity. The more, however, the witness is permitted to tell his story in his own way, and finds encouragement in the looks of those around him, the less of this will be observed. The class described in ( 62,) are competent to testify in matters of a more complicated kind, requiring a larger grasp of the reflective faculties to embrace, and more tenacity ot memory to retain them, but, like the others, they are very liable to be disconcerted by the questions of strangers, and, in con- sequence, betrayed into numerous contradictions of their own testimony. Since, then, the competency of these imbe- ciles is well established, nothing can be clearer than the pro- priety of admitting their evidence, and leaving it for the jury to decide upon its credibility. 421. In partial intellectual mania the capacity of testify- ing under certain circumstances and with certain reservations, is still preserved, though considerable knowledge of the case, and extreme caution are requisite to measure the witness's credibility. In regard to the greater proportion of cases, the only doubt is respecting the second and third conditions of capacity ( 419,) no question being raised as to the presence of the others ; that is, whether the witness has really seen, heard, etc., what he believes he saw and heard, and whether his testimony coincides with his belief. That he may offer in evidence the offspring of a disordered imagination, sin- cerely believing it to have come under the cognizance of his own senses, is undoubtedly true ; but no less so, however, that he may testify only to what has come under his own observation. Which of these events does actually take place, is a question to be settled by reference to the nature of the evidence and the character of the witness's insanity. When the matter on which he testifies, is remote from the insane delusion which he entertains, and cannot very obvi- ously come within the circle of its influence, it would be wrong to reject his testimony on the score of incompetency. When we see these monomaniacs rational on every topic but that which constitutes their derangement, shrewd and me- 424 MEDICAL JURISPRUDENCE OF INSANITY. thodical in the transaction of business, quick to perceive and able to profit by whatever appears conducive to their interests, trusted and respected by their neighbors, it seems more difficult to disprove than to prove then- competency. The power of remembering and telling correctly what they have seen or heard, requires no more strength or soundness of mind, than numberless other duties that nobody doubts their ability to perform. Even on topics connected with their insane belief, their capacity is not necessarily destroyed, and in doubtful cases it would seem better to receive their evi- dence, and leave it for the court or counsel to disprove its credibility. At the very least, the burden of proof should lie on the party that allege the incompetence. Even while the predominant idea is highly false and absurd, they may, and very often do, reason upon it with force and correctness, their deductions being sound and their reflections appropriate. Indeed, this mixture of the rational and the irrational, this inability to discern the relations of congruity between the true and the false, constitutes one of the most characteristic features of madness. Hence, it would not be unnatural for them to see things in some way connected with the delusion, in most of their relations, in their true light ; and of this fact we should certainly avail ourselves in deciding on the admis- sion of their evidence. The man who believes that he is charged by government with the regulation of the weather, may, notwithstanding, observe meteorological changes, and testify accurately concerning the state of the weather at a particular time perhaps no one more so ; and he who believes that he has made an immense fortune by a com- mercial speculation, may talk sensibly on mercantile interests and be perfect master of the price-current, and thus be com- petent to testify on any matter connected with the same, that has come under his observation. The credibility of such witnesses, however, depends very much on the importance of the subject on which they testify, and on the relations of their evidence to that of other witnesses. When they cor- roborate the statements of other witnesses, they may justly challenge our belief, while we should very properly hesitate EFFECT OF INSANITY ON EVIDENCE. 425 to decide upon any great interests of person or property, solely upon the ground of their testimony. 422. The reported cases where the competence of witnesses was destroyed by reason of insanity, are too few to render it very apparent how far the following represents the ordinary practice of American courts. It strikingly illus- trates the effect of a rigid adherence to the common-law maxim, that the insane are incapable of testifying, and, therefore, may be properly introduced in this place. In May, 1833, Jacob Schwartz was tried, at a term of the supreme court for the county of Lincoln, in Maine, on an indictment for assaulting, with intent to kill, Jonathan Jones. Jones himself was the principal witness, and he stated that he went into Schwartz's house for the purpose of conversing on re- ligious subjects with his wife who was also Jones's sister ; that Schwartz who had often forbidden him to do so, follow- ed him into the house, drove him out, seized his gun, and threatened to shoot him ; that he then ran several rods, occasionally looking back at Schwartz who stood in his door-way presenting his gun, as if in the act of firing; that Schwartz finally fired and hit him, several shot lodging in his hat and coat, and a few penetrating into the skin of his back, from which they were taken out by some persons in a house to which he immediately ran. The transaction was witnessed by no one besides Jones. By other witnesses it was testified, that Jones ran into the house where they were, exclaiming that Schwartz had shot him, and that they assisted in taking the shot out of the skin. Thus far his testimony was rational and consistent, and his manner calm and composed. On being cross-examined by the defend- ant's counsel who had some knowledge of his case, he tes- tified, that he used to work on a piece of land which he owned, but that feeling himself called to exhort sinners to repentance, he went about, in imitation of Christ and the apostles, preaching the gospel and exhorting sinners to for- sake their evil ways. He declared himself to be an apostle, and inspired by the Holy Ghost; also, that he was one of the saints who are to judge the world, and that he should 36* 426 MEDICAL JURISPRUDENCE OF INSANITY. bear a part in the judgment of the great day. On this sub- ject he dilated largely and incoherently, his countenance being animated, and his language and manner ardent and impassioned. Other witnesses having testified that in his domiciliary visits he had sometimes represented himself to be the Lord Jesus Christ, he was examined on this point. Here he was not very explicit, and did not seem disposed to make a full disclosure, as, he said, he could not perceive its connection with the question at issue. He did not expressly deny, however, that he so considered himself, but seemed disposed to leave it to be inferred from particular things in which he resembled Jesus Christ, as in his poverty, in his going about to do good, and in the persecution he suffered. The jury, not thinking it safe to convict the defendant on Jones's testimony, acquitted him, and the court signified its approval of the verdict. 423. If the testimony of Jones had stood alone, un- supported by confirmatory circumstances, no fault could be reasonably found with this verdict. It would have been sufficient for the jury to know that he was laboring under extensive delusions, with which the alleged criminal act was not very remotely connected in his mind, to be justified in shrinking from the responsibility of depriving another, on his testimony, of his good name, and subjecting him to legal punishment. Of the two evils, that of convicting on insuf- ficient evidence, and that of suffering a guilty person to escape a few years' imprisonment, they would not have been liable to blame, for choosing to incur the risk of that which they considered the least. The circumstances of this case, how- ever, being very different from what is here supposed, might we riot have reasonably expected a different verdict ? That Jones was assaulted at, or very near the time alleged, could not be doubted for a moment, and his exclamation, as he entered the house with the appearance of sudden fright, that Schwartz had shot him, and his coming in the direction from Schwartz's house, strongly authenticated his statement, that the assault was committed by Schwartz, so strongly in- deed, that in the absence of any conflicting evidence on the EFFECT OF INSANITY ON EVIDENCE. 427 part of the defendant, it was entitled to implicit belief. Such a scene might, no doubt, hav6 been got up by a sane person, for the purpose of gratifying some malignant feelings ; but men, affected with the kind of insanity under which Jones was laboring, rarely, if ever, contrive such schemes. It was a circumstance, too, which should have had its weight, that in relating the facts of the assault, he was calm and consist- ent, and that it was only when touching on the subject of his delusions, that he was excited and incoherent. His insanity was not of the kind which would deprive him of the second condition of capacity to testify ( 419,) and it is the third only, in regard to which there could have existed any reason- able doubts ; and these were obviated more or less satisfac- torily, by the above-mentioned circumstances. 1 424. In a case which lately came before the court of sessions in New York, the principle we have contended for was adopted by the court. A gentleman by the name of Gracie labored under the delusion that various persons to him unknown, were entertaining designs against his life, and he had spent much money in attempting to discover the conspirators. Taking advantage of this delusion, a couple of rogues obtained money of him at different times, under pretence of aiding him in his researches, for which practices they were finally indicted. On trial, their counsel resisted the admission of Mr. Grade's testimony, on the ground of monomania; but the court decided that this objection applied only to his credibility, not to his competency. 2 425. The view here taken of. the competence of some monomaniacs, as witnesses, is not without some support in the legal profession. " Of an insane person," says Mr. Evans, " it might, for defect of other evidence, merit to be considered, whether, in civil cases at least, the testimony of such might not be admissible upon points where his under- standing did nof appear to be subject to disturbance ; it be- 1 For the facts of the above case, the author is Indebted to the kindness of J. G. Reed, Esq., of Waldoborough, Me., who was the defendant's counsel. 2 'Boston Semi- weekly Advertiser, July 15, 1843. 428 MEDICAL JURISPRUDENCE OF INSANITY. ing well known that in many of these melancholy instances, especially when the result of some violent passion, the party affected is entirely cool, clear, and collected in his ideas, and as free as other persons from the delusions of a perverted imagination, in every thing not connected with the cause of his insanity ; with regard to persons who have only tem- porary fits of madness, (those usually termed lunacy,) and at other times are in all respects sound of reason, these are then considered as. capable of testimony as of any other legal act." 1 426. If the evidence of the monomaniacs in question, be rejected, it must be from a fear of deception ; and proba- bly, most of the distrust manifested towards such witnesses arises from a lurking suspicion, that their mental impair- ment is necessarily accompanied with impaired veracity. It cannot be denied that there is some ground for this sus- picion, and though it should not have the effect of totally invalidating their testimony, it is proper to bear it in mind whenever their credibility is in question. It is well known how prone the inmates of lunatic asylums are to complain of the servants, the overseers, and one another, and prefer against them special charges that are without any founda- tion whatever ; whether from an involuntary propensity to lying and mischief, or from a morbidly exalted imagination, which distorts and discolors its perceptions, it is not easy to decide. Some, however, will relate very accurately what they see and hear, and their statements are received with implicit credit. On the whole, we may conclude with Georget, " that it is necessary to know the patient, the character of his madness, his customary relations to sur- rounding objects, before we can know what degree of confi- dence to place in his assertions." It should not be forgotten, also, that in the greater proportion of cases of mental de- rangement, there is a weakness of memor/ that prevents it from retaining impressions so long and so faithfully, as when in its sound condition ; and, therefore, the facts to which a 1 Pothier on Obligations, Appendix, 259. EFFECT OF INSANITY ON EVIDENCE. 429 monomaniac testifies, should always be of recent occurrence, to render his testimony at all credible. 427. Since the second edition of this work was pub- lished, a case (Regina v. Hill) has been decided in England, sustaining the above views, by implication, at least, in all their length and breadth, and a little more. The considera- tions which induced the court thus to reverse what seemed to be a well-settled principle, had reference, less to the nature and degree of the witness's mental impairment, than certain technicalities of legal procedure. As the case is destined, no doubt, to be a leading one on this point, it will be proper to notice it here. Hill, it seems, was an attendant in a private asylum, and was committed on a charge of manslaughter, for causing the death of one of the patients, by violent ill- treatment. At the trial before the central criminal court, London, the principal witness relied upon by the govern- ment, was Donelly, also a patient in the asylum. In reply to the inquiries of the prisoner's counsel, before being sworn, he stated that he had within him twenty thousand spirits, but they were not all his ; that his ascended from his stomach to his head and ears ; that they spoke to him incessantly and were speaking to him at that moment ; that they were im- mortal and would live after he was in his grave ; that they came from various directions and from various persons, some from the Queen who frequently visited him. He believed that after death, his spirit would ascend to heaven or remain in purgatory. He said he understood the meaning of an oath, having learned from his catechism, in infancy, that it was lawful to swear for God's honor and his neigh- bor's good. He considered an oath as an obligation im- posed upon men for the good of the law, and that if he took a false oath, he would go to hell to all eternity. He was then sworn, and gave a perfectly connected and rational account of the abuse inflicted by the prisoner on the deceased, and which was supposed to have led to the death of the latter. He thought it occurred on a Monday, but the spirits told him that it was on Tuesday. The incidents of the transaction were not told him by the spirits, but witnessed 430 MEDICAL JURISPRUDENCE OP INSANITY. by himself. The jury returned a verdict of guilty, but the case was reserved, in order that the opinions of the full bench might be taken, on the competence of Donelly. On the 3d of May, 1851, the chief justice, Lord Campbell, delivered the opinion of the court, unanimously sustaining the decision of the judge at the trial. He declared " the proper rule to be, for the judge, at the time the party is produced as a witness, to examine him "whether he understands the nature of an oath, and say whether he considers him a competent witness, and then leave it to the jury to estimate the value of his testimony. He may be cross-examined as to the state of his mind, and witnesses may be called to prove that his mind was so diseased that no reliance can be placed upon his statements ; but in the absence of evidence to discredit his testimony, it would be competent for the jury to hear what he said, and to act upon it." 428. It will be observed that the question made by the court in this case, was, whether the witness was capable, notwithstanding his disease, of comprehending the nature of an oath ; not whether his disease necessarily incapacitated him from giving testimony. The latter consideration was regarded as affecting his credibility alone ; and how far it had this effect, was a point for the jury to decide. Instead of the four conditions of competency indicated by Hoff bauer (419,) all having direct reference to the object in view, the court here insists upon only one, and that very remotely con- nected with this object. This, certainly, is to disregard old maxims and enlarge the competency of the insane to testify, to an extent hardly warranted by our knowledge of insanity. Many an insane person who could perfectly understand the nature of an oath, as well as any other abstract question in morals or religion, would be utterly unreliable as a witness of things which had come under his own observation. None but those who are practically conversant with the insane, can have an adequate conception of their liability, both to receive erroneous impressions from what passes around them, and to falsify what they really and correctly perceive. After habits of the closest intimacy with the insane, continued through EFFECT OF INSANITY ON EVIDENCE. 431 many years, we are led to the conclusion that those who con- verse so correctly and shrewdly with the transient visitor, and never forget the common observances of life, are scarcely more capable of reporting what they see and hear, than those who cannot utter a single coherent sentence. The most cir- cumscribed delusions, after having existed for a considerable time, are generally accompanied by a mental condition in which the most ordinary impressions are very imperfectly perceived. It would be difficult to characterize precisely the deficiency in question, because it differs, probably, in different individuals. It would seem as if in some, the im- pression were mingled with and distorted by the delusion, while in others, it does not receive the degree of attention necessary for fixing it firmly and clearly in the mind. Thus, without the least disposition to deceive, their statements are apt to be wide of the truth. In that other class of the insane, also, whose disorder is characterized by mental excitement and impropriety of conduct, while they entertain no delu- sions whatever, the competence to testify is completely annulled by an irresistible propensity to exaggerate and color, and frequently to lie without limitation or scruple. Now it is hardly a satisfactory answer to these objections, to say that these traits of the insane would be duly considered by the jury when brought to their notice, and that the only difference between us, is, that in one case it is the judge, and the other the jury, that decides the question of competency. The evidence, if coherently and plausibly given, will leave an impression upon the jury, though experts may testify that the witness is not reliable, and the instructions, of the court may imply the same opinion. It does not appear that the credibility of the witness in the present case, was impeached in the slightest degree, while, on the other hand, a physician and some other witnesses thought him capable of giving a correct account of any transaction he may have observed. All this may have been quite correct, and the punishment of the offender well merited, but unless the physician were familiarly acquainted with the witness, his opinion ought not 432 MEDICAL JURISPRUDENCE OF INSANITY. to have affected the general presumption against the evidence of this class of patients. 429. It may not be out of place to notice one of the reasons offered by the court for admitting the testimony of Donelly, viz., that under a different rule, patients in asylums would be at the mercy of their attendants. It is quite as obvious that under the rule of the court, the attendants would be at the mercy of the patients ; and if this were clearly un- derstood, the most respectable and trust-worthy attendants in our asylums, would seek some other calling immediately. 430. Another consideration upon which the court relied, ought not to be passed over in silence, because it evinces a mistake not unfrequent among persons who have no profes- sional knowledge of the subject. A rule which would ex- clude this witness, said the court, merely because he thought he had twenty thousand spirits, would equally have excluded Socrates who believed that a spirit always haunted him. If there were to be no distinction between a gross delusion admitted to be the offspring of disease, and a notion which, however opposed to the general belief of mankind, is the deliberate deduction of an acute and healthy mind, then, cer- tainly, the reductio ad absurdum would be fairly made out. But where is the warrant for disregarding a distinction which the world has always made ? In one instance, the witness is deemed to be incompetent, because laboring under a mental disease which is indicated by strong delusions as well as by other traits of character ; in the other, the witness is admit- ted because of the unquestioned soundness of his mind, as evinced by its ordinary manifestations, though accompanied by a notion which may be extravagant but not absurd. In short, the two cases are separated by all the difference between health and disease, which, however difficult to be discerned sometimes, is obvious enough between Socrates and Donelly. 1 431. In the subjects of general mania, all competence to testify is lost, except during what is called the lucid inter- 1 15 Jurist, 470. Law Reporter, N. S. iv. 141. American Journal of In- sanity, vii. 386. EFFECT OF INSANITY ON EVIDENCE. 433 val, when they may testify in regard to transactions that oc- curred during a lucid interval, or at a time previous to their illness. Their evidence should be implicitly received, only when it relates to simple facts easily perceived, for their in- tellect may be hardly strong enough to bring to mind and expose in order, a complicated mass of details. 432. In partial moral mania, there is nothing to inca- pacitate one from testifying, unless we except that kind of it where the individual labors under an uncontrollable pro- pensity for lying. Of all the forms of mania, this really diminishes competence more than any other, but it will be long, probably, before it will be considered in this light, in courts of justice. 433. In general moral mania, it has been seen that the intellectual powers are not perceptibly impaired, and that the patient loses none of his interest in what passes around him, nor of his power to observe and remember them with ordinary distinctness. Under such circumstances, there would be little reason for rejecting his evidence on the score of incapacity. Considering, however, the great derangement of the affective powers under which he labors, and the un- founded likes and dislikes which it produces, his veracity may be justly suspected, and his evidence should be entitled to little weight, except when limited to facts in regard to which it can be shown that his feelings are not interested. 434. The competence of old men in the early stages of dementia to testify, is a point frequently discussed in courts of justice, and the want is severely felt, of some fixed princi- ples that shall serve as a guide to correct decisions. In every stage of this affection, the impairment of the memory is more perceptible in regard to recent than remote impres- sions, and it often happens that a person may have a distinct recollection of things that occurred in his youth, while those of a month's or a year's date, are but imperfectly remembered, if at all. To test the strength of his memory respecting cer- tain things, it is only necessary to ascertain if he remembers various other transactions of about the same date, in which he is known to have been engaged. If he can do this, it is 37 434 MEDICAL JURISPRUDENCE OF INSANITY. a strong presumption in favor of his competency ; if not, it is incumbent on the party offering his testimony to show why his memory should have been more faithful in the one case than in the other. This is rendered still more necessary by the fact, that the weakness of mind incident to this con- dition makes its subjects more easily swayed by the sug- gestions of others, and leads them to believe that they re- member what they are told they ought to remember, or what they are assured they actually did remember till within a recent period. The slightest examination will show how much dependence can be placed on their recollections of recent events. CHAPTER XXIV. DRUNKENNESS. 435. BEFORE we can properly appreciate the legal consequences of drunkenness, it is necessary to understand its immediate and remote effects on the mind, and the organism with which it is connected. Correct information of this kind will enable us to avoid many of the prevalent errors that have arisen from vague and imperfect notions respecting the nature of drunkenness. We shall first con- sider the symptoms, or immediate effects, of free indulgence in intoxicating drinks ; for the following account of which we are chiefly indebted to Hoffbauer and Macnish. 1 436. The first effect of alcoholic liquors is to exalt the general sentiment of self-satisfaction, and diffuse an unusual serenity over the mind. The intellectual as well as physical powers act with increased vigor and activity, the thoughts flow with more facility and accuracy, and the individual becomes perfectly well pleased with himself and others. He feels an exhilaration of spirits, a sense of warmth and gaiety, and his imagination is crowded with delightful images. The sight and hearing are very slightly affected ; a low, humming sound is heard in the pauses of the conversation ; and objects are enveloped in a slight mist which prevents them from being seen distinctly. Thus far there is no appearance of drunkenness. Soon the torrent of his ideas becomes more rapid and violent, and he can scarcely repress them. This is the moment of his happiest sallies, and he pours forth his thoughts with a force of expression and a richness of concep- 1 Anatomy of Drunkenness. 436 MEDICAL JURISPRUDENCE OF INSANITY. tion unknown in his sober hours, and now he feels the ecstatic pleasures of getting drunk. As yet the brain is in tolerable order, though a great effort is necessary to relate a story or transaction at ah" complicated in its details, for the thoughts succeed one another too rapidly, to allow sufficient time to arrange them in the order that the recital requires. This is the first well-marked symptom of intoxication. Now his ideas succeed one another with constantly increasing force and rapidity ; his sensations lose their ordinary delicacy ; and his imagination gains as fast as they lose. His language is, in some respects, more oratorical and poetical, and though he now feels an irresistible propensity to talk nonsense, he is perfectly conscious, all the while, that it is nonsense. His voice is louder, because he hears less acutely, and judges of the hearing of others by his own. Now the organic activity of the brain is at its height. His imagination is filled with strange and queer images, and he is conscious, if so it may be called, of a sense of oppression and giddiness in his head. His perceptions of color, form, distance, and number become utterly confused ; he confounds one person with another ; the candles burn all colors in succession, and are multiplied fourfold ; and in stretching forth his glass to set it on the table, he lets it go before reaching its edge. He is apt to imagine, either that he has offended some one, and shows a ludicrous anxiety to apologize, or that he has been offended, and fixes upon some one as the object of his maledictions, per- haps his blows. Judging from his discourse, his ideas begin to want connection, notwithstanding their vivacity, but this vivacity and rapidity of his ideas give to his passions an insur- mountable power, against which reason has nothing to oppose, and unless some accident divert him from their object, he is hurried on wherever they impel him. Soon his tongue stammers and his voice gets thick ; his legs falter ; he falls from his seat ; and is plunged into a profound sleep, in which the manifestation of his physical and intellectual powers is completely extinguished. In this condition, he is said to be dead drunk. Such is the ordinary course of a fit of drunk- enness, but it sometimes varies, more or less, with the tern- DRUNKENNESS. 437 perament or habits of the individual, and the attending cir- \ cumstances. 437. Such is the immediate effect of drunkenness on the mind ; we have now to show how the long-continued and excessive use of alcoholic liquors affects the moral and intellectual powers. Except in some happily-organized na- tures, the original delicacy and acuteness of the moral percep- tions are invariably blunted ; the relations of neighbor, citizen, father, spouse, have lost their accustomed place in his thoughts ; great moral interests no longer obtain a strong hold on his attention ; the voice of distress is apt to fall on his ear like an unmeaning sound ; and the finer emotions of the soul, which will occasionally be felt by the least culti- vated minds, have entirely deserted his nature. The injury sustained by the intellect is more obvious, if not more deplorable. The course of the ideas is sluggish, and they want their former force and brilliancy ; the mind has lost its comprehensiveness of grasp, and experiences a difficulty in seizing the relations of one idea to another ; it is incapable of the long-continued efforts which were once easy, and of i concentrating the whole force of its faculties on the subjects submitted to its examination. In consequence, too, of the . brain having been so much accustomed to artificial stimulus, according to a well-known law of the animal economy, it \ ' becomes incapable of an effort without the aid of this stim- ulus, which is necessary to the performance of even its most ordinary exercise. Drinking is thus made an indispensable habit, and by this means, it sometimes happens that the tame, > cold, and lifeless being, as if touched by a spark of Prome- j thean fire, is converted into the animated, sociable, and ! efficient man of his better days. Sheridan never spoke in the House of Commons without the inspiration of half a pint of brandy ; and numberless are the heroes of the buskin and the sock, who require to be wound up, as it were, to a certain pitch, by artificial stimulus, before they venture to undertake the labors of the night. / 438. This account of the pathological effects of drunk- j enness would be incomplete, without some mention of that j ) 37* 438 MEDICAL JURISPRUDENCE OF INSANITY. curious disease to which it often leads, called delirium, tre- mens, or mania a potu. It may be the immediate effect of an excess, or series of excesses, in those who are not habitually intemperate, as well as in those who are ; but it most com- monly occurs in habitual drinkers, after a few days of total abstinence from spirituous liquors. It is also very liable to occur in this latter class when laboring under other diseases, or severe external injuries, that give rise to any degree of constitutional disturbance. The approach of the disease is generally indicated by a slight tremor and faltering" of the hands and lower extremities, a tremulousness of the voice, a certain restlessness and sense of anxiety which the patient knows not how to describe or account for, disturbed sleep, and impaired appetite. These symptoms having continued two or three days, at the end of which time they have obvi- ously increased in severity, the patient ceases to sleep alto- gether, and soon becomes delirious. At first, the delirium is not constant, the mind wandering during the night, but, dur- ing the day, when its attention is fixed, capable of rational discourse. It is not long, however, before it becomes con- stant, and constitutes the most prominent feature of the dis- V ease. Occasionally, the delirium occurs at an earlier period I of the disease, and may even be the first symptom of any / disorder. This state of watchfulness and delirium continues l /three or four days, when, if the patient recover, it is suc- ( ceeded by sleep which, at first, appears in uneasy and irregular naps, and, lastly, in long, sound, and refreshing slumbers. When sleep does not supervene about this period, the disease is fatal ; and whether subjected to medical treat- ment, or left to itself, neither its symptoms nor duration are materially modified. 439. The character of the delirium in this disease is peculiar, bearing a stronger resemblance than any other form of mental derangement, to dreaming. It would seem as 1 if the dreams which disturb and harass the mind during the i/ imperfect sleep that precedes the explosion of the disease, I continue to occupy it when awake, being then viewed as unrealities, instead of dreams. The patient imagines himself, DRUNKENNESS. 439 I for instance, to be in some peculiar situation, or engaged in certain occupations, according to each individual's habits( and profession, and his discourse and conduct are con- formed to this delusion, with this striking peculiarity, how- ever, that he is thwarted at every step, and is constantly meeting with obstacles that defy his utmost efforts to re- move. Almost invariably, the patient manifests, more or less, feelings of suspicion and fear, laboring under continual apprehension of being made the victim of sinister designs and practices. He imagines that certain people have con- spired to rob or murder him, and insists that he can hear them in an adjoining apartment, arranging their plans and preparing to rush into his room ; or that he is in a strange place, where he is forcibly detained and prevented from go- ing to his own home. One of the most common hallucina- tions is, to be constantly seeing devils, snakes, vermin, and all manner of unclean things around him and about him, and filling every nook and corner of his apartment. The extreme terror which these delusions often inspire, produces in the conntenance an unutterable expression of anguish, and, in the hope of escaping from his fancied tormentors, the wretched patient endeavors to cut his throat, or jump from the window. Under the influence of these terrible apprehensions, he sometimes murders his wife or attendant whom his disordered imagination identifies with his ene- mies, though he is generally tractable and not inclined to be mischievous. After perpetrating an act of this kind, he gene- rally gives some illusive reason for his conduct, rejoices in his success, and expresses his regret at not having done it before. So complete and obvious is the mental derangement in this disease, so entirely are the thoughts and actions gov- erned by the most unfounded and absurd delusions, that if any form of insanity should absolve from criminal respon- sibility, this certainly should have that effect. 440. Before being able to decide the question under- standingly, of the relation of drunkenness to moral agency, it is necessary to proceed one step farther in this investiga- tion, and inquire into the pathological, or, as it is technically 440 MEDICAL JURISPRUDENCE OF INSANITY. called, the proximate cause of drunkenness. No impres- sions, whether from within or without, can affect the mind, but through the brain. In drunkenness, therefore, it is this organ which is principally affected, and that portion of it more particularly which is connected with the manifestation of the moral and intellectual powers. The vital actions of which it is the seat, receive an increased share of activity, so that every process that goes on, is conducted with fresh energy and speed. Drunkenness, however, depends on some- thing more than mere increase of cerebral action, because it varies, in some degree, with the nature of the intoxicating agent, but what this specific action is exactly, it is impossi- sible for us to know. As the fit proceeds, this increase of action continues, until it arrives at such a pitch, that the organ is unable to perform its functions properly ; hence, the disor- der and tumult of mind that attend the last stages of the fit. The torpor and exhaustion that follow, are the natural con- sequence of the previous excessive stimulation, and the one is generally proportioned to the other. This increased action that takes place in drunkenness, degenerates, after frequent repetition, into a permanent state of irritation which, at last, becomes real inflammation. The coats of the vessels are thickened and less transparent than usual, and, in some places, they assume a varicose appearance. The cerebral texture is less delicate and elastic, becoming either unnaturally hard, or soft. Slight effusions of water are not uncommon. These appearances, to a more or less extent, are found in the brains of nearly all confirmed drunkards, and it may be now con- sidered a well-established fact, that the habitual drunkard has always more or less of cerebral disease. 441. Obviously as these pathological changes are the effect of a long-continued voluntary habit, there is strong evidence in favor of the idea that they, in turn, become efficient causes, and act powerfully in maintaining this habit, even in spite of the resistance of the will. So deplorably common has drunkenness been in this country, that there are few who have not seen the melancholy spectacle of the most powerful motives, the most solemn promises and reso- DRUNKENNESS. 441 lutions, a constant sense of shame and danger, bodily pain and chastisements, the prayers and supplications of friend- ship, of as little avail in reforming the drunkard, as they would be in averting an attack of fever or consumption. With a full knowledge of the dreadful consequences to for- tune, character, and family, he plunges on in his mad career, deploring, it may be, with unutterable agony of spirit, the resistless impulse by which he is mastered. Macnish re- lates the case of a young man of fortune, twenty-six years old, which presents an impressive illustration of this truth. " Every morning before breakfast," he says, " he drank a bottle of brandy; another he consumed between breakfast and dinner, and a third, shortly before going to bed. Inde- pendently of this, he indulged in wine and whatever liquor came within his reach. Even during the hours usually ap- propriated to sleep, the same system was pursued brandy being placed at the bed-side for his use in the night time. To this destructive vice he had been addicted since his six- teenth year ; and it had gone on increasing from day to day till it had acquired its then alarming and incredible mag- nitude. In vain did he try to resist the insidious poison. With the perfect consciousness that he was destroying him- self, and with every desire to struggle against the insatiable cravings of his diseased appetite, he found it utterly impossi- ble to offer the slightest opposition to them." * Another, whose case he quotes, replied to the remonstrances of his friend, who painted the distresses of his family, the loss of his business and character, and the ruin of his health, " my good friend, your remarks are just ; they are indeed too true ; but I can no longer resist temptation. If a bottle of brandy stood at one hand, and the pit of hell yawned at the other, and I were convinced that I would be pushed in as sure as I took one glass, I could not refrain. You are very kind ; I ought to be grateful for so many kind, good friends, but you may spare yourselves the trouble of trying to reform me ; the thing is out of the question." 2 1 Anatomy of Drunkenness, 163. * Idem, 162. 442 MEDICAL JURISPRUDENCE OF INSANITY. 442. These phenomena strongly remind us of some of the manifestations of moral mania, and if farther evidence is necessary to convince us that they are both connected with similar pathological conditions, it is abundantly furnished in some other phenomena of drunkenness. It is now well understood that this vice sometimes assumes a periodical character, persons indulging in the greatest excesses peri- odically, who are perfectly sober during the intervals which may continue from a month to a year. From a state of complete sobriety, they suddenly lapse into the most un- bounded indulgence in stimulating drinks, and nothing but absolute confinement can restrain them. Macnish who saw several cases, says that they " seemed to be quite aware of the uncontrollable nature of their passion, and proceeded sys- tematically, confining themselves to their room, and procur- ing a large quantity of ardent spirits. As soon as this was done, they commenced and drank to excess till vomiting en- sued, and the stomach absolutely refused to receive another drop of liquor. This state may last a few days or &. few weeks, according to constitutional strength, or the rapidity with which the libations are poured down. So soon as the stomach rejects every thing that is swallowed, and severe sickness comes on, the fit ceases. From that moment re- covery takes place, and his former fondness for liquor is suc- ceeded by aversion or disgust. This gains such an ascen- dency over him, that he abstains religiously from it for weeks, or months, or even for a year, as the case may be. During this interval he leads a life of the most exemplary temperance, drinking nothing but cold water, and probably shunning every society where he is likely to be exposed to indulgence." * 443. Esquirol has distinctly recognized this disorder, 2 both in its continued and periodical form, under the name of dipsomania; and attributing it to the influence of patho- logical changes, considers its unhappy victims as not morally responsible. This distinguished observer of mental affections 1 Op. cit. 36. 2 Note in Hoffbauer, 195, and Maladies men tales, ii. 80. DRUNKENNESS. 443 affirms, that " sometimes the abuse of intoxicating drinks and drunkenness are the first symptoms, or rather the most prominent symptoms, of the first stages of madness;" that/ "the stomach being in that peculiar condition which pro- duces an extremely painful, moral, and physical depression, craves strong drink ; " that " this craving is imperious and irresistible ; " that " it continues as long as the paroxysm, after which the patient becomes sober and assumes all the habits of a temperate life." He also says, that these people " obey/ 7 an impulse which they have not the power of resisting ; that they are " true monomaniacs ; " and that if carefully observed, we shah 1 find in them " all the characterictic features of par- tial madness." In illustration of his views he relates the fol-/ lowing case. " M. N., a merchant, aged about forty, of a robust but nervous constitution, became, six years before, towards the beginning of autumn, gloomy and disquieted, in consequence, apparently, of some reverses in his affairs. After a few weeks, he neglected his business, and became irritable and ill-tempered in his family. His taste and habits changed ; he took to drinking, and seriously endangered the safety of his fortune and his family. The prayers and tears of his wife and children, the authority of his father, and the inroads upon his property, were equally unavailing in check- ing his career. Thus passed the winter ; at the approach of spring, the craving for drink ceased. M. N. resumed his regular and sober habits, and by his application to business and increased tenderness towards his family, he endeavored to forget the occurrences of the past winter. In the follow- ing autumn there appeared the same phenomenon, the same disorders, and the same spontaneous cure in the spring. It was the same for the two following years, except that the symptoms were so aggravated, that his property suffered severely, and his wife's life was sometimes endangered. At the end of his fourth paroxysm, in 1817, M. N. came to Paris to consult me and submit to my directions, conjuring me to deliver him from a disease that rendered him the most mise- rable of men." Esquirol subjected him to a course of medi- cal treatment, and in August sent him off on a journey into 444 MEDICAL JURISPRUDENCE OF INSANITY. Italy. That year he escaped, except that in December he manifested a slight desire to drink, but found himself able to resist, and never afterwards had a return of his complaint. He also relates the case of a lady who, after being melan- choly for six weeks, with weakness of the stomach, and indis- position to take the least exercise, was suddenly seized with the strongest craving for spirituous drinks, together with sleeplessness, agitation, disturbance of mind, and perversion of the aifections. For six years, these symptoms made their appearance annually, and continued two months. 444. A case is related of a Parisian bookbinder, sixty years old, who for fifteen years was afflicted with periodical drunkenness, having previously been a model of sobriety and virtue. The paroxysm lasted two or three months with an interval of equal duration. M. Pierquin, the narrator of the case, observed him closely for the space of two years, and found that his daily habit was, to rise at five or six o'clock in the morning, take some money out of the till, and hasten to the nearest cabaret, where he would drink incessantly, until ten or eleven o'clock. He would then stagger home, go down into his cellar, bring up some large bottles of wine, and drink night and day, seldom sleeping, and very rarely eating. During the early period of the attack, he would go to the cabaret, forenoon and afternoon ; but during the last eighteen or twenty days, he never went from home. Then he became reserved, passionate, avoiding the light, and seek- ing the darkest corner of the kitchen. He was never observed to be delirious, nor deranged in mind, but would answer questions correctly, and follow the train of conversation. The paroxysm ended in a profound sleep, from which he would awake in his sober senses, and resume his avocations as if he had just quitted them the preceding evening, being unconscious, or pretending to be so, of any thing that had occurred. 1 445. It can scarcely be doubted that the above cases originated in pathological changes ; and there is also another 1 Journal des Progress, etc. xi. DRUNKENNESS. 44f class of cases which strongly point to the same origin, and present a close affinity, both in this respect, and in that of their symptoms. In the cases referred to, the persons, who are habitually sober, are irresistibly impelled to indulge in the reckless, unlimited use of intoxicating drinks, whenever agitated by strong moral emotions. The author was once acquainted with a very amiable, intelligent, and virtuous young seaman, who, by means of strict attention to his duties, his staid deportment, and his knowledge of navigation, rose to the command of a ship, at a very early age. During his second voyage as captain, while in a foreign port, in a hot climate, some circumstances occurred, which subjected him to considerable fatigue and exposure and great anxiety of mind, and seriously affected his health. By this and some other things which took place ori the passage home, his mind was so disturbed, that this young man who hardly knew the taste of ardent spirits, suddenly abandoned himself to the wildest excesses. The fit continued till within a few days of their arrival at port, during which time he was totally uncon- scious of what was going on, and the first officer took charge of the vessel. The same ^cenes again occurred the next voyage, and he lost his employment ; but with these two exceptions, no man living practised more rigid abstinence from every kind of intoxicating drink. Nothing could tempt him to the slightest indulgence, and he evinced the strongest repugnance to all spirituous liquors of whatever kind. The author also knew another young man of similar character, who rose in a similar manner to the command of a ship ; but no sooner did he reach this reward of his merits, than he began to drink with all the recklessness of an old toper. As soon as he was degraded to an inferior station, no man could be more temperate, and this appearance of reform each time encouraging his friends with the hope, that he had aban- doned his bad habits altogether, they would restore him to the station he had lost, to be again and again forfeited by his mad propensity. In these cases, it seems as if the anx- iety arising from a sense of heavy responsibility, and from adverse circumstances, produced an irritation, if not inflam- 38 446 MEDICAL JURISPRUDENCE OP INSANITY. mation of some portion of the brain, of that which, if phrenology be true, is connected with the appetite of hun- ger and thirst. 446. Esquirol mentions the case of a servant girl in the Salpe"triere, who, upon the slightest cross or contradiction, began and continued to drink until prevented by strict seclu- sion. If not prevented in time, she got drunk, became furi- ous, and attempted suicide. 1 447. Marc observes that dipsomania sometimes occurs in women at the turn of life, as it is called, as a result of the important physiological changes which, at that period, take place in the female constitution. He has met with many examples of it in women who previously had exhibited all the virtues of their sex, and especially temperance. 2 1 Des Maladies Mentales, ii. 73. 2 De la folie, etc. ii. 605. CHAPTER XXV. LEGAL CONSEQUENCES OF DRUNKENNESS. 448. BEFORE we undertake to estimate the legal re- sponsibilities of drunkards, it will be necessary to retrace our steps for a moment, in order to ascertain what is the exact state of the mind while under the immediate influence of intoxicating drinks ; and for this purpose we shall dis- tinguish, with Hoffbauer, three degrees or periods of drunk- enness. In the first degree, to use in some measure the language of this writer, the ideas are only uncommonly vivacious ; consequently the empire of the understanding over the actions is so little weakened, that the individual perfectly retains the consciousness of his external condition, and in fact may be said to be in complete possession of his senses. Still this rapid flow of ideas is unfavorable to reflec- tion, and there also accompany it great irritability, and ac- tivity of the moral emotions. It must be remembered, how- ever, that anger is more rare in this degree of drunkenness, in consequence of the self-satisfaction which the person enjoys, and which renders him more patient ; but, on the other hand, some previous circumstances that may have increased his susceptibility, even the sallies of a wild gaiety, or a simple dispute of words, though conducted with cour- tesy, strongly dispose him to transports of passion. Still, as long as drunkenness does not exceed the first degree, the passions can be repressed. In the second degree of drunk- enness a man has still the use of his senses, though they are remarkably enfeebled; but he is entirely beside himself, memory and judgment having abandoned him. He acts as if he lived only for the present, with no idea of the consequences 448 MEDICAL JURISPRUDENCE OF INSANITY. of his actions, nor their relations to one another. The past has gone from his mind, and he cannot be influenced by considerations which he no longer remembers. He conducts himself as if no control over his actions were necessary. The slightest provocation is sufficient to awaken the most un- bounded rage. He is, therefore, not unlike the maniac, and can be responsible for his actions only so far as he is for his drunkenness. In the last degree, he not only loses the pos- session of his reason, but his senses are so enfeebled, that he is no longer conscious of his external relations. In this condition he is more dangerous to himself than to others. 449. In the first stage of drunkenness, it is obvious that the legal relations of the individual cannot be affected, inasmuch as he has lost none of the ordinary soundness of his judgment. In the second and third stages, so much is the soundness of his understanding and clearness of his per- ceptions impaired, and his passions excited, that he acts more or less unconsciously and without deliberation. But since drunkenness is itself a sin, it becomes a question, how far a person's liability for the consequences of his acts in that state, can be affected by a condition which is itself utterly inexcusable. 450. The common law of England has shown but little disposition to afford relief from any of the immediate con- sequences of drunkenness, either in civil or criminal cases. It has never considered mere drunkenness alone a sufficient reason for invalidating a deed or agreement, except when carried to that excessive degree which deprives the party of all consciousness of what he is doing. Courts of equity, also, have strenuously refused their relief in moderate drunk- enness, unless it were procured by the contrivance of the other party, or were made the means of obtaining some unfair advantge. 1 The general doctrine to be derived from modern English decisions is, first, that moderate drunken- ness does not necessarily deprive the mind of the power of rational consent, is not always apparent to others, and ought 1 Story, Commentaries on Equity, 1, 232. LEGAL CONSEQUENCES OF DRUNKENNESS. 449 not, of itself, to avoid any deed or contract ; secondly, that inasmuch as excessive drunkenness deprives a person, more or less, of the consciousness of what he is doing, and is perfectly obvious to every one, all acts executed while in this condition may be avoided at law on the ground of in- competency, and in equity, on that of fraud. Nothing, cer- tainly, can be fairer than this, since it equally guards the interests of the drunken party, and of those who deal with him. In this country, the English practice has been fol- lowed, 1 and in France the courts have been governed by similar views. 2 Writers on natural and public law have regarded drunkenness under any circumstances, as a sufficient cause for avoiding any acts that may have been executed under its influence, upon the principle that the free and deliberate consent of the understanding is essential to the validity of such acts. 8 451. It is the legal relations of drunkenness in regard to criminal aqts, however, which more particularly require our attention. A remarkable diversity of views has pre- vailed on this point at different times and among different nations, and it would certainly be a curious, if not useful inquiry, to investigate the peculiar circumstances that have given rise to it. Respecting the principles and practice of the ancient Greeks on this subject, we know but little more than that Solon condemned to death a drunken Archon ; and that by a law of Pittacus, he who committed a crime when drunk, was to receive a double punishment, one for the crime itself, another for the drunkenness in consequence of which it was committed. 4 The Roman law contains no general provision on the subject, but in practice it had the effect of depriving a criminal act of the quality of malicious intention, and thus lessening the amount of punishment. 5 1 Amer. Jurist, xxL 6. 2 Pothier, Traite des Oblig. by Evans, 26. 3 Puffendorf, Law of Nat. and Nat. ch. 4, 8. * Bruning's Compend. antiquatat. graecar. C. 2, p. 20. 5 Mittermaier, Effect of Drunkenness upon criminal responsibility. Amer. Jurist, xxiii. For the following notices of the law of Germany on this sub- 38* 450 MEDICAL JURISPRUDENCE OF INSANITY. In the canon, imperial, and common criminal law of Ger- many, drunkenness was viewed as a ground of extenuation, and in the sixteenth century, writers began- to distinguish its various kinds, and discriminate between their legal conse- quences. Excessive drunkenness was regarded as exempting from the punishment of dolus, intentional injury, though not from that of culpa, fault ; unless it were intentional, or pre- ceded by a consciousness that it might lead to crime, in which case it was to have no exculpatory effect. When not so severe as to deprive the subject of the use of reason, it was to receive no consideration. These views, which gradu- ally determined the German practice, prevailed also in the practice of Italy, Spain, Portugal, Holland, and the Nether- lands. 452. Modern legislation, in Germany, remains true to the old practice on the subject of drunkenness. In the Aus- trian code of 1803, 2, lit. c, it is made a ground of exculpa- tion from responsibility, when not produced with a view of committing the crime. In the Prussian Landrecht, p. ii. tit. 20, 22, it is intimated, that a criminal act, committed in a state of drunkenness which originates in fault, is punishable for the fault only ; and a case has been mentioned, where a man who killed his child in a drunken fit, was punished by only one year's imprisonment. In the Bavarian code, art. 121, "inculpable disorder of the senses, or of the under- standing," which includes drunkenness, is mentioned as one of the grounds that exempt from responsibility. But if it be intentional, and for the purpose of committing the crime, the code expressly declares, art. 40, that it shall be no ground of exculpation. In the revised project of the Bavarian code of 1827, art. 67, the above-quoted language is retained, with the exception of the word " inculpable." The Hanover project, art. 99, contains the words of the code, with the following additional clause, " namely, in cases of the highest degree ject, we are also indebted to this article, in which the subject of drunkenness in connection with crime, is amply and ably discussed in the spirit of a learned and enlightened jurisprudence. LEGAL CONSEQUENCES OF DRUNKENNESS. 451 of inculpable drunkenness." Drunkenness is also mentioned generally as a ground of extenuation, art. 109. The Zurich project of 1829, art. 159, declares that one who commits a crime, in a state of inculpable drunkenness of the highest degree, is punishable in the same manner as if he were under legal age. 453. Very different from this has been the legislation of France," England, and Scotland, into which these milder views of the legal consequences of drunkenness have never been suffered to enter. In France, an ordinance of Francis I. declares that it shall not in any case absolve from the ordi- nary punishment of crime. In the present penal code of that country, drunkenness is not mentioned, expressly or by implication, as a ground of exculpation. Accordingly in 1837, the court of cassation, which is the highest in the king- dom and receives appeals from all other courts, formally decided that drunkenness being a voluntary and reprehensi- ble state, could never constitute a legal or moral excuse. Many eminent French jurists, however, have lamented the deficiencies of the code on this subject, and contended for the introduction of milder principles. It has even been con- tended that the penal code, art. 64, which declares insanity, without distinction of any kind, to be a ground of entire ex- culpation, would justify the admission of drunkenness which produces a temporary insanity, among the grounds of exten- uation. Within a few years, juries have availed themselves of the suggestion, although in affording relief in the only way they could, that is, acquitting the accused altogether, they have certainly gone too far. In the case of J. M. Erion, mentioned by Georget, 1 who was tried for an assault on his mother, he being intoxicated at the time, the verdict of the jury was, that he was guilty, but acted involuntarily. Con- sequently, he was discharged in virtue of the 364th art. of the code of criminal instruction, viz. : " The court will discharge the accused if the act for which he is indicted is not pro- 1 Discussion medicolegale, 23. 452 MEDICAL JURISPRUDENCE OP INSANITY. hibited by any penal law." 1 In another case, the jury returned that the accused "was guilty, but acted without discernment and without will." 2 454. In England drunkenness has never been admitted as a ground of extenuation for any offences committed under its influence. " A drunkard who is voluntarius demo, hath no privilege thereby," said a learned^ expounder of the com- mon law; "whatever ill or hurt he doth, his drunkenness doth aggravate it." 8 It is not strictly true, however, that drunkenness is an aggravating circumstance when attending the commission of real offences. It may be said more cor- rectly, that it has no legal effect whatever, on any offence which it accompanies ; it neither modifies its nature, nor increases its penalties. Nothing can be farther from the spirit of English jurisprudence than the idea that drunken- ness, unless produced by force or fraud, should afford any relief from the ordinary consequences of crime. Owing to the exclusive influence of this spirit, few are able to contem- plate the milder views that have prevailed in some parts of Europe, with any other than feelings of deep distrust and aversion. The inevitable consequence thereof, it is alleged, is to increase the temptations to crime, and to obliterate some of the most important distinctions of morality. To one who comes to the examination of this subject with an unbiased and inquiring mind, it certainly is not very obvio.us 1 The apparent want of connection between the discharge of the accused and the provisions of this article, is to be explained by a difference of pro- cedure in French and English courts. The former, unlike the latter, permit the jury in criminal as well as civil cases, to render a special verdict, and accordingly they found Erion guilty of the assault, but that having " acted involuntarily, he was guilty of no crime" and was entitled to a discharge from the court, as much as if he had been found by the same verdict, guilty of the assault, but deranged, and not acting voluntarily. The law makes no man responsible for' an involuntary act, and drunkenness is not recognized as a circumstance that deprives acts of this quality, which are committed under its influence. 2 Gazette des Tribunaux, 1828, nr. 839. 3 Thomas's Coke's Littleton, 46. LEGAL CONSEQUENCES OP DRUNKENNESS. 453 how the views in question lead only to mischief. The ap- prehension that men would intentionally make themselves drunk for the purpose of committing a crime with impunity, has hardly the shadow of a foundation. In the first place, the existence of the previous intention is liable to be de- tected ; and again, if the accused be successful in concealing it, and his plea is admitted, still, at the very least, the pen- alty would probably be severe, for the drunkenness is merely a ground of exculpation. We do not apprehend, therefore, that men would abandon the ordinary method of committing crime, in secrecy and silence, for one that is sure to be fol- lowed by severe punishment perhaps the very punishment they would avoid. 455. While we are far from believing that these milder views manifest too much indulgence to drunkenness, we have no hesitation in saying that English jurisprudence has erred most widely in the other direction. The whole theory of the English law in regard to drunkenness, is founded on the fallacy, that because the act of drinking is voluntary, the person is responsible for whatever actions it may lead him to commit. An act that unintentionally leads to the commission of crime, is thus confounded with such as are deliberately designed to have this effect, the distinction being utterly overlooked between what the law calls culpa and dolus, fault and intentional injury or crime. It is difficult to conceive why such a confusion of moral and legal distinctions should be not overlooked but actually acknowledged and de- fended, even at the present day. An essential element of crime is the previous intention, and unless the criminal act be accompanied by wrong intention, the author thereof is regarded by the laws of all civilized people, and even by the English law, except in a few instances, as guilty of culpa, not of dolus. We are not satisfied that there should be an ex- ception to this principle, in the case of drunkenness. If a person who enters a stable with a lighted candle not proper- ly protected, and carelessly drops it into a hay-mow, where- by the building is destroyed, is not deemed guilty of arson, 454 MEDICAL JURISPRUDENCE OF INSANITY. no more should one who, in a fit of drunkenness, kills a fel- low being without any previous intention so to do, be deem- ed guilty of murder. True, the fault of drunkenness is far greater than that of carelessness, and consequently should be punished with proportionate severity ; but the difference is one merely of degree. The doctrine of the common law would have a shadow of support, if drunkenness were really a crime of some magnitude ; but it is not so regarded by the laws of England, and in most parts of this country it is no crime at all. The free, unembarrassed use of the reasoning powers is essential to responsibility ; but while the contrary condition of these powers in insanity absolves its subjects from the legal consequences of crime, it is not permitted to have the same effect when produced and accompanied by drunkenness. It does not seem to be a sufficient reason for this distinction, that in the latter case, the loss of moral lib- erty is the voluntary act of the party, while in the former it is the effect of disease. In the first place, the only object which the drunkard has in view, is animal enjoyment ; for the loss of his reason, though a certain result, is not the mo- tive for his indulgence ; and, secondly, the very insanity which is admitted in excuse for crime, may be, as in a very large proportion of cases it really is, the result of habits of drunk- enness in which the party has voluntarily persisted. Where the moral guilt is very nearly, if not precisely equal, it seems unjust that the legal consequences should differ so widely, as they do in regard to criminal acts according as they are com- mitted under the influence of drunkenness, or of that insanity which may be one of its direct results. 456. Drunkenness, in reference to its moral and legal character, may be divided into three kinds, dolous or crimi- nal, culpable and inculpable. Bearing these distinctions in mind, we shall be able to arrive at more accurate notions in regard to the effect which this condition should produce on criminal responsibility. Dolous drunkenness is that which is deliberately produced for the purpose of committing a crime while under its influence, and is generally regarded LEGAL CONSEQUENCES OF DRUNKENNESS. 455 as affording no relief from the ordinary punishment of that crime. Drunkenness is culpable when, though knowingly produced, it is accompanied by no previous criminal inten- tion. Of course there must be various degrees of culpability, and the amount of punishment they severally require, must be determined by the circumstances of the case. The English law, however, as has been already observed, does not admit this kind of drunkenness as a ground of extenua- tion, though it would seem to be incompatible with one crime at least with which drunkards are often charged, that of murder, as denned by legal authorities. If, previous to the drunken fit, there were no design nor malice, which is essential to murder, we are obliged to suppose that they arose in the mind after it had been brought under the influ- ence of drunkenness. But a mind which has lost the perfect use of its reasoning powers, cannot, without an unwarranted abuse of language, be deemed guilty of originating the feel- ing of malice. Lawyers have occasionally suspected that it is going too far to attribute malice to a mind under the influ- ence of drunkenness, but their doubts have never been suffer- ed to affect their practice. In a case where the defendant was tried for murder committe4 in a fit of intoxication, and where the circumstances precluded the idea of previous in- tention, it was suggested by the court, as worthy the con- sideration of the jury, that, " as drunkenness clouds the understanding and excites passion, it may be evidence of passion only, and of want of malice and design." : It scarcely needs to be added that the accused was convicted of murder ; or that an eminent jurist in commenting on the opinion of the court, should characterize it as " rather refined and hazardous speculation." 2 Juries, however, both in this country and England, are beginning to think otherwise. Thomas, lately tried in New Hampshire, for the same offence committed while drunk, was found guilty of murder in the second degree. 3 In some recent trials in England, the court 1 Pennsylvania v. McFall, Addison's Rep. 257. 2 American Jurist, xxi. 7. * 3 Zion's Herald, April 14, 1841. 456 MEDICAL JURISPRUDENCE OP INSANITY. held that the fact of drunkenness had an important bearing on the question of intention. 1 457. Inculpable drunkenness is that which occurs without any fault in the party, and consequently renders him irresponsible for whatever acts he may commit, while under its influence. The common law recognizes but two ways in which it can be produced, viz., by " the unskilful- ness of the physician, or the contrivance of enemies." 2 It appears to us, that it may also be produced in at least two other ways ; by the party's having drank no more liquor than he had habitually taken without being intoxicated, but which, from some cause unknown to him at the time, was much stronger than usual; or which, without any change in its quantity or quality, exerts an unusually potent effect on the brain, in consequence of certain pathological conditions. This latter kind of inculpable drunkenness, is not an uncom- mon occasion of crime, but in English and American courts, it has never, that I am aware of, been admitted in exten- uation of punishment. The following passage contains in a few words, the spirit of the law on this subject. " There are many men, soldiers, who have been severely wounded, in the head especially, who well know that excess makes them mad ; but if such persons wilfully deprive themselves of reason, they ought not to be excused one crime by the voluntary perpetration of another." 8 It is not very obvious how that can be properly called a crime, which may not be once mentioned in the statute-book ; nor, if it be a crime, why in the absence of any legislative enactment on the sub- ject, it should be visited with capital punishment, as it virtu- ally is when it leads to a capital crime. In the following cases, we have instances of this kind of drunkenness, and a practical illustration of the spirit in which they are regarded. 458. William M'Donough was tried and convicted, on 1 Reg. v. Cruse, 8 Carrington and Payne, 546. Law Times, Sept. 27, 1845. p. 542. 2 Russell on Crimes, 8. 8 Paris and Fonblanque, Medical Jurisprudence, iii. LEGAL CONSEQUENCES OF DRUNKENNESS. 457 an indictment for the murder of his wife, before the Supreme Court of Massachusetts, in November, 1817. It appeared in evidence, that, many years previous, the defendant had re- ceived a severe injury of the head, in consequence of which, he had suffered occasional paroxysms of insanity, though the general habit of his mind was sound and clear. It appeared that they were often produced by intoxication, and there was some evidence to prove that they sometimes occurred, uncon- nected with any apparent exciting cause. In one of these fits of insanity induced by drinking, and while actually under the influence of liquor, he murdered his wife. The court, in its charge to the jury, observed, that " if they believed the prisoner was in a fit of lunacy when he committed the act, he should be acquitted; but if they believed he was of sound mind, or if his reason was impaired, and that it was caused by intoxication only, the fact being proved and no palliating circumstances existing, he must be con- victed." 1 If, in using this language, the court had in view any circumstance that might be deemed to be of a palliating character, it is not easy to see what it was, unless it were the pathological condition resulting from the injury of the head, which rendered him peculiarly susceptible to the effects of ar- dent spirits. If the court actually did consider this a palliat- ing circumstance, it is to be regretted that its language was not more explicit on this point. It is very probable, that in this case also, the jury were considerably influenced by the character of the exciting cause of M'Donough's insanity. If it had been testified, that, instead of getting drunk, he was in the habit of attending religious meetings, where warm and pungent appeals were addressed to his feelings ; that the ex- citement thus produced occasionally degenerated into a fit of madness, in one of which he killed his wife, the jury would have acquitted him without leaving their seats. Yet the essential condition of guilt would have been the same as in the case that actually happened. " The voluntary use of a stimulus," as it is expressed by Dr. Beck, "which he 1 Trial of William M'Donough for the murder of his wife, 65. 39 458 MEDICAL JURISPKUDENCE OF INSANITY. was well aware would disorder his mind, fully placed him under the purview of the law." * It is not a satisfactory reply to this objection, that, in the one case, the exciting cause is, in itself, of a commendable character, while in the other, it is in the highest degree sinful and pernicious. Drunkenness in it- self, is not by law a crime ; and though the moral sense of the community at the present day condemns even the moderate use of intoxicating drinks, it must be recollected that twenty years ago, and especially in the class to which M'Donough belonged, such use was generally considered, not only harmless, but absolutely necessary to the bodily health. Had he not labored under this peculiar irritability of the brain, it is not supposed that the bloody act would have been committed or even thought of, so that M'Donough was virtually convicted for the consequences of a bodily in- firmity. 459. The following case, related by Georget, presents us with another striking illustration of mental disorder excited by the use of spirituous liquors. Vatelot, a gendarme, while passing the Place Louis Quinze, suddenly struck the Sieur Chardon with his sabre. The latter turned round, and see- ing a stranger brandishing a sabre over his head, asked if he knew him, and what he meant. " I know you," replied Vatelot, " you are mine enemy, and I will give it to you." At the same moment he aimed at him another blow, and after pursuing him awhile with his drawn sword, left him. He soon met the Sieur Bellon whom he struck on the head, and aimed two blows at Sieur Avenel who accompanied Bellon. The Sieur Beaupied who ran to their assistance, and another person who never injured him, he also threaten- ed ; and finally, observing a young lady standing at her door, he struck her over the head with his sabre, and then fled. On trial before the court of assizes at Paris, he denied the facts, and admitted that he had been drinking, but was not 1 1 Medical Jurisprudence, 811. In this the last edition of his work, how- ever, the Doctor observes, that in using the language above quoted, he has " probably expressed himself too strongly, in a medical point of view," and seems inclined to retract his approval of the verdict of the jury. LEGAL CONSEQUENCES OF DRUNKENNESS. 459 drunk. He was convicted of homicide committed volun- tarily but without premeditation, and condemned to hard labor for life. 1 460. The homicidal acts of Vatelot obviously have all the characteristics that distinguish those committed by furi- ous maniacs. " He attacked indiscriminately all whom he met," said the court, " and made four successive attempts at homicide, without being moved by any of the passions characteristic of crime, but in consequence of a fatal phrensy which impelled him to the shedding of blood whenever an opportunity offered." One of the elements of guilt in M'Donough's case is wanting in this ; for it does not appear that strong drink had ever produced a fit of insanity before, and thus it could not be urged that Vatelot sinned against the light of his own experience. If he had not drank enough to intoxicate him under ordinary circumstances, he had done nothing which the law or public opinion recognized to be wrong, and there was not a shadow of justice in rejecting his plea of insanity. Even if he had, are we to make no distinction, as Georget forcibly inquires, between a drunken person who commits a crime from motives of interest, such as theft, or to gratify a criminal passion existing before the intoxication, and one, who like Vatelot, becomes a murderer, without interest, without motive, without any rational cause for his conduct ? 461. We shall close our observations on this form of inculpable drunkenness, with a couple of passages from re- cent writers. " If either the insanity has supervened from drinking," says Mr. Alison, "without the panel's having been aware that such an indulgence in his case leads to such a consequence ; or if it has arisen from the combination of drinking with a half crazy or infirm state of mind, or a previ- ous wound or illness which rendered spirits fatal to his intel- lect, to a degree unusual in other men, or which could not have been anticipated, it seems inhuman to visit him with the extreme punishment which was suitable in the other case. 1 Discussion Medico-Legale, 159. 460 MEDICAL JURISPRUDENCE OF INSANITY. In such a case, the proper course is to convict ; but in con- sideration of the degree of infirmity proved, recommend to the royal mercy." l " There is a class of cases in which persons have sustained injuries to the head, as often happens with soldiers and sail- ors, where drunkenness, even when existing to a slight degree, produces sometimes temporary insanity, and leaves the mind in possession of its habitual sanity when the drunken fit is over Such persons certainly ought not to undergo the same punishment as sane criminals, unless the crime be accompanied by many circumstances of aggra- vation, and the plea rest rather upon suspicion than proof." 2 462. In regard to the effect of delirium tremens on re- sponsibility, we have been unable to ascertain the principles and practice of English courts. Those of our own courts will be best exhibited by presenting a few of the cases that have been tried. 463. At the May term, in 1828, of the Circuit Court of the United States, Alexander Drew, commander of the whaling ship John Jay, was tried for the murder of his second mate, Charles F. Clark. It appeared in evidence, that previously to the voyage during which this fatal act occurred, Drew had sustained a fair character, and was a man of humane and benevolent disposition, though addicted to the excessive use of ardent spirits. After recovering from a drunken debauch, in the latter part of August, 1827, he resolved to drink no more, and all the liquor on board of the ship was thrown overboard. In two or three days after, he lost his appetite, was unable to sleep, and manifested various hallucinations. He thought the crew had conspired to kill him, and expressed great fear of an Indian belonging to the ship, calling him by name when not present, and promising that he would drink no more rum, if he would not kill him. Sometimes he would sing obscene songs, and sometimes hymns, and would pray and swear alternately. In the night 1 Principles of the Criminal Law of Scotland, 654. 2 British and Foreign Medical Review, x. 161. LEGAL CONSEQUENCES OF DRUNKENNESS. 461 of the 31st August, he went on deck, and attempted to throw himself overboard, but was restrained by the witness. At seven o'clock in the forenoon, September 1st, while the wit- ness, Drew, and Clark, were at breakfast, Drew suddenly left the table, and appeared to conceal something under his jacket which was on the transom in another part of the cabin. He immediately turned round to Clark, and requested him to go upon deck. The latter replied that he would when he should have finished his breakfast. Drew then exclaimed, " go upon deck, or I will help you ; " and immediately took a knife that had been covered over by his jacket, and before another word was spoken by either, he plunged it into the right side of Clark's breast. Clark fell instantly, but soon afterwards rose and went upon deck. As the witness left the cabin, Drew cocked his pistol, pointed it at him and snapped it, but it missed fire. Drew followed them upon deck, and, address- ing the mate, said, " Mr. Coffin, in twenty-four hours the ship shall go ashore." He was then seized and confined. His whole demeanor, for some weeks after, was that of an insane person. When he first appeared to be in his right mind he was informed of Clark's death and its cause ; he replied that he knew nothing about it ; that, when he awoke he found himself handcuffed, and that it appeared to him like a dream. It also appeared that there had not been for months any quarrel between Clark and Drew. 464. After hearing the witness who testified the above facts, the court interposed, and through Mr. Justice Story, delivered its opinion, that on these admitted facts the indict- ment could not be maintained, because the prisoner was un- questionably insane at the time of committing the offence. " The question made at the bar," continued the court, " is whether insanity, whose remote cause is habitual drunken- ness, is, or is not an excuse in a court of law, for a homicide committed by the party while so insane, but not at the time intoxicated or under the influence of liquor. We are clearly of opinion that insanity is a competent excuse in such a case. In general, insanity is an excuse for any crime, be- cause the party has not the possession of his reason, which 39* 462 MEDICAL JUEISPRUDENCE OP INSANITY. includes responsibility. An exception is, when the crime is committed while the party is in a fit of intoxication, and while it lasts ; and not, as in this case, a remote consequence, superinduced by the antecedent exhaustion of the party aris- ing from gross and habitual drunkenness. However criminal, in a moral point of view, such an indulgence is, and however justly a party may be responsible for his acts arising from it to Almighty God, human tribunals are generally restricted from punishing them, since they are not the acts of a reason- able being. Had the crime been committed when Drew was in a fit of intoxication, he would have been liable to be con- victed of murder. As he was not then intoxicated but merely insane from an abstinence from liquor, he cannot be pronounced guilty of the offence. The law looks to the im- mediate, and not to the remote cause, to the actual state of the party, and not to the cause which remotely produced it. Many species of insanity arise remotely from what in a moral point of view, is a criminal neglect or fault of the party ; as from religious melancholy, undue exposure, extravagant pride, ambition, etc. ; yet such insanity has always been deemed a sufficient excuse for any crime done under its influence." The jury returned a verdict of not guilty. 1 465. At a term of the Supreme Court in York county, Me., April, 1836, Theodore Wilson was tried for the murder of his wife in June, 1835, at Kittery. It appeared in evi- dence, that for several years Wilson had been addicted to in- temperate drinking ; that on the Saturday previous to the mur- der, he had brought some rum from Portsmouth, N. H., and that on the next day he had drank it all. It did not appear that he drank any more after this, and circumstances render it probable that he did not. There was nothing strange or unusual in his conduct till Wednesday morning, when he arose early and went to the house of a neighbor to get some barley and procure a person to sow it for him. He returned home about six o'clock, and then complained of being sick. His wife assisted him to undress, and he lay down, saying 1 3 American Jurist, 7-9 ; 5 Mason's Reports, 28. LEGAL CONSEQUENCES OF DRUNKENNESS. 463 that he was dying. In the mean time he complained that his wife would do nothing for him ; that she had often set traps for him, and once put fire and wood into the oven to burn him up. He ate some porridge only for his breakfast, was constantly talking, and among other things spoke of his having been fishing when he was four years old. While the family were at dinner, he rose from bed and walked about in great agitation, striking the walls with his fists, and beating in the door with the tongs. As he became >more furious, a woman who resided with him at this time, left the house, he and his wife then being the only persons in it. A short time after, he was seen coming out the house stark naked ; and in- this condition he walked rapidly down the road, throwing up his arms, and making a wild howling noise, and finally lay down by a fence. It appeared that after he left the house, his wife went to one of the neighbors to ask his aid in getting her husband back, and this person declining to interfere, she went alone. As she approached him still lying by the fence, she asked him why he was lying there and making such a noise. He immediately sprang up, put his hands upon her shoulders, threw her down and beat out her brains with a stone. He then left the body, and on reaching a house near by, broke in the windows with his fists, and also struck at the doors and side of the house, to seal it, as* he said, with his wife's blood. Here he proclaimed that he had killed his wife, and meant to kill two more ; he was then arrested. To those who watched with him during the night, he declared he was not sorry for what he had done, but was glad of it, and intended to have done it before. He con- tinued furious, talking wildly and incoherently, making unnatural noises, sleeping none, and apparently anxious to kill himself, till the next Saturday morning, when he became, and remained, rational. It further appeared, that in 1830, he went on a fishing voyage, and, that being deprived of spirits, he became deranged after three days' sailing, and had to be confined. He then began to tear his clothes, and try to tear the clothes of others. He complained of being sick, said he should die, and requested the captain to tell his sons to take 464 MEDICAL JURISPRUDENCE OP INSANITY. care of their mother. He was afterwards set ashore and did not go on the voyage. His counsel set up the plea of insanity in his defence ; and the court, in charging the jury, observed that it was not material for them to determine what species of insanity it was under which the prisoner had been suffering, if satisfied with the fact of its existence. He was acquitted. 1 466. John Birdsell was tried, in 1829, by the Supreme Court of Ohio, on an indictment for the murder of his wife, on Thursday, 5th of March, 1829. It appeared in evidence, that for several years the prisoner had indulged in fits of in- toxication, which, in the latter part of the time, had been followed by delirium tremens, which generally lasted for several days, and went off spontaneously. In these parox- ysms he had the physical and moral symptoms that usually characterize the disease. Among many hallucinations under which he labored, the prevailing one was, that his wife was in combination with three of his neighbors, one of whom was his son by a former wife, and that they had conspired to take his life. He imagined that his wife had a criminal intimacy with these persons, and even threatened to kill her if she did not desist. On the Sunday before the murder, he drank freely, and was intoxicated; in which condition he was quiet, dull, and disposed to lie in bed. Monday, * Tuesday, and Wednesday, presented nothing especial. On Wednesday evening he complained to a neighbor of feeling unwell, and asked his son's assistance in the performance of some necessary manual labor for his family. He seemed to the witness to be rational. During the night he slept none, and complained of cramp in the stomach. The next morn- ing his family thought him crazy, but were not alarmed, as they were accustomed to such attacks. In the course of the day he took an axe, and walked rapidly to the house of a neighbor whom he desired to go home with him, saying that they wanted to kill him ; and about the same time he 1 For the facts in this case, the author acknowledges his obligations to Nathan Dane Appleton, Esq., one of the defendant's counsel. LEGAL CONSEQUENCES OF DRUNKENNESS. 465 told another of the supposed conspirators that he overheard his wife and him, that morning, whispering about taking his [the witness's] life. He spent the day at home in the midst of his family, apparently in agitation and terror ; but said he would not hurt any one, and did not wish to be hurt. He also placed an axe with a scythe under the bed, where the former was often kept. He manifested jealousy of his wife, and told her to act better, for she had already caused the death of thirty thousand men. He fancied that the persons of whom he was jealous were in the loft manufacturing ropes to hang him, and going up, returned, saying that he had cut the ropes in pieces, and brought down the fragments in his hands, though he had nothing in them. In the course of the after- noon he fastened both the doors of his house. At the usual I time the wife went out to milk, and he barred the door after her. On her return, he fastened it again. She was seated near the fire, and he was walking the room. At length he took the axe from under the bed, and gave the fatal blow, follow- ing it up with two others on the face. His eldest daughter caught the axe, which he yielded up ; and then he seized the scythe, with which he attempted to strike her. She defended . herself with a chair, till the smaller children having opened the door, she escaped. He took the youngest child in his arms, and sat down by the window. The child complained, " Mamma bleeds ! " which he said made him feel badly. When his neighbors arrived, immediately afterwards, he gave himself up, acknowledged what he had done, said he knew he should be hanged for it, but that he ought to have done it nine months sooner ; that if he had to do it again, he would strike two blows where he only struck one. It was testified, that he talked so rationally, that many of the witnesses could not believe him deranged ; that he evinced no dread of punish- ment for his crime, but was still in great apprehension from the persons who, he had believed, had intended to kill him ; and that he was glad he had defeated their calculations. On his way to jail he talked rationally and composedly about his affairs and various other subjects ; but frequently asked the guard if they did not hear sweet sounds of different kinds ; 466 MEDICAL JURISPRUDENCE OF INSANITY. and, on being answered in the negative, insisted he could not be mistaken. After his committal he became rational, and expressed his regret at what he had done. 467. The point submitted to the jury for their deter- mination was, whether the prisoner was capable of discrim- inating between right and wrong. They concluded that he was, and returned a verdict of guilty. In consequence of a petition from a number of persons who had no doubts of Birdsell's insanity, the punishment was commuted by the governor to that of imprisonment. Previous to the commu- tation, he again became insane, and continued so perman- ently. 1 468. The essential features of the above cases being alike in every thing relative to their pathological nature, we are left, without any satisfactory reason to account for the issue of the last. It is probable that the court adhered to the antiquated maxims of the common law on the subject of insanity, and that the jury was governed by the opinions of the court, or relied, with that confidence which ignorance usually inspires, on their own crude and erroneous notions. The verdict of the jury in Birdsell's case furnishes another instance of the deplorable consequences of obliging a body of men, the most of whom are utterly unacquainted with the phenomena of insanity, to decide the question of its exist- ence in a given example, and with it the fate of an unfor- tunate fellow being, for weal or woe, here and hereafter. They concluded that the accused was capable of distinguish- ing right from wrong, probably because others who knew as little of insanity as themselves testified, that immediately after committing the murder, " he talked so rationally that they could not believe him deranged ; " and on such a con- clusion they founded their fatal verdict. Of course, it would have been too violent a contradiction in terms, to have denied the existence of any insanity at all in a disease whose 1 This case was reported, and the medico-legal questions growing out of it were discussed at considerable length by Dr. Drake, in the Western Journal of the Medical and Physical Sciences, vol. iii. ; extracts from his papers may be found in the American Jurist, iii. 10-16. LEGAL CONSEQUENCES OF DRUNKENNESS. 467 very name is delirium ; but it appeared that the prisoner WE not altogether bereft of his senses, not quite reduced to condition of a brute or an idiot. Now, without resting upon the general fact that the mind is always and unequivocally deranged in delirium tremens, there is proof enough that various hallucinations took possession of Birdsell's mind, and prompted him to the bloody deed for which he was coi demned ; that he was under the influence of manifest, une- quivocal, strong, delusion, that test of insanity which, when present, never deceives. If any one, on being made ac- quainted with the particulars of Birdsell's case, can pronounce it not to be insanity, he must have derived his notions of this disease from some other source than the wards of the hospital and asylum. 469. In the first two cases, the directions of the court to the jury were, substantially, that if they were satisfied the accused was insane when he committed the criminal act, that they were not to go back and inquire into the cause of insanity ; but, on this fact being established in their minds, the prisoner was entitled to an acquittal. In the first case, the court examined the question whether the legal conse- quences of insanity are affected by the character of the cause which produced it ; and so clear and satisfactory is its opin- ion, that any thing further on this point is rendered unneces- sary here. But we are not so well satisfied with its distinc- tion between the insanity which is the remote cause, and that which is the immediate effect of- drunkenness. Where the moral guilt is so nearly alike, as it certainly is in the two cases, we are unable to perceive the justice of making such a fearful difference in regard to their legal consequences. The distinction is not only unjust, but we apprehend that there would often be no little difficulty in applying it to practice. It would not be very easy to determine the precise period when the drunken fit is over, when the individual ceases to be under the influence of the intoxicating liquor. A case is related by Hitzig in which this difficulty would have been experienced, if the legal consequences of the act in question had not been determined by very different princi- 468 MEDICAL JURISPRUDENCE OP INSANITY. pies. A carpenter in Pregelswalde, named Thiel, had con- tracted such a propensity for drink, that he finally became a dipsomaniac. During the fits he would continue drunk from eight to fifteen days together, taking no food in the mean time, and on two occasions, he continued for three weeks in a complete state of drunken stupor. While the fit was on him, he was quiet, taciturn, and peaceable, and during the last three or four days, extremely stupid. The fit that occa- sioned the criminal act with which he was charged, began on the 27th of May, 1824, and continued till the 2d of June, on which day he drank less, and on the following day, (3d of June,) he drank only one glass of beer, and one of brandy. At noon-time he assisted his wife in sawing wood, though she had to tell him just what he was to do. In the evening he slept a few hours, awoke, walked about, and finally went to bed with his wife. The latter, on getting out of the bed for the purpose of going to the window, to watch some cloth that was bleaching, awoke him again. Soon after, he ex- perienced a strong sense of anxiety, and felt a trembling over his whole body, and he imagined that he heard an inward voice commanding him to kill his youngest child, a boy of five years old, who with two older children, were sleeping in the same room. After a while, the command was repeated so peremptorily that he could no longer resist, and he accord- ingly murdered his favorite child. Whether at this moment he was under the direct influence of the liquor he had drunk on the 3d, is a question to which it would be impossible to give a satisfactory answer. In the present case it was not required, for drunkenness being regarded by the German law, as an extenuating circumstance, he was condemned to one year's imprisonment, and to pay the costs of the prosecu- tion. 1 470. In Birdsell's case there was presented a new fea- ture of no little interest to the medico-legal student, which, though it was suffered to have no influence on the verdict, might, if the court had chosen to urge its opinion respecting 1 Henke's Annalen, viii. 186. LEGAL CONSEQUENCES OF DRUNKENNESS. 469 it upon the jury, have prevented an acquittal, even if they had satisfied themselves beyond a doubt that the party was incapable of distinguishing right from wrong. In replying to the arguments of counsel for a new trial, the court ob- served in the course of its remarks, "that they were not called upon to give an opinion whether Mania a potu would, under any circumstances, be an excuse for the commission of a crime ; but they felt no unwillingness to express their opinion, that if the insanity were the offspring of intemper- ance, and the prisoner knew that intoxication would produce it, he could not plead it as an apology." Birdsell, it has been seen, had experienced several fits of delirium tremens following his drunken debauches, previous to that in which he destroyed his wife, and consequently knew that intoxica- tion would b$ likely to produce insanity. How far this fact changes the Attitude of the case, is a point which deserves a careful examination, before being allowed to have a bear- ing on judicial decisions. If the party had known that, in his previous attacks of delirium tremens, he had attempted the life of his wife, then indeed this opinion would not have been without some foundation ; for in that case, perhaps, he might have been justly held responsible for whatever crim- inal acts he committed while in a state of insanity, just so far as he was responsible for the intoxication that produced it. All that Birdsell knew on this subject, however, was, that indulgence in drinking having frequently occasioned delirium tremens, would be liable to produce a renewal of its attacks. As to what acts he might commit while under their influence, he knew absolutely nothing. It is not very clear how delirium tremens can have a different effect on legal responsibility, from that which would follow any other form of mental derangement resulting from habits of intem- perance. If Birdsell's habits had led to attacks of common mania instead of delirium tremens, his guilt, in a moral point of view, would certainly have been no less ; nor, on the hypothesis of the court that insanity is no apology for crime, if the party knew that intoxication would produce it, would his legal responsibility have been diminished. It does 40 470 MEDICAL JURISPRUDENCE OF INSANITY. not appear, however, that in ordinary cases where insanity is pleaded in excuse for crime, the question is ever raised whether the insanity be a consequence of intemperate drink- ing ; and, in the event of its being so, whether the party knew that such a result might be expected. It is not easy to resist the impression, that the opinion of the court against the ex- culpatory effects of Birdsell's insanity was determined, in some measure, by the reprehensible character of its cause. If his insanity had been produced by mingling in scenes of religious excitement, by indulging in schemes of commercial speculation, or a more criminal species of gambling, would the court have said it afforded no apology for crime, because he had suffered previous attacks in consequence of exposure to the action of these same causes ? Probably not ; and yet if guilt is made to consist in disregarding the lessons of experience relative to the manner in which the insanity is produced, then the nature of its exciting causes is clearly an immaterial circumstance. In short, the opinion of the court of Ohio conflicts with the principles laid down by Mr. Justice Story ( 464) ; and if the latter be admitted, as they must be undoubtedly by every one, so far as they relate to the causes of insanity, the former is untenable for a moment, and there- fore it is scarcely necessary to pursue this train of reflections any farther. 471. Few diseases are better marked than delirium tremens, yet occasionally it is not easy to distinguish it from other forms of mental disturbance directly or indirectly pro- duced by drinking. The importance of making this distinc- tion correctly, was recently illustrated in the trial of James McGlue, for the murder of Charles A. Johnson, in the United States Circuit Court held at Boston, October 30, 1851. It appeared in evidence that on Thursday the 15th of May, 1851, the barque Lewis came to anchor off the coast of Zanzibar, about 5 o'clock, P. M ; and that immediately after, McGlue, who was second mate of the vessel, without any provocation or exchange of words, rushed upon Johnson, who was chief mate, and killed him with the sheath-knife which sailors usually carry at their side. After being secured, he LEGAL CONSEQUENCES OF DRUNKENNESS. 471 was very restless, rolled about the deck, laughed, talked wildly and incoherently, cursed and swore, until daylight the next morning, when he came to himself, and was greatly sur- prised and shocked on learning what he had done. It was obvious enough that Me Glue, when he committed the act, was laboring under some kind of mental disturbance result- ing more or less directly from intemperate habits. It was all- important for the prisoner's counsel to show that this was delirium tremens, but the evidence was not so satisfactory as it might have been. It was proved that on the Sunday previous to the murder, McGlue drank to excess, but it was not quite clear that he had not drank more or less, up to the very day of the murder. Between Sunday and Thursday, he was described as looking pale and stupid, and by one wit- ness, as having trembled, but he performed his duty without interruption. On Thursday afternoon he talked in a wild and rambling manner. About half an hour before the fatal act, he asked some of the crew if they wanted to make money, and to their inquiry how it was to be done, he replied, " keep a hard cheek on from this hour." Immediately after the act, he said he was captain of the ship, and told the men to arm themselves with clubs, handspikes, etc. He told the captain to give up the command, unless he wished to be killed too. It was clearly established that he did not sleep for a moment, until after he came to his senses. It also appeared that McGlue did occasionally drink hard, when he seemed to the witness to be " crazy," and " hallooing like a madman." Several medical gentlemen gave their opinions, as experts, all of whom had enjoyed extraordinary opportuni- ties for witnessing delirium tremens. While some were satisfied that McGlue was suffering an attack of that disease, and some were equally satisfied that he was not, all were agreed in stating it as one of the results of their experience, that they had never met with an instance of recovery from delirium tremens, prior to the occurrence of sleep. The jury acquitted the prisoner, and their verdict could not well have been otherwise. It was proved beyond a reasonable doubt, that McGlue was unconscious of what he was doing when 472 MEDICAL JURISPRUDENCE OF INSANITY. he committed the homicide, or, in more general phrase, was insane. The government did not prove as they were bound to, in order to convict the prisoner that this in- sanity was the direct and immediate effect of drunkenness, and therefore the prisoner's plea of insanity was not vitiated, though his counsel failed to show beyond dispute, that his insanity was that particular indirect effect of drunkenness, called delirium tremens. 472. Criminal acts are sometimes committed by drunken people, in consequence of the illusions by which their minds are frequently possessed. Although the ordinary legal con- sequences of such acts would not be regarded by the English law as being modified at all in consequence of the mental illusion under which it is committed, yet it cannot be doubted that the person is actuated by no criminal intention, nor any other improper motive. Such acts have been viewed in France, Germany, and in one instance, at least, extraordinary as it may seem, even in England, with more indulgence than those which arise from the excited passions and quarrels pro- duced by drunkenness. On the Norfolk Circuit, 10th of March, 1840, a man was tried for killing his friend, both being intoxicated, " under the illusion that he was some other person who had come to attack him. The judge made the prisoner's guilt to rest upon the fact, whether, had he been sober, he would have perpetrated the act under a similar illusion. As he had voluntarily brought himself into a state of intoxication, that was no justification. He was found guilty of manslaughter, and sentenced to two months' im- prisonment." i 473. After the thirty years' war in Germany, it was a popu- lar superstition, on the banks of the Elbe, that the spirits of Swedish cavaliers were sometimes seen at midnight mounted on horses and dressed in a blue uniform faced with red. Two peasants who had always been intimate friends, were on their return in the evening from their labors in the fields, when they stopped to rest their limbs under a tree, and there they i British and Foreign Medical Review, x. 1 72. LEGAL CONSEQUENCES OF DRUNKENNESS. 473 i drank from a bottle of brandy they happened to have, until they became quite drunk. In this condition they talked about the Swedish cavaliers, till their imaginations, heated by the drink, made them believe that they were surrounded by the spirits, and that they could only escape by fighting them. Each had a staff, and they proceeded to belabor each other, believing they were contending with the cavaliers, till one was finally killed. The victor went home and pro- claimed his triumph over the devils that tried to carry him off. He was condemned to ten years' imprisonment. 1 474. On the 17th of December, 1838, two young French peasants in the commune of the Prairie of Sept. Vents, started to walk home about ten o'clock in the evening, after having drank excessively. According to the account of the survivor, they were conversing about witches, on their way home, when they arrived at a little bridge which it was rather difficult and dangerous to pass. The survivor offered to carry over the deceased on his shoulders, but the latter refused, and passed over first on his hands and knees. The former did not know how he got over ; he only remembered that when he reached the other side, he could not find his companion, but that in groping about, he stumbled against something white with long hair on its legs. He called out and summoned the strange thing to get up and speak, but receiving no answer, and getting more and more frightened, he took out his knife and stabbed it repeatedly. Losing the knife, he broke the branch of a tree, and attacked the object of his fears with renewed fury, trying, at last, to break one of its legs, that he might be sure of finding it next morning. Being cold and tired, however, he concluded to go home, and the body of his companion was found next day, near the bridge, horribly mutilated. The prisoner was condemned to hard labor for life, and to exposition. 2 475. In the first of the above cases, the verdict of the jury, it will be observed, is directly at variance with the principle laid down by the court, as, indeed, it is with the 1 Marc, De la Folie, etc., ii. 635. 2 Idem, ii. 639. 40* 474 MEDICAL JURISPRUDENCE OP INSANITY. whole doctrine of the English criminal law in regard to this subject. When a man voluntarily deprives himself of the perfect use of his reason, and in this condition commits a criminal act, it is immaterial, so far as his moral guilt is con- cerned, whether the act be prompted by passion, frenzy, or hallucination. The verdict is a memorable one, inasmuch as it is the first within our knowledge, in which an English jury has made any distinction between a homicide committed in a state of drunkenness though without any criminal inten- tion, and one deliberately planned and deliberately executed, in the full possession of the reasoning powers. 476. Criminal cases are not very unfrequent in which in- temperance and insanity are so mingled together that it is impossible to unravel their relations to each other, and ascer- tain their respective shares of influence in producing the criminal act. The following will serve as an illustration of this class of cases. 477. David Abbot was tried by the Superior Court of Connecticut, for the murder of his wife in July, 1841. The facts, as they appeared from the testimony, were substantially as follows. The prisoner belonged to a respectable family, possessed some property, and had twelve children by his wife. For several years prior to the event, he had been very intemperate, but not to such a degree as to prevent his walk- ing about and conversing as at other times. Habitually harsh and cruel to his wife, he became still more so when under the immediate influence of liquor. He became jealous of her, and believed that she had frequent criminal inter- course with two of their neighbors. But it was admitted by all parties that the conduct of these persons and of his wife was perfectly unexceptionable, so far as this subject was concerned. On the afternoon of the day when the murder was committed, he was observed to drink rum and cider several times. After he and his wife had gone to bed, they were heard talking together, and at eleven o'clock he called up one of his daughters, and directed her to summon the neighbors, " as they were all dead, or would be soon." The wife was found dead, apparently choked to death, and LEGAL CONSEQUENCES OF DRUNKENNESS. 475 he lying on the floor with his throat cut in several places, but not fatally. When asked what he had been doing, he replied, " that the devil had been there, that he had had a clinch with him, and that the devil had been trying to kill them both, and had cut his throat." Subsequently, how- ever, when he became more composed, he stated that after they went to bed, an altercation ensued ; that he became provoked, and seized her by the throat, holding her five or six minutes, when he found she was dead. He then at- tempted to cut his own throat with a razor, but having lost the razor, and bled a while, he changed his mind, and called up his daughter. It also appeared in evidence that his father, two brothers, and sister had been insane ; that the prisoner himself, when about eighteen years old, was delirious for sev- eral weeks immediately after attending a camp-meeting ; and that about seven years before the death of his wife, he went to one of his neighbors, with both hands on the top of his head, saying that he had lost the top of his head and must go home and get his wife to put it on again. The court, in laying down the law, relative to the legal conse- quences of intemperance, adopted the principles of Mr. Justice Story in the case of Drew, and the jury was also told, that if they found the prisoner insane, but not to such a degree as to render him wholly irresponsible for his acts, they had a right to take such partial insanity into consideration in con- nection with the provocation, in determining upon its suffi- ciency. If they found that the provocation, in that case, operating upon a mind partially insane, was equal in its effect to a provocation which would reduce a homicide, committed by a man of perfectly sound mind, from murder to man- slaughter, they would have a right to find the prisoner guilty of manslaughter only. The prisoner was found guilty of murder. 1 478. In the present state of public opinion, it would be difficult, perhaps, to convince a jury that the wretched vic- 1 MS. of Mr. Justice Waite who sat upon the case, and kindly furnished by him. 476 MEDICAL JURISPRUDENCE OF INSANITY. tims of periodical drunkenness, or of that other form of the disorder which we have illustrated ( 445) ought not to be held responsible for their criminal acts. It would be ob- jected, probably, that these conditions are the result of habit- ual indulgence, and that at the utmost, the only difference between these and other drunkards is, that they are impelled to the gratification of their insatiable cravings by different degrees of violence, a circumstance which it would be mischievous to recognize in estimating the degree of crimi- nal responsibility. The truth would be overlooked or dis- puted, that this irresistible propensity to excessive drinking is manifested as often, if not oftener, in temperate men, as in habitual drunkards ; and that it is either a symptom of the first stage of madness, or of a temporary impairment of the mind produced by some disturbance of the cerebral circu- lation. The drunkenness being thus an accidental, involun- tary consequence of a maniacal state of the mind, it cannot impart the character of criminality to any action to which it may give rise. If the merchant, or servant girl whose cases we have quoted from Esquirol, ( 443, 446,) had committed murder in one of their paroxysms, we should, no doubt, have had the testimony of that distinguished physician, as he has already recorded it in his writings, that they were " true monomaniacs, not morally responsible." The other cases we have related, though differing a little from these, in some of then: accidental symptoms, evidently proceeded from the same pathological causes ; and if moral responsibility ceases in the former, it must equally cease in the latter. CHAPTER XXVI. INTERDICTION AND ISOLATION. 479. WITH respect to the kind and degree of mental impairment that warrant interdiction, there prevails the utmost diversity of opinion ; and such must continue to be the case, till sounder views are entertained of the true pur- poses of this measure. The radical fault of speculations on this subject is, that the attention has been directed to gene- ral rules and abstract distinctions, rather than to a thorough and discriminating examination of the particular circum- stances of each individual case. In the following para- graphs will be found abundant illustrations of the truth of this remark. 480. Imbeciles in the first degree cannot be justly deprived of the management of their property, on the ground of mental deficiency alone. If they have shown no disposi- tion to squander their money on trifles, nor suffered their affairs to be grossly neglected, there can be no reasonable pretence for taking it altogether from their control and enjoy- ment. Neither should we be too rigid in our scrutiny of these cases. If a whole life of extravagance, or hazardous speculation, is not enough to produce the interdiction of a sound person, why should an occasional act of either in one of feeble intellect, provoke that measure ? Of course there can be no question of its propriety when it is perfectly obvious that he is dissipating his fortune, to the great detri- ment of himself and of those who are dependent on him. 481. Much discussion and tedious litigation have arisen, from the difficulty of determining the exact measure of in- tellectual capacity requisite to the undisturbed enjoyment 478 MEDICAL JURISPRUDENCE OF INSANITY. of civil rights and privileges, chiefly in consequence of losing sight of the real object before us, and pursuing a shadow of our own 'creating. It is a question of capacity in reference to certain ends and duties, and we are not called on to go beyond the consideration of these, in our endeavors to settle this question. The speculative opinions of the imbecile per- son, the little peculiarities of his conduct, his style of living and talking, and his general deportment in society, are points that require but little attention in this inquiry. Our business is with the manner in which he has conducted his affairs, and from this chiefly, we are to draw our inferences respect- ing his probable future conduct and capacity. And here we are not bound to institute a rigid comparison between his habits, and those of people enjoying ordinary soundness and vigor of intellect. We are not warranted in stripping him of all his possessions and leaving him at the mercy of others, the moment we can fix upon a single instance in the course of his life, where he has neglected to profit by a happy turn of fortune, or has rewarded a service, or bestowed his boun- ties, in a manner altogether opposed to our ideas of fore- thought and economy. Has the individual indulged in re- peated acts of extravagance, or of profitless expenditure ? Has he engaged in the execution of visionary projects with reckless indifference as to the extent of his means and appli- ances ? Has he squandered his money on favorites, or become an instrument in the hands of designing and pro- fligate associates for advancing their own selfish projects ? These are among the most prominent questions that require a satisfactory answer ; and if they are kept steadily before us, there will be little fear of losing ourselves in the maze of per- plexities which the judical investigation of cases of imbecility frequently creates. 482. These views, it will be seen, afford no countenance to the usual practice of canvassing the whole history of the imbecile person, arraying act against act, and speech against speech, and drawing from each an inference for or against his capacity of managing his own affairs, in his own way. Few of those whose interests become involved in protracted INTERDICTION AND ISOLATION. 479 litigation, are so destitute of intellect as never to conduct like persons of well-developed minds under similar circum- stances. They may write sensible letters, make shrewd bargains, and converse on ordinary topics without betraying any mental deficiency, while yielding implicitly to the will of others, and committing acts of folly that can arise from nothing short of unequivocal imbecility. The popular error that imbecility is only an inferior endowment of mind, con- sidered in regard to its absolute quantity, has led people to forget that in this condition, the mental faculties may be very unequally defective ; and, therefore, that very different con- clusions would be formed respecting an individual's capacity, according as the attention is exclusively directed to the man- ifestation of this or that faculty. Many also, who, while surrounded by their usual circle of associations, manage their slender means with the utmost prudence and economy, would prove themselves totally inadequate to the manage- ment of a large property, and be easily led, by the influence of new associates and the excitement of new desires, into habits of extravagance and dissipation. 483. The little success that has attended every attempt to fix upon certain criteria as tests of that degree of imbe- cility which is incompatible with the management of prop- erty, and to run the line between this mental condition and that of legal capacity, is another circumstance in favor of the course here indicated. " In order to arrive at the true meaning of < imbecility of mind,'" says Sir .John Nicholl, " we may resort to what the law describes as perfect capa- city, which is most correctly found in the form of pleadings used in the ecclesiastical courts, in the averment in support of a will, that the testator was of ' sound mind, memory, and understanding talked and discoursed rationally and sensibly, and was fully capable of any rational act requiring thought, judgment, and reflection.' Here is the legal stand- ard." l It may be doubted if this definition can ever be of much practical service, for no definition can be so which 1 Ingram v. Wyatt, 1 Haggard's Eccl. Reports, 401. 480 MEDICAL JURISPRUDENCE OF INSANITY. embraces either more or less than is strictly warranted by the exact nature of the thing defined. Many an imbecile who could not be safely trusted with the control of property for a single week, may nevertheless " talk and discourse rationally and sensibly," so long as the conversation is con- fined to simple subjects that have long been familiar to the mind ; and many a man of legal capacity may be found, of whom it cannot be said that he is " fully capable of any rational act" whatever, "requiring thought, judgment, and reflection." The very point to be decided is, whether the person in question, who talks and discourses so rationally and sensibly, and does so many rational acts, is or is not capable of managing his affairs ; and, however much we may scrutinize the character of -his intellect, the only just and ac- curate test of such capacity is the manner in which he has already managed his affairs. The tests of legal capacity so much sought after in imbecility, cannot be obtained, from the nature of things, because the general strength of mind is but an uncertain index of its ability when exercised on particu- lar subjects. The ministers of the law, therefore, should be extremely cautious how they are moved by theoretical con- siderations, instead of particular facts bearing on the point at issue, in examining requests for interdiction on the ground of imbecility. 484. General intellectual and general moral mania are always a sufficient cause of interdiction ; for the reflective faculties are too much deranged in those disorders to discern the relations of property, or to provide the necessary ar- rangements for preserving and improving it. The only ques- tion is, how soon after the manifestation of the disease, are we warranted in taking this measure. Since its publicity serves to expose the patient and his family to the popular and not unfounded prejudice against insanity, and since mania, when early attended to, is cured, in the larger pro- portion of cases, within the first or second year, this step should be delayed, unless extraordinary reasons require im- mediate action, till the effect of judicious treatment has been observed. The restraint and seclusion which curative meas- INTERDICTION AND ISOLATION. 481 ures necessarily require, prevent the patient from engaging in business, and indeed place him in the same condition as would sickness of any other kind. Neither is this measure always justifiable when the disease is so slight as not to pre- vent him from going abroad and mingling in the affairs of the world. If, however, the patient is a merchant, for in- stance, and continues to engage in the transaction of busi- ness, immediate interdiction would be required, perhaps, to save him from the effects of ruinous contracts. Generally speaking, no harm is done by a little delay, but the practice of taking property from its lawful possessors to place it in the control of others who may have no other object than that of enriching themselves by their trust, the first moment the presence of madness is satisfactorily established, must lead to positive and considerable evils. So jealous is the French law of this hasty interference, that it permits nothing less than habitual insanity to procure interdiction. 1 485. In partial mania, Hoff bauer 2 thinks we should be governed by the nature of the predominant idea, not con- sidering it a sufficient ground of interdiction, unless con- nected with the subject of property in a manner likely to lead to its wasteful and improvident management. Such, too, was the opinion of Dr. Rush, 8 and a late writer 4 has con- tended against the opposite practice with signal ability and skill. " Mental derangement, to be a sufficient reason for interdiction," says a French jurist, " should have refer- ence to the ordinary affairs of civil life, and to the govern- ment of the person and property of the individual ; a man who is merely visionary, or entertains speculative notions that are palpably false, should not be interdicted, if he manage his affairs well enough in other respects." 6 Georget, how- ever, thinks that monomaniacs are not to be trusted, and that we can never be sure that the predominant idea may not, by 1 Code civil, art. 489. 2 Op. cit. 110. 3 Lecture on Medical Jurisprudence, Philadelphia, 1811. 4 Conolly, Indications of Insanity, 430, 445. 6 Toullier, le Droit civil Fran9ais, etc. 1811. 41 482 MEDICAL JURISPRUDENCE OF INSANITY. means of some mental associations, lead to the dissipation of their fortunes. Accordingly, he is dissatisfied with the de- cision of the tribunal of La Seine, who rejected a petition for the interdiction of M. Selves, a celebrated advocate, although admitted to be a " meddler in his family, litigious in society, impertinent towards the magistrates, vainly profuse in his expenditures, and subject to some illusions." * 486. This distrust of the insane of whatever descrip- tion, is nowhere more strongly implied than in the habitual practice of Great Britain at the present day. One finds it difficult to believe on what slight grounds interdiction is there every day procured, a measure, that with the osten- sible purpose of protecting the interest of the insane party, is too often, in reality, designed to promote the selfish views of relatives and friends. A kind and degree of mental im- pairment that has never obscured the patient's knowledge of his relative situation, never altered his disposition to be kind and useful to those around him, never weakened his enjoyment of social pleasures, and never affected his capa- city to manage his concerns with his usual prudence, has been repeatedly deemed a sufficient reason for depriving him of the use and enjoyment of his own property, and sub- jecting him to all the disabilities the law can impose. Dr. Conolly speaks of a gentleman on whose account his family applied for a commission of lunacy, because he had become possessed with the idea, that the queen of England was in love with him. Yet this person conducted himself very well in most of the offices of life, and on one occasion after this application was made, while dining with a party of friends in company with the lord chancellor, he contributed so re- markably to the enjoyment of the day by his polite, agreea- ble, and amusing manner, that this functionary could not help expressing to him how much he had been gratified by his introduction to him, and how utterly absurd it now ap- peared to him, to have ever given credit to the story of his delusion. This was enough to produce its avowal from the 1 Des Maladies mentales, 108. INTERDICTION AND ISOLATION. 483 patient, and the issuing of the commission from the lord chancellor. The sequel furnished a striking comment on the injustice of this act ; for the insane gentleman gave so much assistance to those intrusted with the management of his affairs, that he was the means of their getting over diffi- culties which, without his aid, would have been insurmount- able ; and in the end, he was actually, if not formally, con- stituted the steward of his own estate. It is well known that a monomaniac in England, who fancied himself duke of Hexham, and was accordingly interdicted, became the agent of his own committee for the management of his own estate, and did the duties of the office, for a time at least, not incorrectly. 487. The case of Mr. Edward Davies, which engrossed the attention of the English public, a few years since, being, says Dr. Gooch, " by far the most important lunatic cause which has been tried in our time," furnishes a striking illus- tration of the manner in which these things were managed in England. Mr. Edward Davies was born of humble parents, and though particularly shy and reserved among his school- fellows, he was generally considered sharp and intelligent. On leaving school, he commenced the business of a tea- dealer in London, and by indefatigable industry and cautious management, rapidly became rich. It appears that his health, at best, was delicate, and that he suffered much from dyspepsia and nervous excitement. He was fond of reading medical books ; and, like most persons who indulge in such a taste, was fanciful about his complaints, and subject to false alarms. The defects of his early education, he en- deavored to remedy, by reading what he took to be the best authors, and was often guilty of making a ridiculous display of his acquirements, by making long quotations which he would spout with a theatrical air. He was of a remarkably timid and yielding disposition, to such a degree as to be com- pletely subjected to the authority of his mother. Though he was twenty-seven years of age, and managing an extensive and lucrative business, she would not allow him to carry any money in his pocket, nor to spend the most trifling sum 484 MEDICAL JURISPRUDENCE OP INSANITY. without her permission. He dared not go to the play, nor leave the house for a few hours, without asking her leave. She was particularly at great pains to prevent his meeting young women, lest, in the event of his marriage, she might be dis- placed from the control of his conduct and the command of his purse ; and she took various opportunities of inducing him to give considerable sums of money to different branches of her family. At the age of twenty-seven, he grew restive under the maternal restraints, and made many attempts to emancipate himself. He offered to leave the shop to his mother and take his own property away ; or to give her seven thousand pounds, on her consenting to leave the concern ; but she was not to be got rid of at that price. The incessant state of contention at last seriously impaired his health and his mental tranquillity, and on the first of July, 1829, he ap- plied to Mr. Lawrence, the surgeon. He told this gentleman a long story about his health and his tea-trade ; and at another interview, he recited poetry and expressed a strong antipathy to his mother and several relations. Mr. Lawrence considered him of unsound mind, but thought that if he could be reconciled to his mother and family, the disease would be at an end that his antipathy to his mother was his chief delusion. 488. About this time, he applied to Dr. Latham, claim- ing his protection. His discourse was wild and rambling, and his manner strange and excited. He told the doctor in a sort of a whisper, that he had a tale to relate of the greatest horror, and then flung himself away and stalked into the middle of the room. He appeared very apprehensive lest he might be overheard, and begged that he might lock the doors and close the windows. He spoke of his wealth and his trade, and quoted poetry largely, using great gesticu- lation and throwing his arms about. Several times he asked if he looked insane, and on leaving the house, he said : " If you fail (in his promise to call on him) dread the vengeance of a madman ; for I carry a loaded pistol." Dr. Latham thought him insane, though not prepared to recommend that he should be shut up as an acknowledged lunatic. Shortly INTERDICTION AND ISOLATION. 485 after this, he left his own house and went to spend the night at Furnival Inn, on the third of August. About one o'clock, in the night, he rang the bell, and told the waiter that there were thieves in the house ; that he heard them snapping off pistols, and striking a light. On being remonstrated with by the waiter, on the impropriety of his ringing the bell, and thus disturbing the lodgers, he said he was sorry for it, went upon his knees, and humbly begged his pardon. 489. It must be borne in mind, that on the same days on which Dr. ITatham, Mr. Lawrence, and others, saw him in his most explosive state, his friends who had known him long, passed hours with him; and though he was ill and terrified, he appeared to them quite himself, and as equal as ever he had been to give directions about his shop affairs. Indeed, the very persons who were trying to confine him as unfit to take care of his business, were themselves consulting him about the management of that business. 490. Mr. Davies was shortly after this removed to a private asylum, where he remained till the end of Decem- ber, when he was liberated by the verdict of the jury. Here his agitation subsided, his incoherence diminished almost to nothing ; and the only remaining grounds for believing him a lunatic, were his antipathy to his mother, and certain sus- picions that were considered to be delirious. Nevertheless, a commission of lunacy was granted by the lord chancellor, which finally resulted in restoring him to liberty, and the management of his property. The evidence of the physi- cians who were sent expressly for the purpose of examining Mr. Davies at various interviews, and who pronounced him to be mad, is worthy of a little notice, inasmuch as they present the grounds on which, in the year 1829, the most eminent physicians for diseases of the mind shut up patients in asylums, among the English. 491. Sir George Tuthill testified, that he was of un- sound mind, at the period of his last visit; principally, because he spoke indignantly of the manner in which he had been treated by his family. His additional reasons for think- ing him insane, and unable to manage his affairs, were his 41* 486 MEDICAL JURISPRUDENCE OF INSANITY. learning to box, his purchasing a fowl for ten shillings, and his saying that he could weep over his little rabbits, which he had not seen for six weeks. Dr. Algernon Frampton testified, that he could not con- sider him sane on the seventh of December, because he would not admit himself to have been insane on the eighth of August. He thought there was a delusion in his mind as to his mother's conduct, though he admitted there would be no delusion, if his mother had interfered as Davies de- scribed, and as other witnesses testified. He thought that the purchase of a certain estate for 6000 guineas was in itself an act of insanity, considering his circumstances, though he admitted he knew nothing of his circumstances. A man of business, he thought, ought not to lock up so much of his capital. He never inquired how Mr. Davies managed his business, though he declared that he was inca- pable of managing it. Mr. Haslam testified, that he was induced to consider him insane, from his manner of complaining of the dirty habits of the keepers of the establishment where he was confined. He said decidedly, that as long as his morbid hostility remained against his mother, it was not safe for him to go at large. 492. In opposition to this evidence and it is but a small portion of what might be given it may be well to exhibit a specimen or two of that given by Mr. Davies's medical witnesses. Dr. Macmichael, who had been sent down by the lord chancellor to examine into the state of his mind, satisfactorily showed that Mr. Davies's peculiar notions and views which had been considered by many as delusions, either did not exist at all, or proved, upon examination, to be perfectly rational and proper. In attributing his prosperity to the favor of Providence, which had been mentioned as one of his delusions, he said he did not mean immediate or special interference, but that general providence which regu- lates human affairs. His boast of having improved the revenue by his biddings, which had also been imputed to him as a delusion, he explained by saying that there was a certain kind of tea that was now almost given away ; that if INTERDICTION AND ISOLATION. 487 he bid higher than others, the duty would be increased, and that thus he should put money into the pocket of government. He showed, that instead of sacrificing his property by this course, he realized a large sum of money in a very short time. Dr. Macmichael was not willing to admit that his learning pu- gilism, or carrying pistols, was any evidence of unsoundness of mind, for he might have had good reason for doing both. 493. Dr. Mackinnon, who was connected by marriage with the family of Mr. Davies, and had visited him several times during his confinement, thought him, from the first interview to the last, capable of managing himself and his affairs. He showed that many of his peculiar habits and manners which had given rise to the idea of insanity, he had always manifested when in good health. His letters which, from being full of quotations and puns, were thought to indicate disordered mind, he showed were not different, in that respect, from those he wrote long before insanity was imputed to him. He conversed with him freely on the affairs of his family, and his remarks upon his mother's interference were rational, just, and free from excitement. His inquiry into the imputed delusions, ended in the same result as Dr. MacmichaeFs. In particular, he did not consider his hostility to his mother as a delusion, for, from the son's account, there was good reason for it. On a variety of other subjects, his discourse was calm and rational. 494. This case is not calculated to recommend the opinion of those who look on the slightest mental aberration as a sufficient ground of interdiction. The principle to be followed here is precisely that which we have indicated as applicable to cases of imbecility. Instead of puzzling our- selves with vain attempts to gauge the depth and breadth of the absolute capacity of the mind, our duty is simply to ascertain if the individual has been guilty of any instances of gross improvidence, of expenditure beyond his means, or for objects unsuited to his station and pursuits. If it be found that he has, then interdiction is implicitly required by a regard to his own and the interests of those who are dependent on him for support, or entertain rational expecta- 488 MEDICAL JURISPRUDENCE OF INSANITY. tions of being benefited by his wealth. If he has not, it is not very clear how his property can be taken from his con- trol, without violating the first principles of civil liberty. If no one doubts that the mental operations in monomania may be perfectly sound, except within a certain very narrow circle, why should it be a matter of surprise, that ideas of property should sometimes be among those which are un- affected by the influence of the disorder? To deprive a person laboring under a partial rnania that does not involve his notions of property, of the natural right of controlling and disposing of his own fortune, is as unjust and irrational as it would be to inflict upon a felon convicted of theft, the penalties attached to the violation of every article in the criminal code. If, too, we interdict one monomaniac whose derangement is limited to a single subject, we are bound in consistency to proceed till we have included all, from him who believes he has lost his rational soul, to the poor hypo- chondriac who imagines his legs are made of glass, or that a fish has taken up its abode in his stomach. The mischief that would arise from such a course of disqualification, may be easily enough conceived, without the aid of any more particular description. Even when the hallucination has reference to property, as the idea, for instance, that the in- dividual possesses immense wealth, or that every ship which enters the harbor is his and freighted with his goods, we are not too hastily to strip him of what is really his own, for he might, nevertheless, in the management of it, evince the most commendable prudence and economy. It is a remark- able but not an uncommon fact, that monomaniacs often make no practical application of their insane notions to their own conduct or concerns, but continue to manage both as if no such delusion existed. 495. In the progress of dementia, there always comes a period sooner or later, when interdiction is required, where- ever the patient has much property, or conflicting interests are involved in its disposition. To decide when this period has actually arrived, is generally a difficult and a responsible duty. To avoid the disagreeable alternative of favoring the INTERDICTION AND ISOLATION. 489 designs of selfish relatives, which would be promoted by the interdiction and seclusion of the old man, by premature in- terference, or of delaying proper measures, for fear of being thought accessory to schemes of fraud and oppression, until too late to be of any service, is to gain the happy medium which all should seek, but which few perhaps are successful enough to obtain. The difficulties which medical men have to encounter, who are consulted in such cases, are graphi- cally described by Dr. Conolly. " An old gentleman," he says, "whose intellects are so impaired that he does not know whether he has received his rents or not, or who is un- able to arrange his own dress decently, and requires, when up stairs, ah 1 the attention of a child, is seen by the medical practitioner, for the purpose of its being ascertained how far interference with his property is justifiable. The very ser- vant who is hourly robbing him, takes care to send him down very carefully drest. The mere effect of habit is to cause the patient himself to be more guarded and exact in his manner and words in the presence of a stranger ; he feels under a temporary and a wholesome restraint ; asks and answers com- mon questions as well as most other old men, and is per- fectly correct in his deportment. Two very serious evils may ensue. If the practitioner is unacquainted with the varieties of the mind and their tendencies ; and imagines that insanity and sanity cannot be mixed up together in the mind as they are in the body ; he feels a degree of conscien- tious horror concerning any interference with an old gentle- man who may be a little weak, but who, he is quite con- vinced, is no more mad than any of those about him. He turns his thoughts to the probable motives of interest, in the children or the friends, and, determining not to warrant any kind of restraint, inwardly applauds his own sagacity and incorruptibility. The friends, now more afraid to interfere than before, allow the old man to do as he likes, and he sets off, and gets married to a worthless and designing woman, or he alters his will in favor of some unprincipled person, or finds his way to some neighboring town, where he becomes a disgraceful spectacle, and gets robbed of his money and ill- 490 MEDICAL JURISPRUDENCE OF INSANITY. treated ; or perhaps he falls into the pond, and is drowned ; all the world then exclaiming against the heartlessness and inattention of those about him, and the unaccountable supineness of those who were consulted about the case. Thus, the view of a very plain and easy duty is, not unfre- quently, obscured by prevalent opinions respecting the nature of insanity, and respecting the measures which insanity is supposed to render indispensable. If the patient whom I have described, as conducting himself so satisfactorily in a short and common conversation, is left to his own thought for a little time, and his attention is not excited by those about him, his state will become evident enough. He will be seen to be wandering, and lost in his reflections, and will perhaps rise up and endeavor to make his way out of the room, but without seeming to remember the situation of the door. Or he will declare his intention to set off on a long journey, or by many slight indications show that his mind is reduced to imbecility. In some, the effects of the recent restraint of a stranger's presence may be more permanent than in others ; but half an hour, or a few hours at the utmost, will suffice to show the state of the case. The decision is important, and due time must be allowed for it. If one visit is not sufficient, the visit should be repeated, until the prac- titioner can give a clear and decided opinion. " But now comes the other danger. A sanguine practi- tioner sees the undoubted signs of folly and weakness in the old man, and forgetting that they are as much the effects of age as are the unsteadiness of his limbs, and the dulness of his hearing, pronounces the patient to be mad ; and to gratify persons of no feeling or compunction, consigns the poor patient to strange hands, and causes him to spend the little remnant of his days away from his own house, and unseen by any of those whom his former care perhaps preserved, and whom his wealth will enrich." 1 496. The principles we have indicated, as proper to guide us in deciding questions of interdiction in the various 1 Indications of Insanity, 440. INTERDICTION AND ISOLATION. 491 forms of imbecility and mania, are not to be so implicitly relied on here, because the unfitness of the patient to man- age his own concerns is often proved, not so much by spe- cific acts of extravagance or folly as by his subjection to the will of those who are deliberately and cautiously preying upon his substance. "We may also bear in mind, that although we take from him the control of his property, even while his faculties are sound enough to make him capable of performing the duty himself, yet we are only prernaturely taking a measure which a few weeks or months will generally render absolutely necessary. 497. It is to be regretted that in cases of insanity where the mental disorder does not seem sufficient to war- rant so extreme a measure as complete interdiction, while it occasions reasonable doubts of the ability to manage prop- erty with ordinary prudence, our laws have established no inferior grades of restraint. The civil code of France ordains that, " in rejecting a demand for interdiction, the court may, nevertheless, if circumstances require it, debar the defendant from appearing in suits, making contracts, borrowing, receiv- ing payment for debts or giving a discharge, alienating or pledging his property, without the aid of a council which shall be appointed in the same judgment." 1 It would be well, if something of this kind always found a place in the legal regulations of the insane. 498. The views here presented on the propriety of interdiction in different kinds of insanity, can, at the most, affect only the opinions of the expert, or the conclusions of the judge. They cannot easily be embodied into a legisla- tive enactment, and it is doubtful if the slightest attempt thereto, would not be productive of uncertainty and embar- rassment. In the French civil code it is enacted that only habitual imbecility, dementia, or furor, can be a sufficient cause of interdiction. 2 In thus requiring the alienation to have been habitual, it was the object of the legislator, no doubt, to prevent the abuses that might arise, if this measure 1 Code civil, art. 499. 2 Art 489. 492 MEDICAL JURISPRUDENCE OF INSANITY. were allowed in those temporary alienations that readily yield to medical treatment. But as no two individuals would probably agree as to the number of weeks or months necessary to make a case of insanity habitual, the law must, of necessity, either be entirely disregarded in practice, or be- come the means of great injustice, in consequence of the diversity of interpretation to which it is liable. Georget observes, that in Paris, the judge is always governed by the opinion of the patient's physician, relative to the future pro- gress and result of the disease, rather than its previous dura- tion. 1 The French jurists have disagreed as to the construc- tion intended to be put on the terms, imbecility, etc. While some contend that these terms are thus multiplied, merely in order to embrace every possible form of mental disorder, it is contended by others, thai the legislator's object was to prevent interdiction on account of any mental disorder which could not fairly be brought under one of these divisions. The consequence is what might be expected the law is practically disregarded altogether. 499. What the legislator can and ought to do, is to provide for the impartial administration of justice where in- terdiction is provoked, by such a course of procedure as will tend to bring out all the material facts. In France the facts of the case must be stated in writing, and supported by documents and witnesses ; the family-council gives its opinion touching the utility of the measure; and the re- spondent is examined by the court and the attorney-general. If the examination and the documents are not satisfactory, the court may order an inquest. The same formalities are required for removing the interdiction. 2 In England inter- diction is obtained by application to the Lord Chancellor who appoints a Commission of Lunacy, consisting of three or five persons, who cause a jury to be summoned with whom the commissioners sit as a court, and hear the evi- dence adduced. The inquisition may be traversed, though the chancellor be satisfied with it. In some of the United 1 Discussion med. leg. 174. 2 Code civil, art. 493, 494, 495. INTERDICTION AND ISOLATION. 493 States, this method is still preserved, except that in such as have no chancery court, the commission is issued by a court of law. In most of them, however, application is made to the judge of probate who gives due notice to the respondent, ap- points a time and place for the hearing of the case, and decides without the intervention of a jury. This course is far pre- ferable to the English, on the ground of expense, and proba- bly the ends of justice are as fully obtained as if the case were submitted to a jury. In the German States, medical evi- dence is always required by the law, and the opinions of the physicians govern the decision of the judge. In Prussia, for instance, the law ordains that in all cases involving the question of insanity, the opinions thereon of two physicians shall be obtained, one of whom is to be chosen by the friends or relations of the party whose sanity is questioned, and the other by the court ; and no person can be pronounced insane by the court, unless so considered by both physicians. 1 No provision can be better than this for settling the question of insanity, though whether it be sufficient to warrant inter- diction, is another question in the decision of which other considerations must enter. 500. Isolation is a measure entirely distinct from that of interdiction, and neither should be considered, as they sometimes are, necessarily dependent on the other. On no point in the whole range of the subject under consideration, is it more necessary that we entertain clear and definite notions, than on that of the restraint of the insane, because, while often essential to the restoration or comfort of the patient, and to the safety of the community, it is, at the same time, liable to serious abuses. It is a curious fact that this measure, important as it is, has seldom been regulated by any express provisions of law. In France this measure is al- together unknown to the laws, except in relation to those whose liberty might endanger the safety of society. Such, and such only, the municipal authorities are required to con- fine. The Penal Code, art. 341, inflicts the punishment of 1 Schroder, delegibus in commodum mente alienatorum, 197. 42 494 MEDICAL JURISPRUDENCE OF INSANITY. hard labor on any one who shall arrest, detain, or sequester the person of another not charged with any criminal offence, without the order of the constituted authorities. The 4th article of the charter of 1830, also declares that " no person can be pursued or arrested, except in cases provided by the law, and in the forms that it prescribes." Of course, estab- lishments for the reception of the insane exist, but their whole economy is regulated by their respective governments. " In many departments," says Esquirol, " it is sufficient to apply to the administration of the hospital or asylum, in order to obtain the admission of a patient. In some places the authorization of the mayor is necessary, if the establishment is communal ; of the prefect, if it is departmental. In a few establishments, the patient must be interdicted before he can gain admission." The necessity of express legislation on this subject is generally felt, and within the last year or two, it has received the attention of the legislature, but with what result we are unable to say. In the civil code of Aus- tria, it is ordained that no person can be confined on account of insanity, who has not been legally declared to be insane by physicians appointed for the purpose of investigating his mental condition. In this country, the law as it relates to the isolation of the insane, is in very nearly the same con- dition as that of France, except in those States which pos- sess hospitals that are controlled and supported by govern- ment. Isolation is also sanctioned by the law when adopted as a measure of police. In England, a person cannot be ad- mitted into any lunatic asylum, without a certificate of his insanity, signed by two physicians, within seven days of his admission. 501. The seclusion of a person from his family and cus- tomary pursuits, on account of insanity, should be regulated by provisions having reference to the varying circumstances that may arise, and applicable with a suitable degree of ease and quietness. A uniform mode of proceeding would secure no advantages that would not be counterbalanced, either by a degree of publicity and delay exceedingly painful in a majority of cases, while totally unnecessary and uncalled for, INTERDICTION AND ISOLATION. 495 or by a want of that impartial inquisition which, in a few cases, is necessary to remove every suspicion of unfair dealing. It seems better to suit the provision to the nature of the case, and on this principle we have acted in making the following suggestions. 502. When a person is struck down by disease, and is no longer capable of caring for himself, he is completely de- pendent on those around him his family, his relatives, his neighbors, and even the passing stranger. To this appeal for sympathy and care, the ties of kindred, the holiest instincts of our nature, a sense of duty, a decent regard for the opin- ion of mankind, each or all prompt a favorable answer, and the sacred ministry thus exercised is instinctively regarded with feelings of respect and honor. It does not appear, at first sight at least, that there is any difference in the relations of the parties, when the disease is mental, instead of bodily. The essential conditions of the case are the same. The indi- vidual, if not utterly helpless, is incapable of judging what is best for himself, and needs appropriate attendance and medical treatment. Here then, as in case of bodily disease, the duty of making such provisions as the welfare of the patient may require, naturally falls upon those immediately around him or near him. Nature prompts it, the common sentiment of mankind expects it, in most cases all parties are ultimately satisfied with it, and the legislature should legalize it. 503. The doctrine of the common law on this point has not been interpreted with the uniformity which the im- portance of the subject requires. Not long since, Chief Jus- tice Shaw of this State laid down the broad principle, that the friends of an insane person are authorized in confining him in a hospital, by " the great law of humanity." 1 On the other hand, within a year or two, the Lord Chief Baron of the English Court of Exchequer incidentally remarked, that insane persons could not be legally held in confinement un- less dangerous to themselves or to others. 2 In this opinion 1 Law Reporter, viiL 122. 2 Nottidge v. Ripley, Law Reporter, N. S. ii. 277. 496 MEDICAL JURISPRUDENCE OP INSANITY. he was undoubtedly wrong, because the legislature had granted the power (8 & 9 Victoria, c. 100), but it indicates his interpretation of the common law on the subject. If, therefore, the friends of the insane are to enjoy the privilege of providing for them in such a manner as they may deem most suitable for their welfare, there seems to be a manifest propriety in securing it by a legislative act. The provision which, in accordance with these views we have adopted, in- sures the indispensable requisites of a great majority of cases, despatch, domestic privacy, and those natural rights that flow from the family relation, and, considered in all its aspects, is both wise and humane. That the power might sometimes be abused, is not denied, but such a result would be an exception to the general rule, and would be effectually remedied by the provisions hereafter mentioned. For obvi- ous reasons we would give the same power to the guardian over his ward, and to the proper municipal authorities over their paupers. 504. A very different provision is required for a smaller class of cases, in order to secure, in the fullest degree, the rights of persons and the confidence of the public. We all know that insanity does not always derange every operation of the mind, and deprive the patient of every attribute of a rational being. Under certain circumstances, his conduct and conversation are marked by ordinary propriety and dis- cretion, and to those who regard him superficially, he appears to be governed by the ordinary feelings and motives of men. At the worst, he may be supposed to be only a little ec- centric, or to give way too readily to passion and impulse. To those, however, whose relations towards him place them immediately under his control, and whose presence furnishes no check upon the manifestations of his character, he appears very differently. They witness a degree of mental excite- ment and restlessness, an extravagance in his prospects and plans, a readiness to embark in new and hazardous specula- tions, an indulgence in habits of living beyond his means or unsuitable to his condition, an impatience at the slightest show of opposition or restraint, unfounded suspicions and INTERDICTION AND ISOLATION. 497 jealousies, and the most arbitrary and tyrannical conduct in his family, all which traits are foreign to his natural charac- ter, and perhaps of recent origin. He at last evinces so little control over his passions, or is so completely possessed by his morbid fancies, that the peace and comfort of those in any way dependent upon him, are destroyed, and they are in momentary fear of personal violence. Besides this, he may be squandering his estate in a series of ruinous undertakings, and rapidly bringing his family to beggary, or plunging into unlawful indulgences that fill them with shame and sorrow. Now when such a person is placed by his friends in a hos- pital, the discipline of which is necessary, not only to secure the safety of others, but to restore him to his natural and healthy condition of mind, he declares that he is the victim of an iniquitous cabal, and so plausible and ingenious are his representations, that the most intelligent and cautious are sometimes led to suspect that he has not been fairly dealt with. "Wearied by his incessant importunities, and doubtful, perhaps, of the propriety of his confinement, he is finally discharged by the directors of the institution, to renew the same course of ruinous enterprises and domestic tyranny, with the addition, it may be, of a lawsuit against his friends for false imprisonment. Even though he fail by these manoeu- vres to shorten the period of his confinement before it has produced any salutary effects, his mind is kept in a state of agitation and wrath that might, in some degree, have been avoided, if the measure had come from a different quarter, and with some of the formalities of a legal procedure. 505. The condition of a family whose head is laboring under the form of insanity described above, is sufficiently painful and embarrassing, without imposing upon it the ne- cessity of adopting the only appropriate measure, unaided by any of the sanctions and helps of law. To provoke the wrath of such a person by what he would consider the most flagrant indignity and outrage, would be too fearful a thing to be ventured upon until patience had been tried to the utmost limit of endurance, or some overt act of violence called for immediate action. Neither is it a small thing to 42* 498 MEDICAL JURISPRUDENCE OP INSANITY. provoke the criticism of the public by taking a step of this importance, the necessity of which may not be unequivo- cally obvious to the world. In such cases the public is severe in its judgments, and not particularly careful to weigh the parties in an even balance. 506. In the same category, too, we would place those persons who are insane enough to require confinement, but have no relatives or friends with sufficient interest in their welfare to induce them to assume so unpleasant and respon- sible a duty as that of placing them in confinement. 507. After due consideration of the various means that might be adopted for determining the question of seclusion, in regard to the cases above-mentioned, we can think of none better than that of a commission, so constituted that its decisions shall command the respect and confidence of the community. It should consist of not less than four nor more than six persons, one of them a lawyer and another a physi- cian, for the purpose of giving a suitable direction to the inquisition, who should have the party brought before them, hear the testimony, and render a decision accordingly. Of course they should have the power of ordering him to be held in custody pending the proceedings. The authority appoint- ing the commission should be as accessible as possible, to insure the necessary despatch, and might be lodged with the judges of the law courts, and also with judges of probate where these functionaries are at all distinguished from the average run of men by superior knowledge and respectability. The application should be made in writing by some friend or relative, and should present the grounds on which the allegation of insanity is to be established. The success of this proceeding would very much depend on the character of the individuals composing the commission, and no act of the legislature could regulate that exactly. It is probable, how- ever, that the importance would be felt of intrusting so deli- cate and responsible a duty to men, whose intelligence and virtues have given them a merited weight of character in the public estimation. 508. There is still another class of the insane for whose INTERDICTION AND ISOLATION. 499 committal a mode of procedure is required, different from both of those already mentioned, those whose disorder renders them dangerous to the community, and who have no friends to take them in charge, and provide for them ac- cording as their necessities may require. Most, if not all the New England States, and perhaps others, have a statute which gives to a magistrate the power of committing to some place of confinement, "persons furiously mad and dan- gerous to be at large." This provision should be retained. Indeed, there seems to be no other way by which this class of persons can receive the attentions that common feelings of humanity and a regard for public order would dictate. As they are, for the most part, destitute and friendless, and become a charge to the community where they are arrested, there can be no inducement to seek their confinement un- justly. It wotdd not be impossible, certainly, for wicked and cunning men to make the statute an instrument of great injustice ; but the objection arising from such a contingency may be obviated by the fact, that if the case present any suspicious circumstances, the magistrate may decline to take cognizance thereof, and refer the parties to the provisions just mentioned. 509. Having thus provided for the restraint of the different classes of persons who may require it, the next step would be to provide for their restoration to liberty. For the most part, the latter measure, like the original restraint, should remain in the hands of the family or friends. The same authority, also, which commits persons " furiously mad and dangerous to be at large," should have the power of dis- charging them, when satisfied that the original objects of their confinement will be properly cared for. It is proper, too, that those who have guaranteed the payment of the expenses of an insane person in a place of confinement, should have the power of removing him, if that is requisite in order to close their liabilities. Reasons may occur that would render it as expedient to withdraw from such an obli- gation, as it might have been to assume it originally, and if, by the conditions of the obligation, the patient must be 500 MEDICAL JURISPRUDENCE OP INSANITY. removed before it can be discharged, then most clearly the surety should have that power. 510. There now remains but one more class whose dis- charge from confinement we have to consider, those who claim their liberty on the ground of being unjustly confined. The injustice may consist in being confined without having ever been insane, or in the confinement being continued after recovery from the disorder. We can conceive of no better mode of meeting such cases, than by a process very similar to that by which those are committed whose friends do not choose to assume the responsibility. There would be a convenience in making the trustees, directors, or by whatever name that body may be called which has the gen- eral supervision of the hospital, this committee, as they could discharge the duty quietly and cheaply, with the peculiar advantage of having often observed the party in question and heard his statements from his own lips. But their official connection with the institution might be thought to bias their opinions, and therefore there seems to be a propriety in forming the commission of persons having no previous knowledge of the parties. It should be an indispensable condition that they should have an interview with the patient, but it is not necessary that it should be attended with any formalities, or that he should be aware of its object. The proceeding is in the nature of an inquisition, not a trial by jury, and hence the commission may not be bound by any formal rules in pursuing their object. Indeed, the great advantage of this method over a judicial investigation pro- cured by a writ of habeas corpus, is, that it is not necessarily attended with a degree of formality and publicity calculated to excite injuriously the mind of an insane person, and also to produce a mischievous effect upon the minds of other patients in the same establishment. 511. It often happens, that insane persons are attacked with bodily disease, when their friends are desirous of taking them home, and contributing whatever may be in their power to the solace of their declining days. The character of their disorder also often changes, so that they can be safely INTERDICTION AND ISOLATION. 501 managed at their own homes ; and sometimes there may be reasons for merely changing the place of confinement. In all these contingencies, the grounds on which the discharge of the patient is sought for, are so reasonable, that the order of a judge should be sufficient without the interference of a commission. 512. The above provisions, we apprehend, will meet every contingency incident to the confinement, or discharge therefrom, of the insane. They possess the necessary requisites of despatch, convenience, cheapness, and regard to private feelings. By suiting the provision to the particular emergency, we avoid the insuperable objections that would lie against any single provision intended for application to all classes of cases. By far the larger class require no legal procedure at all, and are better left to the management of the family or friends. To subject them to any legal formalities beyond a compliance with a few simple rules, would be to inflict needless pain, and thus produce a certain evil in order to avoid a contingent one. The much smaller class, which require some judicial investigation, are provided for by a mode of procedure, familiar to our practices, accessible, cheap, and well calculated to satisfy the public mind. The commission, let it be observed, is its only essential feature. The manner in which it shall be constituted, and the au- thority from which it shall emanate, are subordinate, though important points, which must or ought to vary with the cir- cumstances of each particular community. To insure the successful working of the system, the appointment of the commission should be conferred upon functionaries having some practical acquaintance with law proceedings, and suffi- ciently cultivated and enlightened to be above the influence of vulgar prejudices. On this account we have selected for the purpose, the justices of the law courts, and perhaps those of the probate courts, and in sparsely populated parts of our country, the public convenience might be served by adding to them the sheriff of the county. In most respects, it would be decidedly better if the duties of these commissions were performed by a single permanent board appointed by the 502 MEDICAL JURISPRUDENCE OF INSANITY. government. The members of such a board would naturally make themselves acquainted, by all the means in their power, with the subjects of inquiry that would come before them, and frequent practice would give that familiarity with their duty that would enable them to avoid mistake, and inspire confidence in their decisions. The only conceivable objection to the plan would be, the large amount of travelling expenses to which it would lead, especially in large States, and this would be sufficient, probably, to outweigh its ac- knowledged advantages. 513. In order to prevent any infringement of the laws respecting the confinement of the insane, the first setp would be, to render it a penal offence for the directors or superin- tendents of hospitals to receive patients, except in strict con- formity to the laws. In respect to persons admitted under the first section, a certificate of insanity from one or more physicians should be required, as well as a written request for admission from some relative or friend. Beyond this we do not know that any safeguard would be practicable or necessary, and, considering the provisions that furnish a remedy against any possible abuse, we see not how any fault can be reasonably found with it. CHAPTER XXVII. DUTIES OF MEDICAL WITNESSES. 514. BOOKS on Medical Jurisprudence usually contain a chapter on MEDICAL EVIDENCE, in which the general sub- ject is discussed. There are some points, however, connected with such evidence in cases involving questions of insanity, which require a more special consideration. Cases of this kind have now become so common, that it is highly impor- tant for the medical witness to know precisely what are his duties, as well as the difficulties which he is likely to encoun- ter. 515. Unlike the ordinary witness who relates only what comes within the cognizance of his own senses, the expert testifies respecting the inferences that may "be drawn from the facts related by others. In other words, certain facts being given, the expert is required to state the general principle which they indicate in regard to the question at issue. This method of obtaining information on scientific subjects is as inappro- priate as possible, but, in this respect, our rules of evidence recognize no distinction between matters of fact and matters of opinion. In regard to the latter as well as the former, the testimony is off-hand, with no other preparation than what may have been anticipated by a shrewd conjecture as to the course of inquiry which the examination might pursue. Objectionable, however, as this method is, it is the only one known to our laws, and its requirements must be met in the best possible manner. 516. The expert should be prepared for his duty by a well-ordered, well-digested, comprehensive knowledge of mental phenomena in a sound as well as unsound state. 504 MEDICAL JURISPRUDENCE OF INSANITY. The question which, in one shape or another, is put to him, is whether or not, certain mental phenomena indicate mental unsoundness. The true character of doubtful cases cannot be discerned at a glance. The delicate shades of disorder can only be recognized by one who has closely studied the operations of the healthy mind, and is familiar with that broad, debatable ground that lies between unquestionable sanity and unquestionable insanity. How little dependence could be placed on the testimony of a physician concerning the results of a cadaveric autopsy, who has not, by frequent inspection, made himself acquainted with the healthy appear- ance of the organs. How this knowledge is to be obtained, is a question not easily answered. In books on mental philos- ophy the various faculties and operations of the mind are un- folded and described, with a show of scientific precision. But the expert will derive from them little aid in preparing him- self for his duties, for the reason that their investigations are partial, being confined chiefly to the individual's own mind, overlooking the manifestations of mind as affected by disease. If any books are to be studied, it should be those immortal works which represent men in the concrete, living, acting, speaking men, displaying the affections and passions, the manners and motives of actual men. Locke and Stewart will here be found of less service than Shakspeare and Moliere. But better than all books, though their aid is not to be despised, are personal observation, and study of mental phenomena as strikingly exhibited in real life. Every men- tal peculiarity, especially in the normal condition, and, above all, those traits of character that mark the transition between health and disease, should be closely observed. The expert should learn to distinguish the thoughts and manners of the one condition from those of the other, and endeavor to gain a ready perception of the general air and tone characteristic of each. No kind of preparation will better fit him for perform- ing the peculiar duty of an expert, which consists in forming opinions respecting mental conditions, from a few and per- haps disconnected facts. Without it he will be constantly liable to the mistake of regarding a trait or act as indicative DUTIES OF MEDICAL WITNESSES. 505 of disease, for no other reason perhaps, than because it occurs in a case supposed to be doubtful, and of confounding natu- ral eccentricities and impulses with the manifestations of ac- tive insanity. The expert who is deficient in this kind of knowledge can never be a reliable witness in questions of insanity. 517. However well prepared the witness may be, he will find it necessary to be on his guard against another dis- advantage incident to our method of eliciting evidence. He is called by the party that has reason to believe, that his tes- timony will serve the purpose of the latter. He is, in form at least, that party's witness, engaged by him, and by him made acquainted with all that he knows respecting the mer- its of the case. Counsel look at one side of the question only, and naturally endeavor to make the expert participate their views, while their intercourse is marked by a kind of cordiality and fellow-feeling somewhat adverse to that inde- pendence which the expert should never relinquish. The consequence of such a relation is that he can scarcely help testifying under a bias. In many cases, no doubt, this would be unavoidable under any mode of procedure, and the only thing the expert can do, is to shun the evils of this arrange- ment as much as he possibly can. There are other points in regard to which an expert not much familiar with courts, may be benefited by a word or two of advice. 518. In the first place, let him beware how he suffers the dread of being thought ignorant of his profession, to draw from him a positive and unqualified reply, where a modest doubt would have better expressed the extent of his knowl- edge. It is not expected, that on the spur of the moment, without any special preparation, he should always be ready to express an opinion on an obscure point, or one somewhat remote from the line of his ordinary duties. Neither court nor counsel ever commit a folly like this. They are careful to make their opinions the result of calm, deliberate reflection, and thorough research. And why should the physician do otherwise ? Life and death may be involved in his testimony, 43 506 MEDICAL JURISPRUDENCE OF INSANITY. and the consequence of his rash confidence may be the ruin of a fellow being, and a harvest of self-upbraiding to himself. He loses no reputation necessarily, by honestly stating that he is unprepared to give an opinion without mature consider- ation, but he cannot help losing much by taking the opposite course. He should also bear -in mind that the object of counsel, as every body knows, is not so much to elicit the truth as to serve their client, and thus every particular question, as well as the general tenor of the examination, is adapted to this purpose. They form an hypothesis, or lay down a plan of operations, and then frame their questions so as to bring out the wished for reply. Let the witness never forget, there- fore, that every question has its object, and take care that his answer be carefully considered. 519. It also happens that an ignorance of medical terms, if not of medical subjects, often prevents the counsel from using language with that degree of precision which is indispensable in the discussion of scientific subjects. The witness should insist, therefore, on having the question clearly expressed, and never allow himself to answer a question he does not thoroughly comprehend. Equally necessary is it for him to be careful how he returns categorical answers to the questions put to him, for they are apt to leave wrong impressions upon those who are imperfectly acquainted with the subject, and may be adroitly used to embarrass the wit- ness and discredit his testimony. If he would avoid this result, he must, in spite of the authoritative demand for a yes or a no, so qualify and explain his answers, as to prevent any mistake of their meaning, and no dread of amplification should deter him from this purpose. Let him bear in mind that he has an unquestionable right to express his opinion in his own way, and that he is put upon the stand, not solely to answer such questions as the ingenuity of counsel may prompt to further their ends, but to give an opinion on a scientific subject for the purpose of promoting the cause of justice. Such, in point of fact, notwithstanding our modes of procedure, is the proper function of the expert, and, as courts generally are disposed to receive any light he can fur- DUTIES OF MEDICAL WITNESSES. 507 nish, they will sustain him in his endeavor to make himself thoroughly understood. Indeed, they are less likely to yield their confidence to categorical and unqualified statements, in- dicative as they must be, either of ignorance or trepidation, than to the cautious and guarded manner characteristic of true science. 520. The medical witness must be on his guard against another favorite manosuvre of counsel that of supposing cases, and drawing out of the witness an opinion that may be advantageously applied to the case in hand. It is easy enough for an active imagination to create a case apparent- ly favorable to a certain hypothesis. And this is its radical fault, that it is without life or substantiality, a mere figment of the brain. It is a well-settled principle, that in matters of science, opinions must not be formed on a partial statement of facts ; but how can any statement be regarded as com- plete or incomplete, which is professedly fictitious? In a case where the validity of a will was contested on the ground of the insanity of one of the subscribing witnesses, it ap- peared in evidence, that he had, at one time, entertained some gross delusions and attempted suicide, but that for a few months previous to the execution of the will, he had renounced the delusions, pursued his studies, wrote a very good book, and in short, seemed to be entirely like himself, with the exception of unusual shyness and desire for solitude. To one of the experts who had expressed the opinion that this person was of sound mind, this question was put; " Supposing he had committed murder about the time he witnessed the will, would you have considered him as mor- ally responsible for the act ? " The question was artfully founded upon the imputed disposition of the expert to admit too readily the plea of insanity in criminal cases. The court did not permit it to be answered, but the reply would have availed the party nothing. An act of homicide is a fact, or more properly a body of facts, a knowledge of every one of which may be necessary to throw any light on the mental condition of the person committing it. Nothing could be more presumptuous than to form an opinion in such a case, 508 MEDICAL JURISPRUDENCE OF INSANITY. without an exact knowledge of all, even the minutest of the circumstances attending it. Here was an endeavor to draw out a professional opinion on an abstract idea, and even if a tissue of circumstances had been supposed, they would have formed no ground for an opinion. 521. Another professional manoeuvre of a kindred nature, is that of selecting one or more particulars which have been adduced among the indications of insanity, and then asking the medical witness if he regards that as a proof of insanity. It is always one of those things which, whatever they may signify when viewed in connection with one another, yet, singly considered, prove nothing respecting the mental con- dition. And it is for this very reason, that the attempt is made to throw the expert upon the horns of a dilemma, for, if he replies in the negative, he appears to deny what he has but just virtually affirmed ; if in the affirmative, he stultifies himself in his eagerness to avoid a fancied inconsistency. The only course for him is, to state the general principles which no one sees exemplified oftener than himself; that, in a large proportion of cases, insanity is manifested, not so much by any particular trait, as by the general character of the person's conduct and conversation, as compared with that which he exhibited when admitted to be sane ; that, in regard to many patients, it would be impossible to mention a single trait that none but an insane man would exhibit ; that even in the strongest cases, it would often be difficult to give reasons for a belief that would be satisfactory to those who-vhave no practical knowledge of insanity ; and that this difficulty becomes an impossibility when the indications are obscure, or consist more in the general style of the conduct and discourse than in any single act or notion. At any rate, let him firmly decline to form an opinion on one or two selected facts. 522. Lawyers are much disposed to ask for a definition of insanity, and it will be well for the witness to be prepared on this point, bearing in mind that the object of the ques- tion is, not so much to obtain any light on the subject, as to perplex and embarrass him. Medical writers have exer- DUTIES OF MEDICAL WITNESSES. 509 cised their wits in seeking what they are pleased to call a definition of insanity, in the belief that if once discovered, they would know precisely what insanity is and what it is not. It is generally admitted, that no one has yet succeeded in accomplishing this laudable purpose, for insanity belongs to a class of phenomena that may be described and explained, but are not the proper object of a definition ; and the reason why an unexceptionable one has not appeared, is not so much on account of the obscurity of the subject, as because the thing is inappropriate and nugatory. If the medical wit- ness suffer himself to be drawn into a metaphysical discus- sion, he will be sure to be worsted, for his opponent is cool and prepared, while he is taken by surprise, and unable to see the point to which he is dexterously lead. 523. The witness is sometimes asked if all people are not more or less insane, and if all crime is not temporary madness. The object of the question is to excite a preju- dice against the plea of insanity generally, by implying that it is used to shield the evil-doer from the penal consequences of unbridled passion. Although never relevant to the case in hand, yet the witness may sometimes deem it proper to return a formal and deliberate answer ; and if his views on the subject agree with ours, he will firmly maintain the dis- tinction between normal passion and maniacal fury, be tween the infirmities and short-comings of a limited nature and the manifestations of unequivocal disease. If people choose to set up, in good faith or otherwise, a fancied ideal of perfection, and regard every one who falls short of it as more or less unsound, the only objection is the misapplica- tion of terms ; but while we acknowledge the difficulty some- times of running the line between vice and insanity where they border on each other, for the most part they are wide enough asunder and easily distinguished. Nature draws no dividing lines in the realms of moral or natural science. Classes and orders and genera are merged in one another, and the inquirer is ever treading upon some debatable ground, where the clearest distinctions and definitions quite vanish away. Why then should it be thought so strange, that the 43* 510 MEDICAL JUKISPRUDENCE OF INSANITY. empire of health should be divided by no palpable line from that of disease ? or that this fact does not authorize the con- clusion that their respective phenomena can seldom be accu- rately distinguished from one another ? Our knowledge of the philosophy of crime, if we may use the phrase, has been greatly enriched of late years, by observations in hospitals, jails and court-rooms, in the purlieus of vice and the walks of respectable society; but the old land-marks, the funda- mental distinctions, remain as prominent as ever. 524. In this country the course usually adopted for eliciting the opinion of the expert, is, to ask him if he has heard the evidence, and if he has, and supposing it to be true, what is his opinion respecting the mental condition of the party. Such also was the practice in England, but recently it has been disallowed for the alleged reason, that it placed the witness in the position of the jury. In the cases where this decision was made, * the court permitted the counsel to mention any particular fact, and ask the witness if that were a symptom or indication of insanity. However objectionable the original practice might be, the substitute is infinitely more so, on the higher ground of its utter irrelevance to the object sought for. Insanity is a disease, and like other dis- eases, its presence is indicated by certain incidents called symptoms. Inasmuch as many symptoms are common to different diseases, they are to be regarded in relation to any particular disease, collectively, not singly ; and inasmuch as the indications thus furnished are often obscure, the observer will need all the aid which the amplest account of the symp- toms can afford. To ask a witness if a certain act or notion is the offspring of insanity, would be like asking a physician if pain in the right shoulder were a symptom of disordered liver ; or pain in the side, of pulmonary consumption. To re- turn an affirmative answer to these questions would not help the matter at all, because these symptoms are also pres- ent in other diseases, or conditions. Neither is it obvious how this method avoids the objection in question. If the 1 Amer. Journ. Insanity, ix. 292. DUTIES OP MEDICAL WITNESSES. 511 incident which is particularized has not appeared in evi- dence, then certainly it can have no bearing on the mental condition of the party, while, on the other hand, even if it have thus appeared, its effect must still be the same, unless supposed to be true. The opinion of the expert, therefore, touching the case on trial, must be formed upon a considera- tion of all the incidents, and whether he learns them from counsel who have picked them out of the evidence and stated them in their own words, or directly from the witnesses on the stand, the result must obviously be the same. The latter has this advantage, perhaps, that the statements of "witnesses are necessarily affected in some degree, by their tones, gestures, and expression, and therefore are deprived of part of their value in passing through the mouth of another. 525. It cannot be denied, however, that the course per- mitted by our courts is encumbered by a practical difficulty which should be carefully considered. It not unfrequently happens that discrepances and contradictions appear in the testimony, quite inconsistent with the idea of its being all true. Having no right to decide for himself, between the true and the false, what is the expert to do ? We can only say that where these contradictions are of a trivial character and confined to subordinate points, they may be overlooked, apparently without any impropriety ; but where they involve the main facts at issue, it is not easy to see how he can ar- rive at any conclusions without assuming the functions of the jury. In this contingency, he can only candidly state his embarrassment and show how the testimony clashes, describe the bearing which its several portions may have on his opin- ion, and leave the farther disposal of the matter to the court. 526. It often happens, too, that the evidence, without involving any manifest contradiction of facts, bears the marks of high coloring, of exaggerated statement, or unintentional omissions. Different witnesses, we well know, seldom state the same facts precisely alike. There will be something either of addition or omission, in the testimony of each, calculated to leave an impression different from that pro- duced by the rest. Here the expert is permitted, if not re- 512 MEDICAL JURISPRUDENCE OF INSANITY. quired, to make such allowances as are naturally made by every other person around him, otherwise he would be for ever debarred from giving an opinion in a judicial inquiry. But the expert must never forget, that it is the whole evidence on which his opinion must be founded, and if it be con- tradictory or deficient, he will best consult his own reputa- tion and promote the ends of justice, by candidly stating the fact. INDEX. [The Figures refer to the Sections.] A. Abbot, case of, 40, 477. A. B., case of, 213. Abraham B., case of, 158. Aidoiomania, 168 et seq. Allis v. Billings, 263 et seq. Amos, Prof., on unsoundness, 5. Allison on the test of right and wrong, 20 ; on delusion, 20 ; on drunk- enness as an excuse for crime, 461. Arnold, case of, 10. Arithmetical acquirements, not proof of capacity, 76, 104. Association of ideas in the insane, 247. B. Barbier, case of homicidal insanity, 196. Barclay, case of, 97. Bagster, case of, 76. Beauquaire, his will established, 105. Beck, on McDonough's case, 449. Bell, on insanity from masturbation, 161; on the plea of insanity, 261; case of Colonel M., 160 ; case of simulation, 362. Bellingham, case of, 15, 37, 44. Ben Johnson's hallucination, 129. Bertet, case of, 257. Bichat, picture of old age, 292. Billings, Allis v., 263 et seq. Birdsell, case of, 466. Brain, small and diseased in idiocy, 52 ; the seat of mania, 109 ; how af- fected by liquor, 440. British and Foreign Medical Review 'on Miss Bagster's case, 77; on drunkenness, 461. 514 INDEX. Brixey, case of, 195. Brown, Rev. Simon, his delusion, 136. Brown, Wm., case of, 186. Brougham, Lord, on the plea of insanity in criminal cases, 3 7 ; on the test of sanity, 39; annoyed by insane persons, 39 ; on partial insanity, 239. Broussonnet, case of, 139. C. Campbell, Lord, on the plea of insanity, 37 ; on competency to testify, 427. Cartwright v. Cartwright, 336. Castelli, case of, 405 et seq. Character, change of, a proof of insanity, 115. Charolais, Count, case of, 74. Chitty, on right and wrong, 19 ; on moral insanity, 23. Classification of mental diseases, 3, 49. Coke on insanity, 3 ; on drunkenness, 454. Combe on change of character, 115 ; on lucid intervals, 332. Commission of lunacy, its proper duty, 5. Committees of physicians, apt to differ in their conclusions, 3 73 et seq. Competency of a witness, conditions of, 419. Conolly, definition of insanity, 131; on simulated insanity, 342, 359; on the writing of the insane, 376 ; on interdiction, 486, 495. Continued observation in the detection of insanity, 376. Contracts of the insane, 7; of somnambulists, 414 ; of imbeciles, 106. Cornier, case of, 205 et seq. Cory, decision in his case, 40. Cox, on moral mania, 143. Crawford, case of moral imbecility, 71. Cretinism, 55. Crime, distinguished from passion, 25. Criminal law of insanity, why so slowly improved in England, 14; ex- pounded by English judges, 26 et seq. ; debate on, in the House of Lords, 37 ; statutes of different nations on, 41. Gumming, Mrs. allusion to her case, 373. Cunning, active in the insane, 21 ; in imbecility, 70. Curability of insanity at different periods, 315. D. D'Aguesseau on lucid intervals, 325, 334. Davies, case of, 487 et seq. Deafness in old age, 292. Delay in trying cases of insanity, enjoined, 256. INDEX. 515 Delepine, case of, 89 et seq. Delirium tremens described, 438 ; cases of, 441 et seq. Delusions, considered as a test of insanity, 22; of monomaniacs, 135 et seq. ; their effect on mental soundness, 240 et seq. Denman, Lord, decision in Oxford's case, 26. Dennet and wife v. Dow, 296 et seq. Design not a test of insanity, 21. Dew v. Clarke, 235. Dewey, Judge, charge in Allis v. Billings, 270. Dipsomania, Esquirol on, 443; cases of, 443 et seq.', Marc on, 447. Donelly, case of, 427. Dolus and culpa in relation to drunkenness, 451, 455. Dreaming, compared with insanity, 247. Depression, alternating with excitement, 145 et seq. Drew, case of, 463. Dyce Sombre, case of, 373. E. Eccentricity, its relation to insanity, 114. Ecstasis, 409. Education of idiots, 54 ; neglected, a cause of ignorance, not imbe- cility, 77. Eldon, Lord, his definition of an unsound mind, 5 ; on lucid intervals, 334 ; case of concealed insanity, 369. Epidemic character of homicidal insanity, 253 et seq.] of suicide, 395. Erion, case of, 453. Errington, case of, 22. Erskine, Lord, his objection to a verdict, 5 ; distinguishes between civil and criminal cases, .10 ; mistakes the facts in Arnold's case, 14 ; on delusion as a test of insanity, 14. E. S., case of, 71. Esquirol, on hallucinations and illusions, 129 ; case of impaired language, 139; cases of homicidal insanity, 190 et seq.] on the validity of a mo- nomaniac's will, 237 ; on the mental condition after recovery, 319 et seq.; on recurrent insanity, 319; on dementia, 282; on the pro- portion of epileptics to other insane, 379 ; on periodical drunken- ness, 442 et seq. Evans, on partial mania, 233, 425. Evidence of medical men, 44, 45. Excitement alternating with depression, 145 et seq. Experts, their duties defined, 44; the necessity of, illustrated, 301. F. Falret, cases of suicide, 392. Ferocity, not the cause of homicidal insanity, 351. 516 INDEX. Ferrers, Earl, case of, 154. Fodere, on the propensity to steal, 164 ; theory of lucid intervals, 333 ; on somnambulism, 415. Flight of homicidal monomaniacs not a proof of guilt, 249. Franck, case of, 1 76. Frederic William, case of, 162. French code relative to insanity, 13, 41 ; relative to interdiction, 105. Friedreich, on the propensity to steal, 165 ; on lucid intervals, 339. G. V Gall, cases of propensity to steal, 165 ; of aidoiomania, 169 et seq.] of py- romania, 173; of homicidal insanity, 189, 199, 202; of suicide, 391, 393. George IH., allusion to the case of, 318. Georget, on Hale's doctrines, 1 1 ; on Cornier's case, 208 ; on imbeciles, 70 ; on the effect of monomania on the mind generally, 244 ; general propositions on homicidal insanity, 258 ; on lucid intervals, 330 ; on Jean Pierre's case, 346 ; on the inquest, 377; on the incubation of insanity, 116; on somnambulism, 415; on competency of wit- nesses, 426. Gerard, case of, 364. Gibbs, Sir Vickery, on the criminal law of insanity, 10 ; on design as a test of insanity, 21. Gooch, gives a test of insanity, 115 ; on the Davies case, 487. Graborkwa, case of, 1 76. Gracie, case of, 424. Greensmith, case of, 258. Greenwood, case of, 234. H. Habitual insanity, ground of interdiction, 485, 498. Hadfield, case of, 14, 256. Hale, Lord, classification of the insane, 8 ; distinction between partial and total insanity, 8 ; on the test of responsibility, 8. Hallucinations, explained, 129; how frequent, 130; may be concealed, 130 ; instances of, 135 et seq. ; in delirium tremens, 439. Hansterin, case of, 202. Hardwick, Lord, on unsoundness, 5. Haslam, gives a case of concealed insanity, 21 ; on arithmetical acquire- ments, 104 ; on lucid intervals, 328 ; on simulated insanity, 342, 356. Head, size of, in idiocy, 52 ; injuries of, their effect on the mind, 314. Henke, on sexual evolution, 1 78. Hinchman, allusion to his case, 320. Hoe we, case of, 382. INDEX. 517 Hoff bauer, on imbecility, 58 et seq. ; on stupidity, 66 et seq.; conditions of culpability, 102 ; on wills of imbeciles, 105 ; on moral mania, 144 ; on the trespasses of the insane, 224 ; on the exculpatory effects of partial mania, 245; on somnambulism, 415, 417; on qualification of witnesses, 419 ; on interdiction, 485. Homicidal insanity, generally attended by physical disorder, 188 ; accom- panying certain physical changes, 192; compared with crime, 218 ; its characters, 217; has prevailed epidemically, 253 et seq.; com- pared with moral depravity, 255 et seq.; simulation of, 361. Homicide, mutual, 400. Hood, case of impaired language, 139. Howison, case of, 23, 31. Humboldt, case of homicidal insanity, 182. Hume, on right and wrong, 19. Idiot, defined by the common law, 4. I. K., case of, 157. Illusions of the Intoxicated, 472 et seq. Imbeciles, classified by Hoff bauer, 62 et seq. ; Georget's account of, 70 ; not fit objects of punishment, 101 ; their knowledge of numbers, 104 ; their testamentary capacity, 105 ; their capacity to make con- tracts, 106 ; to contract marriage, 107 ; to give testimony, 420 ; in- terdiction of, 480 el seq. Impairment, kind of, essential to insanity, 131. Incoherence of ideas, not essential to insanity, 344. Incubation of insanity, 116. Inquest, 377. Insensibility of the insane to medicines, 355. Intermission of disease, 324. Interrogatory, 371. Intoxication, a test of simulation, 340. Irritability of the brain during the lucid interval, 340 ; characteristic of genuine mania, 353. Irritation, the initial stage of disease, 110, 339. J. Jean Pierre, case of, 345. Jensen, case of, 191. Jones, case of, 422. Juries, incapable of analyzing evidence, 301. 44 518 INDEX. K. Kenyon, Lord, decision in Hadfield's case, 336. Kindleside v. Harrison, 295. Lambert, case of, 368. Language, impairment of, 139. Latham, opinion in the Davies case, 488. Law in relation to the plea of insanity, 38 ; how regarded by the insane, 39 ; of different people, in relation to drunkenness, 450 et seq. Lawrence, case of, 40 ; opinion in the Davies case, 487. Lecouffe, case of, 98 et seq. Liberty of will and action essential to criminal responsibility, 249. Lispenard, case of, 99. Locke, definition of insanity, 131. Lying, propensity to, 165. Lyndhurst, Lord, quashes an inquisition, 5 ; decision in Oxford's case, 19 ; on the plea of insanity, 37. M. M., Colonel, case of, 160. Mackinnon, opinion in the Davies case, 493. Macmichael, do. do. do 492. Macnish, cases of drunkenness, 441 et seq. Mansfield, Lord, on the criminal law of insanity, 16. Marc, on pyromania, 288 ; on the propensity to theft, 166 ; on a case of simulation, 356 ; on dipsomania, 447. Marriage of imbeciles, 107; of maniacs, 229. McDonough, case of, 458. Me Glue, case of, 471. McNaughton, opinion of the law lords in case of, 27 ; discussion in the House of Lords in case of, 37. Mechanical ingenuity of maniacs, 21. Memory, how affected in insanity, 282, 286 ; revival of, in acute diseases, 306. Mercer, case of, 122. Metaphysics, unable to explain insanity, 46. Metzger, case of moral insanity, 156. Michu, case of homicidal insanity, 198. Molliens, case of, 196. INDEX. 519 Moral faculties, seldom escape the influence of disordered intellect, 242, 244. Moore, case of, 236. Motives of the insane, not well denned, 246. N. Negretti, case of, 403. Nicholl, Sir J., on the proof of insanity in civil cases, 12 ; sanctions Er- skine's test, 22 ; judgment in the Portsmouth case, 78 ; decision in case of marriage, 229 ; on partial insanity, 235 ; on lucid intervals, 310, 338 ; on suicide, 397 ; on imbecility, 483. o. Old age, description of, 292 ; not to be confounded with dementia, 294. Old men, competence to testify, 434. Oppei, case of, 383. Otto, cases of homicidal insanity, 191, 197, 201, 203. Oxford, case of, 26. P. Papavoine, case of, 251. Parchappe, case of suspected simulation, 368. Parent Duchatelet, on moral imbecility, 73. Paris and Fonblanque, on partial mania, 232 ; on drunkenness, 457. Park, J., decision in Greensmith's case, 25. Parker, C. J. of N. H., on the plea of insanity, 261. Parker, C. J. of Mass., decision in case of application for divorce, 229 ; of sucide, 397. Parkman, case of homicidal insanity, 215. Pascal, his hallucination, 131. Pathology of idiocy, 52 ; of insanity, 109 et seq. Pechot, case of, 360. Perceptive powers, how affected in dementia, 294. Periodicity of disease, 322. Phrenology, well explains insanity, 46. Pierquin, case of periodical drunkenness, 444. Pinel, reformed the treatment of the insane, 1 ; on the incubation of in- sanity, 117; first described moral insanity, 142; case of moral in- -sanity, 154 ; on curability of insanity, 315. Portsmouth, case of, 78. Pothier, on experts, 44. Predominant idea, its effect on responsibility, 240 et seq. 9 520 INDEX. Fresco tt, case of, 94 et seq. Prichard, on moral insanity, 142 et seq.; with cases, 157 et seq.; on the propensity to steal, 165. Procedure in procuring interdiction, 499. Proof of insanity, not the same in criminal as in civil cases, 1 2 ; *burden of, where it lies, 270. Provocation, real or fancied, not the true measure of punishment, 34, 240. Pulse of the insane, 349. Purrington, case of, 215. Pyromania, 173 et seq. R. Rabello, case of, 211. Reasoning of the insane, illogical and confused, 245, 246. Recovery, sometimes gradual, 316; sometimes sudden, 316; sometimes imperfect, 320 ; proportion of, 315 ; as connected with competence, 273. Recurrence of insanity, 319, Regina v. Hill, 427. Reid, on lucid intervals, 331. Relapses, 319. Religious fanaticism, connected with homicidal insanity, 253. Responsibility, its elements, 82, 221. Richardson, C. J., decision in Cory's case, 40 ; remarks on Prescott's case, 95. Rider, Jane, notice of, 406 et seq. Right and wrong, knowledge of, 16 et seq., 246. Rogers, case of, 40. Rush, on moral imbecility, 74; on the propensity to steal, 165; on the pulse of the insane, 349. Russell, on right and wrong, 16 ; on design, 21. S. Schmidt, case of, 86 et seq. Schwartz, case of, 423. Sgambari, case of, 137. Selves, case of, 485. Shakspeare, represents a feature of insanity, 247. Shaw, C. J., decision in Rogers's case, 40 ; on the right of isolation, 503. Shelford on suicide, 13. Sleeplessness of the insane, 350. Smith, on the propensity to steal, 165. Story, J., effect of insanity on contracts, 106 ; on drunkenness, 464. INDEX. 521 Stowell, Lord, decision in a case of marriage, 229. Stupidity, distinguished from imbecility, 68 et seq. Swinburne, on the wills of the insane, 12; and of imbeciles, 105. T. Testamentary capacity, 302, 313. Testimony, medical, 42 et seq. Theft, common in imbecility, 70 ; propensity to, 165. Thiel, case of, 469. Thurlow, Lord, on lucid intervals, 326, 334. Tracy, J., decision, in Arnold's case, 10. Trespass, action of, lies against the insane, 224. Trestel, case of, 210. Turn of life, an occasion of dipsomania, 447. Tuthill, testimony in the Davies case, 491. U. Unsoundness, legal definition of, 5 ; not weakness, 79. V. Vatelot, case of, 459. W. Weber, case of, 175. Wilson, case of, 40, 465. Wills of imbeciles, 105 ; of monomaniacs, 234 etseq.; of the demented, 302etseq.; of the delirious, 311 etseq.; how affected by suicide, 397 etseq. Witnesses, medical, 27 ; differently impressed by the same facts, 75. Wynne, on lucid intervals, 336. Wood, case of, 124. Woodward, on the plea of insanity, 261 ; case of a will made in delirium, 309 ; case of a monomaniac's will, 238 ; on proof of sanity, 273. i A 000667312 3 S..II