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ANNUAL  SESSION,  APRIL, 1873
BY
G. A. SHUKTLEFF, M. D.,  t^CeF
PRESIDENT.
PUBLISHED BY THE SOCIE
     SACRAMENTO:
T. A. SPRINGER, STATE PRINTER.
         1873. 
*>,.  it
<■ 
ADDRESS
DELIVERED BEFORE THE
♦if   ♦
ANNUAL  SESSION, APEIL,  18T3.
BY
G. A. SHUETLEFP, M. D.,
PRESIDENT.
Publislied  by the Society.

          <J •■-'--------------------■i-.-'k.
00
■j- ttp i fV co
             SACRAMENTO:
T. A.  SPEINGEE, STATE  PEINTEE,
                  1873. 
 
ADDRESS.
  Gentlemen: The change in the time of holding our meetings
brings this annual  session within just a half year of the last.
During this brief period so little of new or uncommon interest
has transpired that I deem it unprofitable to attempt an excur-
sive view of general  topics connected with our profession.  I
propose, therefore, to confine my remarks mainly to those sub-
jects which appertain more particularly to that branch of med-
ical science in which I am specially engaged.
  The division of Forensic Medicine termed the Medical Jurispru-
dence of Insanity seems at this time to urgently claim our special
consideration.
  The frequency with which the plea of insanity has of  late
been resorted to, with  undeserved success, to  avoid  responsi-
bility for crime—the irregular, unscientific, and  generally un-
fair manner in which such trials are conducted with regard to
medical testimony—the  danger of a more unenlightened, mis-
guided, reactionary movement, to the peril of the really insane—
the ends of justice  and the welfare of society, all seem to  call
for reform in the law relating to the trial of criminal  cases in
which the mental condition of the  accused is involved.
  We need not stop to consider  the disparaging  comments,
which, in a few rare instances, have been uttered, even from 
4                 ANNUAL ADDRESS.
  the bench, in both England and the United  States, upon the
  testimony of medical experts.  Still less worthy of notice are
  the jeers of the criminal lawyer, whose inflated words scarcely
  outlive their echoes, and who sometimes seeks  to conceal by
  ridicule the parts  of his cause which he is  unable to support
  by evidence.
   As the sciences of law and medicine advance, the more will
  the latter be called in aid of the former, in all cases  involving
  medical questions.   When Lord Hale influenced the verdict of
  a jury by the avowal  of his belief in "such creatures as
  witches,"  and sentenced two  women to be hung, who  were
  accordingly executed for the crime of witchcraft—when insan-
 ity was regarded as a demoniacal possession instead  of a dis-
 ease—the  testimony of medical experts was less sought  and
 less respected than  it is now.
   Although mox-al or psychical causes may produce the physi-
 cal condition on which it depends, insanity is the result of some
 physical disease, change; or defect, as much as  is the dyspnoea
 of asthma or the involuntary motion  of chorea.'  Instruction
 in its causes, nature, and treatment  are  a part of the profes-
 sional  education of the  regular physician, as much as is his
 knowledge of any of the diseases with which man is  afllicted.
   In our physical life the mind is dependent on physical organ-
 ization for its  development and action.  It has its anatomy,
 physiology, and pathology.  Its special organ is the brain, the
 most complex and delicate of organized structures.  This organ
 has its essential auxiliary in the  senses, through which it re-
 ceives impressions from without, and  by which the mind within
is endued with a consciousness of external nature.
  A knowledge of the  nature of mind is  beyond  the reach of
the finite  understanding.   The profound and subtle  logic  of 
STATE MEDICAL SOCIETY.
5
Herbert Spencer fails to grasp it, and all metaphysical attempts
to explain it leave us in confusion and darkness.  Mere science
can neither comprehend it nor pursue its existence or condition
beyond its connection with the body.   It  is only its mode of
action, in  its somatic relations, which comes within the prov-
ince of medical study and  research.  The  conflicting opinions
of mental physiologists arise from an attempt to explain  the
nature of mind, not from any dispute that the brain, with its
nervous connections, is the organ  by which its action is mani-
fested.
  I know of no purely psychical theory maintaining that  the
mind possesses the power of acting to the comprehension of
human beings unconnected with  its material organism, unless
the so-called spiritists, with whose doctrines I am unfamiliar,
entertain  such a belief.
  Among the most eminent and  learned  physiologists  there
seem to be two pretty distinct theories advocated regarding
the connection  between the mind and the body.
  One class of physiologists holds that the will,  or some men-
tal force which is  purely the attribute of the soul, directs  the
mental action of the brain.  The  brain is the necessary instru-
ment of our mental operations, which receives  impressions
from without, elaborates ideas, and gives  expression to  intelli-
gence and emotion, as the telegrapher's  apparatus develops the
electric energy, receives impressions, and intelligibly expresses
them.   The operator represents  the higher mental principle,
the ego or will (Van der Kolk).  Yet he is unable to evoke and
apply  the energy,  and to  receive and give expression  to his
message, without the means of the material apparatus; and the
instrument is equally incapable of performing its oflice without
the higher directing power of the operator.  This view of the 
6                 ANNUAL ADDRESS.
relation between force and matter is illustrated by Faraday, in
his philosophy of vital force.
  Hence we see that though the inexplicable immortal ego, or
higher principle of mind, exists, it can manifest  itself, during
man's finite existence, only through or by means of the physical
organism with which the law of an all-wise Creator holds  it in
inseparable connection; and it can manifest itself, or direct the
natural forces of the mind, only according to the condition of
the organic means of action—feebly in the deficient, powerfully
in the perfect, and in an irregular, deranged manner in the dis-
ordered organization.
  The other  class of physiologists  do not recognize a dualism
of force and matter.  They hold that mind is the product of the
action and development of the  brain—"an organized result,
matured by insensible degrees in the course of life."  Professor
Austin Flint, Jr., in his  recent work  on  the nervous system,
thus  plainly  states his views,  which  clearly  distinguish  him
from the class first noticed.  He says " the brain is not, strictly
speaking,  the organ  of  the  mind;  for this statement would
imply that the  mind exists  as a force independently of the
brain; but the mind is produced by the brain;  and intellectual
force, if we may term the intellect a  force, can  be produced
only by the transmutation of a certain amount of  matter."
  While, therefore, there is a difference of opinion among the
foremost of our profession as to the exact  relation between the
mind  and the body, all agree that the mind is dependent on the
brain and its  sensory and nervous  auxiliaries  for its  develop-
ment, efficient action and manifestation during the finite  life.
Whether above this organized source of mind there is a higher,
independently acting,  directory force,  is a metaphysical ques- 
STATE MEDICAL SOCIETY.
7
tion, or rather a matter of belief, which no physiological investi-
gation can reach.
   It is now satisfactorily demonstrated and generally acknowl-
edged, that the gray cortex of the cerebral  hemispheres is the
seat of the mental  faculties.   At the  base of the brain are the
sensory ganglia, possessed by the lower animals as well as by
man, which receive, but have not the power of retaining, im-
pressions  from  the external world.   Above  these  sensory
ganglia, never developed in  the  lower  animals  as in  man, are
the cerebral hemispheres, with their  deep sulci  and numerous
convolutions.  In the gray substance of these convolutions are
layers  of innumerable  nerve-cells.  Now the  sensory ganglia,
at the base of the brain, which receive impressions from with-
out but never retain them, are connected with the nerve-cells
of the  hemispheres by fine  medullary fibers, whose  function
undoubtedly it is, to take up the  fleeting impressions  from the
sensory nerve-centers  to  the supreme  nerve-centers,  where
they are retained.   Thus, what we see, and hear,  and feel, if
recognized by the  supreme nerve-cells, is preserved, compared,
and arranged, and elaborated into definite ideas.  These nerve-
cells of the cerebral hemispheres are the "nervous centers of
ideas"  (Maudsley); or, more  comprehensively,  of the mind,
including the intellect  and the emotions or feelings,  and  the
executive function  of volition.
   Conductive medullary  fibers  also  connect  the  supreme
nervous centers with each other, thus giving them the power
of reaction upon each other and  securing the coordination of
the whole.   A kind word does not  create a pleasurable emo-
tion until the intellect  comprehends the quality of the word;
and an  insulting  speech cannot  arouse the emotion of anger
until intelligence discerns the offensive character of the speech. 
8                 ANNUAL ADDRESS.
 On the other  hand, from this  intimate connection and  mutual
 reaction,  the  intellect derives force,  earnestness,  and warmth
 of expression from the emotions.  Its faculties thus anatomi-
 cally united, the mind is physiologically a unit.
   Insanity  cannot exist, in my opinion, without  an  affection,
 idiopathic or sympathetic, of the nervous centers of the hemis-
 pheres of the  brain.   For instance, suppose the sensory ganglia
 to be diseased.  The result would be hallucination  of some one
 or more of  the senses.  But as long as the  higher nervous cen-
 ters remain sound, the hallucinatory impression  is  by them
 recognized  as such, and known to be a false impression  result-
 ing from  disease.  Now if the nervous centers of  the cerebral
 hemispheres become involved  in the disease, there is no power
 left to correct the hallucination, and insanity is the result.
   In what particular  part of the brain cortex  are  the nervous
 centers of the intellect, and in what part those of emotion, or
 any  other faculty of the mind, is not known, though some
 advance appears to have been made  in that direction by one
 whose opinions are entitled to the highest consideration.
   Professor Schroeder van der Kolk  says: "As the result of
 many years continued and  accurate examinations, I  can state
 that in proper  intellectual insanity invariably the cortical layer
 under the  frontal bone appears more deeply colored, was more
 firmly adherent to the  pia  mater,  or was softened.  On the
 other hand, in melancholy, where anxious agitation and sensa-
 tion of heat and pressure occur, and where the emotion more
 than the intellect suffers, pathological changes are found  rather
 in the convolutions of the upper and hinder lobes.  Thus we
 come to the  conclusion that  the cells  in the upper and hinder
lobes  have a different  action from  those of the anterior lobe;
the former bring about emotional  feelings."  Again  the same 
STATE MEDICAL SOCIETY.             9
 author, in  his chapter on the pathological anatomy of sympa-
 thetic mania, substantially repeats the same experience: "Gen-
 erally, however, in melancholy, especially when it  proceeds
 from the intestines and sexual parts, the vortex and back of
 the head are most affected, and the anterior part of the hemis-
 pheres, under the frontal bones, displays the fewer pathological
 changes, in proportion as  the patient, during his melancholy,
 has remained free from general intellectual confusion, and apart
 from his ruling false idea, spoke sensibly.  In idiopathic mania
 these  anterior parts of the  hemispheres suffer more.  But if
 now, by long duration of the melancholy the sympathetic brain
 affection has at length become idiopathic, and the melancholy
 passes into mania  or  dementia, then the brain affection is no
 longer circumscribed."
   I quote  these observations of this distinguished contributor
 to the pathology of mental disease, not so much to bring forth
 his immatured  and  unconfirmed views respecting the particular
 location of the nerve-centers of the intellect and those of emo-
 tion, as  to furnish  the pathological evidence  they  afford, that
 the nerve-cells of the cerebral hemispheres, in the aggregate,
 constitute  the immediate organism by which mental phenomena
 are produced.  Insanity, then, is an  affection of the nervous
 centers  of the  cortex  of the cerebral hemispheres, or, as  Dr.
 Skae  defines it, "a disease of the brain affecting the mind."
  I have noticed one or two points in the anatomy, physiology,
 and pathology  of mind, mainly to show how necessary medical
 knowledge is to a proper comprehension of insanity.  Had we
 time to consider all its different forms and the Protean shapes
 each form  may assume, the  necessity of  expert testimony, in
 all cases of disputed mental condition, would appear still more
manifest.
            2 
10                ANNUAL ADDRESS.
   There are two forms of insanity which  in  criminal  cases
there is danger of overlooking where  it really exists, and of
discovering where it does not exist.  I allude to the  so-called
moral insanity and mania transitoria.
   Moral mania  is the  Gordian knot of  the jurisprudence of
insanity.  It has a bad name, because it has been so often used
to shield the wicked from responsibility for their criminal acts.
Its very existence is in dispute.  The name is not an altogether
acceptable one, but as it has  been used by our most eminent
authors ever since the day of Dr. Prichard, the medical witness
can neither ignore nor evade it.  It is the mania without delusion
of Pinel;  the reasoning monomania and the affective monomania of
Esquirol, and, finally, it received its present unfortunate name
of moral insanity from Dr. Prichard, in eighteen hundred and
thirty-five.  He defines  it as "a morbid perversion of the natu-
ral feelings, affections, inclinations, temper, habits, moral dispo-
sitions, and natural impulses, without any remarkable disorder
or defect in the intellect, or knowing or reasoning faculties, and
particularly without any insane illusion or hallucination."
  That  insanity may exist without delusion, of a permanent
character, is a  fact too well established to require discussion
before an association of medical men, though the legal profes-
sion is slow to understand it.
  We see it sometimes  demonstrated in the first stage of the
more violent forms of mental disease.  The manner of the indi-
vidual is changed;  he feels that all is not right with him; a
sense  of impending evil oppresses him; he loses his interest in
his business and is unable to apply himself to anything; family
and friends  fail  to interest him,  and they sadly whisper that
"his mind is not right."  This state may be followed by an
opposite condition of lively and exalted emotions,  before any 
STATE MEDICAL SOCIETY.            11
 delusion is manifested.  Finally, after  weeks and  months, or
 years possibly, insane delusions appear.   Now no one can deny
 that the mind of such a person was just as truly diseased before
 as after the disease had arrived at the stage of delusion.  In the
 first stage suicide may be feared; in the second, waste of prop-
 erty; in the third, any irrational or violent act that the character
 of his delusion might lead  him to commit.  In the  first stages
 the emotions or feelings manifest the unsoundness of mind rather
 than the intellect.
   Metaphysicians as well as physicians  regard the emotions as
 a component part of the human mind.  Brown, the successor of
 Eeid and Stewart, and  Bain, speak of the intellect and  the
 emotions, in analyzing the mind into the faculties or attributes of
 which it is composed.
   Alienists of the present day agree  that the feelings,  no less
 than the phenomena  of intelligence or reason, are produced by
 the action of the nervous centers of the cerebral hemispheres.  I
 may again refer to  Schroeder van der Kolk, whose pathological
 researches so nearly convinced himself in what particular part
 of the hemisphere were situated the nerve-centers of the intel-
 lect and the  nerve-centers of  emotion ;  not  that  he  has
 illustrated the general subject so ably as  Maudsley, but because
 he harmonizes his physiology of mind to an immortal "higher
 principle," though in the finite life  " it acts nowhere but in the
 brain, in which alone is our  consciousness rooted."
   The mind being thus composed of a union of different faculties,
 the logical inference is that  any one faculty, or set of faculties,
 is  as liable to  become the  prominent exponent of the  mental
 disease as another;  that the  emotions, not less than the intellect,
may be the seat of morbid action.
  There are those who seem to hold the  intellect, as long as it 
12
ANNUAL ADDRESS.
presents no marked lesion, responsible for the good government
and proper conduct of all the other faculties of the mind.  Such
a view is inconsistent with the ordinary phenomena of diseased
nervous action.  Do we not know by every day's  experience,
that the  subordinate nervous  centers, under the irritation of
disease or certain poisons, revolt and set up a spasmodic inde-
pendent action ; as,  for  instance, the spinal nerve-centers in
tetanus, or under the toxical effects of strychnia?
  The emotions, I am  satisfied,  have their appropriate nerve-
cells, although they are not distinguishable.  When affected by
disease  they  respond  inordinately,  or  violently  and  spas-
modically, or not at all, to the impressions made by the senses
or the ideas.   The intellect presents no marked or obvious signs
of disease; but a morbid state of the emotions has established a
chafing, dominant, tyrannizing power over it, and destroyed the
harmonious relations.  Without  a loss of knowledge, in  the
excitement and  conflict, there is a loss of relative power  and
control.  Eeason is not held in permanent  and constant sub-
jection, as is the case  in fixed  delusion;  but she is repeatedly
assailed,  and often overcome,  by the riotous outbreaks of the
disordered emotions.
  These nerve-cells also may lose their sensibility and energy,
and not respond to the objects or idea of friendship and love.
A cold indifference takes  the place of the domestic affections
and of social geniality.  The sufferer will sometimes appreciate
the change and deplore the loss of love for relations the nearest
and formerly the most  dear.   The intellect is not impaired to an
extent which prevents it from  recognizing the  disaster which
the feelings have sustained.
  Again,  overstrained, or by  some  failure  of nutrition  and
repair, they may become exhausted.  Melancholy  is likely to 
STATE MEDICAL SOCIETY.
13
result from this state.  The  feelings of hope and courage are
paralyzed.  Darkness and despair brood silently in " ambition's
airy hall."
   In all  these  different  conditions,  and especially in  medico-
legal investigations, we must, however, keep  in view the fact
that the  mind itself is a unit—a complex entity, made up of
the united energies of different organic faculties.  The intellect
may  be utterly incapable, under the  influence of disordered
emotions, of doing what it might perform, or of declining what
it would  reject, in a healthy condition  of the feelings.  With
regard to the action of  the mind, therefore,  I think we may
adopt  this as a maxim:  If it be disordered in a part it is im-
paired in  the whole.
   The mental disorder is the result of pathological  change or
congenital defect of the  somatic structure.  It may exhibit
itself mainly through either the intellect or the feelings, though
it is generally manifested in both.
   When insanity is pleaded to avoid  responsibility for crime, if
there be  no marked lesion of the intellect, and especially if it
be that form of emotional insanity which is characterized  by a
perversion of the moral  sentiments, great care is required to
distinguish between the effect of disease and the result of natu-
ral depravity and habitual vice.   We must satisfy ourselves of
the existence of an  abnormal physical condition, as  the cause
of the  mental obliquity.   The  competent physician can  gen-
erally do  this with as much certainty as appertains to the diag-
nosis of diseases generally.
   The complete change in the character and habits of the indi-
vidual compared with his former self, the variable and easily
accelerated pulse, capillary congestion, or a sickly, palid hue of
the skin,  the  noticeabl ' excited  play of the emotions  in  con- 
14
ANNUAL ADDRESS.
versation, manifested by the quickly coming tear, or tremor of
the muscles of the face, suspicions and jealousies which fre-
quently amount to temporary delusions,  unreasonable views
and impracticable schemes inconsistent with the previous mode
of thought and action, a mixture of religious emotion with out-
rageous immorality, impatience, restlessness, and instability of
purpose, insensibility to shame on being detected in shameful
or criminal acts, and, in some  cases, a periodical exaggeration
of all the usual symptoms, resembling in this respect some of
the more clearly pronounced  forms of  insanity, are  some  of
the sjTuptoms of this  form of  mental disease.   Sometimes the
pulse is so frequent and easily  disturbed that we know there is
disease somewhere; and the mental change  and irregularities
refer it to the  brain.   At length, after years, perhaps, of more
or less unsound and disturbed mental condition, the  intellect
becomes  more manifestly impaired, and the disease at last set-
tles down into chronic mania or dementia.
  Mania  transitoria is  another  scapegoat of crime.   Neverthe-
less, instantaneous outbreaks  of  mania, of brief  duration,  in
certain physical conditions, may occur;  and in no cases does
the law require the aid of medical knowledge more than  in
these.  The public will be incredulous and  uncharitable  to-
wards  the  unfortunate person who may have committed a
fatal violent assault while in this transient aberration.
  The  mania  has been too brief  to  impress itself upon the
observation of the community, or more than a very few indi-
viduals.  It is also rare, and exceptional  to the common fami-
liar phenomena of insanity.
  Since the well-known conflict in the expert testimony in the
Andrews case, the medical literature of our own  country and
Europe has been pretty well searched for cases of transitory 
              STATE MEDICAL SOCIETY.            15

mania, and only between seventy-five  and one hundred  cases
have been found.  It does not properly form any distinct class
of insanity.   There is no uniformity in its character and  dura-
tion, and no cognation in its causes.  Connected with criminal
offenses it is more  likely to  be pretended than real, or nothing
more than unrestrained passion.  When  it really occurs the
instantaneous outbreak  may take  place  as the first decided
manifestation of a hitherto unobserved incubation of mental
disease.  In  such a case the insanity is not cured  by killing a
fellow being.
  It may occur in epilepsy, taking the place  of the ordinary
spasm of the motor nerves.  In this case we  may have a real
transitory mania,  coming on  as  suddenly and passing off as
quickly as an  ordinary attack of  epileptic convulsions^ with
the usual loss of  consciousness  during  its continuance.  It
may take place in  the puerperal state, the  cause being obvious.
The maniacal attack here is sudden, but it does not pass off so
quickly as to deserve the name of transitory.
  Injury of  the peripheral extremities of the nerves may  bring
on  a  sudden attack of mania.  The son of an English gentle-
man, on being called to his breakfast, was  heard to get up, but
he did not leave his  room.   The father went to his bedroom,
where he found him in a maniacal state.   He put him to bed,
when he became calm  and sane.  Getting up again, he became
crazy, and was unable to dress himself, as  before.  A physician
was called in, who, learning these facts, and that he had been
swimming the day before, commenced his examination by press-
ure on the soles of the boy's feet, when at length  he brought
on another attack  of mania.  He  discovered a piece ofsilex, or
a minute pebble, imbedded in the skin of the  sole of  his foot,
which he extracted, when the boy  arose,  dressed himself, and 
16                ANNUAL ADDRESS.
was  found to be entirely cured of his transitory mania.  Thus
we see how slight may  be the cause, how sudden the attack,
how  brief the duration,  how varied the form, and how simple
the cure of mental derangement.
  Now, as I have before observed, these instantaneous out-
breaks of mania, manioc transitorice, belong to no class of insan-
ity.  They are  only  anomalies, or incidents, which may  occur
in connection  with some more permanent disease, or from a
wound or a traumatic affection of nerve.  In the case of the
boy  referred to, the reflex irritation, instead of spending its
force on the spinal ganglia, producing tetanus, as such injuries
sometimes do, passed on up to the supreme nerve-centers, caus-
ing mania.   Says Caspar:  "There is no such peculiar species of
mania—no so-called mania transitoria.   This  unscientific and
dangerous term ought not to be employed in  practice, and the
investigation of each individual case, according to the general
diagnostic criteria, renders it wholly  superfluous."
  I do not think these cases are generally difficult of diagnosis
when they become subjects of medico-legal investigation.   The
criminal  act is  so inopportune as to time  and place, there is
such an  absence of provocation, preparation, and motive, that
the real  cases of this kind  are  generally  readily recognized.
There is no insane cunning, or ability to plan, in this form of
mania.  The subject  of it is delirious, or a  furious raving ma-
niac  for  the time being.  Consciousness and memory are in
abeyance, and his  acts, in their  direction, bear no evidence of
consciousness and design.  The cases which have given rise to
disputes  and doubts  are  based  upon a theory  adopted as a
defense to criminal prosecutions.   For instance, in  the case of
General Cole there was not a single element of genuine transi-
tory  mania.  There was provocation, preparation, seeking and 
STATE MEDICAL SOCIETY.
17
 selecting the offending person, and the successful execution of
 the deed, without any undirected promiscuous demonstration of
 violence.  He was  found to be sane just  before and just after
 the killing.  The foreman of the jury stated that "they found
 the prisoner to be sane at the moment before and the moment
 after the killing,  but  they were in doubt as to his sanity at the
 instant of the  homicide.  The Judge said that  they must give
 the prisoner the benefit of the doubt, and  thus instructed they
 rendered a verdict of acquittal."  So in the case of Mrs. Fair,
 there was an avowed  provocation; the threat, the preparation,
 the choice of time and place, the selection of the threatened
 person  in a crowd, and the execution of the deed without any
 general demonstration of undirected violence, or  any excess of
 violence beyond  what was  necessary to accomplish the act of
 killing.  These cases  do not bear the features of transitory or
 instantaneous mania.
   There should be a change in our laws respecting the criminal
 insane.   Upon the acquittal of  a  person charged  with murder,
 on the ground of insanity, the killing being admitted or proven,
 it should be the duty of the Judge trying the case to commit
 such insane homicide, regardless of his mental condition at the
 time of trial, to an  asylum for  the insane, where he should be
 securely kept.  And there should be no authority vested  in any
 officer of the asylum to discharge patients of this class by rea-
 son of their apparent  recovery  or sanity.  Such  a provision of
 law would render the plea  of  insanity less  frequent and the
 community more secure.
  I know of nothing  further behind the age than the mode of
 obtaining medical knowledge and opinions in our Courts of jus-
 tice.  There  is no certainty of  reaching correct and scientific
results by the method practiced. 
18                ANNUAL ADDRESS.
   It is not  so much the fault of our  profession as it is of the
 law.  The reasons are:
   First—The selection for experts of partisans, instead of com-
 petent and impartial physicians.
   Second—The inadequate opportunity generally given the phy-
 sician for investigation of the case.
   Third—And above all, the mode of examination by hypothet-
 ical questions, it  being  impossible for the medical witness to
 fairly present his opinion to the Court and jury by this mode
 of putting questions.
  In reference to the first proposition I assume it will be admit-
 ted that medical witnesses are too often selected on account of
 the bias they are known to entertain toward the side on which
 they are  called to testify, rather than for  their professional
 qualifications.  Ex  parte in the beginning, they necessarily
 become more and more so in their efforts to sustain a prejudiced
 and preexpressed  opinion. In the  cross-examination the  bias
 becomes so obvious that their testimony justly loses the respect
 and weight which the  opinion of a just and competent expert
 ought to carry with it.  This evil must necessarily continue as
 long as the medical witness is procured by counsel, for the law-
 yer is  expected to select such witnesses as will give evidence
 favorable to his side of the case.  He will descend, if need be,
 in the  scale of professional standing until  he reaches a point
 where, as effecting his purpose, he is sure the evidence will be
 right, even though the witness be wrong.
  Every facility should  be afforded the medical expert for a
thorough investigation of the case upon which his opinion is
required.  In  some  instances the most fearful responsibility
rests  upon him.  The life of the individual on whose  mental
condition he is to decide  in a great measure depends upon his 
              STATE MEDICAL SOCIETY.             19

opinion, whilst justice waits upon his decision as the  lamp to
her own.  The physician himself, then, he being the best judge,
should be authorized  to require all the obtainable information
and evidence he might deem  necessary to the fullest  possible
understanding of the case in question.
  A more awkward  and  faulty  way  of arriving at  correct
knowledge could hardly be devised than that by  which profes-
sional information is sought to be obtained from medical wit-
nesses in the Courts of the United States and England  in cases
of disputed mental condition.  In almost every important crim-
inal case there are two sets of more or less contradictory facts,
produced respectively  by the prosecution and  the  defense,
which form the basis of a series of hypothetical questions, to
be answered upon the presumption that all the supposed facts
are true.  The  inevitable consequence is that there is an appa-
rent contradiction and a real confusion in the physician's testi-
mony.  Even if the investigation  has been full  and satisfactory,
and the conclusion of the expert, as to the party on  trial, be
correct and  well  supported,  his  opinion in this way cannot
possibly be presented to the Court and jury in a clear  and
logical  manner.  It must of necessity be little better  than an
incoherent mass of  incongruities, partaking of the contra-
dictory character of the supposed facts.  The absurdity of  this
practice was forcibly illustrated in the case  of  David  Mont-
gomery, tried for murder in Eochester, New York, in eighteen
hundred and seventy-one.  In this case, the distinguished Dr.
W. A. Hammond was called by  both  the people and the de-
fense.   Both sides  put to him  their hypothetical questions,
based  upon  such  portions of the testimony as  favored them
respectively, which he answered  categorically.   The  conse-
quence was, notwithstanding the great learning of the witness 
20                ANNUAL ADDRESS.
and  his familiarity with  these  trying situations,  there  was
apparently a dual opinion; or, as a recent reviewer remarks,
" a striking conflict between the answers given by Dr. Ham-
mond to the prisoner's counsel and those given to the District
Attorney."  The fault cannot justly bo found in so able,  adroit,
and self-assured an expert as Professor Hammond.   It is in the
sleight-of-hand, dissolving views  style in which the case  was
presented to him.  And this case affords a fair  example of the
manner in  which  such trials are  generally conducted with
reference to medical testimony.  The elements which make up
the whole case are separated and scattered, and the medical
expert is not  permitted to  bring them together and present
them in the concrete.
  To remedy this great evil, which  so often results in the per-
version of justice and the degradation  of our profession, should
constitute one of the objects  and efforts  of every organized
medical association.
  I heartily concur in the suggestion of one of my predeces-
sors, that  medical  experts should be appointed by  the  Court,
and selected for their professional fitness, their personal integ-
rity, and freedom from bias.  Ample  time and means  should
be had for investigation.  And their opinions and  conclusions
should be reported to the Court in full, in writing.   This would
insure something like a scientific presentation  of the subject.
It  would give something  comprehensible  and  tangible to act
upon and  refer to.  To be  sure, the  defendant may call the
same or other  medical witnesses. That is his legal right.  It
is not to gain  an advantage over the  unfortunate  criminal  or
prisoner that  this change of procedure is  advocated;  but to
reach, if possible, some method  of  investigating a  question  of
transcendent importance in a scientific  way, and of communi- 
STATE MEDICAL SOCIETY.
21
eating the result in  an intelligible manner—to render more
valuable and reliable aid to the law and to justice in determin-
ing medico-legal questions.
  Our medical jurisprudence of insanity should  be raised from
the old rut of English common law.   It belongs to the distant
past,  and has not kept pace with the science upon which it is
founded.  The German code and  practice  are far in advance of
it.  The medical witness there has a scope and authority in the
Courts similar to what I  have  suggested as  an improvement
here.
  Witness the results: The Courts there are relieved from much
of the perplexity, haggling, and blundering which characterize
our trials of disputed mental condition in connection with crime;
and  they are storing up a vast treasure of forensic medical lit-
erature from the actual experience and decisions of their own
official experts.   The  reports of Casper alone  have enriched
the literature of forensic medicine more than all that has been
preserved, save  upon chemical questions,  of the testimony of
English and American medical witnesses during all time.
  Excepting Balfour  Brown's feeble  imitation  of Dr.  Bay's
medical  jurisprudence  of insanity,  I would  not presume to
speak disparagingly of the great  works of England on medical
jurisprudence.  But, in relation to insanity, they are great in
the record of famous cases, and in the remarkably uniform, and
now antiquated, opinions of her learned and illustrious Chan-
cellors, from Sir Mathew Hale down, rather-than  in the medical
lore  and forensic experience of her no less learned  and illus-
trious physicians.
  So important do I regard this question, so well satisfied am I
of the unfitness of our laws on  this  subject,  so certain am I
that  a great public good could be accomplished  by adopting a 
22
ANNUAL ADDRESS.
different method from  that  now  practiced,  of obtaining the
opinions of physicians in  our Courts, that I embrace this occa-
sion to recommend that another standing committee be provided
for in  the Constitution of our society, to be designated  as the
Committee on Forensic Medicine.
  Finally, my medical friends, as I was absent when the closing
festivities of our last meeting inaugurated the present officers
of this society, I must take this opportunity to express to you
my acknowledgment and gratitude for the token of your regard
which  my present position implies.
  Special sciences are not  understood  nor correctly appreciated
by the general community.  And, at  best, popular favor is but
a bubble upon the  ocean  of life—raised in a moment, and as
quickly destroyed by the accidental breeze.   It is, therefore, in
the respect  and esteem of his professional  brethren that the
physician receives  his most grateful and valued honors.   And
yet, it  is not those who fill the necessary offices in our society
organizations who occupy the most honorable distinction. The
highest eminence is self-acquired and independent.  It is open
to all, and is gained by those who, laboring most faithfully and
unselfishly, contribute  most ably and liberally to  the  science,
the elevation, and the objects of  their profession.