THE CONNECTION BETWEEN INSANITY 
AND CHIME* 
BY WALTER CHANGING, M. IX, 
Brookline, Mass. 
Early in tlie year I wrote to mv co-members on this 
committee, Dr. II. P. Stearns, of Hartford, Connecticut, 
and Dr. P. L. Murphy, of North Carolina, asking them 
if they would not aid me in preparing the report. To 
my request they made a negative reply, and I have 
been left therefore to prepare it alone. 
Several valuable works have appeared during the 
year in English, German and French, and a mass of 
valuable papers have appeared in journals devoted to 
mental and nervous diseases, especially might I mention 
some in the Italian journals, were it not invidious to do 
so. Instead, however, of passing these various publica- 
tions in review, I have taken up one particular branch 
of our specialty, the medico-legal branch, and this 
paper will be limited to the consideration of the Con- 
nection between Crime and Insanity. 
This I have felt it a duty to do partly because of its 
importance in this country at the present time, and 
partly because of the appearance of the recent valuable 
contribution of Mr. Justice Stephen, of the Queen’s 
Bench, on the subject.f 
Chapter XIX of the second volume of his work, 
entitled the “ History of the Criminal Law of 
* Report of the Committee on the Bibliography of Insanity, read at the 
meeting of the Association of Medical Superintendents of American Institu- 
tions for the Insane, at Saratoga, N. Y., June 17, 1885. 
f History of tlie Criminal Law of England. By Sir James Fitz James 
Stephen. 3 vols. Vol. II, p. 124. England,” is given up to the consideration of the 
“ Relation of Madness to Crime.” 
In a little more than eighty pages lie most thoroughly 
and lucidly enunciates his views of the connection 
between these two conditions, and it is perhaps not too 
much to say that he is able to make clear some of the 
legal ideas of insanity more satisfactorily, than any 
writer that I can now think of. 
He leaves some tilings unsaid, perhaps, and 
occasionally arrives at conclusions, which hardly seem 
warranted, but it can not be denied, that in most 
instances his positions are well taken and skilfully 
maintained. 
I shall give some extracts from his chapter, and 
endeavor to discover in what particulars a medical man 
might justifiably differ from him. 
In the beginning, Sir James very modestly says that 
he approaches the discussion of the subject with 
considerable distrust of his own power of dealing with 
it satisfactorily, “as it can not be treated fully without 
a degree of medical knowledge, to which I have no 
pretensions.” 
In a foot-note he says he has most frequently referred 
to the works of Griesinger, (edition of 1867); Bucknill 
and Tuke, (edition of 1874); and Maudsley, (Pathology 
of Mind, 1879; Physiology of Mind, 1876; Responsi- 
bility in Mental Disease, 1881.) He has read and 
considered many other works on the subject, but does 
not consider it necessary to mention them, as they say 
much the same things in different ways. 
A medical man on reading this list of writers that 
the learned justice refers to will perhaps regret that he 
does not give a somewhat more extended reference to 
the writers he has consulted, for while no authorities 
are higher than those he gives, other writers have 3 
added and filled out the views expressed by them, and 
some of the wants he has found in the works read by 
him might be found supplied elsewhere. 
Psychological medicine has made very considerable 
strides within even a period of ten years, and 'the 
German school, represented by Krafft-Ebing, Schiile 
and others, has done a good deal toward systematizing 
the study of insanity. 
Sir James truly says that there has been much 
excited controversy between the medical and legal 
professions in which many things have been said which 
would have been better unsaid. 
Cruelty, ignorance, prejudice, and the like, are freely ascribed 
to the law and to those who administer it, on the grounds that it 
is said not to keep pace with the discoveries of science, and to 
deny facts medically ascertained. The heat and vehemence with 
which such charges are made, makes a perfectly impartial discus- 
sion of the whole matter difficult. It is hard for any one not to 
resent attacks upon a small body, of which he is himself a member; 
such attacks often being harsh and rude and almost always connected 
with, if not founded, upon misconceptions. The interest, and 
possibly the importance of the task is, however, upon a par witli its 
difficulty and it certainly should be said, in extenuation of the 
violent language, which medical writers frequently use upon this 
matter, that they are sometimes treated in a court of justice, even 
by judges, in a manner, which I think they are entitled to resent. 
Sarcasm and ridicule, are out of place on the bench in almost all 
conceivable cases, but particularly when they are directed against 
a gentleman, and a man of science who, under circumstauces, 
which in themselves are often found trying to the coolest nerves, 
is attempting to state unfamiliar, and in many cases unwelcome 
doctrines, to which he attaches high importance. 
Medical men should thank Sir James for the spirit 
of fairness he here shows, a spirit often lacking in our 
own courts. Often the mere manner and plausibility 
with which an expert opinion is presented are the 
criterion by which he is judged—a cool, unpretentious 4 
enunciation of medical truths, is often belittled and 
argued out of sight by an unscrupulous counsel, or 
carelessly listened to by the court. 
Juries are frequently incapable, without any reflec- 
tion on their education, of appreciating medical expert 
testimony. They easily catch the prevailing spirit of 
judicial indifference and listen with a dull ear, and little 
interest, to perhaps the most important evidence of all. 
Sir James proceeds to say: 
The different legal authorities upon the subject have been right 
in holding that the mere existence Cf madness ought not to be an 
excuse for crime, unless it produces in fact, one or the other of 
certain consequences .... Medical men .... have 
contended in substance that every person who suffered in any degree 
under a disease of which the nature is most obscure, while the 
symptoms vary infinitely, should be free in all eases from legal 
punishment. 
This statement of the position of medical men 
sounds almost like an exaggeration, yet undoubtedly 
is true. It has however an explanation, which is some- 
what as follows: 
Mental diseases are obscure and at any given moment 
rarely present all the symptoms which render their 
diagnosis easily self-evident. If there are one or 
several indications that insanity exists we are right in 
assuming that on a sufficient investigation, we shall be 
able to make the existence of disease certain. There- 
fore what may seem to a lawyer the slightest degree of 
mental disease may be to the expert only one indica- 
tion of deeper trouble, not superficially apparent, but 
none the less, in existence. 
It is a knowledge of this gravity of the disease, 
which is often externally masked, that leads medical 
men to think that all insane men should be free from 
legal punishment. To read judicial opinions correctly is an art in itself, (Sir Janies 
says), to be acquired only by long professional pi'actice, nor Can 
any one begin to do so before lie lias familiarized himself with 
several rules well-known to lawyers, but in my experience, alto- 
gether unknown to medical men. 
If controversy were my object it would be easy to show that 
hardly any one of the medical critics of the law understands what 
he criticises, so far even as to be able to quote correctly the 
authorities on which he relies. 
I have no doubt, from a lawyer’s point of view, that 
this is an entirely correct statement. 
It is quite what we should expect one profession to 
say of another, and is equally in accordance with our 
experience that a legal gentleman rarely interprets 
medical dogmas, precisely as would a medical man. 
To the latter, statements and facts laid down in his text- 
books, have a significance understandable only after 
years of medical training both elementary and practical. 
A technical training may be more necessary to 
rightly convey the meaning of legal dicta, as many 
legal phrases and words have peculiar renderings and 
associations, known only to a legally educated man. 
The moral for the medical man to draw is to more 
carefully revise his acquaintance of matters of law, and 
still further to keep his own opinions within strictly 
medical limits. He is only entirely safe when he holds 
himself to his own province. 
Sir James next takes up a very important question, 
in the present mixed state of medico-legal knowledge, 
namely, the legal meaning of responsibility. We all of 
us have an idea of responsibility, but hardly the legal 
idea. 
He quotes a passage from Dr. Maudsley,* the sense of 
which is that, 
* Responsibility in Mental Disease p. 102. Independently of all law there are conditions of mind called 
responsibility and irresponsibility; that from insufficient observa- 
tion the judges have falsely inferred that irresponsibility is a fact, 
inconsistent with knowledge that a given act is wrong; and that 
judges habitually trespass on the province of the jury by with- 
drawing from their consideration the fact, that physicians assert 
that knowledge that an act is wrong is consistent with irresponsi- 
bility. 
Apart from the question whether the law is as Dr. Maudsley 
supposes it to be, all that a judge directing a jury ever does or can 
understand by responsibility, or irresponsibility is, that the person 
referred to is or is not liable* according to the existing law of 
England to be punished. . . . To allow a physician to give 
evidence, to show that a man who is legally responsible, is not 
morally responsible, is admitting evidence, which can have no 
other effect than to persuade juries to break the law. 
Such is the opinion of Mr. Justice Stephen, and it 
demands our serious attention proceeding as it does 
from so learned a judge. That lie does to a certain 
degree modify this opinion will be apparent I think 
further on. He says: 
If it is true, as I think it is, that the law of England on this 
subject is insufficiently expressed, it is no less true that medical 
knowledge relating to insanity is fragmentary, not well arranged 
and to say the least, quite as incomplete as the law. . . . 
If then due importance is not attached by lawyers to the more 
delicate and obscure forms of disease of the brain, it must be 
observed that medical men have but recently brought them to 
light, and are by no means unanimous as to their nature and 
effect. 
Sir James then proceeds to discuss the meaning of 
the word mind; a sane and insane mind, and in how 
far, and in what case the fact that a person is insane, 
relieves him, by the law of England, from responsibility 
for what would otherwise be a crime, and further how 
far that law is reasonable. 
lie would say that the word mind, may be— 
* Italics mine. 7 
Used as a general name for all the operations commonly called 
mental, namely: sensation or feeling, intellect, emotion volition. 
Sanity exists when the brain and the nervous system are in 
such a condition that the mental functions of feeling and 
knowing, emotion and willing, can be performed in their regular 
and usual manner. Insanity means a state in which one or more 
of the above named mental functions is performed in an abnormal 
manner, or not performed at all by reason of some disease of the 
brain, or nervous system. 
Dr. Bucknill* criticises the above definition of 
insanity, saying: 
It is a medical definition covering the slightest deviation from 
mental health arising from hysteria or alcohol, from bile or gout. 
It includes a state of feeling as sensation, which may not affect 
the mind. It includes abeyance of mental functions which is not 
insanity; for when the mental functions are not performed at all, 
there is no insanity. 
No good, lie thinks, is gained by thus analyzing the 
mind. He gives a medico-legal definition of insanity, 
which is an improvement over most of those given else- 
where. “Insanity,” he says, “is incapacitating weak- 
ness, or derangement of mind, caused by disease.” 
It will be observed that he leaves out the usual 
addition of the seat of the disease, namely, the brain. 
Why he does so, is not clear to my mind. It may be 
that he thinks insanity may be caused by disease of 
the nervous system elsewhere than the brain, an idea 
recently revived. lie says the all important term in 
the definition is the attribute which points to the want 
of power to do something, and that being the case he 
may not regard it as necessary to give a more exact 
medical significance to his definition. 
He thinks it useful and scientifically accurate to make 
a distinction between derangement and weakness. It is 
O 
*A Lecture on the Relation of Madness to Crime. By J. C. Bucknill, 
M. D., F. R. S. Reprinted in the American Journal of Insanity. 8 
hard for me to follow him here, as strictly speaking, I 
do not see how any kind of insanity can exist without 
weakening, impairment, or loss of mental power. 
Derangement is an old-fashioned word in this country, 
usually used as a synonym for insanity. If we say 
a man is deranged, we mean that he is insane. The 
English use of the word is undoubtedly somewhat 
different. Th us W orcester says: “Derangement, aliena- 
tion and delirium are all used to denote a less confirmed, 
or a less violent mental disease than madness and 
mania.” 
If Dr. Bucknill’s definition were changed to “in- 
capacitating weakness of mind caused by disease of the 
brain,” it would seem to gain in accuracy rather than 
to lose. If we use the word disease, it is well to 
further modify it. 
Mr. Justice Stephen, after explaining that the brain 
and nervous system are the organs by which all mental 
operations are conducted, goes on to say that lie finds 
great dfficulty in discovering in any medical work a 
definite account of the course of symptoms collectively 
exhibiting the disease. 
Many forms of insanity are referred to, such 
as total insanity, partial insanity, impulsive insanity, 
moral insanity, pyromania, kleptomania, “ but in the 
absence of any general account of the whole subject, 
showing what is the common cause, of which all these 
symptoms are effects, and how they respectively 
proceed from it, these expressions are like adjectives 
connected with an unintelligible substantive.” 
Again he says he has sought in vain for what 
appeared on the face of it an accurate picture of 
insanity, as a real disease. In Griesinger’s work on 
“ Mental Pathology and Therapeutics” only did he find 
the sketch he sought. Griesinger published his second 9 
edition in 1861, it will be remembered, the English 
translation being issued in 1867. 
Since 1861, as I have already intimated, the medical 
literature of insanity has grown immensely, and many 
new facts bearing on insanity have been brought to 
light. Many excellent, systematic treatises have been 
written; new classifications adopted, and very care- 
fully prepared observations on the pathology, etiology 
and morbid anatomy of insanity have been published 
from time to time. Notwithstanding these facts, how- 
ever, Griesinger is perhaps as good an authority as Sir 
James could have selected for his purpose. 
He sums up what he learns from Griesinger some- 
what as follows: Any one or more of numerous 
causes may produce disease of the brain or nervous 
system, which interfere more or less with the feelings, 
the will and the intellect of the persons affected. 
Commonly the disease if it runs its full course, effects 
the emotions first, and afterwards the intellect and the 
will. It may produce either melancholia or mania, the 
first being much the most common. Both of these 
forms of insanity “commonly cause delusion, or false 
opinions, as to existing facts, which suggest themselves 
to the mind of the sufferer as explanations of his 
morbid feelings.” The delusions are often accompanied 
by hallucinations. 
Melancholia, mania, and the delusions arising from them, often 
supply powerful motives to do destructive and mischievous acts; 
and cases occur in which the earnest and passionate desire to do 
such acts is the first and perhaps the only marked symptom of 
mental disease. It is probable that in such cases some morbid 
state of the brain produces a vague craving for relief by some 
sort of passionate action, the special form of which is determined 
by accidental circumstances; so that such impulses may differ in 
their nature and mode of operation from the motive which 
operate on sane and insane alike. 10 
Insanity affecting the emotions in the form of melancholia and 
mania is often succeeded by insanity affecting the intellect and 
will. In this stage of the disease, the characteristic symptom is 
the existence of permanent incurable delusions commonly called 
monomania. The existence of any such delusion, indicates dis- 
organization of all the mental power, including not only the 
power of thinking correctly, but the power of keeping before the 
mind and applying to particular cases general principles of 
conduct. 
The last stage of insanity is one of utter feebleness. 
Paralysis and epilepsy are also closely allied to insanity. 
Moral insanity is next spoken of, and Dr. Maudsley’s 
account given of it. 
The above account may stand for a fair description 
of insanity from a legal stand-point. The only 
objection to it seems to be that it sometimes conveys an 
imperfect idea of the conditions it describes. 
We should hardly say that melancholia and mania 
are emotional states alone, for accompanying them there 
is intellectual change or impairment as well. Morbid 
thoughts and ideas are evolved in the earliest stages of 
melancholia and mania. Delusions, or delusive ideas, 
are in fact often the earliest indications of mental 
trouble; the first visible outward manifestations we 
might say. The intellectual and emotional changes 
are inter-dependent, developed together. There is no 
arbitrary line between them, and it is hardly safe to 
endeavor to separate them for the sake of greater clear- 
ness of description, or expression, desirable as it is on 
legal grounds. 
A medical man would hardly say, if he desired to be 
very accurate, “ melancholia, mania, and the delusions 
arising from them” but rather, melancholia and mania 
with their accompanying delusions. Delusions are 
characteristic of these forms of insanity. In some 
cases they are unusually prominent and easily recog- 11 
nized, to be sure, but they may be assumed to exist 
when not easily recognized. 
The mistake made by lawyers seems to be that they 
regard delusions rather as entities than an integral part 
of the disease. They do not appreciate the fact that 
the insane condition is a delusive or false one, the 
power of perception being disturbed and weakened. 
Monomania, from one point of view, though a useful 
word to us, is misleading to lawyers, for it conveys this 
same idea, of a single, mistaken idea in one direction, 
whereas it is much more. It is merely the outward 
expression of a general functional, or organic disturb- 
ance. The feelings, intellect and will are all affected, 
as in melancholia and mania. 
Clouston* has very truly said that “ there are very 
few, if any, examples of a pure monomania—that is of 
a person who has one single delusion, and that alone. 
The ordinary form of this type of mental disturbance 
is for the delusions of the patient to refer to one 
particular subject, or set of subjects.” 
Blandfordf in his last edition, deprecates the use of 
the word monomania, and says nothing is gained by 
employing it, as no two persons attach the same mean- 
ing to it. 
Sankeyij; (last edition) particularly dislikes the word 
and says as such a condition does not exist, most 
writers have agreed to abandon the word. 
Krafft-Ebingl refers to the views of the old German 
writers that monomania arose primarily from melan- 
cholia, or mania, and said that in those cases where 
such an origin was not found, the history they thought, 
* Lectures on Mental Disease, p. 189. 
f Insanity and its Treatment, p. 271. 
X Lectures on Mental Disease. 
| Lehrbucli der Psychiatrie, p. 70 et seq. 12 
was imperfect, as an initial melancholia or mania must 
have existed. 
Snell,* in 18G5, described a form of insanity 
characterized by delusions with hallucinations, but 
without the self-absorption of melancholia, or the con- 
fused idea and severity of mania, and which generally 
affected the intellect less than the other forms of 
insanity. lie thought monomania a name not ill- 
adapted for this disease. 
Griesinger at a later period, recognized a form of 
insanity of primary origin. Sander, Schi'ile, Hertz, 
Westphal and others have also adopted the same idea. 
Primare Verriicktheit, is certainly now a well described 
and clearly recognized form of disease with the 
Germans. 
Spitzkaf states that Griesinger formally accepted the 
doctrines of Snell before his death. lie also says that, 
“To-day the German alienists, by a resolution of their 
association, stand unanimously committed to the 
recognition of a primary form of chronic insanity 
known by them as Primare Verrucktheit, and erpiivalent 
to the monomanie of the French.” 
The word 7uouomania appears an unfortunate one, 
possessing as it does, so many different meanings, and 
if used at all must be used with the greatest caution. 
I endeavor myself to avoid it; preferring rather to say 
mania with delusions of a certain nature. 
Primare Verrucktheit is an excellent term in German, 
but an equivalent should be found for it in our own 
language. Monomania will hardly be sufficient, unless 
by common consent we modify, or rearrange our 
nomenclature. 
The time must sometime come when we shall have a 
* Insanity, Spitzka, p. 289. 
f Insanity, p. 289. 13 
clear, precise and scientific system of classifications of 
the different forms of insanity. Until such a time, at 
least in courts of law, it is best to use simple and well 
recognized names in describing the various kinds of 
mental disease. Outside of court rooms, the discussion 
of* a classification is to be desired in order that by 
continual striving we may eventually evolve a uniform 
system. 
Sir James next refers to moral insanity, which he 
relies on Maudslev to describe, and then says as a 
summary of what has gone before: 
Insanity powerfully affects, or may affect the knowledge by 
which our actions are guided ; the feelings by which our actions 
are prompted; the will by which our actions are performed, 
whether the word will is taken to mean volition, or a settled 
judgment of the reason, acting as a standing control on such 
actions as relate to it. 
The means by which these effects are produced are unnatural 
feelings; delusions or false opinions as to facts; hallucinations or 
deceptions of the senses; impulses to particular acts, or classes of 
acts; and in some cases (it is said) a specific physical inability to 
recognize the difference between moral good and evil as a motive 
for doing good and avoiding evil. 
Sir James then proceeds to consider how far these 
conditions may serve as an excuse for crime, and how 
far the state of law on the subject is reasonable. 
In his Digest he has stated the law of England as 
follows: 
No act is a crime if the person who does it is at the time when 
it is done prevented [either by defective mental power orj* by any 
disease affecting his mind. 
(a.) From knowing the nature and quality of his act, or 
(6.) From knowing that the act is wrongf [or 
(c.) From controlling his own conduct, unless the absence of 
the power of control has been produced by his own default.] 
* The parts enclosed in brackets [ ] are doubtful. 
-J- Variously interpreted as meaning morally wrong and illegal. 14 
But an act may be a crime, although the mind of the person 
who does it is affected by disease, if such disease does not in fact 
produce upon his mind one or other of the effects above mentioned 
in reference to that act. 
Sir James speaks of some of the meanings to these 
terms being clear, but not under certain combinations 
of facts. The authorities have not satisfactorily settled 
the matter. Coke mentions the subject of madness 
only casually. Ilale has a chapter on it, which omits 
the difficulties, and is generally marked by the 
ignorance of the in which it was written. 
“From the time of Hale to our own no legal writer 
of authority has discussed this matter on its merits. 
. . . the circumstances have never been such as 
to afford an opportunity for a solemn argument and 
judgment, laying down the principles of law bv which 
the relation of insanity to crime may be determined.” 
Apart from some slight exceptions, Sir James says 
that “every judgment delivered since 1813 has been 
founded upon an authority which deserves to be 
described as in many ways doubtful.” 
The authority to which he refers is that of the 
answers of the judges to the questions on insane 
delusions put to them in consequence of the acquittal 
of McNaghten. 
It has been the custom ever since these answers were 
given for judges to make use of them in charging 
juries, and Sir James himself has done so on several 
occasions. He himself, however, in common with some 
of the most distinguished judges feels that the authority 
of the answers is questionable, and it appears to him 
they leave untouched the most difficult questions con- 
nected with the subject. 
In the first place they do not form a judgment upon 
definite facts proved by evidence. 15 
In the second place “ they leave untouched every 
state of facts which, though included under the general 
words of the questions, can nevertheless be dis- 
tinguished from them by circumstances which the 
House of Lords did not take into account in framing 
the questions.” 
The points on which the law appears to be left in 
doubt may be reduced to one question : “ Is madness 
to be regarded solely as a case of innocent ignorance or 
mistake, or is it to be regarded as a disease which may 
affect the emotions and the will in such a manner that 
the sufferer ought not to be punished for the acts 
which it causes him to do?” 
After carefully analyzing the answers somewhat in 
detail, Sir James gives it as his opinion, “that even if 
the answers given by the judges in McNaghten’s case 
are regarded as a binding declaration of the law of 
England, that law as it stands is, that a man who by 
reason of mental disease is prevented from controlling 
his own conduct is not responsible for what he does.’* 
lie also thinks that the existence of any insane 
delusion, impulse, or other state which is commonly 
produced by madness is a fact relevant to the question, 
whether or not he can control his conduct, and as such 
may be proved and ought to be left to the jury. 
The influence of madness over the will seems to him 
to admit of classification under two heads. If madness 
furnishes a strong, yet a controllable temptation to 
crime it should not be an excuse. A man whose 
temper was intensely exasperated by suppressed gout 
would not be excused for any act of violence which lie 
might commit in consequence, and why should he be 
excused if his general power of self-control remained, 
if the act of violence was caused by insanity ? 
There are cases, however, in which self-control is interfered with, and if this can be proved, the sufferer 
should be excused. 
The man who controls himself refers to distant motives and 
general principles of conduct, and directs his conduct accordingly. 
The man#who does not control himself is guided by the motives 
which immediately press upon his attention. If this is so, the 
power of self-control must mean a power to attend to distant 
motives and general principles of conduct, and to connect them 
rationally with the particular act under consideration, and a 
disease of the brain, which so weakens the sufferer’s power as to 
prevent him from attending or referring to such consideration, or 
from connecting the general theory with the particular act, 
deprives him of the power of self-control. 
Can it be said that a person so situated knows that his act is 
wrong? I think not; for how does any one know that any act is 
wrong except by comparing it with general rules of conduct 
which forbid it, and if he is unable to appreciate such rules or to 
apply them to the particular case, how is he to know that what 
he proposes to do is wrong ? 
Where madness is proved juries should return one of 
these verdicts: “Guilty; Guilty, but his power of 
self-control was diminished by insanity; Not guilty on 
the ground of insanity.” 
Sir Janies justifies the first verdict somewhat as fol- 
lows: Insanity is a disease, but in many cases it is the 
sufferer’s own fault. Medical works make the con- 
nection between insanity and every sort of repulsive 
vice so clear, that it seems more natural to ask in many 
cases, if it is not rather a crime in itself than an excuse 
for the crime it causes. We do not recognize the 
grossest ignorance, the most wretched education or 
involuntary association with criminals as an excuse for 
crime. This should lead to strictness in allowing 
insanity as any excuse at all in doubtful cases. 
It is upon this ground “that the general rule that a 
person should not be liable to be punished for any act 
done when he is deprived by disease of the power of controlling his conduct should be qualified by the words 
unless the absence of the power of control has been caused 
by his own default.” * 
Here Sir James takes the strictly abstract legal view, 
and I for one can not follow him to the extreme which 
he reaches. If medical works make the connection 
between vice and insanity clear in many cases, in a very 
much larger number of cases they make the absence of 
this connection equally clear. They show that heredity, 
want, domestic anxiety or affliction, business cares, over 
education, unavoidable physical disease, all of these of 
a perfectly innocent nature, very frequently lead to 
insanity. 
An exactly opposite inference to the one drawn by 
Sir James would be the more justifiable, and we might 
say the fact that insanity exists should be presumptive 
evidence of the alleged criminal’s innocence. 
Neither have we adequate grounds for reasoning by 
analogy and saying that insanity which very rarely 
leads to crime, as a matter of fact, is similar in nature 
to gross ignorance, wretched education, or involuntary 
association with criminals. The existence of these 
conditions implies favoring circumstances for the devel- 
of crime. Insanity implies nothing of the 
kind. 
Sir James says as to the second verdict: 
Reluctance to punisli when punishment is needed seems to be to 
me not benevolence but cowardice, and I think that the proper 
attitude of mind toward criminals is not long suffering charity, 
but often enmity; for the object of the criminal law is to over- 
come evil with evil. But, however this may be, it is impossible to 
state it more clearly than these passages state it, the position for 
which lawyers have contended as to insanity. That position is, 
that parts of the conduct of mad people are not affected by their 
madness, and that if such parts of their conduct are criminal, they 
ought to be punished for it. 
* Italics mine. 18 
Again Sir James is legal in his view of the subject, 
as indeed he should be. To me it sounds harsh to say 
unqualifiedly the only way to overcome evil is with 
evil. 
We get on dangerous grounds as experts when we 
speak of parts of the conduct of mad people. It seems 
to me both undesirable and unscientific to separate 
conduct into parts. A given case should be considered 
in its entirety and a complete description of all the 
attributes of conduct be given and passed on. 
In relation to the form of punishment to be made use 
of in cases covered by the second verdict, Sir Janies has 
some very original ideas, the latter part of which must 
meet with our approval, however unwilling we may be 
to agree to the expression of punishing of insane 
persons. He says: 
Ought they (the second class) to be punished in all respects 
like sane people? To this I should certainly answer: Yes, as far 
as severity goes; no, as far as the manner of punishment goes. 
The man who, though mad, was found guilty without any qualifi- 
cation of murder, T would hang; but if the jury qualified their 
verdict in the manner suggested in respect of any offender, I think 
he should be sentenced if the case were murder, to penal servitude 
for life, or not less than fourteen years, and in cases not capital to 
any punishment which might be inflicted on a sane man. As to 
the manner of executing the sentence, I think there ought to be 
special asylums, or special wards in the existing asylums, reserved 
for criminal lunatics, in which they should be treated, not as 
innocent lunatics are treated, but as criminals, though the discipline 
might be so arranged as to meet the circumstances of their disorder. 
. . . The man who is acquitted on the ground of insanity and 
the man who is convicted, but found to have been under the 
influence of insanity to some extent, ought, I think, to be separated 
and submitted to different kinds of discipline. 
“ Iu connection with this subject,’1 Sir James says, “ I 
may observe that the principle that madmen ought in some cases to be punished is proved by the practice of 
lunatic asylums.”* 
In a foot-note he says that Dr. Maudsley admits this 
(Responsibility, p. 129). He (Maudsley) goes so 
far as to say “abolish capital punishment, and the 
dispute between lawyers and doctors ceases to be of 
practical importance.” Maudsley says that the punish- 
ment of death should never be inflicted on an insane 
person, but Sir James thinks cases, though rare, might 
occur as he has above intimated. 
As to the verdict of not guilty on the ground of 
insanity, Sir James says: 
It ought to be returned in those cases, in which it is proved 
that the power of self-control in respect of the particular act is so 
much weakened that it may be regarded as practially destroyed, 
either by general weakening of the mental powers, or by morbid 
excitement, or by delusions which throw the whole mind into 
disorder, or which are evidence that it has been thrown into dis- 
order by diseases of which they are symptoms, or by impulses 
which really are irresistible, and not merely unresisted. 
To conclude, it appears to Sir James that the line 
between the departments of law and medicine in this 
matter is, theoretically, and ought to be, practically 
clear. 
What the mental elements of responsibility are, is 
and must be a legal question. It can not be anything 
else, “for the meaning of responsibility is liability to 
punishment; and if criminal law does not determine 
*Wliy should this he an argument in faver of punishing lunatics? 
Punishment is to protect society, and to deter its members from crime, to its 
own injury. Is there anything in the conduct of insane asylum inmates 
who obey rules like a higher order of animals, which would lead us to 
believe that these ends would be better accomplished, if lunatics as a class 
were made to undergo penal servitude? Perhaps it did not occur to Sir 
James that lunatic asylums have to be built and managed in a manner adapted 
to lunatics, otherwise the lunatics could not adapt themselves to these 
institutions. who are to be punished under given circumstances, it 
determines nothing.” 
These elements, so far as madness is concerned, are 
knowledge that an act is wrong and power to abstain 
from doing it, and it is the province of judges to 
declare and explain this to the jury. 
I think it the province of medical men to state for the informa- 
tion of the court such facts as experience has taught them bearing 
upon the question whether any given form of madness affects, and 
in what manner and to what extent it affects, either of these 
elements of responsibility, and T see no reason why, under the 
law as it stands, this division of labour should not be fully 
carried out. 
If I am wrong in thinking that the power to abstain from a 
given act is an element of responsibility for it, the duty of the 
judge is to tell the jury that such is the law and to exclude from 
the consideration of the jury as being irrelevant, all evidence 
tending to show that the accused person was deprived by disease 
of control over his actions. 
Sir James next briefly considers moral insanity. 
Maudsley, Pritchard and Ray describe this form of 
insanity, which seem to diminish, or destroy those 
habitual feelings unfortunately called the “ moral 
sense.” He would shrink from saying that this form 
of disease should never excuse crime. It would 
depend on whether the jury could or could not be 
convinced that the sufferer in a given case was 
deprived of the knowledge, or of the power which he 
regards as the two elements of responsibility by law. 
If the morally insane man is as able to abstain from crime as a 
sane bad man and has the same reason—namely, fear of 
punishment for abstaining from crime, why should not he be 
punished if he gives way to crime ? 
To this question we must answer that we do not 
believe in the morally insane man. That is we believe 
that while cases may exist without delusion, strictly 21 
speaking, we feel sure that in any case of apparent 
moral insanity sufficient intellectual impairment will 
be found to constitute a true instance of complete 
insanity. There may be cases of insanity with the 
immoral elements most prominent, and these to us 
always correspond to the so-called cases of “moral 
insanity.” Unless something besides depravity exist, 
we can not call a man insane. 
Sir James says finally that: 
The impression made on my mind by hearing many, 
some most distinguished judges sum up to juries in cases of 
insanity, and by watching juries to whom I have myself summed 
up on such occasions, is that they care very little for generalities. 
In my experience they are usually reluctant to convict if they 
look upon the act itself as upon the whole a mad one, and to 
acquit if they think it was an ordinary crime. But their decision 
between madness and crime turn much more upon the particular 
circumstances of the case, and the common meaning of words, 
than upon the theories, legal or medical, which are put before 
them. It is questionable to me whether a more elaborate 
enquiry would produce more substantial justice. 
In what I have written above I have quoted very 
extensively and said but little myself, which the more 
commends my report to your consideration. It is 
my earnest hope that it will lead to a thorough 
discussion of the difficult and important subject of 
which it treats.