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INSANITY
IN ITS
MEDICO-LEGAL  BELATIONS.
/
BY
A. C. COWPERTHWAIT, A. M., M. D.
    ^fjilabelpbia:





J. M. STODDART & CO




  No. 723 CHESTNUT ST.,




     1876. 
Q.27U
Entered according to  Act of Congress,  in the  year 1876, by





           A.  C.  COWPERTHWAIT,





   in the Office of the Librarian of Congress, at Washington. 
CONTENTS.
                   CHAPTER  I.
                                             PAGE.

Introduction,    .......      i


                  CHAPTER II.

Pathology,........6


                  CHAPTER III.

Classification,    .......    16


                  CHAPTER IV.

Diagnosis.........29


                  CHAPTER V.

Criminal Responsibility of the Insane,    .    .    36


                  CHAPTER VI.

Epileptic Insanity,    .   .    .    .    .        61


                 CHAPTER VII.

Treatment of the Insane,    .         .         .  70

                       (iii) 
 
              PREFACE.

                     ------------■ <»> ■------------


   IN presenting these pages  to  the public,  the author
     does not flatter himself by thinking that  he is bring-
ing forward any strikingly  new or original ideas in regard
to insanity; on the contrary, he has endeavored to incor-
porate, in as little space as possible, the  ideas and observa-
tions of those who have already become  eminent as alienist
physicians, with a somewhat  extended experience of his
own, and thus to produce a work, which, while it may be
very brief, will contain those essential facts relating to the
pathology and diagnosis, and the legal relations of insanity,
which should be familiar to every physician, and the knowl-
edge of which is of absolute necessity to him  when called
upon to testify in courts of justice.
  The remarkable prevalence of mental diseases in late
years, and the growing tendency thereto, especially in our
own country, together with the enormity of crimes which
are being constantly laid at its door, make it a matter of
paramount importance, that  every  physician  should be
thoroughly posted in regard to insanity  in all its relations,
legal as well as medical.
  In all  cases, the liberty of the individual suspected of
insanity,  depends  upon the diagnosis of  the  physician ;
how important the trust, how great the responsibility there-
fore, when we take into consideration the impending misery
or happiness of all concerned.  Yet this trust falls into com-
parative insignificance by the side of that which  devolves
upon the physician, when his  word is to decide the life or
death of the unfortunate criminal.   How necessary, then, a
(v) 
vi
Preface.
thorough knowledge of the whole  of  mental pathology,
and how greatly to be regretted, is the wide spread profes-
sional apathy and ignorance concerning it.
  In the language of a recent writer:   " Were the  vast
array of incipient  lunatics,  who  mingle  unrecognized
among our large population, to be suddenly discovered,
the  shock  upon the  community  would be profound.
Nevertheless, it would be wholesome.  If the  world clearly
understood how much of the eccentricity and the moral
perversity manifested by  individuals was  to be ascribed to
a positive  derangement  of  the material  instrument of
thought, and how much to a purely capricious and depraved
will, its judgments, in courts of law and at the tribunal
of society, would be more just and charitable."
  There is no  question now before the  public,  involving
more broad and  serious consequences  than that of the
comparative sanity and  moral  responsibility  of  criminals
and  wrong-doers.  In  every case of  erring  or  singular
action, the inquiry  into the  motive should include a con-
sideration of the  relative  soundness  of the brain  that
prompted it.   Now that the fact is known  that a slight
change in the flow of blood to the head, or a little impover-
ishment or impairment of the vital current, is able to pro-
duce at least a temporary disorder of the mind, it becomes
intelligent and humane men to inform themselves perfectly
as to the physical conditions under which evil deeds are
committed  before a settled verdict  is passed upon them.
This obligation might  seem to impose too arduous a bur-
den  of research in order to  reach equitable  conclusions ;
but it is quite as easy to elicit the truth regarding ancestry,
bodily health, and habits of thought and  action, as it is to
secure  the  ordinary  and  superficial facts on which the
judgments  of mankind are  usually based.
   If then,  this  little work may be the means of exciting
an interest in the  profession upon this important  subject,
and  at the same time, exert its influence in begetting in law
and  in society, amorehumaneandcharitablefeeling,not only 
Preface.
\n
for those who are unequivocally insane, but also for those,
none the less  unfortunate  ones, who inhabit the border-
land between mental health and mental disease, my object
will have been fully attained.
  I desire to acknowledge my indebtedness to the follow-
ing excellent works, which have assisted me in the prepar-
ation of these  pages,  and without which no physician's
library is complete:   "The Physiology and Pathology of
the Mind,"  by  H. Maudsley, M.D.; also " Responsibility
in Mental  Disease," and  " Body and Mind," by the  same
author; "A Treatise on Diseases of the Nervous System,"
by William A. Hammond, M.D.; also "Insanity in its  re-
lations  to Crime," by the same author;  "A Treatise on
the  Medical Jurisprudence of Insanity," by I. Ray, M.D.;
" The  Borderlands   of Insanity,"  by A.  Wynter, M.D.;
" A Manual of Psychological Medicine," by  Drs. Buck-
nill and Tuke; "Mental Pathology," by  W. Griessinger,
M.D.   No one can be more  conscious than myself, of the
many  defects which undoubtedly  characterize  this book,
and it is only with the hope that these may be charitably
criticised, or kindly overlooked, that  I  allow them  to go
before the public.                            A. C. C.
   Nebraska City,  January loth,  i8j6. 
 
INSANITY.
CHAPTER  I.
                     INTRODUCTION.
  The position of the medical man when called  upon to
testify in  an obscure  case  of mental disease, though an
unenviable one, is, nevertheless, one of the most important
and honorable in which it is possible for him to be placed.
  Even in this enlightened day there are those who sneer
at the idea of calling a physician to decide the question of
insanity.  A person in order to be insane, in their estima-
tion, must either be a raging maniac, or, at least, be labor-
ing under an outrageous delusion.   They know nothing of
the secret workings of the human mind, either in health or
disease, and too  often think the physician makes crime an
evidence of insanity, simply because they cannot appreciate
the unseen evolutions of the mind.
  The accumulation of knowledge on the subject  of men-
tal diseases by the physician, based upon careful observation
and inductive inquiry, is fast exploding the absurd idea so
long  retained, that insanity is  a subject of moral  inquiry
and not a physical disease.  It is enough for  the  lawyers
to diagnose the crime, and leave the diagnosis of  the dis-
ease to those who know something about it.
  The fact is now established that insanity is a bodily dis-
ease, and scientific men of the profession are now laboring
to discover the particular bodily derangements associated
with the various  forms of mental disease.  The more there
is discovered in this direction, the nearer are we arriving
at absolute truth, and the more  necessary will be the phy-
sician's opinion, for the reason  that he will then be dealing
with  something  entirely beyond the  comprehension  of
those  who have not made the subject a special  study.
                         (i) 
2
Insanity.—Introduction.
  Then, as now, it must be the first duty  of the medical
man to uphold  the truth  against error,  even  though he
thereby becomes a target for the rash and unjust censures
of an ignorant  multitude.  " A wretch foredoomed to in-
sanity by mal-organization  or hereditary defect," observes
Connolly, " or driven mad  by  poverty, or  by disappoint-
ment acting on  a distempered brain, has  no other friends
in the world. The same courage which causes the physi-
cian to brave the dangers of pestilence should support him
in this duty beneath  the assaults  of pestilential  tongues
and pens.   Not the voice of the people calling  for execu-
tions, nor the seventies of the  bench frowning  down psy-
chological truth, should shake his  purpose as an inquirer
and  a witness.   His  business is  to declare  the  truth.
Society must deal with the truth as  it pleases."
  However, the courts are beginning to look with more favor
upon the opinion of medical men, and are less inclined to
be  governed by obsolete  and  ill-established  tests of re-
sponsibility.  This fact is evinced by the position recently
taken by  two judges of the Supreme Court of New Hamp-
shire.  In the case of  Boardman vs. Woodma^ in which
a will was disputed on the ground of insanity, the decision
sustained by the full bench was rendered  in  accordance
with the usual tests.  Justice Doe dissented and maintained
that " the question whether Miss B. had  a mental disease
was a question of fact for the jury,  and  not a question of
law for the court.  Whether delusion is  a symptom  or a
test of any mental  disease was also a question of fact;  and
the instructions to the jury were erroneous in assuming it
to be a question of law.....The tests  and symp-
toms of insanity  are  no  more matters of law than are
symptoms or tests of any other disease in animal or vege-
table life.   If a jury were instructed that certain  manifes-
tations were symptoms or tests of consumption, cholera,
congestion or poison, a verdict rendered in accordance with
such instructions would be set aside, not because they were
not correct, but because the question of their  correctness 
Insanity.—Introduction.               3
 was one of fact to be determined by the jury on evidence.
 Experts may testify to the conditions of mental disease as
 they could not if such indications were  matters of law."
 Judge Doe further observes that legal tests of responsibility
 have always been derived from  medical authorities, who
 profess to have founded their opinions  on the observation
 of facts.   They are virtually the  dicta  of medical men,
 of experts—conflicting and liable to grow obsolete; and,
 therefore, in passing judgment upon them, the courts actu-
 ally trespass on the province of the expert.   They change
 with the progress of knowledge.  Tests and definitions of
 insanity once supposed to be correct and comprehensive,
 have given  place to others  regarded as representing  the
 known facts of science.   Whether they are correct or in-
 correct, current or obsolete,  is a  question  not for  the
 court, but for the expert to answer.
   The same doctrine was repeated by Judge Doe  in the
 case of State vs.  Pike, in  which he observes that " the legal
 profession,  in  profound  ignorance  of mental disease, as-
 sailed the superintendents of asylums,  who knew all that
 was  known on  the subject, and to  whom the world owes
 an incalculable debt, as visionary theorists and sentimental
 philosophers, attempting  to overturn settled  principles of
 law;  whereas,  in fact, the legal profession was invading the
 province of medicine, and  attempting to install old exploded
 medical theories in the place of facts,  established in  the
 progress of scientific knowledge."
   In  the same case,  Chief Justice  Perley instructed  the
jury "that all symptoms and  all tests of mental disease are
 purely matters  of fact to be determined  by the jury."
   In commenting upon these cases, Dr.  Ray observes that
 "against the course of these judges so strongly in har-
 mony, as it is, with the established principles of law, it
would be difficult to offer a satisfactory  objection.  How-
ever necessary the present practice may have been in former
times, when juries were  ignorant  of the little  that was
known respecting insanity, and were obliged to rely on the 
4
Insanity.—Introduction.
court for information, that necessity is now fully obviated by
the services of counsel and the testimony  of experts.  If
courts, instead of charging the jury to acquit the prisoner,
if they find he was unable to distinguish right from wrong,
or knew  not that he was committing an  unlawful act, etc.,
should merely direct  them  to acquit if they believe  the
criminal  act to have been  the offspring  of disease, it can
scarcely be questioned that much dissatisfaction would be
avoided,  while the requirements of justice would be fully
answered.  And this way of settling the question, obviates
the objection suggested by the principle—that insanity, of
whatever form or degree, does not absolve  from the nor-
mal consequences of crime;  because  it will  be observed,
the prisoner is acquitted, not for  the reason that he is in-
sane, but that the criminal act is the offspring of disease."
   From  these observations of eminent professional men,
and from the general drift of the important criminal cases
of late occurrence, it is very  evident that the value of the
testimony of a medical expert in cases of criminal insanity
will transcend those of the legal profession.   Neither upon
the old established commentaries of law, or upon the judi-
ciary, or the counsel, will rest the  question as to responsi-
bility in  mental disease, but  to the  expert alone will all
these look for those matters of fact which, considered and
duly  weighed by the jury, are  to acquit or convict the
prisoner at the bar.   With  such  a  responsibility resting
upon the medical p'rofession, all  will agree  that more at-
tention should be paid by them to the study of mental dis-
eases, and to this end  it is hoped, that this little work may
be of some direct influence and benefit.
                   RULES FOR EXPERTS.
   I will  now give, in  very brief form, a few rules for the
 guidance of the physician when called upon to testify as a
 medical  expert:
   i.   He should, at the outset,  have a well-ordered, well-
 digested, comprehensive knowledge of mental phenomena
 in a  sound as well as an unsound state. 
1 nsanity.—Introduction.
5
  2.  He should be entirely  independent,  not  allowing
himself to be too cordial with the counsel by whom he has
been called and for  whose purposes, it is expected that
his testimony will be of value.
  3.  He should never, from a dread of being thought ignor-
ant of his profession, permit to be drawn from him a positive
and unqualified reply, when a modest doubt  would better
express the extent of his knowledge;  neither should he
ever give an  opinion without mature consideration.
  4.  He should insist on having all questions clearly ex-
pressed, and  never allow himself to answer a question he
does not thoroughly comprehend.
  5.  Notwithstanding  the authoritative demand for ayes
or no, so adroitly used to embarrass the witness and dis-
credit  his testimony, he should qualify  and explain his
answers, so as to prevent any mistake as to their meaning.
  6.  He should not allow himself to be  drawn out into
giving an opinion on any supposed or imaginary case.
  7.  He should decline giving a positive  opinion on one
or two isolated symptoms or facts; such things, whatever
they might signify when viewed in connection  with one
another,  when singly considered, prove nothing respecting
the mental condition.
  8.  He should  be careful about giving a  definition of
insanity;  it may be explained and described, but is not the
proper object of a definition ;  at the same time, care should
be exercised  in allowing one's self to be drawn into any
metaphysical discussion.
  9.  He should not allow himself to admit  that all peo-
ple are more or  less insane,  or all crime madness.  A di-
viding line cannot be drawn that will be appreciable in all
cases, so,  for the individual  case, science and experience
must decide.
  10.  He should not judge of the credit of other wit-
nesses, or the truth  of their  testimony, it is for the jury to
decide upon  this matter.  If the jury are  satisfied of the
truth of the evidence, an opinion, based upon that evidence, 
6
Pathology of Insanity.
may be given ; but it should be borne in mind that it is the
whole  evidence  upon which an opinion is to be founded;
and, if that evidence is contradictory or deficient, the wit-
ness will best consult his own  reputation, and promote the
ends of justice by candidly stating the  fact.
                 CHAPTER   II.
                       PATHOLOGY.
   Insanity, unquestionably arises from a morbid action of
the brain, and is only a symptom of disease of that organ.
For this reason it is not a proper object for definition as a
disease, nor is it possible to give the word insanity such a
meaning as will  cover all possible morbid cerebral manifes-
tations, and yet not include those  cases of brain  disease
which do not properly come under that head.  According
to Hammond, insanity " is a  manifestation of disease  of
the brain, characterized by a general or partial derangement
of one or more faculties of the mind, and, in which, while
consciousness is  not abolished, mental freedom is prevented,
weakened or destroyed."
  The brain is the seat of intelligence  and volition,  and
constitutes the grand centre of the  supreme nervous  sys-
tem.  Receiving, as it does, from the sensitive columns of the
spinal chord, and from the higher nerves of sense, the vari-
ous  impressions there created, it collects, associates  and
assimilates these impressions, and forthwith excites a  cor-
responding  action of the mental system, which operates
upon every motor nervous ramification, and  produces the
varied actions of life.   How these material  impressions
upon the nerve  fibres  and cells can be converted into  an
act of consciousness, is utterly incomprehensible.
  The ganglionic nerve cells of the brain are supposed to
be the centres of its functional activity, as much as  are the
ganglionic nerve cells of the motor system the centres of
its functional activity; and, if  so, mind  is  simply a  de- 
Pathology of Insanity.
7
veloped energy of nerve cell; but whatever be the real na-
ture of the mind, it is most  certainly dependent for its
every manifestation on the brain and nervous system.
  It is interesting to note the intimate physiological rela-
tionship existing between the brain and other portions of the
nervous system, which inductively leads to the assumption
that the latter plays  no  small part in the creation of cerebral
manifestations, and that they hold within themselves, an im-
portant element of  mental force.
  In  the  lowest forms of animal life,  no nervous system
exists, external impressions seemingly being received by
peripheral molecules, and transferred, by reason of the ho-
mogenity of its substance, from element to element, at last
resulting  in visible movement.
   In  the second higher order  of animals,' the substance is
less homogenous, the molecular relations less intimate, and
a rudimentary nervous system appears, consisting of a sin-
gle nerve cell connecting two fibres,  which serve as con-
ductors, and giving rise to the simplest form of reflex action.
   As we  go still higher in animal life, the more heteroge-
nous becomes the body, and the more diffuse and complex
the nervous system, until  rudimentary organs  of special
sense appear, and, with them, a corresponding increase of
ganglionic centres. Here the perception of external  im-
pressions is more varied and discriminating, partaking less
of reflex  action and irritability, and more of that which is
designated  as sensory  perception  and sensori-motor re-
action.
   As yet, however,  no trace  of cerebral hemispheres is
found, these first appearing  in a rudimentary manner in the
fish,  gradually enlarging as we ascend to the mammalia,
becoming nearly perfect in  the higher mammalia, and fully
 developed in  man.
   As soon as these hemispheres appear, external impres-
sions are passed from  the sensory centres to  the brain cen-
tres,  which, in accordance  with  their  special nature, give
 rise to ideas, forming another and higher type of sensibility
which is  known as ideational perception. 
8               Pathology of Insanity.
   As we ascend in the mammalia, the hemispheres gradu-
 ally enlarge backwards, and in the Ruminantia and Pachy-
 dermata  slight traces  of convolutions are  found,  which
 become more fully developed in the Carnivora, and complete
 in the apes and in man.   The longer,  more numerous and
 complicated are these convolutions,  the greater will be the
 degree of intelligence, all other things being equal, and, as
 these cerebral  developments gradually ascend, with a cor-
 respondingly gradual  increase of  intelligence from the
 Ruminantia to the highest type of animal life ; so, too, do
 they ascend from the highest type  of animal life to the
 lowest form  of human life; and the  same correspondence
 continues as we examine, in an ascending scale, intellectu-
 ally, the different races of men as well as different men of
 the same race.
   In addition to the above observations,  it  has also been
 demonstrated that the embryonic development of the human
 brain passes through similar stages to those through which
 the  brains  of  other  vertebrate embryos  pass, and these
 transitory conditions  in him  are  quite similar in form to
 those which are permanent in  the  lower animals, with a
 gradually corresponding ascent.   It is easy to perceive,
 then, that, as Maudsley observes, " an arrest of development
 of the human brain may leave  it very much in the condi-
 tion of an animal brain; and it is  found in some cases, as
 a matter of fact, that congenital idiots have brains very like
 those of the monkey."
   Still further, it has been observed  that there exists a
specific difference in the constitution  and functions of nerve
cells, though to the eye,  the  latter  often appear  exactly
alike ; and the microscope has established the fact that there
are structural differences  between  the nerve cells in man
and those in the higher mammalia.  It is very probable
that these differences extend to both the cells of the sensory
ganglia, and those of the higher nerve centres, and equally
probable that they apply to the different groups of  cells of
the same system,  and  that each form  of  cell life  has its 
Pathology of Insanity.
9
specific function to perform in  cerebral manifestations.   It
is only by the acceptation and  application of these physio-
logical facts that we may safely proceed to investigate the
pathological conditions of mental force, and hold true ideas
as to the relations existing between  the mind and nervous
system.   What constitutes the mind,  or  the relations that
it holds to the body,  whether  material  or spiritual,  can
never be satisfactorily answered from a metaphysical rather
than a physiological standpoint.   We can only look upon
intelligence and  will, as  the special functions  of  the
brain, just the same as transmission and  reflex action are
the special functions of the  nervous  system, while the mind
constitutes pre-eminently the sum of all cerebral states.
  Scientific researches  prove  that the brain alone is the
seat of all mental action,  either normal   or diseased, and
the natural and  acquired  powers of the  mental faculties
depend upon  the proficiency  of development and struct-
ural quality of the brain; when the latter is  deficient in
organic development, there is a corresponding  weakness of
the intellect and will;  or, when diseased, a perversion or
morbid derangement of those  faculties.   Diseased mental
action is always the product of a diseased brain, but a dis-
eased brain does not always  produce a  diseased mental
action, as is evinced by the frequency of those cases where
there is a serious disorganization of  the brain, without any
disturbance of the mental  function.   The query  for  us,
then,  is what character of cerebral  disease  do we find in
insanity?
  To establish this fact from a pathological  standpoint, is
a matter of impossibility, as the character of the anatomi-
cal changes to be found differ so widely  from  each other,
and are so thoroughly diffuse, that in this day, no anatamo-
pathological basis for insanity  can be afforded,  as for other
cerebral affections.   In fact, it  is  often impossible to dis-
cover after death, any  organic lesions of the  brain what-
ever, and this is the reason that some deny that insanity is
a material disease, and consider it to be an affection of  the 
10
Pathology of Insanity.
immaterial principle.  Yet we find that in diseases of other
organs, pathological changes are also often absent, though
the presence of actual  disease in these cases is not ques-
tioned.   Because no pathological changes are found, is no
sign that nerve element does not subserve mental function.
We know comparatively nothing of the intimate constitu-
tion of nerve element, for the reason that it has so far baf-
fled human  investigation, yet, because we do not see the
changes,  we should not conclude  that they have  no exis-
tence.
  Serious disintegration of nerve element may occur from
various   causes,   without  any  discoverable  pathological
changes.   For instance, as  a result of excessive or  pro-
longed mental exertion, the brain may  become, for a time,
entirely  incapacitated  for  further  function,  but without
any visible transformation of nerve substance, though an
increase of phosphates in the urine testifies to its disinte-
gration.  The lightning's stroke may produce instant death,
or leave its indelible mark in a shattered constitution and
disordered nervous system,  yet, in neither case, does the
scalpel or microscope  reveal any pathological change.   So
might we produce many other facts to prove  that serious
changes  of nerve element do take place without any  cog-
nizable evidence, further than the accompanying modifi-
cations of nerve energy.
  However, dissections are abundantly  proving the fact
that deviations from the healthy  structure of the brain, are
found in  insane subjects, and when we  remember the  limi-
ted knowledge of brain anatomy possessed by pathologists
in the  past, we  may  safely  conclude with Dr. Ray,  that
" the absence of  these  changes might be attributed, in not
a few instances, to the fault of the inquirer rather than  to
the nature of the disease."
  The instances in which morbid  appearances in cases  of
insanity are not found, "are," observes  Maudsley, "becom-
ing less  frequent, as  investigation improves;  and  those
who are best capable of judging,  and best qualified by ac- 
Pathology of Insanity.               11
quirements to give an opinion,  are  those who are most
certain of the invariable existence of organic  change.  It
is known that when a morbid poison  acts with its greatest
intensity,  there are fewer  traces  of  organic alteration of
structure found, than  when  the  disorder has been  of a
milder character; and  so likewise, organic change of nerve
element  in insanity, appreciable by the means of investiga-
tion which we now possess, may justly be expected, only
when the  degeneration  has been extreme or  long con-
tinued."
  In insanity as in other diseases, irritation is  the  initial ■
stage of disease, and constitutes the first link in  a chain of
events,  of  which disorganization and destruction  are the
last.  During this stage of irritation,  structural changes
are wanting, and should death occur from any cause what-
ever, even  though the functions were seriously, perhaps fa-
tally deranged, before the outset of the subsequent stages,
there could  be  found no  pathological traces  whatever.
This stage of irritation, should it affect the physical  forces
but little, as is usually  the case, may endure for years suffi-
ciently strong to excite a morbid mental  action, and still
death results before any structural changes had occured.*
  The more we come to know of insanity  in all its rela-
tions, the more it is robbed of its metaphysical aspect, and
the more does it appear to  us as  a material  disease, not-
withstanding  ignorance and superstition  have  ever suc-
ceeded  in  throwing around  it an air of mystery.   It  ob-
serves the  same pathological laws as  other diseases, it fol-
lows the  same  course of incubation  as  other diseases,
  * In the recent case of Joseph Waltz, described elsewhere, a post-
mortem examination revealed no cerebral lesion whatever, and the
learned doctors who assisted in procuring the verdict of guilty, felt
their opinions to be thoroughly vindicated.  It is hoped that discov-
eries will hereafter be made, so that insanity may always be detected
by the scalpel and microscope, but that time is not yet;  and Joseph
Waltz was  none  the less insane for the reason that there were no
pathological changes in the brain discovered. 
12
Pathology of Insanity.
sometimes approaching insiduously, at other times break-
ing out without any warning;  its development presents
nothing strikingly peculiar, as it merges into its most dan-
gerous form; neither does its termination in death or reso-
lution, either  suddenly or gradually, present any remark-
able features, different  from the same  in  other diseases.
Sometimes  proceeding through successive stages to the
end with increasing  severity, or  interrupted by intervals of
a longer or shorter duration.  These intervals or apyrexiae
may either be remittent or intermittent.  In the former, the
mental excitement being only modified and less violent; in
the latter,  the  patient seems  entirely  restored and pos-
sessed of a sound mind.  It never arises from an immate-
rial or strikingly peculiar  cause, but its etiology is analo-
gous to that of other diseases, and may nearly always be
discovered by a careful examination.  These  oft repeated
observations, together  with the fact that it  often yields  to
a judicious medication and hygenization, and  this  also in
proportion to the recency of the  attack,  gives  positive evi-
dence that insanity is a bodily disease, and in no way anom-
alous to established pathological principles.
                pathological conditions.
  In briefly enumerating the results of pathological obser-
vations, it  will be convenient to notice (i) those  morbid
products such  as tumors, abscesses, cysticerci, etc., and
(2) those direct results  of morbid action which are, micros-
copically or otherwise, discoverable in the structure of the
supreme centres.
  1.   There can be no question  but that such morbid pro-
ducts as tumors, abscesses, etc.,  of the brain substance,
more often occur without any  symptoms of mental dis-
turbance, but such is the  case only from the  fact that the
supreme netve  centres  are not implicated by the  disease.
When, however, these products become manifest in  the
membranes,  rather than in the substance of the  brain,  the
intelligence is  more liable to become disordered, owing to
the close  proximity  of the morbid action to  the  delicate 
Pathology of Insanity.
13
centres  of intelligence, and its  serious interference  with
their supply of blood.  Nevertheless these morbid pro-
ducts in the brain substance are sometimes accompanied
by  symptoms of mental disturbance.   In such cases the
mental symptoms are usually of the character of an  inco-
herent delirium, the like of which we  do not meet in any
of the recognized forms of insanity, or of  mental imbe-
cility, deepening into extreme dementia in the last stages,
and are nearly always  intermittent, so that they may disap-
pear entirely from time to time.
  These observations  go to prove that there is no  definite
morbid action going on within the centres of intelligence,
but that the mental disorder, instead of being a direct result
of the disease, is but a secondary or reflex effect.
  2.  The direct results of morbid action in the brain do
not admit of very definite description. It is a fact, however,
pretty well established, that the morbid changes most often
met with after insanity are such as affect the surface of the
brain,  and the membranes  immediately covering  it,  and
these changes are decidedly the most frequent in the cor-
tical substance.  That  inflammation and other pathological
conditions of these parts do sometimes exist without symp-
toms of mental disturbance, there can be no question-; but
it is very probable that in all such cases the cortical layers
of  the brain have  escaped  the  disease.
  The  following general summary of the morbid  appear-
ances met with in cases of insanity, is furnished by Maud-
sley,  as taken from Schrceder van der Kolk, than whom
there is no more eminent authority:
  When the  patient  has died at the beginning of  acute
insanity, and the pia mater is stripped off, the cortical layer
will exhibit unequal coloration;  certain convolutions being
rosy, others pale.   The differences are often  detectable
only by careful  observation; they  are the results  of  great
congestion, or commencing inflammation,  and are found
more often in those who have died of typhus fever, or after
acute delirium, than in insanity, because death but seldom 
14              Pathology of Insanity.
  occurs at an early stage.  After a longer duration, the dis-
  ease  appears to pass into a chronic inflammation.  There
  is some difficulty in stripping off the pia mater, the vessels
  of which are strongly injected, from the surface of the brain;
  and portions of gray matter are sometimes brought away
  with  it.   More or less exudation commonly occurs between
  the arachnoid and the pia mater, and the former may form
  a thick, white, opaque  layer, through which the convolu-
  tions are  scarcely visible.    After a still longer  duration,
  when dementia is thoroughly established, there is no longer
  any increase of vascular injection.  The vessels are less
  full than natural, and the pia mater may even, in some  cases,
  be stripped off with more ease than in health, a clear serous
  fluid  flowing away the while; the gray substance appears
.  pale or anaemic, and somewhat atrophied;  and the vessels
  especially at the base of the brain are beset with atherom-
  atous patches.   The degeneration extends  into the ventri-
  cles, the lining membrane being thickened, and sometimes
  covered with fine granulations, and more or less fluid  being
  effused  into them.   The membrane covering the corpora
  striata is most thickened, and cannot, as a rule, be stripped
  off without leaving the commonly softened nerve substance
  beneath;  this particular  change being  declared during life
  by paralytic symptoms,  such as trembling of the lips, diffi-
  culty  of articulation, and uncertain walk.
    In  addition to the foregoing morbid appearances, it is
  said that the weight and specific gravity of  the brain  is in-
  creased in the insane, but farther experiments are yet needed
  to render  these observations certain.  Microscopical exam-
  inations are fast adding to our knowledge of cerebral path-
  ology, and it is to be hoped that the day is not far distant
  when a distinct pathological basis may be  afforded for in-
  sanity, as  for other diseases.
,   According to Maudsley,  there are three principal stages
  in the degeneration process of cerebral disease : (i) a change
  in the vessels,  hindering nutrition;  (2) atrophy of the
 nerve element, either from imperfect nutrition (Rindfleisch), 
Pathology of Insanity.               15
or from the growth of connective tissue (Rokitansky); and
(3) the subsequent metamorphosis of the connective tissue.
The same author enumerates the following different kinds
of degeneration:  (1) an early stage of inflammatory degen-
eration, or an acute hyperaemia, occurring in the most acute
forms of insanity; (2) connective tissue degeneration, in which
there is an increase of connective tissue, and an atrophy of
the nerve elements; (3) fatty degeneration, either occurring
in the smaller vessels of the brain, or in the proper nerve
elements, or in the new  morbid products ; (4) amyloid de-
generation, in which corpora amylocea, or little starch-like
bodies, are found in great numbers in  the brain; (5) pig-
mentary degeneration, met with in the  ganglionic cells of
the brain in  senile atrophy; (6) calcareous degeneration, in
which there  is not only a calcification of some of the gan-
glionic cells  of the brain, but also granules of earthy matter
found in the hypertrophied connective  tissue of long con-
tinued and extreme cases of insanity.
   " Those who duly weigh the pathological import of these
different sorts of degeneration, who reflect on the great gap
which there is between a calcareous granule and a nerve
cell in the economy of nature, or between a connective tis-
sue corpuscle and a nerve cell in the histological scale,
 must be .constrained to admit that the difference is not less
 great than the difference between dementia and sound
 mental action, and cannot venture to assert that the morbid
 appearances throw no light whatever on the  nature of in-
 sanity.  Even the slight signs of hyperaemia are of weighty
 significance  if their true relations are recognized, if they
 are viewed as results and evidence of that degeneration of
 individual nerve  element, of which the mental disorder is
 also result and evidence, if they and the insanity are viewed
 as,  what they often are, concomitant effects of a common
 cause."
   As regards the pathological condition of other  organs,
 as met with in the bodies of the insane, they are of so gen-
 eral a character, and never in any constant relation to any 
16             Insanity.—Classification.

particular form of insanity, that their study is of very little
practical benefit, so far as they concern the morbid mental
condition.
   Diseases of the lungs are the most frequent local  affec-
tions met with in the insane.  Pneumonia, gangrene, and
phthisis are of no uncommon occurrence,  and tubercular
deposition is said to be about twice as frequent in the in-
sane as in the sane.
   Diseases of the heart,  stomach, liver,  bowels, and peri-
toneum, as well as different forms of sexual disease, are of
more  or  less  frequent occurrence,  but, as a general rule,
there is no sort of connection traceable between the char-
acter of the insanity and the particular disease.
                 CHAPTER  III.
                    classification.
  The classification of the various  phases of insanity ac-
cording  to  its pathology, as we classify other diseases, is
at present a matter of impossibility, owing to the compar-
atively limited knowledge entertained of cerebral anatomy
and  pathology.   We can  only recognize  the different
groups of symptoms as such, and thus we may empirically
establish a physiological and psychological basis of classi-
fication.
  Various classifications have  been  made by different
authors, based upon different plans to meet the individual
views.  The classification of  Esquirol, though  made some
thirty-five years ago,  is still  quite popular, and in  many
respects  is the best of its kind.  It  has the advantage of
being based on symptomatology, rather than on any indi-
vidual ideas of pathology, which are liable to  prove erro-
neous.  It is as follows:
  i. Melancholia.   Perversion of the understanding  in re-
gard  to  an  object  or a small number of objects, with the
predominance  of sadness and depression of mind. 
Insanity.—Classification.                17
  2. Monomania.   Perversion of understanding limited to
a single object, or a small class of objects, with  predomi-
nance of mental excitement.
  3. Mania.   A condition in which the perversion of  un-
derstanding embraces all  kinds of objects, and is attended
with mental excitement.
  4. Dementia.   A condition in which those affected  are
incapable of reasoning, from  the  fact that the organs of
thought have lost their energy, and  the  force necessary
for performing their functions.
   5. Imbecility or Idiocy.   A  condition  in which  the  or-
gans have never been sufficiently well conformed to permit
those affected to reason correctly.
   Dr. Maudsley divides Insanity into two  great divisions:
the one without delusions, [Affective), the other, with delu-
sions, {Ideational).  These,he sub-divides as  follows:

          1.  affective or pathetic insanity.
   1. Maniacal perversion  of the affective life.   Mania sine
delirio.
   2. Melancholic depression ivithout delusion.  Simple mel-
ancholia.
   3. Moral alienation proper.  Approaching this, but not
reaching the  degree of positive insanity, is the insane tem-
perament.

                11. ideational  insanity.
   1. General.
     a. Mania.            1     A         , .
      ,,,,,,.       r     Acute and chronic.
     b.  Melancholia.      )
  2. Partial.
     a.  Monomania.
     b.  Melancholia.
  3. Dementia, primary and secondary.
  4. General Paralysis.
  5. Idiocy, including Imbecility.
                          2 
18
Insanity.—Classification.
  The classification now generally adopted in Germany, is
as follows :
             i.  conditions of depression.
   i. Hypochondria.  2. Melancholia.
             n. conditions of exaltation.
   i. Acute mania.  2. Monomania.

          in. conditions of mental weakness.
   i. Craziness  or incoherence.  2.  Dementia or  fatuity.
3. Idiocy or cretinism.

               iv.' paralytic  dementia.
  General paralysis of the insane.
  The  classification  offered by  Dr. Hammond is much
simpler and more practical than any other I have seen.   It
is based upon the division of the elementary forces of the
mind as adopted  by him.  These elementary forces are
Perception, Intellect, Emotion and  Will.  So he gives us:
  " I. Perceptional Insanity,  characterized by the tendency
to the formation of erroneous perception, either from false
impressions of real objects (illusions), or from no external
excitation whatever (hallucinations)."
  " II.  Intellectual Insanity, characterized by existence  of
delusions."
  " III. Emotional Insanity, characterized by  the  uncon-
trolled or imperfectly controlled  predominance of one or
more of the emotions."
  '• IV. Volitional Insanity,  in which there is an inability
to exert the  full will-power either affirmatively or nega-
tively."
  " V. Mania, characterized by the  union of two or all
four of  these forms in the same individual."
  " VI. General Paralysis, a peculiar form of insanity, at-
tended  with  progressively advancing loss of  mental and
motor power." 
Insanity.—Classification.
19
   " VII.  Idiocy arid Dementia, the first due to the fact that
there are original structural defects in the  brain ; the sec-
ond resulting from the supervention of organic changes in
a brain originally of normal power."
   In these  forms of mental disease there is nearly  always
present one or more of the following important symptoms,
the character  of which must be thoroughly understood,
viz. :  Illusion,  hallucination, delusion,  incoherence and
delirium.
   Illusion.—An illusion  is, according to  Hammond, " a.
false perception of a real sensorial impression "  The ob-
ject which is presented to the consciousness not being per-
ceived as it actually exists.   A lady in one of the western
asylums  invariably imagines any cat she  may  see is  a
panther ready to spring upon her.   This is  an illusion of
the sense of sight.   There  also exists  illusions  of the
other  senses—hearing,  tasting, smelling  and  touching.
Illusion  is  not pathognomonic of insanity, for it may be
owing to either a temporary or permanent defective  state
of the organ or organs of sense, from a multitude of causes.
When, however, it occurs in connection with other symp-
toms of  cerebral disorder,  its diagnostic value becomes
important.
   Hallucination.—A  hallucination  is  a  perception  of"
things which have no  existence; the senses conveying to
consciousness, as an object, that which is only a subjective
process.   While illusions  are external impressions  acting
through  the organs of sense upon the mind (eccentric),
hallucinations are internal impressions acting directly upon
the mind  (centric), the organs of sense not being necessary
to their  existence.  Hallucinations are almost invariably
positive evidence of cerebral disorder.
  Delusion.—" Illusions  and  hallucinations," observes
Hammond,  "  may exist, and the individual be perfectly
sensible that they are not realities.   In such cases the in-
tellect is  not  involved.  But, if he accepts  his false per- 
20
Insanity.—Classification.
ceptions  as facts, his intellect  participates, and  he  has
delusions.  A delusion is, therefore, a false belief.   It may
be based  upon an illusion or a  hallucination ;  may result
from false reasoning in  regard to  real occurrences, or, be
evolved out of the intellect spontaneously by the result of
imperfect  information, or, of an inability to weigh evidence,
or to discriminate between the true and the false. *  * * *
Delusions  are not a test of insanity, as most lawyers and
many physicians  would have us believe."
  "A delusion to be indicative of insanity, must be such a
belief as would not be entertained  in the ordinary  normal
condition  of the individual; must have been formed with-
out such  evidence as would  have  been  necessary  to con-
vince in health, and must be held against such positive
testimony as would in health have sufficed  to eradicate  it."
  Some  of the forms of insanity exist without delusions,
and delusions certainly are of frequent occurrence  in  the
same, so they cannot be considered as pathognomonic of
insanity.
  Incoherence.—Incoherence is  that condition in which
the language is unconnected and incongruous.   The words
are not in proper relation to each other,  neither do they
agree with or depend upon the action of the mind.   Inco-
herence is a prominent symptom of insanity, and is  usually
the result of a want of co-ordination of the functions of
the mind.
  Delirium.—Delirium is  a burst of tumultuous excite-
ment, passion or  enthusiasm, in which  is mingled illusions,
hallucinations, delusions and incoherence.  It is most prom-
inent in acute  mania, but is present in  a modified  degree
in chronic cases.   The delirium of fevers,  meningitis, etc.,
is readily distinguished from that of mania by the well-
known peculiarity of the delirium  itself, as well as by the
physical symptoms present.
               i. perceptional insanity.
  This  form of  insanity is the  most  simple of any, con-
sisting  only of false  perceptions, usually of the sight  and 
Insanity.—Classification.              21
hearing.   It is ordinarily premonitory of advancing cereb-
ral disorder; but its illusions and hallucinations may be but
the temporary result of intoxicating or narcotic substances,
or indigestion, or derangement of the cerebral circulation,
or may occur during the  course of various other diseases.
This form of insanity is amenable to treatment,  but if not
promptly arrested, may pass into a more serious type of
mental disorder.   It does not in any way lessen  individual
responsibility, and from a medico-legal point is only of in-
terest  in its relation to  other forms of mental aberration.

               II. intellectual  insanity.
   Delusion is the characteristic feature of intellectual in-
sanity.  It is usually, but not invariably, preceded by per-
ceptional insanity for a longer or shorter time, the illusions
and hallucinations  of  the  latter gradually becoming ac-
cepted as facts in the diseased mind.   In cases where per-
ceptional  insanity  does not precede  the delusions, there
are usually present  certain prodromata, which, if recog-
nized, would point  to  the  forthcoming cerebral derange-
ment.   It is  often  the case that these  prodromata  are
overlooked at the time, and only  called to mind after the
disease has become fully developed.
   " Intellectual insanity is often uncomplicated  by any
 other  forms of mental derangement.   There are no illu-
 sions  or  hallucinations, no overpowering  influence of the
 emotions, and  no loss of control over the will.   Even
 when  the delusion is of such a character  as apparently to
be connected with some one of the senses, and  this to  be
 based upon a false perception, full inquiry will often show
that there is no error of the sensorial  processes,  centric or
 eccentric."—Hammond.
   Aside from those  physical symptoms, which  most fre-
 quently accompany this form of mental derangement, such
 as sleeplessness, indigestion, loss of appetite, etc., we find
 that the character of the delusion forms to a  great extent
 the symptomatology of the case.  These delusions are 
22
Insanity.—Classification.
 usually of a painfully distressing character, though  occa-
 sionally they are somewhat  pleasing.  More often they
 partake of the most horrid and terrific possibilities and ex-
 periences of life; in fact often transcend these entirely, and
 enter the region of the absolutely impossible.  With such
 unceasing and  perpetual  torments, from which the  unfor-
 tunate patient can never escape, it is not a matter of won-
 der that so many of them strive to end their own existence.
 It is more wonderful that, notwithstanding these  extraor-
 dinary delusions, the mind does not lose its seat entirely
 and irretrievably; yet persons thus affected may go through
 life showing but little, if any, signs of mental derangement;
 converse  intelligently on public affairs, science, literature
 or art; conduct their business and household affairs  even,
 and  not manifest their trouble unless the  subject of their
 particular delusion  be touched upon.
   Delusions are, to a great extent, at the bottom of all tl.e
 crimes committed by the insane.   A person may be labor-
 ing under the delusion that a  certain  person is seeking to
 undermine his  character or destroy his life, and that, as a
 matter of defense it is duty to take the life of his traducer
 or would-be  murderer; or he may think certain ones are
 combining to overthrow  the  government, and that he is
 the one delegated to save his  country by taking the life of
 one or more of the ring.  The parent may entertain the
 delusion that an offended  Deity demands of him the sacri-
fice of his loved children, and, in taking their lives, he is
only fulfilling a Divine command.   A case of this  kind
occurred  under my own observation a few  years  since,
where a mother of two fine girls, aged respectively two and
four years, who had  always evinced a sound mind, suddenly
accepted the delusion that she must send the children  to
heaven, in  order that they might be happy ; and, to make
their transit painless as  possible, she roasted  them on the
kitchen stove.  An ignorant  judge  and jury found her
guilty of homicide, and gave her a  term  in  the peniten-
tiary, where she soon after died a raving maniac. 
Insanity.—Classification.             23
  Persons who entertain such delusions as  lead them  to
crime, and yet, who  are  so unfortunate as to evince no
other signs of mental derangement, are very apt to become
the victims of a fossil judiciary, a conceited prosecuting at-
torney and an ignorant jury.

                in. emotional insanity.
  When the emotions are so aroused as to entirely over-
come  the  intellect and will, so that the individual  is in-
capable of restraining or governing his actions, he is said
to have emotional  insanity.   In  such cases, delusions are
sometimes, but not always present.   This form of insanity
may arise from no apparent cause ; may be the result of
a temporary disturbance of the mental power, or  may pro-
ceed from an insidious cerebral disorder, which will finally
result in intellectual insanity.
   Crimes are often committed  during an attack of emo-
tional insanity; particularly  is  suicide  and homicide  a
common result of emotional disturbance.
   " Many  cases of what are called temporary insanity,
mania-ephemera, transitory mania, and morbid impulse, are
really instances of emotional insanity.
   " The state with which  transitory  emotional insanity is
most apt to  be confounded, is that which has been desig-
nated as heat  of passion.   Passion  is emotional activity.
It  refers to  that mode of the mind in which certain  im-
pressions or emotions are felt, and which are accompanied
by a tendency  or  impulse, often irresistible, to act in ac-
cordance with these  impressions  or  emotions, irrespective
of the intellect. An act performed in the heat of passion,
is  one prompted by an emotion which, for  the  moment,
controls the will, the intellect not being called into action.
It is  an act, therefore, performed without reflection.  The
passions are, to a certain extent,  under the control of the
will,  and this power of checking  their  manifestations is
capable of being greatly increased by self-discipline.  Some
persons hold  their passions in  entire subjugation, others 
24
Insanity.—Classification.
are led away by slight emotional  disturbances.   The law
recognizes the  natural weakness of man in this  respect,
and wisely discriminates  between acts done after  due re-
flection and  those  committed in  the midst of passional
excitement.
  " The  acts performed during temporary emotional in-
sanity, in their obvious aspects,  and when viewed iso-
latedly, resemble those done in the heat of passion.  But
they are so only as regards the acts  themselves.   The act
by itself can teach us nothing.  We must look to the at-
tending circumstances, and to the  antecedents of the per-
petrator for the facts which are to enlighten us  as to  the
state of mind of the actor."—Hammond.
  An act  committed  during the height  of an emotional
paroxysm, may sometimes be entirely disregarded, though
it is nearly always immediately preceded  by symptoms of
mental aberration ; but this is not invariably the case ; and
when it is not the case, it becomes exceedingly difficult to
satisfy a jury that the act  was not  done in the heat of
passion.   The  subsequent  state of the individual affords
considerable aid.  If the act be committed in the heat of
passion, the act itself in its terrible reality sobers the per-
petrator,  and  his  first thought is for his own  personal
safety.  If he be the victim of emotional insanity, he sel-
dom seeks to escape, and seems indifferent to what he has
done, or to the  probabilities  of punishment.  Occasionally,
such an individual may make a feeble effort to escape, but
it is so very feeble  that it  is  really a sign of mental  de-
rangement.
                iv. volitional insanity.
  Dr. Hammond describes this form of mental disease to
be solely an inability to exert the  will in  accordance with
the intellect, and, if uncomplicated, there is no delusion or
emotional disturbance.  He says :  " many cases of morbid
impulse are instances of volitional insanity, in which an idea
suddenly flashing  across the mind is  immediately carried 
Insanity.—Classification.              25
out by the individual, although his  intellect and his  emo-
tions are strongly exerted against it.  Thus a person who
previously has not exhibited any very obvious  symptoms
of  mental derangement—though a careful  inquiry will
invariably show that slight evidences of cerebral  disease
have been present for some days—instantaneously feels a
morbid impulse to commit a murder or perpetrate  some
other criminal act, and  is forced to yield, notwithstanding
all the efforts he may make."
  Volitional  insanity is a frequent  complication with, or
rather forms a part of  intellectual  or emotional insanity,
mania, dementia, and general paralysis.   Cases of klepto-
mania, dipsomania, pyromania, etc.,  are often only cases of
volitional  insanity, the will  being  unable to prevent the
volitional  act, though  there be no inciting  delusions or
motives whatever.
                       v. mania.
   In this form of insanity we have combined more or less of
all those abnormal manifestations already referred to, such
as illusions, hallucinations, delusions, emotional disturb-
ances, loss of volitional  power  or  control, and delirium.
In the majority of cases, mania is preceded by symptoms
of other mental affections, forming a series of prodromata
which are of  more importance in a  criminal aspect than
are those of established mania, from the fact that the mat-
ter of irresponsibility might be overlooked if a crime were
committed during this state, but which is never  the case in
those suffering  acute  mania;  and, moreover, in the latter
the diagnosis is so plainly conformable that there need be
but little danger of erring.
  Usually, the prodromata of acute mania are of a melan-
cholic character.   They  may  be in no ways  suspicious,
and yet the individual is liable at any time to break out in
a paroxysm of furious  mania.   He  at first becomes aware
of a very  unpleasant,  and yet  indescribable  condition of
mind.   He feels  anxious, restless  and uneasy ; nothing 
26             Insanity.—Classification.
pleases him, and especially is he  inclined to wander from
place to place, hoping for relief.   He soon complains of
fullness in the head; he becomes  exceedingly morose and
irritable, and his ideas seem strangely confused.   His di-
gestive functions become deranged ; his kidneys do not act
properly ;  the circulation and nutrition are interfered with ;
he is not able to sleep at all; or, if he does catch a  few
moments sleep, it is filled with agitating dreams;  illusions
and hallucinations soon  supervene ; the countenance  be-
comes altered ;  the pulse accelerated; the skin hot;  the
appetite deranged, usually voracious ; the tongue  coated ;
the bowels constipated ; in women the  menses are usually
suppressed, and, in both sexes, there is usually an aggra-
vation of the sexual desire.  Soon the illusions and hallu-
cinations are  accepted as realities, and delusions exist.  As
the mania  becomes fully pronounced, the physical symp-
toms disappear,  and the  patient  expresses himself quite
well;  but   there is now  developed  incoherent, rambling
talk, laughing, singing, and the performance  of the most
ludicrous antics.  The delusion is now firmly established,
whatever  it may be, and the patient seems to bend every
thought in accordance with it.  The mania soon assumes
a more furious  character, and there  appears  a  constant
tendency to acts of extreme violence.   Even  in this con-
dition the   patient exhibits the most surprising degree of
cunning in the planning and execution  of his purposes,
which fact is  abundantly illustrated in  the  many cases re-
ported by  our standard authors.

                vi. general  paralysis.
  General  paralysis  is a  form of  mental disorder with
which  there  is  associated a  progressive  paralysis, from
which the name is derived.  It  is  usually preceded for
a time by a  morbid condition of  mind, which is princi-
pally manifested in a  loss of confidence, and a distrust of
the individual's own  ability and  usefulness.  The mental
powers  gradually becoming weakened,  have  no  control 
Insanity.—Classification.             27
over the  moral sentiments  and actions, which are often
immoral and  shamefully indecent.  The patient becomes
eccentric  and  whimsical to  an astonishing degree, and
finally delusions  of an endless variety, and  of the most
extravagant nature supervene,  and rapidly succeed each
other.   Simultaneous with these symptoms, or following
closely in their train, there commences an insiduously ad-
vancing paralysis.  This is  first noticed  in  the indistinct
articulation, from paralysis of the lips.   The tongue is next
affected, soon followed  by paralysis of the facial muscles,
presenting the ordinary  symptoms of paralysis of these
parts.   The muscles of the eyes are  next  involved, and
soon the muscles of the extremities.   " Precise co-ordina-
tion of movements, such as is  necessary for writing, sew-
ing, and  like acquired  automatic  acts, is  lost.  As  the
disease still advances, the articulation becomes less distinct,
the walk more and more tottering, the knees fail, the  pa-
tient frequently tumbles, and, finally, is unable to get up at
all.  The contractibility of muscles for the electric stimulus
is retained.   At last, the primary automatic or reflex move-
ments fail, the pupils become dilated,  but unequal in size;
the sphincters lose their power, and the patient may be
choked by a  lump of  food  sticking in the pharynx, and
blocking up  the opening of the  larynx, or  even getting
into the larynx.  Transitory contractions of an arm or leg
occur  sometimes, and a grinding of the teeth  is  not un-
common  in  the last stages  of the disease."—Maudsley.
With this advancing paralysis, the decline  of  the mental
powers keep pace, until the intellect is almost, if not totally
destroyed, and death finally results  from exhaustion.
   During the course of this  disease, there are  distinct
ameliorations and aggravations, the latter sometimes com-
plicated with  other  forms  of insanity, particularly acute
mania; and it is during these complications  that  deeds  of
violence are most often perpetrated.
   General paralysis is a disease of more than ordinary in-
terest.  Unlike other forms  of  mental affection, it selects 
 28             Insanity.—Classification.

 its victims mostly from the higher walks of life, confining
 itself almost  exclusively  to the  male population, and
 scarcely ever occurring  except between the  ages of thirty
 and  sixty.  It seems to arise mostly from alcoholic  or
 sexual excesses, or from severe and prolonged mental ac-
 tivity.   Its duration is variable, lasting from a few months
 to three or  four  years,  or even longer;  but whether pro-
 gressing fast or  slow, it is ever  downwards, and, in most
 cases, sooner  or  later  death  will  ensue.  A few cases of
 actual recovery are on record, but usually, when permanent
'recovery is supposed to have taken place, it proves to  be
 only a temporary intermission, and soon again the disease
^ is fully  developed.

               vii. idiocy and imbecility.
   These are not  properly derangements of  the  mind, but
 rather an  absence or weakness of  the mind.  The former
 being either congenital, or arising during infancy, before
 the mental  faculties  have been  fully developed, and  may
 be a total absence of all the mental powers, or there  may
 be displayed a slight semblance of intelligence.  Imbecility
 is a weakness of the mind  due to a defective mental de-
 velopment, not necessarily congenital.  This defect is not
 such as would  be due from a deficient education, but it is
 a natural  mental incapacity, of which it may present de-
 grees, passing insensibly on the one hand into idiocy,  on
 the other hand into ordinary  intelligence.

                    vni. dementia.
   Dementia is that condition  presented after the mind has
 been destroyed by disease, and may be partial or complete.
   Dr. Maudsley reports the case of a lady  " who had suf-
 fered from an attack  of acute  insanity when only fifteen
 years old ; the development of the mind seemed  to have
 been completely arrested ; twenty years afterwards she had
 quite the appearance, manner and mental  character of a
 girl  of  fifteen ; and though  she had  during  that  period 
Insanity.—Diagnosis.
29
three more acute attacks of derangement, these resembled
in character those that occur in early life rather than such
as are usually met with in adults.  Between this mild form
of mental weakness at one end  of the scale, and the ex-
tremest examples of dementia, in which mental power  is
almost obliterated, at the other end, there  are met with  in
practice, cases marking every shade of the gradation."
  Every sort  of delusion  may be present, and an endless
variety  of strange propensities exhibited.   The individual
may be surly, morose  and depressed, or may exhibit the
most exalted condition of mind, while others are at all
times quiet and cheerful.  It often happens that paroxysms
of acute mania occur  at intervals of a  longer  or shorter
duration, and it is usually only at these periods that  acts
of violence are liable to be committed.
                  CHAPTER  IV.
                       diagnosis.
  There is no class of diseases so various in their manifesta-
tions as those known under the general term insanity, and
their diagnosis is often established with the utmost difficulty,
and only by the most persistent and  careful examination.
The diagnosis of other diseases usually depend, to a great
extent, upon evidence afforded by physical signs—objective
symptoms—but, in mental diseases, it is, for the most part,
dependent upon evidence cognizable by the intellect alone.
Its symptoms are seldom definite and unmistakable, and
scarcely ever do  we find directly palpable and  physical
signs.   For this reason, it becomes  necessary to consider
all  the  accompanying  circumstances, the hereditary pre-
disposition,  nervous constitution, cerebral injuries, dissipa-
tion, hysteria,  chorea, etc.,  as predisposing causes, and
disappointments, fright, intense excitement, and acute dis-
eases, as most frequent exciting  causes.  In this regard, 
30
Insanity.—Diagnosis.
 it is often  difficult to determine  whether the morbid men-
 tal condition is  the  direct result of a  diseased brain, or
 whether it is but the  natural result of the existing predis-
 position.   Dissipation may result in a morbid, demoralized
 mental condition, manifesting itself through immoral con-
 duct,  obscene language, blunted  feelings  and  degraded
 desires.   Sadness  and  depression  of  the mind may be
 the  natural  result of  natural causes.   Family bereave-
 ment,  business losses, or indigestion, are sufficient to pro-
 duce such conditions, yet, upon the removal of the ex-
 isting  cause, a reaction  takes place, and the mind  is nor-
 mal.   The continued presence of this predisposing cause,
 whatever it may be, may finally,  through the continued ir-
 ritation of the functions of the mind, or mental pain, result in
 cerebral disease, and the same symptoms in an aggravated
 form continue as the  result of insanity.   There is  here a
 boundary line to be established between  mental health and
 mental disease, the limits of which  are at best vague and
 unsatisfactory.   It is only by a practical knowledge gained
 by experience in the various forms and phases of insanity,
 that this  most difficult task is to be accomplished.  The
 physician, learned though he may be, and successful at the
 sick-bed, yet if he lack a power of practical observation in
 the management and  treatment of the insane, he is almost
 as incompetent to the task as are the judges and lawyers
 themselves.
   When  called to examine a patient who is supposed to be
 insane, before proceeding to a personal  examination, it is
 necessary to get a thorough history of the patient and his
 antecedents.   This might be expected  fully and candidly
 from the  family of the patient, but the physician would be
frequently disappointed.  The dread entertained of insanity,
and the false shame so prevalent in regard to this affection,
may cause  the members of the tainted family to systemati-
cally deceive, and to  positively deny the slightest heredi-
tary taint.  It is best, however, to take all  things as they
are found,  and listen attentively to  the story that may be 
Insanity.—Diagnosis.               31
told, and which may be all true.   If, after so doing, the in-
formation of the family is not considered reliable, the phy-
sician should  not hesitate to inquire prudently and cau-
tiously of the neighbors and  acquaintances  of the family,
in order to become thoroughly satisfied as to the  heredi-
tary predisposition and  previous attacks, which  are two
most important diagnostic points.
   The hereditary transmission of all  forms of nervous dis-
ease, is an accepted fact, and though the child of an insane
parent may never become absolutely insane, yet it possesses
a neurotic temperament, and is more liable to an outbreak
of insanity than would be a child of sane parents, under
the same circumstances.  The value  of this  hereditary in-
fluence increases with  the amount of insanity occurring in
the same line of relationship..  The insanity  of one parent
is less predisposing than that of  both parents, and the in-
sanity of both parents less than  that of one parent and an
uncle  or aunt in the same line, and still less if we add a
grandparent on that side.  The  insanity of brothers and
sisters may be usually considered as safe evidence of  he-
reditary predisposition.
   The  hereditary predisposition to  insanity varies in its
modifications.  Some  children of insane parents bear con-
tinually through their lives the  impress of insanity upon
their countenances and habits of life, while others present
no evidence whatever  of the insane temperament until  the
disease is  manifested, or they may pass  through  life  un-
touched, but still leave to their progeny the  decided  mark
of mental disease.  The importance of  hereditary trans-
mission  in mental disease must not, in justice to the insane
criminal at least, be overlooked.   It should be remembered,
that there  exists  between  all neuroses a  most  intimate
relationship, and this is  manifested in the oft-observed fact
that children of insane parents are prone to  attacks of epi-
lepsy, chorea, paralysis and neuralgia.  Insanity is a result
of derangement  of  the mental nerve  centres,  and this
derangement  is liable to  be transferred to  the sensory or 
32
Insanity.—Diagnosis.
 motor nerve centres, giving an entirely new train of symp-
 toms.  Several cases are recorded in which there was  an
 alternation between  epilepsy and  insanity, or chorea and
 insanity, the one giving place to the  other  at more or less
 regular  intervals.  Violent paroxysms  of neuralgia have
 subsided at the outburst of mania, and  again  returned as
 the latter passed away.  These observations not only show
 the kinship existing between insanity and nervous diseases,
 but  robs the  former of its metaphysical  existence, and
 practically places it within the reach of scientific investiga-
 tion and treatment.   Mental diseases, of every form, having
 once occurred, are  very liable to recur, and for this reason
 the  existence  of previous attacks is of great  diagnostic
 value.
   Besides  the points  already  mentioned, the  physician
 should inform himself respecting the habits, character and
 disposition of the patient.   Many persons  in good health
 are  remarkable  for  peculiarities  and  idiosyncrasies  of
 thought  and action,  different from those  of mankind  in
 general.   On this account, the patient must be compared
 with himself, as he  is when in a state  of health, that it may
 be observed whether  the present condition  is an absolute
 change from the normal standard, or whether it is simply
 an aggravation, amounting, at best, only to  what is termed
 eccentricity.   True it is, that there  is more or  less con-
 nection between  insanity and eccentricity.  It  has  been
 observed, that in  families where one or more of its mem-
 bers were insane, others of the family have  been eccentric,
 and  further, that eccentricity often culminates in  insanity.
 Persons who are only insane on certain subjects, so-called
 monomaniacs, are often eccentric in  their whole conduct,
 and it is said, after repeated recoveries from insanity, the
 individuals have remained eccentric during life.   However,
 it cannot be held on this evidence, that such persons are
 insane, but only that, other things being equal, eccentricity
 involves  a  greater than usual  susceptibility to  mental
derangement.   If,  without apparent  cause for  so doing, 
Insanity.—Diagnosis.               33
the sober man becomes disappointed, the prudent man rash
and extravagant, the moral or religious man dissolute, the
modest woman shamefully indecent,  there can be  little
question of the presence of cerebral disease ; yet, as pre-
viously remarked, search  should be made for any predis-
posing causes that might operate  in a natural  way to
produce these changes.   They are but a lack  of control
over the affective  and intellectual faculties, which are by
nature depraved, and which depravity is only restrained by
moral and religious principles.  The question to decide is,
whether that lack  of will-power is the subject of disease or
of natural causes.
   It is necessary to conduct the personal examination of
the patient with the greatest tact and discretion.   It will not
do for the physician to at once attack the citadel of disease
by such leading questions as might not be  inappropriate
or unusual in other diseases.  A few years since, I was the
attending physician of a lady who exhibited marked symp-
toms of depression, and whose hereditary predisposition to
mental disease was unquestionable.   In the course of her
treatment, an eminent physician of a  neighboring city was
called in consultation.  Almost the  first inquiry he made
of the patient was: " Are you inclined to be melancholy ?"
The  patient and family were through with  him from that
 moment, and his  superior abilities were ever after entirely
 ignored.   The  patient, as  well  as the  family,  is usually
quite sensitive concerning any allusions to insanity ; and, if
the  former's  suspicions  are  at  once aroused,  it will be
quite  difficult to discover his  real mental condition.   The
physician may nearly always engage the attention and good-
will of the patient, if he will  only employ that sympathy
and tact derived  from good sense  and  a knowledge of
human nature, which is often appreciated as plainly by the
diseased mind as by others.
   In  entering the presence of the  patient, the physician
should avoid a marked and obvious attention in his obser-
vations  of the expression, demeanor, etc., but  should as-
                          3 
34               Insanity.—Diagnosis.
sume a quiet indifference, though  it must  be done  in a
natural  manner, or the  unfitting  mask will  at once excite
the patient's  suspicions.  While, to all appearances indif-
ferently conversing on the most foreign topics, the observ-
ing physician may study the physiognomy and gestures of
the patient, and find in them much valuable aid ; the ec-
centricity of dress, from mere disorder to total nudity, or
absurd peculiarities  of arrangement in shape or color, so
often present, may also assist him in forming an opinion as
to the condition  of mind ; but here, as elsewhere, no es-
tablished  rules or symptoms  can  be given.  Each indi-
vidual case  must be studied  by itself, and nothing  but
experience and a thorough  comprehension  of the peculi-
arities  of diseased mental  action  will  prove unfaltering
aids.  After the  physician has, by ordinary conversation
on any subject, tested the attention, memory and judgment,
" the patient  may be led  to give an account of his  own
powers of body and mind, with reference to health, to ex-
ercise, diet and study.   Thousands  of delusions are enter-
tained by insane people upon these subjects.  He may then
be led to converse respecting his possessions, his means of
livelihood, and his  hopes of  advancement in  rank • or
property.  Such  conversation will open up the  delusions
of pride, ambition an  acquisitiveness.  He may then be
led to converse of his  near  relatives  and  friends,  and es-
pecially respecting his birth and parentage, stress being laid
upon his belief whether his parents were his actual and real
parents.   This inquiry will tend to open up any delusions
respecting imaginary greatness, and  any  perverted  emo-
tions towards those who ought to be dear to him.   The
subject of religious opinion may then be introduced.   The
religious devotions and  exercises which he  practices may
be inquired into, with the reasonable expectation of finding
insane delusions.on a subject which touches the  deepest
sentiments of the  soul.  If the patient is an educated man,
it will be  right to converse with him upon politics and
science.  If he can  stand the test of a discriminating in- 
Insanity.—Diagnosis.
35
quiry on these and similar  subjects,  he certainly cannot
be the subject of mania; and if he has any delusions, he
must either retain the power of hiding them, or they must
exist in some obscure corner of the brain, from which they
are little likely to  influence, with any force, the opinions,
the feelings, or the  conduct."—Bucknill.
   It sometimes becomes necessary to  distinguish between
insanity and some other form of cerebral affection, which
is usually a matter  of but little trouble.  The greatest dif-
ficulty will be found in those cases where an impostor at-
tempts to simulate it, or a drunkard actually does do so.
" Certainly he must be a clever impostor," observes Mauds-
ley, " who can simulate the wild restless eye, the ceaseless
movements, the quick  fragmentary associations of ideas,
and the volubility of utterance  of acute mania, so  as to
deceive an experienced observer;  nor  can he, hov/ever
skillful an actor, pass  days without sleep, and even weeks
with only a few hours' sleep, maintaining a continual  ac-
tivity, as the acute maniac does.   The skin in acute mania
is dry and harsh, or cool and clammy;  but the skin of a
pretender, who tries to keep up a prolonged muscular agi-
tation, will  hardly fail to be hot and sweating.   Chronic
mania is  most likely to be feigned, and if feigned with
skill, the  imposture may  deceive  many.   However, this
imposture  generally ' oversteps  the modesty of  nature,'
and overacts his part;  he is  extreme in  the extravagance
of what he does, while he  falls short of his part in the
emotional expression of the  maniacal countenance.  Think-
ing that a lunatic is widely different from a sane person, he
exaggerates, and  rants, and produces something not like a
lunatic.  He pretends, perhaps,  that he cannot remember
things, as what day follows another, or how many days
there are  in  a week, that he  cannot add the simplest
figures together, and acts foolishly, and  answers stupidly
where  a real lunatic,  who  was  not an  idiot, would act
calmly and answer intelligently.   If a suggestion be made
incidentally  of some symptom which he ought to exhibit, 
36  Insanity.—Criminal Responsibility of the Insane.

he may adopt the hint.  The history of the case, and es-
pecially of the mode  of occurrence of the disease, and of
the circumstance of its development, will  most materially
aid the diagnosis.  If there be no  previous history to be
had, and if the patient refuse to  converse, a long observa-
tion may be necessary to  come  to a  decision.   When a
man feigns  madness so perfectly as to deceive an experi-
enced  observer, we may hold, I think, that he is not far
from  being the character which he  represents; for, unless
there be a foundation  of real madness beneath the feigned
phenomena, there will be some want of coherence in them
as a whole, and  an incongruity with  any known form  of
mental disease."
   Ordinary  intoxication is  usually readily detected by the
smell of the breath, the imperfect utterances at the outset,
and the rapidly ensuing drowsiness and sleep.  " Delirium
tremens will be  distinguished by  its own characteristic
symptoms—the muscular tremors, the  peculiar fearful il-
lusions and hallucinations, the cold skin, feeble pulse,  and
the white  tremulous tongue.  But there are cases in which
positive insanity  is produced by drink, and they are some-
times the  occasion  of great  injustice  being done by our
legal tribunals.  Certain  persons who have a strong pre-
disposition to insanity, or who have been  once insane, or
who have  had a severe injury of the head at some time, do
actually become truly  maniacal for a while after an alcoholic
debauch, or are rendered temporarily maniacal—being prob-
ably thought drunk—by a very little liquor.   In this con-
dition, vivid hallucinations are apt to arise, and the sufferer
may perpetrate crime, not knowing afterwards what he has
done, and certainly at the time not knowing the nature of
the act."—Maudsley.
                    CHAPTER V.
       criminal  responsibility of the insane.
  Throughout the whole system of man there is an inti-
mate and inseparable relationship.  The wonderful network 
      Insanity.—Criminal Responsibility of Insane.    37

of nervous communication unites in harmony man's whole
being, and, while the functions of the brain are specially
connected with the mind, there is not an organ or tissue
in  the  body  that  does  not  bear   a  direct influence
upon that organ.   Man, born with this higher principle of
mind or soul, giving him intellect and reason,  and placing
him in the highest scale of animal creation, is destitute of
many of those instinctive faculties which belong to  the
lower animal creation.  The new-born animal instinctively
knows where to seek its nourishment,  and while the help-
less babe would perish without assistance, the former will,
without parental guide, and placed entirely away from others
of its kind, grow up and develop into one of its own species,
holding the same characteristic traits, performing the same
feats, and living the  same life of its ancestors.  The babe
only  learns by the most  patient induction.   Its mental
faculties  are  only formed and developed under a series of
the most patient and continued education, and, as the child
develops physically to  manhood, the mind is gradually be-
coming formed, disciplined and perfected.  The unfortunate
one, who, from force of circumstances is deprived of all
education, save that gathered from his own observations,
grows up  mentally undeveloped.  The consequences, then,
of a lack of education through successive generations, may
be  readily seen.   The son of an intelligent  and educated
father, deprived of the same  education, reaches manhood
with  an undeveloped mind.   He transmits to his children
a weaker mind than he originally possessed, and so on  the
degeneracy almost imperceptibly extends with each suc-
ceeding  generation, until the  functions  of  the brain  are
so dwarfed and perverted, that mind can  scarcely be said
to exist.  Impulse and passion take the  place of thought
and will, and  these, uncontrolled, naturally  develop  the
evil propensities of man's sinful nature.   Thus we see, that
criminals are often born such ; destitute of all moral sense, 
38   Insanity.—Criminal Responsibility of Insane.

possessed of a mean defective intellect, they are true moral
imbeciles.
   In proportion with this congenital weakness of the mind,
do we find, also, a physical degeneration, which may mani-
fest  itself  in  congenital deformity, scrofula  or neurosis,
but which, in every case, leaves the impress of a low physi-
cal and  mental  capacity  upon the physiognomy, consti-
tuting a family likeness by which they are  distinctively
marked  off from the balance of mankind.
   With  such, crime is  the  spontaneous outburst; the un-
controllable evil nature, over which presides  an unsound
mind, and  for that reason, comes within the range of dis-
eased action, and is itself a  neurosis closely allied to epi-
lepsy.   However, notwithstanding this  diversity of mind,
the result of hereditary influence  and  education,  the law-
makers know nothing of individuals, but form and enforce
laws based upon a uniform mental standard of their own
establishing, which never did and never can exist.   Mental
responsibility can only be in proportion with the  mental
talent possessed, and laying entirely aside all diseased ac-
tion, the uncultivated brain should not be subject  to the
same criterion of responsibility as that of the more highly fa-
vored.   So, too, are the cerebral functions, when undevel-
oped and uneducated, more liable to some forms of disease.
The weaker the elementary functions, the less able are they
to resist  the encroachments made upon them.
   The power of education, quick as is its  influence upon
the growth of the intellect and formation of the character,
is  limited  in its operations  by the individual capacities.
" No training in the world will avail to elicit grapes from
thorns, or figs from thistles," observes a prominent writer,
and this holds true of the mental powers which  can never
transcend the individual capabilities.
   That there exists a definite line of demarkation between
mental health and mental disease, is a matter of consider-
able question, but as  the moral being gradually degenerates
into the sinful, so does the sinful  being  fall still lower in 
      Insanity.—Criminal Responsibility of Insane.    39

cerebral  degeneracy until  he passes the invisible line  of
transition, and is  diseased.  During this  evolution, he oc-
cupies the border land between crime and insanity,  " near
one  boundary of which," says  Maudsley, " we meet with
something of madness, but more of sin, and near the  other
boundary of which, something of sin, but more of mad-
ness.  A just estimate  of the  moral responsibility of the
unhappy people inhabiting this border land, will assuredly
not be made until we get rid  of the metaphysical measure
of responsibility, and proceed by way of observation and
induction to sound generalizations concerning the origin of
the moral  sentiments, the laws of their  development, and
the causes, course and varieties of moral degeneracy.   Here,
as in other departments of nature, our aim  should  be the
discovery of natural laws by patient interrogation of nature,
not the invention of theories, by invoking our own minds
to utter oracles to us.   It must be received as a scientific
axiom, that there is no study to which the inductive method
of research is not applicable ; any attempt to prohibit such
research by authority of any kind, must be withstood and
repelled with the  utmost energy, as a  deadly attack upon the
 fundamental principles  of scientific inquiry.   With a better
 knowledge of crime, we may not come to the practice of
 treating criminals as we now treat insane persons, but it is
 probable that we  shall come to other and more tolerant sen-
 timents, and that a less hostile feeling towards them, de-
 rived from a  better knowledge of defective organization,
 will beget an indulgence at any rate towards all doubtful
 cases inhabiting  the border land  between insanity and
 crime; in like manner  as within  living  memory, the feel-
 ings of mankind  in regard to the insane have been entirely
 revolutionized by an inductive method of study."
   With the above view of the case, how absurd it is for
 law-makers to endeavor to establish  any symptoms or tests
 of responsibility that will act as infallible guides in all cases.
 In fact,  as we look back over the various and  conflicting 
 40   Insanity.—Criminal Responsibility of Insane.

 tests of responsibility that have been conceived and aban-
 doned during the past century, we cannotbutadmitthatthey
 are all unreliable, and that a real and positive test of respon-
 sibility—one that may be  relied upon  in every  case, will
 never be established.  The only just test is " the inability
 to control the action of the mind," and properly speaking,
 this is no test at all, being only a matter of fact to be de-
 cided in each individual case.
   It is not a great while since  every person was  responsi-
 ble for crime in whom there  remained the  slightest trace
 of reason ; and if the truth were known, this theory is not
 entirely  done away  with  in practice, though,  perhaps,
 glossed over by the so-called tests of responsibility.
   One of the most glaring absurdities  of the  undefinable
 notions heretofore prevalent in regard  to insanity,  and
 which  occasionally crops out in these days, is the holding
 of persons  not  considered competent  to attend  to their
 business affairs, to dispose of property,  execute wills, etc.,
 as though  in criminal respects  they were of sufficiently
 sound  mind, to be tried,  convicted and executed for  the
 commission of a crime under an  insane  delusion or  im-
 pulse, which the  unfortunate convict had not the power
 to resist, and for  which he was not in the least morally re-
 sponsible.
  In the well-known case of  Bellingham, the Attorney-
 General of England declared that " a man may be deranged
 in his mind, his  intellect may be  insufficient for  enabling
 him to conduct the common  affairs of life, such as dispos-
 ing of his  property, or judging  of the claims which  his
 respective relations have  upon  him; and if he be so, the
administration of the country will take his affairs into their
management, and appoint to him trustees; but at the same
time, such a man is not discharged from  his responsibility
 for criminal acts."
  Lord Erskine sanctioned this doctrine  in  his celebrated
 defense of  Hadfield, for shooting at the King in Drury 
      Insanity.—Criminal Responsibility of Insane.    41

 Lane Theatre, in which  he said :  " I am bound to admit
 that there is a wide distinction between  civil and criminal
 cases.   If in the former a man appears, upon the evidence,
 to be non compos mentis, the law avoids  his act, though it
 cannot be traced or connected with the morbid imagina-
 tion, which constitutes his disease, and which  may be ex-
 tremely partial in its influence upon conduct; but to deliver
 a man from responsibility for crimes, above all, for crimes
 of great atrocity and wickedness, I am  by no means pre-
 pared  to apply this rule, however well established,  when
 property only is concerned."
   In a recent  case  (i860), Judge Bramwell in sentencing
 the prisoner, said:  " that  you are of unsound mind I be-
 lieve, but that is  no reason why you should  not be pun-
 ished.   ...  I feel bound  to sentence you to the same
 punishment as if you were sane."   It is very true that the
 insane mind is not entirely deprived of all power of moral
 discernment and  reason;  that  on  certain subjects he dis-
 plays a perfectly rational and well-balanced mind, but it is
 preposterous to suppose that  a mind " when meditating a
 great crime is less under the influence  of disease and en-
 joys a more sound and vigorous  exercise of  its powers "
 than when it is making a  contract or will, where the con-
 ditions and consequences of the transaction require no great
 mental exertion in order to be comprehended; and where
 there is ordinarily nothing in it to deprive the mind of all the
 calmness and rationality of which it is capable.  Criminal acts,
 though abstractedly wrong, may, under certain circumstan-
 ces, become right and meritorious ; and if the strongest
 and acutest minds have sometimes been perplexed on the
 point, what shall we say of the crazy and disturbed per-
 ceptions  of him whose reason shares a divided empire with
 the propensities and passions ?  Most maniacs have a firm
 conviction  that all they feel  and think is true, just and
 reasonable; and  nothing  can shape their convictions.—
 {Ray.)  The sane part of the  mind may lead them to love
perhaps  fairly  idolize family,  and yet the insane part of 
42   Insanity.—Criminal Responsibility of Insane.

the mind commands them to sacrifice the lives of that fam-
ily for some insane or delusive reason.  As, for instance,
the case reported by Mittermaier,  when  he enquired of a
man in an asylum, who had killed his father, if he did not
know that parricide is a crime severely punished.  " I know
it very well," he replied,  " but  God having sent me into
the world to punish great sinners, of whom my father was
one, I killed  him  according  to the divine  command."
The madman may  have  the greatest horror and loathing'
of crime in the abstract,  but at the same time the particu-
lar act of which they may be guilty have no connection in
their minds with the same crime in the abstract, being led
by their insane delusion to look upon the particular act as
a duty which is not only  right but meritorious.  The ca-
pability of judging  between right and wrong in the abstract,
without reference to the conditions present in the particu-
lar case has nothing whatever to do with the question of re-
sponsibility.  There must be  present a  power to discern
correctly the good or bad intentions  of others, and their
actual identity, as well as an entire freedom from delusions,
particularly those of a religious nature, which might pro-
duce a conviction  of divine authority or  command, and
also consciousness of guilt and fear of punishment.  The
mind that does  not correctly  distinguish between friend
and enemy, between benefits  and  injuries, that conceives
everything to  be  the reverse  of what  it  is, that allows
self-constituted and false  ideas  of  things to take the place
of realities,  is  certainly  not capable of judging  between
right and wrong in any particular case, even though he may
claim the power of so-doing.
   The individual must, therefore, not only have a general
sense of right and  wrong, but he must know that the par-
ticular act he is about to commit  is wrong, and that he is
doing  wrong  in committing  it, and that  he will  be held
morally and legally responsible for the act—to which should
be added there must be an ability  to control the impulses
of the mind. 
      Insanity.—Criminal Responsibility of Insane.   43

   The individual may know the act to be contrary to law
 and yet think the peculiar circumstances justify him in dis-
 regarding the law.   He may think it is legally as well as
 morally  right to revenge  some supposed defamation of
 character, or  injury to fortune,  by  taking the life of the
 supposed enemy.
   After the acquittal  of McNaughton for the  murder of
 Drummond, in 1843, on tlie P^a of insanity, the House of
 Lords, evidently sympathizing with an ignorant and dis-
 satisfied community in the acquittal under such charges of
 one who evinced no  very  obvious symptoms of insanity,
 propounded to the judge certain queries relative to the law
 upon the subject of insanity, for the purpose of establish-
 ing a standard of law, that would with justice operate the
 same in all cases, though the impossibility of such a thing
 has since been fully demonstrated.
   One of these queries was, " If a person  under an in-
 sane delusion as to existing  facts, commits an offense in
 consequence thereof, is he thereby excused ?"  To this the
 judges replied that on the assumption  " that  he labors un-
 der partial delusion only,  and  is  not in other respects in-
 sane, he  must be considered  in  the  same situation as to
 responsibility, as if the facts  with respects  to which the
 delusion exists were real.   For  example, if  under the in-
 fluence of delusion, he  supposes another to be in the act
 of attempting to take away  his life, and he kills that man,
 as he supposes, in self defense, he would be exempt from
 punishment.  If his delusion  was that the deceased had
 inflicted a serious injury to  his character and fortune, and
 he killed him in revenge for such supposed injury, he would
 be liable  to punishment."   Here is presumed the absurd
 idea that the insane mind is capable of reasoning sanely •
 upon  its own  insanity.  Two of the judges who joined in
the above reply practically admitted its wrong; Chief Justice
Tindal having been the judge who approved of the acquittal
of McNaughton for taking the life of Drummond because
the former fancied that Drummond was one of the number 
44    Insanity.—Criminal Responsibility of Insane.

that were injuring his character, and destroying his peace,
which, had such been real, would not  have justified the
crime of murder;  Lord  Denman,  also,  approved the ac-
quittal of Oxford, who shot at the Queen because he sup-
posed that  killing  the Queen was necessary in order to
accomplish a certain great benefit to the public.
  " Such a remarkable doctrine as this," observed Ray,
" can have  sprung  only from  the most  deplorable ignor-
ance of the mental operations  of the insane.  If the insane
person  really believe that his neighbor is engaged in a
conspiracy  to take  his life, he may anticipate the blow by
killing him; but if he merely  believes that the said neigh-
bor has inflicted a serious injury on his character or fortune,
the law will not hold him guiltless if he hurt a  hair of his
head.  This is certainly very plain, and it must be the fault
of the lunatic if he does not understand it.   It is very rea-
sonable too, if insane men would but listen to reason.
If he fancies there is a design  to  take his life, he may
take life; if he fancies that he is  only insulted or railed
at he may insult or rail in  turn; if he fancies his neighbor
is defrauding him, he may  say hard things  about him,
(taking  care to utter no matter libelous), or bring against
him a suit at law.  This is virtually saying to a man, ' you
are allowed to be  insane;' the disease  is  a  visitation  of
Providence, and you cannot help it; but have  a care how
you manifest your  insanity; there must be  method in your
madness. Having once adopted your delusion, all subsequent
steps connected with it must be conformed to the strictest
requirements of reason and propriety.  If you are caught
tripping in  your logic; if in the disturbance of your mind
and intellectual perceptions, you take a step for which a
sane  man would be punished, insanity will  be no bar to
your  punishment.   In short,  having become fairly envel-
oped  in the clouds of mental disorder, the law expects you
will move  as discreetly and  circumspectly as if the un-
dimmed light of reason were shining upon your path." 
      Insanity.—Criminal Responsibility of Insane.   45

  In the case  of State v. Jones, tried in the New  Hamp-
shire courts, Judge Ladd commented upon this doctrine of
the English judges as follows:
  " The  doctrine thus promulgated as law has  found its
way into  the  text  books, and has doubtless been  largely
received as the enunciation of a sound legal problem since
that day.  Yet it is probable that no ingenious student of
the law has ever read it for the first time without being
shocked by its exquisite inhumanity.  It practically holds
a man confessed to be insane, accountable for the exercise
of the same reason, judgment, and controlling mental power
that is required  in perfect  mental health.  It is in effect
saying to the jury, the  prisoner was mad  when he com-
mitted the act, but he did not use sufficient reason in his
madness.  He killed a man  because, under an insane delu-
sion, he  falsely believed the man had  done  him  a great
wrong, which was giving rein to a motive of revenge, and
the act is murder.   If he had killed a man only because,
under an insane delusion,  he falsely  believed  the  man
would kill him if he did not do so, that would have been
giving the rein to an instinct of self-preservation, and would
not be crime.  It  is true in words the judges attempt to
guard against a consequence so  shocking  as that a  man
may be punished for an act  which is  purely the offspring
and product  of  insanity, by introducing the qualifying
phrase, 'and is  not in other respects  insane.'   That  is, if
insanity produces the false belief which is the prime cause
of the act, but goes no further, then the accused is to be
judged according to the character of motives, which are
presumed to spring up out of that part  of the mind which
has not been  reached or affected  by the  delusion or the
disease.   This is very refined.  It may be that mental dis-
ease sometimes takes a shape to meet the provisions of this
ingenious formula; or, if no such case has ever yet existed,
it is doubtless within the scope of omnipotent power here-
after  to strike with disease some human mind in such pe-
culiar manner that the conditions  will be  fulfilled; and 
 46   Insanity.—Criminal Responsibility of Insane.

 when that is done, when it is certainly known that such a
 case has arisen, the rule may be applied without punishing
 a  man  for disease.  .   .  .  But  it is a rule  which can
 safely be applied in practice, that  we are seeking; and to
 say that an act which grows wholly out of an insane be-
 lief that some great  wrong has  been inflicted, is  at the
 same time produced by a spirit of revenge springing from
 some portion or corner of the mind that has not been reached
 by the disease, is laying down a pathological and psycho-
 logical fact which no human intelligence can ever know to
 be true, and which if  it were true, would not be  law, but
 pure matter of fact.  No such distinction ever can or ever
 will  be drawn into practice; and  the absurdity as well as
 inhumanity of the rule seems to  me sufficiently apparent
 without further comment."
   In the case of State v. Wier, tried a few  years  since in
 the New Hampshire courts, Chief Justice Bell instructed
 the jury as follows :
   "The evidence  must satisfy  the jury that the  party at
 the time of committing the act in  question was insane, and
 that the disease is of such severity that the person is inca-
 pable of distinguishing between  right and wrong in that
 particular case, and of controlling  the sudden impulses of
 his own disordered mind; or, as the same  rule has  been
 laid down by an eminent judge, a  person in order to  be
 punishable by law, must have  sufficient memory, intelli-
 gence,  reason and will  to  enable  him  to distinguish be-
 tween right and wrong in regard to the particular act about
 to be done, to know and understand that it will  be  wrong,
 and that he will  deserve  punishment by committing it, to
 which I add sufficient mental power to control the sudden im-
pulses of his own disordered mind.....I have been
accustomed to regard  as the distinguishing test of insanity,
the inability to control the actions of a man's mind."
   Here is set forth  the only comprehensive and just test
of responsibility.   In the language of Chief Justice Tevley
in  his instructions to the jury in  State v. Pike (New Hamp- 
      Insanity.—Criminal Responsibility of Insane.   47

shire) " if the killing  was the offspring of mental  disease
in the defendant;  that  neither delusion or knowledge of
right and wrong, nor  design or cunning in planning  and
executing the killing, and in escaping or avoiding detec-
tion, nor ability to recognize acquaintance, or to labor, or
to transact business or  manage affairs, is, as  a matter of
law, a test of mental disease; but that all symptoms  and
all tests of mental disease are purely matters of fact to be
determined by the jury."
   From  the illustrations given it would seem that Ameri-
can courts are rapidly progressing  towards the  truth in
their dealings with criminal lunatics, certainly are they far
in advance of those of  any other country; however, as all
people are not progressive, so all courts of justice are not
progressive, and cling  instinctively to the ignorance  and
barbarisms of past centuries.  This is evinced in the case
of People v. Wright, tried September,  1874, in  the  Ne-
braska court, in which Judge Gantt instructed the jury as
follows:
   " In order to excuse the act of the  accused  upon  such
 defense, the  proof must satisfy the  jury that the depriva-
 tion of the understanding  is total, fixed and permanent, or
 that he was laboring under adventitious insanity, and  that
 during such frenzy there  was total  deprivation of under-
 standing.  It is  a sound  principle in the laws of social
 life, as well as  in the enforcement of the  criminal  laws of
 all civilized  and enlightened governments, that to excuse
 a man from  punishment upon  the  ground  of  insanity, it
 must be proved distinctly  and clearly that the accused was
 incapable of distinguishing  right from wrong  at the time
 he did the act, and did not know it was an offense against
 God  and man.  If there be only a partial degree of reason,
 sufficient to have restrained those passions which produced
 the crime; if there be  thought and design, a faculty to dis-
 cover the difference between moral good and evil,at the time
 the offense was committed, then the accused was responsi-
 ble for his act.  *   *   *   It has been said by some learned 
 48   Insanity.—Criminal Responsibility of Insane.

 doctors in the medical profession, that if the man has the least
 taint of insanity entering into his mental structure, it dis-
 charges him from all responsibility to law.  This is a mon-
 strous doctrine, to which may be traced the fruitfulness  of
 crime, and the immunity which  have attended them in dif-
 ferent  parts of our  country.   *****  Did  the
 accused  act in the matter from  thought and design, and
 understand right from wrong ?   Did  he, by seeking con-
 cealment  immediately after  the perpetration of the  act,
 manifest a rational mind, a consciousness that the act was
 wrong ?   If you  shall find from the evidence, that these
 questions should be answered in the affirmative, then the de-
 fense of insanity must fail to  constitute any excuse for the
 act of  the accused."*
   Should there be a single reason leading to the commis-
 mission of the  crime, which  is  to our  perception the  off-
 spring of insanity, even  though to  every appearance  the
 mind is otherwise sound, yet this single delusion, or what-
 ever it may be, renders  the  conscience imperfect, and we
 are left to decide by the best  methods at our command, as
 to the  extent of the perversion of the mental faculties by
 disease, and as to how  far the  apparently sane faculties
 sympathize with, and are weakened and overcome by those
 faculties which we know to be diseased.  This  extremely
 difficult task is not to be accomplished by establishing any
 criterion of right  or  wrong, or  of legal  responsibility of
 any nature whatever.   It must in each  individual case be
 made by  the direct examination of scientific  men, who
 have studied insanity as a disease, and not as a legal prob-
 lem.  Homicidal  mania  is often manifested as the  direct
 result of a delusion, and in such cases, the unfortunate in-
 dividual stands a better chance of having justice done by
 him, all allowing that the knowledge of right and wrong
 is  destroyed by disease.   But if  this delusion does not ex-

  * The above case was taken to the Supreme Court on writ of error,
and the judgment of the court below reversed, the higher court hold-
ing the charge to be contrary to law. 
      Insanity.—Criminal Responsibility of Insane.   49

ist, or if existing, it is not much  manifest, and has not
to all external appearances influenced  the act, then it is
held that he should be responsible.  Even further does so-
called justice go ; for, if the person has  a most  frightful
delusion, but it cannot be known that the crime is a direct
result of that delusion, then he must be responsible. With
a delusion to  prove  in  general  a diseased mind, who can
say there are not other delusions  reigning concealed, and
which have constituted the motive for the act ?  However,
the great trouble is,  that delusions as a mark  of insanity,
are greatly overestimated.  On this  point, Maudsley re-
marks, that " not half the  insane acts of a person laboring
under general mania, are really the offspring of his  delu-
sions ; they represent the  overflow of morbid  energy, are
often aimless and motiveless, so  far as we can judge, the
mere convulsive expressions  of disordered nerve centres.
Even the acts which are the offspring of delusion, are not
such as are the logical outcome of it, or such as are adapted
to the attainment of the delusive aim ; they are the results
of  insane reasonings from  insane premises, or of impulses
which spring up in insane  minds without  being connected
with the existing delusions."  As an example for criticism,
he supposes an individual  to  believe  himself to be Jesus
Christ, being otherwise entirely rational, but who one day,
shoots somebody, and is put on trial for murder.  The act
cannot be shown to  be the direct  result of delusion ; nor
if it were, it would hardly be  in accordance with the char-
acter of Jesus Christ, to do murder, and  as the madman
must be  consistent in his delusive character, therefore, he
is righteously convicted and executed.
   In no  civilized country in the world  would  such a per-
son be executed as  a murderer, though such  a theory is
constantly held, and as a theory is always  violated  in
practice.   We cannot delve within the insane mind and
•follow its incoherent workings without  first becoming in-
sane ourselves;  for in this way only could we  understand
and appreciate its insane  reasonings.  " The  delusion is
4 
50    Insanity.—Criminal Responsibility of Insane.

not the  disease," says Maudsley, " it  is only the striking
symptom of the disease, and it is certain that  the criminal
act  may be the  manifestation of the disease of which the
delusion is a symptom, and  that no  connection between
them  may be detected by the looker-on, notwithstanding
the existence of  a real  pathological condition."   The
courts of justice should  not  strive to trace a connection
between the delusion and the crime, both of which are but
symptoms  of the  same thing—disease ; both being the
effects of a common cause; but  they should seek at once
for a connection between the disease and the crime.  The
former being once  established, criminal responsibility is at
once annulled, for,  " out of the depths  of deranged feeling,
in which the delusion is rooted, there may spring  up at
any moment insane impulses, which are quite  independent
of it,  but which, like it, are born of the disease."
  That  form of insanity which  develops a homicidal or
suicidal  mania, generally accompanies or follows melan-
cholic depression.   These  crimes are often  done  by those
who are just verging on insanity, but have not yet become
actually  deranged.  The  mind  worn down  by trouble,
grief  or anxiety, or perhaps  by ill-health,  becomes over-
whelmed by fear and distress ; sleepless and dejected, and
filled  with anxiety  and despair in regard to  health or busi-
ness,  the mental pain  finally rises into a terrible  and over-
whelming  emotion, in which state  of  frenzy,  or  more
strictly,  convulsion of the mind, a deed is committed  which
is immediately after realized by the perpetrator, in its most
horrible aspect.  In most  of these cases, delusion has  no
bearing  upon the act,  but  sometimes  its  presence is very
evident, being usually of that form in which  the person
imagines himself to be continually persecuted  ; that he  is
surrounded by those  who insult and abuse  him, or who
are trying to injure his health or take his life.   Often de-
lusions of this  kind are  present, but  are  cunningly con-
cealed by him, so that he may the better engage an oppor-
tunity for wreaking out  his vengeance.   That  an  insane 
      Insanity.—Criminal Responsibility of Insane.   51

person can for a long time simulate  sanity, when it is to
their interest to do so, there can be no doubt, and this  fact
is used  as an  argument that the same strength of will by
which he thus controls  his  insane actions should make
him fully responsible for the act which he so cunningly
plans and consummates, knowing it all  the time to be  a
crime.  It  must be realized that  this is all the result of
a diseased brain, and that it is not the individual's self that
is  operating through  a  healthy mind, but  that it is  the
result of an indescribable  feeling of  anxiety and  distress
which leads to the planning of the act, which a sudden and
uncontrollable explosion of morbid energy finally consum-
mates.  The  terrors  of the  scaffold, or  the  horrors of
eternity deter not from the crime, and strengthen not the
diseased will.
   It must be remembered, also, that persons who become
insane, do  not become  rid  of those passions which are
common to all; on the contrary, these become intensified,
and acts prompted by passionate motives, particularly those
of  revenge, are not of uncommon occurrence.  This re-
venge may be for a real or an imagined  injury; it makes
no material difference.   It is a madman taking a madman's
revenge.  We cannot see into the diseased mind, and meas-
 ure in it the exact relations of health and disease, or dis-
 cover the real intensity of morbid impulse, and the exact
power of resistance, but admitting in some a limited re-
sponsibility, who will  assume the power to draw in  each
 case  the dividing line, and give to each their proper limit ?
 The  only just plan is to give to each the benefit of a dis-
 eased mind, for who is able to say that in the least disease
 of mind, the  whole mental functions do not sympathize,
 and are not in fact the product of disease ?
   In these  cases there is  often the  "clearest  evidence of
 premeditation in the plan and ingenuity in the execution
 of the deed.   It is entirely  consistent  with  insanity that
 the individual, knowing in the abstract the difference be-
 tween right and wrong—nay more, knowing that he is doing 
  52    Insanity.—Criminal Responsibility of Insane.

.  wrong in the particular  instance—should  contrive the
  means of murder, do it deliberately, and endeavor to escape
  the consequences afterwards."—Maudsley.
    Wharton & Stille  relate the following case, which is a
  striking example of the cool and daring cunning of insan-
  ity, and of the sense of responsibility that may accompany
  it:
    "A man named John Billman, who had been  sent  to
  the  Eastern Penitentiary of Pennsylvania for horse-steal-
  ing, murdered his  keeper under circumstances of  great
  brutality, and yet with so much ingenuity as  to elude sus-
  picions of his intentions  and almost concealing his flight.
  He  hung a noose on  the outside of the small window
  which is in  the door of the cells to  enable persons on the
  outside to look in; he then induced the keeper, in order  to
  look  at something in the  floor directly at the foot of his
  door, to put his head entirely through ; the noose was then
  drawn, and  but for  an accident  the  man would have been
  strangled. Notwithstanding this attempt, the same keeper
  was inveigled into the cell alone a few days afterwards, on
  the pretense of Billman being sick, and was then killed by
  a  blow on the head with a  piece of washboard.  Billman
  undressed him, changed  clothes with him, placed him on
  the bed in such a position as to induce the general appear-
  ance  of his being  there  himself,  traversed in his as-
  sumed garb  the  corridor  with   an  unconcerned  air,
  addressed an apparently careless  question  to  the gate-
  keeper, and sauntered listlessly down the street  on which
  the gate  opened.   He was however soon caught, but his
  insanity was so  indisputable that the prosecuting  author-
  ities, after having instituted a careful and  skillful medical
  examination, became  convinced of his irresponsibility, and
  united upon the trial in asking  a verdict of acquittal on the
  ground of insanity.  He was then remanded for confine-
  ment,  under  the  Pennsylvania practice,  and some time
  afterward, when in a  communicative mood, disclosed the
  fact of his having several years back murdered  his father 
      Insanity.—Criminal Responsibility of Insane.   53

under circumstances which he detailed with great minute-
ness and zest.   Inquiries were instituted, and  it was found
that he  had told  the truth.  The father had been found
strangled in his bed, the  son had been arrested for the
crime, but so artfully had  he contrived the homicide that
he  had been acquitted by  means of  an  alibi got up by
means of a rapid ride at midnight, and a feigned sleep in
a chamber, into which he  had clambered  by the window.
Here was not only a sense of guilt, but a keen apprecia-
tion of the  consequences of exposure,  and an  abundance
of  evidence of long harbored  intention and  intelligent
design."
   Dr. Hammond claims that "the individual  who has suf-
ficient intelligence to know that pointing a loaded pistol at
a human being, cocking it, and pulling  the trigger, are acts
which will cause the death  of the person against  whom
they are directed, should be subjected to the same punish-
ment for a homicide as  would be awarded  for a  like
offense committed by  a  sane person."  Certainly there
would be no more premeditation or ingenuity of execu-
tion, here than were exhibited  in the case  of Billman,
whose insanity was never  questioned.
   The condition of the madman after committing a homi-
cide is variable.  Some seem completely insensible of the
severity  of the act, and do not realize in the least its crim-
inal nature; others, on the contrary, display the keenest
anguish  and remorse; some make no attempt whatever at
escape;  others make more  or less feeble  attempts, while
some, like Billman, succeed  in adroitly eluding detection
for many years.  As has been before  observed, there are
forms of mental disease in which delusions of any charac-
ter are entirely absent, and in which the  general intelligence
is,  to  all appearances,  uncomplicated  and normal.  This
condition is most marked in that form of disease previously
described as volitional  insanity,  and which, on  account of
the entire absence of all physical manifestations, and the 
54   Insanity.—Criminal Responsibility of Insane.

impulsive character of its paroxysms, becomes a most dan-
gerous form of mental disease.   It  consists  in an  insane
impulse, acting upon a diseased mind, and which the latter
has not the power to resist.   This impulse is  usually either
of a suicidal or homicidal nature; but it is those cases in
which develop the latter form, that most frequently demand
the attention of the  expert.
  It is surprising, how long a person possessed  of a neu-
rotic temperament may live and show no signs whatever of
mental disease.   He may become eminent in his profession
or business of life, be  remarkable for his acuteness of per-
ception, and his ready tact in solving the intricate problems
of business, and yet, either suddenly or gradually, the men-
tal derangement  may become manifest, the homicidal  im-
pulse  may develop, swallowing up  all reflection and will,
and soon,  without  warning, the unfortunate individual
stands  before the world a homicide.   To establish his in-
sanity becomes a most difficult task, the previous workings
of the  mind  having been  entirely unknown, and disease
not in the least suspected.
  In those cases where there has been a  previous homi-
cidal impulse, where  the individual  may for months  and
years have been  striving to  overcome the horrible impulse,
when it has truly had  possession of him, in spite of all  rea-
son and  will, making life a burden to him, then it must
be acknowledged that the  mind is  diseased.  At first he
may have been able to control, or  successfully resist  the
impulse,  so long as  it  was  simply an idea, but, as disease
made headway, the  idea became an  irresistible impulse,
over which reason and will  had no dominion.
  This homicidal impulse  is not strikingly  peculiar, only
that in these cases it is the  only  appreciable  symptom.
There are no other symptoms  or impulses  of a different
character, which serve to  overshadow the homicidal  im-
pulse.  There may  be  impulses to  steal; to break win-
dows ;  to tear clothes; to swear, and do  other acts of  vio-
lence ;  and if, during  such  a state, the homicidal impulse 
       Insanity.—Criminal Responsibility of Insane.   55

 should  supervene, and a  murder  result,  no  one would
 question for a moment the perpetrator's  insanity.   Some
 form of impulsion is characteristic of insanity, yet we may
 not  know  the impulses that may arise from  a diseased
 mind.
    Maudsley aptly compares insanity with chorea, the latter
* being an insanity of the muscles.   " Just as a  deranged
 state of the motor centres destroys co-ordination of move-
 ments, and occasions  spasmodic or  convulsive  muscular
 action, so a deranged state  of the  mind centres destroys
 the healthy condition of ideas, and occasions a spasmodic
 or convulsive mental action.   In the one  case the man is
 unable to perform his  movements correctly; in  the other
 case he is unable to perform his ideas correctly ; in  both
 cases they play him  evil tricks, against his will, though
 within his consciousness."
    Numerous cases exemplifying this form of mental dis-
 ease, are reported by Pinel, Marc, Esquirol and others, but
 it will be sufficient here  to give only two cases of more
 recent occurrence, as reported and  commented  upon by
 Maudsley.   The first of these cases was  that  of Burton,
 " who was  tried at the  Maidstone  Lent Assizes, in  1863,
 for murder.  It was very simple and very shocking.   The
 prisoner was a youth of eighteen years of age ; his mother
 had been twice in a lunatic asylum, having been despond-
 ing, and having attempted suicide ; his brother was of weak
 intellect, silly and peculiar.   He, himself, was of low men-
 tal organization, and the person to whom he was appren-
 ticed, and  others, gave  evidence that  he  was always
 strange,  and not like  other  boys; he had a very vacant
 look, and  when told to do anything, would run  about,
 looking up to the sky as if he was a maniac, so that the in-
 dentures were cancelled.  The prisoner said that he had
 felt an impulse to kill some one; that he had sharpened
 his knife for the purpose, and went out to find some one
 whom he might kill;  that he followed a boy, who was the
 first person he saw, to a convenient place; that he knocked 
56   Insanity.—Criminal Responsibility of Insane.

him down, stuck him in the neck and throat, knelt upon
his belly, grasped him by the neck, and squeezed  till the
blood came from his nose and  mouth, and then trampled
upon his  face and neck  until he was dead.   He then
washed his hands, and went quickly to a job which he had
obtained.  He knew the boy whom he had murdered, and
had no ill feeling against him, ' only I had made up my
mind to murder somebody ;' he did it because he wished to
be hanged. His counsel argued that this vehement desire to
be hanged was the  strongest proof of insanity ; the coun-
sel for the prosecution, on the other hand, urged that the
fact of his having  done murder in order  to be  hanged,
showed clearly that he knew quite well the consequences
of his act, and was, therefore, criminally responsible.  He
was found guilty, and Mr.  Justice Wightman, in  passing
sentence, informed  him that he had been ' found guilty of
a more barbarous  and inhuman murder than any which
had come under my cognizance during a judicial  experi-
ence of upwards of twenty years.  It is stated,' the judge
went on to say, ' that  you  labored under  a morbid desire
to die by the  hands of justice, and for this purpose you
committed the murder.  This morbid desire to part with
your own life, can hardly be called a delusion, and, indeed,
the consciousness on your part that you could effect your
purpose by designedly depriving another of life, shows that
you were perfectly  able to understand the nature and con-
sequences of the  act which  you were committing,  and
that you knew it was a crime for which by law the penalty
was capital.   This  was, in truth, a further, and I may say,
a deeper aggravation  of the crime!'   When sentence of
death had been passed, the prisoner, who during  the trial
had been the least concerned person in the court, said, with a
smile:' Thank you, my Lord,'and went down from the dock,
followed by an audible murmur, and almost a cry of horror
from a densely crowded audience.  He was  in due course
executed, the terrible example having been thought neces-
sary in order to deter  others from doing murder out of a 
      Insanity.—Criminal Responsibility of Insane.    57

morbid  desire  to  indulge in the  gratification  of being
hanged."
  In this case, the  individual's family history, his  low men-
tal organization, his previously acknowledged incapacity,
and mental weakness, the character of the inciting  motive,
the extreme barbarous and horrible manner in which the
deed  was executed, as  well as the  total indifference of
Burton  during the trial, and his evident satisfaction with
the sentence, show positively his insanity, and that he was
entirely irresponsible for the act.
  The case of the Alton murderer is an  example of  that
class  of cases, of by far  more numerous occurrence than
usually  supposed, in which the insane impulse to homicide
springs  up  suddenly without any  apparent provocation.
He was a clerk in  a  lawyer's office at Alton, New Hamp-
shire.   On  a fine  afternoon, he  took a walk outside the
town, when he met some little girls playing in  a field by
the roadside.  One  of them, a bright little girl, between
eight and nine years of age, he persuaded to go with  him
into an  adjoining hop garden, and the others he got rid of
by giving them a few halfpennies.   In a little while, he was
met walking quietly home;  he washed his hands in the
river, on his way, and then  returned  to  his work in the
office.  The little  girl was  missing;  search was made in
the hop garden, and the dismembered fragments of her
body were found scattered about.   Suspicion fell  directly
upon the prisoner, who  was immediately arrested.   In his
desk  was found a diary, in which was this newly made
entry :  " Killed a little girl; it was fine and hot."   He had
killed the child, and cut  her body to  pieces without other
motive  than the gratification of an  impulse which suddenly
came into his mind.  There was no indication of  insanity
in his conversation and conduct after his arrest,  nor was
any evidence of strangeness in him immediately  before the
murder given at the trial.   But it came  out at the trial,
where only the semblance of a defense was made,  that his
father had had an attack of acute mania.   Moreover, it was 
58    Insanity.—Criminal Responsibility of Insane.

proved in evidence, that he himself had been  unlike other
people; that he had been prone to weep frequently with-
out apparent reason; that he had exhibited  singular ca-
prices of conduct, and that it  had been necessary at one
time to watch  him, from fear that he  might  commit sui-
cide.  He was  found guilty, condemned to death, and in
due course executed, all the  newspapers  heartily applaud-
ing.   This man was plainly an instinctive  criminal, if he
were  criminal  at  all;  the impulsive  character  of  the
crime, the quiet and determined ferocity  of it, the savage
mutilations, his equanimity immediately afterwards, and his
complete  indifference to his fate—all these indicated an in-
sane organization,  ill-attempered, a discord in his nature,
which, had it not issued as it did, would sooner or later  have
ended in suicide or unequivocal insanity. *
  The case of Joseph Waltz, hung in  New York a  short
time since, for the murder of  one  Halcher,  a scissors
grinder, was in many respects  a very  peculiar  one.   Dr.
Gray, of Utica, and the State Commissioner of Lunacy in-
sisted that Waltz was  perfectly sane when he committed
the murder, and remained so till his execution.   Dr. Brown,
of Bloomingdale Insane  Asylum, and  two other skillful
physicians, emphatically pronounced him to have been in-
sane.  The subject caused an animated and earnest discus-
sion among the medical men and newspapers of  the State,
the New York Tribune unhesitatingly  declaring him in-
sane, and his hanging a cruel  murder.   The  facts in the
case were remarkable.   No possible  motive for the  deed
could ever be discovered.   When asked why he had mur-
  * Very different was the opinion of Dr. Hammond upon this case.
Although acknowledging the perpetrator's insanity, he unblushingly
says that " such  monsters of depravity should be slain upon  the
same principle as we slay wild and ferocious beasts." Such an in-
human and monstrous doctrine, emanating from such a source, can-
not help retarding the progress of humane justice. It sounds strangely
similar to the barbarous doctrines of past centuries, and is certainly
quite unworthy of its distinguished and talented author. 
      Insanity.—Criminal Responsibility of Insane.   59

dered the poor, inoffensive scissors grinder, he said it was
" the spirits,"  blood-thirsty demons, whom he  could not
resist, although he had  made desperate efforts to break
away from their influence.  On his arrest, he acknowledged
his guilt,  or rather his  crime, for he  seemed to have no
feeling  of guilt;  described with horrid minuteness the
manner in which the  murder was committed, and  showed
the officer who arrested him where he had buried the body,
although, if the body had not been found (as quite likely but
for his pointing out its whereabouts, it would not have been),
he could not have been punished.   His accommodating de-
sire to aid, so far as he was able, in  solving the mystery of the
tragedy, led him to aid in the  one discovery essential to his
conviction and  execution.   After his conviction and con-
finement in a cell, his ferocity increased.  He made further
confessions of crime, not from persistence, but apparently
from a satisfaction in seeing people startled by his  enormi-
ties.  He caps the climax of his  bloody career by beating
in the skull of his keeper, so that he died  in two  or three
days.  When the  act is discovered by the sheriff, Waltz
makes no attempt to escape, no effort at resistance, al-
though he has in his hands the loaded revolver of the man
he has just slain.  To the importunities of his sister, to seek
God's forgiveness for his crimes, he only responds with  a
glare and a growl like those of a wild beast; and he springs
like  a tiger towards the mother who bore him, to strangle
her.   In this mood he goes to the gallows.
   In this case, the prisoner's insanity could scarcely be
called in question.  In the  minds of the most obtuse, there
must have been grave doubts  as to his sanity, to  say the
least, and with the " benefit of a doubt," always accorded
a prisoner, it is  impossible  to  conceive how an intelligent
being could bring in a verdict of guilty of murder in the
first  degree, unless, perhaps, the  advice of Dr. Hammond
influenced their decision, and Waltz was " slain upon the
same principle as we slay wild and ferocious beasts;" at 
 60   Insanity.—Criminal Responsibility of Insane.

 all events, the New York Tribune was fearfully  correct in
 its opinion so boldly ventured.
   From the foregoing observations, it would appear that
 the criminal responsibility of one who labors  under this
 form of cerebral derangement, depends upon the justice of
 law in trying to make all persons control their wrong im-
 pulses, the insane equally with the sane.   People often do
 not do so when it is within their power, and such should not
 be shielded ; but when the impulse is the offspring  of dis-
 ease, it is not for a human bar to decide that it could have
 been resisted.   " Of course, it is the duty of every man to
 control an impulse to homicide, even though it spring from
 disease;  and it may, perhaps, without much violence, be
 assumed that every sane person would be likely to do so,
 seeing that there cannot be supposed to be any  real grati-
 fication in murder, purely for its  own  sake, and in  being
 hanged for it; but to conclude in  a particular case, that an
 impulse springing from disease might have  been resisted,
 and was  not, and, therefore, to hang the  person, is to as-
 sume an  insight which no mortal has, or can pretend to
 have, and to do under the sacred name  of justice,  a deed
 which   may unquestionably  be  a  fearful  injustice."—
 Maudsley.
   The criminal responsibility of the demented, imbecile or
 idiotic, is  seldom a matter with which the medical man has
 to deal, and when such is the case, the same  rules applied
 to other forms of mental disease will equally answer here.
 Occasionally crimes are committed by these persons, and
 when so, the responsibility is in proportion to the  individual
 mental deficiency, and must  be a matter of fact for the
physician to. determine, regardless  of all set rules  or so-
called acts of responsibility.
   In all cases where the  intelligence is feeble, though not
totally extinct, the  passions  are  proportionately strong,
and lead the individual to all  kinds of acts of violence and
crime, for which,  in great part, he is irresponsible. 
                   Epileptic Insanity.                61


                    CHAPTER VI.
               epileptic  insanity.
  The intimate relationship existing between the various
neuroses has already been noticed.   This intimacy is most
marked in the epileptic neuroses which of all others is most
directly related to that of insanity.
  Epileptic insanity, strictly so-called, is that furious mania
which so frequently follows an epileptic fit, or a succession
of fits, or which  occasionally  precedes the fit, and which,
on account of its extremely violent  character, becomes  a
most dangerous  form of mental derangement.   Owing,
however, to the fact that late observations have proven that
attacks of mania  are liable to  occur in  epileptics at any
time, as also to the  now well  established relationship ex-
isting between  the two forms of mental disease, it will  not
be amiss to briefly treat of epilepsy  under the head of ep-
ileptic insanity.
  Epilepsy may be divided into four stages, or rather four
divisions, one or  more of which are liable to be entirely
absent.
  The prodromata which precede almost every attack con-
stitute the  first division.   The second division consists in
what is usually described as the epileptic vertigo, or the
petit mal of some writers, and constitutes the full  extent of
the slightest forms  of epilepsy.  The  third  division   in-
cludes the more  violent  symptoms, corresponding to the
regular epileptic  convulsions, or the so-called grand mal.
The fourth division is  known as epileptic dementia, being
the decay of the  mind from epilepsy.
  The  prodromata  of epilepsy are headache,   dizziness,
sparks before the eyes, or sudden blindness, noises in the
ears, feeling as if the ears are stopped with water or cotton,
bad smell in  the  nose,  trembling, nausea,  urging  to evacu-
ate the bladder  or rectum,  palpitation of the heart  and
chilliness.  As the  attacks increase in number  and  se- 
62
Epileptic Insanity.
 verity,  the  patient's friends  notice that previous to  the
 paroxysm for several days, he  becomes  morose  and ir-
 ritable ;  or,  his  mind  becomes  clouded  and  he forgets
 everything and seems unusually confused and dull of com-
 prehension.  On the other hand exactly the reverse may
 be noted, in  the  patients extreme  cheerfulness, loquacity
 and extraordinary self-esteem.   Falret observes  that  in
 some cases the same ideas, the same recollections, or the same
 hallucinations recur before the attack ; that on each occa-
 sion the patient has the same  vivid mental impressions, or
 sees the same spectral illusions,  or  smells the same odors,
 or hears the same voice  uttering the same words.   In  ad-
 dition to these symptoms,  epileptic paroxysms are some-
 times preceded by the aura epileptica, which is a sensation
 as though air, either cool or warm,  was passing quickly up
 the extremities to the head, but this is either of very rare
 occurrence, or else is of so short duration that it is not re-
 membered by the patient when the attack is over.  After a
 time these prodromata  become so  well known to  the suf-
 ferer that if he is inclined to do violence during the attack
 he may warn his possible victim to get out of his way.
   The second division  of this disorder  constitutes, as be-
 fore stated, what is  the  lighter forms of epilepsy, the  so-
 called petit mal, or as described by some authors, abortive
 or incomplete epilepsy.  The patient " utters a few unin-
 telligible words, or makes some  incomprehensible  sounds,
 or he may exhibit indications  of profound  terror,  with or
 without grimaces,  or  other slight  muscular spasms, and
 then is himself again, quite unconscious of what has hap-
pened him."  These attacks usually recur several times in
 the course of a few hours  or  days.  During the interval
the patient seems  completely  restored, and talks and acts
as if he were so, yet when  the attacks have ceased, he  re-
 members nothing that has occurred, not even  the words he
has said or the acts he  has committed during  the appar-
ently lucid  interval.  If, however,  the  patient is closely
watched during these intervals it  will be observed  that he 
Epileptic Insanity.                63
is unusually dull, his thoughts seem confused, he talks in-
coherently and acts strangely enough to indicate consider-
able deviation from a normal mental condition.  It is quite
obvious then that deeds of violence might be done by the
individual while in this condition of temporary mental un-
soundness for which he should  not  be held responsible.
While it might be difficult to explain from either a patho-
logical or metaphysical stand point this anomalous condi-
tion in which a person may be apparently living a natural
life, transacting business  and performing acts in an appar-
ently normal manner, and yet be in a measure unconscious
his existence or his surroundings, nevertheless  the  fact
exists, and in justice to  the suffering epileptics, should be
constantly borne in mind.
   During the more or less lengthy intervals occurring be-
tween the paroxysms,  which  may be several days, weeks,
er even months, the patient's mind is  at  first apparently
normal, but as the attacks recur from time to time, their
effect upon the mind becomes more marked, and the person
becomes sad and  morose,  easily irritated, cross and peev-
ish ; his intelligence becomes enfeebled, his memory im-
paired, his mind filled with suspicions of distrust and fears
of all around him, creating a condition of most profound
distress, anxiety, and terror, which may finally, in a desire
to become rid of himself, or of those whom he blames for
his trouble,  culminate in  a suicidal  or homicidal impulse
which  he cannot control.   Sometimes  the deed  being
done,  gives  vent to  the  over-charged brain,  and  relief
is at once afforded.  If so,  the patient  at once realizes the
enormity of  the crime he has  committed, and attempts to
flee from justice,  or, perfectly benumbed with terror and
remorse, makes no effort to escape.  In either case the in-
dividual's previous condition of mind not being known, or
if known, not fully appreciated by either judge, jury, or
community, he stands a strong chance  of being hung.
   The third  form of epileptic mania is that class charac-
terized by vivid  illusions, hallucinations,   delusions and 
64
Epileptic Insanity.
furious delirium, but lacking  in a great measure the inco-
herence of ordinary mania.   The  attacks usually occur
without any warning,  though  sometimes  for a  few hours
previous to the attack there will be a noticeable sadness,
irritability and nervous  excitement, or  the patient  may
complain of headache, the eyes be red  and brilliant, and
the face and limbs twitch.  If  prodromata  once occur, the
same may be safely expected  to precede every subsequent
attack;  so, too, will the same  terrifying objects  meet their
gaze, the same threatening voices  fill  their  ears, and the
same form of  delirium characterize every paroxysm.  The
attack usually terminates suddenly in a  few  hours  or
days, and the patient remembers nothing of what has oc-
curred.
  The fourth division  of epileptic mania is  that which
usually  closes every case of protracted insanity, consisting
in a general breaking down and entire destruction of the
moral and  intellectual faculties.   During the progress of
this degenerating process, outbursts of furious mania usu-
ally occur from time to  time, during which, acts of extreme
violence are liable to be perpetrated.
   Between each of these  divisions there  exists an inter-
mediate state, which exhibits every degree of variation,
and which cannot be accurately described.
   Epilepsy often exists  unnoticed  for a  long time, either
because it is too slight to attract the attention of unskilled
observers, or the paroxysms may occur always in the night
and no  one be aware  of their presence.   It is probable that
many cases  of questionable  insanity  could be positively
proven such, were more  care used in the examination of the
case, and the  bringing to light of the epileptic neuroses.
   Having thus briefly noted the usual symptomatic course
of epilepsy, I will say something respecting its effect upon
the mental powers, in the production  of what  may be de-
scribed in a general term as epileptic insanity.
   There still remains much to be  learned of epilepsy in its
medico-legal relations.   The physician is scarcely ever led 
Epileptic Insanity.
65
to think of it except as a purely physical disease, and from
a purely  medical standpoint, while  the  lawyer, as a rule,
only investigates it  from a legal standpoint, where the in-
terests of his client demand such an investigation, and then
it  cannot  be said that  his  investigations  are sufficiently
careful  and unselfish as  to render his conclusions of any
scientific value.   Thus  it happens  that  the  medico legal
history  of* epilepsy  still  remains comparatively  obscure,
and  our  knowledge of it  correspondingly  defective.
Nevertheless it  is  an accepted  fact that  some form  of
mental   derangement  is  liable  to   accompany   epilepsy,
and that,  as a general  rule,  the mind  is  most  affected
immediately  before  or  immediately after  the  fit.  Zac-
chias,  in  his day,  contended that  epileptics should not
be  responsible   for   any   acts  committed  by  them
within three days of a fit, before or after,  and while this
principle is undoubtedly sound  so far as it goes, it never-
theless  establishes an  arbitrary  limit, which is, to say the
least, unjust, and which scientific investigations do not fully
confirm.
   The more I come to  know of epilepsy, the more am I
convinced that in many instances  the epileptic is never
fully responsible; a  temporary  mental derangement being
liable to occur subsequent to any mental  excitement, from
fear or anger, or  any  strong moral  emotion, and during
which a criminal  act might  be  committed.   The natural
soundness of the mind  is  almost  invariably destroyed
where epilepsy has been  present any length of  time, and
if  this  unsoundness in  itself,  is not sufficient to release
from responsibility for crime, it would be difficult to es-
tablish any satisfactory and just limit of responsibility what-
ever.
  The  mania of epileptic insanity is of the most furious
kind, partaking of a wild, blind frenzy, which nothing can
tame ; the individual automatically performing  the most
destructive acts of violence  against  both animate and in-
animate objects, being apparently in a state of unconscious
                          5 
66
Epileptic Insanity.
 ness.  This condition may continue only a few minutes or
 hours, or may  last several  days,  after which he becomes
 mild and sensible, though, in some instances, there remains
 a morbidly irritable condition of mind, which the slightest
 provocation aggravates.   Sometimes this irritability is ac-
 companied by a morose, surly,  suspicious, jealous disposi-
 tion of mind, full  of  unfounded fears, and quite often ac-
 companied by  a great activity of the lower propensities-
 In such cases, where  the disease is fully developed and the
 conditions well known, there is little or no  trouble in ar-
 riving  at  correct conclusions concerning the individual's
 mental condition ; but to  determine  the exact mental con-
 dition  of an epileptic  at the moment of committing a crim-
 inal  act, in whom the disease is not fully developed, or has
 not as  yet produced this  habitual  mental derangement, is
 often a difficult  task.   " It may have taken  place in the
 absence of any observer, in a fit of fury that rapidly passed
 away, and which, perhaps, may not have  followed any  pre-
 vious paroxysm ; or  the  accused, though subject to the
 disease, may not have recently suffered an attack, and may
 have appeared perfectly rational to those around him.  The
 suspicion  that the  accused was  deprived of his moral lib-
 erty, when committing the criminal act, would be strength-
 ened if the paroxysms had been recently  frequent  and
 severe  ; if one had shortly preceded or succeeded the  act;
 if he had  been habitually subject  to mental irritability, or
 other symptoms of nervous  disorder ; and by those  cir-
 cumstances generally  which lead to  the same conclusions,
 were the supposed disease a  form  of moral mania, instead
 of epilepsy.  Cases of this kind should be closely scrutin-
 ized, and when the accused has been  undeniably subject to
 epilepsy, he should have  the benefit  of every reasonable
 doubt that may arise respecting his sanity."—Ray.
  It has also been  ascertained that  the  condition .of  irri-
tability which  has been described as liable to follow an
attack  of maniacal fury, sometimes  exists without the lat- 
Epileptic Insanity.
67
  ter, and occurs periodically from  time to time for months
  and even  years before distinct epileptic fits appear; and
  still farther,  that it not only sometimes precedes genuine
  epilepsy, but  may also  follow  it, and occur periodically
  from time to  time after the fits have entirely ceased.   It
  thus  constitutes a  condition of profound  moral or affective
  derangement, which is  in reality an undeveloped epilepsy,
  and in  which  homicidal  impulses  are quite apt to occur.
    There remains still another form of epileptic insanity, in
  which a homicide may be committed,  which Dr. Maudsley
  describes as  masked epilepsy,  " a  transitory mania occur-
  ring  in  lieu of the usual convulsions.   Instead of the
  morbid influence affecting the motor  centres and issuing
  in a paroxysm of convulsions,  it fixes  upon the mind
  centres  and  issues  in  a  paroxysm of mania,  which
  is,  so  to  speak,  an   epilepsy  of mind.    Many cases
  of  so-called  transitory  mania  are really cases of this
  kind—cases of mental epilepsy.  Both forms of mania may
 occur in the  same patient at different  times; his  fits may
 be followed by mania, as is most often the case, or he may
 now and then have a maniacal, taking the place of an epi-
 leptic paroxysm.  Thus,  in  one case  of  epilepsy, compli-
 cated with  mania, there were' three kinds of symptoms at
 different times : (i)—Epilepsy pure and simple; (2)—Ep-
 ilepsy followed  by  violent delirium,  chiefly  of action, in
 which the patient tumbled about on the ground in an ex-
 traordinary manner, with great rapidity, without speaking a
 word; this condition, during  which intelligence and  sensi-
 bility were abolished,  lasting for  ten  minutes; (3)—An
 attack of mania without epilepsy, the patient falling, after
 excitement, into almost an  ecstatic state, from which he
 returned slowly to reason.  Between these attacks he was
 quite sensible.  The practical lesson which cases of this
 kind teach is, that in the event  of homicide,  we must not
 insist on its being proved in every case that actual convul-
 sions had occurred ;  for the instance maybe one of masked
epilepsy." 
68
Epileptic  Insanity.
   Reference has  already been  made  to  that anomalous
 condition  in which  the epileptic  may at times transact
 business and perform acts automatically, being entirely un-
 conscious of his existence or his surroundings.   A natural
 deduction is that  crime might also be done while in such
 a condition, and for which the perpetrator would be wholly
 irresponsible.  The difficulty lies in the fact that, as a rule,
 but little evidence can be had  to prove such a condition,
 save  from  the  perpetrator's own  testimony, which,  for
 obvious reasons, is not always to be relied upon.
   However, the fact has been abundantly proven that such
 a condition  may exist, and as this loss  of consciousness is
 not far removed from the psychological  impairments or-
 dinarily attributed to epilepsy, the  probabilities  of its oc-
 currence must be admitted,  and  the fact used to render us
 still more cautious how we  estimate  the legal responsibil-
 ity of epileptics.   The following  case recorded by Dr. Ray
 is a very probable illustration of this condition,  and is in
 other respects a case of considerable interest from a medico-
 legal standpoint:
  In  1867,  a young man,  named Winnemore,  was con-
 victed of killing a woman, Mrs. Magilton,  in Philadelphia.
 He was  about twenty-seven years old, of a slim, spare
 habit, with an intelligent, ingenuous expression of counte-
 nance, and without a  single  aspersion  on his moral char-
 acter.  He had been an epileptic  from early youth, having
 had as many as forty fits in a single day, but of late years
 they had much diminished in frequency.  For some months
 or years he  had been much given to spiritual manifestations,
 as they are  called.   He saw spirits with  the bodily eye,
 and roamed about at will  in  a region of spiritual beings.
 His life and conversation  were  more with them than with
 mortals of flesh  and blood.  Once or twice he attempted
 suicide.  He had never been in  any regular employment
 until he entered the army, from which he was discharged,
two or three years previously, on account  of his  epilepsy.
 He had become  intimate  with the  deceased  by reason of 
                   Epileptic Insanity.                69

their common belief in spiritualism, and  was in the habit
of going to her house.   To all appearances, their relations
were of the most friendly character.  On the day of her
death, her husband, after an hour's absence from his house,
about midday,  returned home and was  let in by Winne-
more, who said that  he had just come in and found  Mrs.
M. with her throat cut  and quite dead.   He denied to the
very last that he had a hand in the murder, and though the
circumstantial  evidence was  very  strong  against him, it
was not conclusive.  It certainly did not  indicate the or-
dinary motives  of crime.  It did not appear that he had had
a fit shortly before or after, and he admitted that he experi-
enced no  pain or other unusual  sensations  in his head on
that day.   He  said that he was willing to die, and thought
some great end would be accomplished by his death.   The
jury magnanimously found him  guilty, and he soon  after
died on the gallows, a warning to all epileptics not to com-
mit crime while  in an  unconscious  or  deranged state of
mind.
   On the whole it  may be said, that, in any  form of epi-
lepsy, destructive  impulses, particularly  of a homicidal
nature, are liable to occur, just as they occur in persons of
a distinct insane neurosis, and just when they may occur,
and under  what particular  circumstances,  none can tell.
The epileptic is ever liable to them, and, in cases  of crime
where premeditation and intelligible motive have been ab-
sent, and  unnecessary violence and  ferocity used in execu-
tion, and especially when, in connection with these circum-
stances, there  seems  to be a partial or  complete loss of
memory of the act itself, in such cases, the fact of epilepsy
being proven, none ought, for a moment, to question the
individual's irresponsibility.*

  * Such a  case  in many respects was that of People vs. David
Montgomery, (New York), in which most of the above named points
were proven. However, Dr. Hammond testified that " though he
was subject to epileptic convulsions and had a diseased brain, he was
conscious at the time of the murder,  and that the act was premedi- 
70
Treatment of the Insane.
   However, the difficulty is usually in satisfactorily prov-
ing the presence of epilepsy in those cases  mentioned in
the second division as abortive or  incomplete epilepsy, or
in the  third division, where the  paroxysm  is  short,  or
where it has occurred in  the night, so that no witnesses
can swear to its actual presence.
                    CHAPTER VII.
               treatment of  the  insane.

   One of the most difficult  problems  for the law makers
to solve in the present day, is the character of punishment
to mete out to those who, through the  influence of mental
disease, or, at least, who, during  the existence of mental
disease, are constrained to acts of violence and crime.
   As we contemplate the barbarities and inhuman punish-
ments inflicted  upon  the insane,  for the most trifling of-
fenses, in days  long gone, we  may not be surprised that
notwithstanding the  steady  progress being made towards
a more  humane treatment,  there should still  exist  legal
doctrines upon this subject that are a disgrace to any civ-
ilized nation.   How far such doctrines are  due to the re-
mains of ancient superstition, and to the  idea that insanity
tated and deliberate."  At the same time,  Drs. Gray, of Utica, and
Cook, of Canandaigua, testified to Montgomery's irresponsibility ;
nevertheless, he was convicted of murder in the first degree, and duly
sentenced to be hanged.  An application was mad: to tne Supreme
Court for a new trial, which was refused, but eighteen months elapsed
before the final decision was reached.   " By that time the epilepsy
under which the prisoner undoubtedly suffered, had so far impaired
his mind that it was deemed advisable to send him to the asylum for
insane criminals at Auburn."
  In this case Dr. Hammond took upon himself the responsibility of
distinguishing the workings of the diseased brain, and of saying just
when that  diseased brain was operating  healthfully  or otherwise.
Such insight is beyond mortal ken, and  the acknowledged presence
of disease places a fearful responsibility upon him who thus allows
himself to be the cause of such a verdict. 
Treatment of the Insane.             71
is but a supernatural visitation of the Evil One, I am not
able to say, but it is quite certain that true ideas of insan-
ity, as a  bodily disease,  cannot fail to  do away with tie
unjust and unholy horror which  still hangs over the very
term insanity, and,  at the same time beget, for the poor
sufferers, a more  sympathizing  feeling  in  the  world at
large, and a  more just  and  humane treatment  from the
hands of the law.
  Many insane criminals, if, indeed, they were criminals at
all, have died upon the scaffold because the authorities did
not seem to know  what else to do with them.  They were
dangerous to society, and,  as society must be protected,
the extermination of insane criminals has, to a disgraceful
extent, been  the order  of the  day.   The same thing done
by  heathen nations would incite in us a deep sense of hor-
ror and  disgust, but  in  an enlightened  country, where a
farce like process of law  is used to gloss over the heathen-
ism of the crime we see  fit to call capital punishment, we
can look  upon the execution of the insane  without  re-
morse,  and  read  with satisfaction the applaudings of an
ignorant and sensational  press.
  That society should be protected, no one will for a mo-
ment question, and this is  supposed  to be accomplished :
(i) by punishing the offender to intimidate him from far-
ther lawless acts, and (2) by the example this punishment
affords to others who might  be inclined to commit crime,
but who are  kept in check  through fear of the law.
   Lord Brougham first  gave the opinion that it was nec-
essary to punish insane  criminals in order to deter them,
and those who witnessed their punishment  from farther
mischief.  Here,  as elsewhere, the  great  men of the law
act as if they considered the insane mind subject to reason,
and nothing can be more absolutely unscientific, inhuman,
illogical and absurd.  No insane man will admit his insan-
ity, even in his own mind,  and, though he may witness the
execution of an insane  person  for  murder, it would not 
72
Treatment  of the Insane.
deter him from  murdering  under the same circumstances,
because he considers himself sane and his act justifiable.
  " The adsurdity of an insane person recognizing his own
insanity," observes Dr.  Ray, " forming rules for his con-
duct, and acting upon  them, would seem too gross to be
deliberately uttered by  learned dignitaries of the law, had
we not abundant  proof to  the contrary.   In point of fact,
it may be safely said that not an instance can be produced,
of an insane  person being deterred from the commission
of a criminal act by the punishment of some other insane
person for a similar act, or  encouraged to commit it by an
example of an opposite kind."
  When crimes  are committed  under the influence of an
irresistible impulse,  which impulse is caused by disease,
then either punishment or fear of punishment would have
but little or no effect towards protecting society.   Yet there
is no question but that  insane criminals should be deprived
of their liberty, though not as a punishment for the deed
they have committed, or rather for the deed which has been
committed through them, and not by them, but purely for
the  protection  of society,  and for no other purpose.
  Society has the power of protecting itself from this class
of criminals  without the  aid  of either scaffold or peniten-
tiaries,  if they  are so inclined.  In fact,  insane persons
should never be confined in ordinary prisons ; not only be-
cause it is not justice to them, but because prison rules and
associations  are not such  as  would have a beneficial and
salutary influence upon a diseased mind.   On this point I
am glad to agree with  Dr.  Hammond, who says, " there
ought to be penitentiary asylums, in which insane criminals
should be placed, and in which, while they are so securely
kept as to render society  safe from their propensities and
weaknesses, their unfortunate conditions should come un-
der such humane and scientific treatment as would be best
calculated to afford amelioration and cure."  At least it is
simply  inhuman and  barbarous to say that a madman 
Treatment  of the  Insane.             73
should be hung in order to  protect society, when society
has the power  of protecting  itself  effectually by  other
means.
  Before closing this chapter it may not be inappropriate
to notice briefly the treatment of those insane persons who
have never become the perpetrators of criminal acts.
  In no other direction is progress in the culture and prac-
tice of the humane virtues better exhibited than in the im-
proved treatment of the insane.   Until a very recent period,
this unfortunate class  of persons  were almost universally
neglected and shunned, and,  to a great extent, abused and
cruelly treated.  In  some  countries  they  were regarded
with reverence, as  stricken by  the direct hand of God; in
others, they were  regarded  as  proper subjects for the tor-
ment of coarse, unfeeling jest,  ridicule, and derision ; and,
in others, they  were  imprisoned,  as social pests, or even
executed  as criminals.  The religious houses  gave  a par-
tial refuge to lunatics during the medieval ages ; and, when
these were dissolved, hospitals, popularly called bedlams,
were established for their reception.  The management in
these institutions was everywhere most deplorable, owing
to the ignorance and the cruelty of keepers and physicians.
  Asylums, properly so-called,  were not brought into being
before the beginning  of the  present century.   Even in
these improved infirmaries,  the treatment of patients was
for some  time  marked by  the old and time honored bar-
barity.   The idea  had so long been accepted, that, when
reason departs  from its seat in the mind, it leaves the hu-
man  being a mere  animal, oftentimes  more  furious and
dangerous than the wild beast, it was hard to exchange it
for newer and more  intelligent conceptions.  Devices of a
diabolical nature were contrived, even after the dawn of our
enlightened century, to subdue what was considered to be
the evil demon raging within the breast of the insane.  One
of these was to entice the  sufferers to walk across a floor
that suddenly gave way  and plunged them into a cistern
of  water, in which they were half-drowned and half-fright- 
74
Treatment  of the Insane.
ened to death.  Another was to chain them in wells, into
which  water was gradually  admitted, subjecting the tor-
mented creatures to the horror of watching the slow, sure
approach of what they supposed to be inevitable death.
   In the middle of the  last century,  a circular swing was
much in favor as an instrument of discipline.  To this, mon-
omaniacal and melancholy patients were bound in a longi-
tudinal  position when the  e'esire was to induce sleep, and
in an erect position when  intestinal action was required.
The mere mention of this dreaded machine was enough to
distract a patient who had once suffered its torture.  Yet it
was advised by one alienist physician of the day that the
swing should be used in the  dark in hopeless cases, with
the accompaniment of frightful noises and smells.
   However, such  inhuman practices have rapidly disap-
peared  during the present century, and the management of
asylums, have, with a few noted exceptions, been conducted
according to comparatively humane  and scientific princi-
ples.   Nevertheless, the practical  results of the plans now
in operation for  the  treatment of the insane are in many
respects prejudicial to the true interests of the unfortunate
sufferers.   The crowding together of large numbers  of
insane persons, of different forms  and  shades of disease,
under one roof,  and  restraining them there as prisoners,
behind  bolts and bars, to say  nothing of the more or less
constant cruelty of ignorant and inhuman keepers and at-
tendants, cannot fail to deepen the seeds of disease, rather
than to bring about a natural and  healthy condition of the
mental  functions.
   Three quite important elements are necessary to the suc-
cessful  treatment of insanity;   First, no restraint; second,
open air ; third, association with healthy minds.   Neither
of these are attainable where hundreds—even thousands—
of invalids are assembled under  one roof, and the whole
atmosphere is saturated  with insanity.   Ninety per cent.
of the unhappy prisoners  in  our asylums are supposed to
be incurable,  and from  30 to 40 per  cent, of  these are 
Treatment  of the  Insane.             75
harmless and docile.  It is an injury, as well as a cruelty
to condemn the latter class  to confinement.   They should
be restored to their friends when these are able to provide
for them, and where there seems to be no special objections
to so doing.  Sometimes  it is quite necessary to  keep the
patient  removed  from  the  midst of those  circumstances
under which his insanity was produced.   In some cases
there is " extreme difficulty in treating satisfactorily an in-
sane person in his  own  house, amongst his own kindred,
where he has been accustomed to exercise authority, or to
exact attention, and where he continually finds new occa-
sions for outbreaks of anger or fresh food for his delusion,"
[Maudsley.)   A large majority of cases might be boarded
two or  three together,  in private and responsible families.
The cost of this mode of maintenance would be  less than
to support them as we do, in luxurious and expensive
asylums.
   Very little  medical care is required in cases of chronic
insanity; and the surest way in which comfort can be ad-
ministered  is through  contact with healthy minds, and,
when it is possible, by regular employment in the ordinary
occupations  of life.
   To illustrate the benefits of such a system of treatment,
I would refer to the famous  infirmary  for the  insane at
Gheel, Belgium, where  for ages the open air treatment, as
it is called, has been in  successful practice.   Here  eleven
hundred patients find homes among a sane population of
about ten thousand.  Only one  building answering to an
asylum has been  erected in the town, and that but recently.
It is capable of accommodating but sixty patients.  In this
patients are first  received, and  detained until the  nature of
their malady is determined.  When decided that they need
no special  medical attention, they are distributed among
the cottages and town and farm houses open to them.  In
six hundred different dwellings, lunatics form part of the
household, and share, in so far as they are capable,  the oc-
cupations and the amusements of the family. 
76
Treatment  of the Insane.
  The more  docile patients  are  apportioned  among the
town houses,  and the more violent in the cottages and farm
houses on the borders of the community.  Not more than
three lunatics are domiciled under one roof, and generally
not more than one.  A strict  supervision of the welfare of
the patients is maintained.   Ten physicians and guardians
have charge of all the inmates of the community, and end-
less care is taken to secure gentle and judicious treatment
for every one.  The individual requirements of the luna-
tic are especially considered.  Even  the style of household
and family arrangements is not thought too small a matter
to take into account when  the disposition of the lunatic is
settled,  {Wynter).
  Each patient  is constantly accompanied by an attendant;
but the  latter is  his companion rather than guardian, and
the patient is  never annoyed  by a scarcely noticeable su-
pervision.   Trustworthy patients  are often allowed to take
walks, to sit at home, and to pursue various duties, guarded
only by a child ; and  no  instance  has  ever occurred in
Gheel of a child being harmed by his demented charge.
  In Scotland, a system has  been adopted for pauper pa-
tients that is somewhat  similar to that of Gheel.   Harm-
less lunatics  are  distributed among  their  friends  or in
licensed houses ; and the plan works well.  The mortality
among them  is  lower than among the insane poor in Eng-
lish asylums.
  Dr. Wynter,  a recent and able  writer upon this subject,
warmly advocates the adoption of this system  of open air
treatment every where, that asylums  may be relieved of the
throng of incurable patients  that crowd their wards.  By
this arrangement, room would be made for the admission
of acute cases that demand immediate medical treatment,
yet are  often  compelled to  stand so long without, knocking
at the door, that the period of possible cure is passed, and
they go to swell the army  of  hopeless lunatics.
   I would not  have it presumed that  I favor the doing
away entirely with asylums, or that  I consider non-restraint 
Treatment of the  Insane.             77
essential to all cases, under all circumstances.   There are
cases of a furious  mania, and those  in  whom suicidal or
homicidal inpulses  have occurred, in which restraint in a
properly conducted asylum is quite essential, and, in fact,
often absolutely necessary.  A desirable end to be attained
in the judicious combination of asylum and open air treat-
ment,  the one taking the  place  of the other, as circum-
stances and the welfare of  the patient seem to demand.
  In closing, I cannot  do better  than to quote from Dr.
Maudsley on this subject, to whom I am already indebted
for many of the most valuable ideas herein contained.  He
wisely says :  " I cannot  but think that  future progress in
the improvement of the treatment of the insane lies in the
direction of lessening the sequestration and increasing the
liberty  of them.   Many  chronic insane,  incurable  and
harmless, will be  allowed to spend the remaining days of
their sorrowful pilgrimage  in private families, having the
comforts of family life,  and the  priceless blessing of the
utmost freedom that is  compatible with their proper care.
The one great impediment to this reform at present un-
doubtedly lies  in  the public  ignorance, the unreasoning
fear, and the  selfish avoidance of  insanity.  When knowl-
edge is gradually made to take the place of  ignorance, and
familiarity banishes the horror bred of ignorance, then will
a kindly feeling of sympathy for the insane unite with a
just  recognition of their own interests, on the part of those
who receive  them  into  their houses, to secure for them
proper accommodation and good treatment;  then also will
asylums, instead of being vast receptacles for the  conceal-
ment and safe-keeping  of  lunacy, acquire more and more
the character of hospitals for the insane; while those who
superintend them,  being able to give  more time and atten-
tion  to the scientific study  of insanity, and to the means of
its treatment, will no  longer be  open to the reproach of
forgetting their character as physicians, and degenerating
into mere house stewards,  farmers or  secretaries."
the  end. 
 
INDEX
Abortive or incomplete epilepsy,     62
Affective insanity,    .             17
Alton murderer, case of the,  .      57
Ancient treatment of insane, .     .   73
Associations in treatment of insane,  74
Asylums, first known,  ...   73
Asylums, necessary,    .    .    .77
Asylums, objections to,     .     .   73

Bell, Chief Justice,  instructions  to
  jury,.....46
Bellingham, case of,                40
Billman, John, case of,     .    .    52
Boardman vs. Woodman, case of,  .   2
Brain, physiology of, .     .    .     7
Brain, development of,   .    .    .   S
Brain the seat of mental action,  .     9
Bramwell, Judge, sentence,   .     .  41
Brougham, Lord, on punishment of
  insane,     .     .    .    .     .71
Bucknill, on examination of insane,  34
Burton, case of,    .     .    .     .55

Classification of insanity,  .    .    16
Connolly,  on  duties  of  medical
  witness.   .....     2
Criminal responsibility of  the in-
  sane,      .....36
Definition of insanity,  .
Delirium,  .....
Delusion,    .....
Delusion, as characteristic of intel-
  lectual insanity,
Delusion, not always  cause of  in-
  sane acts,  .....
Demented, responsibility of,
Dementia,
Dementia of epilepsy,
Diagnosis,
   49
   60
17, 28
   64
  . 29
Doe, Justice, on tests of insanity,
Eccentricity,    ....   32
Education, influence of, on mind,  . 37
Emotional insanity,   ...   23
Epilepsy,.....61
Epilepsy, masked,    ...   67
Epilepsy, medico-legal  relations of, 64
Epileptics, responsibility of,     .   65
Erskine, Lord, defense of Hadfield, 40
Esquirol, classification of,    .     . 16
Examination of the insane,    .    33
Execution of the insane,     .     . 71
Experts, rules for,    .     .    .     4

Gautt, Judge, instructions to jury,  . 47
General Paralysis,    ...    26
German  classification,  .     .     .18

Hadfield, defense of,  .     .    .   40
Hallucination,      .    .     .     .19
Hammond, classification of,    .   18
Hammond, definition  of insanity,  .  6
Hammond on emotional insanity,   23
Hammond on penitentiary asylums, 72
Hereditary  transmission   of  in-
  sanity,    .    .    .     .     .31
House of Lords, queries of,
Ideational insanity,
Idiots, responsibility  of,  .
Idiocy, .....
Illusion,  ....
Imbecile, responsibility of,  .
Imbecility,
Impulses, destructive, in epilep
Impulses in insanity,
Incoherence,
Infirmary at Gheel, Belgium,
Insanity a bodily disease,
Intellectual  insanity,
Introduction,
Irritability in  epilepsy,
Ladd, Judge, comments on English
  Judges,.....45

Mania,.....17, 25
Mania, transitoria,     .    .    .23
Mania of epilepsy,   ...    65
Magilton, Mrs., murder of, .     .  68
Masked epilepsy,    ...    67
Maudsley on borderland insanity,  39
          on cerebral degeneration, 14
          on classification,     .    17
          on development of brain,   8
          on delusions,     .     .  50
          on feigned insanity, .    35
          on insanity and chorea,  55
          on intoxication, diagnosis, 36
          on pathological changes, 11
          on treatment of the insane, 77
	10 17
	60
'",	28
	19
	60
. 17	28
SJ>	65
	54
	20
	75
	1
	21
	1
	66
(79)
 
80
Index.
McNaughton, case of,  .
Melancholia,
Mind, development of,  .
Mind,  effects of  hereditary
  ences on,
Mittermaier, case reported by,
Monomania,
influ-
43
16
37

37
42
17
Nervous system, development of, in
  animals,   .....   7
New restraint in treatment of in-
  sanity,   .....    74

Open air treatment of insanity,  .   75
Pathetic insanity,
Patho'ogical  conditions,
Pathology of insanity,
Penitentiary asylums,  .
People vs. Montgomery, case of,  .
People vs. Wright, case of,
Perceptional insanity,  .
Perley, Chief Justice, on tests of in-
  sanity,      .....
Perley,  Chief Justice, instructions
  to jury,.....
Physiology of the brain,
Prodromata of epilepsy,
Prodromata of mania,   .
Protect'on of society,
Punishment of the insane,
Ray, comments on decision of Eng-
  lish Judges,    ....
Ray, on pathological changes,  .
Ray, on punishment of the  insane,
Ray, on tests of insanity, .
Responsibility of the insane,
Responsibility, tests of,
Rules for experts,
Schroeder van der Kolk, on patho
  logical changes,
Scotland,   treatment  of  the   in
  sane in,.....
State vs. Jones, case of,
State vs. Pike,  case of, .
State vs. Wier,  case  of,
Symptoms of  epilepsy,
Tests of insanity,
Tests of responsibility, .
Treatment of the insane,  .

Unconsciousness  in epilepsy,

Volitional insanity,  .

Waltz, Joseph, case of, .
Winnemore, case of,  .
Wynter, on open  air treatment,

Zacchias,  on epilepsy,
   13
i-
.   76
   45
3,  47
   46
   67
40
70
24

58
65
ERRATA.
  Page 11, line 17, for "outset," read "onset;"  line 22, for "results," read
"result; " page 15, line II, for " amylocea," read "amylacea ; " page 25, line 29,.
for  "conformable," read "confirmable;" page 33,  line 1, for "disappointed,"
read " dissipated; " page 38, line 10, for "' outburst the," read " outburst of the ; "
also, line 27, for "quick," read "great;" page  46, line 36, for " Tevley," read
" Perley ;" page 49, line 1, for " much,"  read  " made ;" page 55,  line 3,  for
"yet," read "and;"  page 56, line 5, for " quickly," read  "quietly;" page  53,,
line  17, for  "Halcher,"  read  "Huleher;" page 59, line  16, for "persistence,".
read "penitence; " page 60, line 32, for " acts," read "  tests." 
 
 
 
 
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