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INSANITY
IN
ITS   LEGAL  RELATIONS.
                   \

       ROGER  G. JERKINS, M.D.,

LECTURER ON MENTAL DISEASES AND PROFESSOR OF THE INSTITUTES OF MEDICINE, IN THE AMERICAN
             COLLEGE OF MEDICAL SCIENCE.

'£tstfr
*^;n-
3J*to-gffrk:
PRINTED BY HENRY LUDWIG,

      39 CENTRE-STREET.

           1858. 
w
ioDO

P+5/ L 
  This  is the third article of the Series on Mental Diseases which
has been published  in the North American Journal of Homoeo-
pathy.   As  it contains  matter of some interest  to  many who do
not see  the Journal;  I  have  thought best to have a few  extra
copies  struck off, for private distribution.

                                   R. G. PERKINS,  M.D.,
                                          96, 4th Avenue. 
 
       INSANITY IN  ITS  LEGAL RELATIONS.

   Perfect  physical or  mental  health is, in the present state of
 civilization and refinement,  extremely  rare.  We are the inhe-
 ritors of too many ancestral  iniquities, visited upon and abiding
 in the blood and  brains  of  third and fourth generations, to be
 other than, nine-tenths of us at least, half sick continually.  It
 is certain,  man may be well enough for all practical purposes,
 and yet carry about, shut  up in some part of him, a disease,
 latent so long as an exciting  cause is wanting, but ready to rise
 with the  strength of  a giant  and crush him  into  the grave.
 The  pains  and aches he has, however, here and there, in the
 courses of those  warning sympathizers, the nerves, are such
 vague indicators of the seat  of the morbid taints, as to furnish
 little excuse  for  laying down his burdens;  and until the foe is
 wide awake and abroad, attacking and verily storming the cita-
 del  of life, daily  duties and personal responsibilities must be
 continued by the individual,  and are insisted on by society.
   It may  he that unhealthy minds are more common than un-
 healthy bodies; hut all  men whose minds are unhealthy are
 neither to be called, or treated as if insane.
   It must  have occurred to us all that it is too much  the fashion
 of our day to consider men mentally irresponsible on very in-
 sufficient evidences.    The daily  employments,  the  pecuniary
 interests,  the  home  surroundings, develop those mental facul-
 ties  oftenest used, into an acuteness which eventually destroys
 the  natural relations existing between  them and other parts of
 the  mind.   In this  way  the mental balance is destroyed;  the
 natural  harmony becomes discord ; and the power of many-sid-
 ed contemplation, and  of judgment is lost.   Deprived of its in-
 tegrity  in  the natural relations of its parts, the mind,  as a to-
 tality, is tortured  from its  normal condition, and is, therefore,
 more or less diseased.
  This amount of  disease, however, is too common to fall within
 the popular definition of insanity; and  cannot be considered as
within the  intention  of that legislative enactment  which pro-
vides immunity for acts committed during a state of  mental  ab- 
6
Insanity in its Legal Relations,
erration.  It would thus appear that a degree of technical men-
tal unsoundness may exist, Avith no interference with the moral
responsibilities of  the  man.  For  as nature will have it, there
is no middle ground between health and disease, and a man must
be either well, or  not  well—if not well, he is sick.   There is
thus need of the good sense of the physician to determine, not
merely  if a thorough  equilibrium  of all the mental  faculties
exist;  but supposing it destroyed, to  decide  if the extent of
the disease has produced a state of irresponsibility.
  It is thought by many that  a sort of arbitrary standard of
mental  health  exists,  up to which we must all come or be con-
sidered crazy.   The  labor  of the  psychological diagnostitian
would be indeed infinitely less if such was really the case.  Un-
fortunately, hoAvever, no such standard has been set up, nor can
there ever be  one.  The fact is,  men,  in general, are no more
agreed as to what constitutes soundness of mind than  they are
upon  the constituents of  true religion ; and so long as  this dif-
ference exists, it is  in vain to expect a fixed standard.   This is
very proper.   Insanity should be  tried by no laAvs other  than
those found Avithineach  individual patient.   The history of each
one's  mental life furnishes a standard  for the judgment of all
his  subsequent acts.   The  question to be answered on all oc-
casions is  simply—Is the deed under inquisition, such a one
as the  previous history of the patient would show to be natural
to him: if unnatural, are the  motives sufficient to account for
it;  or  must we look for a morbid element in explanation.
  Manifestly that which is natural enough  for one man may be
furthest from naturalness in another.  For instance, no one will
consider it as  proof,  tending  toward a commission of lunacy,
that a certain woman, born and bred to the business, should  take
in gentlemen's washing; but if a fifth-avenue belle should pro-
pose a  thing so contrary to the instincts of her nature, and so
forbidden by the influences of her education, we should all tap
our foreheads mysteriously,  and be ready to swear her as crazy
as king  Lear.  Again, I  knew a fine old  gentlemen,  who has
spent, as they say Louis Napoleon has, a good  part of his life
in searching for the philosopher's  stone.   However foolish he
may be, he is certainly not crazy; but if a certain  professor of
chemistry, should waste his time in the same manner, the Avorld
Avould  pronounce  him  insane  without benefit of clergy.  The
i 
By Roger  G. Perkins,  M.D.
7
 education of the one  renders unnatural for him what the ab-
 sence  of it has rendered natural for the other.   The views of
 the  said professor may be as erroneous as  to vital dynamics,
 as the dreams of my patient were foolish as to the philosopher's
 stone: and yet neither be crazy, while both are mistaken.
   For the guidance of  the physician, the best psychologists have
 laid down certain conditions, which, being present, must at once
 place men beyond the  reach of punishment; relieve them from
 contracts;  deprive them  of the  power  of testimentary  dispo-
 sitions,  and  take  from them the management  of their  own
 estates.
   The first  of these conditions, which we shall consider, is de-
 lusion.
   The unmistakable presence of this condition is  the most posi-
 tive proof of such mental  derangement as  involves irrespon-
 sibility.   It is not required to shoAV the logical connection be-
 tween the delusion and  the  deed to render the  latter invalid;
 and this is the point of extreme importance.   The delusion may
 be related to the sun in heaven, while the deed may be connect-
 ed with the wife of one's  bosom;  and hence there be no logical
 sequence, still the presence  of the delusion is sufficient to ex-
 culpate the deed.
   I  cannot do  better  than  quote in  this connection an extract
 from the Medical Jurisprudence of Dr. Ray of Rhode Island;
 nor  can  I  permit  this opportunity to pass without paying  my
 tribute to his acknowledged  genius and extensive  learning.   No
 man living or dead has done so much toAvard a thorough under-
 standing of the legal  relations of insanity  as has Dr. Ray in
 the work from which I am about to quote.  I am  very happy in
 being able to count myself among the pupils of the author of a
 book so scientific, philosophical, and consistent.   Dr. Ray is no
 mere bookmaker;  he believes what he Avrites, and writes what
 he believes.  He is neither an enthusiast, nor a  penny-a-liner,
 but has a calm philosophical spirit, and a strong desire  to speak
 truthfully and well.  His book has  been cited as authority in
 all the more important cases, since its publication, in Europe or
 America.
  In regard to the condition of the mind of the patient, during
 the  existence of a  delusion, Dr. Ray  says :  "It is a fact which
every one much conversant with the insane must have recog- 
8
Insanity in its Legal Relations,
nized, that their mental operations are marked by a kind of con-
fusion that finds its analogy only in dreaming.  And this is the
case, not  only with the wild  and raving, but to a degree with
those Avhose  insanity is apparently confined within a narrow
circle, and who would not be readily recognized as insane by the
world at large.  In dreaming  and in insanity there is the same
firm conviction of the reality of false impressions,  the  same
patches of coherence and consistency;  the same embroilment of
the thoughts; the  same absurdity of the conclusions; and on
recovery, the patient often feels as  if just awoke from a dream,
wondering how he could have had such thoughts, and done such
acts."   A case  is  then  cited as having occurred under the ob-
servation of this author, of a  man who held to the delusion of
the infidelity of his wife.  His conduct was calm and his man-
ner quiet, and he willingly busied himself, with the greatest in-
telligence and reason, Avith what  he found to do about him.
Even the professed psychologist was puzzled during the period
he  waited for a history of the case, to find any proof  of insani-
ty.  On the  recovery of the  patient, all the  things which he
thought he  saw in proof of his  wife's guilt, appeared to him
like a dream ; and he could give no other account of them.   To
consider this man accountable  for any act committed during this
state of mind is reprehensible  in the extreme; whether the deed
be  connected  with the  delusion as logical sequence  or not.
   In following out this train of thought, it may be said, the pre-
sence of a single delusion, that is, one thoroughly uncomplicated
with other insane manifestations, is very rare.  There is almost
always  a hidden connection Avith other trains of thought, and
though  this  connection  may not at first be evident  to the ob-
server, some  event AA'hich exhibits it, is pretty sure to happen
during  the course  of the disease.   As is  well understood,  in
physical disease, we  often have but one prominent symptom of
any considerable importance,  and yet the patient may  have an
organic, and perhaps incurable disease;  so also, in mental un-
soundness the mind may exhibit its weakness, in but  one direc-
tion, and yet  be diseased in many others.  It is only required
to consider the intimate relations normally existing between the
mental  faculties, to appreciate the active sympathies between
those diseased and those seemingly healthy.  So certain are we
of these close sympathies of the mental faculties, that the term 
By Roger  G. Perkins, M.D.
9
mono-mania  seems to be  ill-used, and to represent a state of
mind rarely, if ever, existing.  I am free to confess that out of
our  2000 insane,  who  have been  the objects of my particular
study, I have never seen a case in which but one mental  faculty
Avas  involved  in the disease.
   Here now is the proper place to indicate the difference betAveen
delusion and error of judgment.  There is danger of confounding
delusion with eccentric belief.   Manifestly two men, both in their
sober senses, may believe precisely opposite theories: and it may be
each shall consider the  other crazy, from  the simple fact of the
disagreement.  But every thing, whether in form or in idea, sub-
mitted to the contemplation of man, possesses the elements of
both truth  and falsehood.  It is impossible to make any state-
ment (outside of the pure mathematics) which is thoroughly un-
true from every point  of view.  The imagination of the reader
may make to itself any proposition, and no matter how contra-
dictory the  first statement may appear, close attention will dis-
cover  somewhat of truth contained in it.  Take  for instance the
following—the chair in which I sit, is upon the opposite side of
the  table ;  there is nothing which seems to admit of two inter-
pretations less than this ; and yet there is certainly an essen-
tial  element of both truth and falsehood in it.  To me the pro-
position is false; to my friend on the other side it is true.   His
position  makes  it true  to him.   Now then, as the statement
which my physical position renders false to me is rendered true
to my friend in his physical position; so that belief which my
mental conformation renders false to me, may be, by my friend's
mental conformation rendered true to him.
   Delusion may  be defined  as a diseased apprehension of the
relations of things; this diseased apprehension giving founda-
tion to a  fixed  false belief.
   It is necessary in all  cases for the physician to determine from
the  previous history of the case if the belief held by the per-
son  under inquisition is natural to him or the result of disease.
   In the diagnosis between  delusion and  eccentric belief it is
to be borne  in mind, first, that all men are considered, (both by
law  and  common-sense,) sa?ie, who are born  into the Avorld
neither imbecile nor idiotic.   He on whose inborn mentality
jiisease has made no impression, is accountable for his acts,  how-
ever low may be the mental or moral status which God has  as- 
10
' Insanity in its Legal Relations,
signed him.  If a  man  is born with propensities to evil, it is
his misfortune, doubtless; but society must and does protect it-
self against the unhappy results of  such mental conformation,
by means of penal  contingencies.  In the eye of  the law, defi-
cient  moral organization, although  perhaps at the foundation of
almost all crime,  is  no excuse for its commission.   Errors of
education are also inadmissible as extenuating circumstances,
and even impending  starvation will  procure no man immunity
for the theft of bread.  There must be a morbid change, and
this change discovered by contrast  with the mental past life of
the individual before the plea of mental irresponsibility can be
successfully plead on the ground of insanity.
   To  exhibit  more plainly the true nature of delusion it is
deemed  proper  to cite  the folloAving  case :  the only one I shall
refer  to  in this connection, as want of space forbids the multi-
plication of instances.
   An old lady, Avho, residing in the upper part of the city, has
a life-interest in a large estate,  was the subject of legal inquiry
as to  her capacity to manage her own affairs.  As her personal
income  was rising $15,000, and as she Avas  supposed to be un-
der the  influence of a designing person, her heirs apparent in-
stituted  a ucom?nissio de  lunatico inquirendo."   The ground
taken by the relatives was that  a delusion existed:  and on this
account they desired the court to appoint a receiver, and guardian
of her property; out of whose  hands, of course, she was to re-
ceive  her necessary expenses.   I Avas requested to visit the old
gentlewoman professionally, and did so.   In the five interviews
had Avith her, there appeared insufficient evidences of delusion,
and I so testified in court.  The case, hoAvever, in its details, is
perhaps  more instructive than if the delusion had really existed.
It seems that, born before the revolution, the old lady Avas a girl
at the proclamation  of peace, and tells many things Avhich oc-
curred during those stirring  times, when the perceptions of  all
ages, and of both sexes,  may be supposed to have been unusually
active.   Among  other  incidents, she says, that one  evening,
while the British occupied New-York, General Washington was
at a  ball in Beekman-st.—that she  was there and saAv him—
that his  attention was attracted to her from a bird-cage she had
in her hand—that the  ladies  of the city  were presenting the
general  with a piece  of tapestry—and that in the midst of  the 
By Roger  G. Perkins, M.D.
11
festivities of the occasion—she, looking out of the window, dis-
covered the  enemy  approaching with a view  to  the capture of
Washington, and that she hurriedly informed the general of the
fact;  and led the  way  immediately to a hidden  cave, in the
neighborhood, in which  she kept him  concealed for four days.
That, finally, through some indiscretion on her part, the general
was taken prisoner by the British, who kept him a little while,
and then  sent him home with a new suit of clothes.
   This statement made by Mrs.----was considered evidence
of delusion by two medical  men; and as the presence of delu-
sion is proof of insanity, and therefore of mental incapacity,
they  testified to this  opinion.   Five other medical men took a
different view of the case.   While allowing the statement to be
contemptibly false, they were  not convinced it was a delusion.
During my own examination before the court—I was requested
to give a definition of  delusion, as  free from technicalities as
possible.  The following ensued.
   " Delusion is a fixed idea  or belief as to something, which, if
the  reflecting  and  reasoning faculties were in their natural
state of health would seem untrue."
   "What is the difference betAveen delusions and hallucinations ]"
   "Delusions are misapperceptions of the relations of things ;
while  hallucinations are misapperceptions of form and  con-
ditions."
   " Has Mrs.----either   the  one  or the  other 1  Is or is
not the story of Washington evidence of delusion or hallucina-
tion?"  "It  is evidence of neither."
   " Why  do  you think it not a delusion ?"
   Because the possible parts of  the story, in which I think she
believes,  I  have no means  of disproving; and  the impossible
parts of it  she  knows to be false, and has therefore no insane
belief m regard  to them.
   "Does delusion depend on insane belief?"   " Yes."—
   "Why do you think Mrs.----does not believe in the impos-
sible parts of this story?"
   "Because Avhen her attention is called to the impossible parts
of the story she corrects herself  in many things, denies others,
and excuses the remainder.  If this  were & fixed belief on her
part, she would do no  such  thing; but  would insist,  with all
the more  pertinacity, the  more  she was  doubted  or  interro-
gated."— 
12
Insanity in its Legal  Relations,
   "How then do you account for the story?"
   "Simply thus, the old lady, Avhose memory, as is apt to be the
case with old persons, is someAvhat weak, has confused  certain
facts which occurred in connection  with the capture of a minis-
ter in Stamford, Avhile she  Avas living  there, before  her arrival
in New-York, with certain  other  facts, Avhich occurred in con-
nection with  General Washington,  Avhile she Avas living in Beek-
man-st., about the time of the evacuation of the city.  In these
facts she believes; but on to  them she has woven a tissue of
falsehood, which she  does not believe.   She was naturally led
to tell this story, by the love of, and desire to attract attention
to  herself, and as garrulous old women often do, has made her-
self out of much more importance than the facts will warrant;
and now clings to her first statement on most occasions for fear
of being caught in her lie.   This  is, moreover, just such a lie,
as  an uneducated  old  woman is most likely to make  up: and
there is scarcely an old woman, who lived during the revolution,
who has not  done some great deed, by which the life of General
Washington  was saved; if you may believe her own story.  To
render  the absence  of insane belief a certainty in  this case, I
have her own words, in a moment of unusual garrulousness and
confidence, to the effect, that she regretted ever having mention-
ed the story—that it was not true, and that she was  ashamed of
ever haA'ing told it."
   The jury,  not having been satisfied of  the existence of insane
and delusive belief—Mrs.----was permitted to remain in the
possession of her estate.
   Although  wishing to render this paper as short as possible,
as space in this journal is  more or less limited, I cannot leave
the subject of delusion,  Avithout reference  to insatie suspicion
and insane  prejudice ; the first of which is often the cause of
homicide, and the  second of which is frequently productive of
great injustice in testamentary dispositions.
   It has often been a matter of some Avonderment that delusions
of suspicion should be so common among the insane.  Their
presence  has become,  as it Avere, so much a matter of course  ;
that being called  on to examine a patient, the first question is
almost  always: "Do  you think any one is trying to do you
any injury ?" and the reply is quite likely to be a detailed state-
ment of some conspiracy which  the diseased imagination has 
By Roger G. Perkins, M.D.
13
proved to itself from the most trifling and insufficient premises. As
is easily seen, this form of delusion must often lead to homicide.
   A patient, since happily recovered, believing his wife was
intending to poison him,  attempted  to play Othello to  her
Desdemona.  As the would-be Othello was somewhat weaken-
ed by disease, the resisting Desdemona was the stronger of the
two.  The husband  foiled in  his attempt on the life  of his wife,
ran to the cradle, and seizing the infant, carried it  to the open
window, and held it out at arm's length, threatening to dash its
brains out,  unless the mother promised to remain  silent as to
his homicidal attempt upon herself.   She promised,  and he soon
after became calm.  I gave this man repeated closes of brandy
followed them with Opium  and Nux, and he seemed well in a
week, and has remained  at his business ever since.  The man
had never  been  intemperate.  Brandy seemed indicated from
the totality  of the symptoms.  It Avas preferred to  other diffu-
sible  stimulants,  on account of its specific qualities.   As this
attack had lasted only a week, and as the fact of the man's ill-
ness  had been imparted only to his nearest friends, and  as the
patient recovered a week after the event recorded,  there must
have been difficulty  in sustaining a plea  of insanity, in case the
crazy man  had thrown the  child from the window,* in the pa
roxysm  above referred to: there is, however, no doubt of dis-
ease  in  this case, as a more  kindly and amiable man is hardly
to be met with, than he, when in good health.
   Well-informed criminals are aware of  the immunity furnished
by delusion,  and  sometimes  simulate it.  Against those  the
physician must be  upon  his guard.  These  people, however,
commonly overdo the  matter.   They are,  generally, so very
anxious to appear crazy, that  resorts proving perfect sanity, are
discovered.   They are induced to add an element of  mania to
the delusion; which is apt  to  be much more violent than na-
tural ; and cannot  therefore  be  continued long without such
physical exhaustion  as betrays the attempted fraud.  Simulated
delusion  alone is only found among those who have studied in-
sanity with  a good  deal  of care: the popular idea of a crazy
man,  being,  one who raves.  The quiet delusion is  hardly con-
sidered  sufficiently  impressive to attract attention; and those
intending to deceive, try  a  more violent form of  insanity, to
make their pretended disease  the more manifest. 
14
Insanity in its Legal Relations,
   Insane prejudice is a lower form of delusion than those men-
tioned above, but when existing, equally  indicatory of mental
disease.  The most  perfect example of it is found in Shaks-
peare's Lear.  The changed feelings of the aged monarch to-
ward Cordelia are a fine specimen of this form of disease.   I ap-
prehend  this is  much more common among old people than is
supposed.  If thoroughly proved, it should be sufficient to break
a will, made under its influence.   Its existence on the part of a
husband  sometimes begets inhuman treatment of a wife.   All
the woman may do under these circumstances often avails little
toward convincing the husband of his error.  It may be, how-
ever, that  while the  continued love and  duty  of the wife are
acknowledged, the husband finds himself  thoroughly incompe-
tent to overcome his  repugnance, and is unjust and overbearing,
causing much misery, and sometimes procuring  a separation.
If insane prejudice is allowed to continue it may end in delu-
sion.  This state of mind  is apt to follow upon that excessive
love and devotion, which causes both parties to seek the society
of each other too continuously.  Not  only is  an opportunity
thus given  to find out the  weakness of  each other, but there is
such  an  interchange  of magnetism, so to speak, that both be-
come either positive or negative, as the case may be, and a mo-
ral repulsion is  the  result.  The remedy is very  simple, and
will at once suggest itself.  Really intelligent people under-
stand this,  and  unconsciously take precautions against its oc-
currence.   One is naturally reminded, in this connection, of the
character of school-day intimacies.  Two boys or girls walk for
weeks, with  arms about  one another,  hardly happy, when se-
parate.  Presently each has changed his  mate, from most tri-
fling  cause: but in a month more  the original pair come to-
gether again, in great wonder how they could have quarreled.
We do not  wish  to be understood as asserting this to be always
a diseased condition.   But fixed delusion is sometimes engrafted
upon it.
  The next mental condition, which when present, involves ir-
responsibility, is  morbid exaltation.   Its  most marked symptoms
are included under the head of acute mania in  a preceding ar-
ticle. Acts committed  during  the  ordinary  acute mania are
hardly ever the subject of  extended legal inquiry.  The disease
is under these circumstances so apparent, that grand-juries find 
By Roger G. Perkins, M.D.
15
 no indictment, and the unfortunate lunatic is quietly  sent to an
 asylum on the oath of two physicians.
   But by far the most important, least understood, and difficult
 in diagnosis, of all the  forms  of morbid exaltation is what is
 called the homicidal impulse.   Several  cases of this kind are on
 record.  They are all deeply interesting, but none more so than
 the following.  A  woman presented herself at the " Central
 Homoeopathic Dispensary" last  summer  who  confessed, with
 tears  and hysterical  sobs, to an irresistable impulse  to kill her
 child.  | She  had  been recently  confined, (I  believe about a
 month previously,) and had been as she expressed herself ex-
 ceedingly nervous  ever since.   She had had but small appetite,
 but little sleep, hardly any milk, and was in a constant nervous
 tremor, while describing her distressing and unnatural condition.
 She told  me she  had been compelled to run with her child in
 her arms, into the house  of a neighbor, and throwing the child
 on the bed, to rush distractedly into the street, for fear of yield-
 ing to the horrid impulse  which prompted her.   But little idea
 can be formed of her  extreme distress.  She wrung  her hands
 and cried  most piteously, mingling  her sad entreaties for relief
 with hysterical tears and sobs.  Although in  a state of extreme
 nervous erythismus, there seemed to be present no delusion or
 hallucination.  The woman was  mentally well in all respects,
 save in the  direction   of this unnatural impulse.   In this case
 the  erythismus was so marked,  that had the patient been un-
 able to resist  the homicidal impulse, there would have been but
 little  difficulty in  convincing  a grand jury of her unaccounta-
 bility: but cases occur in which the insane impulse comes on
 so  suddenly  and irresistibly,  and passes over  so  immediately
 after the accomplishment of the bloody deed, there is  the great-
 est conceivable difficulty in diagnosis. #
   Supposing ourselves called to the psychological investigation
 of a case  in  which this form of disease is set up as ground of
 irresponsibility—the first  step is to  inquire into the previous
 character  of the  accused.  We should then bear in mind that
 certain physical symptoms are to be expected antecedent to the
 outbreak.  These physical symptoms are as follows.  There is
 apt to  be  an unpleasant  feeling  at the pit  of the stomach, a
 short shuddering through the body; the tongue  may be loaded;
the stomach acid;  burning heat  may.be felt throughout the ah 
16
Insanity in its Legal Relations,
domen; there may also be thirst and constipation.  Not  long
after  may  come a buzzing or singing in the ears,  a fullness in
the head, and of the vessels of the face and neck.  Soon the
general bodily excitement extends to the brain,  and at this mo-
ment  arises the blind impulse to commit murder, suicide, theft,
arson, or some other outrageous act.  No one who has seen and
studied many cases of epilepsy, can fail to discover how much
the antecedent symptoms to one of those attacks resemble the
ones cited above as premonitory of the insane impulse.  In fact
it is a matter of little  question if this insane  impulse may not
be one of the forms of epilepsy.
  It must not be forgotten that in choleric men  a sudden fit of
violent passion is sometimes preceded by some of the symptoms
above enumerated;  and care must be observed lest we  confuse
an ebullition of rage with this  diseased  condition.  A study of
the motives, or provoking circumstances, will materially assist
our diagnosis.  To understand the insane impulse more clearly,
we  shall consider the results upon the mentality of repeated epi-
leptic  attacks, at this stage of  our subject, rather than further
on,  as at first intended.  If we consider the  insane impulse as
one of the forms of epilepsy, we find there are  three,  viz.:  this
insane impulse just described: a form in which the reflex system
of nerves is primarily and principally involved, and one in which
there  are few symptoms of spinal  involvement; the diseased
manifestations being confined  to  the brain alone.  This  last,
which is known among French writers as "la petite mal" is the
most  serious in its  results upon the mind, and is the more dan-
gerous from its insidious approach.
  The popular idea of epilepsy is, like the popular idea of insa-
nity, one which supposes a degree of violence in all cases, which
is in fact only found in agmall number.   Those who have made
the disease a  study, attach  much  less importance to  the  mere
fact of the convulsions, than to the loss  of consciousness.   The
one involves spinal irritation and may occur in hysteria, or from
indigestion; the other is dependent on a cerebral irritation, which
though  sometimes sympathetic  with  the reflex  system  (of
Marshall Hall,)  may  be and often is idiopathic, or  connected
with a thorough poisoning of the afons et origo" of the nervous
influence,  "le  petit mal," which is, as before indicated,  by
far  the worst form of  epilepsy, is the most quiet, and is not con- 
By Roger G. Perkins, M.D.             17
nected with more convulsive  movements than simple manual
tremors, which last but a few seconds.   It is seldom  preceded
by very marked premonitions.   Not long since an opportunity
was afforded me of observing and carefully noting the symp-
toms of one of these attacks, and the case will be found below.
This case is selected  from others, because well marked,  and
freshest in memory.
  The patient was engaged in earnest  conversation, when sud-
denly he ceased to speak; a change came over his features; his
eyes became  fixed; his mind seemed paralyzed; he became
pale, and a silly smile  played about his mouth.   He  presently
recovered himself, took a long breath, and with a wondering ex-
clamation attempted to resume the conversation.  He succeed-
ed, and in a few minutes the mind gradually came up to its usual
activity.  This was a  mild  but  very distinct attack.   This pa-
tient does not always recover so easily and immediately, but is
apt to lapse into silence and dullness, acknowledging himself ill.
  Hardly anything is  more certain to finally destroy  the intel-
lect than this "petit mal."   It  strikes  directly at the cerebral
centre, and is followed  after a while by paralysis.  Dr. Marshall
Hall, who kindly took pains to  describe to me the nature  and
course of this disease,  considered it more frequent than is gene-
rally supposed.  He believed  it  to be often the foundation of
mania and dementia.   Legal cases are of likely occurrence, in
which much aid in the diagnosis may be gained from a course
of inquiries in this direction.
  The form of epilepsy in which, though there is a loss of  con-
sciousness as in  "le petit mal" the disease instead of  spending
its whole force upon the brain,  is diverted,  in some  measure,,
upon the reflex system, is the one to which is attached the popu-
lar  idea.  It leaves behind its  paroxysms, a  state of stupor fol-
lowed  by morbid exaltation.  In this condition the patient is-
entirely unaccountable for his acts, but when recovered, he may
resume his usual business until the advent of another paroxysm.
  The fact that a man is subject to epilepsy, must of course go a
great way toward proving him unaccountable for any unusual
act; but that this plea  should  stand with a jury, or with scien-
tific men, the length of time since the last  paroxysm, and  the
general condition of the patient  between previous attacks, are
the  influential points to be considered.
                 2 
18
Insanity in its Legal Relations,
  The most unimportant form of epilepsy is the simple convul-
sion, in which there is no loss of consciousness; this we find in
children and hysterical young women.   Convulsions occurring
in children, caused by worms, or indigestion, may of course as-
sume the form of the higher epilepsies; but the loss of conscious-
ness in these cases is not so  complete  as would  appear.   The
loss of consciousness is the only fact of direct psychological in-
terest, and when this  symptom is not  present, the  convulsion
cannot be classed among the psychopathies.
  The other  forms of mental exaltation which are frequent sub-
jects of legal inquiry, are  comprised under the  names  pyroma-
nia, an irresistible propensity to incendiarism;  kleptomania, an
insane propensity to steal;  erotomania, insane love ; nymphoma-
nia or satyriasis, a term well understood, and a disease which
may perhaps underlie many cases of rape, as well as be the fre-
quent cause of prostitution.  When called to the psychological
investigation of cases  purporting to belong to either  of these
forms, the physician is to be governed  by the  rules laid down
above  for the  discovery of delusion.   Evidences of a morbid
change are to be sought for, and if  not  discovered, the plea  of
mental disease cannot be sustained.
  For the discovery of  a form of mental exaltation quite  com-
mon, and of  which the case of G. H. (in a preceding article) is
a fair instance, the most profound knowledge of psychopathy,
and the most careful study, as well as a natural power of  deli-
cate mental analysis is necessary.
  As this state of mental exaltation is  frequently found alter-
nated with a morbid depression, the two states will be considered
together.  The French have  given to this form the name "folie
circulaire."   The elder Falret  first described it  in a course of
clinical lectures delivered  at La Salpetriere in the  year  1844.
Ten years after, M. Baillarger read a paper  on the  subject,
claiming priority of observation.   I have seen some six cases,
each differing from the rest in the character of the paroxysms,
but  all bearing a strong  resemblance  in their periodicity and
general peculiarities.   The description  of M. Falret is so point
ed, and so well represents  the cases I  have seen, I subjoin  an
extract from his memoir read before the French Academy soon
after that of M. Baillarger.  "With a  certain class of the in-
sane, mania and melancholia (exaltation and depression)  occur 
By Roger G. Perkins,  M.D,
19
in continuity, and in a succession quite  regular.  This fact has
induced us to establish a form of insanity,  which we call folie
circulaire."  The unhappy subjects  are constantly liable, even
to the end of life, to this succession, with but short intervals.
Nor are the symptoms so striking as in mania and melancholia
proper.   It is not incoherence of ideas,  as in mania, but simple
maniacal excitement, or extreme activity of the faculties,  with
constant restlessness and disordered actions.  It is not the lesions
of intelligence and the prevalence of delusions as in melancholia,
but physical and moral depression of the faculties.  This form
of disease is less curable than either of the forms which together
constitute it, when met with  alone.  Up to the time when M.
Falret's paper was read, the author had made no cures, nor a
single lasting amelioration.  The length of time the paroxysm,
whether of exaltation or  depression, may continue, differs  in
individual cases.  There seems to be a period between the at-
tacks, during which there is a degree of the usual mental health.
In  the  recognized forms of intermittent insanity,  this is cer-
tainly true, though  as in cases of fever  and ague the disease is
still in the system, and is sure to show itself externally when the
proper time for the paroxysm arrives.  "Folie circulaire" fol-
lows the same law in this respect as  intermittent insanity, and
a patient who has  signed a deed or contract on an occasion be-
tween the paroxysms of the disease, must be considered bound
by it.  The question in these  cases  is as to the lucid interval;
and it is proved to exist or not, by the mental manifestations, in
other directions, on the day the  instrument was signed, and by
the previous history of the case.  The  physician should ascer-
tain what  time the lucid interval maybe expected, and how long
it has usually  lasted.  It is easy to see that exceedingly inter-
esting civil cases may hinge on this point.  A man, as was once
actually the case, may see fit to dispose of some of his real es-
tate for an amount which seems a proper estimate of its value.
Subsequent  events  increase the value  of the  property he has
contracted to deliver, and his  friends refuse  to allow the fulfil-
ment of the contract.  A suit is brought, and on the side of the
contractor, the plea is instituted that when the contract was en-
tered into, he, the contractor, was under the influence of mental
disease.   Testimony to be decisive  in  such a  case, must  bear
upon the nature  of  the attack, the period of interval,  and the 
20            Insanity in its Legal Relations,

character of the other acts performed on the day the contract
was signed.  In the case referred to, it was proved that at the
time of contract, the patient should, according to the  previous
history of his case, have been in a lucid interval, and as none of
the acts cited as having been done on the same day were con-
sidered insane, and  as the  amount  accepted  for the land was
about its market value when sold, the Court  sustained the con-
tract.
  It is to be understood the lucid interval occurring in "la folie
circulaire"  and with reference to which the above case is men-
tioned, takes place between paroxysms, and not between the two
phases of mental disturbance, which, when taken together, pro
perly constitute the attack.  Of course the mind in its passagt
from extreme depression to extraordinary exaltation, must, if it
passes slowly, be at one time during its course  in a condition
nearly healthy.  M. Falret, however, is quite determined that
nothing which can be properly called a lucid  interval has been
known to take place between the mania and melancholia which
go together to make up a paroxysm.  The true lucid interval is
doubtless found as above indicated, when after passing through
the two forms of depression and exaltation, the diseased influ-
ence seems  to suspend its  action and a state of mental health is
temporarily established.  The state of mental health is proved
by its similarity to the reported previous mental condition of the
patient.
  Delusions and hallucinations are not generally present in "folie
circulaire.'*   The nearest  approach to the former seems to be a
settled prejudice against  the patient's own family and  friends.
I remember one case, however, in which a virgin imagined her-
self pregnant during the period of depression;   during the period
of exaltation she acknowledged the  delusion with many blushes.
  The physical health is almost always affected, and sometimes
seriously so, during the period of depression.   Dyspepsia, sleep-
lessness, and neuralgia are frequently present. Quite  the con-
trary, however, is true of the period of  exaltation; the powers
of the vitality are so highly excited, that an  unusual condition
q{ health is induced, and  it often happens that chronic disease
.of long standing, such as paralysis, indigestion, &c, disappear
during this stage of  the mental derangement.
  A lady, who had been  suffering from  a contraction of the 
                By Roger G.  Perkins, M.D.             21

 tendons of the flexors of the right hand for several years, so far
 recovered their use as to be able to write letters, to sew, and to
 knit, during her exaltation.
   A young lady who had endured for five years a catarrh of ex-
 tremely offensive  character, intensely annoying to herself  and
 friends, became  gradually better during the  approach of the
 stage of exaltation,  and perfectly well at the climax of excite-
 ment.  The disease re-appeared on the recurrence of the lucid
 interval.  I cured this catarrh during one of the lucid intervals
 with Silicea, with the result of bringing on the exaltation much
 earlier  and more violent than usual.  Patient is now mentally
 well, but still affected with the disease of the nasal passages.
   The  testimentary capacity of old men is sometimes impugned
 by interested  parties, on the ground of senile  dementia.  The
 main difficulty in these cases rests in the necessity of distin-
 guishing the natural decay of the mental faculties  from the un-
 natural change incident  upon  disease.  The first takes place in
 accordance with a natural law  of man's existence, and is  not
 owing to any  external cause.  The second is the result of mor-
 bid influence,  and comes within the limit of the statute made
 for the protection of all concerned.  The difficulty of distin-
 guishing these two conditions is the greater when found together
 in the same case, as often happens. Our study should be directed
 mainly to the former mental habit, and the history of the mani-
 festations now present,  with particular  relation to the  sudden-
 ness  of their appearance, and their exciting cause.   This, how-
 ever, is not sufficient to  decide the matter.   Not only are we to
 inform  ourselves of the former natural  condition  of the mind
 under inquest, but also of the natural changes most likely to oc-
 cur from age, upon a mind so constituted.  The  -probable natu-
 ral change thus inferred, compared with  the real change before
 us, constitutes the grounds of  the  diagnosis.   It Avould seem
 certainly  unjust to class all the manifestations of an intellect
 failing from age among evidences of insanity ; hence the neces-
 sity of  a philosophical distinction between the derangements of
 disease  and the decay of nature.  In some of our  States there
 is a law providing for the  guardianship,  and trusteeship of  the
property, of those incompetent from  old age.   In  those States
 where no such law exists, the  deficiency is no fault of the phy-
sician, and it is not his duty to torture scientific fact for the  ac-
complishment of a result however desirable. 
22
Insanity in its Legal Relations,
  A common mistake among lawyers, is to consider all forms of
mental disease occurring  among the  aged as senile dementia,
thus allowing  more importance to the time of life than to the
symptoms of  the disease.   Old men  may be the subjects  of
other forms of insanity.   I  have seen mania of high activity,
and delusions of an  intensity quite incompatible with dementia,
at very advanced age.  A lawyer, and perhaps more  than one
has failed to prove his case,  because classing manifestations
really insane under  the head of dementia,  which no intelligent
jury could admit within a scientific definition of that term.
  There  is, as every one knows, a loss of memory which when
unrecognized by the patient constitutes disease.  Memory being
one of the mental faculties,  its impairment involves mental de-
rangement;  unless  the external  relations to the world are pre-
served by a sense of the weakness in this direction, and a conse-
quent constant effort to obviate its results.  The mental equili-
brium is  thus maintained, the weakness of the memory is com-
pensated  by the strength of  the reason.  Business men of short
memories are not insane, because aware of their deficiency, they
guard against  its effects by means of memoranda.
  It is not uncommon for lawyers to  examine  witnesses very
particularly on this  point, and it thus requires a good deal of at-
tention.
  There  exists a moral as  well as an intellectual insanity. The
passions  and emotions are as much a part of the mentality  as
are  the imagination and the  reason.   In most uneducated peo-
ple  these last are less cultivated than the first, and a preponder-
ance in the emotional part  of their natures  is a  predisposing
cause to moral diseases.  Morbid  influences may cause as tu-
multuous riot  among the passions of  the human heart as amid
the workings of the human reason; and it is extremely unphilo-
sophical to ignore this fact.  Whether the plea of moral insani-
ty is used,  as  may  be  also  the  plea of intellectual disease,  by
people whose  natural or developed  depravity has brought them
into trouble, is a question  with which  we have  but little to do.
Is is for the medical witness to apply the proper means of diag-
nosis to the case in hand,  and for him to determine, if  the ac-
cused is really sick or simply wicked.
  In following out this theme,  it is evident the moral  change
occurring from a morbid cause, may be either from bad to good 
                By Roger G.  Perkins, M.D.              23

 —good to bad—or bad to worse.  As instance of the first, I re-
 member an old sea-captain, who, when in his healthy and natu-
 ral state was most  passionate, overbearing, unreasonable  and
 avaricious.  He was known among his employers and friends as
 a "hard man," with no milk of human  kindness in his heart.
 Suddenly he "met with a change."  He became as civil as he
 was  before disagreeable.   Never before known to  be just,  he
 suddenly became generous.  His passions were changed to amia-
 bilities,  and the  church seemed about  to  receive a new sup-
 porting  pillar in his  bulky person.   The fisher of whales was
 about to become a fisher of men, and the people were all glad
 of it.  There sprang up quite a breeze of enthusiasm, by which,
 this and  other "brands snatched from the burning," were fanned
 into a flame of ardent zeal.  But the end  was not  yet.   The
 old gentleman had a vertigo one day, which frightened him into
 a box of cathartic  pills, (saints preserve us!) and severe haemor-
 rhoids ensued, which  took the place of the ulcer  he had  too
 suddenly and imprudently  healed with topical applications a few-
 months before.  The occurrence of the hsemorrhoids relieved
 the nervous system,  the natural state of my eccentric acquaint-
 ance  was re-established, and he became as  bad  as ever, to the
 great disgust of all who knew him, myself among the number.
   As instance of a change from good to bad, I  knew a young
 man  of  good mind  and excellent accomplishment,  who was,
 when in  his natural  state, very fond of beauty in all its  forms,
 and  was very amiable and inoffensive.  After some business
 disappointment he became moody for a while, and presently had
 occasional passionate outbursts, and for the first time in his life
 whipped  his astonished dog  and horse most unmercifully.   I
 called on him one day, and found him  in  his father's garden
 striking off the heads of the flowers with his walking-stick, with
 a vindictive and earnest industry which must have startled anv
 observer.   The reason for this strange  conduct  was, that  he
 "didn't like to see  the damned things."   "It was no business of
 mine, if he chose to  spoil the garden."   "I'd better  be quiet,"
 &c, &c.  Presently the poor fellow began  to shed tears, said
 he felt sick and tired of the world, begged I would excuse him
 and sauntered away.   During this illness which  lasted nearly
four months, he procured the most poignant unhappiness of a
newly married couple  by  his ill-designed slanders, and when 
24           Insanity  in  its Legal Relations,

compelled to confess his falsehood, did it in such a manner as to
leave its sting behind.
  Moral insanity exhibited by a change  from bad to worse, is
perhaps common enough,  but extremely difficult of diagnosis.
Public opinion is always against the success of this plea,  and
we  may err on the safe side, perhaps, when agreeing with the
popular mind in  at least this one of its conclusions or prejudices.
There is a  natural growth in wickedness.  Immorality may be-
come hypertrophied as may the arm of the blacksmith by con-
tinued and  unrestrained  use.
  The case of a notorious forger  has recently been the subject
of much public  interest, from the plea of  moral insanity con-
nected with his defence.  The jury decided against the plea in
this  instance, and from the testimony adduced, we cannot  see
how they could have done otherwise.  There  was, however,
one point which Huntington's lawyer seems to have lost sight of,
and  to which a good deal  of  interest attaches.  The  defence
proved the  repercussation of  a cutaneous disease of the  scalp,
during the  childhood of the  prisoner.  Now if it could have
been proved that previous to the disappearance of this eruption,
the  child Huntington had been, like other children, mild, gentle,
obedient, and generally harmless,  and that  subsequently he be-
came Avicked and ungovernable, a very fair question of accounta-
bility might have arisen.  The inquiry in this case would have
been, how far the diseased action on the scalp had permanently
affected the brain beneath.
  When, however, we consider that no such point was made,
we must agree with  the verdict.   The wild excitement engen-
dered by the success of reckless endeavor,  finds natural outlet
in careless  expenditure,  and in the exaltation attendant on sud-
den transition from poverty to wealth, from anxious hope to full
fruition, excesses are natural,  and headlong folly is the law.
  We have thus finished what the occasion seems to demand.
The importance of the subject is,  of course, very apparent,  and
fully justifies the space taken  for its consideration.
  The fourth article of this series will appear in a short time.
In it we shall speak of the  treatment of the insane.
                                    R. G. Perkins, M.D.
 No. 96, Fourth-Avenue, N.-Y. 
■og/gr-

INSANITY
1
ITS  LEGAL  RELATIONS.
i
       ROGER G. PERKINS. M.D.,

LECTURER ON MENTAL DISEASES AND PROFESSOR OF THE INSTITUTES OF MEDICINE, IN THE AMERICAN
             COLLEGE OF MEDICAL SCIENCE.
         $Uto-g0rfe:

PRINTED  BY HENRY LUDWIG,
      39 CENTRE-STREET.

          18 58.


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