INSANITY
IN ITS
MEDICO-LEGAL RELATIONS.


BY


A.'      OWPERTHWAIT, A. M., M. D.
J. M. STODDART & CO.
No. 723 CHESTNUT ST.,
1876.




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.
I


INTRODUCTION)


CHAPTER II.


PATHOLOGY,


6


CHAPTER III.


CLASSIFICATION,


CHAPTER IV.


DIAGNOSIS,


29


CHAPTER V.
CRIMINAL RESPONSIBILITY OF THE INSANE,
CHAPTER VI.
EPILEPTIC INSANITY,  0..
CHAPTER VII.
TREATMENT OF THE INSANE,  0.


36


61


70


(iii)








PREFACE.
IN presenting these pages to the public, the author
does not flatter himself by thinking that he is bringing forward any strikingly new or original ideas in regard
to insanity; on the contrary, he has endeavored to incorporate, in as little space as possible, the ideas and observations 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 knowledge 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 therefore, when we take into consideration the impending misery
or happiness of all concerned. Yet this trust falls into comparative 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 professional 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 consideration 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 impoverishment or impairment of the vital current, is able to produce 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 burden 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, a more humane and charitable feeling, not only




Preface.


vii


for those who are unequivocally insane, but also for those,
none the less unfortunate ones, who inhabit the borderland between mental health and mental disease, my object
will have been fully attained.
I desire to acknowledge my indebtedness to the following 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 relations 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. Bucknill 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, Yanuary ioth, 1876.










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 estimation, must either be a raging maniac, or, at least, be laboring 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 subjeEL of mental diseases by the physician, based upon careful observation
and induftive inquiry, is fast exploding the absurd idea so
long retained, that insanity is a subjed of moral inquiry
and not a physical disease.  It is enough for the lawyers
to diagnose the crime, and leave the diagnosis of the disease to those who know something about it.
The fad is now established that insanity is a bodily disease, 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 diredion, the nearer are we arriving
at absolute truth, and the more necessary will be the physician's opinion, for the reason that hie will then be dealing
with something entirely beyond the comprehension ot
those who have not made the subjed a special study.
(1)




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 insanity by mal-organization or hereditary defed," observes
Connolly, " or driven mad by poverty, or by disappointment a&ing on a distempered brain, has no other friends
in the world. The same courage which causes the physician 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 executions, nor the severities of the bench frowning down psychological 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 responsibility. This fad is evinced by the position recently
taken by two judges of the Supreme Court of New Hampshire. In the case of Boardman vs. Woodman, 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 fad 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 fat; and
the instructions to the jury were erroneous in assuming it
to be a question of law... The tests and symptoms of insanity are no more matters of law than are
symptoms or tests of any other disease in animal or vegetable life. If a jury were instruted that certain manifestations were symptoms or tests of consumption, cholera,
congestion or poison, a verdit rendered in accordance with
such instrutions would be set aside, not because they were
not corret, but because the question of their corre&ness




Insanity.-Introduction.


3


was one of faa 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 fads. They are virtually the dida of medical men,
of experts-conflicting and liable to grow obsolete; and,
therefore, in passing judgment upon them, the courts adually trespass on the province of the expert. They change
with the progress of knowledge. Tests and definitions of
insanity once supposed to be corred and comprehensive,
have given place to others regarded as representing the
known fats of science. Whether they are corre& or incorre&, current or obsolete, is a question not for the
court, but for the expert to answer.
The same dotrine 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, assailed the superintendents of asylums, who knew all that
was known on the subjed, and to whom the world owes
an incalculable debt, as visionary theorists and sentimental
philosophers, attempting to overturn settled principles of
law; whereas, in fa&, the legal profession was invading the
province of medicine, and attempting to install old explodeo
medical theories in the place of faAs, established in the
progress of scientific knowledge."
In the same case, Chief Justice Perley instruted the
jury "that all symptoms and all tests of mental disease are
purely matters of fad to be determined by the jury."
In commenting upon these cases, Dr. Ray observes that
"against the course of these judges so strongly in harmony, as it is, with the established principles of law, it,
would be difficult to offer a satisfa6tory objedion. However necessary the present pradice may have been in former
times, when juries were ignorant of the little that was
known respeding 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 ad, etc.,
should merely dired them to acquit if they believe the
criminal ad to have been the offspring of disease, it can
scarcely be questioned that much disatissfadion would be
avoided, while the requirements of justice would be fully
answered. And this way of settling the question, obviates
the objedtion suggested by the principle-that insanity, of
whatever form or degree, does not absolve from the normal consequences of crime; because it will be observed,
the prisoner is acquitted, not for the reason that he is insane, but that the criminal a& 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 responsibility in mental disease, but to the expert alone will all
these look for those matters of faet which, considered and
duly weighed by the jury, are to acquit or convid the
prisoner at the bar. With such a responsibility resting
upon the medical profession, all will agree that more attention should be paid by them to the study of mental diseases, and to this end it is hoped, that this little work may
be of some dire& 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, welldigested, comprehensive knowledge of mental phenomena
in a sound as well as an unsound state.




1 nsanity.-Introduction.


0


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 expeced that
his testimony will be of value.
3. He should never, from a dread of being thought ignorant 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 expressed, 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 discredit 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 fa&s; such things, whatever
they might signify when viewed in connection with one
another, when singly considered, prove nothing respec'ing
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 obje& 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 people are more or less insane, or all crime madness. A dividing line cannot be drawn that will be appreciable in all
cases, so, for the individual case, science and experience
must decide.
o1. He should not judge of the credit of other witnesses, 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 witness will best consult his own reputation, and promote the
ends of justice by candidly stating the fat.
CHAPTER II.
PATHOLOGY.
Insanity, unquestionably arises from a morbid ation 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 manifestations, 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, charaterized 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 system. Receiving, as it does, from the sensitive columns of the
spinal chord, and from the higher nerves of sense, the various impressions there created, it collects, associates and
assimilates these impressions, and forthwith excites a corresponding 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
ad of consciousness, is utterly incomprehensible.
The ganglionic nerve cells of the brain are supposed to
be the centres of its funrtional adivity, as much as are the
ganglionic nerve cells of the motor system the centres of
its fundtional adtivity; and, if so, mind is simply a de



Pathology of Insanity.


7


veloped energy of nerve cell; but whatever be the real nature 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 relationship existing between the brain and other portions of the
nervous system, which indudively leads to the assumption
that the latter plays no small part in the creation of cerebral
manifestations, and that they hold within themselves, an important 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 homogenity 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 single nerve cell conneting two fibres, which serve as conductors, and giving rise to the simplest form of reflex ation*
As we go still higher in animal life, the more heterogenous 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 impressions 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 reaction.
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 impressions are passed from the sensory centres to the brain centres, 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 gradually enlarge backwards, and in the Ruminantia and Pachydermata 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 correspondingly 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, intelletually, 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 condition of an animal brain; and it is found in some cases, as
a matter of fa&, 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 fun&tions of nerve
cells, though to the eye, the latter often appear exadly
alike; and the microscope has established the fa& that there
are struEtural 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 physiological fats 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 satisfatorily answered from a metaphysical rather
than a physiological standpoint.  We can only look upon
intelligence and will, as the special fundtions of the
brain, just the same as transmission and reflex aftion are
the special funtions 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 aftion, either normal or diseased, and
the natural and acquired powers of the mental faculties
depend upon the proficiency of development and strutural 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
aftion is always the produdt of a diseased brain, but a diseased 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 fun&ion. The query for us,
then, is what character of cerebral disease do we find in
insanity?
To establish this fa& from a pathological standpoint, is
a matter of impossibility, as the charater of the anatomical changes to be found differ so widely from each other,
and are so thoroughly diffuse, that in this day, no anatamopathological basis for insanity can be afforded, as for other
cerebral affedtions. In fat, it is often impossible to discover after death, any organic lesions of the brain whatever, and this is the reason that some deny that insanity is
a material disease, and consider it to be an affeftion 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 atual disease in these cases is not questioned. Because no pathological changes are found, is no
sign that nerve element does not subserve mental funtion.
We know comparatively nothing of the intimate constitution of nerve element, for the reason that it has so far baffled human investigation, yet, because we do not see the
changes, we should not conclude that they have no existence.
Serious disintegration of nerve element may occur from
various causes, without any discoverable pathological
changes. For instance, as a result of excessive or prolonged mental exertion, the brain may become, for a time,
entirely incapacitated for further fundtion, but without
any visible transformation of nerve substance, though an
increase of phosphates in the urine testifies to its disintegration. 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 fa&s to prove that serious
changes of nerve element do take place without any cognizable evidence, further than the accompanying modifications of nerve energy.
However, disseftions are abundantly proving the fat
that deviations from the healthy stru&ure of the brain, are
found in insane subjects, and when we remember the limited 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, " becoming 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 a&s 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 investigation which we now possess, may justly be expeted, only
when the degeneration has been extreme or long continued."
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, strucural changes
are wanting, and should death occur from any cause whatever, even though the functions were seriously, perhaps fatally deranged, before the outset of the subsequent stages,
there could be found no pathological traces whatever.
This stage of irritation, should it effe& the physical forces
but little, as is usually the case, may endure for years sufficiently strong to excite a morbid mental aCtion, and still
death results before any strutural changes had occured.*
The more we come to know of insanity in all its relations, the more it is robbed of its metaphysical aspect, and
the more does it appear to us as a material disease, notwithstanding ignorance and superstition have ever succeeded in throwing around it an air of mystery. It observes the same pathological laws as other diseases, it follows the same course of incubation as other diseases,
* In the recent case of Joseph Waltz, described elsewhere, a postmortem examination revealed no cerebral lesion whatever, and the
learned dot6ors who assisted in procuring the verdift of guilty, felt
their opinions to be thoroughly vindicated. It is hoped that discoveries will hereafter be made, so that insanity may always be detetled
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 breaking out without any warning; its development presents
nothing strikingly peculiar, as it merges into its most dangerous form; neither does its termination in death or resolution, either suddenly or gradually, present any remarkable 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 orapyrexiae
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 possessed of a sound mind. It never arises from an immaterial or strikingly peculiar cause, but its etiology is analogous 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 evidence that insanity is a bodily disease, and in no way anomalous to established pathological principles.
PATHOLOGICAL CONDITIONS.
In briefly enumerating the results of pathological observations, it will be convenient to notice (I) those morbid
produEts such as tumors, abscesses, cysticerci, etc., and
(2) those dire& results of morbid adtion which are, microscopically or otherwise, discoverable in the stru&ture of the
supreme centres.
I. There can be no question but that such morbid produ&s as tumors, abscesses, etc., of the brain substance,
more often occur without any symptoms of mental disturbance, but such is the case only from the fa& that the
supreme nerve 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 aftion to the delicate




Insanlty.- Ciassifica lion.              2


25


out by the individual, although his intellect and his emotions 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 kleptomania, 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 disturbances, loss of volitional power or control, and delirium.
In the majority of cases, mania is preceded by symptoms
of other mental affefions, 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 matter 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 melancholic charader. 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
3




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 digestive functions become deranged; his kidneys do not adt
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 becomes 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 aggravation of the sexual desire. Soon the illusions and hallucinations are accepted as realities, and delusions exist. As
the mania becomes fully pronounced, the physical symptoms 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 adts of extreme violence. Even in this condition the patient exhibits the most surprising degree of
cunning in the planning and execution of his purposes,
which fadt is abundantly illustrated in the many cases reported 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 principally 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.


over the moral sentiments and a(ions, 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 advancing paralysis. This is first noticed in the indistin&i
articulation, from paralysis of the lips. The tongue is next
affe6ted, 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-ordination of movements, such as is necessary for writing, sewing, and like acquired automatic acts, is lost. As the
disease still advances, the articulation becomes less distina,
the walk more and more tottering, the knees fail, the patient frequently tumbles, and, finally, is unable to get lip at
all. The contraaibility of muscles for the ele(tric stimulus
is retained. At last, the primary automatic or reflex movements fail, the pupils become dilated, but unequal in size;
the sphin~ters 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 contraEtions of an arm or leg
occur sometimes, and a grinding of the teeth is not uncommon in the last stages of the disease. "-lMaasley.
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 distina
ameliorations and aggravations, the latter sometimes complicated 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 interest. Unlike other forms of mental affeftion, it selets




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 activity. Its duration is variable, lasting from a few months
to three or four years, or even longer; but whether progressing 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 development, 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 degrees, passing insensibly on the one hand into idiocy, on
the other hand into ordinary intelligence.
VIII. 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 suffered 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 extremest examples of dementia, in which mental power is
almost obliterated, at the other end, there are met with in
pra&ice, 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 a&s
of violence are liable to be committed.
CHAPTER IV.
DIAGNOSIS.
There is no class of diseases so various in their manifestations 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-obje&tive
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 diredtly palpable and physical
signs. For this reason, it becomes necessary to consider
all the accompanying circumstances, the hereditary predisposition, nervous constitution, cerebral injuries, dissipation, hysteria, chorea, etc., as predisposing causes, and
disappointments, fright, intense excitement, and acute diseases, as most frequent exciting causes. In this regard,




30


Insanity.-Diagnosis.


it is often difficult to determine whether the morbid mental condition is the dire&Et result of a diseased brain, or
whether it is but the natural result of the existing predisposition. Dissipation may result in a morbid, demoralized
mental condition, manifesting itself through immoral conduct, obscene language, blunted feelings and degraded
desires.  Sadness and depression of the mind may be
the natural result of natural causes.  Family bereavement, business losses, or indigestion, are sufficient to produce such conditions, yet, upon the removal of the existing cause, a reaction takes place, and the mind is normal. The continued presence of this predisposing cause,
whatever it may be, may finally, through the continued irritation of the fundions 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
unsatisfadory. It is only by a pradical 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 expeted 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 affeftion,
may cause the members of the tainted family to systematically deceive, and to positively deny the slightest hereditary 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 information of the family is not considered reliable, the physician should not hesitate to inquire prudently and cautiously of.the neighbors and acquaintances of the family,
in order to become thoroughly satisfied as to the hereditary predisposition and previous attacks, which are two
most important diagnostic points.
The hereditary transmission of all forms of nervous disease, 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 influence 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 insanity 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 hereditary predisposition.
The hereditary predisposition to insanity varies in its
modifications. Some children of insane parents bear continually 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 untouched, but still leave to their progeny the decided mark
of mental disease. The importance of hereditary transmission 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 epilepsy, 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




Insanit'y. -Diagnosis.


motor nerve centres, giving an entirely new train of symptoms. 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
pradically places it within the reach of scientific investigation 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 respefting the habits, chara~ter and
disposition of the patient. Many persons in good health
are remarkable for peculiarities and idiosyncrasies of
thought and aftion, 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 connedfion between insanity and eccentricity. It has been
observed, that in families where one or more of its members were insane, others of the family have been eccentric,
and further, that eccentricity often culminates in insanity.
Persons who are only insane on certain subje~ts, so-called
monomaniacs, are often eccentric in their whole condu6l,
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 previously remarked, search should be made for any predisposing causes that might operate in a natural way to
produce these changes. They are but a lack of control
over the affective and intelle&tual 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 subje&t of disease or
of natural causes.
It is necessary to conduct the personal examination of
the patient with the greatest ta& 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 symptoms 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 (amily, 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 goodwill of the patient, if he will only employ that sympathy
and tad 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 observations of the expression, demeanor, etc., but should as



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 indifferently conversing on the most foreign topics, the observing physician may study the physiognomy and gestures of
the patient, and find in them much valuable aid; the eccentricity 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 established rules or symptoms can be given. Each individual case must be studied by itself, and nothing but
experience and a thorough comprehension of the peculiarities 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 exercise, diet and study. Thousands of delusions are entertained 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 especially 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 emotions towards those who ought to be dear to him. The
subjeEt 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 conduc."-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 difficulty will be found in those cases where an impostor attempts to simulate it, or a drunkard actually does do so.
" Certainly he must be a clever impostor," observes Maudsley, " 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, however
skillful an actor, pass days without sleep, and even weeks
with only a few hours' sleep, maintaining a continual activity, 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 agitation, 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. Thinking 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 a&t
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 especially 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 observation may be necessary to come to a decision. When a
man feigns madness so perfe~tly as to deceive an experienced observer, we may hold, I think, that he is not far
from being the charader 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 dete~ted by the
smell of the breath, the imperfe&t utterances at the outset,
and the rapidly ensuing drowsiness and sleep. " Delirium
tremens will be distinguished by its own chara~teristic
symptoms-the muscular tremors, the peculiar fearful illusions 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 sometimes the occasion of great injustice being done by our
legal tribunals. Certain persons who have a strong predisposition to insanity, or who have been once insane, or
who have had a severe injury of the head at some time, do
a~tually become truly maniacal for a while after an alcoholic
debauch, or are rendered temporarily maniacal-being probably thought drunk-by a very little liquor. In this condition, 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 adt."-Maudsley.
CHAPTER V.
CRIMINAL RESPONSIBILITY OF THE INSANE.
Throughout the whole system of man there is an intimate 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 fun~lions 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 intellea and reason, and placing
him in the highest scale of animal creation, is destitute of
many of those instinaive faculties which belong to the
lower animal creation. The new-born animal, instinftively
knows where to seek its nourishment, and while the helpless 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 becoming 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 succeeding 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,
4




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 manifest itself in congenital deformity, scrofula or neurosis,
but which, in every case, leaves the impress of a low physical and mental capacity upon the physiognomy, constituting a family likeness by which they are distinctively
marked off from the balance of mankind.
With such, crime is the spontaneous outburst; the uncontrollable evil nature, over which presides an unsound
mind, and for that reason, comes within the range of diseased action, and is itself a neurosis closely allied to epilepsy. However, notwithstanding this diversity of mind,
the result of hereditary influence and education, the lawmakers 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 action, the uncultivated brain should not be subject to the
same criterion of responsibility as that of the more highly favored. So, too, are the cerebral functions, when undeveloped 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 thexworld 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 considerable 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 occupies 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 madness. 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, as well as of the theological notion that
vices and crimes are due to the instigation of the devil,
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 sentiments, and that a less hostile feeling towards them, derived 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 feelings 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.




40   Insanity.-Criminal Responsibility of Insane.
In fact, as we look back over the various and conflicting
tests of responsibility that have been conceived and abandoned during the past century, we cannotbut admitthat they
are all unreliable, and that a real and positive test of responsibility-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 decided in each individual case.
It is not a great while since every person was responsible 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 impulse, which the unfortunate convict had not the power
to resist, and for which he was not in the least morally responsible.
In the well-known case of Bellingham, the AttorneyGeneral 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 disposing 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 inentis, the law avoids his act, though it
cannot be traced or connected with the morbid imagination, which constitutes his disease, and which may be extremely 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 prepared to apply this rule, however well established, when
property only is concerned."
In a recent case (1860), Judge Bramwell in sentencing
the prisoner, said: "that you are of unsound mind I believe, but that is no reason why you should not be punished.... 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 displays 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 enjoys a more sound and vigorous exercise of its powers "
than when it is making a contract or will, where the conditions 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 circumstances, 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 perceptions 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 family 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 particular 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 capability of judging between right and wrong in the abstract,
without reference to the conditions present in the particular case has nothing whatever to do with the question of responsibility. There must be present a power to discern
correctly the good or bad intentions of others, and their
actual idenfity, as well as an entire freedom from delusions,
particularly those of a religious nature, which might produce 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 particular 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 disregarding 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 the plea of insanity, the House of
Lords, evidently sympathizing with an ignorant and dissatisfied 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 establishing 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 insane 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 under partial delusion only, and is not in other respects insane, 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 influence 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; ChiefJustice
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   Insaniiy.-Crimina/ Responsihility 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 acquittal of Oxford, who shot at the Queen because he supposed 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 ignorance 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 neighbor 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 reasonable too, if insane mzen would but listen to reason...
If he fancies there is a (lesign to take his life, he may
take life; if he fancies that he is only insulted or railed
at lhe may insult or rail in turn; if he fancies his neighbor
is defrauding him, lhe may say hard things about him,
(ta king 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 enveloped in the clouds of mental disorder, the law expects you
will move as discreetly and circumspectly as if the undimmed 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 Hampshire 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 committed the act, but he did not use sufficient reason in his
madness. He killed a man because, under an insane delusion, 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 disease 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 hereafter to strike with disease some human mind in such pe--
culiar mann~er 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 belief 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 psychological 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 incapable 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, intelligence, reason and will to enable him to distinguish between 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 impulses 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 detection, 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 American 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-ý
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 deprivation of the understanding is total, fixed and permanent, or
that he was laboring under adventitious insanity, and thatý
-during such frenzy there was total deprivation of understanding. 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 responsible for his act....     It has been said by some learned




48   Insanity.- Criminal Responsibility of Insane.
dloctors in the medical profession, that if the man has the least
taint of insanity entering into his mental structure, it discharges him from all responsibility to law. This is a monstrous doctrine, to which may be traced the fruitfulness ofcrime, and the immunity which have attended them in different parts of our country..........Did the
accused act in the matter from thought and design, and
understand right from wrong?  Did he, by seeking concealment 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 defense of insanity must fail to constitute any excuse for the
act of the accused."*
Should there be a single reason leading to the commismission of the crime, which is to our perception the offspring of insanity, even though to every appearance the
mind is otherwise sound, yet this single delusion, or whatever 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
di-sease, 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 problem. Homicidal mania is often manifested as the direct
result of a delusion, and in such cases, the unfortunate individual 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 holding the charge to be contrary to law.




Insanity.- Criminal Responsibility of Insane.  49
ist, or if existing, it is not inuch manifest, and has not
to all external appearances influenced the act, then it is
held that he should be responsible. Even further does socalled 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 remarks, that " not half the insane acts of a person laboring
under general mania, are really the offspring of his delusions; 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 sping 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 character 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 person 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 insane ourselves; for in this way only could we understand
and appreciate its insane reasonings. " The delusion is




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 melancholic 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 overwhelmed by fear and distress; sleepless and dejected, and
filled with anxiety and despair in regard to health or business, the mental pain finally rises into a terrible and overwhelming 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 delusions of this kind are present, but are cunningly concealed by him, so that he may the better engage an opportunity 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 consummates. 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 revenge 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 measure in it the exact relations of health and disease, or discover the real intensity of morbid impulse, and the exact
power of resistance, but admitting in some a limited responsibility, 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 diseased 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 between 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 insanity, 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-stealing, murdered his keeper under circumstances of great
brutality, and yet with so much -ingenuity as to elude suspicions 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; hie 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 appearpearance of his being there himself traversed in his assumed garb the corridor with an unconcerned air,
addressed an apparently careless question to the gatekeeper, 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 authorities, 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 confinement,, 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




]nsniy.CrmialReponsibility of Insane.  53
under circumstances which he detailed with great minuteness 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 wvindow.
Here was not only a sense of guilt, but a keen appreciation 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 sufficient 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 punishment for a homicide as would be awarded for a like
offense commnitted by a sane person." Certainly there
would be no more premeditation or ingenuity of execution here than were exhibited in the case of Billman,
whose insanity was never questioned.
The condition of the madman after committing a homicide is variable. Some seenm completely insensible of the
severity of the act, and do not realize in the least its criminal 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 character 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
6




54   Insanity.- Criminal Responsibility of Insane.
impulsive character of its paroxysms, becomes a most dangerous 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 neurotic 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 perception, and his ready tact in solving the intricate problems
of business, and yet, either suddenly or gradually, the mental derangrement may become manifest, the homicidal impulse may develop, swallowing up all reflection and wvill,
and soon, without warning, the unfortunate individual
stands before the world a homicide. To establish his insanity becomes a most difficult task, the previous workings
of the mind havingr been entirely unknown, and disease
not in the least suspected.
In those cases where there has been a previous homicidal impulse, wvhere 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 reason 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 impulse. There may be impulses to steal; to break windows; to tear clothes; to swear, and do other acts of violence; 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 perp~etrator'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 movements, 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, thotigh
within his consciousness."
Numerous cases exemplifying this form of mental disease, 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,
"twho 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 desponding, and having attempted suicide; his brother wvas of weak
intellect, silly and peculiar. He, himself, was of low mental organization, and the person to whom he was apprenticed, 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 indentures 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 wvent 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 counsel 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 experience 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 consequences 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 necessary in order to deter others from doing murder out of a




Insanity.- Criminal Responsibility of Insane.  51
morbid desire to indulge in the gratification of being
hanged."
In this case, the individual's family history, his low mental or gai-.ization, 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 duringr 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, Newv Hampshire. On a fine afternoon, he took a walk outside the
town, when hie met some little girls playing in a field by
the roadside. One of them, a bright little girl, betwveen
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 wvhich 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.- Gririnal Responsibility of Insane.
proved in evidence, that he himself had been unlike other
people; that he had been prone to weep frequently without apparent reason; that he had exhibited singular caprices of conduct, and that it had been necessary at one
time to watch him, from fear that he might commit suicide. He was found guilty, condemned to death, and in
due course executed, all the newspapers heartily applauding. 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 insane 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 insisted 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 insane. The subject caused an animated and earnest discussion among the medical men and newspapers of the State,
the New York Tribune unhesitatingly declaring him insane, 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 murVery 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 inhuman 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 desire 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 confinement 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 enormities. 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, although 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   Insani/y.- Criminal Responsibility of Insane.
all events, the Newo 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 imipulses, 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 disease, 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,
seei'ng 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 assume 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."--
Ma zids/ley.
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 fac-.t for the
physician to determine, regardless of all set rules or socalled acts of responsibility.
In all cases where the intelligence is feeble, thougrh 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 neurosis 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 existing between the two forms of mental disease, it will not
be amiss to briefly treat of epilepsy under the head of epileptic 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 constitute 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 includes 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 evacuate the bladder or rectum, palpitation of the heart and
chilliness. As the attacks increase in number and se7




62


Epileptic Insanity.


verity, the patient's friends notice that previous to the
paroxysm for several days, he becomes morose and irritable; or, his mind becomes clouded and he forgets
everything and seems unusually confused and dull of comprehension. 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 occasion 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 addition to these symptoms, epileptic paroxysms are sometimes 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 remembered by the patient when the attack is over. After a
time, these prodromata become so well known to the sufferer 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 before stated, what is the lighter forms of epilepsy, the socalled petit mal, or as described by some authors, abortive
or incomplete epilepsy. The patient " utters a few unintelligible 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 happened 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 remembers nothing that has occurred, not even the words he
has said or the acts he has committed during the apparently 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 incoherently and acts strangely enough to indicate considerable 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 unsoundness for which he should not be held responsible.
While it might be difficult to explain from either a pathological or metaphysical stand point this anomalous condition, in which a person may be apparently living a natural
life, transacting business and performing acts in an apparently normal manner, and yet be in a measure unconscious
of 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 between 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 peevish; his intelligence becomes enfeebled, his memory impaired, 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 individual'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 characterized by vivid illusions, hallucinations, delusions and




.64


Epileptic Insanity.


furious delirium, but lacking in a great measure the incoherence 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 occurred.
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 usually occur from time to time, during which, acts of extreme
violence are liable to be perpetrated.
Between each of these divisions there exists an intermediate 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 neurosis.
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 described 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 interests 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. Zacchias, 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 as far as it goes, it nevertheless 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 establish any satisfactory and just limit of responsibility whatever.
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 inanimate objects, being apparently in a state of unconscious



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 accompanied by a morose, surly, suspicious, jealous disposition of mind, full of unfounded fears, and quite often accompanied 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 arriving at correct conclusions concerning the individual's
mental condition; but to determine the exact mental condition of an epileptic at the moment of committing a criminal 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 previous 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 liberty, when committing the criminal act, would be strengthened if the paroxysms had been recentl, 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 circumstances 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 scrutinized, 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."-Rnay.
It has also been ascertained that the condition of irritability 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 occurring 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 epileptic paroxysm. Thus, in one case of epilepsy, complicated with mania, there were three kinds of symptoms at
different times: (I)-Epilepsy pure and simple; (2)-Epilepsy followed by violent delirium, chiefly of action, in
which the patient tumbled about on the ground in an extraordinary manner, with great rapidity, without speaking a
word; this condition, during which intelligence and sensibility 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 convulsions had occurred; for the instance may be one of masked
epilepsy."




68                Epileptic Insanity.
Reference *hq~s already been made to that anomalous.condition in which the epileptic may at times transact
business and perform acts automatically, being entirely unconscious 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 ordinarily attributed to epilepsy, the probabilities of its occurrence must be admitted, and the fact used to render us
still more cautious how we estimate the legal responsibility 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 medicolegal standpoint:
In 1867, a young man, named Winnemore, was convicted of killing a woman, Mrs. Magilton, in Philadelphia.
LHe was about twenty-seven years old, of a slim, spare
habit, with an intelligent, ingenuous expression of countenance, and without a single aspersion on his moral character. 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 Winnemore, 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 ordinary motives of crime. It did not appear that he had had
a fit shortly before or after, and he admitted that he experienced 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 commit crime while in an unconscious or deranged state of
mind.
On the whole it may be said, that, in any form of epilepsy, 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 absent, and unnecessary violence and ferocity used in execution, and especially when, in connection with these circumstances, 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.*
SSuch 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 premedi8




70


Treatment of the Insane.


However, the difficulty is usually in satisfactorily proving 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 punishments inflicted upon the insane, for the most trifling offenses, 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 civilized nation. How far such doctrines are due to the remains 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 made 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 insanity, as a bodily disease, cannot fail to do away with the
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 atr
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 horror and disgust, but in an enlightened country, where a
farce like process of law is used to gloss over the heathenism of the crime we see fit to call capital punishment, we
can look upon the execution of the insane without remorse, and read with satisfaction the applaudings of an
ignorant and sensational press.
That society should be protected, no one will for a moment question, and this is supposed to be accomplished:
(I) by punishing the offender to intimidate him from farther 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 necessary 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 insanity, even in his own mind, and, though he may witness the
execution of an insane person for murder, it would not




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 conduct, 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 penitentiaries, if they are so inclined. In fact, insane persons
should never be confined in ordinary prisons; not only because 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 under 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.


78


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 practice of the humane virtues better exhibited than in the improved 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 torment 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 partial 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 barbarity. The idea had so long been accepted, that, when
reason departs from its seat in the mind, it leaves the human 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.
encd to death. Another was to chain them in wells, into
which water was gradually admitted, subjecting the tormented 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, monomaniacal and melancholy patients were bound in a longitudinal position when the desire was to induce sleep, and,
in an erect position when intestinal action was requilred.
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 disappeared during the present century, and the management of
asylums, have, with a few noted exceptions, been conducted
according to comparatively humane and scientific principles. 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 attendants, 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 successful treatment of insanity: First, no restraint; second.,
open air; third, association with healthy minds. Neither
of these are attainable where hundreds-even thousandsof invalids are assembled under one roofi, 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 insane 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 occasions 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 inedical care is required in cases of chronic
insanity; and the surest way in which comfort can be administered 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 occupations 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 endless care is taken to secure gentle and judicious treatment
for every one. The individual requirements of the lunatic 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 supervision. 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 patients that is somewhat similar to that of Gheel. Harmless 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 English asylums.
Dr. Wynter, a recent and able writer upon this subject,
warmly advocates the adoption of this system of open air
treatment everywhere, 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 treatment, the one taking the place of the other, as circumstances 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 undoubtedly lies in the public ignorance, the unreasoning
fear, and the selfish avoidance of insanity. When knowledge 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 concealment 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 attention 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,... 8
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 insane,.....   36
Definition of insanity,... 6
Delirium,.....   20
Delusion,....  19
Delusion, as characteristic of intellectual insanity,...   21
Delusion, not always cause of insane acts,..... 49
Demented, responsibility of,.  60
Dementia,....  17, 28
Dementia of epilepsy,..    64
Diagnosis,..... 29
Doe, Justice, on tests of insanity,  2
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,.   35
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,. &
Hammond on emotional insanity,  23
Hammond on penitentiary asylums, 72
Hereditary  transmission  of insanity,..... 31
House of Lords, queries of,.  43
Ideational insanity,. 17
Idiots, responsibility of,.    60
Idiocy,.....  17,28
Illusion,.....   19
Imbecile, responsibility of,.. 60
Imbecility,.... 17, 28
Impulses, destructive, in epilepsy, 65
Impulses in insanity,..   54
Incoherence,... 20
Infirmary at Gheel, Belgium,.  75
Insanity a bodily disease,..  1
Intellectual insanity,..   21
Introduction,....  1
Irritability in epilepsy,..  66
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


(79)




80                               In
McNaughton, case of,.. 43
Melancholia,....   16
Mind, development of,... 37
Mind, effects of hereditary influences on,....   37
Mittermaier, case reported by,. 42
Monomania,...    17
Nervous system, development of, in
animals,...7
New restraint in treatment of insanity,.....   74
Open air treatment of insanity,. 75
Pathetic insanity,..   17
Pathological conditions,.. 12
Pathology of insanity,..   10
Penitentiary asylums,... 72
People vs. Montgomery, case of,. 69
People vs. Wright, case of,.   47
Perceptional insanity,... 20
Perley, Chief Justice, on tests of insanity,..... 3
Perley, Chief Justice, instructions
to jury,.....   46
Physiology of the brain,.. 6
Prodromata of epilepsy,..   61
Prodromata of mania,... 25
Protect'on of society,..   71
Punishment of the insane,.. 73


dex.
SRay, comments on decision of English Judges,.... 44
Ray, on pathological changes,.   10
Ray, on punishment of the insane, 72
Ray, on tests of insanity,..    3
Responsibility of the insane,. 36
Responsibility, tests of,..   40
Rules for experts,...  4
Schroeder van der Kolk, on pathological changes,...    13
Scotland, treatment of the    insane in,..... 76
State vs. Jones, case of,..    45
State vs. Pike, case of,..   3, 47
State vs. Wier, case of,..    46
Symptoms of epilepsy,.. 67


Tests of insanity,
Tests of responsibility,
Treatment of the insane,
Unconsciousness in epilepsy,
Volitional insanity,.


2. 40
70. 68
24


Waltz, Joseph, case of,... 58
Winnemore, case of,...    68
Wynter, on open air treatment,. 76
Zacchias, on epilepsy,..    65


ERRATA.
Page 11, line 17, for "outset," read "onset;" line 22, for "results," read
"result;" page 15, line 11, 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 58,
line 17, for "Hialcher," read "Hulcher;" page 59, line 16, for "persistence,"
read "penitence;" page 60, line 32, for "acts," read " tests."




APPENDIX.
The recent acquittal of Chas. K. Landis, on the plea of insanity,
for the murder of Uri Carruth at Vineland, N. J., March 19th, 1875,
has excited no little interest throughout the country, and has elicited
an almost unanimous condemnation from the public press. The case
is probably the most important, from a medico-legal standpoint, of
any that has ever occured in this country, and the author of this
work has thought it advisable to here give those facts which led to
the acquittal of the defendant on the ground of insanity.
From the evidence it appeared that for several years the deceased
had, with the most fiendish persistency, been assailing the defendant
in the columns of the paper of which he was editor. Not only were
the public acts of the latter criticised, but the privacy of his home
was invaded and foul slanders concerning himself and his family
were published in the most scornful and malignant language possible,
yet couched in such terms as to render no basis for a suit for libel,
and, therefore, no redress from the hands of the law. This continued until the morning of the shooting, when the last article from
Carruth's pen was placed in the defendant's hands by his wife, who
upbraided him as its cause. He seemed very much excited, ran
up stairs and seized a pistol, came hastily down and left the house,
proceeded at once to the office of Mr. Carruth and inquired if he
was in. He was answered in the negative and asked if he.wished to
see him, to which he replied "yes." An office boy was sent to look
for Carruth while Landis remained in the office. The boy returned
in a few minutes and said he could not find him, but was sent a
second time and in about five minutes returned in company with
Carruth. The latter entered the office and closed the door, but soon
hurriedly entered the composing room followed by Landis, who drew
a pistol and fired. He was heard to say, " I've killed him! "...I've
killed him! " " God forgive me! " " I was obliged to do it. I did it
in the cause of God and humanity. There lies the man that has
caused all the misery in my family. Oh! my poor, crazy wife!"
When arrested he made no resistance, but seemed wild and excited;
"his eyes appeared like a crazy man's."  While in prison he acted
and talked strangely and at times complained of snakes, rats, pigeons,
etc., being in his cell.
(81)




82                      A~ppendix.
In the course of the- evidence it was shown that the prisoner's
paternal grandfather had been insane from 1840 until the time of
his death, which occurred in 185o. That in 1861 the prisoner had
purchased a very large tract of land which he was colonizing, making an immense business and producing a severe mental strain on
his system; that in 1868 an unhappy marriage was formed, and domestic afflictions were added to his lot; that for several years there
had been a gradual change in his business habits; that a derangement of mind had been noticed by his friends as early as 1866; that
as early as t868 he entertained fears -of personal injury from unknown hands; insisted that he would be assassinated and employed
men to watch his house and protect him. An employee testified
that he first heard him speak of his fears of bodily harm being done
him in 1869," when he wanted me to stay in his house to prevent it;
stayed there four nights; he directed me to stay in the dining room
and at times to go out into the main hall; he told me to get a pistol
and keep it in my hand all the time; have stayed in his house at
number of times since; at one time, several years ago, be went over
the line of survey of Port Norris Railroad; he directed me to meet
him at Bridgeton, at 6 P. M.; he came in about io and seemed
much excited; inquired if I had the carriage and if I had any nails;*
directed me to get some nails, a hammer, a hatchet and also to borrow a lantern; did so; 'Started for Vineland, and he inquired about
what road I was to take; told him the 'Usual road; he would not go
that way and insisted on going by Millville; he remarked ' this is a
place, they may be waiting here for me;' made the remark again
before we got to Millville; he made same remark again; said 'they
are bound to kill me, anyhow.' After leaving Millville he would not
allow me to drive in the main road; insisted on going less frequented
roads, as they would not think of our going that way; when we
got home he said we were lucky in getting home alive; about five
years ago he showed me some photographs, which he said were of
persons who were going to assassinate him; saw him 17th of March
at his house; as I entered he started toward me, looked wildly at me
and said 'come this way, Ring;' we went into another room when
he closed the door and stared wildly around the room, and said they
were going to kill him and he didn't know what in the name of God
to do; I informed Mrs. Ryan, the cook, of his condition; told her
Mr. Landis was crazy and she must keep a watch, as I feared a
tragedy; saw him again at his house on the 18th of March, when he
seemed worse than before; said he hadn't slept any, and his head
hurt him so he didn't know how he was; said he was afraid they
were going to kill him; said he couildn't sleep or eat, and didn't
know what he-should do, as he was afraid of his life."




Appendix.


83


Other evidence of a similar character was offered, showing conclusively an unnatural condition of mind from 1868 up to the time
of his departure for Europe, in April, 1875.
An acquaintance met him in Liverpool, and testified to his peculiar
looks and actions, and his shabby appearance, being usually very
neat. On his return to America, in December, he acted and talked
strangely. Another employee testified that "before his going to
Europe his manner was uniform and kind toward me; on his return
noticed a decided change; there was a setness of features, and his
eyes did not seem natural; he was nervous and wild in his manner;
could not get any definite directions or answers from him; acted imperiously, as if I was his inferior; asked impertinent questions, etc.
would finish with a laugh; when thus excited, his appearance was
haggard; when quiet, he appeared careworn; at times would mutter
and swear to himself; at other times was overly kind to me; said I
knew him better than any one on his transcendental and aesthetic
side; would give orders and counter orders, thus retarding business;
after speaking of European art, said he would make the squares
glorious with statues; suddenly flew off and asked me, 'don't you
believe in elementary spirits?' he knew one of these elementary
spirits, it was neither that of a man, woman, or child, but of a mountain in the Tyrone; he had met it face to face, and made a compact
with it, which he should sacredly keep; arose and walked toward the
mantel, struck it and said: 'By the living God, we shall yet regenerate or redeem Vineland, and not only Vineland, but all humanity;'
his manner was very wild; talked incoherently about many things,
Napoleon, Gypsies, Greece, Art, Statues, etc.; during the talk I
feared he was getting into a raving fit of insanity."  Others testified
to similar talk and actions at various times. Dr. Lane, Mr. Landis'
family physician, testified to the change in him after his return from
Europe, particularly his incoherency in talk, and manner, and his
gloomy constitution; how he considered his wife insane, and could
not in any way be disabused of the delusion, though his wife was
perfectly sane; " he spoke very loud and was much excited; interview lasted two hours, during which he would speak on no other subject; his expression was one of despair; eyes red and wild in appearance; when he left he requested that I should come down in the
morning (the interview was in the night, Mr. Landis having called the
doctor up to talk on the subject) and see Mrs. Landis; complained of
not sleeping and of pain and flashes of light in his head; expressed
a fear to go home; also a fear that Mrs. Landis would kill the children; at that time (17th of March, 1875) and interview, I thought him
insane, and that reasoning was useless, and so stated to my family."
Other evidence of a similar nature was produced. A large num



84


Appendix.


ber of acquaintances, including several physicians, testified as to the
prisoner's strange looks, actions and talk, and to the fact that they
had, for some time before the tragedy, considered him crazy, and
some had so expressed themselves repeatedly.
Dr. Isaac Ray was called, as an expert, and after some general
testimony touching the nature of insanity, the defense asked: "If
the symptoms and indications testified to by witnesses are proved,
was the defendant, at the time he shot Carruth, insane?" This
question was objected to by the attorney general, who insisted that it
should be put in a hypothetical form, and the court so decided. The
defense then said: " Suppose the following statements to be true,"
and proceeded to state a number of suppositions, regarding the age,
physical form, temperament, etc., of the defendant, the mental conditions and habits of some of his ancestors; the amount of business
done by the defendant, etc., and to state in full the points of evidence
bearing on the insanity of the defendant, and asked: "Assuming
these facts to be true, was the defendant insane or not when he fired
this pistol?"
Dr. Ray answered: " I believe the statements made in the hypothetical question, taken as a whole, indicate insanity, and lead me
to the conclusion that the person therein concerned, Mr. Landis, on
the day when this homicide was committed, was insane; the symptoms stated, and my deductions from them, are not inconsistent
with his delivering occasional lectures, attending to business, etc."
Dr. Buttolph, of the N. J. State Lunatic Asylum, was called, as an
expert, and testified that he had " heard the hypothetical question,
and assuming the supposition to be true, I believe Landis was insane
at the time he shot Carruth."
In the course of his charge to the jury, Judge Reed advanced the
old idea " that a delusion in order to render a person irresponsible
for an act which would otherwise be criminal, must be a delusion,
that a state of facts exists, which, if really existing, would excuse the
act. If it were true that Mrs. Landis was insane, or that Mr. Landis
believed that she thought that he inspired the article in the Independent, which preceded the shooting, that fact would not have justified the shooting of Mr. Carruth. If it had been true that there
was a conspiracy to assassinate the defendant, it would not have
justified the killing, unless Carruth was one of the conspirators, and
it was believed that his death was essential to the preservation of the
defendant's life.... It must be such a delusion as would, if
true, have justified the shooting." The absurdity of this doctrine
has already been pointed out in this book, and needs no further comment. In conclusion, Judge Reed said: " Was the defendant at
the time of firing the shot, unconscious that he was doing an act




Appendix.


85


which he ought not to do? The defense must establish that fact by
a preponderance of testimony. If the evidence hangs evenly balanced, the presumption of sanity will prevail. But if there is a slight
preponderance in favor of insanity-such insanity as I have indicated-then, gentlemen, you should acquit."
While bloodthirsty newspapers are entering their protests in
"thunder tones," and condemning most vigorously the action of the
jury in bringing in a verdict of acquittal, a thoughtful and unbiased
mind, after carefully reviewing the testimony, can only wonder that
any other verdict could have been expected. With such an amount
of testimony pointing conclusively to mental derangement, followed
by the evidence of two of the most distinguished alienist physicians
our country affords, to the effect that they considered the defendant
insane at the time of the shooting, it became a matter of impossibility
for the jury to do otherwise than they did, without sacrificing their own
honor by disregarding the oath they had taken. True, the prosecution proved that the defendant had at times delivered able and connected lectures; had to some extent managed his business, and several persons testified that they had not considered him insane, all of
which amounted to nothing in the face of the positive, affirmative testimony of the defense. The jury have done their duty bravely, and
can well face the anathemas that are being hurled upon them. They
deserve the thanks of the American people for thus taking an advanced step in the cause of humanity, and establishing a precedent
in law that will ever be an honor to American courts.
It may be, and indeed has been, argued that because the state has
made no provision for the care of insane criminals, Mr. Landis
should have been convicted, in order to protect society from any future development of his insane propensities. Such a doctrine is
monstrous.  The important subject has already been sufficiently
discussed in the last chapter of this book, and we may only hope
that the sad case before us may be the means of teaching the authorities of our different states the necessity for providing for the care of
insane criminals, that they need neither to be executed in order to
protect society, or, on the other hand, " be acquitted one day on the
plea of being insane at the moment of committing a crime, and
discharged, the next, on the testimony of the same experts, that he
is now in his right mind."