CLINICAL STUDIES 
IN THE 
RELATIONSHIP OF INSANITY 
TO CRIME 
PAUL E. BOWERS, M. S., M. D. 
1915 CLINICAL STUDIES 
IN THE 
RELATIONSHIP OF INSANITY 
TO CRIME 
BY 
PAUL E. BOWERS, M. S., M. D. 
••a 
Formerly A. A. Surgeon United States Public Health Service 
Formerly Junior Assistant Physician Government Hospital for the Insane, 
Washington, D. C. 
Physician in charge Indiana Hospital for Insane Criminals 
Physician in charge Indiana State Prison Hospital 
President of American Prison Physicians' Association 
Member the Indiana Academy of Science 
Member the American Association Clinical Criminology 
First Lieut. Medical Reserve Corps U. S. A. 
Fellow American Medical Association 
the disFXTCITprint 
Michigan City, Indiana COPYRIGHT, 1915 
BY PAUL E. BOWERS, M. D. PREFACE 
E^VERY year society is unjustly sending to 
j prison hundreds of insane and feeble- 
minded persons who, in the course of 
their mental disturbances, have violated the 
penal law. 
It is my purpose in publishing this little vol- 
ume to show the necessity for distinguishing 
between the criminal acts committed by per- 
sons mentally responsible and those mentally 
irresponsible that the culpable practice of pun- 
ishing the mentally sick in penal institutions 
may, "in the course of justice," cease. 
Society, of course, must be protected from 
the violent acts of all classes of individuals 
whether the perpetrators be sane or insane. 
But it is at once apparent that the mentally 
unbalanced should be committed to the hos- 
pitals for the insane, instead of to prisons. 
Society is being poorly protected when it 
sends insane and mentally defective individuals to penal institutions and then releases them, un- 
cured, from custody, merely because their sen- 
tences have expired. 
Much has been written in a very general 
way about the relationship of insanity to crime, 
but little has been published concerning the 
definite connection of disordered states of mind 
to the commission of criminal acts. 
I have endeavored in this small monograph 
to illustrate by the citation of clinical cases how 
insanity may directly or indirectly be the source 
of penal offences. 
I have dealt separately with each individual 
psychosis for clearness and accuracy. My state- 
ments at times may seem more or less didactic 
and dogmatic, for I have eliminated all theo- 
retical discussions, which are tiresome and 
confusing. 
Foot-notes have not been given in quoting 
the various authorities but I hereby acknow- 
ledge and give full credit for the ideas and quo- 
tations that have been freely appropriated from 
the books and journals listed in the bibli- 
ography. 
P. E. B. 
Indiana Hospital for Insane Criminals 
Michigan City, Indiana. 
Oct. 15th, 1915 CONTENTS 
Page 
CHAPTER I. 
The Causes of Crime 7 
CHAPTER II. 
Criminal Anthropology 14 
CHAPTER III. 
Crime and Insanity 21 
CHAPTER IV. 
Epilepsy ., 24 
CHAPTER V. 
Paranoia and Paranoid States 29 
CHAPTER VI. 
Dementia Praecox 35 
CHAPTER VII. 
General Paresis 41 
CHAPTER VIII. 
Manic-Depressive Insanity 45 
CHAPTER IX. 
Hysterical Insanity 49 
CHAPTER X. 
Puerperal Insanity 54 
CHAPTER XI. 
Senile Psychoses 59 
CHAPTER XII. 
Cerebral Syphilis 64 
CHAPTER XIII 
Drug Psychoses 68 
CHAPTER XIV. 
Traumatic Psychosis and Traumatic Psychopathic States 76 
CHAPTER XV. ■ 
Feeblemindedness 78 
CHAPTER XVI. 
Psychopathic Personalities and Borderline States 85 
CHAPTER XVII. 
Constitutional Immorality 93 CHAPTER I. 
THE CAUSES OF CRIME. 
The question of the causes of crime is one of the most serious 
and difficult problems with which society has to deal. Concomitant 
with the advances made in civilization, there has been an increase in 
the kinds of crimes and the number of criminals. 
The law of the survival of the fittest has ever been active, but the 
surviving qualities have constantly changed and evolved. The physical 
struggle for existence of the past ages, which has been transformed 
into an economic conflict, is, however, none the less determined and 
aggressive, even though there has been a refinement of methods. 
Today it is mind against mind and brain against brain, and as a result 
of the demands made upon the central nervous system by the modern 
standards and manner of living, one of every three hundred persons in 
the United States is insane, and one-tenth of one per cent of the total 
population is housed in penal institutions. 
Over one million of dollars a day is spent in society's efforts to 
stem the criminal tide of degeneracy that bids fair to submerge us, and 
in spite of the claims of enthusiasts and moral reformers, our prisons 
are full to overflowing. 
This problem being so paramount, what measure shall be taken to 
protect our civilization? The method of treatment will not be hard to 
choose when we have, with scientific exactness, determined the 
causes of these foul sores on the body politic. 
It has been recognized only within recent years that vast quan- 
tities of clinical material are going to waste in most prisons for the 
lack of scientific investigations on the part of qualified investigators, 
who, if they had an opportunity, would shed a flood of light on the 
criminal question. 
Broadly speaking, the causes of crime are exogenous and endo- 
genous. The first are the external or environmental causes, and the 
second the internal or constitutional causes. The purpose of this 
thesis is to deal primarily with the endogenous factors of crime. But 
as a matter of brief review, it will be well to give a short synopsis of 
the external or exogenous determinants of crime. 8 
THE CAUSES OF CRIME. 
The environmental forces which contribute to the production of 
delinquency are those which are brought to bear against the individual 
outside of himself, and act upon him throughout the whole period of his 
life. They are the opportunities for securing food and clothing; the 
chances to obtain an education; economic conditions; climatic condi- 
tions; religious influences, and the conventions of social life. 
Economic Conditions. 
The continuous and bitter struggle between capital and labor has 
a most disastrous effect upon the public. The financially weaker 
members of society are the first to suffer the dire effects of this never- 
ending strife. The physical and moral strength of the poor is under- 
mined and devitalized by the sweat-shop systems, which employ women 
and children at a wage insufficient to buy the needed amount of food 
and clothing. 
When the time for parenthood arrives, the reserve strength, 
vitality, stamina necessary for healthy reproduction are lacking, and 
therefore many weakly and defective children are born into environ- 
ments where poverty and ignorance are the only legacy. 
In our rich and well-to-do classes, luxurious idleness, conven- 
tional debauches, and the continuous round of excitement to appease 
the hysterical and unsatisfied craving for novelty and excitement are 
among the causes which operate to produce crimes and criminals. 
Education. 
The recent studies of the Federal Bureau of Education have lead 
to the following conclusions: "'(1) That about one-sixth of all the 
crime in the country is committed by persons wholly illiterate. (2) 
That about one-third of it is committed by persons practically illit- 
erate. (3) That the proportion of criminals among the illiterate 's 
about ten times as great as among those who have been instructed in 
the elements of a common school education or beyond.' " "We must be 
on our own guard, however, against over-estimating the value of mere 
instruction without moral training and power to gain a livelihood by 
skilled labor." 
I found the educational status of one thousand prisoners at the 
Indiana State Prison to be as follows: Eleven per cent were illiterate; 
twenty-four per cent were able to read and write; thirty-eight per 
cent reached the fourth grade; fifteen per cent reached the eighth 
grade; four-tenths per cent graduated from high school, and two- 
tenths per cent were college graduates. 
If a child escapes with its life during the infantile period, educa- 
tion is not always provided, for commercialism often transforms the 
childish minds and bodies into sickly and defective derelicts. Even 
should an opportunity for education be assured and thereby highly THE CAUSES OF CRIME. 
9 
developed wants and desires be created, a spirit of anarchism is pro- 
duced by the economic conditions that do not permit of their satisfac- 
tion. We have abundant testimony of this fact in strikes, lockouts 
and bloodshed, class hatred and serious nihilistic outbreaks against 
the law. 
Our present standards of pedagogics contain many frills which 
should be eliminated; more attention must be paid to vital subjects 
like hygiene and physiology, including that of sex, instead of leaving 
this teaching in the hands of the vicious element of the street. 
The theatre, which performs so great a function in the education 
of the public, has been betrayed for thirty pieces of silver. Licentious- 
ness runs riot on the stage; even the modern problem plays are baited 
with juicy bits of sensuality to form a bacchanalian feast for the eyes 
and imagination of the adolescent girl and boy, and these all lead to 
sexual crimes or those allied and dependent upon kindled sexual 
excitement. 
Bad companionship and vicious associations which foster idleness, 
frivolity and excessive love of pleasure constitute some of the most 
potent contributing factors for the production of crime. 
Intemperance, as we all know, is a most prolific source of offense 
against physical, moral and civic law. 
A growing lack of proper regard for moral and religious teaching 
engenders a disrespect for the laws, which are consequently broken. 
Many practices of the business world are exceedingly questionable, 
and often have I heard this referred to by prisoners in a jesting man- 
ner, who remarked that if their crimes had been the theft of thousands 
of dollars, instead of ten, they might be respected and honored as elite 
and influential members of society. 
Cosmic Causes. 
"There can be no question that climate has some influence on con- 
duct and character; but the phenomena of climate are so intermingled 
with those of history, race and social customs that hitherto few definite 
conclusions have been reached. Apparently crimes against the person 
are more common in the south of Europe, while crimes against prop- 
erty are more common in the north of Europe." 
Quetelet believes: "The number of crimes against property rela- 
tively to the number of crimes against the person increases consider- 
ably as we advance toward the north." 
Enrico Ferri has reached the conclusion: "That a maximum of 
crimes against the person is reached in hot months, while, on the other 
hand, crimes against property come to a climax in the winter." 
"The effect of the seasons on crime is more distinctly marked. The 
criminal within and without the prison is liable to attacks of irrational 10 
THE CAUSES OF CRIME. 
lawless impulses, and these attacks increase in the summer. Through- 
out Europe the greater number of suicides happen in the two warm 
seasons." 
"The prevalence of suicide rises and falls with the sun. In London 
there are many more suicides in the sunny month of June than in the 
gloomy month of November." 
"The influence of temperature on other forms of crime, though 
not so great as with suicides, is very distinctly shown in statistics. 
"Between six and eight per cent of the crime committed in Eng- 
land may with reasonable certainty be attributed to the direct action 
of temperature. In Italian prisons, in four of the hottest months, there 
are the greatest number of offenses against prison discipline." 
Endogenous Factors. 
The environmental causes of crime have received considerable 
attention and study, but the endogenous elements of criminality have 
received but little investigation except from a very few criminologists, 
chief among whom is Lombroso. 
The endogenous or constitutional factors of crime must be sought 
for within the criminal himself, in his prenatal existence with its 
burden of heredity and ancestral tyranny, in his physical, mental and 
moral organizations. 
Violators of the law have sprung from splendid environments, 
where the opportunities for living were ideal; where all forces advo- 
cated by the euthenist, such as education, plentiful provision for food 
and clothing, moral and ethical education were in operation. 
Since infractions of the law and morality often come from this 
sort of environment, we are forced to conclude that some of the causes 
of delinquency rest in the constitutional organization. 
We have not studied crime in a thorough and systematic manner, 
and in the cold light of science, and there are several potent reasons 
why this is so. Prominent among these is the attitude in which the 
social conscience has held crime to be an incurable evil, and to look for 
new remedies was merely a waste of time; even the institutions for 
higher learning have shared to a large degree this same illogical 
attitude. 
Crime is so common and the daily papers are so filled with its 
elaborate rehearsal that society has in a state of careless indifference 
regarded it as an evil necessity. 
The church has appeared to be fearful that the scientific study of 
criminality would lead to materialism, and it has been afraid that 
science would claim a physical basis for crime, which viewpoint it was 
believed would thereby lead to a shattering of the popular idea gen- 
erally entertained concerning free will. 
Prisoners have from time immemorial been more or less under 
the spiritual if not the temporal jurisdiction of the theologian. THE CAUSES OF CRIME. 
11 
The theologian, like the jurist, has Lad his view of the criminal 
obscured, because he has devoted more attention to that element of 
crime, which religious dogma has catalogued as sin. The moralist 
reacting to the bias of his religious training and education has looked 
upon the criminal as a wholly responsible, deliberate and wilful 
chooser of evil. And in accordance with this moralistic sophistry, he 
has been more busy in the application of religious remedies than he 
has in the study of its causes. 
Up to the present time, far more attention and consideration have 
been given to the legal classification of crime and to its various modes 
of punishment, than have been given to the criminal himself. 
Probably fifty per cent of all juridical proceedings are concerned 
with criminality, and yet our jurists placidly and contentedly continue 
to study their books instead of men, searching in ponderous and 
ancient volumes of citations, resurrecting decisions from the legal 
grave-yard of the dead past and with these crumbling, moth-eaten 
and time-worn precedents, they attempt to regulate the anti-social 
conduct that springs from a disordered mentality. 
Experience has proved that the doctrine "Lex Talonis" is an 
unproductive one. A measure of punishment cannot balance or remedy 
a certain measure of crime; experience has likewise taught that the 
religious reformation of the criminal has been ineffective for the reduc- 
tion of criminality in general. 
One of the prime reasons for the lack of scientific study of crim- 
inality is the mawkish sentimentality concerning personal rights. 
The public has very jealously and sacredly guarded the civil and 
personal rights of its prisoners, and this justly so, to a certain extent. 
On the other hand, it has so encompassed the so-called privileges of 
the criminal with legal enactments and a spirit of conservatism, that 
a barrier has been erected which has been most effective against the 
scientific study of the offender; this almost fetish and absurd worship 
of the prisoner's personal privileges, so-called, has served as a brake 
on the wheels of criminological progress. 
How paradoxical is the public attitude which sanctions, permits 
and encourages the study of all forms of social, mental and physical 
degeneracy. We have established clinics and laboratories for the 
study of the insane, the epileptic, and the feeble-minded. We examine 
and investigate with the closest, and most scientific scrutiny, the vic- 
tims of mental alienation. The public eleemosynary institutions that 
do not carefully study their inmates are looked on with distrust and ill- 
favor as being non-progressive, non-scientific and inhumanitarian. 
For the sake of truth and science in effort to relieve suffering human- 
ity, we exhibit pregnant women before classes of young men and 
women at medical clinics, and no one questions the procedure. We 
study clinically and exhibit before classes the innocent and non- 12 
THE CAUSES OF CRIME. 
criminal victims of disease receiving treatment in our private and 
municipal hospitals. 
Is it not just as important to study in the same manner the pathol- 
ogy of moral degeneracy as it is to investigate physical diseases? 
Should not psychological clinics be established in all our state penal 
institutions? These should be opened to qualified persons for the 
study and diffusion of knowledge concerning criminology. When the 
spirit of scientific inquiry once permeates our prisons and reforma- 
tories, real reformation and relief among criminals will follow. 
A study covering more than three thousand prisoners has led me to 
the belief that there is but a comparatively small number of criminals 
who deliberately, wilfully and in a manner wholly responsible, practice 
crime; on the other hand, I have become convinced that there is a 
very much larger group of more or less mentally defective individuals 
who are such by the never-changing laws of heredity or through some 
biological caprice, or through the acquisition of disease, and who are 
destined to be anti-social and dangerous elements in society in spite of 
all the efforts to reform them, and this belief has its foundation in and 
is supported by clinical facts. 
There is a third class larger than the first but much smaller than 
the second, whose legal offenses are more or less accidental in char- 
acter, brought about by vicious environments and faulty or deficient 
educations. 
If ever we are to discover the efficient factors of crime, we must 
subject the prisoners to scientific, physical and mental measurements 
in clinical laboratories. 
We must bear in mind that the criminal cannot be judged accu- 
rately by the face value of the overt act he may commit. His mental 
mechanism must be understood. 
The study of insanity has shown this statement to be true. Crime 
cannot be studied "en masse" any more than ordinary physical disease. 
The individual offender must be interviewed in the same manner 
as the insane patient. We must learn what mental or physical blight 
nature may have bequeathed him. We must discover the motives and 
stimuli which regulate and control his conduct. We must see the rela- 
tion of his criminality to his life history in longitudinal section. 
To do all this, we cannot permit our studies to be obscured by 
preconceived ideas and opinions borrowed from religious or sociolog- 
ical doctrines. In short we must view the criminal with the impartial 
and impassionate eye of science. 
Apropos of this subject White says: "A careful psychological 
dissection, so to speak, has to be carried out in order to determine the 
roots from which such conduct has sprung, and it is only by such dis- 
section and such determination that conduct becomes understandable." THE CAUSES OF CRIME. 
13 
"To attempt to classify conduct upon the basis of the opinion of 
twelve jurymen, whose business it is to say whether the conduct of an 
individual is or is not capable of being squeezed into the limits defined 
by a specific statute, is to confine one's observations to the most super- 
ficial aspects of the individual. Society has been doing this for hun- 
dreds of years. For scientific purposes such superficial glimpses are 
of little value. * * * The identically same act, from a legal point 
of view, may be committed * * * from widely different motives, 
and, therefore, have absolutely different explanations. * * * The 
problem of the criminal must become more individualistic." CHAPTER II. 
CRIMINAL ANTHROPOLOGY. 
Before directly entering upon the discussion of the relationship of 
mental defect to crime, it will be of some little interest, if not of value, 
to touch briefly upon the subject of criminal anthropology. 
Ever since Cesare Lombroso published his monumental work, 
"L'Uomo Delinquente," the students of sociology and criminology have 
been waging constant warfare for and against the conclusions and 
deductions made in this famous volume. 
The question as to whether there exists a "criminal type" of man 
continues still to draw the heated fires of controversy. 
Criminal anthropology seems to have been constantly misunder- 
stood because there has been a confusion between the "technical value 
of anthropological data concerning the criminal man and their scien- 
tific function in criminal sociology." 
The real function of criminal anthropology is to determine whether 
the criminal is normal or abnormal; to learn the nature of his abnor- 
malities and to ascertain whether or not they are of such a nature as 
to respond to treatment and correction. 
The results and conclusions herein stated are from my daily 
observation and contact with all classes of criminals and these conclu- 
sions of necessity are empirical. 
Heads. 
It has been my observation that the heads of criminals when com- 
pared with persons living at liberty do not show a very marked dif- 
ference in size; small heads and large heads have been observed with 
greater frequency among prisoners than have heads of medium size. 
Asymmetry of the cranial vault is quite common, and I believe is 
more often seen in criminals than in an equal number of civilians. The 
cranial anomalies, such as plagiocephaly, macrocephaly are found 
among the insane, epileptic and feeble-minded persons in about the 
same ratio. CRIMINAL ANTHROPOLOGY. 
15 
Goring's measurements of heads lead him to the following conclu- 
sion: "It will be seen from the examination of the differences recorded 
that in correlation there is no difference at all * * * between 
criminals and university men." 
Certain anatomists have devoted much attention and study to the 
brains of criminals. They have carefully noted the weight, size and 
structural peculiarities, but however deserving their studies have been, 
they have shed but little light upon criminal anthropology. 
The following brain weights indicate at least the negative value of 
this method of examination: 
"Oliver Cromwell's brain weighed 82.29 ounces; Lord Byron's, 79 
ounces; Cuviers', 64 ounces; Ruloff's, a thief and murderer, 59 ounces; 
an adult idiot's, 54.95 ounces; Daniel Webster's, 53.50 ounces, and Gam- 
betti's brain had the weight and size common to a microcephalic idiot." 
Ears. 
I have noticed a great relative frequency of anomalous ears in the 
prisoners I have studied. The Morel ear is very common, as are the 
presence of Darwinian tubercles. I have noticed among negro crim- 
inals that the small shell ear is very frequent, but whether or not this 
is characteristic of the American negro I cannot say. Large ears, I 
believe, on the whole, are the more frequently observed among convicts. 
Eyes. 
"It will be seen * * * that fraudulent offenders have rather 
better, and thieves have rather worse eyesight than offenders gen- 
erally. The amount of this association, however, between the eyesight 
of criminals at constant age and the nature of their crime is very small, 
and for all practical purposes may be regarded as negligible." 
Nothing particularly striking about the eyes has been noted except 
the great frequency of the arcus senilis and pupillary irregularities 
which indicate early degenerative morphological changes, the result of 
luetic infection. About fifty per cent of the prisoners show at the time 
of their entrance examination some defects of vision. These defects 
may generally be classified under three heads; congenital defect, such 
as myopia; astigmatism and hypermetropia; errors of refraction, due 
to acquired disease or traumatism and various degrees of presbyopia 
due to an advance in years. 
Skin. 
It has been a very popular practice of criminologists to refer to 
the anaemic and cachectic look of prisoners. While such conditions 
do exist in those prisons which lack an abundance of fresh air and 
sunshine, this pallor of the skin cannot be described as one belonging 16 
CRIMINAL ANTHROPOLOGY. 
exclusively to criminals, for it is also noted in those persons who are 
shut in from air and sunshine by reason of their occupations. 
Goring concludes from a statistical study of the English convict 
that "offenders committing crimes of violence are on a whole rather 
less anaemic and have a ruddier complexion than criminals generally." 
Heart Beat 
I have noticed an irregular cardiac rhythm in many prisoners at 
the time of entrance to prison. This condition is, no doubt, brought 
about by alcoholism, irregular hours of sleep, excitement and sexual 
excesses. 
The regime of prison life has a quieting influence on this functional 
tachycardia, as the prisoner is compelled to live a regular life, free 
from excitement and dissipation of all sorts. 
Left-Handedness. 
It has been the common assertion that a large number of prisoners 
are left-handed, but I am of the opinion that this claim is somewhat of 
an exaggeration, though possibly the percentage of left-handedness is 
slightly higher among convicts than among free individuals. 
Goring, in speaking of this condition, declares: "Comparative 
statistics of left-handedness are remarkably few and for Englishmen 
practically non-existent. Among 266,270 German recruits 3.88 per 
cent are left-handed, a proportion practically identical with our per- 
centage of criminals with this peculiarity." 
Nervous Sensibility. 
I find that among a certain class of prisoners, such as hysterics 
and malingerers, there is a tendency to exaggeration of the slightest 
pain, or any form of physical discomfiture; this is especially noticeable 
among those who attempt to evade daily tasks and work assigned them. 
Indeed, the morning sick lines in penal institutions are full of 
prisoners pretending to be ill and furnishing only the most flimsy 
excuses for such claims. On the other hand, however, I have noticed 
an astonishing degree of sensory disturbances, especially those of 
anesthesia. 
I have performed many minor surgical operations on convicts 
without general or local anesthesia when no complaint was made of 
pain. In very severe injuries I have sometimes found it necessary to 
exercise authority under the threat of demerit to keep injured convicts 
in bed. 
I have known prisoners to amputate their fingers and otherwise 
mutilate their bodies without apparently suffering pain. These self- 
inflicted mutilations were usually made for the purpose of avoiding 
labor. In one instance it required twenty-seven deep and superficial CRIMINAL ANTHROPOLOGY. 
17 
stitches to close a gapping wound made with a sharp knife across the 
shoulder and arm of a prisoner while in a fight with a fellow convict. 
The severed ends of the muscles were sewed together and the edges Of 
the skin approximated without the slightest sign of pain on the part 
of the patient. 
Genitalia. 
I have observed that the genitalia of prisoners are usually well 
developed and the reason for this is very apparent, since most of them 
are given to very frequent sexual intercourse and masturbation. 
"The sexual sense of the youthful male criminal is usually intense 
and previous to apprehension was gratified physiologically unless it 
was perverse or exaggerated; in which case, onanism or pederasty 
were resorted to." 
The life in penal institutions does not seem to suppress or diminish 
the genetic desires, and since the opportunities for physical intercourse 
are lacking, inverse and perverse sexual habits are acquired in not a 
few instances. In those prisons where for lack of room, it is necessary 
to put more than one prisoner in a cell, the practice of sodomy and 
other forms of homosexuality must be expected. 
Tattooing. 
The practice of tattooing is very common among prisoners, but 
it is more or less limited to the members of the lower strata of crim- 
inal society. The forger and the convicts of his type are not given to 
this mode of adornment, since it makes identification more easy and 
certain. Young criminals may in a spirit of bravado submit to this 
painful form of decoration to display their nerve and ability to endure 
pain. 
I have found all portions of the body tattooed, even including the 
genital organs, but the most common location of these "cutaneous 
embellishments" is the inner surface of the forearm. All manner of 
figures are found, common among them are initials and names, 
religious symbols, crucifixes, nude female figures, dancing girls, ships, 
stars, geometrical markings, obscene legends, birds, insects, dragons 
and designs for good luck, such as horse-shoes, etc. 
One reason offered for this, practice is that the tattoo marks pre- 
vent blood poison in the case of injury; another, that they bring good 
luck. Burglars recognizing the dangerous character of their hazardous 
occupation have been tattooed for means of identification should they 
meet a violent death. 
"It is clear that the practice of tattooing cannot be such a pecu- 
liarly criminal characteristic as has been alleged." 
It is extremely gratifying, no doubt, to the disciples of Lombroso 
to have such a worthy opponent as Goring to declare: 18 
CRIMINAL ANTHROPOLOGY. 
Conclusions. 
"The thief, who is caught thieving, has a smaller head and a nar- 
rower forehead than the man who arrests him; but this is the case 
not because, of the two, he is more markedly inferior in stature. 
"The incendiary is more emotionally unstable, more lacking in con- 
trol, more refractory in conduct, and more dirty in habits, etc., than 
the thief; and the thief is more distinguished by the above peculiar- 
ities than the forger; and all criminals display these qualities to a 
more marked extent than does the law-abiding public, not because of 
any of these classes are more criminal than the other, but because of 
their inter-differentiation in general intelligence. 
"From our statistical evidence, one assertion can be dogmatically 
made; it is, that the criminal is differentiated by inferior stature, by 
defective intelligence, and to some extent, by his anti-social pro- 
clivities. 
"The following figures, however, may assist the imagination in 
realizing the nature and proportions of this differentiation. We may 
take it that one in thirteen persons of the general population are con- 
victed at some time of life for indictable offenses. If the total adult 
population were made to file by in groups of thirteen, and out of each 
group one person was selected who happened to be one of the smallest 
there in stature, or the most defective in intelligence, or who possessed 
volitional anti-social proclivities to a more marked degree than his fel- 
lows in the group, the band of individuals resulting from this selection 
would-in physical, mental and moral constitution-approximate more 
closely to our criminal population than the residue. 
"We find, also, that crimes of violence are associated with the finer 
development, with the more marked degrees of ungovernable temper, 
obstinacy of purpose and inebriety, and with the greater amount of 
insane and suicidal proclivity, of persons convicted of these offenses; 
and that tall persons are relatively immune from conviction of rape; 
and that fraudulent offenders are relatively free from the constitu- 
tional determinants which appear to conduce to other forms of crime." 
If it were possible to measure physically and mentally one thou- 
sand prisoners and one thousand average free persons, I am convinced 
that the criminals as a class, allowing, of course, for individual differ- 
ences, would show physical and mental stigmata with a greater 
regularity in a more marked degree than would the equal number of 
civilians. 
Goring, who denominates the Lombrosian idea of crime as a 
superstition, comes to the following conclusions, after the compara- 
tive study of four thousand English convicts and an equal number 
of university men: 
1st. The criminal is mentally and physically defective. CRIMINAL ANTHROPOLOGY. 
19 
2nd. That environment bears but an insignificant causal rela- 
tionship to crime. 
3rd. That criminal traits and tendencies are inherited in the 
same manner as tuberculosis. 
4th. That classes of criminals may be differentiated one from 
another by physical and mental attributes. 
While many efforts have been carefully, honestly and scientifically 
made by anthropologists to determine whether or not there are cor- 
poral differences between those who have been convicted of crime 
and those who have not; there has not yet been furnished sufficient 
definite data to warrant positive conclusions. 
We are therefore justified, especially in view of the findings of 
the positivistic school of criminologists, to conclude that there is no 
distinct criminal class. There are no signs or symptoms which so 
mark or label an individual that we can say with absolute certainty 
that he will or will not be criminal, but we are compelled to acknowl- 
edge that the stamp of constitutional inferiority is indelibly impressed 
upon these individuals who constitute our prison populations. 
Is it not possible in our zeal to obtain anthropometric data that 
we have lost sight of the efficient factors of crime? Has there not 
been a tendency to over-estimate the value of mere mathematics and 
measurements? We have jumbled statistics until we are practically 
lost in the maze of confusing and misleading arithmetical calculations. 
We must ever bear in mind that the criminal is a human being, 
that the biological element is to be considered, the environment, the 
disease or defects which govern, regulate and modify the mental 
activities are of far more value than bodily measurements. The 
anthropological study of crime must give way to the methods of 
psychological investigations. 
In very large proportions, the real, though not always the appar- 
ent force for criminality was mental defect and this generic term 
includes insanity, epilepsy, feeblemindedness, borderline or psycho- 
pathic states, and with these states of mental aberration this thesis 
has to deal. 
In the "American Journal of Neurology and Psychiatry," Vols. 
II and III, P. 135, Dr. J. S. Wight says: "The concurrent and unani- 
mous testimony of those who are, from their experience and knowl- 
edge, most competent to judge, is: That the under class of criminals 
have more or less defective organizations especially as relates to 
their nervous system and more especially to their brain; that they 
are more or less deficient in moral sense, showing in this respect the 
lack of development or the result of decay, the best and last developed 
sense, the moral sense, disintegrating first of all; that they are per- 20 
CRIMINAL ANTHROPOLOGY. 
versely wicked and indomitably inexpedient, committing crimes when 
doing right would be of more use to them; that they are as passionate 
as the wild beasts of the forests, and as restless as the ocean that 
heaves at every gust of the wind; that they are at war with mankind 
and ever in commotion with themselves; that they are, like the ship 
beaten out by the storm-the ship without compass, rudder, or cap- 
tain; that they are formed and fashioned by the hand of an evil 
genius, whose name is bad heredity, and whose hand-maid is ignor- 
ance; and that they cannot be very much reformed, and that their 
reformation ought to have been begun in their ancestors." CHAPTER III. 
CRIME AND INSANITY. 
It is a matter of common knowledge that a relationship exists 
between insanity, feeble-mindedness and crime. 
In every penal institution there are to be found persons who 
properly belong in hospitals for the insane and institutions for the 
mentally enfeebled. ' 
The belief is rapidly gaining ground that at least one or more 
trained psychiatrists should be a part of the official personnel of 
every penal institution. 
The crime problem is rapidly being given into the hands of the 
alienist, and criminality will sooner or later be recognized as a legiti- 
mate branch of psychiatry. 
One of America's leading criminologists, though not a physician 
or alienist, was strongly impressed by his observation and the study 
of criminals with the striking resemblance that crime bears to 
insanity. 
"The analogy between crime and insanity was the theme of an 
extemporaneous address made by the author (Wines) in 1886 to the 
inmates of the Elmira Reformatory, of which the following were 
the heads: 
"1st. The basis of insanity is physical, its manifestations are 
physical, mental and moral. The same is true in a large measure of 
criminal propensities. 
"2nd. Insanity and crime are both hereditary-to what extent 
is not definitely known. The predisposition to both is often congenital. 
"3rd. The approach of insanity and the growth of criminal char- 
acter are alike gradual, in many instances, and unsuspected by the 
victim of either. 
"4th. The change from innocence to depravity corresponds with 
the alteration in personal character observable in the insane. 
"5th. The lunatic and the criminal both form theories, to account 
for the perversion of which they are more or less conscious, which 
are very far removed from the truth. 22 
CRIME AND INSANITY. 
"6th. The manifestations of insanity assume one of two opposite 
forms-undue exaltation or undue depression; in either form they 
present the appearance of a pronounced self-consciousness, amount- 
ing to egotism, and often accompanied by hallucinations and delusions. 
In this particular the resemblances between insanity and crime are 
striking. 
"7th. As insanity tends to make progress and to end in dementia, 
so does the habitual criminal sink into moral imbecility-the com- 
plete loss of moral perception, depravation of moral tastes and inclina- 
tions, and paralysis of volition. 
"8th. Insanity and crime are both the occasion of intense pain, 
succeeded by insensibility or indifference. 
"9th. Both incapacitate their subjects for normal social life; 
and both are treated by incarceration, if of a dangerous or trouble- 
some type. 
"10th. The cure of either is difficult; much depends on beginning 
in time, and, for success in the effort to develop the power of self- 
restraint or self-direction (which may have been originally lacking, or 
lost by disuse or abuse) the co-operation of the patient is indis- 
pensable." 
There is probably no type of crime that has not been committed 
by insane persons, and often the intrinsic acts of crime itself are not 
to be distinguished from crimes committed by normal persons, except 
by the underlying motives which prompted their commitment. 
The overt act committed by the mentally alienated usually carries 
with it tangible evidence of mental disease. The attending circum- 
stances in such instances likewise are marked by the distinguishing 
characteristics of mental unsoundness. 
The dangerous assaults committed by the insane epileptic in the 
furore and frenzy of an epileptic automatism, the violent acts per- 
petrated in the agitation and delirium caused by alcoholism or other 
narcotic drugs are so labeled as to leave but little room for doubt as 
to the mental status of the persons performing them. 
Impulsiveness is a symptom of insanity which is often shown by 
crime. The insane often react in a very sudden and precipitous 
manner to overpowering obsessions and imperative ideas. The very 
lack of forethought, the suddenness and violence of certain criminal 
acts point to the nature of their origin. Very often the misdemeanors 
are so absolutely silly, ludicrous and devoid of any purpose whatso- 
ever that they could not have been committed by any individual than 
one suffering from some form of dementia. We are at once suspicious 
of the mental integrity of the person who commits crime openly and 
boasts of it as an accomplishment. 
The crimes of some types of insanity are so characteristic that 
the misdemeanor committed at once suggests the form of insanity CRIME AND INSANITY. 
23 
with which its perpetrator is suffering, yet, on the other hand, the 
mentally unbalanced may use such deliberateness, such skill in 
execution, such a degree of apparent reasonableness, that all except 
qualified alienists are ready to condemn them as wilful and perfectly 
sane criminals. An insane criminal may be so cunning as to hide his 
crime and seek to evade responsibility and the consequent punish- 
ment But his self-preservative act should not be employed as an 
argument or criterion to prove the sanity and responsibility of an 
individual. There is a widely prevalent notion entertained by the 
laity that the insane must behave in a most unreasonable and out- 
landish manner and that every crime of an insane person must show 
such morbidity or senselessness that he who runs may read. 
Again, the pathology of a criminal act may be so hidden and 
obscure as to defy the ordinary means of detection. In other words, 
the physical act of the crime may be but a bubbling expression of its 
hidden pathological source, which lies deep in the substrata of a 
diseased intelligence. Instances of this variety often furnish the 
bone of medico-legal contention. 
Every prison surgeon, if he be at all versed in mental diseases, is 
soon convinced of the fact that many persons are sent to prison who 
properly belong in the hospitals for the insane. 
After careful observation and study, I feel satisfied in saying sixty 
per cent of the prisoners admitted to the Indiana State Prison are 
mentally defective, and these may be classified under the following 
heads and in the indicated proportion: Insane, twelve per cent; 
feebleminded, twenty-three per cent; epileptic, eight per cent, and 
constitutional inferiors, seventeen per cent. This is an exceedingly 
low and conservative estimate. 
I have attempted, as far as it is possible, to illustrate by clinical 
cases, examples of the relationship between mental defect and legal 
offenses. 
No endeavor has been made to describe any part of the symptom- 
complex of the individual psychosis except those of a criminal nature. CHAPTER IV. 
EPILEPSY. 
History is replete with examples of the causal relationship 
that this disease has sustained to delinquency. The remotest ages 
of antiquity furnish us very striking instances. 
Mythology tells us that Hercules murdered his wife, Ophelia, 
and their children, during one of those unconscious automatic states 
that are characteristic of epilepsy. Seneca tells us: "One day, as 
Hercules was offering a sacrifice to Jupiter, he suddenly stopped, 
rolling his bloodshot eyes in a hideous manner, the saliva ran down 
his beard, his smile was convulsive and strained, and laying aside 
his garments, he became very much agitated. They thought he had 
returned to his senses, when he suddenly rushed to his weapons, ran 
after his father, his own children, and everybody, till finally he slew 
his wife and children. He was about slaying his father when Pallas 
appeared and checked him, throwing him on the ground. Then he 
quickly fell into a profound sleep As he awoke the sight of all the 
slain around him terrified him and his despair became extreme when 
the news was broken to him that he alone was the author of all this 
slaughter." 
Epilepsy is probably responsible for more pathological offenses 
than any other form of positive mental disease It is very common for 
prison physicians to observe that many prisoners have distinct dizzy 
spells, and these are many times true forms of petit mal which may 
be overlooked by a careless mental examination. 
Marked changes in the morals and the emotions are most con- 
stant characteristics. The epileptics, as a rule, are most mercurial 
and volatile in their temperaments; the merest trifles are sufficient 
to stir them to serious outbreaks of temper and violence. They are 
radicals of the most extreme type, and especially this is true in the 
sphere of religion and politics. 
Their manner of living and their modes of behavior are prac- 
tically regulated by their appetites; they love power and notoriety, 
and they shrewdly use immoral and illegal methods to secure these; EPILEPSY. 
25 
they are extreme sensualists and they are prone to commit sexual 
crimes as rape, incest and sodomy. 
Delusions of persecution are common characteristics of the 
epileptic mental degeneration and therefore it is very easy to see why 
dangerous assaults should be so common among epileptics with their 
hair-trigger temperaments, their lack of emotional control and their 
impetuosity. 
Clouston has well said that, "Murder by an epileptic should be 
looked upon as being as much a symptom of his disease as is larceny 
by the general paretic." 
Delasiauve forcibly stated: "It is certain that on passing an 
epileptic, we elbow one who might be an assassin, and that epilepsy, 
through the delusional ideas it originates, furnishes a considerable 
share of the crimes ascribed to mental alienation." 
The phenomenon of epileptic automatism has long been observed, 
but a concise explanation of this phase of the disease has not as yet 
been offered. We know, however, that some epileptics complete cer- 
tain definite acts in a seemingly perfectly, conscious and coherent man- 
ner. But in reality consciousness is practically blotted out, and when 
the individual regains his mental status, there is likely to be no mem- 
ory of any of the acts that he may have committed during sued 
periods, or if he does have any memory it is usually but an indistinct 
hypnogogic idea that closely corresponds to the dream-state. 
The automatic acts of the post-epileptic stage more frequently 
follow the petit mal paroxysm and it is rare for criminal acts to be 
committed following a severe form of the major paroxysm. It is 
usually the rule that the actions which are performed in a post- 
epileptic automatic state are always the same in character; the act 
performed usually portrays in some manner an habitual movement 
that is customary to be made in normal consciousness. And in the 
consideration of epileptic criminal acts we must bear these facts in 
mind. If called upon to give expert testimony as to the responsibility 
for criminal acts that may have been performed by an epileptic in the 
post- or pre-epileptic automatic state we must determine if the overt 
act was habitual in any character or if the person was accustomed to 
performing similar actions when "at himself." 
It would be in perfect harmony with the observations that have 
been made to find an epileptic butcher having assaulted another indi- 
vidual with a knife, nor would it be strange to find a soldier in a 
post-epileptic state shooting an individual. 
The handling of a gun or knife are habitual acts of the soldier 
and butcher respectively; but should a butcher kill an individual by 
administration of poison, we should be exceedingly slow to regard 
such a crime as an expression of epilepsy, since the handling of drugs 
is a foreign procedure to the act of cutting meat. 26 
EPILEPSY. 
The condition known as psychical epilepsy is one in which the 
paroxysm is replaced by a nervous storm which is not accompanied 
by the usual signs of epilepsy. "Psychic epileptics may commit all 
manner of crimes; thefts, arson, rape, assaults and homicides. They 
are not infrequently pyromaniacs, entirely without reason or impelled 
by the flimsiest motives." 
"The medico-legal aspects of this type of epilepsy depend, so far 
as responsibility is concerned, upon our ability to determine the exist- 
ence of the automatic state at the given moment. This may be diffi- 
cult to do beyond reasonable doubt, though if we can prove the per- 
son is a sufferer from epilepsy at the time, or ever had it in any 
form, we can always create a reasonable belief that the patient may 
have acted while in a seizure, without any intent whatever, and under 
conditions that should free him from responsibility. 
"The evidence of the presence of epilepsy * * * needs to be 
carefully studied in order to arrive at a just conclusion in medico- 
legal cases. If it can be proven beyond reasonable doubt that the 
individual has epilepsy, the question of responsibility is not difficult 
after that. We may not be able, it is true, to say positively that he 
was under the influence of a seizure at the moment an overt act was 
committed, while, on the other hand, we are equally as unable to 
prove that a seizure was not present. Psychic convulsions defy all 
ordinary methods of detection. They can readily be noted, however, 
by one trained in the observance of their expression." 
The following cases came under the writer's care and observa- 
tion: 
Clinical Cases. 
Case 1. A man, fifty-eight years of age, was admitted to the Indi- 
ana State Prison, in the year 1911. He bears a heavy burden of ances- 
tral defect, the relentless tyranny of which he failed to escape. His 
father, two uncles and one aunt were epileptic before him. He trans- 
mitted this falling disease to his daughter; he has twice been an inmate 
of a hospital for the insane, and he was once arrested on a charge of 
rape. The crime for which he is now paying the penalty at the Indiana 
State Prison was an atrocious, cold-blooded murder. He killed his 
hired man with a shotgun and then chopped his body to pieces with 
an axe and hid it in the barnyard. 
This outrageous act was performed without any assignable cause 
whatsoever, and in one of these periods of absolute forgetfulness and 
automatism. 
Case 2. White male, sixty-seven years of age, has been convicted 
twice of rape, and four times for assaults and grand larceny. He car- 
ries a heavy hereditary burden. His father was an epileptic, and his 
maternal aunt died in a hospital for the insane. Both of his assaults 
were made on little girls under the age of twelve. He displays the EPILEPSY. 
27 
usual epileptic temperament and slow degeneration of his mental 
processes is taking place. 
Case 3. White male, thirty-five years of age, has been convicted 
twice for larceny and once for malicious mischief. His father was epi- 
leptic; one brother died in status epilepticus and one maternal aunt 
died in a hospital for the insane. He has twice been an inmate of an 
insane hospital; he is a marked sensualist; has been married twice, 
but his last marriage was illegal. He forced his wife to act as a public 
prostitute. He is a very shrewd malingerer. 
Case 4. White male, fifty-six years of age, has been seven times 
arrested for public intoxication. He was sent to the Indiana State 
Prison for assault and battery with intent to murder. This crime 
was committed without any provocation whatsoever and was merely 
the result of a violent explosion of temper. One paternal uncle was 
insane, his mother and one maternal uncle were epileptic. 
Case 5. White male, aged thirty-one years, has been twice con- 
victed of petit larceny. He has a violent temper, is deceitful and unre- 
liable; the truth to him is an unknown quantity. He is constantly 
violating the rules of the prison, and entertains delusions of perse- 
cution. 
Case 6. White male, forty-five years of age, has been convicted of 
assault with intent to commit a felony. He is quarrelsome and 
irritable and is given to alternate periods of religiosity, profanity 
and obscenity. He has a hypertrophied sense of self-justification. 
Case 7. White male, thirty-five years of age, guilty of incestuous 
relations covering a period of more than two and one-half years. This 
man presents the anatomical, physiological and mental signs of 
degeneracy. His hair is very gray, and became so when about twentj- 
years of age. He has suffered for fifteen years with intense dizzy 
spells and headaches which are associated with semi-conscious and 
delirioid states that occur every ten days or two weeks. This man 
once tried to commit suicide during one of these petit mal attacks. 
These minor paroxysms are accompanied by intense perverse sexual 
desires, and the moral inhibitory qualities of the mind are practically 
in abeyance at such times. 
Case 8. Colored male, thirty-two years of age when admitted to the 
Indiana State Prison. He was convicted of grand larceny. This pris- 
oner has been epileptic since early childhood, having grand and petit 
mal attacks at very frequent intervals. 
Just before the commission of his crime, it was learned from his 
relatives, that he had a very pronounced series of epileptic seizures, 
amounting to status epilepticus. This convulsive period was followed 
by delirious automatism, clouding of consciousness and mental con- 
fusion. There has been marked deterioration of this individual and 
his mental state is now one of terminal epileptic dementia. 28 
EPILEPSY. 
Case 9. White male, age sixty-six, sentenced to the Indiana State 
Prison for the crime of bestiality. Little is known of the prisoner's 
family history; he has had major convulsive attacks at irregular inter- 
vals for about twenty years. He admits being an inmate of two hos- 
pitals for the insane, but refuses to give the names and locations of 
these institutions. 
The act for which he was committed to this institution was sexual 
intercourse which he had with a female Shetland pony in a public 
park. Prisoner states that before his arrest he had felt very miserable 
and depressed and that he knew convulsions were approaching. He 
remembers petting the animal and caressing it, but denies any memory 
of his perverse sexual act; says that he knew nothing of his bestiality, 
but when he came "to himself" he was in jail; had a headache, and 
severe pains in his muscles and various portions of his body; he felt 
very confused and dazed. 
Physical examination of this prisoner at the time of entrance 
showed the patellar reflexes to be increased; the eyes protruded 
slightly as in exophthalmic goiter; there was general sclerosis of the 
superficial blood vessels; his pulse was eighty and the second pul- 
monic sound of the heart was slightly increased. 
Mental examination showed this man was dull and stupid; was 
oriented as to time, place and person; his memory was fairly good for 
remote and recent events; emotionally he was depressed, irritable and 
sullen; he entertained vague delusions of persecution. CHAPTER V. 
PARANOIA AND PARANOID STATES. 
Paranoia and allied paranoid states furnish us with a very large 
quota of pathological crimes. The most common of these are homi- 
cides, homicidal attempts, assault and battery, blackmail, perjury, 
impersonation of officers and sexual crimes. The most dangerous of 
all insane patients is the one who harbors in the recesses of his 
diseased mentality systematized delusions of persecution. This is 
especially true of the paranoiac, who many times appears to be intel- 
lectually normal and occasionally, aside from his paranoidal ten- 
dencies, he may be the superior of the average individual. The proper 
perspectives of life are impossible for the paranoiac since each 
instance and circumstance is colored and tinged by an abnormal sensi- 
bility and reaction to the most common place and trivial affairs. 
The paranoiac in the stage of persecution, out of the most insig- 
nificant circumstance, constructs a nebula of persecutory ideas which 
are intangible and obscure. Finally these hazy, indistinct ideas of 
persecution take on a more definite character, and then step by step, 
supportive and contributive ideas are formed and elaborated which 
build up a definite, systematized, delusional preconception or system 
of thought through which must pass every idea that is translated into 
action. 
This delusional formation is so closely and intimately connected 
with the whole of consciousness, that it regulates and dominates the 
individual's manner of feeling, thinking and acting. It is easy to see 
therefore that any paranoiac is a potential homicide while harboring 
delusions of persecution. Should he believe that his supposed enemies 
have designs upon his life, or that they desire to make him the butt 
of theirsridicule, or the object of some diabolical conspiracy, it is not 
at all strange that the persecuted should turn persecutor. 
He employs logical methods of argument to convince himself that 
he is perfectly right in seeking means to protect himself against 
machinations, and should he ever be called into court to explain some 
of his erratic behavior, he is more than convinced that he is justified 
in seeking any measure that he may see fit to employ. 30 
PARANOIA AND PARANOID STATES. 
Clinical Cases. 
Case 1. Prisoner, born in 1874 in the state of Illinois. His educa- 
tion was very meagre. His early life was spent on a farm and about 
the mining-camps in his home district and is negative as it relates 
to this case; his maternal grandmother was insane. At the age of 
twenty, in the year 1894, he and two other men were arrested for 
wrecking a train, but on account of his youth he was released 
without being brought to trial. In the year 1904 he was arrested for 
assault and battery on a fellow miner, but was acquitted on this 
charge. In October of the year 1906 he assaulted a fellow citizen who 
had opposed his getting a license to sell intoxicating liquors. 
At the time of the trial in Terre Haute, Vigo County, for arson in 
1908, when the verdict of "guilty" was announced he thereupon shot 
and killed the chief of detectives, whom he believed to be the instru- 
ment of his persecution and conviction. The above stated facts are 
named to show that said prisoner was at frequent times in serious 
conflict with the law. 
His record shows at the institution, beyond question, that he is an 
individual of constitutional inferiority. In the early part of the year 
1909 he exhibited delusions of persecution concerning persons at 
Terre Haute and the officers of the institution. At this time he be- 
lieved that his food was being poisoned and that a fellow prisoner 
who sat near him at the dining table was a detective employed by 
the railroad company to gather evidence against him. This delusion 
was so strong that at one time he attempted to point out this man in 
the general dining room before the prisoners and officers. In the latter 
part of the year 1909, his depression resulting from his ideas of per- 
secution became so great that he attempted suicide by jumping from 
the cell range that he might be free from his persecutors. His con- 
duct at various times was so governed by his delusional rystem that, 
for the peace and safety of others, it was necessary to put him in 
seclusion. 
Very frequent mental examination and daily observations of this 
prisoner revealed his insanity, even though he very craftily attempted 
to hide his systematized delusions of persecutions. Whenever he is 
interviewed concerning his commitment to this institution and the 
supposed persecutions that he thinks he endured at the hands of his 
enemies, he becomes exceedingly emotional; he laughs, cries and 
threatens within the space of a few minutes. These lightning changes 
in his emotional status Indicate a marked lack of control and inhibi- 
tion. The burden and chief character of his conversation at all firms 
is his delusional beliefs of persecution. 
He states on every opportunity offered that he has been "hounded" 
by railroad corporations, the church, a bunch of crooked politicians, 
lawyers and judges. "I have suffered unjustly at the hands of the 
law without being given a show and it is my purpose to secure my PARANOIA AND PARANOID STATES. 
31 
rights at all times, even though violence is necessary. The law failed 
to do its duty by me and I had to protect myself when the gangsters 
were giving me a raw deal." 
It is obvious that an individual whose actions are governed wholly 
by persecutory ideas will have an impaired reason and judgment and 
will therefore be unable to reach rational conclusions, though his 
manner of argument may be logical and orderly. This prisoner has an 
exceedingly high and uncontrollable temper and the slightest circum- 
stances of prison life are sufficient to arouse outbreaks of violence and 
temper. He displays an excessive degree of egotism and considers 
himself vastly superior mentally to his fellow prisoners; he is per- 
fectly oriented as to time, place and person; consciousness is clear; 
his memory for recent and remote events is excellent, and he has no 
auditory hallucinations. He spends his time in writing lengthy argu- 
ments which are filled with many legal phrases, to prove that he is a 
misunderstood victim of the law and society. Physically he is very 
powerful and well developed; his head is small and of the dolichoce- 
phalic type; the lobes of his ears are attached and each presents a 
Darwinian tubercle. 
Paranoiacs of the religious variety often come into conflict with 
the law directly through theii' insane beliefs concerning religion, 
and examples of religious paranoia are not uncommon. They often 
feel that they have been commissioned by God to deliver humanity 
from its sin, or to perform some other mission which the Deity may 
have imposed upon them, and while many of the religious mystics are 
extremely harmless, there are those who are decidedly dangerous to 
society when anyone attempts to contradict their insane ideas, for 
they regard such imputations as direct sacrilege and effrontery to 
Deity and may feel themselves designated to kill those who denied 
their religious pretentions. 
The socialistic orators of the curbstone variety, the propagandist 
and religious reformers who become leaders of such anarchistic organ- 
izations as the I. W. W., or of such societies as the Holy Rollers, are 
individuals of the paranoid type. The following case is one of this 
class: 
Case 2. Prisoner, white male, thirty-four years of age when ad- 
mitted to the Indiana State Prison in 1911. His father used alcoholic 
beverages to excess; his mother died of tuberculosis; one sister died in 
status epilepticus; one brother was insane and was confined to a hos- 
pital for years; one paternal cousin is insane and is confined to a 
hospital. The prisoner was queer and eccentric as a child and much 
preferred to be alone instead of playing with children of his age. He 
was always subjected to peculiar feelings, headaches, dizziness and 
bright spots dancing before the eyes. He was much given to introspec- 
tion and self-analysis; he enjoyed reading the Bible and sectarian 
religious papers. 32 
PARANOIA AND PARANOID STATES. 
His crime was the shooting of a fellow miner in cold blood who 
had incurred his displeasure because of arguments on religious ant 
socialistic subjects. His fellow miner refused to accept the absurd 
and foolish notions that the prisoner entertained concerning unionism; 
he therefore regarded him as an enemy. His suspicions and hidden 
animosity developed into genuine delusions of persecution. He repeat- 
edly complained to the chief of police in the town where he was living 
that enemies were following him about and he therefore asked permis- 
sion to carry a revolver for protection. One day he met his supposed 
enemy in a saloon and deliberately shot him without any provoca- 
tion whatsoever. At the time of the commission of this crime the 
prisoner was no doubt in the second period of paranoia, that of delu- 
sional explanation. Since coming to this institution he has passed 
into the period of transformation of the personality. 
While delusions of persecution are still entertained concerning 
certain individuals at his home town, they are gradually losing their 
acutely painful character and are vanishing in the background of his 
consciousness. He has developed new delusions; he has discovered 
why his enemies have persecuted him; he says the Lord has appeared 
to him in a dream and revealed to him a plan of salvation; he believes 
he is the Apostle Paul reincarnated; that he is a great Mormon prophet 
and that angels visit him in his dreams. 
He continues to be egotistic and arrogant, and this is especially 
true when he finds an opportunity to discuss religious subjects. On 
the whole, however, his mental status is more tranquil and peaceful 
than it was when he entered the institution. There has been but 
slight mental deterioration; he is oriented as to time, place and per- 
son; he takes an active interest in the affairs of the hospital and he 
spends a greater part of his time reading the Bible and explaining it 
to his fellow prisoners. 
Case 3. Prisoner, white male, fifty-four years of age, sodomist; 
family history obtained, unreliable; has used alcohol to excess since a 
young man; has had gonorrhea and syphilis; since twenty years of age 
he has tramped about the country. His wanderlust is the direct reac- 
tion to paranoid beliefs; his wanderings were the results of his attempts 
to escape the charges of electricity by means of which, he thought, Edi- 
son was persecuting him. He avoided large cities because of the 
presence of many telegraph and telephone wires; he often left places 
of employment without waiting to collect the wages due him. On one 
occasion he went to Orange, N. J., to gain vengeance on the inventor 
for the torture he was enduring at his hands. He assaulted the janitor 
who prevented his gaining entrance to Mr. Edison's office and for the 
assault served several months in jail. 
This prisoner skillfully hides his delusions of persecution and 
it is by the most careful psychiatric examination that his delusions 
can be elicited. He is perfectly oriented as to time, place and person; PARANOIA AND PARANOID STATES. 
33 
he has an excellent memory for recent and remote events; he conducts 
himself while in prison, for the most part, in harmony with the disci- 
pline of the institution. He has occasional periods of depression due to 
the influence of his delusions. No evidences of dementia are present. 
Case 4. Prisoner, white male, age forty-eight when admitted to the 
Indiana State Prison, March 21, 1911. He was convicted of murder and 
sentenced to life imprisonment. Previously he has served seven jail 
sentences for assault and battery. 
His paternal grandmother was insane; one paternal great uncle 
was insane; one paternal aunt insane and one brother is an epileptic. 
This man had a quarrel with a negro who had visited his office. 
The negro was ejected from his place of business and the prisoner 
in question shot the negro in the back three times as he was going 
out of the hall upon the street. 
Throughout this prisoner's stay in this prison he has worked for 
a short while in every shop. He has practically accused every officer 
of the prison of being his enemy. He has been unable to adjust him- 
self to any department of the prison; he has been in constant conflict 
with the prison discipline; he is constantly insisting that he has never 
had a square deal in prison or out. In fact, he believes that society 
in general has been and always will be his enemy. 
These delusions of persecution so controlled and regulated his 
conduct that he made many assaults on the guards and fellow prison- 
ers. Finding it impossible for this prisoner to get along peaceably 
anywhere in the institution, I placed him in the observation ward of 
the hospital for eighteen months. Here in the hospital he was com- 
paratively free from prison discipline and rule, but he was unable to 
conduct himself in such a manner as would insure the safety and 
welfare of those about him. 
In view of this fact he was transferred to the Indiana Colony for 
Insane Criminals after a properly qualified commission had found him 
to be insane. 
Mental Examination. 
This prisoner is neat and tidy in personal appearance; he is 
usually slightly depressed, he is perfectly oriented as to time, place 
and person. His memory is good for recent events, there are no 
defects of attention or apperception, he reads the newspapers and 
magazines and is well informed in current events; his knowledge of 
mathematics, geography and history are in perfect harmony with his 
educational advantages; he entertains systematized delusions of per- 
secution; he believes that the officers and inmates of the prison are his 
enemies, that they seek to do him harm in every conceivable manner 
at all times; he is given to violent outbursts of temper and violence, 
and has repeatedly threatened the life of the prison officials. 34 
PARANOIA AND PARANOID STATES. 
Very recently he remarked that he would kill the prison physi- 
cian, "Since they have declared me insane they cannot electrocute me." 
He would no doubt be able to convince the average jury that his 
false claims are justifiable because he is a smooth conversationalist 
and in a very logical and systematized manner sets forth his delu- 
sional ideas and beliefs. 
Certain sexual crimes are true offsprings of paranoid ideas. In 
Psychopathia Sexualis, in discussing the sexual manifestations of 
paranoia, Kraft-Ebing says: "Abnormal manifestations in the sexual 
sphere, in the various forms of paranoia, are not infrequent." 
"Many of these cases are developed on sexual abuse (masturbatic 
paranoia) or sexual excitement, and, according to experience, in 
individuals psychically degenerate, with other functional signs of 
degeneracy, the sexual sphere is for the most part, deeply implicated." 
"Girard has reported a case of rape of a little girl by a religious 
paranoiac, age 45, who was temporarily erotic. Here, also, belongs 
a case of incest: M impregnated his daughter. His wife, mother 
of eighteen children, and herself pregnant by her husband, lodged 
the complaint. M had had religious paranoia for two years. 'It 
was revealed to me that I should beget the Eternal Son with my 
daughter. Then a man of flesh and blood would arise by my faith, 
who would be eighteen hundred years old; he would be a bridge 
between the Old and the New Testament.' This command, which he 
deemed divine, was the cause of the insane act." CHAPTER VI. 
DEMENTIA PILECOX, 
The crimes of those suffering from dementia prsecox partake of 
the fundamental basic characteristics of mental enfeeblement that 
mark this psychosis. 
The misdemeanors and unlawful offenses of those affected wit^F 
this disease are characterized by more or less defect of reason and 
judgment, a marked emotional poverty, a more or less complete state 
of indifference, a condition of puerility and often a thoughtless, sense- 
less, and impulsive brutality. 
A very large number of the violations of the law committed by 
insane persons are directly chargeable to dementia prsecox. 
"Many of these cases go to swell the ranks of the criminals, the 
prostitutes, and hoboes, and are often mistaken for cases of feeble- 
mindedness. Wilmans, in a study of one hundred and twenty-seven 
vagabonds, found sixty-six cases of dementia praecox." 
Cases of arrested dementia praecox are often noted in prison. In 
these types of this disease, the progress of the underlying dementia 
is inhibited, and though the psychosis fails to reach a stage of 
dementia, the individual never again reaches his own normal mental 
status. 
A distinct difference corresponding to the three main divisions of 
dementia praecox is shown in the character and the circumstances 
attending the crimes committed by the patients with this disorder. 
The crimes and misdemeanors of hebephrenia partake of the 
character of this form of dementia praecox-the crimes are petit lar- 
ceny, trespass, vagabondage, drunkenness, the breaking of box-cars, 
sexual offenses, and public prostitution in the female. 
The offenses which ofttimes go to make a part of the catatonic 
symptom-complex occur with much less frequency than in the para- 
noid and hebephrenic form. 
The crimes and misdemeanors of" this type are marked by impuls- 
iveness, a lack of premeditation, thoughtlessness and usually no effort 
is made by the patient to escape the consequences entailed by criminal1 36 
DRMENTTA PR^COX. 
actions. The catatonic makes vicious assaults, commits murder, and 
destroys property by incendiarism. 
The paranoid form furnishes a large number of criminals; the 
delusions of persecution lead to assault, homicides, theft of property, 
blackmail, and perjury. 
The crimes of hebephrenia and paranoid dementia praecox are 
about equal in number. 
Hebephrenia. 
Case 1. Prisoner, white male, thirty years of age when admitted 
to the Indiana State Prison, November 7, 1914. He was convicted of 
grand larceny and sentenced to a term of one to fourteen years. His 
crime was the theft of several suits of clothes. 
History: Father dead, cause unknown; one paternal aunt insane; 
prisoner has used alcoholic liquors since sixteen years of age; reached 
fifth grade in common school; he has served several jail sentences for 
larceny and one prison sentence on the same charge; he has three 
times been an inmate of a hospital for the insane. 
Examination on the day of his admission to the prison showed 
him to be partially oriented as to time, place and person; he did not 
know exactly where he was and he could offer no reason for being in 
prison; he was exceedingly stupid, and paid little or no attention to 
what was said to him; he was very slow in answering questions; he 
entertained fleeting auditory hallucinations; he heard voices calling 
him "Dr. Zeon Zo," "the champion acrobat," "the great barrel jumper," 
and "the master contortionist." 
He talked in a very egotistical manner about his accomplishments 
as an actor. He said that he was booked by many managers, but 
owing to the spells he had with his head, and that he did such 
"strange things," he was unable to fill his contracts. He also stated 
he was a graduate in law. His conversation was loosely connected, 
distracted, and was filled with many similar grandiose expressions. 
Physical examination showed prisoner to be fairly well nourished: 
there was a scar on penis; the inguinal, epitrochlear and cervical 
glands were enlarged; there were copper-colored scars on shins and 
chest; no disorders of the nervous system were noted; prisoner's 
mental condition has remained essentially the same during his stay in 
prison; he continues to entertain auditory hallucinations; he is 
extremely egotistical; he behaves in a theatrical manner; his judg- 
ment is exceedingly childish; is absolutely lacking in foresight; con- 
stantly finds it difficult to obey the simplest rules of the institution; 
his memory is very poor, especially in regard to recent events, and 
his general knowledge is entirely out of harmony with the schooling 
he has received; his mental enfeeblement, while insidious, is pro- 
gressive and constant. DEMENTIA PRJECOX. 
37 
Case 2. Prisoner, white male, thirty-one years of age when admitted 
to the Indiana Stale Prison, Septembei 25, 1513. he was convicted of 
sodomy. No reliable family history obtainable in this case. Prisoner 
was a user of alcohol and narcotic drugs. This convict has been 
arrested about ten times during his life for intoxication, disorderly 
conduct and fighting. He was for a few months an inmate of the 
Government Hospital for the Insane at Washington, D. C. He was 
sent to that institution from Ft. Thomas, Ky., after he had deserted 
from the United States Army. 
The medical certificate on which he was committed to the federal 
institution reads as follows: 
"When admitted to the Ft. Thomas post in Kentucky, his actions 
were erratic. He had delusions and hallucinations-imagined he saw 
angels and devils, etc. He tore and tried to burn his clothing. Cause 
of the attack not definitely known." 
At the time of his admission to prison he exhibited the cardinal 
symptoms of dementia praacox; there was an abnormal state of indif- 
ference to his environment. The fact that he had been committed to 
prison did not worry him in the least. He was well satisfied with his 
surroundings, and he had no particular desire to be at liberty; there 
was no clouding of consciousness, and the prisoner was well oriented 
in the temporal, personal and spatial spheres; there was marked 
impairment of memory for recent occurrences, but this defect owes 
its origin partly to his failure of voluntary attention and lack of per- 
ception. The prisoner's thinking processes were slow, inaccurate and 
superficial; he entertained very poorly defined unsystematized delu- 
sions of persecution. His conversation was irrelevant, circumstan- 
tial, and filled with senseless remarks having no bearing on the con- 
versation at hand; he had less judgment than a ten-year-old child; 
he was unable to reason even in the simplest abstract or concrete 
manner. He heard voices accusing him of sodomy. He stated these 
voices were not constant, and he heard them more frequently at night. 
When I asked him to describe the details of his crime, he did so 
in a very listless, indifferent and careless manner, laughing very fre- 
quently in a silly, idiotic way. 
The prisoner failed entirely to appreciate the fact that he had 
committed any serious offense at all; he seemed to be utterly lacking 
in any moral or legal sense of responsibility. 
Physical examination showed the prisoner to be in a fairly good 
state of health; body was well nourished; the musculature was soft; 
the patellar reflexes were exaggerated; the pupils were slightly 
enlarged and the condition of binnns was noted; the skin of the hands 
and feet was rather cyanotic and bathed with a cold, clammy per- 
spiration; there was a bubo scar in each groin and scar on penis; 
copper-colored scars on forehead and shins; Wassermann test was 38 
DEMENTIA PRyECOX. 
positive; prisoner's movements were slow, listless and clumsy; he 
has gradually deteriorated since his admission to prison, and his 
mental condition is now one of simple terminal dementia. 
Paranoid Dementia Praecox. 
Prisoner admitted to the Indiana State Prison, June 6, 1914. He 
was convicted of assault and battery with intent to murder and sen- 
tenced by the court for a term of two to fourteen years. This prison- 
er's mother has been an inmate of a hospital for the insane for the 
past twenty-two years; one maternal uncle was also a patient in the 
same hospital; cause of father's death unknown. 
This man has used alcohol since early manhood, and admits 
gonorrhea but denies syphilitic infection; Wassermann test negative; 
he has entertained auditory hallucinations for the past six years and 
has served several jail sentences for assault and battery, and the 
origin of these misdemeanors was his auditory hallucinations. The 
offense for which he is now incarcerated in the prison was committed 
in the following manner: Prisoner went to his employer, whom he 
accused of stealing his child. In fact this belief had no foundation. 
The prisoner insisted that he heard his child crying in his employer's 
private office, and no amount of argument was sufficient to shake 
this delusion. He insisted on entering the private office, and on being 
refused this privilege he shot his employer. 
At the time of this man's admission to the prison he was very 
delusional; he stated he could hear his child crying during the night, 
in a cell somewhere above his own; he declared that his unseen 
enemies were charging him with electricity, and sending electric 
shocks to his heart, by means of machines which they kept going 
night and day. 
He was only partly oriented as to time, place and person; his 
memory was exceedingly poor for recent events and likewise for 
remote ones; consciousness was slightly clouded; there was also some 
disorder of attention; conversation was coherent and relevant, but 
chiefly concerned with his delusional beliefs. 
I placed the prisoner on entrance to the institution in the psycho- 
pathic ward of the prison hospital, and after eight months' stay in the 
institution there has been no improvement in his mental condition. 
He still insists that he hears his child crying every night, that he 
is being charged with electric currents by his unseen enemies. He no 
longer attempts to support his foolish beliefs by arguments; a marked 
mental deterioration is taking place; there is general dilapidation of 
his thought; marked diminution in his power to form new ideas; a 
state of emotional indifference is observed, which is not in harmony 
with his delusional beliefs; there is a marked failure of voluntary DEMENTIA PR^COX. 
39 
attention, and on the whole, a gradual loss of mental power, that is 
characteristic of dementia praecox. 
Prisoner's physical condition is marked by the physical signs 
common to this disease. There has been some loss of body weight, 
disturbances of digestion; irregular, rapid heart action; disturbances 
of the capillary circulation, shown by the cyanosis of the skin of the 
hands and feet and a condition of dermatographia. The extremities 
are cold and covered by a clammy disagreeable perspiration. 
Owing to the prisoner's deteriorated mental condition, I will trans- 
fer him to the criminal insane hospital as soon as there is room in 
this department. 
Dementia Pnecox. 
(Catatonic Form.) 
Case 1. White male, twenty-three years of age when admitted to 
the Indiana State Prison, July 20, 1913. He was convicted of murder. 
There is an indefinite history of insanity in his family; one brother and 
sister were erratic and had strange spells at times. His mother states 
that the prisoner has always been queer and eccentric. He was always 
impulsive when a child. He was a poor student at school, and found 
it impossible to keep pace in his studies with children of his age. 
He was unable to work for any length of time at any one occu- 
pation; his mother said he would often quit work without any reason- 
able cause for doing so. 
At times he was subjected to marked depressions and often felt 
very much inclined to commit suicide. 
This prisoner lived in a district that had been flooded with water 
about a week prior to his crime. He had been somewhat subjected 
to the exposure, and to the incident mental worry and strain connected 
with the catastrophe and to relieve his depressed feelings, he imbibed 
alcoholic beverages rather freely. Two days before his criminal act 
he became very irritable, sullen and morose and frequently quarreled 
with his brothers and sisters. 
He would sit about the house and stare stupidly for hours at a 
time into space, occasionally complaining he heard persons talking 
about him in a defamatory manner. At the time of the crime, prisoner 
was sitting before the fire in a very sullen and morose frame of mind; 
he had spoken very little to any member of the family during the day; 
suddenly he raised from where he was sitting, seized a chair, with 
which he struck his sister across the face, knocking her down. He 
then dropped his chair and struck her several times with his fist. 
After making his assault, the prisoner again sat down in an appar- 
ent state of stupidity and semi-consciousness. 
His sister died a few days after the assault. 40 
DEMENTIA PRtECOX. 
At the time of his admission to prison, the prisoner was very 
dazed and stupid. When asked about the murder of his sister, he 
replied in a very indifferent manner that he knew nothing at all 
about it. 
He complained that he heard voices calling him vile and obscene 
names; he said that people about him were reading his mind and 
filling it with disgustful obscenity; said his head felt very full and 
oppressed. 
Physical examination was negative, except that the pupils were 
very widely dilated, and responded slowly to the usual tests; the patel- 
lar reflexes were unequal and markedly increased; the skin was bathed 
in a cold, clammy perspiration of a disagreeable odor; dermatographia 
was present; the prisoner moved in a slow, stiff and ungainly manner. 
It seemed to him as if his thoughts were blocked; prisoner said 
he was afraid to stay in his cell; he complained that certain unseen 
enemies would persecute him when alone; it was necessary to transfer 
this prisoner from the cell house to the psychopathic ward of the 
general hospital. Here he exhibited marked catatonic symptoms, such 
as mutism and negativism; he would sit all day without moving his 
position until forced to do so. He took no interest in the affairs about 
him. He would occasionally go without his meals for two or three 
days at a time; he accused the officers of the institution of heaping 
abuse upon him; he often complained that his food was poisoned; 
that his heart was being charged with electricity. 
He frequently made violent assaults on his fellow prisoners, whom 
he accused of insulting him; occasionally he tore his clothing and 
broke up the furniture. 
After several months of observation in the psychopathic ward of 
the hospital, I transferred him to the Indiana Hospital for the Insane 
Criminals. His condition here does not show any material change, 
except the delusions of poisoning are more often exhibited and periods 
of catatonic excitement are more frequent. CHAPTER VIL 
GENERAL PARESIS. 
The crimes of general paresis as compared to epilepsy, dementia 
praecox and paranoid states are comparatively rare. Of two hundred 
and five admissions to the Indiana Hospital for the Insane Criminals 
but five patients were general paretics. 
The criminal offenses of general paralysis generally fall into one 
of the following categories, immorality, alcoholic debauch, indecent 
behavior, thievery, dishonest speculation, forgery, and very rarely 
homicide and suicide. The misdemeanors of paresis generally occur 
in the incipient stages of this disease. The moral qualities of the 
mind share in a very large way in the general degeneration. Very 
often the moral symptoms are the first to point to paresis. The 
paretic fails to understand and seems entirely oblivious to the moral 
relations that he sustains to society and his family. His speech, which 
was formerly chaste and decent, becomes filled with profanity and 
obscenity. The once temperate individual indulges in wild alcoholic 
debauches, and the formerly respectable husband and father seeks 
the company of the public prostitute openly and without shame. 
"Volition, as the highest function of the mind, is one of the first 
to suffer in general paresis. The loss of control, both of actions and 
of ideas, is one of the earliest symptoms, and in the fully developed 
stages there is no longer any volitional direction of the thoughts, and 
consciousness is filled with the creations of a morbid phantasy, and 
with such sensorial impressions as chance to rise. This failure 
of will power and of all persistency of purpose makes the general 
paretic a comparatively easy subject for management." 
The paretic manner of committing misdemeanors, and the environ- 
ments and circumstances attending them generally, leave room for 
little doubt as to the source and nature of their real origin. The 
patient has no apparent knowledge of the quality and nature of his 
overt acts. The paretic seldom tries to hide his crime and he dis- 
plays no foresight or caution. If on a tour in a department store, 
the rich and well-to-do patient may steal articles of small value, such 
as handkerchiefs and gloves. He will pocket them under the eye of 42 
GENERAL PARESIS. 
the clerk in a state of apparent forgetfulness after having examined 
them as a prospective buyer. 
Magnan recites the case of a paretic who asked the aid of a police- 
man to help him steal a barrel of wine. The perfect frankness, 
innocence and apparent reasonableness of the request made upon the 
policeman, so impressed him, that he assisted the paretic to carry out 
his theft. 
"The apparent kleptomaniacal propensities of the general paretic 
consist mostly in an automatic appropriation of whatever articles 
attract his attention rather in any perverse desire to steal, and in the 
demented stage he still continues to accumulate things when he is no 
longer capable of making any distinction as to ownership." 
Under the dominating influence of grandiose delusions, the victim 
of paresis forges checks, makes fraudulent claims on property, gives 
false promissory notes, makes wild speculations in the market and 
undertakes impossible financial operations without apparent knowl- 
edge of the quality of his acts. 
The following paretics were sent to the Indiana State Prison to 
be punished for acts that were purely symptomatic of this fatal 
disease: 
Case 1. White male, forty-one years of age, convicted of petit lar- 
ceny. Entrance examination. The Wassermann test and cytologic exam- 
ination were one hundred per cent positive. The patient was fairly well 
nourished, plenty of adipose tissue, muscles were soft and flabby. The 
respiratory system was normal. The heart rate was slightly irreg- 
ular; some slight sclerosis of superficial vessels. The digestive system 
was normal. Some enlargement and induration of the inguinal, epi- 
trochlear and cervical glands were noted. The osseous system appeared 
to be normal. Examination of the genito-urinary system showed little 
except a slight scar on the glans penis. Urinalysis was negative. 
General incoordination was present. Power of hand grip was 
diminished. The stereognostic sense was defective. Speech was 
defective; the patient stumbled over test phrases, speaking in a slow, 
hesitating manner. The pupils were unequal in size, the right was 
larger than the left, both were irregular in outline. Consensual and 
sympathetic reflexes were absent. The pupils did not respond to 
light; accommodation reflex very sluggish. The abdominal reflex was 
present; cremasteric and patellar reflexes were absent. There was 
no ankle clonus; the Babinski sign was present. Pain sense was 
defective; pin pricks were felt five seconds after the skin was stim- 
ulated on the anterior surface of the lower limbs. Some areas of 
anesthesia were found on the posterior surface of the limbs and 
trunk. The heat, cold and color senses were defective; vision %o- 
Audition was normal. Olfactory sense defective. Motor reactions 
were slow. GENERAL PARESIS. 
43 
The patient was untidy in personal appearance; clothes were not 
properly buttoned, and were stained with food. Consciousness was 
clouded; he was disoriented as to time, place and person. A consid- 
erable degree of euphoria was present. The patient was pleased with 
himself and his environment. Insight was lacking. He said that his 
mind was all right. He talked disconnectedly about his environment 
and the persons near him. Memory for both past and present events 
was nil. Hallucinations and delusions were present. Mathematical 
calculations of simple multiplication and addition were sixty per 
cent correct. 
The general clouding of consciousness, the confusion of ideas, 
dilapidation of thought, progressive failure of memory, the failure of 
reason and judgment, the grandiose delusions together with the 
results of the neurological and Wassermann examinations made the 
diagnosis of general paresis easy. 
Case 2. White male, thirty-nine years of age, was convicted of 
forgery. His crime was in direct harmony with his insane, expansive 
delusions and his utter lack of judgment. This man, in a silly, grotesque 
and clumsy manner, raised a check from fifteen to one hundred and fifty 
dollars, and then in a way quite becoming his mental disease, he 
asked the cashier of the bank if he had properly raised the check, and 
as a result of such inquiry of the bank official he was promptly placed 
under arrest, tried and convicted of forgery and sentenced to the Indi- 
ana State Prison for a term of two to fourteen years. Neurological 
examination and Wassermann test of the blood and the spinal fluid 
were positive for paresis. 
Case 3. White male, fifty-four years of age; has twice been con- 
victed of rape since 1910. For the first offense he served six months' 
sentence in jail. The mental and neurological examinations and the 
Wassermann test of the blood and the spinal fluid confirmed the diag- 
nosis of paresis which I made of the prisoner at the time he entered the 
state prison. 
Case 4. White male, fifty years of age. The prisoner was convicted 
of grand larceny. He was in an advanced stage of general paresis 
when received at the Indiana State Prison. He was absolutely 
demented and as helpless as a child. The Wassermann tests of his 
blood and spinal fluid were one hundred per cent positive. Three 
months after this prisoner had been admitted to the prison, he passed 
into a state of status epilepticus; after this series of convulsions 
had ceased, the contractures and decubitus of the terminal stage of 
general paresis developed, and three months later he died. 
Case 5. White male, convicted of bigamy; fifty-two years of age. 
When nineteen years old he contracted syphilis, which was only treated 
intermittently over a period covering six months. He always used 
alcoholic beverages to excess. He was admitted to the Indiana State 
Prison, June 10, 1913. At the time, neurological examination showed 44 
GENERAL PARESIS. 
an absence of light reflex; the consensual and sympathetic reflexes 
were absent. Pupils were unequal in size and very irregular in out- 
line. There was a tremor of the nasiolabial fold. Speech was slow, 
hesitating and tremulous. Muscular co-ordination was very poor; 
the hand-writing showed ataxic tremors; patellar reflexes were 
absent; Babinski reflex present; Romberg sign was present. 
The prisoner was untidy in dress; consciousness seemed to be 
somewhat clouded; he was not fully oriented as to time, place and 
person; memory markedly impaired; reason and judgment very de- 
fective. His emotional state was one of euphoria. He boasted in a 
most extravagant manner that he had been able to marry two women 
within six months, though his first wife was still living and not 
divorced from him. He said he possessed great sexual power, and on 
account of this reason it was necessary for him to have three wives. 
He spoke of his crime as follows: "My first wife was jealous because 
I married two other women, but in reality she ought to be glad, for 
I was doing her a kindness. She would not have been able to have 
sexual intercourse with me as often as my great sexual powers 
demanded. You see, doctor, it was really a kindness on my part." 
Four months after he was admitted to prison he began having 
convulsions of the grand mal type. His mental deterioration was 
progressive and rapid. He exhibited no other expansive delusions 
except those of his sexual nature, and these rapidly became indistinct 
and lost in the process of mental disintegration and dementia that 
soon became complete. The Wassermann test for his blood and spinal 
fluid was positive. CHAPTER VIII. 
MANIC-DEPRESSIVE INSANITY. 
The crimes of the manic-depressive psychoses are relatively 
infrequent. 
The alternate cycles of good behavior and freedom, crime and 
imprisonment which I have noticed in habitual criminals somewhat 
resemble the manic-depressive psychosis with its intervals of lucidity, 
separated by periods of depression and excitement. In the period 
of remission of the cyclic form of criminality the prisoner is exceed- 
ingly well behaved and often takes a very active part in the religious 
services and societies at the prison, and often it is thought this indi- 
vidual has reformed and that he will become a model citizen. 
He is sooner or later discharged from prison and he does exceedingly 
well for a limited period of time. But shortly our hopes are dashed 
to the ground, for a second cycle of criminality develops; new crimes 
are committed and the individual is returned to the prison from which 
he was but recently discharged or is sent to some institution in an- 
other state. The following is an excellent example of this peculiar 
phenomenon: Prisoner received at the Indiana State Prison convicted 
of passing fraudulent check, was classified as insane at time of admis- 
sion; was a model prisoner, and though he was a Hebrew, he was 
exceedingly active in the Protestant Bible Class and professed the 
Christian religion. After serving his minimum sentence he was 
paroled, and for some time he kept his parole obligation very well. 
He was often pointed out as an example of reformation among prison- 
ers. Very recenty, it seems, that he has developed a new attack of 
criminality. We have received information from reliable sources that 
he has passed fraudulent checks in the East, embezzled sums of money 
ranging from two to three hundred dollars from philanthropic but 
unsuspecting individuals; tried to consummate a marriage with the 
daughter of his benefactor although already married, and that he 
represented himself to be the chaplain of the Indiana State Prison to 
further help himself in his practice of fraud and embezzlement. 46 
MANIC-DEPRESSIVE INSANITY. 
The most common violent act of this phase is suicide. 
All melancholic patients are potential suicides, and in a state of 
raptus this act is frequently performed in public and without pre- 
meditation. The depressive patient sometimes becomes so occupied 
with a single idea that it amounts to an obsession. These ideas are 
often very terrifying and brutal, and because they occupy the entire 
field of consciousness, there often develops a state of "raptus melan- 
cholicus," in which their absorbing obsessions are translated into 
murder, vicious assaults, mutilations of the body, especially those of 
the genitals and the most painful forms of suicide. 
Consciousness is markedly clouded in these outbreaks by delirious 
passion, and the memory, if retained at all, is imperfect and hazy con- 
cerning any actions performed during this period. In the state of 
raptus guided by a delusional sympathy, a mother will murder her 
children to protect them from hardship, trials and supposed evils 
with which she thinks they are threatened. 
An individual once made an attack on an English king knowing 
that such a crime would result in his death; he was impressed with 
ideas of his own sinfulness and unworthiness and thought that his 
own death was necessary for the good of humanity, but because he 
was so scrupulous about the sin of suicide, he assaulted the king 
knowing that the punishment for this act was death. 
Clinical Cases. 
Case 1. White male, fifty-two years of age, was admitted to the In- 
diana State Prison in 1909. He was convicted of the murder of his nine- 
year-old daughter. His mother died of tuberculosis; his father died 
of senile dementia; his maternal grandfather was insane; one 
maternal aunt was insane; one uncle committed suicide; three 
brothers and one sister died of "softening of the brain," and one sister 
is now an inmate of a hospital for the insane. This prisoner labored 
under delusions for several months prior to his crime that he had 
communicated syphilis to his wife and daughter, and that terrible 
misery and suffering were in store for them. He felt that he ought to 
have his life taken for his sin. A few weeks before he murdered his 
nine-year-old daughter he consulted an attorney as to how he should 
proceed to secure his execution for infecting his wife and child. He 
was directed by his attorney to consult the police department of the 
city. He went there as directed, and asked to be executed for his 
supposed crime. He was detained a few days for observation, but 
was released without being committed to an asylum. A few days 
later he killed his daughter; he made no effort to conceal the fact, and 
when brought to trial he apparently was very regretful that his 
daughter had become so diseased with syphilis as to require that her 
Depressive Phase. MANIC-DEPRESSIVE INSANITY. 
47 
life be taken to avoid the misery that this disease entailed. He said 
that he felt that he had been commanded by God to kill her and he 
offered arguments to try to prove this delusional idea. At the time of 
his trial he objected to the defense of insanity which was made for 
him, and when given an opportunity to testify for himself, he said 
he was justified in killing his daughter because he had thereby saved 
her from the torture and misery that this disease would bring to her, 
and that he was ready to suffer any penalty the law might impose 
upon him as sane and accountable for the deed. The following is a 
transcription of a letter he sent to the trial judge: 
"Mr. Judge, your honor, I want to make a strong appeal in my 
case, as I think it is my duty to ask you for help and assistance in 
this matter. It is very easy to examine me and find I am sane, and in 
my right mind, and have never been any other, your honor. Make a 
thorough examination and you will find I am telling the truth as sure 
as there is a God in Heaven. I am guilty and sane and I don't want 
to be sent to a criminal insane hospital to have the doctors work on 
me when there is nothing the matter. I am anxious to take what 
comes for my act. I want to make a confession and clear my con- 
science as I am positive I will go insane if I do not get my mind clear. 
I got a disease in my groin and in my blood and system, and I know 
that my dear wife and child had it in their systems. I committed 
adultery when I was running a street car and got this disease in my 
blood and system, and for this reason I took my little daughter's life 
because she had the disease in her blood, and this is the truth. I am 
not insane and I do not want to go to an insane hospital. I want to 
get this out of my mind and take what comes and be satisfied." 
While at the prison, this prisoner was always oriented as to time, 
place and person. His memory was good for remote and recent 
events; he was retarded in the matter of movement and speech; he 
had no hallucinations, and no other delusions except he had trans- 
mitted syphilis to his daughter and that God had commanded him to 
take her life; he was always emotionally depressed, seclusive and non- 
communicative; he was always making accusations against himself; 
he said he was unworthy to live, that he had caused much suffering 
and distress. 
Manic Phase. 
The crimes of the manic phase are also rare. The extreme psycho- 
motor activity interferes with the accomplishment of definite criminal 
acts. The patient is destructive rather than criminal; he is given to 
the demolition of furniture, mirrors and window panes. They not 
infrequently disturb public peace by running amuck through public 
thoroughfares. They often frequent saloons, and indulge heavily in 
liquor, thereby becoming obstreperous and unruly in public places. 
The ordinary womanly modesty is frequently lost in the manic phase. 48 
IvlANIC-EErHESS IVE INSANITY. 
The female patients of this type are often arrested and charged with 
public indecency and exposure. Nymphomania, kleptomania and 
dipsomania are not uncommon symptoms. 
The maniacal excitement occasionally assumes a character of 
extreme fury and frenzy during which vicious assaults and homicides 
are committed. 
Clinical Cases. 
Case 1. Prisoner, white male, admitted to the Indiana State 
Prison in 1914. He was convicted of the crime of grand larceny. His 
father died of senile dementia; his mother died of cancer of the 
stomach; one sister was insane; one brother died of tuberculosis; 
prisoner has twice been an inmate of a hospital for the insane; he 
eloped from the last institution December 20, 1912. This prisoner 
has had frequent maniacal attacks for the last ten years, and during 
this time he has displayed conditions of excessive eroticism, incen- 
diarism and kleptomania. In 1907, he fired two elevators and two 
hay warehouses, causing a great fire loss. These fires occurred on 
four consecutive nights, and though arrested on the charge of arson, 
he was released because it was thought by the prosecuting attorney, 
before whom he appeared, that the evidence was insufficient to convict 
the prisoner. A few months later his mental condition being recog- 
nized, he was sent to a hospital for the insane. 
While awaiting trial for his last offense, he attempted to set fire 
to the jail, and on the day of his trial he concealed three blankets, 
which he had taken from his cell, about his body. 
When the prisoner was interviewed on the day of entrance to the 
prison he exhibited the usual classical sign of the manic phase of 
the manic-depressive psychosis, namely, a flight of ideas, psycho- 
motor activity, and emotional excitement. 
He constantly interrupted the examiner by foolish, extravagant 
and disconnected statements. When asked to give his name, he 
replied: "I am Happy Jack. I am the man who gave Rockefeller his 
start. I knew him when he was as poor as Job's turkey. Say, doctor, 
I am a great singer-I want to sing you a song. I preached my 
mother's funeral sermon; you bet, I could do it, too. Yes I can fight, 
and the Lord will have to pity those policemen that arrested 
me if I ever get out and they are not so smart as they think they are." 
This stenogram was typical of his whole conversation. He was 
restless, walked the floor while talking, assumed theatrical poses, 
and sang one verse of a religious hymn. 
He was oriented as to time, place and person. He was easily 
ovritnfl and became very much angered when it was suggested to him 
that he was in prison and that he should try to make some effort to 
control his conduct. 
After about seven weeks' sojourn in the Indiana Hospital for 
Insane Criminals, he became quiet, well behaved and peaceful. This 
state lasted about three months, and a new cycle of manic excitement 
is just beginning. CHAPTER IX. 
HYSTERICAL INSANITY. 
It is not at all to be wondered at that crimes, misdemeanors and 
the violations of morality should be found in the symptom-complex of 
hysterical insanity. 
The exaggerated impressionability to external stimuli, the abnor- 
mal tendency to simulation, the excessive emotionalism, the volitional 
impairment, render the patient a plaything of his whims and passionz 
and the easy victim of evil circumstances. 
The combination of these named psychic attributes of this mental 
anomaly create or constitute a condition of moral inco-ordination. 
Delusions of persecution are to be expected in the hysteric whose 
abnormal sensitivity to the slightest irritating trifles translates the 
most common relations of life into schemes and machinations for his 
injury. And it naturally follows that homicidal assaults should grow 
out of this disordered paranoid state of mind. 
The basic eroticism of hysteria leads to sexual crimes; the 
hysterical ascetic in his life of imperfectly repressed sexual desires 
and celibacy often sinks to a state of homosexuality, which finds relief 
in such sexual crimes as sodomy and bestiality. Other hysterics, 
through fear of venereal disease, through a dread of shame, and a 
horror of being detected in illicit sexual relations, frequently commit 
rape on infant children. 
Individuals of this type are to be found in every prison. Often 
overt acts are perpetrated in the periodic episodes of this psychoneu- 
rosis that are attended by states of amnesia. 
"Many of the cases of blackmail and false accusations against 
physicians may be credited to this form of hysteric derangement in 
females, and we have known one or two striking instances of the kind. 
One, a young woman, well connected, but cut loose from her family and 
rather repudiated by her relatives, used to frequent doctors' offices and 
have hysteric attacks there, and in one or two cases, at least, attempted 
to get up compromising situations, and once succeeded so far as to 
give considerable mental uneasiness for a time to a rather prominent 50 
HYSTERICAL INSANITY. 
physician. There are cases on record where still more serious conse- 
quences have resulted; men have been convicted of crimes of which 
they were innocent on false testimony of hysteric women. 
"While this special form of mental disorder is by far most fre- 
quent in the female sex, it is not unknown in males; of course, in these 
cases the symptoms are somewhat modified, but it occurs only in men 
with somewhat abnormal and feminine mental organizations. In some 
of these, sexual perversion is a notable symptom, and it seems prob- 
able that this hysteria is at the bottom of many cases of this abnor- 
mality. 
"In male hysteric insanity we see many of the same tendencies to 
morbid emotionalism, eroticism, false accusations, the exaggerated 
suggestibility, certain kinds of delusive conceptions, occasional threats 
or apparent attempts at self-injury or suicide, refusal of food, etc., 
that we observe in the female, but actual hysteric convulsive attacks 
nre very rare, and the well-marked hysteric physical stigmata are also 
uncommon. Male hysteric insane are more likely to be suicidal or 
homicidal than are the females." 
"Something may be said in regard to traumatic hysteria, which 
sometimes amounts to a kind of insanity, showing itself in an exag- 
gerated valuation of physical disabilities and a certain moral weaken- 
ing that leads the individual to overact and sometimes simulate. There 
are probably sometimes actual hallucinations and certain delusive con- 
ceptions. These cases may be regarded as rare, though hysteria from 
this cause is common. They have chiefly a forensic importance." 
The hysterical type of prisoner is the bete noire of the prison- 
surgeon. He is irritable, quarrelsome, goes about seeking to provoke 
an argument, constantly complains he is ill-treated by the prison 
officials, that unfair tasks are assigned him, that the fellow prisoners 
steal his tools and delay his work. 
He constantly makes demands for interviews with the disciplinary 
officer; he is rebellious at discipline. He finds the obedience to the 
prison's simplest rules a hard task. At other times he is extremely 
cheerful, vivacious, and his actions are liable to overstep the bounds 
of prison convention. This brief period of apparent improvement in 
conduct is usually followed by a train of hypochondriacal complaints. 
This type of prisoner comes to the sick line every morning. One 
day he complains of precordial distress; the following day he confi- 
dentially tells the prison physician that he has very frequent nocturnal 
emissions, that he is troubled with nightmare and insomnia. At the 
i. ; morning's sick call he gives a new revelation concerning gastric 
disturbances with which he suffers. In a few days he becomes 
xtremely depressed and melancholy. He imagines himself the victim 
of conspiracy by the officials of the institution. He becomes lachrymose 
and he relates his grievances to his fellow prisoners to create sym- 
pathy. Failing to do this he frequently pretends to attempt suicide. HYSTERICAL INSANITY. 
51 
Should this fail to arouse the sympathy which he morbidly craves, he 
frequently becomes maniacal, throws his food on the floor, breaks the 
dishes, tears his clothing and talks in an incoherent and senseless 
manner. After a few days, whether placed in the hospital or not, his 
mental condition returns to its normal state and in course of time 
another cycle of such behavior and conduct is again enacted. 
The hysterical criminals constitute possibly four per cent of the 
insane cases in prisons among the male prisoners, and this percentage 
is much higher among the female delinquents. 
Dr. Spaulding, of the Woman's Reformatory in Massachusetts, 
stated, in a recent report, that eleven per cent of the female offenders 
showed manifestations of hysteria. 
It has been noted among female prisoners that maniacal hysterical 
outbreaks occur very frequently and more especially at the time of the 
menstrual periods. The following stenogram is taken from Mrs. Mary 
Carpenter's "Female Life in Prison": "'Miss G., I'm going to break 
out tonight.' 'Oh, nonsense; you won't think of any such folly, I'm 
sure.' 'I'm sure I will.' 'What for?' 'Well, I've made up my mind, 
that's what for. I shall break out tonight. See if I don't.' 'Has any- 
one offended you or said anything?' 'N-No, but I must break out.' 
'And then you will go to the dark cell.' 'I want to go to the 'dark'.' 
And the breaking out often occurs as promised; the glass shatters out 
of window frames; strips of sheets and blankets are passed through 
or left in a heap in the cell; the guards are sent for, and there is a 
scuffling and fighting and scratching and screaming that pandemonium 
might equal, nothing else." 
Clinical Cases. 
Case 1. Prisoner, colored male, age thirty; reliable history con- 
cerning relatives not obtainable; he has a long criminal record; was 
arrested sixty times at his home town for fighting; was sent to reform 
school at the age of twelve, and after serving four years he was 
paroled. He was again sent to the Boys' Reform School for shooting 
a boy and was kept in that institution until he was twenty-one years 
of age. In the year 1902 he was sent to the Indiana Reformatory foi' 
assault and battery with intent to kill. 
He was admitted to this institution the first time August 9, 1910. 
He was paroled February 1, 1914, and discharged from the institution. 
He was again admitted to the prison July 6, 1914, convicted of murder 
and condemned to death by electrocution. 
While a prisoner at this institution he exhibited continuously the 
hysterical character; he was always emotionally unstable; there were 
rapid changes of his temper, also in his desires and in his attitudes; 
there was a continual oscillation between excessive religious preten- 
tions and states of vulgarity and obscenity. 52 
HYSTERICAL INSANITY. 
After pouring for hours over his prayer-book, he would return to 
the steady gaze of the pictures of actresses dressed in abbreviated 
costumes, such as are found in the popular magazines. He would 
label these pictures, especially the suggestive ones, with sexual titles. 
He was extremely quarrelsome with his fellow prisoners; in order 
to get them into trouble with the prison officials he wrote anonymous 
letters and dropped them about the prison hospital; he often feigned 
sickness in order to avoid tasks assigned him. 
He would develop unreasonable and baseless hates against the 
hospital nurses and often made threats to do them violence. Occa- 
sionally he exhibited fairly well systematized delusions of persecution 
and periods of melancholia. 
After maniacal and convulsive paroxysms, transient paralyses and 
areas of anaesthesia were often seen. A very common development of 
his psychoneurosis was hysterical aphonia and mutism. He com- 
plained frequently of the globus hystericus and clavus just preceding 
a convulsive or excited period. 
At the time of his parole from the Indiana State Prison an hys- 
terical hemiplegia of the right leg was present and he made much of 
this defect to promote and excite sympathy from the members of the 
parole board, and he succeeded in doing this. He was paroled and dis- 
charged against the physician's advice. 
Four weeks after his release from prison he was again able to 
use his leg in a perfectly normal manner. After the use of his leg 
returned, he resorted to his old life of carousing, lewdness and 
debauchery; one night after a carousal, without cause and in a very 
theatrical manner, he murdered a policeman. He was then returned 
to the Indiana State Prison under the sentence of death. While await- 
ing his execution he manifested the same signs and symptoms of 
hysteria that he had exhibited in his previous confinement. He was 
exceedingly religious, obscene, irritable, good natured and egotistical 
by turns. Occasionally he complained of insomnia, globus hystericus, 
and violent headaches; he continually wrote letters to his lawful wife 
and to a prostitute; he insisted that this was perfectly consistent with 
his profession of religion. While being prepared for his execution 
he remarked to his attendants in a joking manner that, "The police 
will not any more have to dodge behind telegraph poles and my wife 
will no doubt have many gentlemen callers the next day after my 
funeral." 
If the electrocution could have taken place in public, he would 
have derived great pleasure in posing in a theatrical manner as a 
martyr to society. 
While awaiting the sentence of death he wrote a false confession 
stating that he had murdered a woman several years before, merely to 
appease and satisfy his insatiable desire for newspaper notoriety. 
Case 2. Prisoner, white male, thirty years of age when admitted to HYSTERICAL INSANITY. 
53 
the Indiana State Prison, November 1, 1911. He was convicted of rape 
on a child of six years of age. 
This prisoner's paternal uncle is now serving sentence in prison 
for the same charge. Prisoner's father served two sentences in this 
prison, one for poisoning the prisoner's mother and the other for 
raping the prisoner's sister. 
This convict presented at the time of his commitment to prison 
the hysterical stigmata and character. Physical and neurological 
examinations revealed scattered patches of anaesthesia and a condi- 
tion of hyperesthesia over the left breast and scrotum. He complained 
of clavus and globus hystericus. He stated that very frequently hot 
flashes passed over his body; he often had chilly sensations up and 
down his spine; he stated that intercourse with adult females was not 
attended with a very great degree of sexual pleasure because of the 
mental confusion, embarrassment and disgust that he felt at the time 
of coitus. 
He therefore chose a six-year-old child for his partner since he 
felt that he could control her, and he stated in explanation: "My 
mind was stronger than hers and I did not feel embarrassed." 
He has shown during his stay in prison, periods of depression, 
exaltation, mutism, emotional instability and an undue reaction to 
external stimuli. At irregular intervals minor paroxysms occur and in 
these attacks the prisoner apparently passes into a semi-conscious 
state, from which he may be aroused by loudly calling his name. He 
rolls his head from side to side in a rhythmical manner, at the same 
time he continually twists the muscles of his mouth and opens and 
closes his hands. These convulsive movements last about twenty 
minutes. These paroxysms occur at the times when he is displeased 
or about to get into trouble because of violation of prison discipline. 
Case 3. Prisoner, white male, thirty years of age, convicted >f 
assault and battery to commit rape on a fourteen year old girl. This 
is the prisoner's second conviction on this charge. 
While in jail awaiting trial, he pretended to commit suicide, but 
satisfactory evidence shows that he was merely trying to arouse 
sympathy. 
While in prison he has exhibited excessive states of emotional 
reaction; a lack of foresight, of perception, of reason and judgment. 
His conduct has been regulated by his feelings and impulses rather 
than by reason and thought. He has been in constant conflict with 
prison discipline, and his disciplinary record is full of reports against 
him. Very often he would have alternate fits of crying, laughing, 
whistling and singing in the shops, rendering himself a serious menace 
to prison discipline. Occasionally he complains of auditory and vis- 
ceral hallucinations; tremor of the eyelids; a feeling of numbness in 
the throat and aching sensations in the mammary and testicular 
regions. He has frequent convulsive paroxysms that are attended 
by choreiform movements and twitchings of the eyelids. CHAPTER X. 
PUERPERAL INSANITY. 
Puerperal insanity is a generic term applied to certain psychotic 
symptoms which occasionally attend the physiological epochs of preg- 
nancy, parturition and lactation in those who possess a hereditary 
predisposition. The causal factors operating to produce this psychosis 
are the lack of the proper medical attention at the time of childbirth, 
the infection and exhaustion, shock and hemorrhage, the mental 
anxiety and fear attending this physiological cataclysm. It has been 
claimed that this mental disturbance takes place about twice as often 
in illegitimate pregnancies as in legitimate ones. This fact seems to 
indicate that the psychogenic factor of worry, remorse and shame 
exert a tremendous influence for the production of this disorder. 
Occasionally violent states of mania and frenzy are noted in puer- 
peral insanity and during these periods of great motor excitement, 
restlessness and delirium, criminal acts are committed, and chief 
among them are infanticide, suicide and homicide. 
A large percentage of infanticides may be charged to the insanity 
attending the puerperium. It is a strange perversion of the maternal 
instinct for a mother to murder her helpless offspring, and in every 
case of puerperal insanity, the infant should be taken from its mother. 
It seems as if this mental disorder is not alone confined to human 
beings. It is a well known fact that horses, cows, rabbits, squirrels 
and cats often kill their young at the time of birth or soon after. It is 
a very frequent occurrence for a female hog to kill and devour her 
entire litter. 
"When the disease develops at this time, delirium is common, par- 
ticularly in cases occurring early-before the fourteenth day. Here 
also there are, in at least half the cases closely observed, prodromal 
symptoms during pregnancy. These symptoms may have been over- 
looked, or the offset may arise with startling suddenness accompanied 
by suicidal or homicidal tendencies. Fever, which is commonly pres- 
ent, may be very high in septic cases. If the patient is maniacal, which 
is the most common type, she is sleepless and violent and attempts to PUERPERAL INSANITY. 
55 
destroy those about her. There are delusions and hallucinations. The 
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rapidity and incessant change. Now sensuous, obscene, profane, and 
making attempts at self-exposure; in an instant she may revert to 
religious ideas, to indulge in prayer and the singing of hymns. In 
one case, that of an illegitimately pregnant colored girl of nineteen, the 
writer was thought to be the Almighty, from whom the girl piteously 
besought pardon for her sins. The moment while counting her pulse 
he was turned upon with a frenzy from which he barely escaped, the 
patient, now terrorized by his presence, believing him to be Satan him- 
self, upon whom she spat with fury. Within a very short time he left 
her singing a Sunday school song, which was soon followed by word 
pictures of obscene situations mingled with revolting profanity. Melan- 
cholia in the puerperium occurs less frequently than mania-usually 
after the fourteenth day-and it is very apt to be accompanied by per- 
sistent attempts at suicide, requiring unremitting watchfulness on the 
part of the attendants; delusions involving frequently the husband's 
fidelity, and hallucinations of sight and hearing are commonly present." 
Female prisoners are not received at the Indiana State Prison, so 
I am unable to furnish examples of this particular psychosis, and its 
relation to crimes and misdemeanors from case histories of this 
institution. 
Through the courtesy of Max Bahr, M. D., Clinical Psychiater of 
the Central Indiana Insane Hospital, at Indianapolis, I have been fur- 
nished with the following hospital records: 
Clinical Cases. 
Case 1. Female, age twenty-five, single, was admitted to the Cen- 
tral Indiana Insane Hospital for the Insane, May 27, 1904. 
Father was neurotic, one sister and one cousin insane and at one 
time in this institution. Aside from the ordinary diseases of childhood, 
the early history was negative. She was considered an average child 
and did well at school. 
At the age of twenty-one she was employed as a domestic in a 
private family and about a year later became impregnated by her 
employer. The patient worried and cried a great deal during her 
illegitimate pregnancy and kept the matter a secret from her friends 
and relatives until within a short time of her confinement. The patient 
received a stipulated sum of money from the father of her child and 
also provision was made for its future care. 
Patient all through her life had been very religious and this "sin 
against God," as the patient designated it, could never be forgiven. 
She had a very difficult labor as the child was large and its 
delivery necessitated the use of instruments. 
The first manifestations of her psychosis was about the third day 56 
PUERPERAL INSANITY. 
after birth of her child, when she developed hallucinations, mild cloud- 
ing of consciousness, with an anxious emotional state. 
These hallucinations, which became the basic factor for her crim- 
inal act later, became more elaborated from time to time and assumed 
afterwards an imperative character as "God appeared before me and 
commanded me to sacrifice my child." In the visual hallucinations 
she saw God appear before her dressed in a white gown and pointing 
His finger to her, say, "Go and sacrifice your child." Patient fought 
these hallucinations for nearly two years, but eventually they had such 
an overpowering influence over her that she finally had to give in, and 
she went to a neighboring stream and drowned her child. 
Patient was indicted for murder in the first degree in Clark County, 
but was later committed to the Central Hospital. 
Patient since in this institution has never expressed any regret 
or remorse for the crime she had committed, but frequently stated she 
was glad she committed it as it was God's wish and it was the only 
way in which her sin against God (her illegitimate pregnancy) could 
ever be forgiven. 
After the patient murdered her child her hallucinations never 
reappeared. 
Case 2. Female, age twenty-seven, admitted to the Central 
Indiana State Hospital for the Insane, July 30, 1912. 
Family history negative, personal history of no consequence. 
Patient had one miscarriage and also one child living five years of age. 
During the latter period of the patient's pregnancy arrangements 
had been made to send her to a general hospital for her confinement. 
Previous to her being sent to this hospital an indiscreet neighbor 
related to her a number of fabulous tales about new-born babies being 
frequently exchanged by nurses and that hospital-born babies were 
seldom ever returned to their right mothers. 
This worried the patient a great deal and on the fourth day after 
her delivery she presented an acute psychosis in which she manifested 
an anxious state of excitement with many delusions and hallucinations. 
She had the delusional idea that there was a plot to get rid of her, 
and also that her husband had been killed. She also developed an 
extreme hatred for her child, which she believed not to be her own, 
and during one of her periods of excitement she threw the child 
through a window and also made a desperate attempt to take her own 
life. In the most miraculous manner the child remained uninjured, as 
it was well protected by a large amount of clothing. Patient made a 
complete recovery and was discharged October 21, 1912. 
Case 3. Female, age forty-three, admitted to the Central Indiana 
Hospital for the Insane, December 23, 1909. Father died insane in Ire- 
land. Personal history of early life negative. Came to America at the 
age of twenty-five and married at the age of twenty-six years. Had six PUERPERAL INSANITY. 
57 
children living and five dead, had one miscarriage, on two occasions 
patient had twins. 
Previous to the psychosis the patient had been in poor health for 
several months. She became greatly emaciated and it was feared she 
had tuberculosis. 
A psychosis followed almost immediately after childbirth when 
she presented the picture of a puerperal, exhaustive delirium. She 
became confused, presented numerous hallucinations with a marked 
clouding of consciousness and complete disturbance in orientation. 
During her psychosis previous to her admission to this institution 
there was a period of complete amnesia lasting for about ten days. 
For an entire week she was in a hospital in LaFayette and the patient 
had no recollection of being there. Previous to her admission to the 
LaFayette hospital she locked her new-born child and two small 
children in her room and set fire to the house. After doing this, 
patient ran to a neighboring house and said she wanted to see her hus- 
band. The fire was extinguished without damage to the property, and 
the children were rescued by neighbors uninjured. 
This act was undoubtedly committed while this individual was in 
a state of delirium, as she has only a very faint recollection of the act, 
and furthermore, could not give any reason for having committed it. 
Patient made a complete recovery and was discharged September 2, 
1910. 
Case 4. Female, age thirty-six, admitted May 7, 1906. Nothing 
could be learned as to the family and early personal history. Onset 
of psychosis second day after childbirth. Patient manifested an acute 
delirious excitement. Had a number of hallucinations and illusions 
and also the delusional idea her child was not the one which she gave 
birth to just a few days previous. Stated that it looked like a negro 
child and that she wanted to kill it. Patient made several attempts to 
kill the child, which had been closely guarded, and when she could 
not do bodily harm to her child she made a homicidal attempt on the 
nurse who was entrusted with the child. Patient made a complete 
recovery and was discharged October 30, 1906. 
Case 5. Female, age thirty-four, admitted February 27, 1912. 
One uncle died insane. Father neurotic. Marked evidences of mental 
disturbance were noted almost immediately after childbirth. She be- 
came maniacal with outbursts of passion and violence. She wanted to 
kill her husband, who, three months previously, however, had deserted 
the patient. Many hysterical phenomena were manifested in this case, 
i. e. a complete aphonia extending over a period of seven weeks, 
sensory disturbances as a complete circular analgesia around her neck 
about three inches in width and also an area of anesthesia on the 
lower forearm extending about four inches above the wrist on both 
sides. Patient threatened to kill her child, but it was removed imme- 
diately after the outbreak of the mother's psychosis for fear that she 58 
PUERPERAL INSANITY. 
would carry out her threats. Patient had a previous admission in this 
institution in 1905 following a self-inflicted abortion at six and one-half 
months. During her former admission she made persistent attempts 
at suicide and presented the picture of an agitated depression. The 
conscious feeling of her previous criminal abortion was, however, a 
large factor in the production of her psychosis. She believed herself 
eternally lost, that she will live forever in torture and that there is no 
hope for her as the world knows her disgrace. Patient is still in this 
institution at the present time. 
Case. 6. Female, age eighteen, admitted 1904. Father was an alco- 
holic, mother and aunt were patients in this institution. 
Patient was employed in a boarding house and had an illegitimate 
pregnancy and was sent to the county poor house, where she was con- 
fined at the age of eighteen, just previous to her admission to this insti- 
tution. The psychosis had its onset about two days after the child was 
born, she became destructive and maniacal, incoherent in her conver- 
sation, and suicidal. On one occasion she asked to see the child, as she 
stated she wanted to kill it. Patient is still in our institution. 
Case 7. Female, age twenty-seven, admitted January 11, 1905. 
Nothing known as to family history of patient. Had an illegitimate 
pregnancy followed shortly after her confinement by an acute delirious 
excitement, with a marked psychomotor activity, and numerous illu- 
sions. During this attack she attempted to smother her child, which 
had been carelessly left unguarded in an adjoining room. Patient was 
then restrained and sent to this hospital. Since patient has been here 
she has presented a dementia praecox reaction. Mental deterioration 
is quite pronounced, is apathetic, indifferent and gives frequent 
evidences of mannerisms, with a tendency at times to catatonia. 
This case I would not consider a puerperal insanity, but rather a 
case of dementia praecox, which had as its etiological factor a puer- 
peral state. CHAPTER XL 
SENILE PSYCHOSES. 
It is commonly observed that, as the period of senescence 
approaches, the fires of passions are cooled, the ambitions of 
youth are quieted, the scheming and planning of youthfulness for the 
future successes and work to be accomplished ceases, and all is 
changed into a life of reminiscences, metaphysical and religious specu- 
lation. We pay the proverbial reverence for gray hair, the stooped 
form, the slow, unsteady, tottering gait, and for the kindly human 
sympathy so characteristic of the aged. 
In marked contrast this senile period of mental and physical 
decay is not always attended by a peaceful and undisturbed serenity. 
Occasionally there is a profound moral deterioration; an even quiet 
spirit gives way to excessive irritability; the senile dement objects to 
any change in his manner of living; he becomes exceedingly egotis- 
tical and unreasonable; he makes senseless demands upon his wife 
and children, and it is not an uncommon occurrence for vicious 
assaults to be made on them, should they neglect his slightest whim. 
The formerly chaste and respected individual becomes intem- 
perate, his conversation is filled with coarse and obscene remarks. 
Satyriasis is not an uncommon symptom, and this manifests itself in 
acts of rape, especially on young female children, or by disgraceful or 
bigamous marriages and indecent exposure of person. 
I have observed in a hundred and seventy-five cases of rape and 
attempts of rape that I have studied, that two-thirds of these sexual 
crimes were committed by decrepit and physically defective individ- 
uals, in whom the physical and mental signs of senile decay were 
evident. 
In some instances in senile insanity, there develops a paranoid 
state with delusions which may be loosely organized, systematized 
and accompanied by auditory hallucinations; consciousness is fairly 
clear and orientation is but little disturbed. The emotions are exceed- 
ingly unstable, and tears and laughter can be alternately produced in 
a space of a few seconds. Homicides are frequently a symptom of 
this form of senile insanity. 60 
SENILE PSYCHOSES. 
Regis, in speaking of misdemeanors and crime of senile insanity, 
says: "Their actions all carry the stamp of dementia. They are: 
absurd and infantile thefts, like those of general paralytics, but even 
more foolish; sudden and causeless fits of passion; ridiculous and 
heedless attempts at suicide; there are also especially libidinous 
actions, obscene exhibitions of themselves in public, attempts at rape, 
unnatural crimes, all resulting from lack of conscience and abso- 
lute loss of the feeling of modesty." 
Clinical Cases. 
Case 1. White male, sixty-eight years of age, was admitted to the 
Indiana State Prison, January 29, 1912. He was convicted of the crime 
of manslaughter; prisoner's mother was epileptic; two brothers 
insane; one sister insane; one maternal aunt and uncle insane. This 
prisoner fatally shot his son-in-law while laboring under delusions 
of persecution, respecting this relative. At the time of his admission 
to prison, physical examination revealed marked signs of decay; hair 
was almost white; body was poorly nourished; skin was harsh and 
dry; general muscular weakness was present; valvular heart disease 
existed; neurological examination showed the patellar reflexes very 
much diminished; pupillary reflexes reacted slowly to the usual tests; 
arcus senilus was present, and general superficial arteriosclerosis 
existed. There was a marked fibrillary tremor of the tongue and hand. 
Mental examination showed the prisoner to be oriented as to person 
and place, but not perfectly to time; there was but little clouding of 
consciousness. 
Prisoner told the story of the murder in a very circumstantial way, 
characteristic of the illiterate and the aged; his conversation was often 
interrupted by attacks of crying and wringing of his hands. He 
repeated many times during my first interview with him that he would 
feel more happy and not so depressed if "I only knew the Lord has 
saved my poor boy's soul." His memory was good for remote events, 
and the scenes of his boyhood were easily remembered. 
He entertained auditory hallucinations. He heard voices of the 
angels telling him it was wrong to use tobacco; that the Lord had 
appointed him to form a new political party caller the "True Be- 
liever" to take the place of the corrupted Republican party. 
All that was necessary to provoke a flood of tears from this unfor- 
tunate senile dement, was to say, "poor old man." This lachrymose 
state could be immediately changed into one of irritability accom- 
panied by a fiery and vehement tirade if one suggested that there was 
at least one good principle in the Democratic platform. 
While at prison this man's physical condition slightly improved, 
but there was a gradual and slowly progressive deterioration of his 
intellect. When discharged to the care of his relatives at the expira- SENILE PSYCHOSES. 
61 
tion of his two-year minimum sentence, he was very demented and 
unable to care for himself in any way whatsoever. 
Case 2. White male, sixty years of age, admitted to the Indiana 
State Prison, June 11, 1911. He was convicted of rape. He served a 
sentence in prison when about twenty-five years old for larceny; has 
been arrested and served jail sentences for assault and battery and 
indecent exposure of person. 
At the time of this last crime this prisoner was a janitor of a 
church, and into this building he had frequently enticed young girls 
for immoral purposes. The crime for which he is now serving in this 
prison was committed in a state of hyperesthesia sexualis, from which 
he has suffered continuously for the past seven years. On this last 
occasion, he attempted intercourse with three little girls under eleven 
years of age, and, unable to make entrance into the vagina, he seriously 
injured these three children in his violent efforts to perform coitus and 
by the manipulations of their genitals. 
At the time of entrance to the prison, the prisoner was in a feeble 
state of health. His hair was very white; his skin was harsh, dry and 
wrinkled; genital organs were very well developed; musculature, soft 
and flabby; pupils were very small, but round and regular; arcus 
senilis was present; pupils reacted slowly to light and accommoda- 
tion; patellar reflexes diminished; cremasteric reflex absent; some 
deformity of hands due to frequent attacks of arthritis deformans. 
He was oriented as to time, place and person; memory fair for 
recent events; emotional tone was one of depression; was very 
lachrymose when questioned about his crime; he said he could not 
control his actions. He stated that since his wife was divorced from 
him, it was necessary for him to relieve his sexual passion with any 
female who happened to be near him during these periods of sexual 
excitement. He had violent headaches and priapisms that were 
markedly relieved after intercourse. 
During his three years' stay at this institution, this man has 
greatly deteriorated mentally and physically. He is now bedridden 
because of arthritis deformans; he continues to experience patho- 
logical sexual desires, and is very much annoyed by periodic priap- 
isms; he is exceedingly emotional and cries very frequently; reason 
and judgment are very defective. 
Case 3. A decrepit, physically infirm, colored male, approximate 
age between sixty and sixty-five. He was convicted of incest and 
rape; he was admitted to the Indiana State Prison, May 9, 1909. He 
had led a loose life of immorality and drunkenness; one maternal 
aunt insane; one half-brother served a sentence in the Indiana State 
Prison for sodomy. Prisoner has been arrested many times for drunk- 
enness, assault and battery. The crime for which he is now serving 
sentence was the rape of his seven-year-old daughter, which act took 62 
SENILE PSYCHOSES. 
place two months after his sixteen-year-old daughter had given birth 
to a child of which he was the father. 
The prisoner entertains very erotic delusions; he believes that he 
is possessed of wonderful sexual powers; he says he is unjustly 
detained in prison and that he should be released to take care of his 
many hundred children; his consciousness is somewhat clouded; he 
does not know the day of the week, month, or year; he has but little 
appreciation of his environments; he is partially disoriented as to 
person; his reason and judgment are nil; memory is defective for both 
past and recent events; he occasionally displays signs of irritability 
and moroseness; his mental condition is now one of terminal dementia. 
Case 4. White male, sixty years of age when admitted to the 
Indiana State Prison, April 5, 1911. He was convicted of manslaughter. 
His crime was the direct offspring of delusions relating to property; 
he thought he was being defrauded and robbed by the individual whom 
he murdered; he has been three times an inmate of a hospital for the 
insane, previous to this crime. His physical condition when admitted 
to prison was that characteristic of senile dementia; hair was gray; 
skin harsh and dry; general weakness of the body muscles present; 
general sclerosis, the temporal vessels were torturous; skin and ten- 
don reflexes diminished; there was a tremor of the tongue and hands; 
his writing was very tremulous and characteristic of senile insanity. 
Whatever may have been his form of insanity, when an inmate of 
a Kentucky hospital for insane, his mental condition at the time of 
admittance to this institution, was one of senile dementia. He dis- 
played unreasonable and unfounded fears concerning his property. He 
believed his enemies had designs against his life and possessions. He 
was very lachrymose; exceedingly irritable; very profane and obscene; 
he was only partially oriented as to place, time and person; there was 
some intellectual clouding; perception very defective. 
The memories of his boyhood were fairly clear in his mind, but he 
knew and learned nothing of current events. In view of this prisoner's 
helpless demented state, I transferred him to the Indiana Hospital for 
Insane Criminals. His present state is one of terminal dementia. 
Case 5. White male, seventy-eight years of age, admitted to the 
Indiana State Prison, January 1, 1914. This prisoner at the time of 
admission was in a very feeble state of health. He was convicted of 
felonious assault and battery to commit rape. It was shown in the 
evidence admitted to the court that this senile dement had fondled 
a nine-year-old girl and also manipulated her genitals in the libidinous 
excitement of senile satyriasis. At the time of his admission to prison, 
his case was a complete picture, both physically and mentally, of 
senile dementia. 
Case 6. White male, seventy years of age when admitted to 
Indiana State Prison, January 22, 1913. He was convicted of rape. 
Family history not obtainable. This man, two years previous to his SENILE PSYCHOSES. 
63 
admission to this institution, was arrested twice for intoxication, once 
for rape, and once for contributing to the delinquency of young girls. 
It was shown by the evidence admitted in court that the prisoner had 
enticed two small girls into his room with candy and money. He was 
physically unable to have intercourse with them because of his own 
impotency, and secondly on account of the smallness of the children 
concerned. He therefore satisfied his pathological sexual desires by 
bringing his sexual organs in contact with the genitals of the children. 
The trial judge stated that this old man had been ip the habit of 
following women and young girls about the streets, making obscene 
remarks and gestures to them. When I examined this prisoner at the 
time of his entrance to this institution, he exhibited the characteristic 
physical signs of senility. His hair was white; there was general 
emaciation of the body muscles; general muscular weakness; his gait 
was faltering and hesitating; pupillary reflexes were exceedingly slow; 
patellar reflexes were absent; cremasteric reflex absent; penis 
shrunken and flaccid; large scrotal hernia present; mental examina- 
tion revealed general failure of memory and a tendency to irritability; 
a considerable degree of egotism relative to his good health and bodily 
powers; attention was poor; was practically impossible to engage him 
in conversation on any subject for more than a minute; he was very 
circumstantial; he omitted important words in his speech; he seemed 
to have difficulty in finding proper words to express himself; he did 
not know the month of the year; did not comprehend he was in prison; 
he was unable to tell what he had for breakfast; was devoid of any 
moral or legal sense of responsibility, and laughed rather boister- 
ously when asked concerning his sexual offenses; reason and judgment 
were nil, and he was mentally unable to care for himself. 
Arteriosclerotic Dementia. 
The unlawful acts of this psychosis are essentially the same in 
character as those of senile dementia, with the possible exception that 
homicide and homicidal attempts are slightly more frequent because 
of the paranoid nature of the delusions and hallucinations entertained 
by this class of patients. Their crimes usually show a little more pre- 
meditation, lucidity, provision and foresight to escape the consequences 
of illegal acts. CHAPTER XII. 
CEREBRAL SYPHILIS. 
Psychopathic states are likely to develop during any stage of 
syphilis, but they more commonly occur during the secondary and 
tertiary periods. They appear in the form of a delirious mania or 
acute depression. There is a profound disturbance of the moral and 
emotional qualities. The maniacal excitement may consist of any 
degree of psychomotor activity ranging from simple cerebral excite- 
ment to a state of mania attended by automatic agitation, incoherence 
and violence. After this state of mental alienation, there may follow a 
mental lethargy and sluggishness, a clouding of consciousness, a 
defective ideation and a perversion of the sentiments. In the depressed 
form of acute syphilitic insanity, the patient is often exceedingly 
morose and sullen, he may entertain delusions of persecution, he may 
be fearful of poisoning or of secret enemies; the delusions are usually 
attended by olfactory, gustatory and aural hallucinations. 
"In some cases the psychical defect may show itself in the field of 
the moral sentiments by indifference, brutal conduct, selfishness, and a 
tendency to revelry." 
"Among the early symptoms are irritability, culminating in alarm- 
ing explosions of anger or in acts of violence. Suspicion, too, is height- 
ened, and takes the form of delusions of persecution. These delusions 
often arise from the many strange and annoying sensations to which 
the patient is subject, and which he seeks to explain by reference to 
external agencies. Thus the paraesthesiee are attributed to electricity 
or irritating gases, which enemies use as means of torment. The hal- 
lucinations of taste and smell, which may be due to local syphilitic 
processes, lead to delusions of poisoning or of foul odors, which pa- 
tients believe are generated in their rooms at night to injure their 
health." 
"Hallucinations of sight and of hearing are also common, and they 
are often the result of specific lesions of the organs of sense; their 
general character, furthermore, is disagreeable, like the prevailing 
emotional tone, and they sometimes re-enforce, and at other times they 
are the sole origin of the delusions of persecutions." CEREBRAL SYPHILIS. 
65 
"The diagnosis of syphilitic insanity must rest not only on the 
history of specific infection, but also on the actual presence of syph- 
ilitic lesions, which may reasonably be supposed to bear a causative 
relation to the mental disease. If the physician is called to pronounce 
an opinion in a case with something like the following medley of symp- 
toms, he need not hesitate to diagnose syphilitic insanity. These 
symptoms are not all supposed to be present in a single case, and a 
few of them would suffice for a diagnosis, and they are chiefly as 
follows: Great irritability and violent outbreaks of temper, confusion 
of ideas and loss of memory, exacerbations of mania or of hypochond- 
riacal melancholia, and a constantly progressive dementia, accom- 
panied by cephalalgia, insomnia, vertigo, syncope, apoplectiform 
attacks, sudden and temporary paralysis of cranial nerves, loss of 
power in single muscles or in one arm or leg, loss of sight and optic 
neuritis, or loss of hearing, and sudden and unaccountable remissions 
in all the symptoms." 
Clinical Cases. 
Case 1. Prisoner, colored male, admitted to the Indiana State 
Prison, December 27, 1909. He was convicted of first degree murder; 
two paternal aunts were insane; one paternal uncle insane, died by 
suicide; two maternal cousins insane; father died of senile dementia. 
Prisoner had syphilis when twenty years of age and treated this disease 
intermittently for a period of one year. Owing to the development of a 
syphilitic iritis, which almost rendered him blind, and chronic severe 
nocturnal headaches, he took a short course of treatment at Hot 
Springs in 1900, after which he practically recovered his eyesight, but 
continued to suffer severe headaches; was irritable and morose; had 
violent outbreaks of temper, and was extremely forgetful and absent- 
minded. In February, 1909, while in Chicago, he learned that the girl 
to whom he had been engaged for nine years had married another man. 
This news produced a profound depression. He then bought a ticket 
to Virginia via Indianapolis, and left Chicago March 16, 1909. On the 
following day he left the train at Indianapolis under the impression 
he was in Cincinnati. During his aimless wanderings about the 
streets he shot a man who was a perfect stranger to him. Before 
leaving Chicago, the prisoner sent the following incoherent telegram to 
his brother in St. Louis: "Please see your superintendent there. Have 
him change your name. Tell why, for safety. I am being tried to be 
killed by a band of wealthy men. Beware." 
In the period preceding the murder, and often since his crime, 
the prisoner wrote much in the form of letters and essays. These 
writings were incoherent, irrelevant and absurd. The following state- 
ment is taken from one of his letters: "I have killed this man twice 
before, with my sweetheart in Chicago, once in a sleeping-car between 
Chicago and Montreal, and a third time at Indianapolis." 66 
CEREBRAL SYPHILIS. 
During the early part of his stay at the Indiana State Prison, the 
prisoner's consciousness was quite clouded; he was greatly confused; 
was extremely irritable; he entertained delusions of persecution; had 
a slight ankledrop and a chronic syphilitic iritis. The prisoner was 
given vigorous anti-syphilitic treatment, and there was a gradual 
improvement in his mental and physical condition. The ideas of per- 
secution disappeared; he became oriented as to time, place and person, 
and the irritability gave way to a peaceful state of mind. In the mean- 
time, however, there developed a slow, persistent and progressive con- 
dition of mental enfeeblement which terminated in a state of slight 
dementia. This prisoner was pardoned by the governor, December 11, 
1911, on the condition that he be taken to Virginia to live and there to 
be provided for by a relative on a farm. 
Case 2. White male, forty-five years of age, was admitted to the 
Indiana State Prison, March 10, 1911, convicted of assault and battery 
to rape. He has been arrested four times for assault and battery; 
served a term in the workhouse for one hundred eighty days for public 
indecency. He acquired syphilis in 1905. I was unable to obtain a reli- 
able family history of the prisoner at the time of admission to the prison. 
Tertiary signs of syphilis were present; patellar reflexes were unequal; 
slight motor defect of speech present; pupils irregular in outline; 
inguinal and cervical glands were enlarged; consciousness was some- 
what clouded; he was oriented as to time and place, but not to person; 
reason and judgment markedly impaired; conversation was childish 
and rather incoherent; memory was poor for remote and recent 
events; complained of severe headaches; moral sense entirely lacking; 
regarded his crime as a huge joke. Prisoner was put on a vigorous 
anti-syphilitic treatment and in a short time there was a marked 
improvement in his mental and physical condition. 
Case 3. Prisoner, white male, forty-seven years of age when 
admitted to the Indiana State Prison, June 26, 1913. He was convicted 
of murder of his wife. One brother was deaf and dumb; one brother 
has been in prison for stealing and bigamy; prisoner had sunstroke 
when sixteen years of age. He had been regarded as an undesirable 
citizen for some years by the people in the community where he 
lived. He traveled about the country at night, associated with men of 
questionable character, and was suspected of many law violations. 
For some time after this crime had taken place the prisoner 
behaved in a very erratic manner. Nothing especially significant was 
noticed until one day he went to the office of his attorney and 
told him that "they were going to fasten this crime on me, but I am 
innocent and it is very hard to bear." From his lawyer's office he went 
to jail to see the chief of police. While interviewing this officer he 
became so excited and disturbed that it was necessary to confine him 
in jail; for several days he was very maniacal; he yelled, cried, 
preached, tore his clothes and did many other strange and erratic acts. CEREBRAL SYPHILIS. 
67 
On one or more occasions his attorney visited him and tried to engage 
him in conversation, but the prisoner apparently did not recognize 
him and was unable to carry on a conversation. In an interval of 
lucidity and quietness, this prisoner made the following confession: 
"In the presence of X , I voluntarily make the following state- 
ment in regard to the death of my wife at our home near Greensfolk, 
Ind., in the month of September, 1912: Because she had been nagging 
at me about $1,640 in money, I killed her with a 'billy' and then poured 
coal oil on her and set fire to her. The 'billy' I got out of the bureau 
drawer, and I hit her back of the ear with it. There was no one 
present at the time, except she and I. The coal oil I used, I got out of 
a can. The first match I lighted, my wife blew out. I then lighted 
another and set fire to her. My wife shrieked and made a loud outcry 
when I struck her. I cut the sleeve out of the shirt I had on at the 
time, because I had spilled coal oil on it. This sleeve I took to the 
barn and put in the hay the morning of the fire. I killed my wife 
because she was always nagging after me, and because she had 
threatened to put a spider in my cup. We had been having trouble 
for about two years and it started at the time I got the $1,640 from her. 
This statement I make of my own free will, without any promise or 
threat from any person. I make this statement in order that I may 
have relief of my mind in the presence of God." 
At the time of his admission to the prison there was paralysis 
of the left arm, and incomplete paralysis of the left leg. The paralyzed 
arm was senemic, slightly swollen, and of lower temperature than the 
rest of his body. Body was fairly well nourished; large copper colored 
scars on shins; inguinal, cervical and epitrochlear glands enlarged; 
tongue deviated to left side of mouth when protruded; Wassermann 
reaction positive. 
Prisoner's mental condition was so clouded that it precluded the 
possibility of any mental examination at the time. About six months 
after his admission to the institution he regained the entire use of his 
left arm. Consciousness became clear, but there was a slight mental 
defect. Prisoner denied ever having made a confession. He has 
amnesia concerning this statement, and all events that transpired from 
the time of the commission of his crime until he recovered conscious- 
ness, and became aware of his condition and environment in this 
institution. CHAPTER XIII. 
DRUG PSYCHOSES. 
Under this title of drug psychoses will be considered the aberrant 
and disordered mental states due to the use of alcohol, cocaine and 
morphine. 
Alcoholic Insanity. 
Alcoholic insanity is a generic term employed to embrace the vari- 
ous forms and types of reaction which follow alcoholic indulgence. 
We have more or less arbitrarily applied to these different alco- 
holic reactions the terms, acute and chronic drunkenness, delirium 
tremens, alcoholic hallucinosis, dipsomania, alcoholic pseudo-paranoia, 
alcoholic psuedo-paresis, alcoholic epilepsy and Korsakow's psychosis. 
The disastrous effects of the narcotic, alcohol, on the brain and 
central nervous system are to be seen every day throughout the civil- 
ized world. Acute alcoholic intoxication or the ordinary form of 
drunkenness, from a psychological viewpoint, is but a transitory form 
of insanity. "Both psychologists and jurists have properly, however, 
maintained a distinction between those mental disturbances produced 
by the direct imbibition of alcoholic liquids, and which cease in a few 
hours after the imbibition ceases, and those mental derangements and 
hallucinations that may continue for days, weeks or months after all 
use of alcohol has ceased." 
The exact relationship that alcohol bears to crime is problematical 
and cannot with mathematical precision be determined. 
I found that ninety-three per cent of three thousand prisoners 
were users of some form of alcoholic beverages and that eighty-three 
per cent claimed that they used this narcotic to excess, getting drunk 
at very frequent intervals. 
Prison authorities, and especially prison surgeons, know that many 
prisoners in order to have an excuse for their overt acts readily 
attribute their crimes to temporary states of drunkenness. Therefore 
statistics on alcoholism from penal institutions and reformers are to 
be taken cum grano salis, for they are more or less inaccurate. DRUG PSYCHOSES. 
69 
Apropos of this subject, Mercier has stated: "The insanity that 
is most frequently associated with crime, and directly leads to crime 
in a large number of cases, is undoubtedly the insanity of drunkenness. 
In nine years, one and three-quarters of a million of persons were 
sentenced, in courts of summary jurisdiction in this country (England), 
for offenses committed during drunkenness, and to which the drunken- 
ness contributed, even if it were not, in every case, the efficient cause, 
without which the offense would not have been committed." 
The usual answer that I receive from prisoners during my exam- 
ination of them concerning the cause of their crimes is generally one 
of this sort: "I was drunk; I did not know what I was doing; I may 
or may not be guilty; I cannot remember." 
These excuses for crime are so common and so easily made, that 
the courts are extremely reluctant to place any confidence or value in 
them. In many instances, however, they are absolutely correct con- 
cerning the state of consciousness and memory. 
We find in the misty nebulous mental states that occupy the border- 
line regions which separate sanity from insanity, conditions of auto- 
matism, somnambulism, double consciousness, cataleptic states, con- 
ditions of frenzy and furore, all of which are attended by amnesia. 
During these apparent dream-states, which are probably due to 
disassociation or cleavage of consciousness, every conceivable crime 
in the criminal category has been committed. 
In delirium tremens, murders have been committed by the frenzied 
alcoholic under the delusion that those about him were his enemies. 
Suicide is not an infrequent termination of this form of alcoholism. 
The dilapidated, deteriorated mental state of chronic alcoholism is 
conducive to crime, for the moral sense is perverted, the will power is 
practically inert and the individual becomes the abject slave of his 
own passions. 
The crimes of acute alcoholism are petty thefts, larceny, forgery, 
rape, incest, sodomy, assaults and homicides. Petty thefts, obscene 
exhibitions and sexual crimes have been noted in alcoholic pseudo- 
paresis. 
Alcoholic hallucinosis, which is attended by hallucinations espe- 
cially of the auditory variety and persecutory delusions of a sexual 
nature, lead to homicide and homicidal attempts. 
I have observed that a large number of wife murderers committed 
their crimes when reacting to delusions of marital infidelity relating 
to their wives. 
The same crime producing delusions and auditory hallucinations 
are characteristic of alcoholic pseudo-paranoia. We usually find 
dipsomania to be dependent upon neuropathic heredity, diseased con- 
ditions brought about by trauma, lack of proper food, malnutrition and 
the inebriate is in fact a diseased person. 70 
DRUG PSYCHOSES. 
"The best statistics show that from seventy to eighty per cent of 
persons who drink spirits convulsively, and are called inebriates, have 
a defective heredity. All studies of the steady drinker show a pro- 
found and progressive impairment of all the senses, functional activi- 
ties of the body and reasoning. The more accurate the measurements 
are made, the more positive the deviation from the normal becomes." 
"There can be little doubt but that much the larger number of 
those shocking homicides which disgrace the criminal annals of civ- 
ilized countries, in which mothers, or children, or both, have been 
suddenly slaughtered in the midst of the father's debauchery, have 
been the direct result of true paroxysms of mania a potu, such as we 
have briefly described. The medico-legal bearing of this class of 
cases deserves more thorough investigation than it has hitherto 
received. And as one attack of this form of mania leaves the patient 
more disposed to another, whenever indulging in the use of alcoholic 
drink, they constitute the most dangerous class of inebriates." 
It will be well to review briefly the attitudes and beliefs that 
society has entertained concerning alcoholism and responsibility. 
Lord Coke of England set forth the idea in his ruling in the sev- 
enteenth century that drunkenness and inebriety augmented a crime 
or misdemeanor and therefore called for an increase of punishment. 
For many years moralistic speculation and theories have deter- 
mined in a large degree the attitude society has held toward drunk- 
enness. 
The reformers and philanthropists have ever held the inebriate 
morally responsible. They have endeavored fruitlessly to rehabilitate 
the dipsomaniac by moral suasions, incriminations, insults and 
punishments. 
It cannot be denied that moral treatments do exercise some influ- 
ence in cases of inebriety, but they should always be secondary to 
medical and hygienic measures. 
Dr. Crothers, America's leading authority on alcoholism, convinc- 
ingly states, relative to this phase of the subject, the following: "It 
is a delusion to interpret acts associated with premeditation and rea- 
soning in inebriates as evidences of sanity. It is a delusion to 
consider inebriety and alcoholism as not impairing the sanity and 
integrity of the brain and body. It is a delusion to consider such 
persons as possessing free will and judgment, with consciousness of 
their condition and ability of control. It is a delusion often repeated 
and has become incorporated in jurisprudence, that alcohol may be 
used to give capacity to commit crime. In reality this is true, but in 
a very narrow limit. 
"The exciting stage following the use of alcohol might be limited 
to ten minutes or an hour, but after that, there is no certainty that 
any act premeditated could be carried out. The fact is sustained by DRUG PSYCHOSES. 
71 
unmistakable evidence that all crimes committed by such persons are 
the acts of defective minds. All this signifies a recognition of the 
condition of the criminal, not to diminish the punishment, but to 
change it to more rational lines. Criminals of this class need control, 
care and changed conditions. They are clearly defectives and degen- 
erates who have lost the power of rational thought and conduct." 
The positions taken by our courts on the subject of intoxication 
are contradictory and illogical. 
If an individual in a state of intoxication makes a will, signs a 
contract, a deed, a promissory note, or a bank check, the courts of law 
do not hold such papers and testaments as valid or legal, if a proof of 
intoxication can be brought to bear. Law in this case questions and 
even denies the responsibility and the capacity of an intoxicated indi- 
vidual to execute a legal instrument. 
In the practice of criminal law this is quite the reverse. If a 
drunken man commits a crime while intoxicated he is held to be 
responsible and qualified to commit a crime. Yet psychologically and 
physiologically, the mental impairment, the lack of reason and judg- 
ment, the incapacity to act normally are just the same whether an 
offense be committed against criminal or civil law. Our conceptions 
concerning alcoholism and responsibility must change. Society in 
general and law in particular still look upon an individual as a pos- 
sessor of an absolutely free will. Is not this doctrine an unsubstan- 
tiated metaphysical hypothesis? Can we look upon intemperance as 
prima facie evidence of deliberate viciousness? This is hardly possible 
in the light of recent research. 
It has been demonstrated beyond the shadow of doubt that the 
dipsomaniac is always a neurotic. His nervous system is impaired by 
heredity, disease or trauma. The defects of his brain and central 
nervous system produce at intervals an insatiable, uncontrollable 
craving for alcoholic stimulants. 
Clinical Cases. 
Case 1. Prisoner chronic alcoholic, convicted of murder of his 
wife. During the several months previous to his crime, the prisoner 
entertained delusions of infidelity on the part of his wife. 
On coming home from his daily employment, the prisoner would 
search his house from cellar to garret, looking for his wife's supposed 
paramour. He heard voices telling him that a man was hiding in the 
house. He was often unable to sleep because of these auditory hallu- 
cinations, unless he became intoxicated on retiring. 
This man's statement concerning his crime is as follows: "When 
this thing happened I did not know anything about it. I was alto- 
gether out of my head several months previous to the shooting." 72 
DRUG PSYCHOSES. 
Case 2. The following statement made by the prisoner concerning 
his crime has been substantiated by the court: "On the night of April 
17, 1908, I went to the house of an aunt of this lady Fairy, but did 
not know she was there at the time. Fairy and I quarreled after 
some words, and I drew my revolver and shot her twice. I was stag- 
gering drunk at the time." 
Case 3. Prisoner was drunk at the time of the theft and has no 
memory of his act. 
Case 4. Prisoner convicted of forgery. The judge in the case 
says the crime was undoubtedly due to drunkenness, without any 
criminal intent. 
Case 5. Prisoner convicted of grand larceny; stole an automobile 
to take a joy ride; he knew nothing of his theft or arrest until he 
became sober at the police station awaiting his trial. 
Case 6. Sodomy. Prisoner claims he knows nothing about the 
crime for which he is charged. At the time of his arrest, at the scene 
of his crime, he was found in a state of intoxication in the company 
with a ten-year-old child, the prosecuting witness. 
Case 7. Prisoner convicted three times of grand larceny. Has 
been paroled seven times in thirteen years, and has been unable each 
time to keep his parole obligation. Prisoner is a dipsomaniac; while 
out on parole the last time he pawned his overcoat, dress coat and 
vest in the dead of winter time to secure drink. He then broke into 
a barber shop and drank witch hazel and bayrum. 
Case 8. Convicted of arson; was paroled at the expiration of his 
minimum sentence; he began to drink immediately upon his release 
and spent five hundred and fifty dollars in twelve days' debauch. He 
was returned to the state prison in a state of delirium tremens. 
Case 9. Prisoner convicted of forgery; is a periodical drinker; 
while on parole his child died, and he used the money that was given 
him to buy a coffin for the corpse to go on a prolonged debauch. When 
returned to prison his mental condition was one of alcoholic hallu- 
cinosis. 
Morphinic Insanity. 
The medico-legal aspects of the narcotic drug habits need to be 
more carefully studied than they have been in the past. 
Eight per cent of the prisoners received at the Indiana State 
Prison are users of cocaine, morphine or other narcotic drugs. Fully 
five per cent of all the crimes for which prisoners are committed to 
this institution are due directly or indirectly to the use of these agents. 
The victim of morphinic insanity is absolutely a slave to the 
almost insatiable desire that possesses him to use opium or any of its 
alkaloids. The moral degradation and misery of oxymorphinism will DRUG PSYCHOSES. 
73 
lead the habitue into the performance of any crime in his efforts to 
secure morphia. The drug victims will commit larceny, burglary, 
forgery, arson, blackmail, homicidal attempts, murder and sexual 
crimes to satisfy their morbid cravings. 
Women have been known many times to prostitute themselves to 
secure the drug. A very large per cent of the commercial prostitutes 
are morphinomaniacs. The psychotic disturbances of morphinism fre- 
quently develop a depressive and melancholy character and these are 
attended by delusions of persecution and a tendency to suicide. Occa- 
sionally states of incoherence, confusion and mania are observed, 
during which periods homicidal attempts are frequently made. 
Police Surgeon Dr. Guimball, who has had a wide experience with 
criminal drug habitues, says the following: "First, morphine causes 
defects of attention, particularly of sense observations; second, the 
ethical sense * * * is blurred. The victim is unable to discrim- 
inate any moral basis that should dominate. He acts from impulse; 
third, his will is lost and power of control over the impulses lessened. 
Both physical and mental impulses dominate him from the slightest 
exciting causes; fourth, the morphinist is literally a lunatic, only more 
subtle and concealed; like the dipsomaniac he is liable to be dom- 
inated any moment by impulses that are unforeseen; fifth, the 
responsibility, like judgment, is impaired and enfeebled. He is con- 
stantly doing acts and saying things the import of which he does not 
understand." 
Cocainism. 
The criminal manifestations of cocaine insanity are essentially 
those of morphinism, except possibly they are slightly more profound. 
The cocainists as a rule are very easily irritated, and their con- 
duct is largely governed by violent impulses. Pronounced changes in 
their characters take place; the patients become dishonest and deceit- 
ful and seem to possess a morbid propensity for lying. 
The will power is markedly enfeebled; all sense of moral or legal 
responsibility is weakened; reason and judgment are greatly impaired. 
The development of a paranoid state is a very common occur- 
rence. The victim develops and entertains delusions of a persecutory 
nature; he becomes suspicious of his wife's attitude toward other men. 
Frequent homicidal assaults grow out of these delusions of marital 
infidelity. Erlenmeyer has observed that the sudden withdrawal of 
the drug from the cocaine fiend often induces a profound state of 
depression and delirium which is accompanied by persecutory delu- 
sions that render the individual an extremely dangerous person. 
Suicide is not an infrequent termination of chronic cocaine intoxi- 
cation. 
The psychotic states dependent upon the chronic use of such nar- 
cotic drugs as cannabis indica, sulphonal, veronal, hyoscyamus^ 74 
DRUG PSYCHOSES. 
chloral, bromides, ether, chloroform, belladonna, lead, arsenic and 
mercury, are usually acute or chronic confused paranoid conditions 
attended by delirium. 
Clinical Cases. 
Case 1. Prisoner, white male, received at the Indiana State 
Prison, May 10, 1909, for issuing fraudulent checks. He has a long 
record of crimes; has served not less than seven prison sentences, and 
many other jail and workhouse terms. 
He has been a constant user of morphine and cocaine for the past 
fifteen years and many of his crimes were committed during the state 
of morphinic intoxication. When out of funds to procure the drugs, he 
would steal to obtain money to buy morphine and cocaine. His moral 
sense is dulled and perverted; he is deceitful and untruthful to the 
extreme. He frequently exhibits homosexual tendencies. He was 
paroled on his last sentence and a few months after his release he 
began the use of narcotic drugs, and running short of funds, he issued 
a fraudulent check for twenty dullars, and for this crime he served a 
sentence in the Missouri State Penitentiary. On his return to the 
Indiana State Prison from the violation of his parole, he was under 
the influence of narcotic drugs. 
Case 2. Prisoner, white male, twenty-five years of age when ad- 
mitted to the Indiana State Prison; convicted of entering a house to 
commit a felony. 
His occupation was that of a manufacturing chemist. This pris- 
oner had used morphine and cocaine for eight years, and at the time of 
the commission of his crime, he was using eight grains of each drug 
daily. Several days preceding the theft, the prisoner was unable to 
obtain these narcotics because of lack of money. Under the irresist- 
ible craving for these opiates, he entered a drug store during the 
night time to steal the drugs. On obtaining the morphine and cocaine, 
he took hypodermically fifteen grains of morphine and one-hundredth 
grain of hyoscine hydrobromate. This dose of these drugs so stupified 
him that he was unable to leave the scene of his crime. In this dazed 
and stuporous state he was found by the police. At the time of his 
arrest he had on his person fifteen dollars' worth of morphine and 
cocaine tablets. 
When admitted to prison, the anterior surface of both forearms 
was covered with small abscesses due to the use of a septic hypo- 
dermic needle. 
Both legs from hips to knees were covered with copper colored 
scars. The prisoner's mental state was one of mild delirium. 
Case 3. Prisoner, admitted to the Indiana State Prison, Novem- 
ber 15, 1911. He was convicted of grand larceny. DRUG PSYCHOSES. 
75 
This man is of very much higher grade of intelligence than the 
average convict. His occupation is that of clerk and accountant, and 
his record was absolutely clean before he began the use of narcotic 
drugs. This is the prisoner's second conviction on this charge. 
About ten years ago, this man developed a very serious and 
painful type of gonorrheal rheumatism in the knee joint, and soon 
after the toes became involved and local foci were established, which 
finally made it necessary for the toes to be amputated. At the time of 
his illness the prisoner contracted the habit of using morphine and he 
continued to use the drug for ten years, taking a daily dose of about 
six grains. 
The crime for which he was convicted and sentenced to the 
Indiana State Prison was the theft of sixty dollars from the safe of a 
hospital where he was clerk. The prisoner claims he took the money 
in order to go to an institution to take a cure for the drug habit. 
At the expiration of his minimum sentence he was paroled. He 
immediately resorted to the use of morphine, and while under the 
influence of this drug he stole a ring. At the time of his arrest for 
the theft he was found wandering about the streets in a dazed and 
stuporous condition. He was immediately returned to prison for the 
violation of his parole. He claimed to have no memory of stealing 
the ring. 
This prisoner has been given a second parole, and for three 
months he has been successful in letting narcotic drugs alone. 
Case 4. Prisoner, white male, admitted to the Indiana State 
Prison, May 22, 1899. He was well educated and a physician by pro- 
fession. 
This prisoner had indulged very heavily in alcoholic liquors and 
narcotic drugs. Under the demoralizing influence of these agents he 
neglected his wife and became enamored with a public prostitute. His 
illicit sexual partner was not altogether devoid of the sense of honor 
and propriety, and she told the prisoner that she was going to leave 
the town in which they lived in order to save the prisoner's profes- 
sional reputation and the disgrace to which he was subjecting his 
wife and family because of their illegal relations. 
While intoxicated and under the influence of drugs, the prisoner 
discovered his paramour waiting at the railroad station to take a 
train to leave the town. He then went to his office and secured an 
amputating knife and returned to the station. When his clandestine 
sweetheart refused to give up her intention of leaving, he stabbed her 
to death with the knife he brought from the office. After serving 
twelve years of a life sentence, he was paroled by the Governor on 
the belief that the prisoner had committed the crime of murder while 
under the influence of these drugs, and that he had fully recovered 
from the drug habit. CHAPTER XIV. 
TRAUMATIC PSYCHOSIS AND 
TRAUMATIC PSYCHOPATHIC STATES. 
The term traumatic insanity has been applied to a certain group 
of psychotic symptoms of more or less definite clinical character, the 
origin of which may be traced to some injury to the head or spine. 
These psychic symptoms occur more often in those cases in which 
there has been an extensive injury, great pressure or concussion ta 
the brain substance, than in those in which the cerebral injury is 
restricted to a single limited area. 
The mental symptoms following a head injury may often be 
divided into two classes, namely, a delirious state, and one of mental 
enfeeblement. 
Crime more frequently occurs as a symptom in the condition of 
traumatic feeblemindedness than it does in the state of traumatic 
delirium. 
Immediately following an injury to the head or spine there may 
develop a state of unconsciousness which lasts a longer or shorter 
period of time. When consciousness is regained, the patient usually 
fails to remember anything of the accidents or happenings that 
occurred a short time before. Ordinarily after the injury the subject 
is soon restored to normal, and for weeks, months, or even years, he 
may not display any signs of mental failure. 
The first symptom of the mental disorder that is noted is an 
insidious change in the patient's disposition; he becomes egotistical, 
irritable, fault finding and morose; he has periods of despondency and 
depression; he worries about his health, financial matters and kindred 
affairs; his moral sense becomes weakened, his judgment and reason 
are impaired, violent outbreaks of temper occur, and to allay his 
unpleasant and distraught feelings he often resorts to the excessive 
use of alcoholic beverages, to which he shows a pathological reaction. 
The psychopathic state just described creates a most favorable 
disposition for the perpetration of crimes and misdemeanors and 
the instances are by no means rare in which the violations of the law 
show their direct origin to cerebral trauma. TRAUMATIC PSYCHOSIS. 
77 
Case 1. Prisoner, white male, thirty-six years of age when ad- 
mitted to the Indiana State Prison, March 5, 1915; convicted of forgery 
and sentenced for a term of two to fourteen years. Family history 
unreliable; he received a common school education and was a book 
keeper and clerk by occupation. In the year 1903 he was very severely 
injured and burned in a theatre fire. His skull was fractured and body 
badly burned. A trephining operation was immediately performed, and 
on account of the great destruction of the skull a plate was inserted. 
The prisoner remembers nothing of the accident except that 
someone shouted "fire" and he started to get out of the theatre. This 
amnesic period continued during his six weeks' stay in the hospital. 
On being discharged from this institution he tried to resume his 
old occupation as clerk. He then found great difficulty in doing the 
simplest form of clerical work. It was almost impossible for him to 
add a simple column of figures; he could not concentrate his mind on 
his duties and he was easily distracted and irritated by the most 
ordinary trifles. On account of his inability to perform his duties in a 
satisfactory manner he was discharged, and he secured employment 
as a woodworker in a piano factory. At this occupation he only 
worked intermittently owing to intense headaches, which occurred 
about every ten days. 
A gradual change in his disposition took place and he became 
very irritable, loquacious and fault finding. Moral sense became 
obtused and perverted; he drank to excess and frequented houses of 
prostitution, whereas formerly he had been chaste and virtuous; he 
deserted his wife and a few months later married a public character; 
he seemed to forget his lawful partner and denied in the face of docu- 
mentary evidence to the contrary that he had ever been married. He 
was tried and convicted for bigamy and sentenced to a prison in Ken- 
tucky. He was released from the institution after serving his sen- 
tence ; he then traveled about the country as a hobo, stealing, begging 
and writing fraudulent checks occasionally to secure food and 
clothing. 
When this prisoner entered the Indiana State prison on the above 
date he was exceedingly dull and stupid; he stated that he did not 
know on what date he entered the institution and that he did not 
remember his trial or arrest. 
There was marked failure of perception and attention; he was 
disoriented as to time; he was unable to remember what was told or 
read to him; his case presented the picture of mild dementia. 
During his stay in the institution he has had occasionally delirious 
states and violent headaches; he goes about the prison reservation 
doing the simplest sort of work in a dull and mechanical manner. His 
movements are slow and inaccurate, and he constantly appears to be 
in a state of mental lethargy. This man's whole career of mendacity 
and crime is directly chargeable to the head injury he received twelve 
years previous to his confinement in this institution. 
Clinical Cases. CHAPTER XV. 
FEEBLEMINDEDNESS. 
The greatest causative mental factor of crime is feebleminded- 
ness. Several divisions of mental defect have been made, and while 
they are more or less arbitrary, they are very useful for the purposes 
of description. 
The American Association for the Study of the Feebleminded has 
formed the following definitions relating to the classes of mental 
defect: 
First. Idiots; mental age below two years. 
Second. Imbeciles; mental age from two to seven years. 
Third. Morons; whose mental age exceeds that of imbeciles, 
ranging between seven and twelve years. 
Fourth. Subnormal variety; whose mental capacity is slightly 
above the average custodial case. 
All of these varieties are found in the Indiana State Prison with 
the exception of the idiot class. 
As we are only concerned with the symptoms of feebleminded- 
ness that relate to crime, no other symptomatology will be described. 
Brutality and cruelty seem to be universal symptoms of imbe- 
cility. The precocious cruelty of the feebleminded which enables 
them to torture animals, to cripple birds, to tear the wings and legs 
off insects, to laugh at the pain of others, to inflict torture with delight, 
forms the basis when they are physically able for assault and battery, 
for homicidal attempts and murder. 
The easy disintegration or cleavage of consciousness which 
occurs so often in the feebleminded permits violent explosions of 
anger against those who interfere with their pleasure. Their wrath is 
shown by outbursts of fury and frenzied attacks; again it is exhibited 
by well calculated and cunning cruelty. 
The feebleminded, lacking in reason and judgment and devoid of 
all moral critique, commit all manner of sexual crimes without any 
feeling of restraint or shame. They masturbate openly and exces- 
sively; the imbecile father impregnates his own daughter; he may 
commit sodomy with his own son; or, the imbeciles may attempt inter- FEEBLEMINDEDNESS. 
79 
course with their mothers and, "sexual satisfaction with animals is 
frequently attempted. The great majority of cases of injury (sexual) 
to animals must be attributed to imbeciles." Many of the attempts 
to murder, and murder itself, committed by the mentally defective, 
are perpetrated when the person attacked resisted their erotic 
assaults. 
Often they are cunning thieves; articles of small worth seem to 
have a great attraction for them; to satisfy their vanity, they often 
steal wearing apparel. They set fire to property to appease their 
desire for the excitement which attends conflagrations. Many of 
the pyromaniacs who are a constant source of worry to the fire 
insurance companies are feebleminded persons. 
"Higher imbeciles are predisposed to systematized delusions, and 
more particularly to communicated insanity. Imbeciles are the neai' 
neighbors of paranoiacs, and are apt to pay tribute to them by 
blindly professing their delusions on the occurrence of the slightest 
opportunity. 
"When a paranoiac is a propagandist of mystical ideas, and 
reigns as a sovereign or high priest, it is the imbeciles who compose 
his court, and form the majority of his subjects (Jacoby). The con- 
tagion is favored by the affinity of tendencies in paranoiacs and imbe- 
ciles; every paranoiac is mildly imbecile, and every imbecile is at 
least a candidate for endemic paranoia if he lives in isolated and 
fanatical surroundings. * * * In epidemics of religious and polit- 
ical delusion, it is among imbeciles that spies and traitors are most 
easily found. Their want of critical power, their fickleness of char- 
acter, and the servility that drives them to become the apostles and 
slaves of paranoiacs, whose ideas they do not understand, lead them 
also to surrender when intimidated by warnings, flattery and threats. 
Their intelligence is equally incapable either of originating a delusion 
or of spontaneously correcting a delusion; but it is accessible to the 
positive and negative suggestions of others, and does not appreciate 
how compromising it is to suddenly abandon a principle." 
"In the moral point of view the lacunae are perhaps more marked 
than in the domain of the intellect, and if these patients are capable 
of showing to varying extent sentiments and affections of a low 
order, they are only the least elevated ones, and the lower instincts 
that dominate them. The majority are vain, gluttonous, cowardly, 
credulous, idle, irascible, inclined to venereal and alcoholic excesses 
and to acts of violence (Maree); nearly all are given to onanism, and 
some to unnatural crimes. At certain times they may be seized more 
or less suddenly with melancholic or maniacal attacks, during which 
they are particularly liable to commit acts of obscenity, or even arson, 
robbery, suicide, or homicide. When these attacks, which very often, 
assume in them a periodical or circular character, occur many times,, 
the patients soon fall into a condition of dementia." 80 
FEEBLEMINDEDNESS. 
Alcohol plays a very important role as an element for the pro- 
duction of crime in the feebleminded. It serves to intensify the defect 
already existing, it weakens the already enfeebled volitional powers; 
it is influential in firing misguided, wild and erratic emotions. It 
distorts previously inefficient and irrational judgments. In fact, it 
raises to the nth power all the potential and latent elements for crim- 
inality that lie dormant in the constitution of the feebleminded. 
Feebleminded Prisoners. 
I classed twenty-three per cent of the criminals whom I studied 
as feebleminded. In the employment of this term I have endeavored 
to limit its application to those persons who as a group possess 
"All degrees of mental defect due to arrested or imperfect mental 
development as a result of which the person so affected is incapable 
of competing on equal terms with his normal fellows, or of manag- 
ing himself or his affairs with ordinary prudence." This, in the lan- 
guage of the American Association for the Study of the Feebleminded, 
is necessary for the diagnosis of feeblemindedness. 
Various estimates have been made by different physicians and 
psychologists as to the number of feebleminded persons in penal and 
reformatory institutions. This number has varied from twenty to 
sixty per cent, and these differences can be easily understood when 
we consider the various natures of the institutions giving this data 
and the general broadness or narrowness of the psychopathological 
examination employed in such determinations. 
Dr. Walter Fernald has stated: "At least twenty-five per cent 
of the inmates of our penal institutions are mentally defective and 
belong either to the feebleminded or to the defective delinquent class. 
"At that rate we should have twenty thousand such individuals in 
adult prisons, and six thousand in juvenile reformatories, making a 
total of twenty-six thousand defective delinquents in actual custody, 
not to mention those who have never been arrested and the large 
number who have been discharged or paroled from institutions and 
are now at large. There are doubtless as many defective delinquents 
at large as there are in custody." 
The following tables give approximately the percentage of feeble- 
minded persons to be found in the following institutions: 
New York State Reformatory, Elmira, about thirty-seven per cent. 
New Jersey State Reformatory, Rahway, about thirty-three per 
cent. 
New York Reformatory for Women, Bedford, about thirty-seven 
per cent. 
Massachusetts Industrial School for Girls, Lancaster, about fifty 
per cent. FEEBLEMINDEDNESS. 
81 
Maryland Industrial School for Girls, Baltimore, about sixty per 
cent. 
New Jersey State Home for Girls, Trenton, about thirty-three per 
cent. 
Illinois State School for Boys, St. Charles, about twenty per cent. 
At the present time a large part of the estimates made of the 
number of feebleminded persons in penal institutions are based upon 
the results of the application of the Simon-Binet scale of intelligence 
to the institutional inmates. And for this reason, and various others, 
these statements are to be regarded conservatively. 
No one will deny the value of the Simon-Binet test, for it is of 
very great value, and one of the best instruments we have for the 
determination of intelligence, and yet it is not absolutely to be. 
depended upon without first making some qualifications. 
This test is in a large degree the measure only of education. It 
does not give any definite idea of the capacity for achievement. It 
does not determine the ability of an individual to adapt himself to 
his environment. It does not take into consideration the mental habits 
or racial characteristics, and these are very serious objections. 
There are many individuals living quiet, simple lives, who accum- 
ulate property, who care for their children, who never come in con- 
flict with the law and conventions of society, who are peaceful and 
law abiding, self-supporting citizens, never asking assistance from the 
state. And yet they would be classified as morons and high grade 
imbeciles by the Simon-Binet system. 
On the other hand, there are individuals, many of them educated, 
even college graduates, who can pass this system with perfect ease, 
and yet they are absolutely lacking in judgment; childish and puerile 
in their behavior and relations to others, and "incapable of conducting 
themselves with any degree of prudence," in business and social 
relations. They are, in fact, lacking in "mother wit" and are really 
"educated fools." 
A third valid objection is to be counted. Psychologists are spring- 
ing up all over the country like mushrooms, eager to promiscuously 
deal out the labels of feeblemindedness to the state's wards without 
fear or conscience. Many of these same persons have never had more 
than a few weeks' experience with the insane or feebleminded and 
are utterly lacking in any knowledge of pathology, and yet they are 
permitted to give out inaccurate statistics. 
What value or what worth can there be in having pedagogic 
psychologists, unequipped with the knowledge of pathology, to go 
about saying this and that individual is but six or seven years of 
age mentally, and thinking "there's an end to it." This is just what 
is happening every day. 82 
FEEBLEMINDEDNESS. 
Persons with remedial defects which retard the mental processes 
are being labeled as hopelessly feebleminded. Imagine the terrible 
fate if some of our brilliant celebrities had had the cruel misfortune 
to fall into the hands of this type of psychologists when children. 
Every day cases of organic brain diseases, hyperthyroidism, cre- 
tinism, juvenile paresis, and, in rare instances, psychotic states occur- 
ring in febrile diseases are receiving the diagnosis of feebleminded- 
ness from those who are only psychological diagnosticians. 
It was my experience to see a prominent psychological authority 
apply the meaningless term of "confusional insanity" to the delirium 
of typhoid fever. A few hours later the interne on whose service the 
patient happened to be, did a Widal test, thereby clearing at once 
the diagnosis and prognosis in the case. 
This instance very well illustrates the need that the average 
psychologist has for a training in pathology. The psychologist is 
not the only one at fault, however, the average physician is as poorly 
equipped in the elements of psychology as the psychologist is in the 
rudiments of pathology. 
It is at once apparent that full value and credence cannot be 
given to the mental examinations of defectives by persons who are 
not properly schooled in pathology as well as psychology and with 
this knowledge supplemented by an institutional training and 
experience. 
It must be borne in mind that a moron, whose chronological age 
is thirty and whose mental age is nine, does not have, and never did 
have, the mentality of a normal nine-year-old child. 
Even though a thirty-year-old moron measures nine years by the 
Simon-Binet scale, it must be remembered that he has had twenty-one 
years of experience and training, and this added factor is an element 
of confusion. 
The question then arises, did this twenty-one years' experience in 
life enable him to pass the nine-year-old tests? If so, the native 
intelligence has not been accurately tested, and he is not to be classi- 
fied as of the same mental age as a nine-year-old child, who is with- 
out experience, but whose mental development has kept pace with his 
physical growth. 
The reports of psjTchopathic laboratories which operate in con- 
junction with our courts are not altogether reliable for the reason of 
the haste in which these examinations have to be given. And second, 
the states of apprehension, anxiety and fear which often develop in 
prisoners preceding trials do not offer the best opportunities for 
accuracy and precision in applying mental tests. FEEBLEMINDEDNESS. 
83 
Clinical Cases. 
Case 1. Prisoner, white male, thirty-two years of age when 
admitted to the Indiana State Prison, February 18, 1912. Prisoner 
comes of a neuropathic family; father was a demented epileptic; his 
mother suffered from Huntington's chorea; one paternal aunt and 
sister had chorea; the prisoner himself is feebleminded, measuring 
seven years by the Simon-Binet scale of intelligence. 
Prisoner has a long criminal record; has been in trouble several 
times on account of his murderous and brutal tendencies; he has 
served three jail sentences for assault and battery and has paid two 
fines for the same charge. 
This feebleminded individual brutally beat his demented father 
to death with a club because the latter had displeased him. He had 
assaulted his father many times before he succeeded in killing him. 
He has been in constant conflict with the discipline since coming 
to prison. He fails utterly to appreciate the enormity of his crime; 
he is extremely egotistical and feels he has been grossly insulted 
because he has been sentenced to prison for a term of two to twenty- 
one years. 
He is lacking in reason and judgment; his conversation is silly 
and childish; occasionally he exhibits transient unsystematized delu- 
sions of persecution. He is a permanent custodial case and had he 
been placed in an institution for the feebleminded youth when within 
the age limit for admission to that institution, much crime and need- 
less expenditure of money could have been averted. 
Case 2. Prisoner, white male, forty years of age when admitted 
to the Indiana State Prison, convicted of statutory rape on a fourteen- 
year-old female child. 
This prisoner's mentality falls within the moron group; his family 
history is bad; the mother died of cancer; father died of senile 
dementia; his paternal grandmother was insane and died in an insti- 
tution; one brother also died in a hospital for the insane. 
His crime was merely the expression of mental defectiveness; he 
has been guilty of this overt act several times; but had heretofore 
•escaped arrest; he is intensely erotic in his conversation, and he has 
no appreciation of the fact that he has committed any moral offense 
whatsoever. He justifies his behavior by saying that he had paid his 
victim money, candies and articles of small value and she had no 
reason whatever to be dissatisfied, and that the "nosy people" should 
liave minded their own business, instead of his. 
This individual will be a constant source of danger when released 
from prison on account of his mental defect and sexual tendencies. 
Case 3. Prisoner, white male, age eighteen when admitted to the 
Indiana Hospital for the Insane Criminals. He was found by the 84 
FEEBLEMINDEDNESS. 
court "guilty of grand larceny, but insane." This man has been a 
continual source of trouble and annoyance in the community from 
which he came. He is an habitual thief and on several occasions he 
made attacks on small female children; his mental age is five years; 
he presents all the mental and physical stigmata of degeneration; the 
mammary glands are as well developed as those of a normal eighteen- 
year-old girl. He is given to perverse sexual practices and on two 
occasions he has been found playing the passive role in the act of 
sodomy. 
Case 4. Prisoner, white male, fifty-two years of age when, 
admitted to the Indiana State Prison, November 22, 1914, convicted 
of grand larceny. This is his fourth conviction; twice before he has 
served time for burglary and the definite number of jail sentences 
could not be ascertained, but the number is no less than eight. 
He has also been an inmate of a hospital for the insane. His 
mental age by the Simon-Binet scale is but five years; his mother 
was insane at the time of her death; other family history unobtain- 
able; he presents all the stigmata of degeneration; has a marked 
defect in speech; his conversation is filled with profanity and obscen- 
ity and he displays homosexual tendencies. 
Case 5. Prisoner, white male, twenty-one years of age when 
admitted to the Indiana State Prison, convicted of murder. He had 
previously been found guilty of larceny, and was serving sentence at 
the state reformatory on this charge when he stabbed a fellow pris- 
oner to death with the idea in mind that he would be transferred to 
the Indiana State Prison, where he would be permitted to use tobacco. 
Whenever asked to do so, he very freely discusses his crime without 
the least evidence of remorse or shame. 
Even though he passes all the tests of the Simon-Binet scale, he 
must be classified as a feebleminded person; his reason, judgment and 
behavior show marked mental weakness, and he is absolutely "incap- 
able of competing on equal terms with his normal fellows or manag- 
ing himself or his affairs with ordinary prudence." He is in 
constant conflict with the discipline in the psychopathic ward where 
he is detained, and in this department the rules correspond to those 
of the hospital for the insane. He is quarrelsome and irritable, and 
occasionally makes pretended attempts on his life merely to create 
sympathy. 
In this instance the characteristic mental poverty of the imbecile 
permitted the brutal and murderous tendencies to act that the taste 
for tobacco might be satisfied. CHAPTER XVI. 
PSYCHOPATHIC PERSONALITIES AND 
BORDERLINE STATES. 
There is a group of psychopathic individuals whose mentalities 
lie in that ill-defined state where sanity shades imperceptibly into 
insanity, where the markings between responsibility and irresponsi- 
bility are hazy, indistinct and confused. Because of this lack of 
mental equipose, they are very potential lunatics or criminals. 
These persons constitute a very much greater portion of the 
defective delinquent class than do the criminals of the positive 
psychoses. 
For purposes of description the individuals of this type have been 
variously designated as psychopaths, constitutional inferiors and 
sexual perverts, and they will be briefly described. 
The psychopaths constitute a group of individuals who may be 
said to be "semi-insane or semi-responsible." The following is a 
description of the psychopath by Dr. Parker: "In the psychiatric 
sense he is neither flesh nor fowl, neither sane or insane, and he is a 
dangerous individual at every stage. He is bright, responsive, reactive 
and in a varying degree adaptable for certain periods. He is anti- 
social, either for brief periods or persistently." 
There are individuals who display many eccentricities of char- 
acter and conduct. But these characteristics seem to be no departure 
from the individual's usual manner of feeling, thinking and acting, 
nor are they sufficient to warrant calling the individuals who possess 
them insane. Yet these characteristics in question hinder the efficient 
adjustment of the individual to his environment. It is noted that a 
positive insanity is a very frequent development in these cases. They 
have been graphically described by Regis as follows: "Their lives 
are one long contradiction between the apparent wealth of means 
and poverty of results." 
Their mental twists, so to speak, make it impossible for them to 
live at ease in their environments. Their distorted mental per- 86 
PSYCHOPATHIC PERSONALITIES. 
spectives lead them to magnify the wrongs they see in the social 
organism. 
They are dreamers, reformers, propagandists and curbstone 
socialists; and should they come into conflict with the law, they assert 
that the wrong lies with society in its laws and not with themselves. 
The psychopath is often the victim of obsessions and imperative 
ideas. While in the majority of cases they are limited to harmless 
results so far as society is concerned, they may, however, occasionally 
lead to the performance of criminal acts. 
"It is not to be thought that crimes of obsessive origin present 
diagnostic difficulties from the medico-legal point of view. Before 
he obeys the criminal impulse, the patient is deeply grieved about it; 
he upbraids himself, and does his best to restrain himself. He is 
ready to suffer the most painful forms of treatment-isolation, pre- 
ventive correction, etc. If, in spite of all efforts, he succumbs to the 
obsession (a very rare and almost impossible eventuality), he can 
show a hundred facts that testify to the morbid origin of the offense 
and prove its fatal determinism, excluding every possibility of crim- 
inal responsibility. As it is superfluous to prove, the ordinary inciting 
cause of a crime is absent. On the other hand, it is evident that 
there is a psychopathic cause which is capable of becoming a para- 
doxical incentive; the offense is committed because it has become 
an obsession, and it is an obsession because it is repugnant to the 
honest, gentle and sensitive character of the alleged criminal." 
Constitutional Inferiors. 
The largest single group of-criminals that I have studied may be 
classified under the term "constitutional inferiors." The term is self- 
explanatory. While the individual of this group is not feebleminded 
in the strict sense of the term, he is below par either physically or 
mentally. He is unable to stand the strain imposed upon him by 
the ordinary conventions of society; without assistance he cannot 
occupy the place that he should in the social order. Indecision, 
inability, vacillation and dependency are his chief characteristics. He 
readily takes to every vice that comes across his path, he indulges 
in prostitution, falls an easy victim to the drink and drug habit. His 
mental operations are slow or inaccurate; his reason and judgment 
are defective. The constitutional inferiors possess an unsatisfied crav- 
ing for continual and unusual excitement, and in their impetuous 
endeavors to secure it they live on the borderline of insanity and crim- 
inality, over which they are swept back and forth by the force of 
tempting circumstances in which they often find themselves. In them 
the call of the Wanderlust is particularly strong; they travel from 
place to place, and the railroad employees and detectives in par- 
ticular can testify to this fact. With the coming of warm weather 
hundreds of them traverse the continent in search of contentment, PSYCHOPATHIC PERSONALITIES. 
87 
which leads them a never-ending chase. Many of them are convicted 
of petty crimes and a very common one for them to commit is the 
breaking of box cars to secure food and small plunder. 
The treatment to be attempted in this class is the removal of 
these physical conditions brought about by dissipation and venereal 
disease, removal from vicious and bad associates, re-education and 
tactful direction of their thoughts and activities into channels of use- 
fulness. If it were possible to transform their restlessness and unpro- 
ductive activity, and if employment could be secured that would in a 
measure afford them novelty and excitement, their rehabilitation 
might be expected if it were not for their neuropathic organizations. 
There are to be found in this constitutionally inferior class of 
persons a group of individuals to whom the term pathological liar can 
be applied with a marked degree of descriptive accuracy. This tend- 
ency to excessive prevarication has its origin in the higher types of 
mental defect and especially in those cases where there is a marked 
degree of emotional instability and a lack of mental equilibrium. 
These individuals are the gossips of the prison. They seem to 
take a particular delight in spreading unfounded, senseless rumors 
and falsehoods about the institution; they are sincerely hated and 
distrusted by the other prisoners. Very often they make confessions 
of crimes which they never committed merely to gain notoriety and 
the attention of prison officials. 
In one instance, there came under my notice, one of these morbid 
liars who made a confession that he committed a murder. He was in 
reality not guilty at all, but on the strength of his confession he was 
convicted in court and sentenced to life imprisonment. 
Sexual Perverts. 
There are very many sexual perverts to be found outside of penal 
institutions and hospitals for the insane. We are only interested with 
those sexual anomalies, so far as this thesis is concerned, that sho tv 
a direct relationship to legal crimes which may be classified as rape, 
incest, sodomy and necrophilia. But it is to be understood that cer- 
tain other inversions and perversions of the sexual instinct lead to 
various other crimes. Murder has often been the outcome of sadistic 
practices. 
Not all expressions of homosexuality are to be regarded as evi- 
dences of insanity, yet it may be safely said that the majority of 
sexual perverts are psychopathic individuals. 
Sexual perverts of the most disgusting types are found among 
the psychopaths. 
Whether these anomalies of the sexual instinct are always con- 
genital or not has not been settled, and it does seem that inverse and 
perverse sexual habits may be acquired early in life by the associa- 88 
PSYCHOPATHIC PERSONALITIES. 
tion with vicious and depraved individuals. The sexual perverts are 
at any rate an exceedingly dangerous and demoralizing class, which 
should be permanently isolated to prevent their mingling with others. 
Sodomy is not an infrequent crime among prisoners. About one 
per cent of all admissions to this prison are for this perversion. A 
most constant and strict supervision is kept over the prisoners by the 
prison officials to prevent this practice, and in those prisons where 
more than one inmate is housed in a cell extreme caution must be 
exercised. 
Approximately two per cent of all admissions to the Indiana State 
Prison are for incest. But it no doubt occasionally happens that some 
of the men convicted of incest are innocent, and that blackmail, 
hysteria and fraud play a part in such convictions. 
During the last five years four and eight-tenths per cent of all 
the prisoners admitted to this institution were convicted of rape. 
The average age of the men convicted of rape admitted to the 
Indiana State Prison is forty-four years plus; ninety per cent of them 
showed disorders of the nervous system and an increase or decrease 
of the tendon reflexes and a general condition of arterio-sclerosis; 
seventy-three per cent of them were married men in whom the habit 
of frequent intercourse was established; sixty per cent of the cases 
of statutory rape were committed by men over fifty years of age. 
Clinical Cases. 
Case 1. White male, thirty-five years of age when admitted to 
the Indiana State Prison, convicted of bigamy. Reliable family his- 
tory non-obtainable; has been arrested on several occasions for 
vagrancy. 
This man is a constitutional liar and seems to take a particular 
delight in telling the most outlandish, unreasonable lies. He has 
been in constant conflict with the prison discipline during his stay 
in the institution; he has been reported thirty-two times to the dis- 
ciplinary officer for the violation of the prison rules. 
At various times he claims to be a novelist, playwright, newspaper 
editor, army officer, navy officer, or any character that his fertile 
imagination may suggest. To explain his last crime of bigamy, he 
states that he made a wager with a newspaper man to travel from 
Boston to San Francisco on Pullman trains, to stop at the best hotels 
in the country without paying a cent for any accommodations, and 
to marry a girl on this trip. If he carried this proposed trip through 
to successful conclusion he was to receive twenty-five hundred dollars. 
His second reason was that this sort of an adventure would furnish 
him with a plot for a novel. 
Between Boston and Chicago he stated that he was arrested five 
times on various charges and also that he called on seven governors PSYCHOPATHIC PERSONALITIES. 
89 
and other prominent officials. On reaching Terre Haute, Indiana, he 
met a young lady, and on three days' acquaintance he persuaded her 
to marry him. It was soon discovered that he had a living wife from 
whom he had not been divorced. As soon as this fact became known 
to his wife he was arrested on the charge of bigamy. 
He has a rather handsome face as far as regularity of features 
go, but it is decidedly weak and childish. He appears on superficial 
examination to be fairly intelligent, but a conversation of any length 
soon discloses his mental instability and his pathological tendency 
to excessive lying. He is subject to periods of alternate depression 
and elation; he is absolutely lacking in steadfastness of purpose, and 
his mental activities are non-productive of results. His judgments 
are most defective and puerile. 
Case 2. Prisoner, white male, convicted of false pretense, age 
thirty on admission to the Indiana State Prison, January 25, 1910. 
No history of insanity obtainable; prisoner was born of wealthy 
parents and was afforded the economic and social opportunities to 
secure an education. Because of his mental instability, roving dispo- 
sition and lack of fidelity to purpose, he did not take advantage of his 
educational opportunities. 
This man denies previous imprisonment, but letters have been 
received at this institution to show that this is not the truth. 
His favorite way of securing money under false pretense was to 
pose as a dress goods salesman, soliciting orders and collecting money 
fraudulently from housewives. This prisoner is extremely egotistical; 
he looks upon other prisoners as being much inferior to himself. 
He is very affected in his manner and speech; makes silly and 
extravagant claims about his attainments, culture, financial and love 
conquests; boasts extravagantly that men of public life are his friends 
when as a matter of fact he has been a "ne'er do well" all his life. 
He has been a petty thief, a cheap embezzler, a board-bill jumper, 
a defrauder of gullible old women, and a source of constant annoy- 
ance to his parents, who have often paid his board-bill and stayed 
his fines. 
His life has been an uninterrupted course of prodigality and 
dependency. He has twice been released on parole from the prison 
and has as many times violated it. At the present time he is a 
fugitive from justice. 
Sexual Pervert. 
Case 3. Prisoner, white male, forty-eight years of age when 
admitted to the Indiana State Prison, convicted of murder in the first 
degree. He has served two prison sentences for larceny. 
Paternal grandmother was insane at fifty-five and died in an 
insane asylum; her mother was also insane; other family history 90 
PSYCHOPATHIC PERSONALITIES. 
unknown. Prisoner had syphilis when twenty-five years of age; occa- 
sionally he drank to excess. 
He was married three times; performed an abortion on his first 
wife, and after she died he married two other women, from whom he 
was soon divorced. Prisoner began practicing cunnilingus on his 
first wife and said he would have done so before had the opportunity 
afforded itself; he says he has felt the desire ever since he was a 
small child. He states that he inherited this sexual perversion from 
his father, and he claims his father brought about his mother's death 
by this practice. 
He appreciates the fact that he is different from other men, and 
this thought makes him very unhappy at times. He generally sits 
about the ward with his head covered by his coat. 
Occasionally he remarks that he is very much inclined to commit 
suicide because he lacks the opportunity to satisfy his perverse sexual 
desires, and second, he is ridiculed and held in disdain by the normally 
sexual prisoners with whom he would like to associate. 
This man's crime was due directly to sexual perversion, and 
though he occasionally tells different narratives as to how the crime 
took place, the following one he tells the most often and is most 
likely to be the true one: 
He had been living for several months with his housekeeper and 
mistress as man and wife. He derived but little pleasure from normal 
sexual intercourse and he insisted that his sexual partner permit him 
to practice cunnilingus. On this occasion she refused to allow this 
and he became exceedingly angered and killed his paramour with a 
shotgun. After she was dead he satisfied himself sexually in the 
manner he desired. 
This man speaks very freely of his sexual perversion. He states 
that he had violent fits of anger before coming to prison. On one 
occasion he killed a rooster that disturbed him by crowing. He then 
chopped the body to pieces in order to satisfy his angry passion. 
This man has occasional dizzy spells; exhibits fits of temper at 
rare intervals; he is oriented as to time, place and person. He says 
that there are two marks on his heart and that these "markings" are 
responsible for all his trouble and crime. His memory is good for 
remote and recent events, and, but for his slight state of mental 
enfeeblement, he exhibits no particular symptoms. 
Case 4. Prisoner, white male, convicted of sodomy, age fifty on 
admission to the Indiana State Prison. This prisoner is well educated; 
was an instructor in English and stenography at a commercial school; 
he was also choirmaster in the Protestant Episcopal church. He is 
extremely religious and at one time had ambitions and desires to 
become a member of the celibate priesthood of the religious denom- 
ination to which he belongs. He states that he has had sexual inter- 
course with women but on one or two occasions, and no pleasure PSYCHOPATHIC PERSONALITIES. 
91 
or satisfaction was derived from such relations. He has felt, however, 
strongly attracted and excited by young choir boys with whom he has 
associated in various churches for many years. The offense for which 
he was committed to this prison was the corruption of ten choir 
boys at the church of which he was the musical director and organist. 
Aside from his sexual perversions this man displays no mental 
symptoms. He is rather effeminate in his manners and behavior, and 
when not occupied with his work as clerk he spends his time reading 
and discussing religious subjects. 
Sadism. 
Case 5. White male, twenty-six years of age; last crime com- 
mitted, uxoricide. Prisoner's paternal grandfather insane; father has 
been an inmate of a hospital for the insane for the last twenty-two 
years. Prisoner reached the eighth grade in school; has used alcohol 
to excess since eighteen years old; practiced masturbation since ten 
years of age; had sexual intercourse for the first time at fourteen 
years of age with a girl four years his senior, who was menstruating 
at the time. 
After his first sexual congress he was always sexually aroused 
at the sight of blood-he often watched his mother kill chickens in 
order to be sexually stimulated. He married at nineteen years of 
age; he found that intercourse at the menstrual period gave him 
more pleasure sexually than at any other time. Prisoner tells the 
story of his crime in a frank and unhesitating manner: 
One evening he had a quarrel with his wife, accusing her of 
infidelity. In the course of the quarrel he threw her to the ground, 
and in doing so he stumbled against an iron pipe which he used 
as a weapon to crush her skull. He informed the examiner in a glib 
and easy manner that each time he struck his wife he felt an erection 
taking place and for the satisfaction of his sexual passion he con- 
tinued to strike her until an orgasm was effected and when this had 
occurred his wife was dead. He then secured a razor and severed 
the head from the body. 
This act and the sight of blood gratified him intensely and he 
desired very much to have intercourse with the dead body, but cir- 
cumstances were such that he hesitated to commit the act of necro- 
philia, lest he be caught, which exposure he would have regarded very 
disgraceful. But he did not regard the murder in the same light. He 
left the body and returned to it three times under the influence of 
his sadistic passions-ejaculating at the third visit. His sexual hyper- 
esthesia being relieved, he then gave himself up to the police. 
Physical examination of this prisoner reveals the presence of 
anatomical stigmata, face shows weakness of character, features 
irregular in outline, ears of the Morel type, palate is slightly and 92 
PSYCHOPATHIC PERSONALITIES. 
sharply arched, malocclusion of teeth and slight internal strabismus 
of the left eye. Prisoner answers all questions in a coherent and 
relevant manner. His general intelligence is in harmony with his 
common school education. He has no hallucinations or delusions. 
He has no remorse for his deed, but is extremely sorry that his liberty 
is taken from him. He has wishfulfilling dreams of a sexual nature. 
Sense of moral and legal responsibility absolutely lacking. He 
says he will commit suicide when tired of prison life. CHAPTER XVII. 
CONSTITUTIONAL IMMORALITY.* 
Among the interesting and intricate problems met with in prisons 
and reformatories is the subject of constitutional immorality, the 
obscure and difficult pathology of which offers a most inviting field for 
study and research to the alienist and criminologist. The idea that 
some individuals are immoral because of constitutional defect of the 
neural organism is most repugnant, as it seems to challenge the 
traditional belief in man's free will, and this is especially true of 
those unfamiliar with mental diseases. 
Yet we who have delinquent individuals within our care and 
custody know that there are persons who cannot refrain from crime 
because of their degenerate organizations, which predispose and impel 
them to immoral and illegal acts. 
Before going further, it may be well to speak of morality or the 
moral sense in the general acceptance of this term. Every individual 
is presumed to be the possessor of an innate moral sense or conscience, 
which enables him to decide as to what is right or wrong in human 
conduct, and act accordingly. Morality and character may be de- 
scribed as a function of the brain, as is memory, imagination, or 
thought; and it is certain that no life is lived without the develop- 
ment of what we term character. 
The moral sense or quality is, however, the last of the psychic 
functions to be developed; it is also the first to be confused, dis- 
ordered, or destroyed by pathological processes affecting the mind. 
It is perfectly apparent that the function of intellection may be 
limited by developmental defects occurring in the physical evolution 
of the brain substance; this being the case, there is no logical reason 
why the moral capacities of the mind should not suffer from defect 
for the same reason. 
* By Paul E. Bowers. Reprinted from International Clinics, Vol. IV, Series 23, 1913, by 
permission of the J. B. Lippincott Company. 94 
CONSTITUTIONAL IMMORALITY. 
Since well-qualified observers have found to be an entity a con- 
dition which has been variously termed constitutional immorality and 
moral insanity or moral imbecility, it will be apropos to quote several 
definitions describing it. 
Tanzi states, "Constitutional immorality is recognized * * *; 
in such instances the faults of character are out of proportion to the 
insignificant disorders of intelligence.'' 
White defines this condition as follows: "Moral imbecility is a 
condition of mental defectiveness which. is shown by the absence of 
the highest functions, particularly the moral; capable of training to 
a considerable degree, but always a menace to society." Maudsley 
speaks of cases of this kind as "a group of persons of unsound mental 
temperament, who are born with an entire absence of the moral sense, 
destitute even of the possibility of moral feeling; they are as truly 
insensible to the moral relations of life, as deficient in this regard, as 
a person who is color-blind is to certain colors, or as one without the 
ear for music is to the finest harmonies of sound. Although there is 
usually combined with the absence of moral sensibility more or less 
weakness of the mind, it does happen in some instances that there is 
a remarkably acute intellect of the cunning type." 
According to Herbert Spencer, higher feeling is merely the centre 
of co-ordination, by which less complex aggregations are brought 
into proper relations. In the process of evolution, this centre of 
co-ordination may never be developed, and moral insanity may result, 
or great waywardness of moral conduct without marked disorder of 
the intellect. The doctrine of moral imbecility and moral insanity is 
then, as Tuke says, "in full accord with mental rules of evolution and 
dissolution as laid down by Spencer." 
Spitzka has defined constitutional immorality as follows: "Dis- 
orders of the moral sentiments may be congenital * * *, an original 
deficiency analogous to that lack of musical sense or color-blindness 
which may coexist with a fair faculty of language and good contour 
of perception * * *, with fairly good logical powers in the 
abstract." According to Sir James Crichton-Browne, "The moral im- 
becile is a person who by reason of arrested development or disease 
of the brain, dating from birth or early years, displays at an early age 
vicious or criminal propensities which are of an incorrigible and 
unusual nature, and are generally associated with some slight limita- 
tion of intellect." 
s 
General Considerations. 
The operation of the indeterminate sentence laws which are so 
generally in force separate the accidental and occasional criminals 
from those who are constitutionally immoral. The first class is com- 
posed of those persons who have strayed from the paths of moral and 
legal rectitude while under the strain of some unfortunate circum- CONSTITUTIONAL IMMORALITY. 
95 
stance which provokes an outburst of passion; an individual in whom 
the social tendencies are strongly developed might commit a murder 
in the heat of passion to avenge a sexual outrage on a member of his 
family committed by an anti-social person. A too free indulgence in 
alcoholic beverages or association with vicious companions may lead 
to crime in persons who do not differ from the normal members of 
society. These persons regain their former standing in civil life, 
and forget their crimes, which were merely solitary and incidental 
experiences in their lives. The constitutionally immoral serve sen- 
tence after sentence, are paroled again and again to the best of 
environments, but they cannot be kept out of prisons, toward which 
they gravitate, irresistibly drawn to them by inherent defects in their 
constitutions. 
These unfortunate moral defectives we generally find to be bur- 
dened with an evil heredity, a harsh, unrelenting tyranny of ancestral 
defect. Many of them are ignorant, and do not rise above the level 
of the feebleminded; in marked contrast, others are highly educated 
persons who assent to general propositions concerning right and 
wrong, and frequently delight to discuss moral customs and laws in 
order to exploit their casuistic and argumentative powers, but to them 
the concrete application of moral or legal restraint is a hardship 
which they cannot understand. 
Some of the highly intellectual immorals fail to display the 
grosser and more vulgar evidences of their defects; their moral anaes- 
thesia shows itself in an absence of the desire to do good, and a 
poverty of altruistic sentiments. They conform in a negative manner 
to the conventions of society for personal gain alone. They regard 
marriage as legitimate prostitution. They perform acts of apparent 
charity to gain personal advertisement; make various professions of 
religion to suit the community in which they may happen to live, if 
they find it pays; again they pose as humanitarians or public leaders 
for the satisfaction of their exaggerated egotism. 
"They are, nevertheless, immoral persons without honor, without 
remorse, without feeling, without passion, and without humanity. 
They never yield to the cruder forms of crime; they are furious at 
the slightest suggestion that they are immoral." 
The greatest criminals today belong to the highly educated type 
whose crimes are so cunningly executed and who are so veneered 
with an appearance of respectability that for long periods of time we 
fail to discover their moral bankruptcy. 
Mechanism of Constitutional Immorality. 
The processes of the mind are continuous, and so-called faculties 
or states of mind have no separate and distinct existence; yet the 
terms of the old psychology may be used conveniently in this paper 
to designate those three great expressions of mental life, intellection, 96 
CONSTITUTIONAL IMMORALITY. 
feeling, and volition. These are conjoined and blended continuously, 
and no one of the three can be taken into account without considering 
the other two. So, in my endeavor to describe moral insanity, I will 
classify it under three heads, according to which one of the three 
great functions of the psyche is most involved. We may, therefore, 
divide constitutional immorality into four types, as follows: 
1. Where the defect of the psyche is most marked in the sphere 
of intellection. 
2. Where the defect is most pronounced in the emotional sphere. 
3. Where the volitional sphere is primarily involved. 
4. Where more than one sphere of the mind is affected. 
The function of the mind is to continuously adjust the individual 
to his ever-changing environment, and a proper balance of the intel- 
lectual, emotional and volitional activities is necessary for this adjust- 
ment. In the constitutionally immoral we find a disequilibration* 
of the above-mentioned functions of the mentality which leads to the 
consummation of the criminal acts. A bank robber skilfully opens 
a most intricate lock to a vault and secures its valuable contents. 
The criminal's intellectual capacities were adequate to the under- 
standing of the mechanism of the difficult lock, the necessary voli- 
tional activities were evidenced by the skilful manipulation of the 
same and the successful completion of his well-calculated crime, but 
the much-lowered or inert emotional capacities of his mental organ- 
ism failed to exert a proper moral inhibitory influence. Dispropor- 
tionate activity of the intellectual and volitional attributes of the 
psyche over the emotional qualities resulted in a decidedly abnormal 
reaction. This illustration does, no doubt, seem to be quite extreme, 
yet it very adequately fits some cases of criminality with which I 
am familiar. 
Immorality Due to Defect of the Intellectual Sphere. 
There is a wide range in this form which extends from imbecility 
to a condition of high-grade feeblemindedness. The individuals who 
belong to this class fail to see, because of their mental deficiencies, 
the relation they bear to other individuals, so far as moral and legU 
obligations are concerned. The crimes of this class are homicides, 
assaults, rapes and petty thefts. 
Immorality Due to Defect of the Volitional Sphere. 
This form is one of the most striking and interesting in the field 
of morbid psychology, and it is to be regretted that these individuals 
* Disequilibres. CONSTITUTIONAL IMMORALITY. 
97 
of defective will power are more studied and observed by our legal 
friends than by the physicians. These persons are easily influenced; 
they know the difference between right and wrong, and yet are unable 
to suppress or restrain their inclination to crime; they frequently 
experience explosions of anger, and at these times commit most 
atrocious and barbarous offenses against the law. Often they are of 
remarkable intelligence and mental training, and no better descrip- 
tive term can be applied to them than that of "black sheep." 
The defects of the will may be arbitrarily classed under three 
heads: 
1. The explosive will.-This condition is due to defective inhibi- 
tion of the intellectual and emotional impulses which restrain the 
activity of the volitional sphere. Persons of the mercurial type with 
their hair-trigger temperaments are familiar to us all. In these indi- 
viduals the motor impulse is translated into criminal acts before 
their defective mental me'chanism can release the inhibitory social 
impulses. 
2. Exaggerated impulsions.-Criminal acts are committed where 
the normal amount of inhibitory power is present, but is insufficient 
to overpower the pathological and exaggerated impulses which lead 
to criminal acts. To this class of moral defectives belong the dipso- 
maniac, kleptomaniac, and pyromaniac; when attempting to resist 
their impulsions these persons experience such physical symptoms 
as prostration, tremors and vertigo, which disappear when the im- 
pulsive act is performed. Unfortunate individuals of this type are 
aware of the morbidity of their acts. James relates the following 
case: A tippler who, after making several unsuccessful attempts to 
secure liquor, deliberately chopped off his hand, then called for 
a bowl of rum, which was obtained for him, and into this he plunged 
the bleeding member, and then drank the liquor, following the act 
by the exclamation, "Now I am satisfied." Another dipsomaniac 
made the following statement: "If a bottle of brandy stood at one 
hand and the pit of hell yawned at the other, and I were convinced 
that I should be pushed in so surely as I took one glass, I could not 
refrain." Similar statements are frequently heard by those who come 
in contact with inebriates. 
3. Arrest of the will, or abulia.-This defect, we find, may be due 
either to an excess of inhibitory ideas or to a lack of sufficient voli- 
tional impulse to perform the social duties demanded by society. Tn 
this condition the intellectual and emotional spheres are usually no- 
wise affected, but the connecting link between these two or the voli- 
tional sphere seems to be lacking. The crimes or misdemeanors 
resulting from this defect are sins of omission rather than com- 
mission. To this class of psychopathic characters who display many 
anomalies of mind and mood, whose psychological tensions are 
lowered, and whose mental perspectives are distorted, may be assigned 98 
CONSTITUTIONAL IMMORALITY. 
the vagabonds, prostitutes, fakirs and deadbeats. Their lives are 
classically described by Regis as being "one long contradiction be- 
tween an apparent wealth of means and poverty of results." 
Immorality Due to Defect of the Emotional Sphere. 
In this form the primary or greatest defect of the psyche seems 
to be in the emotional sphere. The defect of the emotions may be 
divided into two varieties, in one of which there is a condition of 
transient and ephemeral hyperactivity of such emotions as anger, 
hatred, jealousy and eroticism which leads to atrocious and abhor- 
rent acts of cruelty. In the second variety we find that the emotional 
defects are evidenced by a cold, heartless, and indifferent paucity of 
ethical sentiments. We find in this class men of excellent education 
and others who, though not conventionally educated, are keen and 
cunning and possessed of an abundance of native intelligence. Among 
the immorals of this type are the skilful forgers and swindlers who 
practice their art of fraud so carefully that they are able to cover 
their heartless depredations with a cloak of legality and respect- 
ability. To this same species of criminals belong the professional 
gambler, the avaricious capitalist who corners the necessities of life, 
and the absconding bank cashier who steals and squanders the savings 
of small depositors without one pang of conscience or remorse. I do 
not wish to be understood as saying that all persons who commit such 
crimes are abnormal, and we should be exceedingly slow to pronounce 
them irresponsible and undeserving of imprisonment. Tanzi employs 
the following analogy to describe them: "As there are dogs without 
scent and flowers without perfume, even so also are there persons 
devoid of benevolence and sympathy." 
I have selected the following cases of constitutional immorality 
to illustrate each of the four types that I have enumerated. The 
first case may be classified under that form where the greatest defect 
of the psyche is shown in the emotional sphere. In this one we find 
an absence of sympathy and other altruistic qualities, an excessive 
egotism, and a capacity to inflict physical pain on others in the most 
predatory manner. 
Negro, twenty-nine years of age, convicted of murdering his com- 
mon-law wife. One brother insane. Physical examination: General 
functions of the body normal; health excellent; physical signs of 
degeneracy present; head of the plagiocephalic type; marked inferior 
prognathism; malocclusion of the teeth; palate low, flat and irregular. 
The following is the prisoner's own story of his crime, which he 
tells in a most indifferent and careless manner, which offers abundant 
proof that he is morally anaesthetic: "She commenced fussing about 
nothing, and then tried to hit me with a rock, but I caught her, and 
she lay her head upon my arm in the same way as a chicken's head 
on the block, like she did not know anything. I then bear down on CONSTITUTIONAL IMMORALITY. 
99 
the razor, and had to get the blood out of my eyes which made me 
blind. After this I walked around the house, and told the neighbors 
that I had killed May. I then went into the house, washed my face 
and finished dressing, fixed my breakfast, and before I had finished 
eating the police came and got me. Never felt sorry, conscience 
never hurts me, don't feel guilty of doing any wrong, didn't do any 
wrong, I ought to be free. The only thing wrong about it is that I 
ever came to Indiana." 
The prisoner has intelligence equal to the average of his race. 
Mental processes a little slow; memory good for past and recent 
events; is perfectly oriented as to time, place and person. He has 
no delusions or hallucinations; takes an active interest in his fellow- 
prisoners; reads library books and magazines to a considerable extent. 
He will not work, and prefers absolute idleness to employment. He is 
so constituted that he is devoid of any sense of moral or legal responsi- 
bility, and is therefore a dangerous individual, and should be detained 
permanently in a hospital for the criminal insane. 
Immorality Due to Defect of the Emotional Sphere. 
Prisoner a white man, twenty-seven years of age, born of wealthy 
parents and afforded every opportunity for success in life. Prisoner 
had the usual diseases of childhood. He graduated from the common 
schools at fifteen, had played truant at school, and was self-willed 
and stubborn as a child. He has indulged freely in alcoholic beverages. 
This prisoner tells in a very glib and theatrical manner the way 
in which he killed his mother for the purpose of obtaining money 
which she carried about her person. Prisoner entered the kitchen 
where his mother was preparing dinner, and without saying a word 
struck her with a hammer on the occiput. After she fell he removed 
from her person one hundred dollars and a diamond ring; he then 
went upstairs to cleanse his hands and rearrange his clothing. While 
in his room he heard his mother groan and, fearing that she would 
make some outcry, he returned to the kitchen, where she lay uncon- 
scious and prostrate on the floor, and deliberately fractured her skull 
a number of times with the hammer until he was certain that she 
was dead. 
Prisoner is oriented as to time, place and person; his memory 
is good for past and recent events; his answers to questions are 
coherent and relevant; delusions and hallucinations absent. He dis- 
plays an excessive amount of egotism; he affects some remorse and 
sorrow for his atrocious crime, but this veneer of remorse is so 
studied and superficial that it is easy to see that it is feigned for the 
purpose of impressing his observers with the idea that he has 
reformed. 100 
CONSTITUTIONAL IMMORALITY. 
Constitutional Immorality Due to Defect of the Volitional Sphere. 
Prisoner is a burglar, forty-four years of age. His mother died of 
brain tumor. He received a common-school education. He never 
has indulged in alcoholic beverages, but has been convicted ten times 
of larceny, robbery and burglary, and, altogether, has spent eighteen 
years of his life in prison. 
Prisoner is oriented as to time, place and person; intellectual 
operations are prompt and accurate-he has no hallucinations or delu- 
sions; he knows right from wrong, and that punishment will follow 
his crimes, but withal he is unable to control his actions when he 
becomes possessed with an irresistible impulse to commit a theft. 
He offers the following explanation for his crimes: "I can work 
very well for several months, then I become possessed with an irre- 
sistible desire to steal and rob. This desire is so intense and powerful 
I cannot resist it. After committing the deed I experience great relief 
and satisfaction. I feel no particular remorse or sorrow for my deed, 
but I do have considerable anxiety and dread that I will be caught." 
Immorality Due to Defect of the Emotional Sphere. 
White man, wealthy farmer, thirty-five years of age, reached fifth 
grade in school. This prisoner adopted a fourteen-year-old boy from 
an orphanage. One day in a fit of violent anger he bit and mutilated 
the child's body in two hundred places. His victim died in two hours 
after this barbarity. This convict is stolid and phlegmatic, but occa- 
sionally displays periods of excessive anger. He attempts to justify 
his crime by saying that the boy was stupid, and worried him con- 
tinually by breaking his farm machinery and his tools. 
Immorality due to Emotional Defect; Intellect Above the Average. 
Prisoner is fifty-five years of age, a graduate of the Phillips Acad- 
emy at Exeter; was surrounded with every advantage and social 
opportunity during his childhood and youth, and his crimes in no way 
can be charged to his environment. After graduating from the acad- 
emy he was given an excellent position in a manufacturing establish- 
ment. At this time his inherent tendencies began to display them- 
selves. He commenced a system of robbery and thievery which he has 
followed throughout his entire life. He has swindled company after 
company by making false entries on their business ledgers, forged 
checks and floated wildcat schemes, but owing to his keen intellect, 
diplomacy, refinement of manner, elegance of appearance and shrewd 
business ability he managed to keep out of prison until two years ago, 
when he was convicted and sentenced to the Indiana State Prison for 
forgery. At that time he was commanding a salary of nearly five 
thousand dollars, and there was absolutely no other incentive for 
forging or robbing except the satisfaction of his inherent desire to CONSTITUTIONAL IMMORALITY. 
101 
defraud. He neglected his invalid wife and family while he lavished 
money upon n puulic prostitute wliGm tie tooli on a pleasure trip to 
Japan, where he resided for two years, living on forged and stolen 
moneys in extravagant style. This prince of forgers is a model pris- 
oner, and is now employed as expert accountant in the prison office. 
At the present time there are nineteen indictments against him for 
forgery in various states. The field of his criminal operations ex- 
tended from New York to California. He never displays any remorse 
or sorrow because of his wholesale swindlings and frauds, but feels 
that a man of his keen business ability is being very much imposed 
upon because he was not released at the expiration of his minimum 
sentence to practice further depredations upon the stupid public. 
Emotional Defect Type of Immorality. 
White man, forty-six years of age; claims to have a college educa- 
tion; he has twice been convicted of bigamy and three times of forg- 
ery; he has been a n'er-do-well and deadbeat all his life; has trie! 
nursing, soliciting, lecturing, writing, preaching and numerous other 
fields of activity, and has signally failed at each of them. He was 
not content to confine his fraud and forgery strictly to the financial 
sphere, so he three times forged ordination papers to preach the 
Gospel. His deceptions were discovered by his ecclesiastical asso- 
ciates, and he was promptly deposed each time from the ministry; then, 
as his inherent criminal tendencies were stronger than his inclinations 
for honest work, he always resorted to his old occupation of forging 
checks. This prisoner is a good conversationalist, and by his suave 
and diplomatic frankness secures entrance into the most exclusive 
circles, which promptly suffer from his wily schemes and inborn 
crookedness. 
While under my observation I found him to be a pathological liar. 
It seems that he cannot tell the truth even when veracity would be of 
greater advantage to him. He does not hesitate to practice the lowest 
forms of calumny, backbiting and deceitfulness, which stand out in 
marked contrast to his religious pretensions. 
Diagnosis. 
The diagnosis of constitutional immorality is by no means easy or 
even always possible, and a careful investigation and consideration 
of the individual's full life-history is absolutely essential. His life 
must be reviewed from infancy, and full weight be given to the influ- 
ences of environment, education, standards of living and the character 
of the reactions to the same. 
We must be most careful that we do not stigmatize as born crim- 
inals intelligent prisoners who may through some unfortunate circum- 
stances or some legal error find their way to prison. Again, we must 102 
CONSTITUTIONAL IMMORALITY. 
be exceedingly slow to pronounce as irresponsible those violators of 
the law who wilfully resort to crime for personal aggrandizement, 
lest we make a farce of our present judicial system, and thereby 
endanger the public safety. We must distinguish constitutional im- 
morality from those crimes and misdemeanors which are so often a 
part of the symptom-complex of essential insanities. The motives and 
circumstances connected with the crimes associated with ordinary 
mental diseases generally bear the impress of marked mental derange- 
ment, and such crimes are rather characteristic. 
The crimes of epilepsy are the most difficult to differentiate from 
those of constitutional immorality, and, in fact, some moral defective- 
ness has been thought to be an expression of epilepsy itself; in accord- 
ance with this view, Lombroso, described criminality as a form of 
epilepsy, but this position is not altogether tenable. 
Constitutional immorality must be distinguished from the symp- 
toms which attend the prodromal period of hebephrenia which is 
marked by extreme wilfulness, incorrigibility, impulsive assaults and 
sexual crimes. Gradual mental deterioration and progressive indif- 
ference to environment will serve as diagnostic factors. The heboido- 
phrenia of Kahlbaum offers another difficulty for differentiation; here 
we find little or no evidence of progressive deterioration. The misde- 
meanors and petty crimes constitute the chief symptoms of this 
psychosis, but the average puerile intelligence and the pettiness of the 
misdemeanors are such as to distinguish this type from the intellec- 
tual and educated moral defective whose violations of law show a 
keenness of intellect. 
The crimes associated with senile dementia are acts against public 
decency, rape, foolish thefts and suicides. The crimes attendant upon 
arteriosclerotic dementia are practically of the same character, with 
the addition of arson and homicide. Persons suffering with paranoia 
frequently commit homicides, assaults and blackmail. The crimes 
and offenses of general paresis are so pathognomonic that there is 
little chance for them to be overlooked. As a rule, they are foolish 
and absurd actions. The patient afflicted with the expansive type of 
this disease undertakes impossible financial operations and indulges in 
wild speculations without apparent knowledge of the quality of his 
acts. Debauchery and lewdness usually attend paresis. The nervous 
phenomena and the positive Wassermann reaction of the blood and 
spinal fluid render the diagnosis easy and certain. 
Treatment 
The specific treatment of the constitutionally immoral is very dif- 
ficult for various reasons. Our prison populations are heterogeneous 
masses composed of insane criminals, epileptic criminals, feebleminded 
criminals, habitual criminals, occasional criminals, and criminals by 
passion, and they are all subject to the same discipline and treatment. CONSTITUTIONAL IMMORALITY. 
103 
Now it is the crime that regulates the term of imprisonment, and not 
the needs of the criminal. The imbecile offender is condemned to the 
same rigors of law as is the educated man, when convicted of the same 
statutory offense. Our courts are exceedingly loath to recognize consti- 
tutional moral defectiveness lest it weaken our methods of dispensing 
justice, and thereby jeopardize the safety of society. Physicians will, 
no doubt, at some time in the future be asked to give to our criminal 
courts such data concerning the prisoner's physical and mental status 
as will lead to a more scientific dispensation of equity. There is no 
need, however, that our courts become medical clinics, and never 
should medicine attempt to usurp the prerogative of the law. The 
proper scientific classification of the prisoners is too ideal to be 
obtained under the present-day administration of penal institutions. 
Several methods of treatment have been offered for the morally 
insane, but none as yet have passed the limits of the experimental 
stage. These may be briefly mentioned. 
Why should not the born criminal remain in prison so long as 
he is dangerous to society? We do not release the violent and danger- 
ous insane from hospitals merely because they have been detained 
there a number of years; then why should we release the instinctive 
criminal to practice his criminal acts upon the public? We quar- 
antine smallpox, and we exile the leper; then why should we not 
isolate the incurable moral defectives who disseminate dangerous 
moral contagion? The question of sterilization needs no other atten- 
tion than to be mentioned, as it is being brought before the public 
in the most active way, and, no doubt, when the mists and miasma 
of superstition and ignorance which now enshroud the subject of 
heredity have been cleared away, sterilization will no longer be 
regarded as a predatory measure. 
Craniectomy has been tried in children with success in some cases 
and failure in others. The procedure is not altogether warranted, and 
to be of any use at all the operation must be performed very early in 
life, at a time when we are unable to judge accurately of the moral 
character. 
Lugaro has suggested that the impulsivist should have his thyroid 
gland mutilated-care being exercised that the parathyroids are not 
injured-with a view to bring about a mild degree of intoxication, 
not unlike that found in myxoedema, which would calm and allay 
irritable and impulsive tendencies without impairing the integrity of 
the intellectual capacity. This measure is not being carried out, so 
far as I know, and before attempting it, the physician should make 
sure of his legal protection. 
We must seek to detect abnormalities in the children and, should 
we find deviations toward criminal tendencies, we should place them 
in a healthful environment, and give them such schooling as will par- 
ticularly develop their social instincts and tend to compensate for 
their inherent defects. The prognosis, however, is bad, for no amount 
of training will alter or long hide the vices of organization. 104 
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