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A MANUAL OF
MEDICAL JURISPRUDENCE,
WITH SPECIAL REFERENCE TO
DISEASES AND INJURIES OF THE
NERVOUS. SYSTEM.
BY
ALLAN McLANE HAMILTON, M. D.,
One of the Consulting Physicians to the Insane Asylums of New York
City, -€té.,. €bc.
WITH IELUSTRA TIONS.
BERMINGHAM & COMPANY,
20 KING WILLIAM ST., STRAND,
LONDON.
28 UNION SQUARE,
NEW YORK. i
1883.
$37 496
Copyright, 1883, by Bermincoam & Co,
WELLCOME INSTITUTE
ey
TO MY FATHER,
FHILIP HAMILTON, Fea,
WHOSE HONORABLE CAREER
AND UNBLEMISHED LIFE,
BRING TO HIM THE
REWARD OF
HAPPY OLD AGE,
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PREFACE.
This little book is presented as an elementary treatise,
and book of reference, for lawyers and doctors.
Its scope is limited, for I have considered only those
conditions of the nervous system which nowadays are so
often the bases of litigation; and as a guide in such cases
I trust it will prove useful.
43 East 33 St., N. Y., JuNE 15, 1883.
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CONTENTS.
CHAPTER I.
INSANITY.
CHAPTER: EH.
INSANITY IN ITS MEDICO-LEGAL RELATIONS,
CHAPTER 11h
HYSTEROID CONDITIONS AND FEIGNED DISEASES,
CHAPTER. 1V.
EPILEPSY.
CHAPTER. V.
ALCOHOLISM.
CHAPTER VI.
SUICIDE.
CHAPTER VII.
CRANIAL INJURIES,
CHAPTER VIII.
SPINAL INJURIES.
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INSANITY.
CHAPTER I.
GENERAL CONSIDERATION,
Definition.—No definition of Znsanzty exists that will stand
legal analysis, and it is exceedingly unwise in courts of law
to attempt to give one. It is a favorite method with lawyers
to make the medical witness commit himself in defining the
word, and then hopelessly entangle him in quibbles.
For practical purposes INSANITY may be said to be an im-
pairment of the mind, manifested by intellectual, moral and
emotional perversion, and due to physical changes of the brain,
other than those temporarily produced by intoxicants, or the
poison of fevers.
The two definitions that are the most satisfactory are those
of Bucknill and Maudsley.
The former defines insanity as “a disease of the brain (idio-
pathic or sympathetic) affecting the integrity of the mind,
whether marked by intellectual or emotional disorder.”
Maudsley’s definition is as follows:
“Insanity is, in fact, disorder of brain, producing disorder
of mind; or, to define its nature in greater detail, it is a disord-
er of the supreme nerve centers of the brain,—the special
organs of mind,—producing derangement of thought, feeling,
and action, together or separately, of such degree or kind as to
incapacitate the individual for the relations of life. Mind may
be defined physiologically as a general term, denoting the sum
total of those functions of the brain which are known as
thought, feeling, and will. By disorder of the mind is meant
disorder of these functions.”
It will be seen that Bucknill insists upon actual dsease of
the brain while Maudsley rather leans to the view that the
mind as a function is disordered, and he makes the distinction,
however, calling attention to the fact that numerous diseases
of the brain are not attended by zusanity, but are attended by
18 MEDICAL JURISPRUDENCE.
mental changes. I prefer the definition of Bucknill which
comes more directly tothe point, and until experimental psy-
chological-physiology and pathology enable us to localize the
supreme mental centers, we cannot be more exact.
Legal Definition.—Bucknill advises the medical witness
who is asked to define insanity, that he should, in addition to
the medical definition given above, add the words, “ that the
cerebro-mental disorder is such as to suspend or impair the
action of the healthy will.”
General Indications of Insanity.—The expressions of
insanity are of the most varied character, and in the examina-
tion of any particular case, it should be our aim to determine
the existence and meaning of any change in temper or habits,
and any unlooked for act whether the result of premeditation
or morbid impulse. There are also physical alterations, as
well as mental. Of course the evidences of such a departure
from the normal state as we are often called upon to explain,
vary with the forms of insanity, of which there are many.
The indications of a disordered mind are manifested in dis-
turbance of the emotions, the reasoning powers, the judgment,
the memory, and the will of the individual, and though various
types of insanity resemble each other, no two cases can be said
to be exactly alike. We should be on the alert to discover the
presence of delusions, hallucinations and illusions, the evidences
of impaired will power, the feebleness of the memory, and the
alteration of the moral nature of the patient.
Classifications of Insanity.—The following great divisions
of insanity may be made:
Idiocy.
Imbecility.
Mania,
Acute and Chronic.
Melancholia,
Dementia.—Primary and Secondary.
General Paresis of the the Insane,
DICKSON’S CLASSIFICATION,
One of the best classifications of Insanity is that of Dickson.*
* Medicine in Relation to Mind. n ara
GENERAL CONSIDERATION. ; 19
Variety I. Involving emotions;
delusion not necessarily obvious A. Excitation.
.s | but reasoning power impaired } B.Depression.
4 or overwhelmed.
=
A Variety II. Involving intellect; { 4 Excitation,
, 1 delusion essential, reasoning (Mania).
I + 2 | power not necessarily impaired |) B. Depression
res < | but judgment warped. (ALelanchoha)
a
5
oA
Variety III. Involving all the ( ,
assive state.
mental faculties ; delusion not 4 (Dementia)
| essential.
Sub-class § Congenital deficiency off Idiocy.
Amentia ( mental faculties, | Tinbeziy
There are various classifications which might be reproduced
in these pages if space would permit. Some of them deal with
the etiological factors. Those of Pritchard, Griesinger and
Maudsley divide mental disease into two classes, the Intellect-
ual and Emotional. The Germans, notably Krafft Ebing,
are fond of generalization, and we consequently find very
elaborate terminology. A favorite scheme in this country is
that of Ray which is the following:
RAY’S CLASSIFICATION.
{ Deficient devel- from congenital defect.
opment of the) 7,2. { from arrested development in infancy.
mental faculties ~ { from congenital defect.
from arrested development in infancy.
Mania of authors, ex-
citation of the faculties
( Intellect- ( General{ Melancholia or lype-
tecnait ual;main- mania of authors, de-
Y: Lesion of | Mania ly affect- ( Partial pression of faculties.
mental ing the
faculties. | (of Ray) < intellect.
subse M oral]; ( General ( Monomania of authors
quent to mainly Partial affection of the
their de- affecting ( Partial. ( faculties,
velop- | the will.
ment. Consecutive to mania or injuries of brain.
Dementia Senile, peculiar to old age.
20 MEDICAL JURISPRUDENCE.
Monomania, Moral and Partial Insanity.
There is scarcely a classification that does not include sub-
divisions of the above, and many of them embrace, like that of
Ray, Monomania, Moral and Partial Insanity. When it is re-
membered that in nearly all carefully studied cases of either
Melancholia or Mania, though there is a prevailing delusion,
there is as well a variety of others. The term J/onomania
is an impractical refinement. So too, oral Lnsanity I am
convinced should have no isolated place, for I do not be-
lieve that such a condition can exist without general intellectual
perversion, which latter, however, may be masked or obscured. It
is impossible to have insanity limited to one faculty of the mind
so I think the term partzal is a misnomer as well when applied
to a diseased mental state, and much confusion arises from con-
founding “ partial responsibility,” which may exist, with partial
insanity which I believe we haveno more right to consider than
“partial”? malaria or “ partial’’syphilis. These terms are only
relative at best, and are convenient but dangerous. It is uni-
versally conceded that there may be forms of general insanity
in which certain delusions predominate, or in which there may
be a conspicuous defect in the morals of the individual, but
this is all. Various convenient terms have been used to ex-
press the dominant character of the patient’s insane tendencies,
and these are valuable in a nosological sense. We find allu-
sion to homicidal manta, suicidal mania, erotomania, dipsomania,
kleptomania, pyromania, etc. So too, other varieties of insanity
derive their names from their causation or circumstances under
which they appear.
Somatic Classification.—Post Connubial, Puerperal, Cli-
macteric Insanity are applied to various conditions of sexual
development, excitement, or decay, as are Vymphomania, and
Satyriasts, and Masturbatic insanity. Toxtc, Diabetic, Metas-
tatic, Syphilitic, Epileptic, Phthisical, and Traumatic insanities
are varieties dependent upon poisoning, disease or injury,
while we speak of “Senile” dementia to qualify the condition,
by suggesting the question of age in regard to that particular
disease, or Pubescent insanity to indicate the fact that the
mental disease is connected with the general development of
change that occurs at adolescence.
The terms used by Skae * include many of the above as well as
* Journal of Mental Science, Oct., 1873.
GENERAL CONSIDERATION, 271
others having a pathological significance. He further divides
idiopathic insanity into sthenic and asthenic with regard to the
dynamic expression of the mental derangement. The true
division of the subject, however, should be a simple one, and
it is injudicious to specialize etiological conditions, which may,
after all, have the same method of expression.
The first three varieties of insanity to be considered are those
characterized by mental feebleness and include za@ocy, tmbectlity,
and dementia. The first is considered by some authors to be
congenital and acguired ; I think, however, the so-called acquired
idiocy should be defined as imbecility.
Idiocy, then, is a congenital condition manifested by imper-
fect development of both mind and body. The idiot is either
non compos, or his capacity is, as Pinel has observed, below that
of another person of his own age. In some cases the intelli-
gence is even upon a par with that of some of the lower
animals, and his mental expression is chiefly emotional. He
manifests feeble degrees of pleasure when he is shown bright
objects, and indulges in fitful and short-lived gusts of passion
without cause. He delights in rhythmical musical sounds, and
is fond of repeating one word over and over, or indulges in
automatic movements.
The instinct of the idiot is animal, and his habits are of the
most repulsive kind; without the restraint of judgment he
gratifies every appetite, howeverlow. In completely idiotic
persons there is no sign of recognition, no indication of mem-
ory, and the intellectual capacity is not to be compared to that
of some intelligent animals. Thereis the absence of the mental
apparatus, the absence probably of a sufficient number of sen-
sory cells and their connecting filaments, and the result is the
absence of mind. ;
Balfour Browne says: ‘“‘ Thus we see that an idiot is a person
so thoroughly without mind that all mental cultivation has been,
and is, out of the question. It is as difficult to make money
without some capital, either in money or the power to labor, as
to acquire knowledge without a brain. To distinguish idiocy
clearly from dementia with which it is sometimes confounded,
it must be remembered that the former is a congenital absence
or at least serious defect of all the faculties of mind, while de-
mentia may be regarded as the gradual obliteration of faculties
which have been possessed.”
There are idiots, however, in whom the imperfection of the
cerebral structures is not so extreme, and in whom the above-
22 MEDICAL JURISPRUDENCE,
mentioned condition of mind does not exist to so great a de-
gree. We find in every asylum many idiots who in some ways
manifest a partial brightness, if it may be so called, of a few
faculties. They are docile and tractable. It is possible to do
a great deal for them, and they may be taught much more
readily than the imbeciles whose weakness results from
disease. ‘The idiotic child may be sometimes taught to talk, to
read, and with great care and training by means of object teach-
ing and judicious discipline, he may be raised to a level much
above that he once occupied.
Head Configuration of Idiots.—Idiots often present
peculiar physical defects which are sometimes remarkable, and
this is especially the case in hereditary cases. The configur-
ation of the head is one of these, and Broca has described
several varieties, the most important of which is the microce-
phalous head. ‘The diminutive head may have a circumference
of but thirteen inches, and an exceedingly great facial angle.
Broca holds that the possessor of a skull with an antero-pos-
terior diameter of 148 millimeters is a mzcrocephaie.
Of the two principal varieties the dwarfed idiot, and the idiot
of ordinary height (des natns, et les invidus de taille ordinatre) the
latter are almost always deprived of the faculty of language—
sometimes they can pronounce a few words without any appre-
ciation of what they mean. ‘The cranium is larger than that of
the first variety, and may be 140-145 millimeters in length, and
may have a circumference of 420-425 millimeters, and a capa-
city of from 600-700 cubic centimeters.
The greater number of microcephalous aha are of the first
variety (dwarfs) and rarely grow taller than a boy of eight
years (Broca). Many always remain undeveloped; _ others
are taught to talk, and but few advance beyond the mental
status of a child of two years. The antero-posterior diameter
of the skull may be no more than over 10 to 13 centimeters, the
horizontal circumference may be from 32-37 centimeters, and the
capacity is always below 600, and may be no more than 3co0
cubic centimeters. Other idiotic heads are referred to by
Broca—the demi-microcephale. The scaphocephalous defor-
mity consists of an exaggeration of the vertical and longitudinal
diameters ; the Alagiocephalous or oblique-oval deformity, which
depends upon premature obliteration of one of the branches of
the coronal suture, and of the lambdoidal suture. In the platyce.
phalous deformity the sinciput is flattened and the vertical
diameter is diminished, In the acrocephalous head, on the
GENERAL CONSIDERATION. 23
contrary the sinciput is conical, and there is an increase in the
vertical diameter (Broca). Various other uncommon deformi-
ties are the result of premature closure of other sutures.
The association of atypical cranial with various bodily de-
formities should suggest idiocy rather than imbecility. This
is true especially in regard to the condition of the mouth. The
teeth of the idiot are apt to be irregular, double, or connected
with some imperfection of the hard palate, such as vaulting or
fissure ; or the alveolar process may be projecting.
The features of the idiot are coarse and his mouth is large.
His vision is defective and he is apt to suffer from disease not
only of the eyeball itself, but its muscles as well, so that there
may be atrophy of the disk, cataract, or strabismus, and there is
an inability to fix the eye upon small objects. The hair upon the
body of the idiot 1s sometimes coarse and plentiful, or on the
other hand is unusually fine and silky, though this latter condi-
tion of affairs is, I think, more marked in imbecility. Idiots are
slow and awkward in their movements, disinclined to work, and
the muscular system is weak. Cutaneous sensibility may be
either elevated or depressed ; in the latter case there is toler-
ance of external disagreeable irritation—flies crawling on the
skin or the bite of insects produce little discomfort. The gait
of the idiot is often waddling and unsteady, and his grasp
weak. His habits are untidy and sometimes disgusting. He
gorges himself with whatever may be placed before him, and
often carries in his mouth a bolus of food for hours at a time.
He voids his urine and feces wherever he may be, and very
often indulges in masturbation and objectionable amusements
of a vile character.
Idiocy is due much more often to the intemperance of the
progenitors than to any other cause. Of 359 idiots seen by
Dr. Howe, it was found that in gg cases the parents were con-
firmed drunkards. Consanguineous marriages are believed by
Maudsley to lead more often than is generally supposed to
degeneracy which is manifested in succeeding generations by
idiocy. How much syphilis predisposes to this condition it is
difficult to say. The longevity of idiots is short and they rarely
live beyond the age of thirty.
Cretinism.—A rare form of idiocy is known as Cretinism,
which was formerly supposed to be purely of limited endemic
origin, but such is not the case. The skin is infiltrated with
a mucoid substance giving the person a distorted, bloated
appearance. The thyroid gland is either enlarged or entirely
24 MEDICAL JURISPRUDENCE,
absent, the mouth is large, and the hands and fingers mis-
shapen and “clubbed.” The eyes are squinting, the com-
plexion pale and sallow, and the speech is thick or muffled.
There is usually sluggishness of movement and lowered surface
temperature. The mental condition is allied to that of idiocy.
Imbecility is distinguished from idiocy in the fact that it is
due to disease of the brain commencing usually shortly after
birth, that unlike idiocy, the bodily defects are asymmetrical
and the intellectual imperfections are rather different, the mind
of the imbecile being insusceptible to training except to a
limited degree.
The power of speech is not absent, so often as it is in the
idiot, and when speech disturbances exist they are usually
aphasic or ataxic.
The mental characteristics of the imbecile are manifested in
low mischievous cunning, bad temper, silliness and stupidity.
The condition is accompanied by epilepsy or paralysis. I do
not agree with Browne, who says that it is impossible to make
a distinction between idiocy and imbecility. There is in most
imbeciles some indication of the existence of mind, though its
manifestations are weak and distorted and almost blotted out.
Weak-Mindedness.—The degrees of imbecility vary greatly,
and at one end of the line we find the person of weak mind,
while successively we find the vicious imbecile, “the fool,’ the
eccentric individual whose eccentricity is diseased ; and various
other representations, until we reach the other end to find the
subject whose mental state is so low that he resembles the idiot
in the paucity of his intellect.
Congenital Viciousness.—Ogston speaks of another class
of persons who are undoubtedly imbecile.
“Short of this,” he says, “ we havea class of beings in whom
the mental deficiency is less apparent and less easily proved to
exist, and who are considered by medical authorities to be irre-
sponsible, though they frequently become objects of punish-
ment before the criminal tribunals. They are mostly found
amongst the lower classes of society, are capable of some easy
occupations, are looked upon as simpletons, and often as such
subjected to much annoyance. ‘They are often lazy and
drunken, are dextrous in thieving and are thought to be very
cunning. ‘They are sometimes violent and passionate, commit-
ting homicide or arson upon the least provocation. These,
too, have strong sexual propensities, are easily betrayed into
GENERAL CONSIDERATION, 25
otitrages on modesty. In such cases, though the medical man
may not discern that the individual is insane, he may perceive
that he is not quite right in his mind, for in most of these cases
there is something about the individual which makes him un-
like the generality of other people. There seems in all such
persons some want of intellect. They do not appear to possess
the same composure of mind as common people. They have a
great look of cunning, or of vacancy or unsettledness. They
will speak rationally and with consideration, but not with or-
dinary energy or depth of reflection, and consequently their
judgment appears to be impaired.” Many people of this class
have been sentenced to punishment, sometimes unjustly, per-
haps, but great care is necessary in pronouncing upon the re-
sponsibility of one of this kind. The nature of the crime
itself, and its motiveless or wanton character should be
considered in connection with the mental condition of the per-
son, and every care should be taken, for society needs protec-
tion as well as the criminal.
Many so-called cases of moral insanity are built upon the
foundation of congenital viciousness.
Dementia.— Dementia is a term used to define the con-
dition manifested by a decay of the mental powers. It is
always attended by an enfeeblement of intellect, and in
the latter stages there is a blotting out of every thing like
intelligence. We may consider it as a state commencing
in early life as the result of shock or disease; a conse-
quence of acute insanity—a result of coarse cerebral disease
or injury (commonly vascular plugging such as embolism)
or cerebral occlusion from vascular disease; or as a senile
condition connected with extensive and general arterial degen-
eration. The most striking symptom of dementia is the
weakness of memory, which deepens so that the individual is
practically shut out from the past and cannot remember what
he has heard, or what he has done a few, minutes before. In
cases of mania or melancholia the loss of memory marks
the transition into dementia. Dementia is always characterized
by an extreme weakness of mental action which gives his ex-
pression a feebleness which is manifested in wavering play of
worn out emotions, incoherence and half-formed and varying
delusions. His excitement is fitful and like the sputter of an
expiring candle flame, or the combustion of a dampened squib.
He is ill at rest, cannot concentrate his mind upon the subject
of the present and cannot connect his thoughts, and it is im-
20 MEDICAL JURISPRUDENCE.
possible for him to clearly recognize the relation of an idea
with others that have preceded it. As Browne says: “ Famil-
iar objects are not recognized ; places in which he has resided
are mistaken for other places ; times are forgotten ; the future
is not, the present is a haze, the past is dim. He cannot keep
these shades separate from one another. He confounds the
past of to-day with the past of yesterday.”
The delusions most characteristic of dementia are those of
suspicion. A dement before his mental condition reaches the
last stage is distrustful, doubting and full of fears. He may
believe he is beaten or maltreated, but his delusions are rarely
elaborate ; unlike the melancholiac he cannot go through with
the details of a gigantic conspiracy, for this would require
much greater mental strength. His hallucinations are com-
mon, and they are of the simplest kind, and usually so unreas-
onable as to attract the attention of the lay observer. In this
respect they resemble to some extent those of acute alcoholism,
except there is little of the personality of the latter.
The incoherence of dementia differs from that of mania in
the fact that in the former there is a paucity of ideas and the
patient becomes demoralized in his attempt to associate and
connect them. In mania the loquaciousness and incoherence
arise from the excitement and liveliness of mental action—the
ideas are formed much more rapidly than they can be expressed.
_ The dement shows his condition in the vacancy of facial ex-
pression the lack-lusterless eyes which are often suffused with
tears, and commonly he exerts himself but little.
Secondary Dementia follows organic diseases of the brain—
which may be slow in appearance. Such mental enfeeblement
may anticipate the conspicuous nervous lesion, the cerebral
hemorrhage, thrombosis or embolism and be manifested by loss
of memory, irritability or aphasia, or it may follow the accidents
I have mentioned. In the first case the arterial degeneration
is slow and the mental defects are sometimes unnoticed. A
case in which the question of testamentary capacity was con-
sidered lately came under my notice, the patient being an old
man who first manifested mental symptoms a week before an
attack of hemiplegia. Upon the day his mental disturbance
became conspicuous he made many blunders in his business,
such as paying his employees more than their wages, and not
knowing his mistakes until reminded ; making an important en-
gagement in the morning and not knowing any thing about it in
the afternoon, as well asa series of trifling neglects of various
kinds. <A week later he had an attack of hemiplegia, followed
GENERAL CONSIDERATION. 27
by two others and died in a month. His mind gradually be-
came weaker and weaker, his memory more feeble, and he died
in a condition of coma.
Other cases are less rapid and their course is marked by a
gradual exhibition of mental weakness which goes hand in
hand with physical decay. The dementia of syphilis is an ex-
ample of this kind—the stupidity, however, being more marked
than in other varieties. The syphilitic dement is apt to pre-
sent in addition to the loss of memory, which is quite marked,
and a tendency to somnolency, various symptoms indicative
of organic changes. Localized cranial nerve paralysis, optic
neuritis and convulsions are among them, or it sometimes hap-
pens that a rapidly developing dementia complicated at some
period by delusions of grandeur is presented, which at the
early stage may resemble general paresis. The mental enfee-
blement is earlier, however, than in the latter disease, and more
marked.
When dementia succeeds primary forms of insanity such as a
mania or melancholia it # secondary or consecutive. Maniaruns
much more frequently into dementia than does melancholia.
Bucknill and Tuke divide dementia into three forms, “Par-
tial or incipient,’ and “complete or confirmed,” and an intermediate
form.
“tst. Those who, whether previously well or insane, are grad-
ually passing into a decidedly demented condition. Some con-
fusion of thought, a perplexed rather than stupid expression,
and a failing memory, are the most obvious symptoms. Such
patients are not incoherent, or are only occasionally so. They
are sometimes conscious of their condition, and carefully avoid
committing themselves. They can read and write, but in regard
to the latter it will be found that after composing a few sentences
correctly, they express themselves confusedly and spell incor-
rectly. This is partial or incipient Dementia.
“od. Those who are so far advanced that they cannot tell
their names.—Many of this class are dirty in their habits.
Their time is mostly spent in listlessness or muttering to them-
selves, twirling their fingers about in all directions, now catch-
ing up something from the ground with which they play until
some fresh fancy seizes them, or scraping together bits of paper,
sticks, strings, stones, etc.; not with the constructive power of
the child, but purposelessly ; or if otherwise, only with the mis-
chievous propensity of the magpie. We then have complete or
confirmed Dementia.”
Senile Dementia is usually attended by physical debility as
28 MEDICAL JURISPRUDENCE.
well as mental failure which conspicuously betrays itself by
impairment of the memory and childishness. The senile
dement is apt to repeat himself, as the same worn-out story
is told over and over again, while petty incidents of former
life are constantly gone over, and in advanced stages the
individual is unable to recollect what he has said a few minutes
before, and is incoherent, and silly. He may, perhaps be
unable to remember the names of two children, but mixes
them up. He is ill tempered and petulant. There isa pitiful
lack of concentration which results in restlessness of mind and
body. Sleep is broken and in consequence he wanders about
the house at night, or out into the street in an aimless way,
where his peculiar behavior may lead perhaps to his arrest.
Incontinence of urine causes him to wet his clothing fre-
quently and he gives off an ammoniacal odor. The old man
undergoes a moral change as well as an intellectual, and he is
amatory, obscene, and fond of telling of the adventures of
his youth, and living over again its gallant frivolities. His
leer is lascivious, and he goes* about with unbuttoned
clothing, and is lost to all shame. He is extravagant and
prodigal, and buys useless things despite the remonstrances of
his friends.
The subjects of the disease are often elderly men who have
suddenly freed themselves from the cares of business. The
reaction which idleness entails intensifies the tendency to mental
enfeeblement and perversity.
The demented old man sinks into a condition of vegetative life.
The mental vacuity and helplessness is painful, and he
gradually sinks and dies finally of exhaustion. It is occasion-
ally found that just before death there may be a slight
evidence of intelligence, but this is by no means common.
Melancholia.—J/elancholia is an asthenic variety of insanity
of easy recognition and of variable form, and is much more
common among women thanmen. It may be acute orchronic,
and according toits grade has received avariety of names. The
French writers describe Zypemanie which corresponds more
closely to the simple melancholia of English writers, and a
severer form which is designated stupédité, which has its anal-
ogue in melancholia attonita. Still further subdivisions are
made with reference to the predominance of religious, erotic,
hypochondriacal or other prominent characteristics. Melan-
choha is characterized by a state of despondency and may be
defined as “‘a mental affection manifested by delirious ideas
GENERAL CONSIDERATION. 29
of a sad nature and by a depression that may amount to stupor
(Lutaud).”
The depression may be of a passive nature, with mental and
physical relaxation, and with utter dejection and hopelessness,
or there may be a more forcible expression of mental suffering,
with anxiety, despair, and muscular rigidity and some excite-
ment. As in mania there may be a great variety of insane
hallucinations and delusions expressed by the patient, but these
are mostly of an erotic or religious character, and there is in
nearly every case a history of persecution. ‘There is in the
beginning after a prodromal stage of bad health a change in the
patient’s habits and disposition. A naturally happy and joyous
person becomes sad, reserved, and takes little interest in her
surroundings. ‘There may be an oversensitiveness and a sense
of personal shortcomings, and a feeling of self-deprecia-
tion ; the patient is tortured by doubts regarding her religious
views and her fitness for association with others. She may
imagine that she has committed some unpardonable sin, or that
she is beyond help. She will not go to the communion table,
believing her presence there will pollute those whom she may
meet, and one who has led a blameless and pure life may con-
sider herself the lowest of women. In other cases the depress-
ion exists in regard to more worldly things. The merchant will
believe that he is bankrupt, that he is dishonest, or that he is
the special object of contempt among his business associates.
Very often melancholia arises from a belief that the individual
isin a hopeless state of bodily disease, and this form of trouble
may follow simple hypochondriasis. Delusions of persecution
are exceedingly common, and in fact I know of no well marked
case where they have not existed at some time or other. Under
the influence of hallucinations or delusions the melancholic
patient may and often does resort to suicidal and homicidal
violence, but more often the former, and such demonstrations
are as arule unlooked for. Under the sway of delusions of
persecution the melancholiac may attack imaginary enemies and
at this stage of the disease should be carefully watched, for
these acts are commonly impulsive, and though in the begin-
ning she may describe her feelings and promptings and no at-
tention may be paid to them, she may tothe astonishment of all
commit some horrible-crime.
The disease rarely exists in an uncomplicated form, but is
associated with excitement and may alternate with attacks of
mania. Dickson very properly suggests that we should be very
careful in our investigation of these cases, as they may be the
30 MEDICAL JURISPRUDENCE,
basis of subsequent legal complications. The melancholic
patient pays very little attention to her bodily wants, if the
disease be at all well marked. May refuse food, either as the re-_
sult of a delusion perhaps that she is being poisoned or that she
can live without it, or on the other hand from entire disregard
of life and its duties, and it may be necessary to use forcible
measures to compel her to take nourishment. She becomes
dirty in her habits, soiling her clothes and paying little atten-
tion to the appearance she presents. With disordered hair and
averted eyes the melancholiac sits by herself lost in her
own reflections, although there are some who are communica-
tive and loquacious. Physically the patient reflects her mental
disturbance and in the facial expression which is almost too
familiar to need description. Asa rule the physiognomy is of
asimple kind. The face is pinched and wan and unnaturally
pale, the eyelids droop, and the facial folds are dependent ; the
lips are bloodless, the pupils are dilated and every thing indi-
cates inaction. The hands are livid and hang idly, and the
maintainence of a fixed position sometimes for hours at a time is
characteristic of the intellectual torpor. The subject of
anxious melancholia is restless, the manner may be excited
and full of energy, and she betrays in her facial expression the
mental suffering incident to her torturing doubts and fears.
Simple Melancholia.—In medico-legal cases we are often
called upon to-distinguish between simple melancholia without
delusions and the more serious forms where there is much beside
the depression. In the latter, volitional control is often inter-
fered with or lost, and this may arise from the false belief in per-
secution, or some other such indication of intellectual perver-
sion. If crimes are committed as the result of simple melan-
cholia, suicide seems to be the most common, and this may be
due to utter dejection and hopelessness, and an unwarranted
belief that there can be no change for the better. In such
cases the most ordinary physical disturbance is exaggerated
into a incurable malady, and hypochondriasis is a complicated
condition.
Mania.—J/ania is a form of mental disease accompanied by
more or less excitement and is acute or chronic. Most authors
divide it into general, intellectual, and moral, and moral mania
is again divided into general and partial. The two important
divisions however are acute and chronic, and the other terms are
only convenient as fixing predominant features of an attack of
active insanity.
GENERAL CONSIDERATION, ea)
Mania begins by changes in the patient’s habits and disposi-
tion, and may at first be poorly marked, but afterwards mani-
fests itself in attacks of violence. The acute maniac isin a
constant state of restless activity which is expressed in sudden
and rapid muscular movements, and he undergoes great fatigue
without complaint. The eyes are bright and injected, the face
flushed, the hair bristling, the temperature heightened, and the
pulse smaller and rapid. The urine is scanty and loaded with
urates, and the tongue is glazed and red. Such a patient is
violent, destructive, and tears his clothing, or breaks articles of
furniture. He eats ravenously and is apt to help himself not only
from his own plate, but from the dishes upon the table. He
is voluble and usually incoherent and emotionally excited. In
some cases of mania as well as melancholia the derangement
“seems to be almost confined to the intellectual faculties and it
is this fact that has led to the adoption of the term Intellect-
ual Insanity. Ray and others believing that derangement may be
limited to one or more faculties, speak of partial moral mania
or monomania. Mania and melancholia are symptomatic condi-
tions after all, and may exist not only by themselves but as sec-
ondary or intercurrent complications of coarse brain disease or
even imbecility or idiocy. (Ogston). This irregularity and
inconsistency in the expression of insane symptoms have led to
the greatest difference of opinion. It should be borne in mind,
however, that an ordinary case of mania at different stages
may be designated not only as “ monomania,” but “ partial”
or “moral” insanity by those who look upon the case super-
ficially. The morbid moral changes are displayed in perversion
of natural feelings, appetites, habits and impulses. These may
be prominent, and for a time disconnected from any marked
hallucination or delusion. Then mania is manifested by cer-
tain forms of moral perversion and we apply a variety of terms.
Kleptomania.—X/eptomania for instance enters into the
history of certain cases of insanity, and consists of a propen-
sity for theft. In itself I do not think we are justified in con-
sidering this necessarily as insanity. It is only when useless
gew-gaws and trifles are stolen, that the matter should be
looked upon seriously. When the theft is connected with
secretiveness there is usually something wrong. I can recall
the case of a well-to-do lady who appropriated a_ great
number of trifles such as children’s small china dolls, pencils,
bits of worsted, and a variety of small objects which she filched
from the shops she visited. » When her insanity assumed a well
32 MEDICAL JURISPRUDENCE.
marked form and she was less careful, these objects were found
wrapped up in bits of rag and paper, and stowed away in all
sorts of out of the way places in magpie fashion. Klepto-
mania has been spoken of as a consequence of disor-
dered menstruation, as a phase of idiocy, as a feature of
the so-called lucid interval, and as of occurrence in mania.
It is not safe in courts of law to testify positively as to
the insane character of certain thefts, without we find there
have been some other manifestations, for the morbid propensity
to steal cannot be looked upon as an isolated symptom.
Pyromania.—Pyromania or the mania for burning is
another form of moral perversion occurring in connection
with mania. I have found it to be a feature of certain varieties
of epileptic insanity occurring with mental weakness. ‘There
is a boy at the Hospital for epileptics and paralytics who has
repeatedly attempted to set fire to the wooden pavilion where
he and his fellow patients are kept. Under the influence of
delusions we sometimes find that mothers will attempt to burn
their children by setting fire to their clothing, or will commit
destructive acts with fire as the result of various promptings.
A well known instance of pyromania to be found in the
books is that of Martin who attempted to set fire to York Cathe-
dral.
It is rare for this tendency to be found alone and it is usually
connected with suicidal and homicidal impulses, and fire is
used for the destruction of the patient or his victim.
An interesting American case* in which pyromania was urged
as the defense, was that of Speir, who set fire to the Utica
asylum. He had been:committed to the asylum upon the or-
der of a judge, but discharged subsequently, it having been
doubtful whether he had ever been really insane. After his
discharge, 1t was found that the several acts of arson committed
were the result of personal pique and although of a vicious turn
he was not insane.
A case of a different kind is that of Nathaniel Greemont, of
Danbury, Connecticut,+ a young man of previous good charac-
ter who attempted to burn the whole village, but when he had
destroyed two barns was arrested after confession of his crime.
He claimed to have an accomplice, but this was subsequently
shown to be a delusion. It was shown that he was an epileptic
* American Fournal of Insanity, Vol. xv., No. ii, p. 200.
tIbid Vol. v., No. iii, p. 237:
GENERAL CONSIDERATION, 33
and that he presented physical peculiarities, his head being un-
usually small, in fact he presented the indication of epileptic
insanity. Throughout the trial he manifested great unconcern.
He was discharged the jury failing to agree upon a verdict.
“A young girl of less than fifteen, named Grabowska, afflicted
with nostalgia, twice set fire to the house, in order to quit her
masters. She declared that from the moment she entered their
service she was unceasingly possessed with the desire to burn
the place. It seemed to her that a specter continually before
her impelled her to the act. It was noticed that this girl for a
long time suffered from violent headache and that menstruation
was behindhand.” *
Dipsomania has been applied to the form of insanity
which is manifested by acraving for alcohol. In cases of
this kind the question whether the inordinate appetite for
drink is a result or a cause of the insanity is to be deter-
mined, and one of the most important and common ques-
tions that arise, especially in criminal trials, is whether a
specific act is the result of intoxication or whether it is
a genuine insane delusion. In a subsequent chapter I will
discuss the medico-legal relations of alcoholism, and it
only remains here to call attention to a sudden change of
habit which occurs in people who before were temperate and
useful members of society. It sometimes happens that an indi-
vidual who has borne an irreproachable character, the head of
a family or a church, will suddenly wth other changes develop
an inordinate craze for liquor. He will plunge into violent
excesses which will last for a time, and then he may suddenly
cease his orgies and for a considerable period lead a blameless
life until the next period when he repeats his excesses. Forms
of sudden moral change with mania or melancholia are always
grave and should be looked into.
When the dipsomaniac drinks he does so without any con-
sideration of conviviality ; he does not care for liquor during
the remission of his disease, and will not take it if placed be-
fore him or offered to him.
The female dipsomaniac is more apt to crave drink during
her menstrual periods, and the appetite may suddenly dis-
appear after the cessation of the particular period. When the
condition occurs after sunstroke or injuries to the head the
diagnosis from ordinary drunkenness may be made out.
Suicidal Mania is one of the most common forms of
* Forbes Winslow’s Fourna: of Psychological Fournal, Vol, xiv,
3
34 MEDICAL JURISPRUDENCE.
mental derangement in which the moral change is marked.
The existence of a dominant depressing delusion may con-
stantly suggest insanity, or there may be nothing of the
kind, there being only a constant impulse to commit
suicide for no reason whatever. In some of these cases
the intellectual aberration may be very slight, and no
indication of the patient’s real state of feeling is manifested.
A man apparently in the full possession of his faculties may
blow out his brains or jump into the river, and those left
behind are filled with wonderment and unable to account for
the motive. Some of the individuals whose impulse is not
strong enough to lead them to extreme measures are able, upon
recovery, to refer to the period when they purposely avoided
all agents with which they might make away with themselves,
and have spoken of their terrible temptations.
Forbes Winslow and others have referred to numerous cases
where the delusion has been that it was necessary to make
some such sacrifice to gain admission to heaven, or an insane
hallucination has been the basis of the mental state leading to.
the suicide. -
The question of suicide is often considered in relation to
life insurance policies. It cannot be denied that a perfectly
sane man may destroy himself for what he really believes to be:
a holy end, the prevention of suffering or to avert an impend-
ing calamity that will ruin his family, just as a soldier goes into
battle from patriotic motives, or a miner or sailor gives up his
life in a “forlorn hope.” It is well therefore to distinguish
whether the insured man is insane when he makes away with
himself or whether he dies by his own hands, that his family
shall receive the amount of his life insurance policy. The
method of suicide should be considered, his relation with his
family, change in his habits and way of business. Hereditary
taint is an important question, and Bucknill and Tuke refer to
the fact that many interesting cases are on record showing the
inherited tendency.
Falrét reports the case of a young woman who became
melancholic from the knowledge that an uncle had committed
suicide by his own hands, and under the delusion that her blood
was corrupted attempted the act of self-destruction. Winslow
refers to a case of the same kind: A few months ago I was
called to see a young lady whose two uncles had taken their
lives and whose father had made a similar attempt. She knew
nothing of all this, yet when laboring under melancholia made
desperate and repeated attempts to kill herself, and upon one
GENERAL CONSIDERATION. 35
occasion was found with her throat bared and a number of
knives and razors before her.
The sexual phase of insanity should always receive attention
while it occurs in connection with other phases of mental dis-
ease or asa symptom of hysteria, and the commission of an —
unnatural crime should always suggest a careful examination
of the patient’s antecedents and present condition.
Nymphomania and Satyriasis, the first being a disease of
females, the latter of males, are symptomatic conditions and are
connected with emotional excitement rather than intellectual
disturbance.
Homicidal Mania, which may occur in the course of any
form of insanity is sometimes a predominant feature of this
particular mental derangement, and is often concealed or
masked. For this reason many horrible crimes have been
committed by persons who had not been suspected of any
thing but slight derangement which did not call for their
confinement, or sometimes were not believed to be insane at
all. The recent case of Dobourque, the insane French-
man, who rushed through a crowded street stabbing right
and left with a pair of steel dividers, is a startling example.
He had been regarded only as a person of eccentric habits,
harmless for years, and wandered about without restraint ;
just as most of these cases are, he was seized with an impulse
which led to the death of two or more of the many unsus-
pecting women he struck.
I am not disposed to grant that in such cases this is simply a
perversion of the moral faculties while the intellectual are in a
normal condition. In the majority of cases the development
of the murderous tendency, and the intellectual derangement
is slow, and not the flash from a clear sky. A long course
of symptoms indicative of cerebral disturbance, are displayed in
various little changes in temper, and in the fact the sub-
jects are persons, (usually women) who are or have been hys-
terical, hypochondriacal, or unbalanced so far as their emotions
are concerned. Epileptics are very apt to have such impulses
and Ogston refers to its origin as the result often of a peculiar
condition connected with pubescence in many people of bad
temper with poor digestion. Ina case of hysterical insanity I
recently committed no one supposed the young girl to be more
than engaged with her own ailments, and it was hinted that her
incarceration was a great wrong. She was found a few days
before leaving home to have a rope concealed beneath her
36 MEDICAL JURISPRUDENCE.
night dress, and she several times alluded to the possibility of
the nurse to whom she was devotedly attached, being found
dead in the morning. “ How strange it would be,” said she to
her attendant, “if you were choked to death during the night
and found dead in your bed in the morning.” When she
parted with this woman at the asylum she buried her fingers in
her throat, meanwhile kissing her affectionately. Such morbid
impulses are characteristic of these forms of irregular mental
trouble.
Persistence of Suicidal Attempts.—The persistence in
the suicidal attempt is sometimes remarkable. I have lately
seen a woman whose insanity was of an hysterical char-
acter and her jealousy of her husband was something
remarkable. Not only did she for years dog and follow him
about, but she would not allow him out of her sight except in
company of two of their children. She insisted upon sewing up
his underclothing with many colored silks, so that he should be
prevented from opening them and prove unfaithful to her
without being detected. The development of mania with
moral perversion was marked, she was excited, cursed, and used
obscene language, and finally became suicidal. Three separate
attempts were made in one day—at one time she rushed to the
window and tried to throw herself out; the second attempt
was made to sever her wrist with a knife, which was too dull,;
however ; in the third she placed her head in an open grate
and was severely burned. She could assign no motive for the
act.
Homicide as the Result of Hallucination.— Homici-
dal mania may lead to the commission of an act of violence as a
direct result of hallucination or insane delusions, such halluci-
nations or delusions being either a primary element in the sugges-
tion of the act, or a result of the diseased propensity. Bucknill
and Tuke direct especial attention to the fact that the morbid
moral tendency is as important in coloring the hallucination
as the actual intellectual suggestion. In other words a person
may kill another because he delusively believes that the other
intends his destruction, or he may kill him simply because his
morbid propensities impel him to kill some one for no reason
whatever except it perhaps may be the pleasure of seeing blood,
or executing his fell purpose. A case of the latter kind is that
of Jesse Pomeroy, the Massachusetts boy-murderer, who tor-
tured and murdered small children for the simple gratification
it gave him.
GENERAL CONSIDERATION. 37
Homicidal Mania with or without Delusions.—That
there is an underlying intellectual perversion even in these
cases I have no reason to doubt. For convenience we may
x pce homicidal insanity as follows :
. Cases in which the act is the result of an insane delusion.
2. Cases in which the act is apparently purposeless (so-called
moral insanity) and in which there is usually some emotional
excitement.
Bucknill and Tuke in an analysis of cases present 50 exam-
ples. These are divided into:
I. Without marked disorder of the intellect :
(z) Without premeditation or design, 31
(4) With premeditation or design, 4
gametes
II. Cases in which there was more or less disorder of
the intellect :
a) With deficiency of intellect, 5
6) With delusions, etc. 10
Total, 50
It would appear from this table that the prominence of gen-
eral intellectual disorder was not great, for the majority of
cases are of the impulsive variety—but these statistics refer
only to the nature of the act which may have been committed
at a stage when the presence of delusion or intellectual dis-
turbance was not pronounced.
Premeditation.—The insane often show great ingenuity
in the execution of their crimes. They are able to scheme
and plot and exercise an amount of reasoning power which
usually, however, arises from false premzses and eventuates in the
commission of an act which in no way helps the patient, and
which he would never do in health.
“A man aged 32, a laborer of no education, no religious
belief, of bad habits, became the subject of chronic mania
following prolonged ill-health; killed the adopted son of his
brother-in-law by repeated stabs with a pitch-fork and knife.
The murder was premeditated, well-arranged plans of conceal-
ment were laid and carried out, the instruments were carefully
washed, and the body buried underthe barn. His motives were
grounded in personal hatred and revenge. He had always
borne the reputation of being a bad man. The act was com-
mitted in the daytime. Demented, and after nineteen years
was removed to the County Asylum.”
38 | MEDICAL JURISPRUDENCE.
In this case there is just enough to create a doubt of his
insanity inthe lay mind. ‘The common idea that lunatics cannot
reason, and the prisoner’s previous bad character and revengful
motives were against him, but the subsequent termination of
his disease gives the case a different light. Many lunatics
commit acts, however, for which they are entirely responsible,
and while insane in other ways are perfectly capable of knowing
the difference between right and wrong, and Winslow refers
to a confirmed chronic maniac who was overheard to say: “If
I were to set fire to the asylum they would not punish me for
it, for I am insane.”
Cunning of the Insane.—A patient of my own had been
the subject of melancholy for some time, but no one suspected
any dangerous form of insanity. She managed, however, to
coax her sister into her room, and when there turned the key
and sprang upon her and would have killed herhad help not come.
Dr. Gray had under his care “an educated woman and mother
of a large family. Was of an amiable and gentle disposition,
but sank into melancholia at the climacteric period. There
was a strong hereditary taint inher family. One night she re-
quested to sleep at the front of the bed, which was permitted.
On retiring, she drew a small stand to the bedside, and when
she supposed her husband asleep, cautiously took a razor,
which she had concealed in a drawer of the stand, and drew it
across his throat. He, however, had not been asleep, and re-
sisted ; she then cut her own throat; she never spoke after-
ward, but continued very suicidal to the day of her death,
which occurred about six months after.”
I mention these cases to show how lay witnesses may be de-
ceived, and how easy it is for a person to derive a wrong idea
of a really serious case and perhaps so testify.
The persistence of certain lunatics in their homicidal at-
tempts even when every precaution 1s taken, is well illustrated in
the following case reported by Gray: ‘“‘ Man, aged 27, German,
member of Lutheran church, of good education, a musician by
profession ; was married to a lady of great personal beauty, his
superior physically, and to whom he had been long and tenderly
attached. Some months after marriage he made an attempt to
push her into the canal, and also into the river. After several
attempts of this kind, she demanded his reasons for such strange
conduct ; he burst at once intoa paroxysm of weeping, mingled
with the fondest expressions of endearment, and an obscure re-
ference to the bliss of heaven. She concluded that he was be-
GENERAL CONSIDERATION. 39
coming insane, and that, under some delusion, he desired to
kill her, and afterwards take his own life ; wishing to avoid the
shame and despair of such an exposure, she courageously deter-
mined to keep the secret, and rely upon her own strength and
presence of mind to prevent the accomplishment of his purpose.
He was paler than usual, and suffered from headache, but was
able to discharge his accustomed duties. He continued his at-
tempts, his wife searching him every night, often finding a brace
of pistols, a razor, a carving-knife, then locking the door and
securing the key. It occurred to her that traveling might
benefit him, and they accordingly started to visit some friends
at the West. On board the steamboat, crossing Lake Erie,
he was most persistent in his efforts to induce her to walk with
him on the upper deck, and did not cease begging to have her
do so until midnight, and then cried himself to sleep. Having
nothing to do, his attempts only increased in frequency. They
retired one night, after a most careful search, as usual; when
about half asleep she was aroused by feeling the edge of a razor
drawn across her throat. By combining great presence of mind
with all the strength she could summon, she escaped with an
extensive but fortunately superficial wound ; and to use her own
language, ‘thinking it about time,’ she brought him to the
Asylum. There, one of his first acts was to conceal a razor.
His disease was dementia. He soon recovered, and subse-
quently acknowledged that his sole and engrossing aim was to
kill his wife, and then himself, to secure the mutual enjoyment
of heavenly bliss; thinking, as he expressed it with eyes
dancing with delight, ‘if we were so happy, happy here, what
would it be in heaven!’ His object in concealing the razor
was to cut his wife’s throat the first time she should be per-
mitted to visit him, and then his own.”
Cases of homicidal insanity are mentioned, in which the mo-
tive given by the murderer is that the victim is to be spared
future torment and misery. In one case mentioned by
Winslow—that of Sarah Grant, who murdered her boy by
cutting off his head with a bill-hook and almost killed two
others in the same way,—the prisoner, when arrested, con-
fessed that she had done the deed because she believed that all
her children were going to hell. In this case, asin many others,
there is a suicidal tendency upon the part of the patient. I
have known of several such cases and in each case the horrible
nature of the act is increased by the fact that its execution is ac-
complished in the most cold-blooded and brutal manner.
Gray reports the following cases, which are of acommon type :
40 MEDICAL JURISPRUDENCE.
“Woman, aged 46, married, five children, temperate. Had
attack of melancholia, with depressing delusions. Said her
children would all get sick and die, and that all would die to-
gether within twenty-four hours. Soon after this seized one of
her children, a daughter, and attempted to cut her throat, was
prevented by others. Afterward she tried to dash her own
brains out against a stone wall. She had an appreciation of
her condition and gave her own history. She was discharged
after about nine months, in an improved condition,”
“Woman, aged 35, married, temperate. Had suffered from
melancholia for more than a year and was very much depressed,
said she was tired of life and did not wish to leave her boy be-
hind her. She attempted to kill him by cutting his throat,
wound severe but not dangerous, then tried to cut her own
throat, but desisted before she inflicted severe wounds. With-
in amonth was brought to the Asylum, where she recognized
her condition and said that at the time she was insane. She
was thin and anemic, but regained her health, and in a few
months was discharged RECOV creda
Reasoning Homicidal Insanity.—The reasoning power
of the insane is sometimes remarkable. The following case is
one in which a woman attempted a homicide after a process of
ratiocination having for its basis a delusion, and her motive be-
ing the desire to prove the truth of her original delusion :—
“A woman about thirty-six years of age, who had been well-
educated, but whose conduct had not been exempt from some
irregularities in consequence of intemperance and manifold dis-
appointments, became affected with madness.
“She was by turns furious and melancholic, and conceived
she had murdered one of her children, for which she ought to
suffer death. She detailed the manner in which she had
destroyed the child and the motives which actuated her so cir-
cumstantially and with so much plausibility and feeling, that if
it had not been known that her child was living, the physician
under whose care she was placed might have been deceived.
By her own hands she had repeatedly endeavored to terminate
her existence, but was prevented by constant vigilance and due
restraint. Her disposition to suicide was afterwards relinquished,
but she still insisted that for the murder of the child she ought
to suffer death and requested to be sent to Newgate in
order to be tried and undergo the sentence of the law ; indeed,
she appeared to derive consolation from the hope of becoming
a public example and expiating her supposed crime on the
GENERAL CONSIDERATION: Ai
scaffold. While in this state, and with a hope of convincing her
of its safety, the child was brought to visit her. When she be-
held it there was a temporary burst of maternal affection ;
she kissed it and for a few moments appeared to be delighted.
But a look of suspicion quickly succeeded, and this was
followed by a frown of indignation, which rendered the
removal of the child a measure of wholesome necessity. Per-
haps in no instance was the buoyancy of madness more con-
spicuous over reason, recollection, and feeling. She insisted
they had attempted to impose on her a strange child, which
bore a faint resemblance to her own; however, by such
subterfuges she was not to be deceived; she had strangled the
child until life had totally departed, and it was not in the order
of nature that it should exist again. The effect of this interview
was an exasperation of her disorder; she became more cun-
ning and malignant, and her desire for an ignominious death
was augmented. To render this more certain and accelerate
her projected happiness, she enticed into her apartment a young
female patient, to whom she appeared to be attached, and hav-
ing previously plaited some threads of her bed-quilt into a cord,
she fixed it round the neck of the young woman and proceeded
to strangle her. Fortunately some person entered the room and
unloosed the cord in time to save her. When this unhappy
maniac was questioned concerning the motive which induced
her to attempt the destruction of a person for whom she had
manifested kindness, she very calmly replied that as the mur-
der of her own child was disbelieved she wished to exhibit a
convincing proof of the ferocity of her nature, that she might
instantly be conveyed to Newgate and hanged, which she de-
sired as the greatest blessing. With considerable satisfaction
we may add that in a few months, notwithstanding her de-
rangement had been of three years’ duration, this woman per-
fectly recovered, and for a considerable time performed the
duties of an important and respectable office.”
Homicide Through Insane Inspiration.—The instances
when the individual commits a crime under the influence of an
insane inspiration are numerous. Dr. Gray reports the case
of a “ man, aged 65, married, two children, farmer, temperate ;
was a case of periodic mania, and had suffered from several
previous attacks. Had been insane a month prior to admission,
was talkative, incoherent and exalted in his delusions. At-
tempted to kill his son with an ax and a pitchfork, under the
delusion that he had received a divine commission to perform
42 MEDICAL JURISPRUDENCE.
the act. Son was wounded in the head. He continued in the
Asylum for some eight years, when he died suddenly, from heart
disease.”
A second case is that of. a “man, aged 31, married, two
children, cabinet maker, temperate. After becoming insane he
talked much upon the subject of spiritualism, developed de-
lusion that he was the medium of Jesus Christ, that he was
filled with the Holy Ghost, said there were five persons in the
town whom he was authorized to kill and bury, that he might
afterward raise them from the dead and make them better.
A few nights before he was sent to the Asylum, after retiring,
got up, told his wife he was going to get a hammer with which
to kill her, as one of the five persons. She escaped from the
window to a neighboring house, whence he followed her in a
state of great excitement, but was secured before inflicting
any Injury. He remained in the Asylum, some eight months
in a maniacal condition. Was noisy, destructive and violent,
and in this state broke out during the night and escaped.”
Distinction Between Acute and Chronic Mania.—
Acute mania is distinguished from chronic mania by the in-
coherence of ideas, by the excitement and violence. In the
confirmed disease the delirium is not so continuous.
Circular Insanity.—/ole circulaire (or folie a double
form) is a form of insanity characterized by alternating attacks
of mania and melancholia. It is most common among women,
and the prognosis is bad. It is to be recognized in the success-
ion of attacks separated by periods of comparative freedom
from mental disturbance. ‘The melancholia is variable in in-
tensity and is attended by great debility and emaciation. The
patients are irresolute, emotional and present delusions. The
mania is aptto be of a low grade and it may simply be a form
of excitement of a mild kind.
Delirium as distinguished from Mania.—The d-
lirtum of fever is often confounded with maniacal excitement.
Besides the history of the particular disease we find that the
mental excitement of delirium is disorderly and chaotic in the
extreme. There is arapid succession of expression in which
there isno consecutive character. ‘‘ Memories are confounded
with perception, and are often more real than sensory im-
pressions.” Reasoning power is lost. In mania the reverse is
the case for the individual reasons, though falsely ; and there
are times when the mental disturbance wanes and is broken by
GENERAL CONSIDERATION, 43
interruptions when the patient is more cognizant of his sur-
roundings. The age of the person and the association of
physical prostration are inseparable from delirium—we find no
such marked functional disturbance in mania—the departure
from ordinary bodily health being comparatively slight.
Crimes of the Puerperal Insane.—A form of mania
follows delivery in from a few days toa month or more, and
occurs most frequently before the lochia are stopped. It is
usually attended with the appearance of albumen in the urine,
with interruption or suppression of the secretion of milk, or
the subsequent stoppage of the lochial discharge. The patient
may either in the beginning be melancholiac or, on the other
hand, loquacious, laughing, and foul in her talk. She then has
delusions of a religious character, or believes she is persecuted ;
and there is incoherence perhaps if the excitement be sufficiently
acute. She seems to have aloss of memory of recent events,
may or may not correctly recognize persons about her, but
most frequently does, and she seems to pay very little attention
and evidently does not care much for her baby. During a
period of acute delirium, or more often at times when there is
an apparent lull in her mental condition and when it is sup-
posed that she is getting better, she may, when carelessly left
to herself, strangle or make away with her offspring. Puerperal
mania is often of such a masked character that the homicidal
acts are simply incredible, and in many instances there is acute
realization upon the part of the patient of the nature of the
crime and its consequences, but we will be convinced of the
irresponsibility of such a person by the motiveless method of
execution and the open way in which it is perpetrated.
Women suffering from puerperal mania are very apt to com-
mit the most unexpected crimes. Sometimes the acts of vio-
lence are entirely misunderstood by juries, and despite com-
petent medical testimony the patients are simply supposed
to destroy their children with the idea of ridding them-
selves of incumbrances; fortunately, however, the crimes
are so brutally executed, and often more than one person
is murdered, sothat no doubt can be raised as to the
real condition of the patient. Such a case is related by
Winslow. “A woman was delivered of a child on the tenth of
December, 1848. At the expiration of a week she was seized
with a violent attack of puerperal mania. Mr. Bell of Til-
stead, her medical attendant, gave instructions that she should
be carefully watched, and on no account have access to her
44 MEDICAL JURISPRUDENCE.
child. On the twenty-third of December, in the absence of
her attendant she persuaded her daughter to bring the infant
to her, and obtaining possession of a razor, she almost im-
mediately cut the child’s throat. The prisoner appeared quite
calm and collected after the occurrence and admitted that she had
destroyed the child, and that the crime was premeditated.” ‘This
case 1s but one of a large number. Crimes committed by the
puerperal woman are very often impulsive and may be preceded
by a state of torturing doubt, which the patient generally con-
ceals ; and we find in many women who perhaps do not go so
far as murder, a history of morbid impulses which they have
resisted for a long time. One of my patients felt a strong de-
sire to kill her child when it was placed in bed by her side,
and insisted that it should be taken out of the house during her
convalescence. Most authors insist that the presence of the
object is a strong incentive to the stimulation of the homicidal
instinct. We find that certain individuals are incited to suicide
by drowning when they hear the rushing of water, as was the
case In an example reported by Burroughs, and this same
theory applies to puerperal insanity, in fact, to many of the
other impulsive forms of mental derangement. A woman aged
about thirty-five who consulted Falret, declared that she had
sudden temptations when nursing her infant, to dash it to the
ground, trample on it and destroy it. She was also prompted to
destroy herself in different ways. When passing through a hall-
way she was prompted to dash her head against the wall, or if
she saw a knife on the table when carrying the child, it was as
much as she could do to restrain herself from seizing the
instrument and cutting its throat.
General Paresis of the Insane.—General Paresis of the
Insane is a disease in which conspicuous mental and physical
symptoms are presented. Beginning with shght alterations in
manner, which are often disregarded or mistaken, and by very
subtle physical changes, the affection very rapidly advances, so
that before many months there can be no doubt about the na-
ture of the affection. The disease nearly always follows dissi-
pation, remote syphilis or high living, and as a cause alcoholism
or syphilis play important parts—though undoubtedly in many
patients no such causes exist, and mental overwork is sufficient
to account for its genesis. In America, especially, we find
that the unreasonable haste to accumulate riches and the
overvaulting ambition to keep abreast with the more suc-
cessful, have had much to do with the development not
GENERAL CONSIDERATION. 45
only of nervous diseases in general, but general paresis in
particular.
Delusions of Grandeur.—The earliest mental change,
after carelessness in appearance and habits, is a boastful vanity,
—which renders the individual ridiculous—mere lying is followed
by the wildest Munchausen dvaggadocio, He will perhaps tell
you that he has horses which are faster than any in the world.
That his diamonds exceed in value the crown-jewels, or that he
has crossed the Atlantic several hundred times when he has per-
haps been only two orthree. Later on he grows more expansive.
No scheme is too great for him. One man told me that he had
hired Patti, Nillson, and all the great prima donnas, and had built
an opera house ten miles long ; another that he could speak all
the known languages including Arabic, Sanskrit, and the He-
brew although he was a printer with scarcely any education to
speak of. Many paretics believe themselves possessed of extra-
ordinary physical force and avow their power to lift the heaviest
weights and perform the most extraordinary feats. The grand
delusions of some take the form of sexual capacity, and it is
not rare to find them boasting of powers that excelled
those belonging to any of the personages of the Old Tes-
tament who possessed innumerable concubines. With this there
is foolish extravagance, and the purchase of useless things.
One man will contract for property for which he cannot pay,
or buy numberless pictures for which he has nouse. He will
order large quantities of jewelry or precious stones. He re-
sents interference and the counsel of friends with violence, and
plunges into the wildest excesses. He debauches himself and
consorts with prostitutes, and no form of bestiality satisfies his
desires At this time it will be noticed perhaps that his pupils
are unequally dilated, one being larger than the other (usually
the right)—or that they are contracted to the size of pin-heads.
His tongue when protruded trembles slightly, the tremor being
fine, and accompanied with sudden retraction of the whole
organ when the effort is continued to keep it protruded. As
the disease advances the lips in turn become tremulous, and
the corners of the mouth uneven. ‘The speech is clumsy, and
there is great difficulty in pronouncing the labials and lin-
gual consonants. The mental state keeps pace, and the delu-
sions are more marked—they are however occasionally con-
cealed, but this is rare. It is common to find fits of violence
from time to time, and in these the patient may be actually
dangerous. In some cases, and by no means a small number,
4b MEDICAL JURISPRUDENCE
there 1s an initial stage of melancholia, and I am convinced
that this is more marked in cases of general paresis following
alcoholism. Epileptic attacks, or attacks of hemiplegia often
occur during the course of the disease, but these latter are
indications probably of some organic disease which occasionally
accompanies the disease.
Periods of Remission.—A feature of general paresis are
the periods of remission, which may last several weeks, during
which the patient is apparently sane, but they never continue
for any great length of time, and the mental and physical
symptoms reappear with great violence. As the malady be-
comes established there are changes in the gait, which is titu-
bating and unsteady. The patient’s ocular condition may vary,
the pupils for a time becoming equal, and afterwards unequal
again. The temperature is elevated during the disease, more
particularly throughout the late stages, and generally after
periods of excitement or convulsions. ;
Dementia is the ending of general paresis, and an enfeeble-
ment of all the mental powers takes place. ‘The disease is re-
markably rapid in its downward progress. It commonly ends
fatally in three years, yet there are cases where it has lasted
eight or ten years, but these are by no means common. The
French authors are disposed to consider the average duration of
the disease to be less than two years, and some English writers
fix it at twenty-two months. ‘The duration of the remissions is
extremely variable. Baillarger has reported 19 cases in which
the period of the remission varied from one month to two
years. Le Grand du Saulle has presented 6 cases in which it
varied from ten months to two years. Dagonet believes that
during the remission there is a state of mental feebleness which
is incompatible with perfect responsibility.
The early stages of general paresis are sometimes likely to be
the subject of legal inquiry. - In the beginning of the disease
the individual’s extravagant plans are apt to be looked upon by
laymen as simply evidences of great business tact and energy,
and sympathetic juries do not take the trouble to ascertain
whether the expenditures are in keeping with the means of the
individual. So, too, during the lucid intervals of the disease,
legal steps may be taken which are not warranted by the his-
tory of the disease.
Disputed Cases of Paresis.—In many cases, and that of
Henry Prouse Cooper was an example, the question of alco-
holism arises. In this case, it was urged that his peculiar be-
GENERAL CONSIDERATION. 47
havior was simply the result of the immoderate use ot alcohol,
and it was attempted to show that some of his physical ex-
pressions were those of alcoholism. Nothing of the kind was
made out, and when we come to carefully compare the two
diseases, especially in regard to their stages, it is easy to make
a diagnosis. ‘The testamentary capacity of a person suffering
from general paralysis should always be doubted, especially
when the question of extraordinary or unjust bequests are made
under the influence of the extravagant delusion.
His early extravagance may lead to civil suits, and unsus-
pecting tradesmen are astonished to find that their liberal cus-
tomer is after all a lunatic. So too may his destructive
propensities get him into trouble. The interference of any one
who presumes to dispute the paretic’s right to do just as he
chooses, is very likely to be assaulted, but crimes of this kind
during the early stages of the disease are not common. In
certain’ irregular cases, however, the subject may, under delu-
sions, indulge in homicidal tendencies. The two following are
examples, and both patients were confined in the Utica
Asylum :
“Man, aged 56, married, five children, laborer. He had
borne the reputation of being an intemperate, vicious man,
and had spent the season in the County House; was arrested,
wandering about the streets in a drunken condition, and
placed in jail. Here he developed delusions, regarding
the chastity of his wife, became maniacal and violent in threats
and actions, and fractured the skull of his keeper by throwing
a heavy padlock at him. He was sent to the County Asylum
as an insane man, where he was violent in speech and action,
and made homicidal attacks upon his keeper; thence he was
committed to the Asylum at Utica. After admission said he
tried to kill the keeper because he was violating the chastity
of his wife, in an adjoining room. He soon developed delu-
sions of wealth and power, presented the marked physical
characteristics of paresis, gradually failed, and died in about
six months.”
“Man, aged 28, married, farmer, temperate. Patient was a
soldier in the late war, and while in the service, suffered from
rheumatism and chronic diarrhoea, and never regained former
good health. He read and studied the Bible a great deal, as
the embodiment of the higher law, and upon this study based
his claim to being an educated and superior lawyer. For three
or four years had entertained this delusion, and during this
time had neglected his legitimate work, claiming he was fully
48 MEDICAL JURISPRUDENCE.
engaged in legal business. He went about talking to people
of legal matters and serving papers upon various persons, of
an incoherent and peculiar character, much to their annoy-
ance. Was recognized by people generally as a lunatic. He
attended an auction, and having bid off some articles, gave
his note for them, which was worthless. The patient was
about to take possession of them, but being opposed by the
owner, attacked, choked, and upon his attempting to escape,
fired at him with a revolver. For this he was arrested, placed
in jail, where he was noisy and sleepless, and thence brought
to the Asylum, on a criminal order. He had exalted delusions
of his own power, asserted he had direct communication with
God, was noisy at night, talkative, and refused medicine, and
at times food. After about six months he was transferred to
the Asylum for Insane Criminals.”
Relations of Criminal Acts to Sleep.—aA_ peculiar
mental condition named by the Germans Schlaftrunkenhett, or
SLEEP DRUNKENNESS, leads sometimes to the commission of a
variety of acts for which the individual is usually clearly irre-
sponsible. Inthe hazy mental state between sleeping and
waking, there may be a veritable condition of somnambulism.
I have known of a gentleman who sometimes did the most pur-
poseless things immediately after being aroused. He wasaman
of most exemplary habits and refinement, and yet swore like a
trooper when suddenly awakened upon one occasion from a
sound sleep in a railroad car, when asked for his ticket. He
often struck his wife during the night under the impression that
she was a burglar with whom he was having a struggle for life.
Instances of homicidal violence are reported, and not only may
this question arise as a legal defense, as it did in the case
mentioned by Bucknill and Tuke, of the woman who threw
her child out of the window; but it may become a question
for divorce proceedings, or theft.
The medico-legal questions arising In connection with som-
nambulism are interesting, and it cannot be denied that the
somnambulist is irresponsible for actions which are the result
of unconscious cerebration. The courts all hold that when,
he does not preserve the rational use of his will, and is deprived
of the cognition of outward surroundings, he cannot be con-
victed.
In cases of homicide committed in the half somnolent
state, it is well to ascertain a// the facts in the case, for there
mav be in addition to the somnambulistic condition an element
GENERAL CONSIDERATION. 49
of actual insanity. Dr. Gray reports the following case, which
may be presented in illustration :
“Male, aged 29, a boatman, of intemperate habits, and of
insane parentage; had been in a melancholy state for some
months. His father went to his room one evening to ascertain
whether his son was at home. Havingno light, he repeated
his name several times. Patient, who was dozing upon his
bed, sprang up, thinking his father was shouting for help,
seized a club, and encountering him in the dark, killed him by
a single blow. Was demented when admitted to Asylum.
Discharged, recovered.”
Somnambulism and Epilepsy.—The complication of
epilepsy with somnambulism often exists, and the following
interesting case of murder committed by a young man, is re-
ported by Dr. Yellowlees :
‘ James Fraser was 28 years of age, married and had one child.
He was pale, dejected, hair black and always rigidly erect, gen-
eral health and habits good, and he was in regular employment.
Asa child he was rather dull and stupid, and his father always
thought there was a ‘kind of want about him;’ as a man his
intellect seemed below the average, but not so much so as to
attract attention, nor to prevent him from earning a livelihood.
His mother and maternal grandfather were subject to ‘ fits,’
and died in this condition; these were doubtless epileptic,
from the description. His maternal aunt and her son were
inmates of an asylum, and the child he killed had had convul-
sions about six months before this.
“He had always since a child been a somnambulist, and in
this condition had often had delusions that he was attacked
by some wild beast, or that the walls of the house were about
to fall in upon him ; and under such delusions would chase the
imaginary beast about the house, hurling chairs and tables at
it, with his eyes wide open, and avoiding any article of furniture
in his pursuit. Sometimes he would seize his companion by the
throat, thinking he was struggling with the beast, and afterwards
was quite unconscious of having assaulted any one. It was in
one of these attacks that he killed his child; he thought he
saw a wild beast fly up through the floor and pass toward the
back of the bed where the child lay ; he grasped at the beast,
trying to catch it; succeeded in seizing it, and springing out
of bed, dashed it on the floor or wall to destroy it. This
awakened his wife, who got out of bed and found that he had
killed the child, its skull being extensively fractured. He
4
50 MEDICAL JURISPRUDENCE,
then came to himself, and evinced the greatest remorse and
sorrow, ran for a doctor, and did all in his power for the child.
“Fraser was tried at the High Court of Justiciary in Edin-
burgh, on July r5th, 1878. On being asked to plead, he said :
‘I am guilty in my sleep, but not guilty in my senses.’
“The trial then proceeded, and a special defense was lodged
that at the time of the alleged crime the prisoner was asleep.
Several medical men were called who agreed in testifying
that when the fatal occurrenee took place, Fraser was under
the delusion that he was killing a wild beast, and was entirely
unconscious of the real nature of the act. They also agreed
in thinking that all somnambulists are not insane, and that
there is no recognized category of insanity under which som-
nambulism is included. :
“The important question was whether, in the wild paroxysms
which distinguished this extremely aggravated case, Fraser was
or was not technically legally insane, for had he been so found,
his committal to a criminal lunatic asylum would have been
inevitable, and this would have seemed a peculiarly hard fate
for a man whois sane except for a few minutes of unconscious
excitement recurring every two or three weeks. And on this
question the medical gentlemen differed. Therefore His
Lordship suggested to the jury the following verdict, which
was at once and unanimously accepted :
“ “That the jury find that the parent killed his child when he
was unconscious of the nature of the act which he committed
by reason of a condition arising from somnambulism; and
that the parent was not responsible.’
“Two days later Fraser was set at liberty, an undertaking
having been given by himself and his father that he would hence-
forth sleep in a separate room, apart from any other person.”
Many writers allude to the case of a man who awoke in
the night and saw a fearful specter. He called out “who is
that?” and receiving no answer raised his hatchet and
struck at the advancing phantom. It was found that he
had killed his wife. A case related in the British and
Foreign Medico-Chirurgical Review and referred to by Hood,
is that of a peddler who was in the habit of going about the
country with a sword stick. While asleep by the side of the
road one evening he was roughly shaken by some practical
jokers. The peddler suddenly awoke and seizing his cane
plunged it into the body of the nearest man. He was tried
for manslaughter and convicted, notwithstanding the testimony
of medical witnesses that his mental condition at the time
GENERAL CONSIDERATION, ; 51
was one of irresponsibility. It was adduced that the act
after all might have been due to passion. If there had been
no provocation such an explanation would have been ab-
surd, but as it was it must be said that it might have been an
element in the case.
Cases of suicide in the half somnolent state are occasionally
reported. An old lady awoke in the middle of the night, went
down stairs and threw herself into a cistern of water, where
she was found drowned. It was held that the suicide was the’
result of certain mental impressions conjured up in the mind
during a horrible dream.
Hereditary Infiuence.—The question of hereditary in-
fluence is often referred to in courts of law and much impor-
tance is attached to the admissions of the medical witnesses. It is
only in late years that evidence showing the existence of in-
sanity of the ancestors of an individual has been admitted.
The case of the Queen vs. Rose Touchett in 1844 was the first
case in which the decision of Chitty was reversed. Hereditary
tendencies are so important that in every case they should be
shown to exist if possible, but some caution isnecessary. Vague
history of mental disorder, such as eccentricity, is almost value-
less when it exists alone; but when it can be shown that the
parents of the alleged lunatic have been deranged the matter is
different. According to the experience the tendency to mental
disease is greater when insanity has existed in lineal ancestors.
The insanity of aunts and uncles or cousins has no such impor-
tance as the insanity of the grandfather or grandmother, the
mother or father, or the sister or brother. So, too, we should
take into consideration the date of the remote insanity, for that
occurring after the birth of the child does not necessarily show
that there is any reason to suppose it to be the subject of any
inherited tendency. An exception may be made, however,
in those forms of insanity which crop out late in life
in persons in whom the insane predisposition exists. Bail-
larger’s conclusions, referred to by Bucknill and Tuke,*
show that the insanity of the mother is far more serious
than that of the father as regards transmission, and _ so,
too, the transmission from the mother is more apt to
be shown in girls than boys, while the reverse is true regard-
ing the insanity of boys. Of course the existence of insanity
in several members of the same family is serious. In epileptic
insanity it may be found that the mother of the patient has
* Manual of Psychological Medicine, p. 63,
52 MEDICAL JURISPRUDENCE.
suffered from migraine or some other form of nervous disease,
and it will often be found that the existence of phthisis, as
shown by Anstie and others, 1s very apt to predispose to the
development of epilepsy in the following generation. Itisa
common thing to find organic nervous diseases occurring in the
parent after the birth of the alleged lunatic, brought for-
ward as an hereditary factor when it often has no connection
whatever with the possible mental disease. In the matter of
prognosis hereditary tendency is avery dangerous factor. The
prognosis of insanity is fairly good in acute forms—mania
better than melancholia, but with dementia, general paresis or in-
sanity, dependent upon organic diseases of the brain the case is
different. Recovery sometimes follows, even after insanity last-
ing a number of years, but this 1s rarely so ; or an acute disease
may break up the condition and turn its course. Prognosis 1s
better in young subjects than old. Epilepsy in complication
is a bad feature. Insanity, coming after the change of life, is
very apt to run into dementia.
Post Mortem Examination of the Insane.—In cases of
suspected insanity where during lifetime its existence has been
doubted, the matter is often settled by an examination after
death. As I have already said we cannot predict that distin-
guished cerebral disease always exists with insanity, thats, dis-
ease which gives rise to the insanity 5; on the other hand, it is
not uncommon for us to find very extensive and general gross
lesions producing no appreciable disturbance of intellect; so
in our limited state of knowledge it is not well to be too
positive.
We must consider in all cases the configuration of the brain,
its size, and the depth of the gray cortical substance, as well as
the signs of recent disease. If a small brain has an increased
specific gravity which is disproportionate with its size, we shall
probably find the existence of sclerosis and atrophy. It has
been found that the weight of the brain undergoes decided
modifications in connection with insanity, and Dr. Clapham of
the West Riding asylum, who has done so much in craniometry
presents an interesting table which includes 1200 cases of in-
sanity. It would appear, according to this, that the weight of
the brain is greater in the insane, between the ages of 40 and 50
in women, and between 50 and 60 in men, than at any other
time ; that in the male the brain weighs more proportionately
in idiocy than it does in the female; that the average weight
of the brain is greater in mania than ‘melancholia, and in other
GENERAL CONSIDERATION, 53
forms of acute insanity than in senile or organic dementia, im-
becility or general paresis.
Encephalon, Cerebellum,
Disease. (Grammes.) Pons and Medulla. Age.
Idiocy, 1148.947 156.7 21.94
Imbecility, 1285.009 174.6 36.2
Dementia (simple), 1310.956 169.7 49.132
Senile, 1278.382 163.8 64.843
Organic, 1291.949 170.5 53.810
Mania, Melancholia and acute forms, 1350.425 172.8 42.082
General Paralysis, £270_271 174.0 41.610
Epileptic Insanity, 1314.410 164.4 36.646
Chronic Mania, 1327.267 171.9 46.863
Brain Wasting, 1256.644 164.3 60.929
It is a popular but erroneous impression that the largest
brains belong to the possessors of the greatest intellect. This
is far from thetruth, and one of the largest upon record belonged
to an idiot. The left frontal lobe is, according to Broca,
heavier than the right, and Luys has found a difference in favor
of the former of from five to eight grammes.
The depth of the gray matter of the convolutions we are en-
abled to detect by means of an instrument invented by Dr.
Herbert Major. This consists of a glass tube finely graduated,
by which we may remove portions of the cortex of the brain by
thrusting the gauge into the particular convolution, the depth
of which we wish to determine, and removing a plug of white
and gray matter. It will be found in certain forms of insanity
that the depth of the gray matter has undergone material dimi-
nution ; and in certain cases, notably those where congenital
deficiency is suspected, we shall find that the proportion of the
white and gray substances is very much changed, the latter
being reduced. In measuring the depth of the gray substance
of the convolutions it will be found that it is reduced from
eight one-hundreths of an inch to six or seven one-hundredths.
Bucknill and Tuke prefer measurements made with a hair
divider, a variety of small compass, to the instrument invented
by Herbert Major.
Benedikt and other German writers place great reliance
upon peculiarities in the arrangements of the convolutions
and sulci in the brains of insane criminals. While I do
not believe that Benedikt’s ideas are always susceptible of
proof, it is still a noteworthy fact that in the brain of the con-
genital criminal there is great complexity and irregularity in
the arrangement of the convolutional folds, and fissures, In
his book upon the subject he presents a number of autopsies
54 MEDICAL JURISPRUDENCE.
Fig. x.
(Benedikt).
External fissural arrangement of a typical brain.
~ (For reference see American translation.)
“nm
Fig. 2.
(Benedikt). ;
External fissural arrangement of an atypical brain.
GENERAL CONSIDERATION. B55
the subjects of which were criminals, and in every instance
there were certain peculiarities which he has minutely detailed,
and these consisted not only in the excessive fissure develop-
ment, but in the repeated existence of asymmetries of the brain
and the skull itself. The parietal lobe was usually dwarfed, the
cerebellum was only partially covered by the occipital lobe, and
there was a deficiency in Wernicke’s fissure; the inter-parietal!
fissure communicated very frequently with the fissures of
Sylvius, and the parieto-occipital with the horizontal and inter-
parietal.
We are also to look for asymmetry of the two hemispheres,,
and for convolutional errors of development.
The brain in imbeciles and idiots presents malformations and’
arrestment of development which are very characteristic. These:
modifications take the form of atrophies of parts of, or groups of, .
convolutions of the cortex; and the partial atrophies are re--
vealed by a thinning of the folds, and by a corresponding en-.:
largement and depth of certain fissures. Theseare principally
in the frontal convolutions, which present irregularities of for- -
mation. Asymmetry is very noticeable in the brains of idiots, .
the two lobes presenting very often a want of correspondence
which is very decided. From a histological point of view we
find arrested development depending upon defects in the ap-
paratus of nourishment in the cortical substance.
Luys* has devoted much attention to the subject of the con-
volutional anatomy of the brain in the insane, who finds
that the fissure of Sylvius is usually enlarged, and extends
much further back than it does in the normal brain, ex-
posing the insula. The fissure of Rolando is very nearly
normal, but its continuity is interrupted by irregularities which
jut out from the marginal convolutions.
Luys has collected pathological data of great interest
which show that certain definite convolutional changes are to
be found in many cases of insanity. The most frequent,
according to him, are seen in the frontal convolutions which are
much more irregularly disposed in the right than in the left lobe,
The first frontal, especially, is very frequently atrophied and
diminished in breadth. Luys has found ina case with well
marked hallucinations that in the internal aspect of the cere-
bral hemisphere the paracental lobule jutted out, and the first
frontal was depressed, and the second frontal had undergone
at its anterior part decided irregularities. Hereits continuity was
* Traité clinique et Pratique des Maladies Mentales, 1881.
Roa MEDICAL JURISPRUDENCE.
——
broken up by a series of secondary multiple folds having a ver-
miform appearance and bridges over the superior frontal fissure
which was obliterated. In certain cases of chronic dementia the
second frontal convolution becomes almost rudimentary. The
third frontal convolution (the speech center) is rarely modified
except when there is aphasia. Luys has found in three deaf
mutes that it was atrophied upon the left side.
The ascending frontal convolution often presents change in
its length and continuity. At its union with the second frontal
we find numerous variations, and Luys has seen a change at
the origin of the third frontal. The ascending parietal is quite
rarely affected except in cases with paralytic symptoms. I saw
a case, the drawing of whose brain I present, who had in addi-
tion to chronic mania and dementia well marked paralysis and
contracture upon the opposite side of the body ; the insanity
began shortly before the paralysis and the secondary dementia
appeared very rapidly. Luys is of the opinion that the ascend-
Fig. 3.
A. Atrophy of ascending frontal and parietal convolutions.
ing frontal and parietal convolutions least often present patho-
logical changes. ‘The angular gyrus is sometimes affected, and
in cases with visual hallucinations it probably is frequently,
GENERAL CONSIDERATION, 57
The internal surface of the brain shows that the paracentral
lobule is often the seat of pathological changes, on one
side or both, and it is the opinion of Luys and other writers,
that in advanced cases of dementia both lobules will be affected.
In the insane it will be found, especially in forms of chronic
mania, or where there has been excitement, that the meninges
are thickened, hyperemic, or that there are collections of blood
known as hematome. The dura mater is often adherent to the
skull, and the other membranes show evidences of various
grades of inflammation, and it is difficult to remove the arach-
noid and pia mater without tearing away more or less of the
brain substance. There may be found lesions of the blood-
vessels, which vary from simple congestion to atheromatous de-
generation or permanent dilatation, and this is found either in
the substance of the meninges or in the brain itself.
The vascular condition is either one connected with hyper-
emia or anemia. Evidences of hyperemia are common in
disease attended with excitement such as mania or paresis. The
gray substance is darker and the white is more pink or yellow
than in health. Minute puncte vasculosa, extravasations or
local tracts of active congestion are found. In general paresis
Luys has found these spots of hyperemia more marked in the
frontal region, though in this disease it is common to find the
congestion very general. In melancholia we meet with a pale
condition of the tissues, with diminished vessels and perivascular
accumulation of fluid. The brain is blanched and soft. Terri-
tories of edematous brain are found in association with the
plugging up of small vessels by an embolus, or as the result of
thrombosis. Evidences of cerebral ischemia are important.
There may be bony plates in the dura mater which are very
common in chronic insanity, or adventitious substances scatter-
ed over the surface of the brain, both at the convexity and the
base.
The brain itself presents certain changes in the appearance
of its convolutions and deeper parts which are quite conspicu-
ous. We may find softening and sclerosis giving rise to atrophy
and depression, and changes of color which are always import-
ant and suggestive.
Solly, who first made extended examinations of the cortex in
insane patients, found a paleness of that portion of the brain,
particularly in cases of imbecility, and the white matter of the
brain assumed a “dirty brownish hue,” very faint but quite
distinct. ,
The lining membrane of the ventricles is often thickened, and
58 MEDICAL JURISPRUDENCE.
the seat of a granular change, and an accumulation of serots
fluid not only in these cavities but in the meshes of the arach-
noid, both at the upper surface and at the base of the brain
is present. The substance of the brain may be the seat of a
diffused change, there being small collections of indurated tis-
sue which are so frequently present in general paresis. In insanity
produced by alcohol this appearance is particularly noticeable.
In other cases we find collections of gummatous substance
peculiar to syphilis. In still others, those with diseased vessels,
there is one or more blood clots partially organized, and per-
haps some softening.
In many brains we shall find a condition known as the e¢at
criblé, which consists in a number of small openings giving to the
brain a porous appearance, and it is a result of a previous hy-
peremia from probable exudation of serum and atrophy. It
ig rare to find increase in size of the brain as an indication of
chronic insanity. Atrophy is much more common.
Attention may be called to the thickening of the cranial bones
in chronic insanity and the existence of bony spiculz which
is sometimes met. Greding presents 216 autopsies; 167 of
these presented thickening, and 38 more or less thinness of the
bones.
In melancholia, Luys has found in several cases great hyper-
emia of the gray substance of the third ventricle. The left
optic thalamus presented on its internal face hyperemic red-
ness, which was also found in the third ventricle. The gray
substance of the cortex of one of these patients was thin, and
most of the convolutions appeared of a pale color, with irregu-
lar vascular arborizations irregularly disseminated. It seems
to be a peculiarity of this form of disease that there is a gen-
eral ischemia with localized spots of hyperemia.
In some cases of profound melancholia with stupor, the brain
was found to be completely exsanguinated, the white substance
deprived of vessels, and an appearance of atrophy of the cor-
tex and small vascular groups was presented (de petit boquets
vasculier disposer enilots).
In cases of general paresis excessive and abundant proli-
feration of the neurogha with choking of the nerve-cells was
apparent, the latter being diminished in number. The white
substance presented the same appearance of sclerosis, the nerve
fibers appeared as withered filaments, and were torn and much
reduced in size; and there were areolas which marked the dis-
appearance of nervous elements.
In acute mania, Luys found evidence of active and violent
GENERAL CONSIDERATION, 59
hyperemia in all parts of the brain, but the vessels of the
corpora striata were most dilated and engorged, and the white
substance was as much injected as the gray. In one of his
cases there was yellow coloration of the insula, with degenera-
tion of all the nerve elements of this region. In another an
old foyer of softening occupying the center of the protuberance
was found, the walls of which were encrusted with colorini
matter, granular corpuscles and crystals of hematoidin, whick
indicated the existence of prolonged congestion, atid which for
some time had played the role in this region of a patholo-
gical point of irritation,
The microscopic appearances of diseased nervous tisstie are
perhaps of greater interest than any others, and in cases where
no grave lesions are presented the microscope will often reveal
delicate changes which consist most commonly in degenera-
tion of the nerve cells of the cortex, and vascular hypere-
mia and its consequences. The large cells of the cortical gray
substance often break down, and leave in their places collec-
tions of granular matter which may be either found in isolated
masses, or the cell wall may be intact and its contents entirely
disorganized, there being disappearance of the nuclear elements.
We shall also find that the inter-communicating fibers and
nerve cell processes are broken off, and that the inter-cellular
connective tissue is increased, with proliferation of the neuro-
glia cells, and perhaps there may be the appearance of amyloid
bedies. The bloodvessels are choked. ‘There is exudation of
coloring matter and infiltration. In hyperemic states the
vessels are dilated, their walls are covered by fat granules and
hematoidin crystals. Sometimes masses of pigment are found.
The vessels are varicose or-disrupted, and the peri-vascular
spaces may be filled witn exudation corpuscles.
The nerve cells undergo change in disease which are so de-
cided as to have attracted the attention of several observers,
Luys among the number. It has been found that in cases of
insanity with hallucination they are greatly increased in size,
and Meschéde has found that in general paresis the increase in
size of the central cells was very decided. Luys on the other
hand has found a reduction of the cells in general paresis as well
asa diminution in their number. in some brains we find small
vacuoles scattered through the brain substance, which, however,
are more often the result of careless manipulation (as. they were
in the Guiteau brain), than of a pathological process.
In this connection a word of caution is necessary, for it is a
very easy matter through improper hardening or incautious
60 MEDICAL JURISPRUDENCE.
staining to so alter the arrangement and character of the
anatomical elements as to produce appearances in every respect
resembling those of actual disease. Hardening in alcohol is
quite likely, unless great care be used, to have this result, and
sometimes carmine staining with a badly prepared solution will
give granular changes which are very confusing. In hardening
the brain, especially where medico-legal questions are involved,
we must frequently change the fluid, protect it from dust, and
conduct our manipulations in a systematic and careful manner ;
and it is well to have our observations confirmed by another
person.
It is a well known fact that heart disease is very common
among the insane, and autopsies reveal hypertrophy and val-
vular obstruction in melancholia, and usually some dilatation
where the mental disease has taken the form of excitement. In
chronic forms of insanity, such as dementia, we find fatty de-
generation in connection with atheroma, not only of the large
vessels, but of those of the brain as well. In other forms of dis-
ease it is not rare to discover evidences of renal or hepatic
degeneration and pulmonary complications leave signs of their
presence during life.
CHAPTER II.
THE LEGAL RELATIONS OF INSANITY.
We now come to the consideration of the special questions
that may arise in connection with the legal investigation of the
acts of a person who is presumably insane. ‘The welfare of the
individual, and of society at large, necessitates the most careful
and patient consideration of the nature of the behavior and re-
sponsibility of the alleged lunatic.
Naturally there is much difference of opinion, and in the un-
settled state of our knowledge of mental disease grave mistakes
are frequently made. The medical man looks more humanely,
perhaps, upon this weakness of the person, and considers the
mental vagaries as the result of disease—in fact, he is too often
inclined to build up an impossible standard of mental integrity
and loses sight of the perversion for which the parents or
guardians and the subject himself are directly responsible.
The jurist, on the other hand, is disposed to take an unneces-
sarily hard and practical view of the situation, and is apt to dis-
regard the facts of medical science. The legal tests are some-
‘times too arbitrary, or perhaps too loose, and are not warranted
by the conclusions of carefully made psychiatric data.
Legal Tests.—We are called upon to testify in court in
civil and criminal cases under the following circumstances :
1. In civil cases where the validity of a will or contract is
questioned—where the nature of the instrument and the dis-
position of the property suggest unsoundness at the time the
instrument was made. In cases where the ability of the indivi-
dual to manage his affairs and take care of himself is ques-
tioned, and to appoint for him a guardian. In cases where
a marriage or other contract has been made by an insane
person. In cases of divorce.
2. In criminal cases where the acts have been committed by
an insane and irresponsible’ person.
Many troublesome points arise, even though the facts are
often clear, and our task is usually adifficult one. Especially is
=
62 MEDICAL JURISPRUDENCE.
this true in instances where the departure from normal mental
health is slight, or where the insanity is shadowy and poorly
defined. In individuals of weak mind the delicate question of
responsibility should be patiently sifted.
The Border Land of Insanity.—There are a large
number of individuals who are not insane in the legal sense.
These persons are the possessors of the insane temperament,
and in mental constitution are so peculiar as to to attract atten-
tion of those with whom they come in contact. The
shades of defect are of the most varied description. Actual
weakness or silliness, or harmless eccentricity may exist,
or there may be viciousness and criminal tendencies which
may render the person dangerous to society. In such cases
there may be a considerable degree of intellectual vigor, but
the mental operations are directed in a channel which degrades
the individual, and a defect of moral depravity exists which
crops out upon every occasion. ‘The criminal class is largely
composed of these persons, and ordinarily, hereditary tendencies
andscarly meslectsare. atthe Oot of the troubles LO; suchya
class belonged Guiteau the assassin, who showed a remarkable
vigor of mind and a sickening moral nature. Ruloff, the Bing-
hamton murderer, was another, who, though his intellectual gifts
as a philologist were something extraordinary, and. who was a
laborious student, delighted in committing innumerable robber-
ies and petty crimes, but ended his life on the gallows for the
murder of a clerk who attempted his arrest. Though not act-
ually insane in the legal or medical sense, both of these men are
pitiable examples of the “badly arranged mind,” and though
presenting no pathological insanity, were of eccentric mental
organization. The Germans especially have devoted much
care to the establishment of various grades of weak-minded-
ness, and Krafft-Ebing and others have under the names
primare and originére verucktheit defined these kinds of moral
depravity of congenital origin. I regard many of these delicate
distinctions as founded upon a too sentimental plane, for if we
are to excuse men who are simply dad for the crimes they may
commit, we shall open the doors of escape for all manner of
wickedness. ;
The Guiteau Case.—Guiteau, as I have said, was an ex-
ample of the class of neurotic criminals which is so large, and
so constantly increasing, and in his case had there been proper
environment, he might have become at least a harmless member
of society, if not a useful one. I may be pardoned for going
THE LEGAL RELATIONS OF INSANITY. 63
into this case rather extensively, and will make use of notes
previously published.*
Charles Julius Guiteau, aged forty years, is of spare build, of
hervous temperament, weighs one hundred and thirty- -five
pounds, and is five feet five and three quarter inches in height.
He is badly nourished and anemic.
In appearance he resembles the criminal known to the police
as the “sneak,” and his physiognomy is one more familiar to
the visitor at the prison than the asylum. The facial lines are
deep, and express the constant exhibition of the baser emotions.
There is a slight furrow between the brows ; ‘the nasal lines are
deep, the nose thin and pointed ; and the lips are thin and
usually slightly parted. His hair is short and mixed with gray,
and so cut as to give some appearance of flatness to the top of
his head. At the anterior part of the left side of the head is a
slightly depressed scar about three cm. long, the lower edge
being about nine cm. above the center of the external auditory
meatus, and the superior extremity about six cm. below the
longitudinal median line. There is no evidence of premature
closure of the sutures, no bregmatic depression, and no cranial
exostoses. The conformation of the head is no way atypical,
neither drachy-cephalic or dolicho-cephalic. The basal circum-
ference is 55.9 cm. ‘The antero-posterior arch 20.2 cm.; the
transverse arch 16.5 cm.; the basal antero-posterior diameter
19.5 cm.f¢ A conformateur measurement taken at a higher
level posteriorly at the plane of the parietal eminences reveals
no special asymmetry. {
There is slight fullness on the right side both anteriorly and
* Boston Medical and Surgical Fournal, May, 9, 1882.
+ It has been stated by a writer in the Mew York Medical Record that
my measurements were made at so low a level as to prevent me from recog-
nizing the existence of an alleged ridge of bone passing across the back of
the head, The writer was not probably aware at that time that this con-
formateur measurement was taken at the high level, but nothing was shown.
I would take this occasion to refer to the trick of the prisoner’s counsel, who
placed the conformateur tracing over one of the above—of course they did
not agree.
N. B.—Subsequent measurements made upon the naked skull, and the
tracings made by Dr. McConnell of the Army Medical Museum fully sub-
stantiate my original measurements.
t Clapham (W. R. Reports, vol. vi., 1876, page 150), gives some ‘ables of
skull measurements. He found that a man weighing 130-140 pounds
should have a head with circumference of 21.993 inches. A man 65 inches
high should have a head with circumference of 22.016 inches. It will be
seen that the head of Guiteau was of fair size according to Clapham’s figures.
64 MEDICAL JURISPRUDENCE,
posteriorly. [did not calculate the facial angle, there being
nothing to attract attention. There is no appearance of
hematoma auris or crenation of ears so often found in the
chronic insane, and his skin showed no abnormal change,
being moist and not scurfy. The fingers were devoid of
ungual defects, there being no hangnails, no clubbing, no
temperature nor circulatory changes. The teeth are regular,
but the two first incisors in the upper jaw are separated by a
slight fissure which increased the malignity of the prisoner’s
facial expression when his mouth was open. The back teeth
are carious. ‘There is no abnormality in the roof of the mouth,
no extreme vaulting of the palatine process of the superior max-
illary bone, and no fissure.
When the prisoner was told to open his mouth he did so,
and the opening was symmetrical, there being no defective
muscular antagonism. Upon my first visit I found what ap- .
peared to be a fine fibrillary tremor in the upper cheek-muscles,
and eyelids, but this was after an exciting day in court, and I
never saw it again. ‘The unequal tremor of the tongue, alluded
to by Dr. Folsom in his able paper, was not observed by me
except upon this occasion, and it was not manifested except
when the tongue was kept protruded for some time. In no
respect did it resemble the tremor of general paresis, and it
was not accompanied by tremor of the lips. The tongue was
protruded slightly to the left side, but there was no atrophy
whatever, and it could be freely pointed to the other direction,
and its tip approximated to the roof of the mouth. I tested
his speech carefully, but found no impairment, but in court he
momentarily hesitated because his ideas were evolved too
rapidly, and the function of the cerebral speech centers did
not seem to keep pace. A careful ophthalmoscopic examina-
tion failed to reveal any neuritis or atrophy, and Dr. Loring
was equally unsuccessful in making any discovery of oculer
trouble. We found him to be hypermetropic, and the left eye
was the seat of conjunctivitis at the first visit, and quite sensi-
tive, and as a result the pupil was slightly contracted, but only
upon one occasion was this observed, his pupils being after-
wards normal, and contracting perfectly to diffused and artifi-
cial light. The pupils were not contracted as is the case in
the early stage of general paresis.
Tests of motility were negative. He walked well without
any drag, and there was no disturbance of coérdinating power.
I tested the tendon reflex in the extremities both by Buzzard’s
and Gower’s method, and in the ordinary way, and I failed
THE LEGAL RELATIONS OF INSANITY. 65
after repeated examination to discover any abnormal increase,
and light and heavy blows failed to evolve a jerk of any kind,
but there was moderate responsive action, equal on both sides,
with no secondary jerk. Hand grasp unaffected, and he could
localize small objects. Hearing was normal. Retains urine
for several hours even when excited, and when passed it is
neither forcibly ejected nor does it dribble. He says he has
had a gonorrhoea, and his stream is spiral, so he probably has
some stricture. He denies absolutely that he has ever had
syplilis, and no evidences are found. He has a small herpetic
patch on-the forehead, but this is probably due to his depraved
physical condition. There is no evidence to show that he has
indulged in bad sexual habits in jail. Pulse found to be 88
upon two occasions. ‘Temperature taken daily by jail physician
shows no abnormal rise.
It would be going over much wearisome ground to again
attempt to analyze the evidence introduced in court except to
insist upon what I believe to be the truth, that he is an eccen-
tric criminal, who has been playing a part in court that might
at least (if not humbug the experts) affect the jury, and gain
for hifn a disagreement.
None of the expressions of disorderly mental action upon
the part of the prisoner, either isolated or with others, were, in
my opinion, incompatible with sanity, nor indications of any
known mental disease. The evidence brought forward was
such as to show that the prisoner had been brought up badly,
and had, from the time he began to look out for himself, lived
as a parasite upon society, making use of all methods of
shrewdness and deception to gain shelter and food, until he
found his path in life becoming more and more difficult to fol-
low, and then he resorted to more desperate methods. Like
the murderers in Macbeth he might have said :
‘* T am one, my liege,
Whom the vile blows and buffets of the world
Have so incensed that I am reckless what
I do to spite the world.”
** And I another, so weary
With disasters, tugged with fortune,
That I would set my life on any chance
To mend it, or be rid on ’t.”
When we analyze his actions I do not think there is any
alternative for us. We can only say that his crowning crime
was the culmination of uncontrolled wickedness, and his convic-
5
66 MEDICAL JURISPRUDENCE,
tion and sentence the natural result of the failure of his last
desperate scheme.
Thomas Beggs Gilpin,* in speaking of the psychology of
crime, says, “ It matters not what may be the character of the
crime ; it may be arson, it may be rape: the first successful
gratification of vindictive feeling leads by similar progression
to the one; the first flirtation of simple sensuality, unchecked,
if not encouraged, leads by the like gradation to the other ; in
all cases progress from venial to bad, from bad to worse, and
thence to extremes, is the invariable trait of a criminal career ;
consequences are first calculated with anxiety, then merely
weighed against immediate gain, and finally disregarded alto-
eether
There are thousands of men at large to-day who display all
the eccentricity of Guiteau, but their actions are as impulsively
good, or at least their intentions are as well meant, as his were
bad, and still they are not called insane. In some cases these
persons are reformers, with projects in every way as absurd as
any of Guiteau’s. What can be said of the educated individual,
for example, who advocates the abolition of vaccination ?
Guiteau is only a shrewd scamp, with the plausibility of an
Alfred Jingle in swindling his boarding-house keepers, and
evading the payment of his debts; the visionary enthusiasm of
Micawber or Colonel Sellers; the cant and hyprocrisy of
Aminadab Sleek or Uriah Heap ; the ambition of Erostratus,
and the murderous manners of Felton, who assassinated the
Duke of Buckingham, of whose crime the killing of Garfield
was an almost exact counterpart.
None of his “delusions” were akin to those of general
paresis of the insane, for in that disease there is no reasonable
basis whatever, and, moreover, if Guiteau is a general paretic,
as Dr. Folsom suggested in a communication, his boasting and
immense projects have been expressed for at least twenty
years, and there are few cases of general paresis that live
beyond the tenth year of the disease, and they nearly all end
fatally in three or four years, or less. Guiteau’s projects were,
as a rule, substantial, and were at some time realized.
The Jnter-Ocean scheme was a pronounced success ; the
Theocrat, conducted, perhaps, in a more modest way than
Guiteau might have wished, had an existence of several years
as the Mew York Daily Witness, a small religious daily paper ;
and even his last and most fatal “delusion ’”’ was verified, for
* Forbes Winslow’s Yousnal of Medicine, vol, v., p. 177
THE LEGAL RELATIONS OF INSANITY. 67
he did “unite the Republican party,” and his act has thor-
oughly changed the features of American politics. In some
countries where a president is assassinated every year or two,
he might even have become the martyr he expected to be, but,
unfortunately for him, his own was not one of these.
Dr. Folsom* very aptly says, “‘ His shooting of the President
was, to a certain extent, the logical result of bad training, char-
acter somewhat unscrupulous, enormous self-conceit, self-will,
disappointment in not getting office, cowardice, extreme politi-
cal partisanship, delusions or deceit regarding religion, despera-
tion of poverty, expectation of personal gain, love of notoriety,
and hope of praise from the ‘ stalwarts,’ ’’—but are these neces-
sarily expressions of insanity?
While I do not agree with an English criticism that “ Guiteau
is a type of American civilization,” I do believe that in a new
country as large and great as ours, a land in which religious
and political liberty is as universal as it is in this, and in which
the creed that “one man is as good as another” has so many
believers, there must be many Guiteaus; not Guiteaus who
necessarily kill a president, but eccentric individuals with
“badly arranged minds.” In many sections of the country
there are religious sects and communities whose teachings are
as immoral and unstable as that of the establishment at Oneida,
from which the assassin graduated. In the section in which
the elder Guiteau lived I understand that a large number of
people, even to-day, hold that with careful bodily care life may
be prolonged indefinitely ; but the counsel for the prisoner
inadvertently proved, in alluding to the elder Guiteau’s views
on this subject, as an element of his insanity, that he neverthe-
less made a will and insured his life. In Massachusetts there
is a body of “Second Adventists,” many of whom, I under-
stand, fully approved at the time the crime of Freeman, who
sacrificed his child ; and in other parts of the country there
are colonies of equally ignorant and fanatical people, whose
teachings and practices are calculated to stimulate the baser
emotions of the ignorant, and send them adrift to prey upon
society, with the most loose views both religious and ethical.
Guiteau’s behavior subsequent to his conviction is too well
known to be recalled, and his appearance upon the gallows was
fully in consonance with his previous life. He was a hardened
yet weak wretch, and the same spirit which led him during the
trial to express his vanity and allude to the attention of certain
* Boston Medical and Surgical Fournal, Febrpary 16, 1882, page 151.
68 MEDICAL JURISPRUDENCE,
“ladies ” prompted the verses and the sickening “last words ”
upon the scaffold. Such scenes are by no means novel, and
the murderer’s parting speech in other cases where insanity is
not hinted at, is, as a rule, a mixture of cant and blasphemy.
Only a few weeks after Guiteau’s hanging a negro murderer in
St. Louis cried out as the trap was sprung: “I’m going to the
‘Lordy’ like Charlie Guiteau.”
Is this moral depravity necessarily insanity? I am sure not.
It is not folie raisonante, because the man’s weaknesses were
many—he was consistently bad, and his false premises were
those adopted by the thousand of miserable inmates of our
States prisons and penitentaries.
Dr. Mayo * in a valuable article thus alluded to persons of
this class :
“Doubtless these symptoms, wavering between eccentricity
and insanity, but combined with vicious propensities, are often
received into an asylum, when a prison would be more ap-
propriate. I was told lately by Mr. Pownall, chairman, I think,
of the Brentford Quarter Sessions, the following anecdote re-
specting Oxford, who afterwards attempted the Queen’s life.
Sometime before that act he was brought before Mr. Pownall
and another magistrate, on account of some very eccentri¢
cruelty shown towards some fowls; and for this offense let off
with a reprimand. Seeing Mr. Pownall some time afterwards,
when in the penal wards of Bedlam—‘ Had you,’ said Oxford
to that gentleman—‘ had you punished me when I was brought
before you for that former offense, I should not now have been
here.’
“Tn this point of view the case of the Hon. Mr. Tuchet was
probably a sad instance of mismanagement, both legal and
educational. Mr. Tuchet wantonly shot the marker in a
shooting gallery. Before this event, while this young gentle-
man was on the town in a state of progressively increasing dis-
content and exnuz, if the eye of science had been brought to
bear upon him, the observer might have possibly seen good
reason for calculating upon his exhausting his powers of self-
control so far as to acquire good grounds for claiming the pro-
tection of the law, before he had rendered his claim to that
protection questionable or inappropriate by an act which, at
that stage of abnormal conduct, assumed all the frightful char-
acter of murder. It is difficult without more knowledge than
we possess of the antecedents of this gentleman to substantiate
* The Journal of Psychological Medicine, April, 1861.
THE LEGAL RELATIONS OF INSANITY, 69
completely our hypothesis, but it may be plausibly suggested ©
that he was protected by the decision of a court of justice
from punishment for a great crime on the plea of insanity, in-
stead of being prevented from committing that or similar
crimes by early surveillance and detention. Meanwhile the
punishment which he escaped was /egally deserved, as he un-
questionably well knew the murderous nature of the act which
he committed at the moment of commission.”
Genius and Insanity.—Lack of steadiness and concentra-
tion, effervescent genius, hobby-riding and crotchety versatility
are the mental traits of many of these unbalanced persons of
weak mind, and we find in the ranks many of the reformers
who occasionally startle the world, and keep society alternating
between discomfort on one hand, and the enjoyment of the
ridiculous on the other; as well as the fools who delight in
keeping themselves prominent in the press and elsewhere.
Examination of the Patient.—The medical man should
carefully investigate the patient’s condition. He should de-
termine by questions directed to draw out the alleged lunatic
what his relations towards and opinions of his family are, and
whether he believes himself the subject of persecution or con-
spiracy. He should note whether the patient is preoccupied,
or excitable and communicative ; whether he is incoherent or
violent ; whether he lacks concentration and betrays a loss of
memory. Skillful questions directed to show the business re-
lation and capacity of the patient should be put, and the re-
ligious tendencies or changes should be inquired into. Altera-
tions in dress, personal untidiness or disregard of the bodily
wants often exist and should be noted. Besides the speci-
mens of handwriting should be examined and compared with
letters written in health.
The physical changes if any, are to be looked for. The
presence of paralytic obliteration of the facial folds, the devia-
tion of the tongue, the shriveled ear of chronic insanity, un-
equal dilatation of the pupils, the dryness or scurfyness of the
skin under the hair, and the posture and method of gesticulation
are common in insanity. Speech disturbances, whether ataxic
or aphasic, are valuable signs of insanity dependent upon de-
generative disease of the brain, and often are confirmatory
symptoms.
Tardieu’s Formula.—Tardieu lays down the following
formula for examination ;
70 MEDICAL JURISPRUDENCE,
A. Mental state-—Three orders of facts should be investi-
gated. 1. The intellectual troubles. 2. The perversion of
the affective faculties and the instincts. 3. Alteration of the
sensorial functions.
The intellectual disorders consist in a general derangement,
marked by delirious conceptions with complete abolition of
judgment, memory and conscience ; afterwards commonly in
a partial derangement of understanding. From a medico-
legal point of view the most direct and immediate result of the
disorder of the intellectual faculties is a perversion of will
and a resulting impairment in action, either in an absence of
control or purpose, or in action which bears the impress of in-
coherent or erroneous ideas:
Disorder of the affective faculties are constant in insanity.
There is more or less alteration of affections and instincts.
The more natural sentiments are abolished or perverted, and
the instinct 1s sometimes abolished as well.
The sensorial troubles are singular and characteristic in
insanity and hallucinations and illusions are the most im-
portant.
*% *% * * * % *
B. Somatic state. The position, attitude, walk, gestures,
the dress, malformation of head, physiognomy, expression.
i - : ¥ The circulation and temperature
are diminished in.the inaction of melancholia, and increased
in the agitation of mania. ‘The general sensibility is exalted
or perverted in monomania, or diminished to the point of
analgesia in lypemania. ‘The spasms, the startings, the mus-
cular twitchings, the partial paralyses of sensation and motion,
indicate a grave alteration of the nervous centers. The em-
barrassment of speech, the unequal dilatation of the pupils, the
permanent deviation of the uvula, the ataxia of movement,
suggest general paresis ; finally we are to recognize all the symp-
toms which are connected more or less directly with mental alien-
ation. Vertigo, musce volitantes, cutaneous and neuropathic
manifestations. The mobility of the tongue, and scars which
may be indicative of epilepsy, or traces of cicatrices which may
be the result of attempted suicide.
Physical Tests.—We should make careful examination
with instruments of precision. The ophthalmoscope should
be employed. The condition of the tendon-reflex should be
ascertained, and various tests should be brought into play to
THE LEGAL RELATIONS OF INSANITY. 7
determine the possible evidences of organic nérvous disease.
The patient’s family history ; previous habits, vicious or other-
wise ; the progress of his disease and its complications are to be
gone into.
Duties of the Medical Expert.—Whether in civil or
criminal cases we are to determine the influences that may
destroy the responsibility of an individual, and it should always
be borne in mind that the offices of the physician are only those
in which he is warranted in forming an opinion relative to the
enfeeblement of mind through disease. Questions of law do
not concern him, and the courts will not permit him to express
more than what he knows regarding the medical aspects of the
case. He should always remember the dignity of his calling
and never lose his temper, no matter how much galled he may
be by the impertinence of the opposing counsel, who is not
always a gentleman. He should however never be flurried,
never give hurried answers, and should demand time for his full
answer if “choked off” or interrupted. He should, on the
other hand, never show an eagerness to testify, or an enthu-
siasm in espousing the cause of the side upon which he may
be employed. His testimony should be given in a cool, im-
partial manner. He should be on the alert and avoid the
possibility of being trapped by his ingenious legal opponent.
A favorite method of some lawyers is to dissect a hypothetical
question and demand answers to isolated portions. By this
means it is possible to get a truthful negative answer to many
of the elements of real insanity. “Do you consider the fact
that a man is slovenly in his habits an infallible sign of in-
sanity ?”’ may be asked, and the witness of course answers,
“no ’—while this very untidiness taken with other indications,
may be a very important element of the mental disease.
The medical man should therefore be on his guard and
refuse in such a case to give any thing but a qualified
answer.
Tricks of Counsel.—All manner of dodges may be re-
sorted to, as asking the witness for example, if he has read
such and such authorities, while in reality no such works are in
existence. He should avoid being drawn into discussions upon
various other subjects which are foreign to the case in hand,
and if these be not strictly medical, the witness may refuse to
answer—at least so far as he may be made to pose as an expert
in some other field. In ome case I was asked in reference to my
views upon theological subjects and this I refused to go into
72 MEDICAL JURISPRUDENCE,
except in the most superficial way. It is unwise to pose either
as a radical, or as a person of more than ordinary ability, and
therefore do not tincture your answers with any thing extra-
neous. A man who declares himself an agnostic is apt to
injure his case, and render himself ridiculous. So, too, he is
not warranted in ventilating any extreme views or theories
that do not bear the stamp of proof. The flippant witness is
sure to injure his case by trying to raise a laugh or by an
attempt at repartee. He will find to his cost that some sober
old lawyer on the other side is quietly listening and awaiting
his chance to turn the laugh upon the unfortunate jester, and
to create in the minds of the jury a prejudice which is ex-
tremely uncomplimentary, as well as injurious to the case. In
fact a thoughtless answer may destroy the weight of all the
sound testimony that may have been given before.
Medical witnesses are very often asked whether insanity can
exist without disease of the brain and the assumption is that it
can. While it behooves the medical man to be exceedingly
cautious, he may safely say that although our instruments of
research do not always reveal to us the signs of disease after
death,.there can be no doubt but that insanity is always due to
some organic change. So far we cannot with great positiveness
recognize distinctive appearances, yet the majority of chronic
cases at least are attended by well marked changes. It cannot
be denied on the other hand that extensive disease of the brain
may exist without any marked intellectual disturbance. (See
Post-Mortem Examination of the Insane.)
Legal Terms.—There are various terms used in the law
which should be borne in mind, not because they are always
consistent with medical facts, but for the reason that the
medical witness may answer more intelligently with the possess-
ion of such knowledge,—and here another word of caution may
. be given to those who are inclined to wander into the fields of
a profession to which they do not belong. The medical man
called to the stand should confine himself to insanity as a dis-
ease, and should avoid the floundering which must follow when
he uses legal terms, and attempts legal distinctions.
/llustons are sensory perversions and have for their creation
some outside suggestion. Real things are distorted. An indi-
vidual looks at a post and sees two, or at the pictures upon the
wall and declares that the figures move. He mistakes shadow
for substance. He considers the whistling of the wind te be
that of men in the street, or believes that the contact of his
THE LEGAL RELATIONS OF INSANITY 13
clothing with the skin is that produced by ants or other insects.
The tricks of the magician or clairvoyant are examples of illu-
sion, and our senses deceive us every day in a variety of ways.
When the illusion is persistent and incontrovertible, and when
connected with various errors in reasoning capacity, it becomes
an indication of mental unsoundness.
Hallucinations are perverted perceptions without material
bases, and like delusions may be szmple or imsane. Through
disease of the organs of sense or receptive apparatus distorted
impressions are conveyed to the ideational centers. If the indi-
vidual is able to correct them then they will have no significance,
but if he does not appreciate their false character, and if he
elaborates false ideas the case is different. If the patient says
that he hears voices which say horrible things to him, or sees
purely imaginary personages, the symptom has a dangerous
significance. The individual who believes he sees the Almighty
and proceeds to detail a conversation he has had with him, has
an insane hallucination connected with a delusion. The insane
character of the hallucination is further increased by its asso-
ciation with mental perversion of other kinds. Insane people
frequently hear voices speaking through walls, waste pipes and
imaginary telephones, and it is not uncommon to find a patient
in a fixed expectant attitude listening to some fancied commu-
nication.
Brierre de Boismont in speaking of hallucinations in connec-
tion with insanity, says :—
“Out of 178 persons who presented this complication, 30
—under the influence of false sensations—threatened death,
struck, overturned, wounded their pretended enemies, attempted
to kill themselves, and if deplorable accidents did not take
place, it was simply because they were promptly placed under
restraint. Hallucinatory perceptions and illusions of hearing
lead to quarrels, to extreme anger and fury, and to violence in
considerable proportions. One of our patients, to whom in-
sulting words were addressed, flew each time into a violent
rage ; he exclaimed that there had been enough of it, and that
he must-kill somebody. This patient is all the more dangerous
because his attacks are instantaneous. Were he not constantly
accompanied by his servant, some accident would have oc-
curred ; yet despite his excitement, he knows what he is doing,
“However strict may be the surveillance, these auditory illu-
sions constantly occasion struggles between the insane, and
more or less serious injuries. A merchant used to hear two
voices ; one polite, the other insulting. With the former he
7A MEDICAL JURISPRUDENCE.
was amiable, cheerful, ready to oblige; but when it was the
turn of the latter, he became formidable—his strength, already
great, was doubled. During one of his crises he seized in an
instant a stake, and he had to be surrounded before it could be
taken from him. Life is often endangered by these kinds of
illusions. Two ladies unexpectedly flew at a female employed
in the establishment, and attempted to murder her; a vigorous
struggle became necessary. A patient, insulted by these voices
threw himself out of the window. We attended once a mer-
chant in whose ears the word dankruptcy continually resounded.
He energetically protested against this insult, and would have
committed suicide had not precautions been taken.
“Accusations of theft, of abused confidence, of perjury, and
voices addressed to the victims of hallucinations have fre-
- quently led to avowalsfrom them. ‘It istrue’ they admit. I
have to add fresh facts to those we have published to prove that.
remorse may be a determinating cause of madness and halluci-
nation. A tradesman who until then had deserved the esteem of
all who knew him, heard voices reproaching him for a bad
action. ‘These voices left him no moment of repose, though his
family and friends were prodigal of consolation. I was called
in and tried to tranquillize him ; every thing denoted impending
madness. He went up-stairs to go to bed. A few minutes
afterwards he was found hung.
“A clerk, about thirty years of age, was brought eighteen
years ago to my establishment in the Rue Nueve St. Genevieve.
It was suspected that he was simulating insanity. The house
in which he was employed had discovered an embezzlement of
about twelve thousand francs, respecting which he could not
or would not give any information. Three hours after his
arrival he threw into the fire a set of chimney ornaments. I
asked him what had induced him to commit such a foolish
action; he was some time before replying to me; then he
said in a low voice and in a mysterious manner, ‘He com-
manded me to do it.’ From that moment it was impossible to
get a word out of him, and he ended by falling into a state of
complete insanity.”
Disorderly Conduct Explained by Hallucinations.—
The police reports from time to time contain accounts of
arrests for disorderly conduct, and sometimes there is no ex-
planation for the violent acts of the prisoner. Occasionally he
is ‘committed for medical examination,” but more often he is:
hurried off to the workhouse or penitentiary and perhaps pro--
we
THE LEGAL RELATIONS OF INSANITY. 75
nounced “drunk and disorderly,” while in truth this disturb-
ance of the public peace may be entirely due to the existence
of hallucination. Brierre de Boismont* says: “ This false sen-
sation leads to desperate consequences. A person, a prey to
this delusion, flew at a friend, whom he took for a thief,
knocked him down, thrashed him soundly, and called him a
scoundrel. In our establishments patients are often seen who
try to beat other inmates whom they consider enemies. We
attended a maniac who, believing himself surrounded by malig-
nant beings, continually wished to rip up his companions.
Many of those confided to us had struck policemen and others
because they had assumed the form of enemies; for the same
reason some lunatics beat their keepers and severely wound
them. One had his face mutilated by a decanter ; when assist-
ance came he was blinded by blood and could not defend
himself.”
Delusions are szmple or insane. A false belief, which is not
tenaciously adhered to when proper negative evidence is pro-
duced, is a simple delusion and need not be a mark of insanity.
But when the individual believes in something which originates
and exists only in his own disordered imagination, and which
he will not permit to be controverted by indubitable evidence,
this may be said to be an insane delusion. A person may
simply display bad judgment in the formation of opinion ; or
he may believe that he has committed the “unpardonable sin,’
or that he is the object of a vile and well arranged conspiracy,
or that he has changed his identity. If, when confronted with
contradictory proof, he still persists in clinging to his delusion,
and especially if he acts upon it to the detriment of himself
or some one else, he may fairly be considered insane.
Delusion of this last kind is clearly evidence of mental un-
soundness. In legal matters the relation of the delusion is
however the real issue. If such a delusion prevents the indi-
vidual from exerting a “rational act of volition,” which for
instance is pertinent to the disposal of his property, then he
does not possess testamentary capacity, and is so far of un-
sound mind. Such a delusion may arise in relation to his
family, and he may through disease entertain a bitter hatred
for persons who are entitled to gratitude and consideration.
Delusions which lead to acts of violence are also equally of im-
portance, and more than one writer upon medical jurispru-
dence has held that “all insanity was manifested in morbid
——,
* Journal of Psychological Medicine, vol. ix,
76 MEDICAL JURISPRUDENCE.
beliefs, and that consequently delusion was a good test of
insanity.”” The question of responsibility, however, depends
upon the connection of the act with the particular delusion.
It is the province of the medical man to study the relation
of delusion with other evidence of insanity, with change in
habits, morals, and the many perversions that go to make up
the picture of mental disease.
Delusions not Necessarily Expressed in Conversa-
tion.—Delusions need not necessarily be expressed in actual
words but the insane person may suggest for instance his belief
that he is some one else by his manner, behavior or dress. He
may strut about wearing upon his breast decorations that he has
constructed from bits of bright metal and rags, or he may per-
sonify a member of the Trinity. The possessor of a delusion
is usually restless and absorbed only in himself. The expression
of the face, the manner of speaking and a thousand and one
little actions betray the extstence of a delusion or series of
delusions.
Concealed Delusions.—The insane are often cunning to a
degree it is difficult to imagine. JI have known of many cases
in which the patient who appeared in court under writ of
habeas corpus made so good an appearance and under skillful
coaching refrained from expressing the delusion that would
disclose his insanity to the jury that he has been discharged,
and every Superintendent of an asylum has had cases of this
kind.
In well marked cases of insanity of advanced stages, the evi-
dence of the disease cannot be restrained, but in the masked
intellectual forms it is possible for the lunatic to resort to in-
genious reasoning. This form of mental perversion is known as
Reasoning Mania, manie raisonnante (the manie sans délire
de Pinel) (See Reasoning Insanity) has been applied to a form
of insanity in which the intellectual faculties are less affected
than the others, and many of the so-called cases of moral insanity
are those in which false conclusions are reached and as a result
of the deprivation of judgment and the false exercise of will the
patient may commit some act of violence which is almost
incredible, because the ordinary mental condition of the indi-
vidual seems to be unaffected. The plans laid by such people,
the pretexts used to justify the crime, and the means used, all
appear at first sight to stamp him as a responsible being, but
usually there are striking mental inconsistencies which indicate
insanitv
THE LEGAL RELATIONS OF INSANITY, 77
s
The patient’s troubles always begin with change in temper
and disposition. He grows quarrelsome, disorderly and vio-
lent. The will of such subjects is enfeebled and they are incon-
sistent and act from impulse. Sexual desire is expressed in
attempts at rape or bestiality, jealousy by sudden assaults, and
the individual is dominated by his passions,
Dagonet,* in speaking of the subjects of mante ratsonnante,
says that a prolonged and attentive examination of the insane
of this class will impress the observer with the fact that the
intellectual vigor of the patients is more apparent than real.
In fact, the patients reason logically in a given circle, but when
the conversation is prolonged or when other subjects foreign
to their ordinary line of thought are introduced, they will not
be slow in manifesting fixed ideas, strange illusions, errors in
perception, false appreciations, exaggerated conceit and a variety
of other indications of a morbid mental condition. I re-
cently examined a patient, with Dr. Clymer, who suffered from
this form of mental trouble. He freely admitted that his in-
sane acts were the result of reasoning, and that during the night
he would bring himself to believe in the propriety of making
certain purchases, or doing things he afterwards regretted.
Upon one occasion he walked down Broadway and _pur-
chased several umbrellas and other things he was already pro-
vided with. He had spent a considerable sum of money in a
few weeks, and when we saw him, had begun to seriously con-
sider the performance of acts more harmful to himself and
society.
Lucid Intervals.—In some of the common forms of in-
sanity there are remissions in the course of the disease, during
which the patient is apparently sane. These periods must not
be confounded with the temporary remissions which occur in
mania for instance, but we do find them notably in general pare-
sis of the insane. Legally defined, a lucid interval consists of
a period during which the patient regains the power of using his
judgment in the management of affairs. It is, however, question-
able whether an established form of insanity ever has remissions
during which the patient is entirely sane. Mania has remis-
sions of short duration during which the individual may im-
press the bystanders with his apparent capacity, but medical
men hesitate, and justly so, to admit that such a thing asa
genuine lucid interval exists. It cannot be denied that some
* Nouveau traité elementaire et pratique des maladies mentales, etc., H.
Dagonet, Paris, 1876, p. 203.
98 MEDICAL JURISPRUDENCE.
particular illusion disappears, which removes, perhaps, the bias
of the patient’s judgment regarding a specific act. ‘There are
cases of mental disease of a recurrent form which are charac-
terized by periods during which the patient may, with some in-
telligence, conduct his affairs or preserve his relations with
society in a creditable manner but a smoldering fire exists
which is likely to break out when least expected.
The law recognizes the right of the individual during the so-
called lucid interval to make a will, sign an obligation, or exer-
cise his civil rights. He is held ‘responsible for crimes com-
mitted during such a period, so the rule works both ways, and
by no means with perfect equity.
The plaintiff in a suit against a lunatic who is supposed to
have a lucid interval is required to substantiate the fact that the
individual was sane when he signed a particular deed or con-
tract. Under these circumstances the nature of the written
contract, its possible amendation and correction by the alleged
lunatic, should be examined, and the facts bearing upon the
matter in hand should be brought out. Upon the part of the
defendant, it can be usually shown by his friends and legal ad-
visers, that such a lucid interval is only a partial remis-
sion.
Contracts made by the Insane.—The determination of
the mental condition of individuals in relation to the validi-
ty of contracts they may enter into, or wills they may make, is
frequently necessary. Insanity is always a convenient excuse
for those who find themselves bound by distasteful bargains, or a
plea presented by disappointed relations who have not what they
consider their due, when the estate of an inconsiderate testator
is divided. A large number of the cases in the Surrogate’s
Court are contested because of the alleged mental incompeten-
cy of the dead man, and testimony is given which is often in-
dicative of any thing else but mental feeblness. Eccentricity of
conduct and dress and peculiarities of language are brought to
light and dignified as insane symptoms, and the skeleton of
many a closet is laid out in the court room. It may be safely
stated that two-thirds of all the suits brought to set aside wills
are based upon the flimsiest ground work.
The capacity to make a will need be, according to the law,
dependent upon a very ordinary state of mental integrity. The
will of an insane man who may, even with the existence of con-
spicuous mental defects, be able to recognize the objects of his
bounty and have sufficient intellectual vigor to appreciate the
THE LEGAL RELATIONS OF INSANITY, 79
extent of his property, and dispose of it properly, is frequently
admitted to probate.
Testamentary Capacity.—We are to investigate the con-
dition of the testator at the time he makes his will, and decide
whether his disposing capacity is affected in any way—either
by the natural decay of old age, by senile dementia or other
kinds of insanity—or whether there exists a delusion which pre-
vents him from intelligently disposing of his holdings.
Wills made zz extremzs usually have no value in the eyes of
the law, and these as well as contracts are often contested.
Tardieu, Laségue * and other French writers have extensive-
ly written upon the mental condition of the individual during
the last moments of life. They announce their belief that either
as a result of general disease or insanity the brain is always
affected just before death, and intelligence obscured to some
extent, so that the capacity for will making is at least doubt-
ful.
Old Age and Dementia.—Much has been said about the
distinction between the mental decay of simple old age and the
appearance of senile dementia, and it is important to make the
distinction when we are called upon to testify. Dr. Ray says,
“This form of the disorder, or senile dementia, is so often the
subject of medico-legal inquiries, especially in connection with
wills, that it deserves particular attention. Senile dementia, it
must be recollected, is something more than the mere loss of
mental power which results from the natural decay of the fac-
ulties; it is not only feeble but it is deranged. Were it not so
every old man would labor under acertain degree of dementia.”
Senile dementia, as Prichard has written, is not the lot of old
persons universally, though it is a condition to which old age
has a tendency, and to which the last stage of bodily decay
approximates.
Extreme old age sometimes prevents the testator from know-
ing the objects of his bounty and from intelligently disposing of
his estate. If his mind is so weak, either through disease or old
age that he may be tricked or swindled; if his memory and
perception are so blunted as to prevent him from knowing the
extent or condition of his property or the persons to whom he
wishes to give it, then true doubts arise in regard to his com-
petency. Simple old age does not necessarily bring with it in-
capacity, for there are men who have attained very great age
* Etude de la folie, p. 126,
80 MEDICAL fURISPRUDENCE.
without any suspicion of mental unsoundness arising. In the
Watson case, an old man of 86 was held to be competent to
make a will, and cases are on record of wills made at ninety or
over which stood. ‘The law that “if aman in his old age be-
comes avery child again in his understanding, and is become
so forgetful that he knows not his own name, he is then no
more fit to make a testament than a natural fool, a child or a
lunatic.” (Browne).
In the case of Harwood vs. Baker in which a will was made
in favor of a second wife to the exclusion of the testator’s fami-
ly, the testator being in a condition of mental feebleness from
disease, the charge of Erskine was to this effect.
“Their lordships are of opinion that in order to constitute
asound disposing mind, a testator must not only be able to
understand that he has by his will given the whole of his prop-
erty to one object of his regard, but he must also have capacity
tocomprehend the extent of his property and the nature of the
claims of others whom by his will he is excluding from all par-
ticipation in that property, and that the protection of the law
is in no cases more needed than it is in those where the mind
has been too much enfeebled to comprehend more objects
than one, and more especially where that object may be so forced
upon the attention of the invalid as to shut out all others that
might require consideration.”
The Test of a Disposing Mind.—With regard to the
proof of a disposing mind an English Judge (Brett) said “that
it was not sufficient for the testator to understand merely that
he was making a will, but they (the jury) had to say whether
at the time the will was made, the testator had sufficient intelli-
gence to understand substantially the state of his family and of
his affairs, and the disposition of his property as made by the
will, and if he had sufficient power of mind to intend to make
such disposition.”
Case J.—ALLEGED IMPAIRMENT BY REASON OF OLD AGE—
WiLL SuSTAINED.—Matter of Lucy H. Eddy, 32 N. J., Eq.,
701.
Lucy H. Eddy died in Rahway, in 1879. She was a daugh-
ter of the late Thomas Eddy, of New York, who was distin-
guished for his public spirit and philanthropy, and inherited
from him his strong mental qualities and convictions of duty.
She left a will dated Jan. 15, 1875, and a codicil dated Sept. 5,
1876. This will was contested in the Prerogative Court, on the
THE LEGAL RELATIONS OF INSANITY. 8r
ground of lack of testamentary capacity. Deceased was 83
years old at the time she executed the will, and none of the wit-
nesses for contestants testified that deceased was of unsound
mind, but only averred to the weakness of memory regarding
recent occurrences, which might be expected in a person of
such advanced age, and some would not even say that she was
unfit to make a will. On the other hand it was shown that she
read the classics and histories, and would excite admiration by
her able discussion of them ; that she seemed to remember old
events ; she answered questions intelligently ; knew what she
was doing; that she knew who her relations were; that she
used an old will as the basis of her will of 1875 and made all
the necessary memoranda thereon herself.
Another point advanced by contestants was the confidence
reposed by deceased in her attorneys, and her indifference to
the fact that much more money had been expended on the
building of a house for her than was at first contemplated, and
it was claimed that this was evidence of the want of that capa-
city requisite to the making of a will, but it was held that this
merely amounted to natural confidence in capable business
men. Held also, that mere forgetfulness of recent events is no
evidence of incapacity to make a will.
The will was therefore admitted to probate.
Testamentary capacity is destroyed then by actual weakness of
mind, as well as by insane delusion; or by any thing that will
weaken the individual’s memory and judgment and _ volition in
relation to the disposal of his property, or the objects of his
bounty. So far as the delusions do not interfere with the ac-
tual disposition of the property it has been held that this will
may be valid. Such was the ruling of Cockburn in the case of
Banks vs. Goodfellow.
“No doubt when the fact that the testator had been subject
to any insane delusion is established, a will should be regarded
with great distrust, and every presumption should in the first
instance be made against it. When insane delusions have once
been shown to have existed, it may be difficult to say whether
the mental disorder may not possibly have extended beyond the
particular form or instance in which it has manifested itself.
It may be equally difficult to say how far the delusion may not
have influenced the testator in the particular disposal of his
property, and the presumption against a will made under such
circumstances become additionally strong when the will is, to
use the term of the civilian an insufficient one, that is to say,
one in which natural affection and the claims of near relation-
6
82 MEDICAL JURISPRUDENCE.
ship have been disregarded. But when in the result, the
jury are satisfied that the delusions have not affected the general
faculties of the mind and can have no effect upon the will,
we see no sufficient reason why the testator should be held to
have lost his right to make a will, or why a will made under
such circumstances should not be upheld.”
The celebrated Jumel will case was one in which the ques-
tion of delusion arose. Madame Jumel died some years ago
leaving a large and valuable estate to different religious and
charitable institutions, cutting off her family. It was shown
that the testatrix, who was a very old woman when the will was
made, was peculiar and crotchety, and that she labored under
the delusion, among others, that she was the victim of a plot—
that her relatives had attempted to poison her, and so deep-
seated was her belief that she refused all food until she pro-
cured it herself. The case was tried in the Supreme Court of
New York in 1866, and the Court took the position that if she
was insane because of these delusions, she was incompetent to
make a will.
A case not so clear as the above is referred to by Dr. Lee in
an able paper. Such examples are very common in the courts,
but it frequently transpires that the original hatred of the tes-
tator is well founded.
“George Moore, of Kentucky, made his will in April, 1822,
and shortly afterward died. ‘The validity of the will was dis-
puted on the ground of unsoundness of mind in the testator.
It was shown that, about twenty-four years before his death he
had a dangerous fever, during which he contracted a strong
hatred against his brothers, who he imagined intended to injure
or destroy him, although they had attended him through his
illness, and never gave any cause for his suspicion. ‘This an-
tipathy continued until the day of his death, with a single ex-
ception, when he made a will in their favor, which he subse-
quently canceled. The Court, in its decision, said: ‘that he
cannot be accounted a free agent in making his will, so far as
his relatives are concerned, although free as to the rest of the
world. But, however free he may have been as to other ob-
jects, the conclusion is irresistible that the peculiar defect of
intellect did influence his acts in making his will, and for this
cause it ought not to be sustained.’ ”’—(Little’s Reports, 371),
THE LEGAL RELATIONS OF INSANITY, 83
CasE II.—GENERAL COMPETENCY, WITH THE EXISTENCE OF
A DELUSION IN REGARD TO SON—WILL NOT ADMITTED TO
PROBATE.
Merrill
US. 5 Redfield, 220.
Rolston,
(Will of Caroline A. Merrill.)
Deceased made a will in 1856, bequeathing all her property
to G., her adopted son, in reversion. G. subsequently married
against the wishes of deceased, which led to an estrangement
between them, and deceased thereafter manifested an intense
hatred for him; mutilated her will and his portrait, and in
various other ways manifested her displeasure ; made vulgar
charges against himself and his wife; and subsequently (in
1871) made the present will in which she ignored G.
Upward of 20 different witnesses testified to the rational
conduct, intelligence and conversation of deceased. She
traveled from place to place, crossing the ocean, paid her own
bills, kept a diary of her travels and books of account, wrote
various letters evincing judgment, coherence and discretion,
and showing no evidence of mental weakness.
ffeld, that while no reasonable doubt arose of her general
capacity to execute the will, the instrument propounded should
be refused probate because it was executed by decedent when
laboring under an zwsane delusion, the same being the direct
offspring of such delusion. See Miller vs. White, 5 Redfield,
320.
CasE IIJ.—ALTERATION OF WILL UNDER INFLUENCE OF
DELUSION— CopicIL REFUSED PROBATE.
Miller
US 5 Redfield, 320.
White,
(Will of Anna M. White.)
Testatrix executed a will in 1877, containing a legacy toa
niece. In 1878 her mind began to fail. She became untidy,
mean, vulgar, averse to company, abusive and suspicious. She
conceived a great dislike for her niece, and frequently accused
her of dishonesty. She also had delusions, believing that she
saw persons who were dead or not present. In March, 1878,
84 MEDICAL JURISPRUDENCE,
she executed a codicil to her will revoking the legacies to her
niece.
ffeld, that while the testatrix may not have been of unsound
mind she was the victim of an insane delusion at the time of
making the codicil, and that the codicil must be refused probate.
CasE IV.—IMBECILITY—WILL NOT ADMITTED TO PROBATE.
Townsend
US. 5 Redfield, 93.
Bogart,
(Will of Mary E. Hatfield.)
Testatrix could not read or write although she attended
school for three years ; could not count more than ten; could
not tell time by clock ; could not recall any ordinary event in
her life ; could not comprehend value of money or property ;
would make presents of pictures cut from magazines, and old
pieces of calico and silk ; and was easily lost in familiar streets.
She attended her own housework and was very devout and
regular in her attendance at church. She had a sister in an
insane asylum and was herself adjudged insane two years after
making her will.
Several witnesses testified that from impressions received
while conversing with deceased they believed her to be of
sound mind; but beyond the circumstances attending the
signing of the will no incidents of any import were adduced in
support of their belief.
Held, that decedent was not of sound and disposing mind
when she executed the will.
The question of so-called partial insanity arises in relation
to the will of a person of whose insanity no evidence can be
brought forward except the fact of a particular delusion.
Wharton and Stillé allude to the case of an eccentric old
woman who made a will disinheriting her brother who she in-
sanely believed had joined the Catholics, to whom she had a
strong aversion. ‘The decision of Lord Brougham in this case
has a healthy tone not often found in these days. He ex-
pressed his disbelief in partial insanity and held that the mind
was “one and indivisible, and if unsound on one subject, pro-
vided that unsoundness is at all times existing on that subject,
it is quite erroneous to suppose such a mind really sound on
other subjects ; it is sound only in appearance.”
THE LEGAL RELATIONS OF INSANITY. 85
CasE V.—EXISTING DELUSIONS NOT INTERFERING WITH
CAPACITY—WILL ADMITTED TO PROBATE.
Dickie
US. 5 Redfield’s R., 284.
Van Vleck,
(Will of Patrick Dickie.)
The testator executed the will in controversy in 1871. A
few days before its execution testator called upon the attorney
who drew the will, and who knew nothing of his financial or
family affairs, and gave him instructions with intelligence and
coherence as to its provisions. In 1874, the testator was ad-
judged a lunatic. It was attempted to prove by the opinions
of medical experts, based upon certain occasional acts and
delusions of the testator, that he was not of sound mind before
and at the time of the execution of the will. Among the evi-
dence relied on to support these opinions, was the testimony
of a servant to whom the testator stated in 1870, “that his
housekeeper was an English spy, and her numerous boxes
filled with gunpowder,” and that he ordered a barrel of flour
sent from the basement because it contained a dead body.
There was much conflicting testimony regarding the conduct
of deceased, both before and after he executed the will; for
while contestant’s witnesses testified to various strange sayings
and doings of decedent, several of proponent’s witnesses with
whom deceased had had frequent dealings for years, stated
that they observed nothing unusual or extraordinary in his
conduct during that time.
ffeld, that these occasional acts were not sufficient proof
that the testator was of unsound mind at the time of the exe-
cution of the will.
CAsE VI.—ALLEGED INSANE DELUSIONS IN REGARD TO
CHILDREN— WILL ADMITTED.
~ Leslie
US. 15 N. Y. Weekly Digest, 56.
Leslie,
Testator executed a will in December, 1879, and died Janu-
ary 8,1880. He bequeathed all his property to his wife, and
ignored his children, who contested the will. Testator received
an injury to his head twenty years before his death. Contest-
86 MEDICAL JURISPRUDENCE,
ants claimed that he had been induced to disinherit them
through insane delusions ; that considerable rivalry in business
had existed between himself and his sons; that they had
assisted in certain lawsuits against him ; that testator believed
from these circumstances that his sons were unfriendly to him
and his interests. That testator had lost all affection for one
of his sons because he refused to visit him when ill.
On the other hand it was shown that he had successfully
and intelligently conducted a large business for over twenty
years, and none observed in his conduct any word or act to
warrant the belief that his mind was impaired.
fTeld, that to constitute an insane delusion, something more
than an unwarranted conclusion from existing facts must be
shown.
CasE VII.—ALLEGED INSANITY OF TESTATOR NOT PROVEN
—FANCIED RESENTMENT NOT AMOUNTING TO INSANE
DELUSION—WILL ADMITTED.
American Bible Society
US. F20N; Yo Weekly Dicestae1s;
Stover,
Deceased was a man of peculiar temperament, of poor
health, of weak intellect, miserly, and wandering habits. He
became angered toward his family because of a fancied slight,
and manifested his resentment to an exaggerated degree upon
every occasion. It was conceded that he was not affected
with any form of general insanity.
ffeld, that this was not proof absolute of an insane delusion.
The Bristed will case was one in which no evidence of in-
competency was proven, although testimony was adduced re-
garding the testator’s insanity previous to the making of the
will. .
CasE VIII.
In Bristed
US. 5 Redfield’s Surrogate’s Court Repts. 529.
Weeks,
(Will of John J. A. Bristed.)
The testator, wno died in 1880, executed a will in 1871. In
February, 1873, he was examined at Paris by Dr. Blanche,
who caused him to be conveyed to a lunatic asylum, where he
remained under Dr. B,’s observation for a week, Dr. B. states
THE LEGAL RELATIONS OF INSANITY. 57
that in his opinion the decedent “was born under bad condi-
tions of cerebral heredity, and had never been, even in his
infancy, in a well balanced nervous condition, nor of a thor-
oughly sound judgment.” In support of this opinion he says.
_ “From his infancy, John J. A. Bristed was subject to nervous
crises, during which he uttered cries. He was never able to
fix his attention continuously. He could not remember what
he learned.” * % *
Another witness (Mrs. Caroline Carson), a friend of the
Bristed family, testified that the decedent was naturally good
natured, and she could not believe he would have been guilty
of the acts of violence he had committed, if he had been in his
right mind. That “as a child he seemed gentle and sweet-
tempered ; but as he grew older he seemed to be bereft of
reason. He would shriek like a wild Indian, and rush out of
the house like a madman without any cause. He would play
the piano for hours by day, and then get up in the dead of
night and go on playing. * * On returning home at night,
instead of ringing the bell, he would throw stones at the house.”
She concludes: “I saw him in 1877, when he was acknowl-
edged a lunatic. His talk was precisely the same I had always
known it.”
The Court says, after reviewing this testimony: “On the
whole, therefore, I do not feel justified in attaching much
importance to Mrs. Carson’s testimony which relates to the
testator’s mental capacity.”
Other witnesses testified that the testator was very nervous
and would get into a passion about very trivial matters ; also,
that he was “a little forgetful at times.”
With regard to the plea of hereditary insanity, the Court
says: “The circumstance that certain collateral relatives of
decedent, the descendants of his great-grandfather, have been
afflicted with mental disease, throws little light upon the ques-
tion—at what period of his life he first became its victim.
Evidence that he had an hereditary tendency to insanity does
not establish, of course, that such insanity was probably con-
genital, or that it declared itself at any particular stage of his
career. And besides, the evidence does not disclose the exist-
ence of insanity among his immediate family or his lineal
ancestry on either his father’s or mother’s side.”
ffeld, that at the time of the execution of the will, the dece-
dent “wes of sound and disposing mind and memory.”
Notr.—Beyond the statement that some twenty witnesses
stated that they saw nothing irrational in the conduct of de-
5S MEDICAL JURISPRUDENCE.
ceased at the time of his departure for Europe in 1871, there
is no further reference to the testimony in support of his sanity
in the report of this case. The opinion of the Surrogate seems
to be based mainly on the failure of contestants to prove mental
unsoundness of deceased.
I examined Mr. Bristed during the last year or two of his
life, and though at the time he suffered from a light grade of
chronic mania, there was no reason to believe he did not pos-
sess testamentary capacity ; in fact, his will was an exceedingly
just one, the principal legatee being a sister who had not fared
as well as hein the original division of the property. ‘The con-
testants were his step-mother and an infant half-brother.
Case IX.—INSANITY EXTENDING OVER A LONG PERIOD, NO
EVIDENCE OF . DELUSIONS AFFECTING ‘TESTAMENTARY
CAPACITY—WILL DECLARED VALID.
Kingsbury
US ne 32 Louisiana Annual Reports 1055.
Whitaker,
G. M. Bowditch died August 1, 1877, leaving a will dated
June 24, 1876, bequeathing all his property to his sister, Mary
Ann Fiske. He had been a successful business man and had
accumulated some property, but during the late war and the
corrupt administrations which followed it, he met with serious
losses which, as he himself says, rendered him “‘irascible, sad
and despondent.” He became subject to violent paroxysms
of rage which rendered him for the time being insane, and he
was frequently confined in jailandin asylums. His relatives fin-
ally procured his confinement in an asylum in Massachusetts,
from which he was released 1n 1874. Thereafter he manifested an
intense dislike for the said relatives, particularly his brother-in-
law, Rev. Mr. Dowse, whom he styled “an orthodox thief ;”’ but
it appeared that his mother was living with said Dowse and that
he was paying $3.00 a week for her board, and that Dowse had
demanded more as she was growing old and troublesome. It
appears that when under one of his insane attacks he would
gather from the streets cigar stumps and other refuse, and pre-.
serve them as valuables. His letters written between 1864 and
1877, both before and after his temporary fits of insanity, prove
him to have been a man of great intelligence and learning,
and a close observer of men, ‘There was no direct proof that
he was insane when he executed the will ; on the contrary it is
shown that he drew the will himself, and both the witnesses
THE LEGAL RELATIONS OF INSANITY, 59
who attested it say that he spoke very rationally on that occa-
sion. ‘There is also a letter written by him July 14, 1876, in
which he speaks of the proceedings instituted to have him de-
clared insane and of the plans he has formed to resist them.
This letter is very coherent and full of sound reasoning,
On appeal, the Supreme Court declared deceased to have
been sane when he executed the will.
CasE X.—ALLEGED DELUSIONS IN REGARD TO SONS, NOT
PROVEN HOWEVER—WILL SUSTAINED.
(Will of Ebenezer W. Cole, 49 Wisconsin Reports 179.)
Ebenezer W. Cole executed his will January 1, 1872. He
died Nov. 4, 1878 aged 78 years. He left two children, one
(Elliott G.) by his first wife, and one (Rinaldo) by his second
wife, from whom he was divorced in 1869, and a widow whom
he marriedin 1870. ‘The will which left the bulk of his property
to his widow was contested by the sons on the ground of insanity.
It was shown that about 1863 deceased conceived the idea that
his wife was untrue and that Rinaldo was not hisson. No
ground for this belief was shown. In 1864 deceased and his
wife separated, and in 1869 he procured a divorce under the
Wisconsin statue, making five years’ separation ground therefore.
Deceased was in the habit of taking large quantities of mor-
phine and chloral daily, but ceased using the chloral a few days
before he executed the will, and it was claimed that his mind
was seriously affected thereby. No other evidence was given
to prove testator’s insanity.
In sustaining the will the Supreme Court held that as there
was no proof that deceased was laboring under the delusion re-
garding his son Rinaldo at the time of its execution, the will
was valid.
Case XI.—ALLEGED INSANITY (PROBABLY BAD TEMPER AND
HyYsTERIA)—WILL ADMITTED TO PROBATE,
Coit.
US. 73 .N aX. 533
Patchen,
Emily Coit died in June 1875 aged 67 years. Her will was
executed Aug. 1,1874. She left real estate valued at $150,000.
The will was contested on the ground that testator labored
under delusions regarding her husband and some of her chil-
dren; that she believed her husband had held improper rela-
90 MEDICAL JURISPRUDENCE:
tions with othér women ; that she showed no affection for some
of her family ; that her daughter, Mrs. Grey, was ill-treated by
the rest of the family (because she had sympathized with cle-
ceased in a divorce suit between her and her husband, and had
stood by her in all her domestic troubles) ; and that she (Mrs.
Grey) was in danger of coming to want, that these delusions
were the result of illness in 1868. It was shown that she was
jealous of her husband and once struck him for looking at
another woman ; that they often quarreled, and lived apart sev-
eral times ; that at one time a divorce suit was pending between
them. That her son had assaulted her and been convicted
therefor. It was also shown that after her illness in 1868 and
up to the time of her last illness she continued to manage her
estate with intelligence and prudence, as she had done thereto-
ROS
The Surrogate made a decree admitting the will to probate,
and on appeal both the Supreme Court and Court of Appeals
affirmed this decision.
Kecentricity in Relation to Testamentary Capacity.
—Mere disproportion in the division of property or eccentricity
are not necessarily evidence of testamentary incapacity, and
although the law is very careful in regard to the question of un-
due influence, great care should be taken to distinguish between
cases in which the individual defers with perfect propriety to
the suggestions of intelligent and life-long friends instead of bad
children who never have shown any filial respect or interest in
the testator until the question of the division of property is
raised. When, on the other hand, a kind father, whose rela-
tions with his children are of the pleasantest kind, becomes,
during the latter years of life, morose, irritable, and shows un-
warrantable dislike, neglect, with moral and intellectual weak-
ness grave doubts arise.
Eccentricity should not be misunderstood and looked upon
as disease, nor should superstitious belief, or the striking ex-
aggeration of character of old age we sometimes find, which,
however, are perfectly consistent with mental integrity. In
the Bonnard will case the testator, an old man, left a
large sum of money to the Society for the Prevention
of Cruelty to Animals, and a clause was inserted pro-
viding for the care of certain dumb beasts. At first this
was looked upon as a positive sign of mental unsoundness,
but when it transpired that the aged testator was a believer in
metempsychosis, the rational character of the act was manifest.
THE LEGAL RELATIONS OF INSANITY. gt
The belief in spiritualism or Swedenborgianism or any other
ism which, perhaps, leads the testator to leave a legacy to some
religious body, no matter how irregular, is not necessarily in-
sanity and should not be so considered.
In courts of law it is often contended that because the indi-
vidual wears certain loud colors and ungainly, conspicuous
dress, or because he eats, or drinks, or walks, or sleeps in an un-
usual way, he is of unsound mind. Not only life-long pecu-
liarities, but personal traits which may be the offspring of igno-
rance or vanity or even vulgarity, may sometimes be sufficient
in the eyes of snobbish or ungrateful children to stamp their
progenitor as of unsound mind.
CASE XII.—RELIGIOUS ECCENTRICITY—WILL ADMITTED TO
PROBATE.
Hartwell
v. 4 Redfield, 389.
McMaster,
Deceased executed his will on September 25, 1880, and died
October 1, 1880, aged 72 years, leaving no children. He had
been in business in New York city, had taught school, preached,
and had some knowledge of electricity. On behalf of contes-
tants it was claimed that testator lacked testamentary capacity,
and it was shown that he did not believe in the doctrine of the
“Real Presence” or transubstantiation, nor in the necessity of
baptism in infancy. That he lived alone and locked himself in
during his last illness ; that he had once disturbed a religious
meeting by abusing the minister; that he wished to attend a
public school as a pupil; that when over 60 years old he fell in
love with a girl of 12.
Held that this was not sufficient to prove that testator was
insane or lacked testamentary capacity.
The question of the effects of bodily disease upon the mind
is a favorite one sometimes, though several important cases
have been decided adversely when such an issue has been
raised. A familiar case is that of
La Bau
v. 3 Redfield, 384.
Vanderbilt,
(Will of Cornelius Vanderbilt.)
Case XIII.
The deceased executed his will in 1875, bequeathing most of
g2 MEDICAL TURISPRUDENCE.
his property to his son Wm. H. The will was contested by
his daughter, Mary A. La Bau, on the ground, among others,
that deceased was not of sound mind and memory. After his
death an autopsy was held and revealed the fact that deceased
was afflicted with several chronic and painful diseases which
most of the medical experts agreed had a tendency to affect
the mind. It was testified that deceased had stated that he was
the railroad king of America ; he had also said that his memory
was failing him; that deceased was ambitious, excitable,
violent, and irritable; that his mind vacillated for some time
before he made his will as to whether he would distribute his
estate equally among his children as he had expressed an in-
tention of doing years before, or whether he should bequeath it
as the present will provided ; he was very capricious in his likes
and dislikes of his children ; that he was credulous, suspicious,
talkative, vain; that he contemplated a monument 100 feet
higher than any other; he believed he received spiritual com-
munications regarding the terms of his will and business affairs.
On the other hand many eminent persons who had known
him for years, and transacted business with him, testified to his
intelligence and good judgment down to his last illness. Re-
garding the autopsy, it was shown that the brain of deceased
had not been examined, and it was claimed that the surmises
as to the probable effect of the diseases upon the mind of de-
ceased.
ffeld that there was no evidence that deceased was of un-
sound mind and memory.
Case XIV.—WILL oF ALLEGED “ KLEPTOMANIAC” OF ECCEN-
TRIC HABITS NO EVIDENCE OF INSANITY—WILL Sus-
TAINED.
Wi
eee pees a 33 N. J. Equity Reports, 219.
Joseph L. Lewis died in Hoboken, March 5, 1877, aged 86
years, leaving considerable property. On October 1, 1873, he
executed his will, which, after making several bequests, directed
that the remainder of his estate be applied in reducing the na-
tional debt of the United States incurred during the rebellion
of 1861. The attorney who drew the will stated that there was
much care and consideration given to the will by the testator,
he himself making the memoranda for its preparation, and
‘that a draft of it was made and submitted to him before it was
THE LEGAL RELATIONS OF INSANITY. 93
executed ; that he was very solicitous about some stocks and
bonds deposited in New York city, and wished the will drawn
so that they would be disposed of by it ; that his mind was per:
fectly sound and his memory good. It was claimed, however,
that he was a kleptomaniac ; would pilfer articles of small
value ; toward the close of his life he became miserly ; used
profane language; was unclean and careless in his personal ap-
pearance. It was proven, however, that in his business trans-
actions he was, up to the time of his death, shrewd, prudent ;
that he never manifested any symptoms of an unsound mind ;
was suspicious; had an iron will; of strong attachments; of
strong antipathies ; always made good investments.
The Prerogative Court, in admitting the will to probate, held
that there was no evidence of unsound mind. His bequest to
the United States was evidence of a lofty attachment and fidelity
to his country—not of his disordered imagination.
CasE XV.—INCOMPETENCY TO MAKE A WILL ALLEGED TO
BE DUE TO BRIGHT’S DISEASE— WILL SUSTAINED.
Mairs
US. 3 Redfield, 181.
Freeman,
(Will of James Mairs.)
The testator in this case had in his will mistaken the order
of birth of two of his children ; had misstated his own age, and
had neglected certain grandchildren in his will. He had been
suffering from Bright’s disease in connection with other
diseases for two years previous to his death, and it was claimed
that his intellect had been impaired thereby. There was
no direct testimony of the mental unsoundness of deceased,
but there was conflicting testimony by medical doctors as te
the effect of Bright’s disease, etc., on the mind.
fTeld, that deceased was of sound and disposing mind.
Cask XVI.—TESTAMENTARY CAPACITY ALLEGED TO BE
DESTROYED BY INSANITY RESULTING FROM CANCER—
WILL SUSTAINED.
Fraser
US. 42 Michigan Reports, 206.
Jennison,
This was a contest of the will of the late Alexander D. Fraser,
of Detroit, a leading member of the Michigan bar. The will
was dated May 17, 1877. The evidence showed that deceased
04 MEDICAL JURISPRUDENCE,
was over eighty years old and had been suffering for over
twenty years from a cancer on the nose which ultimately con-
sumed the flesh on one side of his face and also his eye, and
from which he finally died on August 2, 1877. Prior to the
winter of 41876 he had been very fond of society, had- always
been neat in appearance, and had always been kind and con-
siderate to the members of his household ; but after that time
he secluded himself, became slovenly, and frequently abused
and assaulted the members of his household. He was eccen-
tric in dress and at the execution of the will appeared dressed
In anight-gown and Scotch cap. After the execution of the
will (in May, 1877,) and up to the time of his death he fre-
quently had delusions and raved to such an extent as to dis-
turb his neighbors. On these facts five physicians believed
him insane. On a trial before the jury a verdict was rendered
sustaining the will, which verdict was, on appeal to the Supreme
Court, affirmed.
CasE XVII.—WILL MADE By LUNATIC WHEN INSANITY
FOLLOWED ORGANIC DISEASE oF BRaiIn.—NOT SvUS-
TAINED. (Was probably incompetent for some time before the
will was signed.)
(Matter of Sarah M. Blakely’s Will, 48 Wis. 294.)
Sarah M. Blakely executed her will April 7, 1876, and it was
contested by her husband on the ground of insanity. It
appears that she had a stroke of apoplexy in December, 1875,
and for some time thereafter was subject to paroxysms of grief
and crying. In April following she executed the will. In the
summer of 1876 she had another stroke of apoplexy, and on
Sept. 26 was sent to an insane asylum, where she died March
10, 1877. In February, 1876, she wrote several clear and co-
herent wills. For a long period she had manifested a great dis-
like for her husband and entertained groundless suspicions of
him. She was nervous, flighty, excitable and hysterical, dis-
contented and unhappy. Dr. Barnett who attended her says
that after the paralytic stroke in December, 1875, her mind be-
came enfeebled and that she was suffering from dementia and
did not consider her in a proper condition of mind to attend to
business in the spring of 1876. Drs. Hunt and Russell testi-
fied as to her condition before the paralytic stroke, that her
conduct might be the result of nervous excitement or childish-
ness. Dr. Kempster, Superintendent of the asylum in which
deceased was confined, from an examination made in Septem-
THE LEGAL RELATIONS OF INSANITY, 95
ber, 1876, believed her to have been of unsound mind in
April, 1876.
The Supreme Court (on appeal) he/d that deceased was
laboring under no insane delusion when she executed the will ;
that she did not lack testamentary capacity ; and that the will
was correctly admitted to probate.
CasE XVIII.—CEREBRAL DISEASE, SOFTENING, DEMENTIA,
UnbDvuE INFLUENCE—WILL NOT SUSTAINED.
Cherbonnier
US. 56 Maryland Reports, 276.
Evitts,
Seth H. Evitts died September 22, 1877, aged eighty years.
On August 27, 1875, he executed a will bequeathing to plaintiff
all his property with the exception of a few small items. On
April 2, 1876, and September 22, 1876, he made two other
wills which were substantially the same as the will of 1875, the
only change being in the minor bequests. These wills were
severally offered for probate but rejected on the ground that
testator was not of sound mind when he executed them,
and the will of 1875 was probated.
On December 20, 1876, deceased executed a deed to defend-
ants, transferring most of his real estate. His deed it is now
sought to set aside on the ground of mental incapacity in the
grantor.
In setting aside the deed the Maryland Court of Appeals
said, in reviewing the evidence, that after the execution of the
will of September, 1876, the defendants, through false state-
ments, produced in the mind of deceased an insane delusion
that plaintiff was treating him badly and robbing him of his
property ; that he had always been on affectionate terms with
plaintiff ; that there was no grounds for the delusion. That
he had several strokes of apoplexy in 1876, and was perma-
nently paralyzed ; became imbecile ; was childlike ; had few
ideas ; his mind became inert; was easily controlled and in-
fluenced ; his memory failed; was unable to walk without
assistance and required constant attendance; his hobby was
politics.
On this evidence the court held that deceased was not com-
petent in mind when the deed was executed.
96 MEDICAL JURISPRUDENCE.
CasE XIX.—WILL—PREvious History or CEREBRAL Dis-
EASE—IMPROPER ADMISSION OF EVIDENCE—WILL Sus-
TAINED ON APPEAL.
Brinkman
US. 71 Missouri Reports 553.
Reieggesick,
Deceased, some years previous to his death, had a sun-
stroke, and although he had previously been sane and rational
he thereafter became imbecile and unable to read or write ;
did not care for money; never transacted business with any
one. Shortly before his death he executed his will, which is
now offered for probate. ‘The witness to the will testified to
his soundness of mind at the time it was executed. On the
original trial the Circuit Court received the testimony of sev-
eral witnesses as to rumors of the insanity of deceased, and
rejected the will on the evidence.
On appeal the Supreme Court reversed the judgment on the
ground that the Court erred in receiving hearsay testimony as
to testator’s incapacity.
Undue Influence.—Medical witnesses are frequently asked
to express an opinion whether the patient’s mental disease is
not such as to make him an easy prey to designing friends and
relatives, who may have ends of their own to gain, and through
the agency of undue influence may lead or force the person to
dispose of his property in a way he would not were he in full
possession of his faculties. It is sometimes a difficult matter
to give such an opinion, for although the physician may have
no doubt of the mental status of the testator, he is often bound
by rules of evidence to answer a badly-drawn hypothetical
question which is unscientific and negative. Undue influence
may be brought to bear in cases where through disease the in-
dividual is either unable to reason correctly, or where, to avoid
opposition and worry, he injudiciously accepts the arrange-
ments made by other people, or where his will power is so
much impaired that he cannot resist well directed and decisive
demands of interested plotters. The suspiciousness and unrea-
sonable delusions which the insane man harbors towards those
he has always loved are very often played upon by interested
persons, and in certain stages of mania and melancholia as well
as the first stage of dementia, it is possible to lead the insane
THE LEGAL RELATIONS OF INSANITY. 97
individual to do many unjust acts under the delusion that
indignities have been heaped upon him, and that insults and
slights have been offered to him. It may readily be seen how
the subject of religious melancholia may be made to give all
his money to the church, and instances of this kind are ex-
ceedingly common, especially when the testator is a woman
who is tortured with ideas of future unrest and punishment.
The majority of cases where undue influence is alleged to
have been exercised are those where there is a history of de-
mentia in old people. The senile dement is prone to make
foolish and trivial disposition of his property, and particularly
is this the case when he is aided by designing people who sur-
round him, and the individual of this kind is very apt to be
easily turned from his original purpose by fresh suggestions or
new influences. He is liable to imposition and unjustifiable
prejudice. The Carlton-Gates case, reported by Dr. Lee, is
one which may be adduced as an example where a will had
been made as the result of undue influence. In this case the
testator was of insane temperament—‘“‘ was impressionable to
subtle and usually unrecognized influences,” and under the
dominance of a delusion which had been created by a very
dear and “ particular friend”’ he committed an act of injustice
which was clearly the result of his insanity. “ When it is con-
sidered that just before his last visit to Europe, Gates had
made a will restoring the whole of his property to his mother,
and that it remained unaltered until his weak and perverted
mind had been thoroughly poisoned against her, and nearly up
to the time of his death, when a new will was executed revok-
ing his former bequests in favor of the very individual who it
is proved had caused the new will to be made, and who had
had sole charge of Carlton’s person for the last two weeks of
his life; such an instrument appears so unreasonable, so un-
natural and unjust on its very face, and bears upon it such
irresistible marks of intrigue, dishonesty and fraud, that it must
necessarily be rejected.
“In forming a judgment in this case in regard to the state
of mind of the testator,”’ says Lee, “ I also find sufficient evidence
of insanity 77 the nature of the wiil itself. To say nothing of the
strange and unnatural nature of the bequests themselves, prov-
ing conclusively the change of feeling and disposition already
referred to, the confident expression of Carlton’s belief in the
fact of his having been fotsoned notwithstanding the positive
assurance of all his physicians that such was not the fact—the
direction to have the contents of his stomach analyzed for the
7
98 MEDICAL JURISPRUDENCE.
detection of poisons, supposed to have been administered
many months before—he being a medical man ; the appropria-
tion of $25,000 (at first named $50,000) for the prosecution of
certain suspected persons not named in his will; the gift of
the Yonkers estate to the corporation of Yonkers, although he
knew he had no legal title to it and was only trustee of the
property; the false statement in regard to his father and
mother, and her income, imbecility, etc., etc. ; when to all this
we add the extraordinary fear and suspicion of detection and
atscovery, during the drawing and execution of the will, direct-
ing “doors to be carefully closed,” and “to see that no one
was about,’ who might possibly hear what was going on—all
this so characteristic of the cunning and secrecy of the insane,
proves, in connection with the other circumstances, the posi-
tive insanity of the testator. There was, undoubtedly, reason
enough remaining to render him conscious that he was about
doing a wrong, perverse and wicked act, for the insane are
often able to distinguish between right and wrong, for, as soon
as the will was executed, he exhibited no fear or suspicion
whatever.”
In general paresis the individual is very apt to squander his
property and to fall a prey to the many parasites who are ever
ready to take advantage of his donhommie and boastful good
nature. In a recent case the paretic whose illusions of grand-
eur were of the most magnificent character became involved
in a variety of schemes devised by ingenious sharpers, and
when legal proceedings were instituted it was found that he
had gone so far as to buy for his new friends a cargo of bric-a-
brac, and to secure a place for the sale of the same he had
bought up the stock of the occupant of the store, spending
$30.000, so that his friends might take immediate possession,
In patients suffering from the first stages of the disease, it may
readily be seen how any one, by judicious flattery and acqui-
escence in the startling projects and ideas of the individual,
may wheedle him into parting with property.
In other forms of organic insanity a condition of mental
feebleness akin to dementia is manifested by irresolution,,
irritability or intellectual torpor. It will frequently. be found
that disease of the cerebral vessels, especially on the left side.
of the brain, is very apt to be followed, if at all extensive, by:
degeneration of the mental faculties ; and if such degeneration.
is followed by an early fatal result, and a biased and unjust.
will is made even though there can be brought forward very:
few instances of mental irregularity, still we should question
THE LEGAL RELATIONS OF INSANITY. 99
the ability of the patient to withstand the arguments of inter-
ested friends.
Softening is so common after accidents of the kind men-
tioned above, and is so frequently symptomatized by loss of
memory, indecision and childishness that intellectual compe-
tency should always be questioned.
CAsE XX.—UNDUE INFLUENCE—WILL NOT ADMITTED TO
PROBATE.
Greenwood
US. 7 Oregon Reports, 17.
Cline,
On October 12, 1872, Mrs, Elizabeth Greenwood, then 62
years old, executed her will. She died August 9, 1875, leav-
ing an estate worth $26,000. By the terms of her will she be-
queathed to two of her children, Eliza Smith and William
Greenwood (the contestants) $100 each and the residue of her
estate to Olive Newsome, a granddaughter and Mrs. Mary
Cline her remaining child. The will was contested on the
ground that the testator was of weak mind at the time it was
executed and unduly influenced. It was not claimed, however,
that she was incapable of executing the will but that she was
laboring under a delusion with regard to contestants brought
about by the undue influence exercised upon her weak and im-
paired mind by Mrs. Clineand Mrs, Newsome. Upon the trial
of the issues in the County Court the will was rejected, the
court holding that while deceased had testamentary capacity
the will was executed under undue influence. On appeal to the
Circuit Court this judgment was reversed and contestants then
appealed to the Supreme Court who reversed the judgment of
the Circuit Court and rejected the will, on the same ground
taken by the County Court, and also sustained the claim of
contestants that deceased was laboring under a delusion regard-
ing them at the time she executed the will. The evidence which
is voluminous shows that deceased had a severe attack of par-
alysis in 1866 from the effects of which she never recovered ;
that her memory became defective ; she could not tell who was
working for her; would lease a piece of land and forget it next
day ; would ask the same question repeatedly. Two medical
doctors who had known deceased testified that she was very
despondent ; was different from the majority of people; at
times exhibited mental obliquity: her mental powers were im:
100 MEDICAL JURISPRUDENCE.
paired. Others testified her eyes had a dead expression ; she
sometimes acted like an intoxicated person; in 1872 she was
peculiar in her conversation ; would stop short while making a
remark and fail to finish it; was absent minded; while ill she
imitated with empty hands the action of a person breaking a
piece of quartz and examining for gold ; she very readily gave
up her opinions and would side with any body who disputed
them ; that while going from Salem to Howell’s Prairie alone,
she became turned around in the road and was coming back to
Salem without knowing it ; that she did not appear cheerful or
laugh ; paid no attention to her housework ; she was frequently
told that her mind was not right. That on the day she exe-
cuted her will she submitted herself to a short examination by
two doctors from whom she obtained a certificate of her sound
mind and competency to make a will. That Mrs. Cline by
means of a pretended communication from her deceased hus-
band obtained through a spiritual medium, stating that her son
John W. was a rough character and would squander her prop-
erty and that she should get it all out of his hands, produced a
delusion in her mind regarding the character of her son. There
was some evidence on behalf of proponents regarding the
sanity of deceased but as this was admitted it is not necessary
to give a resumé of the evidence.
The will was rejected on the ground of undue iufluence ;
that it was the offspring of a delusion regarding the contest-
ants.
Undue Influence in Relation to Crime.—Undue influ-
ence directed to make another an accomplice in crime is rare.
Imbeciles are sometimes persuaded to do acts of violence at the
instance of designing persons. ‘Therisks are too great and the
danger of discovery too probable, and we rarely find that the
pressure of influence is brought to bear as it is in civil cases.
A case of this kind where the individual confessed his crime
under the dominion of an hallucination is that of Lecouffe.
Lecouffe, a young man, aged twenty-four years, accused of rob-
bing and murdering an old woman, was brought before the Court
of Assizes, Dec. 11, 1853, condemned to death and executed.
In the opinions of those who knew him he had always been an
imbecile. His mother, notoriously immoral, had entire
control over him. He accused her of instigating him to
the commission of the crime, and so great was her ascendency
over him that he was not at all times able to sustain this charge
in her presence. He had some matrimonial projects, and his
THE LEGAL RELATIONS OF INSANITY. IOL
mother taking advantage of his imbecility had bribed his ac-
quiescence in the perpetration of the crime; and she had be-
sides appropriated almost exclusively the proceeds of the theft,
since, out of the sum of two hundred and fifty francs, she gave
him only forty.
Lecouffe at first denied the charges, but finally made a full
confession. This change appears to have been very singularly
produced. Theday after the murder, the ghost of his father
had appeared before him, commanding him to tell the truth ;
and he had heard the voice of God promise his pardon on this
condition.
In prison the jailors were surprised at his mental weakness,
and his incoherent and puerile language. They witnessed sev-
eral returns of convulsive attacks, at the end of which a prey to
hallucinations, he uttered dismal cries. These paroxysms oc-
curring during the trial, did not prevent the prosecuting at-
torney from inferring the absence of insanity; and he could
only perceive in the false perceptions of the accused the re-
morse of a guilty conscience.
In explaining these several particulars, Georget has _ skillfully
shown the fallacy of the premises on which the verdict was ren-
dered. To him, the early date of his disease, and the frequen-
cy of his attacks, his uniform stupidity, his abject submis-
sion to his mother’s will, the strange phenomena observed in
prison, and which were probably not unusual to him, were all
so many proofs that the condemned did not possess full free-
dom of will; and with insufficient moral perceptions, a nature
weak and uneducated, he was fatally predisposed to serve as a
ready instrument to any foreign suggestions or to his own bad
passions. Brierre de Boismont in commenting upon the above
case says: “I admit that the mere finding that this patient had
obeyed an obvious selfish interest, dissented from the conclu-
sions of Georget, but we have seen that the intention which
governed the act does not necessarily imply the possession of an
independent volition. Hence the elements of the case upon
which Georget rests his view are such as to attach us to his
opinion.”
The Medico-legal Relations of Aphasia.—The question
of apoplectiform attacks in connection with apfasta arises fre-
quently in cases in which the testamentary capacity of an indi-
vidual is questioned. The occurrence of general arterial de-
‘generation with its attendant accidents, is one which very often
invalidates the patient’s capacity to know the objects of his
102 MEDICAL JURISPRUDENCE.
bounty and dispose of his property in a sagacious manner.
The first indication of cerebral mischief may be tendency to
attacks of cerebral congestion with irritability of temper, forget-
fulness, a disposition to burst into tears and a condition of ex-
citement, succeeded by very marked intellectual disorder
amounting to dementia. ‘There may be attacks of hemiplegia,
and they usually closely succeed each other. In connection
with these there may be a condition of asemasia (aphasia),
which gives rise to speech defects as well as inability to com-
municate by writing. The question of aphasia suggests sev-
eral points. (1). Whether the condition be such as to prevent
the individual from communicating to others the ideas he in-
tends toexpress. (2). Whether his affection of intellect is such
as to prevent him from recognizing the mistakes he may make
in talking and writing.
Aphasia with Responsibility.—In the determination of
the importance of aphasia as a symptom in any particular case,
we must discover whether or no it is connected with insanity.
In a will case in which I was recently called to testify, the pa-
tient had an attack of right hemiplegia with aphasia. She had
always been a person of weak mind and her mental degenera-
tion deepened towards the later years of her life. A peculiarity
of her aphasia, which was complete, was that she reversed
“yes” for “no,” and then her state of intellect was such as to
prevent her from realizing her mistake. Dr. Bancroft* reports
the case of a farmer who was aphasic and insane. He could
read printed or written words, could see the figures upon dom-
inoes, but could not understand spoken words and he denied
being able to read. He was unable to understand that he was
speaking incorrectly. This very point is one that has medico-
legal importance. The sane aphasic is usually apt to realize’
his mistakes and either attempt to correct them or express
annoyance. ‘The insane aphasic makes no such attempts and
his mental condition is not indicative of the fact that he retains
cognizance of his error.
Case XXI.—One of the most celebrated cases is that of Del-
afield vs. Parish. The following report is to be found in
Wharton & Stillé’s Medical Jurisprudence and is an abstract
from a very interesting account of the case published in the ©
American Journal of Insanity (Oct. 1862): The alleged loss ©
* Boston Medical & Surgical Fournal, Vol. civ No, 21 p. 483,
THE LEGAL RELATIONS OF INSANITY, 103
of understanding on the part of Mr. Parish was as usual depend-
ent upon physical disease. He had threatenings of cerebral
disturbance for several years before his attack of apoplexy and
paralysis in 1849, and had hereditary tendency to disorders of
that nature. The shock of this final attack rendered him in-
sensible and convulsive for several hours.
It was soon discovered that his right side was paralyzed.
His physicians characterized the seizure as “ hemiplegia” lead-
ing to “defect of motion not of sensation,” and implicating
“the right arm and right leg, and also the organs of speech.”
He subsequently acquired a slight control over the right leg, but
- the arm,which improved somewhat after the first six months im-
mediately after the attack, afterwards entirely lost its power.
The left arm and leg were not permanently affected by
paralysis.
It is stated that Mr. Parish recovered, in a considerable de-
gree his strength after the first shock, and that during the re-
maining seven years of his life he enjoyed good, but not unin-
terrupted, health. He suffered from a severe and painful dis-
ease of the bowels, in Oct. 1849 ; subsequently, he had a num-
ber of attacks, “distinct from the general disease, but the
most frequent dependent upon its cause, or, in other words,
dependent upon the condition of the brain which led to the
disease.”
“He had one or more severe attacks of cholera morbus, one
or more of inflammation of the lungs, an abscess formed at one
time under the jaw, which became so large as to threaten suffo-
cation, and there were several minor attacks from time to
time.”
In addition to these disorders, ever after his apoplectic at-
tack, Mr. Parish was subject, at regular intervals, to spasms or
convulsions, the intervals extending from one or two weeks to
six months, and evena year. Their approach was preceded
by despondency and irritability on the part of the paralytic,
and after the convulsion had passed off, he was generally bet-
ter and brighter than he had seemed before. The convulsions
are described as commonly coming on suddenly with a noise in
the throat resembling a shriek or scream, a violent reddening
of the face, and a convulsion of the whole body—the muscles
becoming alternately rigid and relaxed. Some of these parox-
ysms were so violent as seriously to threaten a fatal result. It
was the opinion of Mr. Parish’s attendant physician that they
were “connected with the condition of the brain left
by the apoplectic attack.” The main feature of Mr,
104 MEDICAL JURISPRUDENCE,
Parish’s final illness was congestion of the lungs, but it was a
complicated disease depending, also, in the opinion of his phy-
sicians, upon the condition of the brain.
His power of speech was mainly abrogated on his ek attack
and from that time to his death he was never able to utter any
thing except a few imperfectly articulated monosyllables.
These were principally ‘yes’ and “no,” which he pronounced
very imperfectly, and there is even great doubt whether he ever
uttered them intelligibly.
He expressed himself most frequently by the use of unarticu-
lated sounds. These are described by witnesses as sounds re-
sembling the syllables, “yah, yah, yah,” “nyeh,” “nin, nin,”
‘yeah, yeah, yeah,” and others of a similar character.
He accompanied thése sounds by gestures and motions of
the left hand and arm, and by nodding or shaking his head.
The gestures usually consisted in his waving his hand in differ-
ent directions with his fingers extended, putting his fingers in
his mouth, or raising his hand and shaking it. The external
‘senses, feeling, hearing and smelling, do not appear to have
been seriously affected. His eyesight was always more or less
imperfect.
He would occasionally look at books and papers, but the
preponderating evidence was that he could not read at all. An
attempt was made to induce him to write with-his left hand,
but after several trials with paper, slate and blackboard, which
in one or two instances, resulted in his writing after a copy the
first few letters of his name in very doubtful characters, the at-
tempt was abandoned.
Block letters were procured, but he could not use them, and
pushed them away. A dictionary was suggested, but whether
the trial was ever made or not, he never adopted that method
of communicating his ideas. It was the constant practice of »
Mr. Parish’s nurses, in accordance with his wife’s directions,
to read the newspaper to him, but the proponents failed to
prove that he ever manifested comprehension of what was thus
communicated, or exhibited any intelligent interest in the
reading.
Subsequent to the attack he was never entrusted with the
management of his own affairs, nor allowed to have money in
his possession. He could not supply his own wants, and was
washed, dressed, and attended at table like a child, and was
even frequently unable to control his evacuations,
His wishes, as might be expected, were not easily ascertained.
He expressed, by rarticulere sounds and motions before re-
~<
THE LEGAL RELATIONS OF INSANITY. 105
ferred to, that he desired something, and various suggestions
would be made by those attending him until he expressed as-
sent, though it often happened that it was utterly impossible to
comprehend him, and the attempt would be abandoned by
both parties. He would also assent to contradictory sug-
gestions,
Before his attack, Mr. Parish is described by his relatives
and acquaintances as.a “placid and unexcitable man,” of great
self-respect and with great command of temper; “his manners
were mild, gentle and unruffled;” a quiet undemonstrative
gentleman, rarely exhibiting any emotion, and deeply absorbed
in his commercial transactions.
After his attack he manifested a marked change of disposi-
tion; he occasionally shed tears; and, in several instances, ex-
hibited a want of appreciation of the requirements of decorum,
and even of decency. He had, occasionally, uncanny freaks
and caprices, such as searching for his clothes in impossible
places, going out to see the moon, and making excursions to
the garret and the cellar, for no ascertained purpose ; and it
sometimes became necessary to use physical force to prevent
him from undertakings which threatened his personal safety.
He exhibited some recollection of his former daily and fami-
liar places of resort, and of his former habits of business, which
he would attempt, in trifling matters, to resume, as, by pulling
out his watch when he passed the City Hall clock, or insisting,
when driven out, upon being taken to the Bank of which he
was once a Director, or to his old office, or to various trades-
men with whom he had been in the habit of dealing. In addi-
tion to these, the proponents, who contended that Mr. Parish’s
intellect was never materially impaired, brought forward many
particular instances in which it was claimed that he manifested
undiminished intelligence. One or two of these may be men-
tioned.
It was said by one witness: “‘ Having been riding out of the
city, he would take his watch out of his pocket, look at it, turn
round and look at me, when I would ask him if he wished to
return, if it was late or about his usual drive; he would say
‘yes’ and nod his head.” Elsewhere, the same witness says :
“T recollect, on one occasion, the dining-room clock was run
down; when he pointed at the clock, I perceived that it had
stopped ; remarked to him that it had stopped, and I would
wind it up, when he nodded his head.” An old acquaintance
testified that he recalled to Mr. Parish a ridiculous circumstance
that had happened to them in company, many years before, and
106 MEDICAL JURISPRUDENCE,
that Mr. Parish “gave him to understand that he recollected
the circumstance, and laughed at it quite heartily.” These in-
stances, however, of which the above are specimens, were iso-
lated, and taken together were not deemed of sufficient signifi-
cance to avoid the conclusion derived from the facts before
stated.
In regard to the actual execution of the codicils, it seemed
that the counsel employed to prepare them read them to Mr.
Parish in the presence of the subscribing witnesses, put to him
the requisite formal questions, and received from him by sound
and gesture, as usual, what were supposed to be affirmative re-
plies. The counsel then assisted Mr. Parish by guiding his
hand while he made his mark. At least this was the case at
the execution of the first and second codicils; there was no
evidence whether or not he received assistance in making his
mark at the execution of the third.
Such were the main points of the case presented to the Court
of Appeals. The opinion of the Court was delivered by Judge
Davies, from which we quote the comments upon the facts
which we have narrated, and the conclusions, in which the ma-
jority of the Court concurred.
After adverting to the change in Mr, Parish’s disposition
after his attack, Judge Davies, says : “ How diametrically oppo-
site to the previous conduct of his whole life is that now ex-
hibited. And the inquiry forces itself upon the mind, What
cause has produced such results? Can such totally incon-
sistent and opposite characters be reconciled with the theory
that the faculties, the mind, and moral perceptions of Mr.
Parish underwent no change, but were the same after July 19,
1849, as they were before that day? * * We confess our-
selves totally unable to assent to any such theory. ‘The con-
viction on our mind is clear that these facts and circumstances
show unerringly that the attack of July 1gth obliterated the
mental powers, the moral perceptions, the refined and gentle
susceptibilities, of Henry Parish; that after that period he
ceased to be the mild, intelligent, and unruffled man he had
been theretofore, and that thereafter he was not responsible for
the unbecoming and ungentlemanly conduct he so frequently
exhibited. He then ceased to be Henry Parish, and was no
longer an accountable being.”” Upon the point of Mr. Parish’s
method of communicating his ideas, Judge Davies says : “ With
these imperfect mediums for ascertaining the thoughts of Mr.
Parish, it is doing no injustice to any one to assume that they
have been mistaken when they supposed that they correctly
THE LEGAL RELATIONS OF INSANITY. 107
understood him. We more naturally and readily come to this
result, because we find that all who had any intercourse with
Mr. Parish, on many occasions, found great difficulty in under-
standing his wishes and thoughts, if they even understood them
at all; and the instances are frequent and clearly established
where he often made an affirmative and negative motion of his
head, immediately succeeding each other, to the same question,
leaving the inquirer in perplexity which he really intended.
% * * * % * %
“All the testimony shows that he could only indicate with
his fingers and hands, or by sounds, that he wanted something,
or that something was the matter, and which motions or sounds
were construed by those around him as evidences of his wish to
put a question, whereupon they began to suggest various topics,
and when they thought they perceived that they had hit upon
the subject in his mind they supposed he wished to inquire
about, they put such questions as suggested themselves to
them, and to which they supposed they had received affirmative
or negative answers. If Mr. Parish had no power to express a
wish to destroy a will, it follows he had none to create one, and
the manifestation of his wishes depended entirely upon the in-
terpreter and the integrity of the interpretations.
“Tt is thus seen that great difficulty and uncertainty, to say
the least of it, attended any expression of the thoughts or
wishes of Mr. Parish, and that a large number of those having
business or intercourse with him, utterly failed to attach or
obtain any meaning to his signs, sounds, motions, or gestures.
The natural and obvious deductions to be made from all these
facts and circumstances are, that Mr. Parish had no ideas to
communicate, or if he had any, that the means of doing so,
with certainty and beyond cavil and doubt, were denied
to him.”
After referring to the testator’s failure to communicate by writ-
ing, or by the use of any artificial means, Judge Davies states
the final conclusions as follows :
“To what result does this review of the facts and circum-
stances in this case, adverted to and commented on, lead the
mind? Ona careful consideration of them all, with a most
anxious desire toarrive at a just and correct conclusion, we are
clearly of the opinion that the attack of Mr. Parish on the roth
of July, 1849, extinguished his intellectual powers, so obliter-
ated and blotted out his mental faculties, that after that period
he was not a man of sound mind and memory within the mean-
108 MEDICAL JURISPRUDENCE.
ing and language of the statute, and was therefore incompe-
tent to make a will. % * * % ® *
“Tt is not the duty of the Court to strain after probate, and
especially toseek to establish a posterior will, made in con-
ceded enfeebled health, unsustained by previous declaration of
intention, over a prior will, made in health, and with care and
‘deliberation, when the provisions of the posterior will are in
direct hostility and conflict with those of the prior one.
* * ok * * * *
“Tt would be in violation of long and well established princi-
ples, and an almost uniform and unbroken current of decision
in England and in this country, to admit to probate testamen-
tary papers, prepared and executed under the circumstances
these were by a man who was in apparent full physical health,
and possessing nearly his natural strength, who could not or
would not write, who could not or would not speak,
who could not or would not use the letters of the
alphabet or even a dictionary, for the purpose of convey-
ing his wishes, upon proof solely that they were supposed to
express the testator’s wishes from signs, gestures and motions
made by him, and especially when it appeared that such signs,
gestures and motions were often contradictory, uncertain, fre-
quently misunderstood, and often not comprehended at all.”
Dr. Hughes* of St. Louis, in a paper upon the medico-legal
bearings of aphasia, takes as his text the case of Wm. T.
Bevin vs. Powoll et al. In this case the patient’s family con-
sidered him insane at the time of making a deed of trust, but it
appears from the evidence that such was not the case and his -
aphasia was not such as to prevent him from expressing himself
in other ways.
Case XXII.—“ On the 13th day of March, 1873, Mr. Wm. T.
Bevin, a few months after the death of his wife, was stricken
with right hemiplegia, and aphasia. A cardiac valvular lesion
preceded the paralysis and is still persistent. At the time of
my last examination, February 7, 1876, I found his respira-
tions, without discoverable pulmonary lesion, to be twenty-one
per minute, and the heart and wrist pulsations asynchronous,
the latter counting as high as one hundred and eight, and the
former sometimes ten to eighteen more, per minute. At this
* American Journal of Insanity, January, 1879, ,
THE LEGAL RELATIONS OF INSANITY. 109
time there was incomplete paralysis of motion on the right side
and general anesthesia. He was insensible to the pricking of a
pin in both hands and feet. The sublingual temperature, on
either side was 96° F. Hecorrectly and promptly comprehended
oral signs, but tardily and imperfectly understood written ones.
He soon recognized my name and wrote it for me, with his left
hand. He likewise wrote his own name and the surname of
his attorney (Mr. Rainey), upon my asking them. An H,
written by myself, and an imperfectly erased tracing of my
surname, were on the card on which he wrote myname. He
first attempted to attach “ughes” to the H I had written, but
afterwards changed his mind and made an H of his own, which
accounts for the somewhat disjointed appearance of the word
Hughes ;
His tongue was clear, but he said he always had a disagree-
able taste in his mouth. He either really had, or feigned, de-
fective vision. When the thumb was held up before him, look-
ing with one eye, the other being blind-folded, he would say it
was two, and when the thumb and little finger were held up, he
would say they were three. I intended making an ophthal-
moscopic examination, but before I had an opportunity the case
came on trial, and my testimony not being satisfactory to the
family, I did not offer to examine him further. He either had
defect of hearing in the left ear, or feigned it. Icould not cer-
tainly determine which. He signed that he could not hear the
ticking of a watch half an inch from his ear, yet he distinctly
understood a remark addressed to him by his sister in quite an
ordinary tone, at least twelve feet off from him, at the time I
was testing his hearing. None of the family spoke to him in a
very high tone, as is customary when oneis deaf. He repeated
the word wzn-nin, accompanied by a nod of the head, to signify
yes and by a horizontal turning to indicate no. When I wrote
W. T. Bevin and asked if that was his name, he shook his head
and taking the pencil wrote Wm. T. Bevin: He _ had
three paralytic strokes, and was seen by his relatives after
each attack. He has grown steadily better, and they now
regard him as perfectly rational, but considered him unsound of
mind on the fifteenth day of July, 1873, four months after his
110 MEDICAL JURISPRUDENCE,
first seizure, when he signed with his left hand a deed of trust
of his portion of some houses he was building jointly with some
other parties, and in fulfillment of a promise and purpose,
made and entertained prior to his attack. He could not write
with his left hand before he was stricken. About the time of,
and prior to the signing of this deed of trust, heis said, by some
of the members of his family—principally his two sistersand a
brother-in-law with whom he lived and is now living—to have
done some things which they swore they regarded as evidences
of insanity, such as on one or two occasions (none of the wit-
nesses testifying to more) bowing to pictures in the parlor,
when he knew members of the family were present, and with a
pleased but silly smile on his countenance. Once he is said to
have wiped his nose on his napkin, and once or twice, in the
early stage of his paralysis, they say he spat on his plate.
Once he unbuttoned his drawers when his sister and another
lady were in the room. It was said that once, shortly after his
first stroke of paralysis, he defecated in bed. Once, he is said
to have struck his mother with a stick, though one of his
brothers, who swore there would have been no suit if he had
got his three per cent. commission, as promised, for taking his
afflicted brother’s place in conducting the work, never saw or
heard of his bowing to pictures, striking his mother, or un-
buttoning his drawers.
“Some time in the June following the stroke of paralysis, he re-
cognized and pointed at the picture of the crucifixion, and
other objects when asked to point them out. At this time he
could not, the family say—all but one brother—distinguish
letters or tell if they were upside down or not, but readily recog-
nized them if theirnames were called. As early as the first of
May, 1873, he could sit in a chair and get about the room. In
June he appeared to one of his physicians to besilly, “ because
he smiled peculiarly ” and was exceedingly violent and irritable
when the battery was apphed. ‘To another of his physicians
he appeared demented, though he was able to go unaccom-
panied in the following November, a long distance to this
physician’s office, correctly select and count his money and pay
his medical bill, and take and put away carefully a receipt for
the same. It was said also that he made grimaces before a
glass once or twice, and pulled out his hair, and he ate things,
when set before him, that he never ate before. He handled his
food with his fingers (he could not use a knife and fork), and
his manners and tastes at table were changed in some other re-
spects, he having been formerly very fastidious and precise.”
THE LEGAL RELATIONS OF INSANITY, Tit
**When he first learned to write his name he would make signs
to visitors for a slate, write his name for them, and express his
pleasure at the accomplishment by a peculiar smile. After the
description of his property, mentioned in the deed of trust, was
read to him, he pointed in the direction of it and gave an as-
senting nod, pointing immediately after in the direction of
other property not alluded to in the document, and indicating
his understanding that it was not included, by the usual turning
away of the head indicative of dissent.
“ He was attended by different physicians during the first at-
tack. The physician who first saw him at the time of his first
seizure found him only partially paralyzed on the right side,
with consciousness still remaining, and helped him home. In
six hours after this physician saw him he was hemiplegic and
unconscious, and so remained for several days. He commenced
to improve in two or three weeks. He was then annoyed by
movements about the room and exhibited ‘not much, but some
signs, of intelligence in his countenance.’ He made signs and
efforts to convey ideas, and would mumble unintelligibly in
answer to questions and had difficulty of deglutition. He
never, at any time, had delirium, delusion or hallucination,”
Case XXIII.
A recent case of some interest, where the question of apha-
sla arose among others, is that of—
Legg
US. 5 Redfield’s Reports, 628.
Meyer,
(Will of Ephraim P. Meyer.)
The testator instructed one J. K. Merritt to prepare a codi-
cil to his will and gave him written memoranda for such codicil.
Shortly afterwards he was smitten with apoplexy, resulting in
paralysis of mind and body, and lost his power of speech. He
subsequently recovered and although he was never able to talk
again he became able to read the Bible and daily papers. A
few weeks after his recovery he executed the codicil and its
probate was contested on the ground that testator did not have
testamentary capacity at the time of its execution.
The court held that although the codicil differed in a few re-
spects from the memoranda made by deceased before his
illness, yet such memoranda was sufficient proof of his ztention
to alter the provisions of his will. That although his mind and
faculties were enfeebled by his illness, he had sufficient mind
to comprehend the nature of the codicil.
1 OF MEDICAL JURISPRUDENCE,
Another case is reported by Lucas Champonniere illustrating
the fact that aphasia may exist with slight intellectual perversion,
not sufficient in itself to destroy the patient’s capacity to dis-
pose of his property or make judicious contracts. I have al-
ready referred to this case in another work, where the subject
of aphasia is more thoroughly considered.”
“The question was raised in this particular instance apropos
of a case in which the patient, in spite of an enfeebled intelli-
gence, had become capable of writing with the other hand. He
could not, however, write if left to himself, and could only recopy
what was written and set before him, and the expert physicians
vainly tried to make him recopy a power of attorney or a will,
while he willingly wrote any ordinary phrase or document
which did not bind him to any thing. This man, then, knew
perfectly what he was doing, and the Société de Medécine
Légale concluded that he possessed still thorough intelligence
and free will to be able to continue to enjoy his civil rights, the
intellectual debility which he had suffered not appearing to be
Sate to justify what the French laws call an ‘interdic-
tion.
The Handwriting of the Insane.—The handwriting of
the insane, as presented in contracts, wills or other documents,
or in their letters, often shows singular evidences of the dis-
ordered state of mind of the writer. Not only are we to look
for insane peculiarities in the literary style of the person, but
the substance of the letter itself is often an index of irresponsi-
bility and incompetency.
The chirography is often illegible because of omissions and
interlineations. The page may be so “cross-hatched” with
lines as-to be all but undecipherable. Many words are sub-
stituted or transposed, and there may be scrawls and diagrams
which are meaningless. The handwriting of the general
paralytic is perhaps the most interesting, and it is well to com-
pare a series of letters, some written during undoubted mental
health and others at different stages of the disease. In the
latter it will be found that letters are omitted or imperfectly
formed, or later that the peculiar delusions of the writer are re-
produced.
Business Contracts.—In contracts which are questioned
because of the alleged insanity of one of the parties it is neces-
* Nervous Diseases, their Description, etc.; 2d. Ed., p 197.
+ British Medical Journal,September 15, 1877.
THE LEGAL RELATIONS OF INSANITY. _ 113
sary to examine not only the individual but the instrument. If
it is discovered, in addition to the insanity of the contracting
party, that the bargain is clearly disadvantageous to him, the
question of fraud and imposition is raised. It sometimes hap-
pens, on the other hand, that the question of mental unsound-
ness is agitated when it is the aim of a person to shirk a respon-
sibility. In a recent case in which I appeared, the question of
melancholia was urged, and it was averred that the plaintiff had
made a contract under the impression that his business was in
a ruinous condition, and that this was a delusion resulting from
melancholia. In this case I was unable to find any character-
istic intellectual derangement, but only simple emotional
disturbance of a depressing character. I found that his
view of the state of his affairs was perfectly in accord-
ance with the real facts; that the contract was dictated by
him and contained pertinent marginal corrections and inter-
lineations; that his letters, written at the time, were intel-
ligent, and that his motives in bringing the suit were to upset
a bargain that did not bring him subsequently what he consid-
ered to be his proper share of the business he conducted with the
contracting parties. We must take cognizance of the fact
in such cases as this, as well as others, that no question of the
insanity existed at the time of the alleged imposition ; that usu-
ally the friends of the person do not consider it necessary to
seek legal advice, and it is not necessary to resort to an asylum
or other means of protection. Casper relates a case of interest
in this connection : |
“In a civil process the accused merchant, W., asserted that
from his ailing condition he was unable to prepare a statement
of his affairs and to confirm it by an oath. I had to satisfy
myself in regard to this, and at the same time to give an opinion
whether he could be arrested personally, if necessary. The in-
vestigation proved that W. certainly labored under the well-
known disease called hypochondria, which in itself could be re-
garded as a mere simulation, though it could not be denied
that the manifold ailments alleged to exist were either inten-
tionally or unintentionally exaggerated. ‘Granting, however,’
I said, ‘ that W. is ill, nevertheless, since he is not feverish nor
confined to bed and is of clear intellect, it is not easy to see
why such an employment.as the one in question, the prepara-
tion of a statement of his affairs in his own apartments, should
be impossible for him or likely to be injurious. When he
alleges that the mere addition of sums causes him anguish, such
a statement is to be rejected as inconsistent with medical ex-
9
II4 MEDICAL JURISPRUDENCE,
perience. Only if he were to be forced and hurried in the per-
formance of such a work could there be a possibility of injury
resulting.’ Accordingly I declared that W. was in a fit condi-
tion to prepare a statement of his affairs and to confirm it by
oath, provided a few weeks were granted to him for this pur-
pose, and that if necessary he might be personally arrested.
This opinion was communicated to W. and a statement of his
affairs was very speedily thereafter handed in.”
The following case relates to the validity of a promissory
note drawn by a person who shortly afterwards became insane :
CasE XXIV.
Stigers
V. 50 Md., 214.
Brent,
On July 1, 1874, and November 1, 1874 John J. Brosius
executed two promissory notes. Suit was brought upon them
in November, 1876, and judgment obtained February 12, 1877.
On March 10, 1877, it was judicially declared in a proceeding
de lunatico inguirendo that Brosius was a lunatic and had been
since August 1, 1875. It was conceded that Brosius was of
sound mind at the time he executed the notes, but it was
claimed that he was a lunatic at the time suit was brought. The
Circuit Court for Washington County held that Brosius was
liable, and on appeal to the Supreme Court of Maryland this
judgment was affirmed.
CASE XX V.—DEED MADE BY AN ALLEGED LUNATIC DECLARED
VOID.
Turner
v. 53 Maryland Reports, 65.
Rusk,
William L. Rusk, who had previously been successful in
business in the City of Baltimore, and was remarkable for his
energy and industry and shrewdness, was, on April 19, 1861,
suddenly thrown into a condition of intense excitement, caused,
it was believed, by the military preparations and excitements of
those times. He remained in this condition for some time and
was removed to the residence of his sister, and finally, in the
latter part of May, was admitted to have been insane. His
disease was declared to be a case of general brain trouble
caused by the financial excitement, etc., of that period. On De-
cember 27, 1862, while residing with his sister, he executed a deed
THE LEGAL RELATIONS OF INSANITY. 115
for a nominal consideration of property valued at upwards
of $10,000 to Robert Turner in trust for his mother who was
then 75 years old, and after her death absolutely to his sister,
He left his sister’s in 1864 and lived with his mother until 1875
when she died, and after her death the cestuz gui trust claimed
the property named in the deed. He then brought suit to have
the deed set as.de on the ground that he was nct mentally cap-
able of making a valid deed at the time it was executed, and
the deed was declared void. It was shown that although the
property stood assessed in his name that no mention of the
transfer had ever been made to him, and he claimed to have no
recollection. It was also proved that he was incapable of
transacting business at the time of the execution of the deed,
and that he had not completely recovered from the effects of
his attack in 1861 until several years thereafter.
On appeal to the Court of Appeals the judgment declaring
the deed void was affirmed.
CasE XXVI.—CoNTRACT ALLEGED TO HAVE BEEN MADE BY
AN INSANE PERSON—CONTRACT SUSTAINED.
Kneedler’s Appeal. g2 Penna. State Repts., 428.
Solomon A. Kneedler through his counsel, on August 18,
1876, borrowed $5,000, giving as security a mortgage on prop-
erty in the City of Philadelphia. This money he used to pay
off a mortgage on some other property. Hewas afterwards, on
March 2, 1877, adjudged to have been insane at the time of
this transaction, and subsequently, the mortgage having mean-
time been foreclosed and judgment rendered thereon, by de-
fault, he began these proceedings to have the judgment opened
in order that he might plead his insanity as a defense, but the
Court dismissed the proceedings. On appeal to the Supreme
Court the dismissal was affirmed, the Court saying that though
Kneedler was insane at the time he executed the mortgage, it
was undoubtedly a sane act. He did so through advice of
counsel, and applied the proceeds to a judicious purpose.
The Question of Dissolution of Partnership by Rea-
son of Insanity.—In the matter of business associations,
especially when the interest of one member is monied, and that
of the other is the experience and “ brains” he brings, lawsuits
may arise and attempts at dissolution growing out of the in-
sanity of one member of the firm and the consequent danger
that mutual interests may be wrecked. Thesane party may de-
116 MEDICAL JURISPRUDENCE.
mand an inquisition upon proof of the insanity of the other so
that the co-partnership may be dissolved.
Impeachment by Reason of Insanity.—In the matter of
guardianship, where the trust funds are being squandered, or
where the protection of the ward demand it, steps may be taken
for the deposition of the guardian. The most painful cases are
those where the medical man is required to testify as to the inca-
pacity from old age or mental disease of an officer holding a posi-
tion of public trust. It cannot be denied that even learned judges
whose long and honorable service has resulted in mental decay
are able in a routine way to go through with familiar duties of
the past, and in fact those mental operations which become
automatic are apt to fail long after minor perversions have at-
tracted the attention of his immediate friends and family. In
such cases the office of the medical man is a disagreeable one,
and he should act with more than ordinary care and prudence.
No blow is so great as that inflicted upon a sensitive and high-
minded person when he is made certain of his intellectual
failure. The symptoms of ordinary disease or temporary
manifestations of overwork should never form the basis for a
hastily expressed opinion.
Marriage and Insanity.—It sometimes happens that an at-
tempt is made to invalidate a marriage, one of the contracting
parties being insane at the time. It may be that the person
in whose aid the power of the courts may be exercised is at the
time of marriage a declared lunatic, in which case all that is re-
quired is a showing of the finding of a previous commission.
More often the contracting party is one of weak mind who has
been entrapped by designing persons. The same influences that
may have been brought into play to make him link himself
with some prostitute or adventuress may be brought to bear to
make him an earnest defendant when his family bring action
to set aside the marriage.
In such a case he is amply provided with friends and advice
who supply the brains he unfortunately does not pos-
sess. It will be readily seen that the sexual perversion insepa-
rable from various forms of insanity may lead to a union per-
haps with some one far beneath the patient, and the influence
of nymphomania leads to impulsive acts which the per-
son, who perhaps is an hysterical girl, does not stop to
consider. The celebrated English case of Miss Bagster is an
example of this kind. “Miss Bagster was proved by the evi-
dence to be a frivolous and weak minded girl whose education
THE LEGAL RELATIONS OF INSANITY. 117
had been much neglected. She was a lady of fortune, and she
ran away with and was married to a Mr. Newton. An appli-
cation was made by her family to dissolve the marriage on the
ground that she was of unsound mind. Amongst other facts
urged before the commission as proof of the allegation it
was mentioned that she was occasionally violent and self-
willed, that she was passionate as a child, and that even in ma-
turer years she had little or noself-control. That she was igno-
rant of arithmetic, and therefore incapable of taking care of
her property. That she had some erotic tendencies which
were evinced by her want of womanly delicacy and by her
having engaged herself with a view to marriage to several in-
dividuals. On her examination before the commissioners her
answers were intelligent, and her conduct in no way different
from that of ordinary individuals. Seven medical witnesses
were summoned to support the commission, and each of them
deposed that she was unsound mind. The commissioners, how-
ever, had recourse to Drs. Morrison and Haslam, who visited
her and who came to the conclusion that she was neither imbe-
cile nor idiotic, and that her inability to manage her affairs arose
from ignorance. She was aware of her deficiencies, and de-
plored her ignorance of arithmetic, and explained it on the
ground that her grandfather had been too ready to send ex-
cuses for idleness when she was at school. Her conversation
greatly impressed Drs. Haslam and Morrison with a belief in
her sanity. The jury by a majority of twenty to two returned
a verdict that Miss Bagster had been of unsound mind since
November, 1830, and the marriage was consequently dissolved.”
Breach of Promise and Insanity.—Breach of promise
cases are often defended upon the plea of insanity and irre-
sponsibility. Inthe case of Harford vs. Singleton it was claimed
that the defendant’s softening of the brain and insanity were
cogent reasons for his non-fulfillment of the marriage contract,
which plea, however, was unsuccessful.
Case XXVII.—Harford vs. Singleton.—This action was
defended on the ground that at the time defendant had prom-
ised marriage he was advanced in life—viz., 60 years of age ;
and that before areasonable time had elapsed from the request
to marry, namely, in May, 1855, he was, by a visitation of God,
attacked by a fit of apoplexy, since which time he was in an
infirm state and afflicted with softening of the brain, in con-
118 MEDICAL JURISPRUDENCE.
sequence of which he could not perform his promise without
putting his life in great peril, and hastening his death.
Evidence was called, on the part of the plaintiff, to prove
the engagement and to show that no apparent impairment of
health or vigor remained after recovery from the attack.
It was stated by defendant’s counsel, Mr. Ball, that in 1849
he had suffered from dropsy and disease of the kidneys; that,
in 1852, he had an attack of apoplexy and congestion of the
brain. During the interval from that time until May last he
had promised to marry the plaintiff ; but that in the latter month
he was afflicted with another attack of apoplexy, and was now
suffering from paralysis and softening of the brain. The de-
fense then called several medical men who had attended the
defendant. They testified that he had had apoplexy and was
paralytic, was suffering from loss of memory and other mental
symptoms, and that he was liable to another attack, and that
any excitement would increase the tendency to such attack, but
would not say that he might not marry without imperiling his life.
The jury returned a verdict for the plaintiff £300 damages
and costs. The ground of this verdict, it is said, was that the
jury considered that an unreasonable time had elapsed between
the date of the promise of marriage and the date of the last
attack of apoplexy.
Marriages contracted zz extremis are usually very apt to be
dissolved by courts of law. Tidy refers to the case of Roche-
fort, who was married to his former mistress on her death-bed,
he being taken from prison for the purpose. It appeared that
the woman was in her right mind, and consequently it was heid
to be valid. But where one of the parties is over-awed, or
there is any evidence of mental perversion, the legality of the
contract is questioned.
The seduction of an insane or irresponsible person is punish-
able, but sometimes the questions involved are extremely dif-
cult to decide. The case of the People vs. Royal is one of some
importance, although the theory of the prosecution is perhaps
not in accordance with the soundest psychological doctrines.
CasE XX VIII.—RAPE—ALLEGED [RRESPONSIBILITY OF VICTIM
—CONVICTION OF PRISONER—VERDICT SET ASIDE ON TECH-
NICALITY.
People
US. 53 California R., 62.
Royal,
Defendant, who was a practicing physician in Santa Rosa,
THE LEGAL RELATIONS OF INSANITY, 119
was tried and convicted of rape committed on a girl 16 years
of age. Defendant drove in a buggy to the house where the
girl lived and invited her to go home with him. (She was in
the habit of visiting his wife). She assented, and on the way
defendant practiced “manipulation” on her. Upon arriving
at his office he accompanied her up-stairs and had carnal inter-
course with her. There was no evidence of force, but it was
claimed that his manipulation had destroyed her will and there-
fore rendered him as guilty of rape as if he had used force.
The girl testified that defendant’s lewd conduct during the
drive made her so dull and stupid as to be unconscious of the
act he was performing. The conviction was made on the
theory that defendant’s manipulations were equivalent to force. °
On behalf of defendant it was claimed that defendant’s
manipulations did not amount to force, and that he could not
therefore be convicted of rape, and, on appeal to the Su-
preme Court of California this conviction was set aside on these
grounds.
The following case is one where damages were obtained for
alleged mental disease as the result of seduction. ‘This, like
others of its kind, is of an exceedingly questionable character.
the defendant being held by the law responsible for much more
than that of which he is guilty.
ace X XIX.
Blagge
US. 127 Mass. Reports, 191.
Isley,
In a suit for damages for injuries resulting from seduction,
where it was shown that previous to such seduction the girlhad ~
been strong and well and of gay and cheerful spirits ; and that
after her seduction she became nervous and excitable; and as
no pregnancy or sexual disease was proven, a verdict was ren-
dered for plaintiff, and, on appeal to the Supreme Court of
Massachusetts, it was held that this evidence was sufficient to
warrant the verdict.
Divorce and Insanity.—The plea of insanity is often
urged as a ground of divorce, and in one case of which I
know the husband of an insane woman whose disease devel-
oped after marriage, brought suit for separation, In ordinary
cases such inhumanity in disregarding the existence of the
affection as an unfortunate calamity for which the patient is no
more responsible than she would be for smallpox or typhoid
fever, rarely finds favor in the eyes of the law; but it can be
120 MEDICAL JURISPRUDENCE.
realized that in instances where insanity has existed before
marriage, and when the husband or wife has been kept in igno-
rance of the fact by the patient, or by his or her parents or
near relatives, a delicate legal point may arise.
Cas—E XXX.—Puerperal insanity as the basis of irrespon-
sibility is rarely advanced in civil cases. In fact, I know of
but one case, that of Lady Mordaunt. This was the famous
divorce case in which a Prince of England figured as a witness
Lady Mordaunt, after her confinement, admitted that she had
committed adultery before the birth of her child, and the evi-
dence substantiating her story was seemingly very strong, for
entries in her diary a year before recorded the visits of a noble-
man at an hour of the night inconsistent with the strictest pro-
priety. This occurred two hundred and eighty days before the
birth of her child. It appeared from the testimony of servants
and others that there had been no signs of any thing peculiar in
the conduct of Lady Mordaunt either before or after the birth of
her child, and this was in contradiction of those friends, of the
patient herself, who asserted that her confession was the result
of a delusion; for not only had the wife admitted improper
relations with other men, but, swore that the child was not her
husband’s. The patient was delivered of her child on the
twenty-eighth of February, 1869, and a week or two later made
her extraordinary admission. The physicians ¢alled by the
plaintiff were inclined to think that she was not. insane, and
that there was nothing in her conduct inconsistent with feign-
ing. ‘The reasons assigned as evidences of her insanity were
of the most extraordinary description, but they were met with
much that was contradictory. It was shown that her habits
had become filthy, that she destroyed her clothing and was
unclean in her habits; and in 1870 she was demented, and
could not comprehend communications that were made to her.
The jury and the judge took this latter view of the case, and
it was decided that as early as the thirtieth of April the respon-
dent had not sufficient capacity to bring the suit, and had been
unfit eversince. The charge of the judge to the jury was, that he
did not ask them to say whether Lady Mordaunt was sane or
insane, but simply to decide “whether she was or not in such
a state of mental disorder as to prevent her giving instructions.”
The case was afterwards appealed and tried upon its merits,
the matter of insanity being left out of the question, the de-
fendant being considered guilty of adultery, and the divorce
was granted. Woodman and Tidy, in commenting upon this
THE LEGAL RELATIONS OF INSANITY. 121
case, say: “It is thus seen that insanity is no bar to a decree
of divorce, a principle which seems to us far from being a safe
one. Ina case of murder, the evidence of other persons or
circumstantial evidence may be sufficient. In the relations of
husband and wife, it seems hard to punish the wife while she
is unable to defend herself. At all events, if the principle be
admitted, it seems unjust that a poor laborer should have to
pay towards the support of an insane wife in Colney Hatch or
Hanwell, and be liable to a prosecution for bigamy if he mar-
ries again, whilst the wealthy baronet escapes almost scot free
and may marry again if he choose.”
CasE XXXI.—ACTION FOR DIVORCE UPON PLEA OF
INSANITY, AND FAILURE OF DEFENDANT TO SUPPORT
PLAINTIFF— DENIED.
Baker
US. 82 Indiana Repts., 146.
Baker,
i
Plaintiff and defendant weré married in 1867. In 1874,
defendant became insane and was committed to an asylum,
where he has since remained. Plaintiff instituted this suit for
a divorce on‘the ground that defendant failed to support her.
The Supreme Court, on appeal, held that this did not con-
stitute sufficient ground for divorce; that the statute providing
for divorce where the husband fails to support his wife, does
not apply where such failure is caused by mental or physical
disease.
Case XXXII.
Gerhold
US. 12 North Western Reporter, 811.
Wyss,
Plaintiff and defendant were married in “ September or Oc-
tober, 1867.” A few days thereafter plaintiff learned of de-
fendant’s insanity, but continued to live with her until Septem-
ber, 1881, when a decree of separation was made. He now
sues for her support during the time they lived together.
The Supreme Court of Nebraska held that as plaintiff knew
of defendant’s insanity but continued to live with her, he was
obliged to support her.
122 MEDICAL JURISPRUDENCE.
Insanity and Life Insurance.—The question of insanity
in relation to life insurance occasionally arises, and is made the
basis of refusal to pay the amount of the policy upon the part
of the companies.
It sometimes happens that an individual insures his life and
fails to state that he has suffered from a nervous disease which
is the precursor of a form of insanity. A case reported by
Taylor and Tardieu* is that of a gentleman who insured his
life, afterwards becoming insane. ‘The company refused pay-
ment, asserting that the assured was aware of his malady when
he applied for a policy, and refused to so state. The jury de-
cided for the defendant, and the judge charged the jury that
they must decide if the mental disease had a tendency to
shorten life, for in this case the dissimulation that had been
proved was important. If the alienation had this tendency
they must decide in favor of the defendant.
One of the oldest cases of this kind is that reported by Beck
and the high position of the insured party gives the case much
interest.
“Tn 1824, a policy was effected by the Baron Von Lindenau
on the life of Frederick IV., Duke of Saxe-Gotha and Alten-
burg, in the Atlas Insurance Company. The Duke died on the
tith of February, 1825, and the insurers refused to pay the
sum insured for.
“On the trial it appeared that Lindenau had stated in his
application that the Duke was not gouty, asthmatic, or con-
sumptive, or subject to fits ; that he had never had apoplexy,
and that he had no disease tending to shorten life. Two phys-
icians of the Duke certified, that since the year 1809, he had
had a dimness of the sight from amaurosis in the left eye, and
since 1819 had been “ Azndered”’ in his speech from having had
an inflammation of the chest, of which he had been perfectly
cured. In acommunication from an agent in Germany, it was
mentioned that the Duke had formerly led a dissolute life, by
which he had lost the use of his speech, and according to some
that also of his mental faculties, which however is contradicted
by the medical men.
“On this the company, instead of asking an ordinary pre-
mium of £2 17s. per cent. per annum, required £8 per cent.
“It now, however, appeared that the Duke had been afflicted
with almost a total loss of speech from 1822 to the time of his
death, which one of the physicians attributed to local paralysis,
* Annales d’hygiene publique, Ixxvi, page 152.
THE LEGAL RELATIONS OF INSANITY. 123
and that he had periodical catarrhal affections, accompanied
with fever. The chamberlain of the Duke, in his examination,
mentioned that he had never complained of pain in his head.
He ate, drank, and slept well, but could not speak. Dr. Dorl,
physician to the Duke, agreed that his intellectual faculties
were impaired, although his bodily health was good. On ex-
amination after death, no chronic disease was discovered in the
viscera or any part of the trunk ; but in the head was found a
large tumor six inches in length, two in breadth, and one in
depth, which not only pressed on the brain, but had depressed
the skull at its base. It was inferred that this tumor had com-
menced in early life.
“The defense was that there had been a suppression of ma-
terial facts.
‘Dr. Green, an eminent English surgeon, gave it as his opinion
that from the history of the case merely, there were no symp-
toms of organic disease. He further thought that the tumor in
the skull must, during life, have been in a passive state ; and
from its appearance on dissection that it must have been formed
in early life. He was only willing to allow that the symptoms
mentioned above, would lead to a suspicion of disease in the
head ; and he was disposed to ascribe the difficulty of speech
to want of volition, and not to tumor in the brain. In reply
however, to a question of Lord Tenderden, he answered: “If
I., as a medical man, was asked by an insurance company,
concerning the state of a man’s health, who was unwilling to
move, who was subject to control upon his intellect, and who
had lost his speech, I should not consider myself at liberty to
forbear mentioning these circumstances.”’ Lord Tenderden,
who tried the cause, said this was sufficient ; and that he should
charge the jury, that if any material facts relative to the Duke’s
health were concealed, then the policy was void.
“The plaintiff elected to be non-suited, and subsequently
made an effort to obtain a new trial but it was refused.”
A French decision holds that, if a person applies for a policy
and withholds the fact that he has been insane, or has a disease
which may lead to insanity, his policy is null and void, and he
cannot expect the return of the premium, even though the per-
son assured may die of some other disease.
General paresis may sometimes enter into thequestion of life
insurance. A case is related by Le Grand du Saulle which
shows how one of the French companies was victimized. Two
brothers went to the office of a Parisian alienist, and the elder
had a private consultation, the result being that he was informed
124 MEDICAL JURISPRUDENCE,
that the other had the incipient signs of general paresis, arid
that death would occur in three or four years. They departed,
and the result was that a policy of insurance was procured for
too,ooo francs. Three years afterwards the elder brother
quietly pocketed the results of the robbery.
A peculiar case is reported by Le Grand du Saulle. A physi-
cian well known in science had for nine years before his death
a life policy for 100,000 francs. He suddenly presented the
signs of great cerebral excitement, became boasting, and wrote
and spoke in an exaggerated manner. He again went to the
companies and insured for 500,o0o more. When the contract
was prepared and ready for signature the manner of the doctor
was so vehement and excited that the agent believed him to be
drunk, and under the pretext of having forgotten to insert an
indispensable clause took back the policy. Upon the following
day the medical man was sent to an asylum, and six months
afterwards died of general paresis. ‘The company paid to the
widow the 100,000 francs and considered itself very fortunate in
not having to add the half million francs the husband desired to
insure for.
CasE XXXIII.—Suicipr, DispuTED PoLicy or INSURANCE,
NEGLECT OF INSURED TO ANSWER QUESTION IN POLICY
REGARDING HEREDITARY INSANITY—VERDICT FOR PLAIN-
TIFF.
Newton
US. FO NDYs,7426;
Mutual Benefit Life Ins. Co.,
Henry C. Ross had effected an insurance on his life with de-
fendant and subsequently terminated his life by taking a dose
of laudanum while insane. In his application for a policy he
had stated that no member of his family had been afflicted
with insanity or other herditary disease, but stated that his
father had died of a brain disease caused by a hurt. On the
trial it was proved that his father had received an injury on his
head in childhood resulting in a weakening of his mental powers,
and that at the age of 47 he was placed in an insane asylum,
and afterwards died. On this testimony plaintiff was non-
suited, but on appeal the Court of Appeals reversed the judg-
ment of non-suit and ordered absolute judgment for plaintiff.
THE LEGAL RELATIONS OF INSANITY. 125
CasE XXXIV.—SINGULAR FRAUD UPON INSURANCE Com-
PANY, MURDER; DEFENSE OF INSANITY; No EVIDENCE
HOWEVER OF ITS EXISTENCE; ACQUITTAL.
State
US. 1 Houston’s Dela. Criminal Repts., 373.
Isaac C. West,
Defendant was indicted for the murder of a negro known as
“Couch” Turner, in the town of Dover. It appears that de-
fendant was experimenting with an apparatus for the manufac-
ture of a peculiar gas, which he claimed, if inhaled, would cure
several kinds of diseases. That two weeks before the murder
prisoner rented rooms on Loockerman street, Dover, stating
that he wished them for a short time only, as he wanted “to
do enough in two weeks to make or break him.” That
on the morning of December 2d the prisoner engaged
deceased, who was a stranger to him, to carry a box
to his rooms, and that deceased had not since been seen
alive. That between 11 and 12 P.M. of the next day, while
in the Capital Hotel, prisoner suddenly left saying that his
retort was leaking and he feared an explosion. That an
hour afterwards his rooms were discovered to be on fire, and
when broken into the mutilated body of deceased was found,
with the head, hands and feet severed, and saturated with coal
oil. On the 5th of December prisoner, who had fled, returned
to Dover and surrendered himself and made a confession, in
which he said that after he had paid deceased for carrying the
box he offered to come again in the afternoon and fill his gaso-
meter with water ; that he met deceased on the street in the
afternoon and brought him to his rooms, preceding him up-
stairs ; that after he arrived in the room he turned and saw
deceased with a hammer in his hand and the deceased de-
manded his money or he would kill him; that he then picked
up a piece of axle and deceased struck him, crushing his hat.
That he then struck deceased on the neck, killing him instantly.
He then cut off the head, hands and feet, and skinned the
body and broke several of the bones of the body. He
also cut the nose and lips from the head and then crushed it,
to prevent recognition. He then buried the head, hands and
feet and saturated the skin with alcohol and lit it to see if he
could thus change the color of the skin; that in doing this he
set fire to the premises; that he then left town but returned
the next day. Also that his life was insured for $25,000. It
126 MEDICAL JURISPRUDENCE,
was claimed on behalf of the State that the confession that
prisoner had endeavored to change the color of the skin after
mutilating the body, and then firing the premises, was proof that
he had committed the murder in furtherance of a conspiracy
to get the amount of insurance on his life; believing that the
remains would be mistaken for his. On behalf of defense
insanity was urged and it was testified that prisoner’s father
had been of unsound mind for three months in 1836; that
prisoner had had several falls when achild which had rendered
him unconscious ; that in 1869 he walked from Baltimore, one
hundred miles, to Dover to see his mother, whom he had
dreamed was ill; that in the summer of 1872 he had washed
two cats and hung them in a basket to dry. That he had
made a collection of various articles, chiefly of no value, for
the purpose of forming a museum, and which he highly prized,
in which were an old shoe, an old umbrella and a valuable
frame mirror. That in packing these for removal he had care-
fully wrapped the shoe in paper and a sheet while the mirror
was unprotected and consequently badly broken. He had also
attended a political meeting with a dog, which he said he
intended to present to General Grant. He had driven to a
meeting on one occasion and in the course of two and a half
hours had got in and out of his carriage twenty-five or thirty
times ; he appeared each time to do something to the horse or
harness though nothing seemed required to be done.
Several witnesses testified to his general unsoundness of
mind, but the State produced a number of witnesses who testi-
fied to a long acquaintance with him and who had never
noticed any symptoms of an unsound mind.
On the trial the jury returned a verdict of “Not Guilty.”
This verdict, however, may have been given on the ground of
self-defense.
The Legal Status of the Idiot.—Though in the United
States the idiot is deprived of his civil rights, he 1s, curiously
enough, permitted to vote. He is considered incompetent in the
matter of will-making and obligations of any kind contracted
by him are null and void because of his want of comprehension
of the nature of these acts. He is also considered irresponsible
criminally when it can be shown that the crime is motiveless
and unintentional (in their legal sense) and the existence of
will is disproved. In these cases there is neither realization of
punishment nor consequences.
The Responsibility of the Deaf and Dumb.—The mute
THE LEGAL RELATIONS OF INSANITY. 127
was at one time considered to be as irresponsible as the idiot,
so far as testimony was concerned in courts of law. However,
a much more intelligent view of the question of competency of
the deaf and dumb is now taken, and it is by no means the rule
because certain channels of expression which put the individual
in communication with the world are cut off that he is entirely
deprived of intelligence.
Under the English law a deaf mute is not incompetent to
give evidence unless he is also blind, and a deaf and dumb
person who has had no education or instruction cannot be held
responsible in a criminal case (Taylor).
A deaf mute who enters into a marriage knowing what he
does and assenting by signs is considered responsible, and such
a contract is binding.
Dr. Peet, who has had very wide experience with the deaf
and dumb, gives the following general principles in regard to
their rights and responsibilities :
““A deaf mute who has no knowledge whatever of written lan-
guages may yet, if his dialect of gestures is sufficiently copious
and precise, possess the intelligence necessary to manage his
own affairs, to make all civil contracts, to execute a deed or a
will, or to give evidence in a court of justice.
“But as the degree of intelligence and of moral development
in uneducated mutes is very various, some who have been
neglected in infancy being but a step above idiots, they should
be carefully examined to ascertain whether they really possess
the necessary degree of knowledge and intelligent will.
“With respect to the formalities used, it may be laid down as
a general rule that the deaf mute who can read and write but
imperfectly or not at all, should be regarded as in the position
of a German or Frenchman, whose ignorance of our language
necessitates the employment of asworn interpreter between him
and the court.
“But when the deaf mute can read and write well, the best
mode is that prescribed in the French code. In the case of such,
reading supplies hearing, and writing suppliesspeech. Hence it
follows that a paper presented to a well instructed deaf person
calling his attention by pointing with the finger to the writing
should be considered as read to him, it being understood, of
course, that there should be sufficient light and sufficient legi-
bility of writing. We think, however, it ought to be specially
enacted that a legal service, in the case of such persons, should
consist in giving them a copy of the writ or notice to be served
informing in writing of its nature andcontents ; and in the case
128 MEDICAL JURISPRUDENCE,
of deaf mutes who cannot read or but imperfectly, the
reading may be accomplished by the aid of a competent inter-
preter. Any legal oath or obligation may be taken or assumed
by a well instructed deaf person by writing out with his own
hand the formula before witnesses with such forms of solemnity
as the occasion may demand, or by a conversation in writing
with the officiating magistrate.
“It should, however, be generally understood that many of the
deaf and dumb who have received more or less instruction in
our schools are still but imperfectly acquainted with written
language, and that signs are the surest and readiest means of
reaching their conscience and intelligence, the surest means,
also, that they possess for explaining their own meaning
clearly. * * * * And before the criminal as well as be-
fore the civil law the deaf mute has the same rights and is sub-
ject to the same accountability as his brother who speaks and
lied Coane ie The ignorance and neglected condition
of the uneducated deaf mute may, however, be justly urged in ex-
tenuation of his faults, as an appeal to the compassion of the court
or of the pardoning power. And cases may occur in which a
deaf person has acted under erroneous impressions, natural in
his circumstances as, for instance, in resisting legal process, be-
lieving it to be unlawful violence. In such cases there is evi-
dently no more accountability than in cases of hallucination.
‘ Andas it is of great importance to every man whose interests,
liberty, or life are at stake in a court of law, to know, as they
transpire, the proceedings and evidence against him, we think
it ought to be made a rule that in all such cases an interpreter
should be assigned to the deaf mute who will keep him ad-
vised of at least all the important points in the proceedings, by
writing, or by the manual alphabet and signs according as the
one or the other mode is the more clearly intelligible to the
prisoner.”
XXXV.—MvuURDER BY A DEAF MUTE—ACQUITTALBY REASON
OF IRRESPONSIBILITY.
State
US. 1 Houston’s Dela. Crim’l Reports, 291.
Jesse Draper,
Defendant was indicted for the murder of Nathaniel H.
Dickerson, and pleaded not guilty. The evidence showed that
THE LEGAL RELATIONS OF INSANITY. 129
prisoner was a negro, aged thirty, deaf and dumb from birth,
and had been employed for seven years by the father of
deceased ; that he was strong and powerful, and of a very
violent temper at times; he had always evinced a strong parti-
ality for all of the family except deceased, who was the only
one who could subdue him when he was violent; that on
November 9g, 1867, while returning from Georgetown in
company with deceased and others, he was ordered by de-
ceased to get out of the cart in which they were riding. He
got out and became very violent ; shook his fist at deceased,
who jumped from the cart and grappled with him; he then
stabbed deceased with a pocket knife fifteen times, killing him.
(It was proved that prisoner had been seen sharpening this
knife two days prior to the murder, and that he had shown it
to parties to see how sharp it was, and had flourished it as if
cutting some one.) It was also shown that prisoner was pos-
sessed of considerable intelligence and mechanical ingenuity ;
was able to make himself well understood, although he had
never learned the language of mutes; he was a good work-
man; knew the boundaries of the land in the vicinity better
than the owners; knew the value of our coins and bank notes ;
he believed in future reward and punishment, although he
never received any religious instruction ; knew and understood
the punishment for crime. His previous character had been
good. After the commission of the murder he seemed to exult
over it, although he was conscious of what he had done.
On the trial the jury returned a verdict of not guilty by rea-
son of insanity, or want of criminal responsibility.
Criminal Responsibility.—The question of responsibility
in criminal cases is one worthy of the closest study. We are
not to consider the subject in any sentimental manner, nor to
build up a flimsy and utopian theory with which to excuse those
in whom it is dificult to find marked phases of intellectual de-
generation—in other words, the classical evidence of disease.
The moral element is one of difficulty.
In the words of Bucknill :*
“Tf the speculations of the school or closet lead us to the
belief that insanity may sometimes occur through the domina-
ting power of a mental habit, without the intervention of disease,
such opinion will be found foreign to the practical questions to
be decided in courts of criminal justice. However interesting
it may be to the psychologist to trace the growth of a vicious
* Bucknill—Criminal Lunacy, p, 20,
130 MEDICAL JURISPRUDENCE,
indulgence in some passion or instinct through all the grada-
tions of mental habit, until he feels himself, justified in denomi-
nating the result, a state of insanity ; he must not forget that
in the trials of criminals supposed to be insane, the question is
not alone respecting the existence of insanity, but respecting
that of irresponsibility also. The man who would claim for a
criminal exemption from punishment on the plea of insanity,
arising from the vicious and uncontrolled indulgence in some
passion or emotion, would have to establish not only the ex-
istence of such a form of insanity, but to defend two other
positions, namely, that a man is not responsible for conduct re-
sulting from vicious habits of mind, provided the latter gain
over him a complete mastery, and compel him, contrary to all
dictates of prudence, to actions injurious to society and ruinous
to himself. And secondly, that neither the fear, nor the inflic-
tion of punishment, will prove efficacious in preventing the
repetition of such acts.
“Tt would be a puerile employment to show the untenable na-
ture of such positions, and it must suffice to express in this
place our conviction that insanity resulting solely from vicious
habits of mind without disease, cannot confer irresponsibihty
for criminal acts ; and that punishment, or more properly speak-
ing, corrective discipline, is competent to restrain its mischiev-
ous manifestations.
“Cicero says that all fools are insane; and Hale, that all
criminals are insane; and when folly and criminality have
reached their climax and borne their fruits, it is not an edifying
spectacle to behold the psychological physician stepping for-
ward for the purpose of claiming immunity for the offender.
“The element of disease, therefore, in abnormal conditions of
mind is the touchstone of irresponsibility, and the detection of
its existence or non-existence is the peculiar and oftentimes the
difficult test of the psychopathist.”
Responsibility in Relation to Imbecility.—In determ-
ining the responsibility of an zmbecz/e we are to inquire into the
circumstances of the crime, as well as his education, and his pre-
vious life. In regard to the first, we are to determine whether
there has been any attempt at secrecy, or whether he has been
regardless of consequences, his explanation, the method of the
execution of the act of violence, and his behavior after the
commission. If a person of low intelligence and depraved
morals (his propensities from his earliest years, as the result of
cerebral disease, being bad) commits a crime, more or less pur-
THE LEGAL RELATIONS OF INSANITY. ESE
poseless, or at best with slight motive, perhaps a murderous
assault without sufficient provocation; if such a crime is
attempted or accomplished without any concealment, and
boasted about ; there would at least be the suspicion aroused
that a degree of irresponsibility existed.
CASE XXXVI.—ASSAULT BY AN IMBECILE—MOTIVELESS ACT.
- CONVICTION.
Johnson
US. 1o Texas Appeal Reports 571.
The. State,
Defendant was tried for an assault with intent to murder J.
H. Daniels, and convicted. On the evening of Dec. 7, 1880,
while Daniels was entering his home in Grand View he was shot
in the back by the prisoner. He immediately turned around
and struggled with the prisoner who escaped, uttering a sound
resembling the bark of a dog, but was arrested the next day.
He. was a stranger in the neighborhood and no motive was
shown for the act. He had frequently been known to get up
during the night, when asleep, and on the night of the shooting
was very uneasy. Dr. Young, who had known him for some time
believed him to be imbecile, but not insane, while Dr. Keating
who was his regular physician, positively pronounced him insane.
There was no further evidence as to this defense except that of
a few witnesses on the part of the State who believed him to be
sane.
On appeal the Court of Appeals affirmed the convic-
tion.
There are, as I have said, many individuals who know the
difference between right and wrong and yet cannot restrain
their tendency to the latter. Many persons consequently fight
against their impulses and many partially succeed as did the
old lady whose case is referred to by Casper. Yet their reason-.
ing is as often powerless.
This author says: ‘In itself this case,in the form it as-
sumed at the period of our examination, was one of daily oc-
currence, for it was unquestionable that the old lady, at the
time sixty-eight years of age, a sensible, educated woman of
pure morals, who a long time previously had been judicially
declared to be ‘imbecile,’ that is ‘incapable of considering the
effects of her actions,’ and was still under guardianship, and
the effects of her interdiction which she was endeavoring to
get removed, was perfectly restored, and, as the statutes ex-
132 MEDICAL JURISPRUDENC#,
presses it, had re-attained ‘the full and free use of her under-
standing.’
““T relate this case here, however, because it gives a most in-
structive peep into the interior of a mind under the trammels
of disease, and gives from a credible witness a confirmation
of the well-known psychological experience, that those mentally
diseased may not only have a dim cognizance of the difference
between good and evil (vide p. 110, vol. iv.), but also that even
in respect of this obscure consciousnes they can command
themselves up Zo a certain point.
“The discipline of every lunatic asylum is based upon the
very proper recognition of this fact. Our convalescent had
gone deranged fifteen years previously, and had remained so
many years. With the greatest composure she communicated
to me many particulars in regard to her derangement and its
excesses, describing with the utmost distinctness her then pro-
cess of ratiocination. For a time she was impelled to break
panes of glass with stones. But she knew how improper this
was, therefore she threw the stones carefully, so as not to break
the glass, but if this happened, chen she rejoiced atit! She set
about tearing her paper bed-screen; but, as she found it abun-
dantly replaced, she came to the conclusion that this was done
intentionally to keep her from destroying more valuable articles,
therefore she left off tearing the screen. Similar tendencies and
similar logic were exhibited in many other proceedings, and
she could not sufficiently describe to me how puzzling to her
now seemed the reasoning which then seemed clear to her.
Similar statements are made every day by insane people, who
have become truly restored; but similar confessions to these in
respect of individual minor traits, are not so frequent.”
The English Test of Responsibility.—The English law in
brief is that the criminal cannot be held responsible if at the
time of the commission he was incapable of distinguishing right
from wrong, and did not then know that the act was an offense
against the laws of God and Nature. If on the contrary he
was capable of distinguishing right from wrong, then, although
the delusion may be connected with the crime, and its basis—
the person committing the act of violence in revenge for imagin-
ary injury—if the person has capacity to know that he has
committed an illegal act he is fully responsible. The real
knowledge of the difference between right and wrong has been
the test for years, yet it is not sufficient. The charge of Lord
Deas of Aberdeen is as follows; “1, If a man knows what he
THE LEGAL RELATIONS OF INSANITY. 533
is doing—that is to say, if he knows the act that he is commit-
ting—if he knows also the true nature and quality of the act
and apprehends and appreciates the consequence and effect,
that man is responsible for what he does. If from the opera-
tion of mental disease he does not know what he is doing—or
if, although he knows what is the act he is performing, he can-
not appreciate it or understand either its nature or quality—its
~ consequence or its effect, then he is not responsible.
“2. If the jury believed that the prisoner, when he committed
the act, had sufficient mental capacity to know, and did know
that the act was contrary tothe law, and punishable by the law,
it would be their duty to convict him. This,his lordship thought,
was a safer and more accurate mode of putting the question
before the jury than that they should consider whether the ac-
cused knew right from wrong.” (Ogston.)
American Decisions in Regard to Responsibility.—
The American decisions in regard to criminal responsibility
are practically alike, and the question of the knowledge of right
and wrong seems to be that to be decided by juries. I may
quote the charge of two American judges:
The decision of Judge :Smith in the Montgomery trial at
Rochester was substantially as follows:—‘ There is now no
room for doubt as to the rule of lawin this State, a man
must have sufficient knowledge, reason, capacity and mental
power to understand not merely that his act is in violation of
law, but that it is intrinsically wrong. Every human being en-
dowed with reason knows that to take the life of a human be-
ing is against the law of nature and of God. It is not sufficient
that he knows the thing is an offense against human laws, but he
must have reason and capacity to know that he is not only vio-
lating the laws of man, but the laws of God and nature.”
The late Recorder Hackett in the McFarland case charged
the jury “that in uttering the phrase, ‘state of insanity,’ I am
not to be understood throughout as meaning thereby the state
in which a man knows the act he is committing to be unlawful
and morally wrong, and has sufficient reason to apply such
knowledge and to be controlled by it. In using the phrase,
“state of insanity,’ I am to be understood throughout as meaning
the state under which a man is not accountable for an alleged
criminal act because he does zof know that the act he is com-
mitting is unlawful and morally wrong, and has not reason
sufficient to apply such knowledge and to be controlled
by it.
134 MEDICAL JURISPRUDENCE.
To constitute a crime, the accused must have
been acted upon by motives and governed by will.”
The Test of Right and Wrong.—It isa very difficult
matter sometimes to say whether the alleged lunatic knows the
difference between right and wrong. Unless there be obvious
insanity, great care should be taken in answering the questions
propounded by counsel. This is a question for juriesto decide
and after all the medical man can only say that he considers
the patient’s mind diseased. “It is sufficient,’ says Haslam,
“for the medical practitioner to know that. the person’s mind is
deranged, and that such a state of insanity will be sufficient to
account for the irregularity of his actions, and that in a sound
mind the same conduct would be deemed criminal. If vio-
- lence be inflicted by such a person during a paroxysm of rage,
there is no acuteness of metaphysical investigation which can
trace the successions of thoughts, and the impulses by which he
is goaded for the accomplishment of his purpose.”
“Right and wrong” are relative terms. What may be right
in one community may be wrong in another. Browne
says: “There is no right and wrong, merit or demerit existing
independently of the agents who are virtuous or vicious.” The
want of harmony and wide diversity of opinion for example
among religious bodies, is a simple example of how difficult it
is to make the test to go a step further. It has been proved
as I have shown that lunatics know the consequence of
their acts and the penalties prescribed by law. ‘The true test
after all is the condition of the will.
Mittermaier maintains “that two conditions are required to
constitute that freedom of will which is essential to responsi-
bility, viz.,a knowledge of good and evil and the faculty of
choosing between them. The knowledge of good and evil will
require, first, that knowledge of one’s self by which we recog-
nize our personal identity and refer our acts to ourselves.
Secondly, acknowledgment of ‘the act itself, z. ¢., of its nature
and consequences ; thirdly, a knowledge of the relation of the
act both in regard to men and measures ; fourthly, a knowl-
edge that the act in question is prohibited either by the moral
or the statute law. He rebukes the English jurists for their
rigid adherence to the antiquated doctrine, that whoever can
distinguish good from evil, enjoys freedom of will and retains
the faculty if he chooses to use it, of framing his action to the
requirements of the law. The true principle, according to
this authority, is to look at the personal character of the indi-
* * %*
THE LEGAL RELATIONS OF INSANITY. 135
vidual whose responsibility isin question. To his grade of
mental power; to the notions by which he is governed ; to his
views of things ; and finally to the whole course of his life and
the nature of the acts with which he is charged. A person who
commits a criminal act, being fully cognizant of the nature of
the laws, and of the punishment to which he is exposing him-
self, may yet be of insane mind. The true test of irresponsi-
bility should be, not whether the party accused was aware of
the criminality of his action, but whether he has lost all power
of control over his actions.”
Ordonaux on Responsibility.—Dr. John Ordonaux, the
well known writer upon the legal relations of insanity, thus
sums up the questions to be determined in relation to criminal
responsibility :
First—Whether the defendant, at the time of the alleged
crime, knew the nature and consequences of the act he was
committing ?
** Second—Whether, if he did so know them, he had a felo-
nious intent in committing the act?
“ Third—Whether, knowing the nature and consequences of
the act, he had the power to choose between doing or not doing
it ?
“ Fourth—Whether, supposing he had lost the power of
choosing between right and wrong in reference to the particular
act, he had lost that power through dsease, and not through in-
toxication, violent anger, or any form of self-produced mental
convulsion ?
‘“‘T cannot conceive of any case of insanity combined with
crime to which these questions would not be relevant. They
give the defendant every opportunity of showing what his true
mental condition was at the date of the offense, and at the
same time leave no loophole through which simulators can es-
cape detection and conviction.
‘But there is a far more difficult class of cases to deal with
than these, and one which taxes not only the skill of experts,
but the legal wisdom of counsel and the judicial forbearance
of courts. J allude to those cases of paroxysmal insanity which
never come into the field of judicial investigation without giv-
ing rise to much unjust criticism upon all knowledge of mental
disorder. Thus whenever, upon a return to a writ of ha-
beas corpus, a party is discharged from a lunatic asylum, it
seems to be taken for granted that he was either illegally com-
mitted there or improperly detained beyond the period of his
130: MEDICAL JURISPRUDENCE.
established convalescence. Apart from forms of procedure re-
quired by statute, you will observe that both the above
questions involve radical problems which cannot always be
easily or safely decided by a judge at chambers after a short
conversation with the alleged lunatic, or hearing a few affidavits
read of persons who have made quasi medical examination of
him in an hour’s time. Without further testimony relating to
his life, habits, conduct and conversation, no one can safely un-
dertake to give a final opinion upon his mental sanity.
““T can produce any day a hundred lunatics, selected from
our various asylums, who, if they were placed in any parlor or
office and engaged in general conversation, would no more re-
veal their insanity necessarily than they would their religious
convictions or their parentage. If you were asked to state
under oath what your opinion of such person’s sanity was, you
would feel almost ashamed to doubt it for fear of casting im-
putation upon your own. Yet these people are lunatics, and
need hospital treatment. You think they are well because they
are not in an actual paroxysm of their malady, but they are
just as much within its grasp as a man with tertian ague is
within the grasp of his disease on his well days. Insanity, like
all the neuroses, is a disease characterized by intermittent exa-
cerbations, and while in its intervals its victims may seem per-
fectly restored to the eyes of casual observers ; experts know
but too well the unreliability of any opinion based on a per-
sonal examination, when not accompanied by a complete histo-
ry of the patient’s past life.”
Impulsive Insanity.—J/mpulstve insanity is often urged as
a criminal defense. I cannot believe that any individual can
be sane immediately before and immediately after the commis-
sion of an act and insane at the instant. A well known writer
thus expresses himself :
“TI see no ground on which to rest an hypothesis of an im-
pulsive insanity, or to justify an incorporation in our medical
jurisprudence of such a form. I cannot conceive of a homi-
cidal act, impulsive, without motive, delusion, or passion, sim-
ply a so-called impulse to kill, and a careful analysis of clinical
cases, under my own observation, as well as a large experience
in the examination of criminals, sustains this view. Impulsive
disease can not exist. The term impulse used to describe cer-
tain acts of the insane, executed suddenly, and without appa-
rent premeditation, may be proper enough, as qualifying a men-
tal state during an act, as impulsive homicide, but this does not
‘THE LEGAL RELATIONS OF INSANITY. 134
justify the transposition into homicidal impulse. Such trans-
position would show, not that the acts were apparently unpre-
meditated and sudden, but that in the mind there was suddenly
generated a murderous impulse, an irresistible power, which,
without the intervention of reason, or any intellectual act or
motive, suddenly impels to the physical act. Man is not the
prey of blind impulse.”
The annals of the New York courts are filled with instances
of so-called emotional or paroxysmal insanity. The cases of
Cole, MacFarland and Scannell, are familiar to many of our
readers and it only remains for me to call attention to the utter
flimsiness of the so-called evidence of insanity produced by in-
genious lawyers and desperate friends.
Case XXXVII.—Major General George W. Cole was tried in
the city of Albany in the year 1868 for the murder of L. Harris
Hiscock, who seduced the wife of the former. In this case the
social position of both parties greatly increased its interest and
caused much excitement throughout the state; after much
trouble in procuring the jury the facts of the homicide were de-
tailed. On the evening of the 4th of June, 1867, Hiscock was
standing in front of Stanwix Hall talking to two friends. The
defendant Cole meanwhile entered the hotel through a side
door, and advanced rapidly to where Hiscock was standing, and
placing a Derringer pistol within a few inches of the victim’s
head, fired, killing him instantly.
The defense in this case was emotional insanity, and after an
eloquent speech by Mr. Hadley the counsel for the defense, a
number of medical witnesses were called to prove the condition
of the prisoner’s body and mind previous to the murder. Dr.
Manly who had been in the army with the defendant, Dr.
Roberts, and others testified to the fact that the prisoner had
had an injury to the bowels, with hemorrhage ; that he was de-
pressed and gloomy and suffered from “bilious”’ troubles.
The evidences of mental disease detailed by these gentlemen
were instanced : as constant whittling while in the field, of lockets,
and rings and other perishable little ornaments of no conse-
quence, absent mindedness, “ cheerful’? when he was well and
dejected and melancholy when he was sick. One witness tes-
tified that he had melancholia “and melancholy and _ klepto-
mania are about the same thing.”’ Another witness testified that
if one person should suddenly come upon another who was
alleged to be the seducer of his wife he would be very likely to
138 MEDICAL JURISPRUDENCE.
take his life, and he further stated that such would be an in-
sane act. He further stated that bleeding at the nose, which
was a frequent occurrence with the prisoner, indicated com-
pression of the brain. Most of the other testimony for the de-
fense was of like character, and it appeared: that the prisoner
though physically disabled as the result of his honorable service
in the field, presented no evidences of mental disturbances other
than those any individual in his right mind would display if
outraged in the same way that the prisoner was. Many wit-
nesses testified for the prosecution that the prisoner before the
homicide seemed to be in his right mind ; took interest in his
business, appeared robust and in good spirits, and while in the
army did not impress any of his comrades, except the one who
testified, that he was at all out of his mind. The cowardly
commission of the murder in this case, its deliberate execution
and his subsequent behavior, were incompatible with actual in-
sanity or at any rate with “paroxysmal insanity.” It is almost
unnecessary toadd that as aresult more of the eloquence of
the late James T. Brady and others, than any thing else, the
prisoner was acquitted.
This case, as well as all others, is an example of the difficulty
of conviction in murders prompted by motives of revenge as a
consequence of the alienation of a wife’s affections, and so long
as the present state of chivalrous sympathy (?) exists we may be
prepared to find the defense of emotional or paroxysmal insan-
ity a sufficient one.
Judge Parker in the Cole case instanced no less than eight
examples where men have taken the law in their hands
and have been acquitted under these circumstances. The last
and most farcicalexample of acquittal by reason of emotional
insanity is that of the Kentucky Congressman, whose mind
appears to have been in such an unstable condition that
the unfounded suspicion of his wife’s infidelity was sufficient
to produce paroxysmal insanity, though the evidence clearly in-
dicated deliberate, premeditated murder.
CasE XXXVIII.—EmoTIONAL INSANITY—MURDER OF A
WIFE’S PARAMOUR—CONVICTION.
Anthony Clark,
US. 8 Texas Court of Appeals, Rpts. 350.
State, |
The prisoner was tried for the murder by shooting of Gabe
Leonard on March 2, 1878, having obtained a confession from
THE LEGAL RELATIONS OF INSANITY. 139
his wife that said Leonard had been intimate with her. There
was no controversy over the corpus delicti and the principal de-
fense made was insanity created by jealousy. ‘There was no
attempt made to prove insanity either before or after the mur-
der but the defense rested on the testimony that defendant
was a good husband and an industrious man, and several citi-
zens gave him an excellent character generally.
The prisoner was found guilty of murder in the second de-
gree and this was affirmed by the Court of Appeals.
Case XXXIX.—MuvuRDER—TRUMPED UP DEFENSE OF [IN-
SANITY—CONVICTION.
State .
US. 8 Missouri Appeal Repts. 1.
Redemeier,
The defendant was convicted of murder of Franz Vosz, a
stone-mason jn North St. Louis, whom he without provocation
shot dead. The defense pleaded insanity. There was no
proof that prisoner had ever been considered insane prior to
the shooting ; but defense claimed that the incidents surround-
ing the shooting and the fact that no motive for the act was
shown were proof of prisoner’s insanity. Several witnesses tes-
tified that the prisoner had stated to each of them different
motives, some of them very absurd, for committing the crime,
and each of these motives was shown to conflict with the facts.
He seemed to have no conception of the crime he had com-
mitted. Several witnesses, among them his own mother, testi-
fied that they knew him for years and had never observed any
symptoms of a deranged intellect in him. About two years
before the murder deceased had refused to include prisoner in
an invitation to drink with him but it was not shown that de-
fendant exhibited any anger on that occasion. Beyond this no
motive was attempted to be shown. ‘Three experts were ex-
amined, one of whom believed that a taint of insanity was
present in the prisoner; this opinion was based on a personal
examination. The other two experts, from hypothetical cases
based on the facts, believed the prisoner to be sane.
On appeal to the St. Louis Court of Appeals the conviction
was affirmed.
In this case after the prisoner was hung an attempt was made
to show that his brain was that of an imbecile.
140 MEDICAL JURISPRUDENCE.
CasE XL.—WIFE MurRDER—DEFENSE OF INSANITY—DOUBT-
FUL EVIDENCE—CONVICTION.
Sayres
US. Oo Pas St 20m
Commonwealth,
Prisoner, in 1875, having had some difficulty with his wife,
threw her down-stairs and broke her arm, for which he was
sentenced to imprisonment, but, after a short time, upon her
solicitation, he was released, although she refused to live with
him again. After his release he made several unsuccessful
attempts to induce her to take him back. OnSunday, Novem-
ber 18, 1877, the prisoner followed his wife into church and at
the conclusion of the services shot her in the back. He
attempted to escape, but when arrested made no resistance,
and complained of a pain in the head. Mrs. Sayres died Nov.
29th. It was proved that prisoner was impoverished while his
wife was in good circumstances, and a motive thus shown for
his wishing to live with her. The fact of the shooting was not
seriously disputed. The defense was insanity, and it was
attempted to show that deceased had said after the shooting,
“My husband shotme, but I don’t want him punished,” to show
that she knewhe was insane. This was very properly ruled out.
(On appeal the Supreme Court sustained this ruling.) It was
shown that several blood relations of the prisoner had been
afflicted with mental disease; a sister was weak-minded; a
niece subject to fits; a cousin born an idiot. One witness
testified that prisoner was queer, of peculiar habits. Another
that he was “as crazy as a bed-bug ;” that his brain was shat-
tered ; others that he cried because his hands were stained ;
gave strange answers to questions ; was afraid to sit alone; he
supposed his wife and children had poisoned him ; was nervous
and could not sleep ; complained of his head ; was afraid of a
dog or cat. Another witness testified to his conduct fora
week preceding the shooting—his eyes were wild ; threw meat
on the floor, and preserves on the table. Dr. Wise, who exam-
ined him, believed him to be of unsound mind. To controvert
this the physician of the prison in which he was placed, two
keepers and the officers who arrested him, all believed him to
be sane at the time of his arrest. Others who were associated
with him in business testified to their belief in his mental
soundness. Others testified that he had said “ that his life was
miserable and unpleasant, but that was no excuse for the shoot-
THE LEGAL RELATIONS OF INSANITY. 141
ing,” and that “not being allowed to visit them (his children)
was the cause of his shooting her.” Several letters and a will
of the prisoner were also produced to prove his sanity.
On the trial he was convicted of murder in the first degree
and on appeal to the Supreme Court the conviction was
affirmed.
CasE XLI.—HomicipE By ALLEGED Lunatic—HistTory —
SIMPLY OF HyPOCHONDRIASIS—MOTIVE REVENGE—PRISs-
ONER CONVICTED, BUT CONVICTION REVERSED ON APPEAL.
Levi King
US. 9 Texas Appeal Repts., 515.
The State,
The prisoner, on March 22, 1880, shot and killed Dr. H. W.
Harrington. “On the trial it appeared that Harrington levied
on some property of the prisoner for debt, and that prisoner
had threatened vengeance upon him therefor. After the shoot-
ing the prisoner stated that he had first been assaulted by de-
ceased, but when it was shown to him that such was not the
case, he appeared confused, but gave no other explanation.
For the defense it was claimed that the prisoner was suffering
from masturbation, which produced hallucinations. It
was testified that for three years before the murder he would
occasionally leave home and wander through the woods ; that
he was while under these spells dull and sleepy ; that he claimed
he was a ruined man; neglected his business ; and several wit-
nesses testified on general impressions both for and against the
insanity theory.
The prisoner was convicted ; but on appeal to the Court of
Appeals the conviction was reversed.
Case XLII.—MurpDER-—DEFENSE OF INSANITY—HEREDITARY
TENDENCIES PROVEN, BUT NOTHING ELSE—MOTIVE FOR
CRIME—CONVICTION.
Webb
US. 9 Texas Appeal Repts., 490.
The State,
On September 2, 1876, in the city of Galveston, defendant
shot and killed Charles R. Foster, and was tried and convicted
of murder in the second degree. It appeared in evidence that
Foster had garnisheed some money of defendant for debt and
that he had said that “Foster had better hunt his coffin before
142 MEDICAL JURISPRUDENCE,
he tried to collect that debt.’ After the shooting the prisoner
appeared somewhat excited, but made no attempt to escape,
although he had ample opportunity to do so. He finally sur-
rendered himself to an officer ; he was then very indiffierent
and manifested annoyance when questioned about the murder.
A brother and cousin of prisoner testified that his mother is
insane ; his grandfather was insane and committed suicide as
also did a cousin who was insane. His sister was subject to
epileptic fits; his father was very eccentric; none of these
persons had ever been sent to an asylum. That on the night
before the murder the brother met prisoner, who had been
away from home for three weeks, and it was several minutes
before he (prisoner) recognized him. His manner for some
time before the shooting was strange and unnatural, and he
became morose, moody and careless in dress. One witness
testified that after the shooting his eyes glared and he looked
so unearthly that witness became frightened. Drs. Seeds and
Gibson, who had heard all the evidence, believed the prisoner
was insane when he committed the murder. Dr. Stone would
not express an opinion on the evidence, but said he had heard
no evidence of insanity that could not be attributed to de-
bauchery ; he believed that the mind of defendant was dis-
tracted at the time of the murder, but not enough soas to relieve
him from responsibility. Of the witnesses of the shooting (five
in number) two stated that they saw nothing unusual in his
appearance ; the other three did not observe his appearance.
On appeal to the Court of Appeals the conviction was
affirmed.
Insanity in Relation to Theft.—Theft may be com-
mitted by the insane, the crime being in some respects a fea-
ture of the early stage of the disease. Six patients suffering
with general paresis who were admitted to the West Riding
Asylum during a period of four years, had been arrested for
larceny. Browne suggests that this propensity may be a direct
result of the exalted delusion.
A patient with general paresis who had delusions of great
wealth, believing that he was the possessor of 8,o00 pounds, and
had 16,000 children, was convicted of larceny. Shortly before
the commission of the theft he showed his first symptoms af
general paresis, and there was no history of intemperance or
bad habits—in fact he had been a respectable man. His theft
was petty, a few nuts having been stolen.
Theft is often the result of an insane delusion, the person
THE LEGAL RELATIONS OF INSANITY. 143
believing that the stolen articles belong to him, or that he has
been commanded by God or some one else to take them for
a purpose. The nature of the act and the purpose itself should
be clearly those of insanity to bring irresponsibility.
The Commitment of Lunatices.—The laws regarding
the commitment of lunatics are practically the same in every
State. The certificates of one or more physicians who have
examined the patient are required, and these must be approved
by a judge of one of the higher courts.
State Laws.—In some States the case must be brought
before a jury. In brief, the laws of the different States are as
follows :
LVvew York.—Patient to be examined by two physicians of at
least three years’ standing, who have been declared Examiners
in Lunacy by a judge of a Court of Record. Upon certificates
of these two medical men, sworn before, and approved by a
judge of a Court of Record, the patient may be sent to an
asylum. The approval may be procured at any time within
five days.
Maine.—Patient to be examined by the municipal officers of
the town, upon application of the friends of the patient or a
Justice of the Peace.
Vermont.—Upon the certificate of two physicians residing in
the probate district in which the patient lives, who shall not be
members of the same firm, the patient may be committed.
In New Hampshire, upon order of the Court or a Judge of
Probate, based upon the certificate of two reputable physicians
whose respectability shall be vouched for by the Judge of the
Supreme Court or Court of Probate, or Mayor or Chairman of
Selectmen.
In Massachusetts, upon representation of the friends of the
patient and the certificates of two graduated physicians of three
years’ practice, the patient is committed by order of the Court,
after a personal examination, it necessary.
In Rhode Island, the certificates of two physicians of good
standing are required, and an order of court procured at the
solicitation of the guardian or friends.
In Connecticut the certificate of one or more physicians prop-
erly acknowledged by some officer or magistrate authorized to
administer oaths or take acknowledgments of deeds when given,
is necessary.
In Vew Jersey the patient is committed at the request of a
friend, who shall present a certificate signed by at least one
144 MEDICAL JURISPRUDENCE,
respectable physician, who shall declare under oath that the
patient is insane.
In Pennsylvania two certificates are required.
In Virginia the patient must be brought before a commission
in lunacy, consisting of three magistrates, who shall summon
the family physician and other witnesses, and if the patient is
judged insane after a careful examination, he is sent to an
asylum.
In Maryland the patient may be committed upon the cer-
tificate of one physician.
In Worth Carolina, upon representation of some respectable
citizen, sworn to before some justice of the peace in the county
in which the patient resides, he may be committed.
In Mississippi the patient may be received into an asylum
upon the certificate. of two physicians who shall swear to his
insanity before a justice or county clerk.
In Alabama patients are received in the State asylum on cer-
tificate of the probate judge of the county, attested by one res-
pectable physician or other witnesses, with or without a jury,
as the judge may decide.
In Ohio the probate judge issues a warrant for the produc-
tion of the alleged lunatic, and subpoenas such witnesses as he
deems necessary, one of whom shall be a respectable physician,
and upon being satisfied of the insanity of the person, he Sse
issue a certificate of commitment.
In /ndiana, the insane are committed by two magistrates,
who are required to personally visit the alleged lunatic, and to
report to the county clerk, who subpcenas witnesses, and sends
a certified copy of the proceedings to the Superintendent of a
State hospital, requesting admission.
In //linois, upon petition of a near relative of the alleged
lunatic, he is brought before a jury of six persons, one of whom
shall be a physician, and upon their verdict, a committal shall
be made out by the clerk.
The law of Michigan requires that the probate judge, after
calling two respectable physicians and other credible witnesses
shall decide upon the question of the insanity of a person either
with or without a jury.
In Kentucky the insane are committed by the inquest of a
jury, their presence being required in open Court, unless it is
shown upon the affidavit of two respectable physicians that it
would be dangerous to bring the supposed lunatic into Court.
In /owa the patient is examined by a permanent commission
of lunacy composed of a practicing physician, a practicing
THE LEGAL RELATIONS OF INSANITY. 45
lawyer, appointed by the Circuit Judge, and a clerk of the
Court. A personal examination is required to be made by the
physician, and after a report to the commission a conference 1s
held, and the patient committed if they deem him insane.
In Wisconsin, upon the certificate of two physicians the
patient is committed by the county judge. A jury trial is ac-
corded if requested by a relative.
In Minnesota, the probate judge, upon application, shall ap-.
point some physician or physicians (not less than one nor more
than three) to examine the person and to take proof, and upon
their certificates a warrant of commitment shall be issued. In
the city of St. Louis application is to be made to the health
commissioner, who shall direct an examination by physicians,
who shall request his commitment.
In Arkansas, upon application of any reputable citizen,
any county or probate judge shall appoint a hearing, take tes-
timony of competent witnesses, and shall direct an examination.
of the alleged lunatic by one or more practicing physicians of
good standing, who shall submit a sworn statement of their
examination, upon which a certificate shall be issued.
In Zexas, upon the presentation of competent testimony, a
patient may be committed by a jury of six if found insane.
In California and Oregon, upon the representation of either
a friend of the patient, or two householders, and upon the pre-
sentation of certificates signed by at least two respectable phy-
sicians, the insane patient may be committed by an order of the
Court. .
The laws of other States contain practically the same pro-
visions. A person of weak mind has not the same status in the
eyes of the law in civil questions as in criminal. His responsi-
bility is differently gauged.
Commissio de Lunatico Inquirendo.—In civil matters
his incompetency may be so great as to suggest protection.
He may be able to distinguish right from wrong, and have suf-
ficient intelligence to prevent him from committing crime, but
his mental condition otherwise may be such as to incapacitate
him for the transaction of business, and the management of
property. In this case he is afforded a protector in the shape
of a guardian, after the process of the appointment of a com-
mission de lunatico inguirendo. A guardian who shall protect
him from imposition and fraud, and who shall prevent him from
squandering his money. Not only issuch a step taken for the
protection of the idiot and imbecile, but for the insane and con-
Io
146 MEDICAL JURISPRUDENCE.
firmed drunkard. The application for such a guardian is to be
made by a near relative, who procures the affidavit of at least
two physicians, and a commission of three members, one of
whom shall be a physician, and the other a lawyer, shall be ap-
pointed by a Judge of a.Court of Record. The case is then
tried before a jury”, and upon their verdict a guardian, who
must give bonds, is appointed by the Court. The individual is
then practically a minor. In the event of his recovery, an ap-
plication for the restoration of his ordinary privileges is made
upon affidavits of physicians, and if the judge is satisfied of his
sanity the guardian is discharged.
Great care should be taken in giving or preparing
testimony, for it has often happens that the reasons assigned
are of the most flimsy character, and may be trumped up by
designing relatives, and too readily accepted by careless medical
men. It should be ascertained whether the individual has been
insanely extravagant—whether he has been swindled repeatedly,
or drawn into absurd speculations. One old lady whom I ex-
amined, invested two-thirds of her small fortune in bogus
mining companies within a few months, and spent considerable
sums of money in the most foolish ways, while before this
time she was penurious and economical. It is often neces-
sary to decide the question whether a person of weak mind
should be detained in an asylum or placed in charge of a guar-
dian and permitted to live outside ; and the courts are exceed-
ingly lenient in such matters, being especially careful in regard
to the possible abridgmént of personal liberty. The cele-
brated Dickie case was one of this kind, and though the medi-
cal men who examined the patient considered her an insane
person, thus placing themselves in direct opposition to the
press, their view of the case was disregarded, and Judge Brady
ordered Miss Dickie’s discharge, but appointed a guardian.
The following interesting and truthful account of the case ap-
peared in the NEw York TIMES:
CasE XLVI.—“ Miss Dickie was sent to Bloomingdale six
and a half years ago on the certificates of Dr. White, a prominent
homceopathist, and of Dr. Alfred C. Post. She was accepted as
a lunatic by Dr. Tilden Brown, and retained as such by Drs.
Nicholl and McDonald, with the implied consent of her aged
and imbecile father’s physician and guardian, Dr. Ranney. It
1S highly improbabl e that she was unjustly committed and con-
— - —
* In the city of New York by a sheriff’s jury.
THE LEGAL RELATIONS OF INSANITY. 147
fined, for the prestige of that merciful institution is too great
and its medical staff too distinguished to allow great mistakes
on such important matters.
“On the afternoon of January 16, 1878, Miss Dickie was
visited by a physician, who gave her his name and address,
and told her he was a physician who had cometo see her. She
was found to be diminutive in size, lame, and apparently de-
formed, hard of hearing, and with speech very indistinct and
imperfect from a very wretched condition of her gums, teeth,
and mouth. The latter, it was supposed, could easily have
been relieved by careful rinsing and washing of the mouth.
There were other signs of carelessness of person and dress
which were not visible in the persons of the Matron, attend-
ants, and other patients who were casually observed.
“Tn a little while she was conversing quite freely about bad
treatment she had received from her father, who, she said,
used to pull her hair and otherwise maltreat her; of deceit on
the part of her brother and sisters; of bad treatment on the
part of Dr. Brown and others. She also complained of the
food she received; among others, that they sometimes had
onions for dinner, and that they were served especially to
annoy her. She also asserted that she had been promised any
kind of food that she wanted. She stated that an effort was
being made with her consent and that of her family to remove
her from the asylum, and expressed a preference to live in the
city rather than in the country, with some slight hint which
suggested that she did not like green things, but desired to
visit shops, go to her own church, give money to it, and live by
herself. She volunteered to say that she read the Suz and the
Observer, and showed copies of them; that she had a great
impulse to improve her mind; quoted some simple little
maxims at times, especially about not talking too much, when
she was monopolizing almost the whole conversation, and men-
tioned with great glee that she had been down to court, but
they had got nothing out of her, which I supposed meant that
she had not committed or betrayed herself. She also insisted
that Dr. Post had testified in her favor, and reiterated this
statement when told that she was probably mistaken. As she
occasionally quoted Scripture, she was asked if she had a
Bible ; it was then noticed that she seemed to keep almost all
her property under lock and key, but she quickly produced
her Bible from a locked drawer, and it was found not only filled
with pencil marks from Genesis to Revelations, but many pages
were folded in the most curious and complicated ways, as if to
148 . MEDICAL JURISPRUDENCE,
mark special passages of great import to herself, but her visitor
was surprised on unfolding these curiously doubled-up pages
to find no pencil marks whatever upon some of them, and she
avoided answering why she thus pointedly singled out particu-
lar pages. It is barely possible that those were pages which
she did not wish to read, but nothing could be detected strik-
ingly peculiar in the contents of those pages upon a short
examination.
“Her first visitor had been alone with her for half an hour or
more, when another physician came into the room, was intro-
troduced by name and title as a second medical man who had
come to see her. She immediately went on conversing with
him, and the first party looked at the surroundings. Her room
was very neat, quiet and comfortable, was prettily furnished
with a blue carpet, blue cottage furniture of a superior kind.
His attention was attracted by hearing her tell her second visi-
tor that there was a language of food as well as of flowers, and
when asked for an illustration stated that coffee was brown,
brown was a Quaker color, a Quaker was a friend, and that
hence coffee meant friendship. That if one person gave
another acup of coffee, it was a sign of friendship, and if milk,
which was white, was put into it, it was a sign of pure friend-
ship, and the addition of sugar made it an indication of sweet
friendship. In short, that coffee with milk and sugar in it was
indicative of pure, sweet friendship. Then she volunteered
to say that bread represented a friend ; that a big piece of
bread was a sign of a large friend; that butter signified refine-
ment, and bread and butter a refined friend. She then quickly
said that cabbage was white on the inside, and that signified
purity, and green on the outside, but no questioning could
make her say what the green meant. She continued to say if
one cut up the inside of cabbage and put it on a little plate, it
would indicate purity and something else which she would not
disclose, possibly because it had reference to the green color.
It is to be regretted that no inquiries were made as to the sig-
nificance of onions, to which she has an antipathy, and by what
articles of diet she represented the opposites of friendship,
purity, sweetness, etc.
‘Repeatedly while this conversation was going on her visitors
were warned not to speak loud, as persons were watching all
the time, up-stairs and down-stairs, through the register, pipes,
etc., presumably the waste, water, or gas pipes, none of which,
however, could. be seen on casual inspection. These persons
were also said to whisper to her through these tubes. She de-
THE LEGAL RELATIONS OF INSANITY. 149
clared that this food language was not peculiar to herself, but
was known to and in constant use by all the attendants and
patients; that her conversation and letters were communi-
cated or perhaps telegraphed about the house, as she inferred,
by single words, said by different persons, in various places, in
the midst of their conversation, and by putting these detached
words together, she found out by something in her heart or
chest, not in her head, that they had become acquainted with
the letters she had written, and the conversations she has had
with others, and presumably with herself.
“Tt was very evident that Miss Dickie was of unsound and
imperfect mind and understanding, yet for an hour and a half
she had given no positive signs of absolute mental derange-
ment. She knew who and where she was, described the insti-
tution as a honse of affliction, but she made no allusion or
complaint of her fellow-sufferers, or of any noises or annoy-
ances except the imaginary whisperings through the tubes.
She was conscious of her own weakness and ignorance of many
things, seemed satisfied to have as her guardian a bank presi-
dent, whom she named, as she was not accustomed to deal with
large sums of money. In short, she presented the usual mix-
ture of reason and unreason so common in many simple luna-
tics. Sometimes she exhibited a good deal of tact and cun-
ning, at other times of extreme childishness and simplicity,
mixed up with delusions, hallucinations, unfounded suspicions,
extreme prejudices and hatreds, great Christian piety, charity,
and benevolence. :
“The only question that could arise was whether it was abso-
lutely necessary to retain herin the asylum. There seemed no
objection to a trial elsewhere, provided all her property should
not pass into the hands of strangers and irresponsible persons;
that a proper residence should be selected where her peculhari-
ties shouid not become the sport of the foolish and indiscreet ;
and that a competent maid, nurse, assistant, or matron could
be found possessed of unmeasured patience, tact and resolution.”
In such cases, it undoubtedly happens that the patients may
fall sometimes into the hands of designing guardians, so that
the legal action may prove rather a curse than a blessing.
A case where interdiction was I think very improperly refused
is the following :
Case XLIII. .
(31 Louisiana Annual R. 757.
Scott Watson, Sr., died in 1859, leaving a widow and minor
150 MEDICAL JURISPRUDENCE,
children, and the widow was confirmed as natural testatrix of
herchildren. In 1866 the children were sent to France to com-
plete their education, One of the children, Scott Jr., who was
then 19 years old, and was described as “the brightest boy in
school, both mentally and physically sound,” was brought home
two years afterwards in a condition of mental idiocy and imbe-
cility and has since so remained.
It 1878 the parish judge of Tensas made a decree of inter-
diction. In these proceedings it was shown by the testimony
of two physicians, who had examined him the previous day,
that he was very weak in mind and body and was unable to
take care of his property. That he was suffering from dementia.
On behalf of the mother it was shown that he was very trac-
table. That the only violent propensity he exhibited was
cutting his clothes. That he ate with the family and had per-
fect freedom of action ; and that he manifests a very warm love
for his mother.
On appeal to the Supreme Court it was held that the evi-
dence adduced was not sufficient to warrant the interdiction.
CasE XLIV.—APPLICATION FOR DISCHARGE FROM ASYLUM
—NOT GRANTED.
Commonwealth ex rel Dr. Helmbold
US. 11 Philadelphia R. 427.
Kirkbride,
Dr. Helmbold who had been regularly committed to the
Penna. Insane Asylum, made an application to be released
therefrom, denying that he was of unsound mind. There was,
however, as the Court stated, a preponderance of evidence to
prove his insanity, and it was also shown that he had during
five years been committed to insane asylums four times ; also
that his insanity was hereditary and that two brothers and an
only sister were then confined in insane asylums. None of the
testimony is given in the opinion.
On the grounds above stated the Court refused the applica-
tion.
The testimony of insane persons is usually not received in
Court, and a recent decision is that of
Case XLV.
Hand
US. 3 N.Y. Monthly Law Bulletin, 6.
Burrows,
THE LEGAL RELATIONS OF INSANITY. I51
Application for a commission to take testimony of a witness
confined in an insane asylum :
ffeld, that if the witness is sane he can be produced ; if
insane, his testimony cannot be received in a court of justice.
By some judges the insane person is permitted to testify in
his own behalf, his evidence going for what it is worth with the
jury.
Concealed Insanity.—In some cases lunatics will conceal
their insanity when upon the witness stand, so that their
incarceration may be looked upon as an outrage, and their re- ©
lease may be promptly induced. If, however, a person familiar
with their delusions properly interrogates them, the barriers of
self-restraint are broken down and the justice of and necessity
for their detention becomes evident. A stout, healthy looking
Irishman was brought into one of the Courts upon writ of habeas
corpus several years ago. He answered the questions pro-
pounded to him in amanner at once ready and intelligent, and
the lawyer proceeded to shake his head knowingly and comment
upon the “burning wrongs.” The Superintendent, who had
waited patiently, begged permission to ask the prisoner one
question, and it was reluctantly given. It wassimply “ who did
you say you were?” Without a moment’s hesitation the wit-
ness growing flushed and excited shouted out “I am the Lord
Jesus Christ,” and launched forth into a furious exhortation.
This man, it is needless to say, was promptly sent back to the
asylum. He was a violent and dangerous lunatic, believing
that his change in identity gave him power to inflict such
punishment as he saw fit.
The Popular versus the Scientific View of Insanity.
—In many instances it is difficult to make an ordinary jury ac-
knowledge the existence of lunacy, for the average layman has
his own idea of what amadman should do, and all the finer dis-
tinctions go for naught. Until the time arrives when it will not
be considered necessary for an insane person to tear his hair
or drivel, or indulge in the violence which is found only in
novels and onthe stage, we may expect to find juries more
often wrong than otherwise. |
A case where the jury were completely deceived by the pa-
tient came under my observation a few months ago and the ludi-
crous termination of the affair is worth recording. A certain
man of respectable family and in comfortable circumstances
entertained an idea that he was an apostle, and hired a hall in
the Bowery to which he invited the young women and men
552 MEDICAL JURISPRUDENCE.
from the streets, and the result was that the place was crowded
night after night with a turbulent crowd of young thieves and
prostitutes. Robberies of articles upon clothes lines in the
neighborhood were committed and the police were called in.
In consequence the proprietor was arrested and brought into
court and committed to an Asylum, as it was believed his con-
duct was that of an insane man. His religious views were
novel in the extreme, but the jury before whom he subsequent-
_ly came in’ lunacy proceedings for habeas corpus were not dis-
posed to consider him necessarily insane and he was discharged
from the custody of the Asylum. He, however, of his own
volition went back to the Asylum where he staid despite the
efforts of the Superintendent to get rid of him, and his beha-
vior was clearly that of a lunatic. He threatened to sue the
physicians who committed him unless they gave him the oppor-
tunity to deliver his peculiar address before one or more medical
bodies. I examined him and found the well marked symptoms
of early general paresis. He had delusions of power, and had
a confidence in his own capability as a reformer that was re-
freshing. His theory in regard to the /mmaculate Conception
was that it was through a kiss, and he proposed to do away with
the ordinary method of intercourse and substitute a plan of his
own, which was in every way to be more pure. The
patient was liberated upon application of a lawyer who
was one of the strongest agitators in the movement which was di-
rected to open the doors of lunatic asylums, and his interest in
his client was very great. He, however, received a rude check
when he presented his bill for professional services and the
client proceeded to issue bonds and bank notes for its payment,
which he made with a pen and whatever scraps of paper he could
lay his hands upon. This man has since committed suicide.
Feigned Insanity.—We are called upon very often to de-
cide the question whether a certain alleged lunatic is shamming
or not, and sometimes the task is one of great difficulty. The
ability to detect a simulator depends much upon the experi-
ence, the shrewdness and the patience of the medical man. He
should not only examine the person’s behavior presented during
the interviews, but cause him to be closely watched ; and his ac-
tions for some time previous to the examination should be investi-
gated. The medical man is also to make careful physical ex-
aminations, the pulse and urine often furnishing striking indi-
cations. The greatest difficulty of the simulator of insanity, and
in fact of all feigned diseases is the inability of the patient to
THE LEGAL RELATIONS OF INSANITY, 153
keep up his deception, especially when he believes he is not
watched, Sometimes he will overdo the part he strives to play,
or at others will act upon a hint purposely conveyed without
his knowledge. Such a case is that reported by Montigna.
Several physicians examined the individual and purposely in his
hearing, expressed their doubts of his insanity for several rea-
sons, one being that he retained the nourishment they gave him,
the second because he had not smiled, the third because he had
not fixed his attention upon any object. ‘he ruse succeeded
and he changed his methods in a way to remove all doubts of
the physicians, following their suggestions as closely as he
could.
Snell says: “Common people have not the slightest rational
idea of insanity. They believe that all mental manifestations
are completely altered in it, and that an insane person knows
nothing; that he ceases to read, to write, and to reckon
and that all his relations and conditions are completely revers-
ed, hence it happens that all uninformed people find it difficult
to acknowledge actual insanity. When they speak of an insane
person, thay say that he is not mad, that he knows every one
about him, and that he altogether conducts himself like a rea-
sonable man, only that he shows some peculiarities. Unedu-
cated people have the idea that an evil spirit, as it were, takes
possession of an insane man, and drives out his being into alto-
gether new and perverted elements. When they observe mem-
ory, reflection, feeling of right and wrong, they think that in-
sanity cannot exist and yet among the insane all these things
are seldom altogether wanting and often exist to a high degree.
On this rock simulators generally make shipwreck if they at-
tempt a part at all active. But itis more difficult to form a
judgment if the simulator preserve a complete passiveness and an
obstinate silence. It is not impossible that by these means in-
sanity may be simulated with success, yet in order to do so
the simulator must possess a rare strength of will in order,
through all observation and tests, to preserve his role.”
There are certain well defined features of real insanity the
simulator cannot counterfeit, however skillful and cunning he
may be. He cannot remain watchful any great length of time,
he must eat and he can never voluntarily present the pulse and
temperature changes of melancholia or mania, *Gavin says
* Zeitschrift fur Psychiatrie, Dec. 1855, quoted by Bucknill and Tuke, p.
479.
#? 170,
154. MEDICAL JURISPRUDENCE.
on feigned diseases: “On points directly involving his inter-
est, the impostor will display the full endowment of the shrewd-
ness compatible with this condition, while his stupidity is re-
served for occasions where his interests are not particularly con-
cerned, his replies notwithstanding his imbecility, never tend
to criminate himself ; but whatever he says, is rather meant to
induce a belief in his innocence; and this game he pushes as
far as he dares.”
Ray states “that where the person replies to inquiries in such
a manner as to criminate himself, it may be pretty safely
concluded that the imbecility is genuine; and though the con-
verse of this rule may just be equally true, yet if the whole tenor
of his replies be of an exculpatory turn, strong ground of suspi-
cion, at least, is afforded, that all is not right.” .
The nature of the act itself, which is alleged to be of
an insane nature, should be taken into account, with
the possible existence of motives, the possibility of a de-
sire for revenge or gain, the existence of an unfortunate and
unprofitable business contract, or the desire to escape some dis-
agreeable duty are suspicious circumstances and may suggest
the groundwork for perjury. The possible existence of pre-
vious symptoms, if any, will throw some light upon the present
condition of the person, and the various questions of heredity,
the history of head injury and the presentation of symptoms al-
luded to upon a previous page are to be weighed, although, so
far as heredity 1s concerned, it will be found that many vicious
criminals have a well marked nervous saturation from trans-
mitted taint from insane ancestry. Macdonald and others al-
lude to the fact that there is an absence of the change of char-
acter so universal in insanity ; so, too, he points out that the
alleged insane act is suspicious if it is the first evidence of the
insanity—“ an act of violence is never the first symptom of in-
sanity.” The simulator of insanity will indirectly repudiate all
knowledge of persons with whom he was, perhaps, formerly inti-
mate, though he may know the names of officers of the jail where
he may be confined. He shows an eagerness to avoid the recogni-
tion of persons which is too marked to be natural and usually
springs from an obstinacy which he adopts, believing it necessary
to keep up this form of ignorance. Ray calls attention to the
fact that the impostor’s interest in his family does not lessen.
A forgetfulness of names and dates is very suspicious, espec-
ially if in the course of a long conversation the malingerer has
given them correctly upon a previous occasion, or if he pleads
loss of memory as a result of disease.
THE LEGAL RELATIONS OF INSANITY, 155
The simulator will often disclaim any knowledge of what he
has done or what he is doing. He will, perhaps, say that he
has delusions, and that he acted under their dominance.
The absurdity of this becomes at once apparent, for, as Casper
says, ‘‘the instant they acquire the knowledge that their delu-
sion is a delusion it ceases to exist as such.” In fact, the real
lunatic will not admit that he is insane.
Feigned Mania.—J/ania is often shammed, and usually by
persons of mediocre intellect, the consequence being that the
popular idea of madness is carried out, and detection is the in-
variable result. We find that such persons overact. No pre-
tended delusions are too extravagant, and the malingerer’s con-
duct is entirely too violent to last. The real victim of true
mania presents physical symptoms which are beyond the simu-
lator. The quick pulse, the furred tongue, and the dry skin
are indications that are in themselves almost conclusive. The
person who thrashes about to carry out his idea of mania sweats
profusely. This, coupled with profound sleep after great ex-
ertion, Bucknill considers to be more than suspicious. Under
certain circumstances various tests have been applied such as
the administrations of anesthetics and corporeal punishment,
but these are not always to be recommended.
As a rule, the patient who is feigning mania is very apt to try
his hand in other directions and may manifest the symptoms
of melancholia; after all, inconsistency is the feature of the de-
ception.
Gavin, * whose article upon feigned insanity is the best of
which I know, says :
“The real monomaniac never troubles himself to make the
subject of his delusion accord with other notions having rela-
tion to it, and the spectator wonders that he fails to observe the
inconsistency of his ideas, and that when poirted out to him
he should seem indifferent to or unaware of this fact. In the
simulator, the physician will discover an unceasing endeavor to
soften down the palpable absurdity of his delusions or reconcile
them with correct and rational notions. This marked anxiety
to produce an impression is widely different from the reserve
and indifference of the real disorder, and will of itself furnish
almost conclusive proof of simulation.”
The peculiar bodily odor so marked in mania is absent of
course when the disease is simulated. The clothing and bed-
*
* Ray’s Medical Jurisprudence of Insanity, pp. 318, 319,
156 MEDICAL JURISPRUDENCE.
covering always become impregnated with this, and it is, of
course, most distinct in the morning after the room has been
shut up. Esquirol, Barrows, Knight and Hill all place great
reliance upon this test. The greasy appearance of the skin, so
marked in some patients, or the scurfy dryness are disease
manifestations which are absent in he who shams.
The simulator rarely feigns Idiocy, and if he attempts to do
so he cannot succeed. The physical deformities are beyond his
reach—the shape of the head, the teeth, the ocular symptoms.
If we have any doubt it is only necessary to inquire into his
previous history.
Imbecility is a condition that is still likely to be simulated.
Le Grand du Saulle calls attention to the fact, however, that the
imbecile may for a purpose—to escape punishment, for
instance,—sham and feign more grave conditions. Thecase of
Guiteau furnishes us with an example of this kind. Of weak,
vicious mental organization, he, when threatened with punish-
ment, clumsily resorted to methods of simulation which he be-
lieved would at least convince one or more of the jury of his
insanity. His so-called delusions were innumerable and always
expressed dramatically in court. He was “ God’s man.”
In jail he was a very different person and never manifested
any such nonsense ; his pulse was regular, his bodily functions
good. He never attempted to deceive those who visited him
who he knew were able to see through his tricks. (See pre-
vious page).
Feigned Melancholia.—Melancholiais seldom shammed,al-
though certain forms, notably those characterized by a fixed delu-
sion, might be feigned with comparative ease. Gavin says of this :
‘“The true melancholic seeks to shut up within himself his sad
ideas, or at least he speaks but little of them, and betrays him-
self less by his discourse than by his physiognomy, his coun-
tenance, gestures and whole external habit. The signs indica-
tive of it are the more apparent the less he believes himself
observed. The contrary takes place in simulated melancholia,
unless one has got to deal with an experienced impostor. The
simulator is deficient in the presiding principle, the ruling de-
lusion, the unfounded aversions and causeless attachments
which characterize insanity. He is unable to mimic the solemn
dignity of characteristic madness, nor recurs to those associa-
tions which mark this disease ; and he wants the peculiarity of
look which so strongly impresses an experienced observer.”
THE LEGAL RELATIONS OF INSANITY. 157
Feigned Dementia.—Dementia is more often feigned than
melancholia, but not so frequently as more dramatic and noisy
troubles. The simulator will be apt to be ignorant of the fact
that memory in regard to recent events is affected in the dis:
ease, and that the remembrance of remote events is fairly good.
He cannot possibly consistently carry out the deception when
he attempts to feign the incoherent loquacious stage of the
disease.
It seems hardly possible that any one would attempt to sham
the mental symptoms characteristic of organic disease of the
brain, but such a case occurred. In several of the English
works upon medical jurisprudence the case of Jaikes is pub-
lished, who while under trial for picking pockets fell in
a pretended apoplectic fit, and when he returned to con-
sciousness feigned hemiplegia and secondary dementia so suc-
cessfully as to deceive several medical men, who recommended
his commitment to an asylum, from which he subsequently
escaped. This, however, 1s an exceptional instance.
Ray alludes to the fact that no matter how skillfully demen-
tia may be counterfeited there is always a kind of hesitation
upon the part of the person who feigns, which suggests delibera-
tion of what he will do next. He Aalts so that his exaggerated
ideas do not succeed each other as they would in true dementia
nor so rapidly. Forgetting the fact that the excitement of de-
mentia is continuous, he falls into the error of assuming a kind
of periodicity.
Criminal cases are numerous when insanity is feigned.
To a man who has no defense the assumption of the
insane state 1s a natural way out of his difficulties, and it
cannot be denied that many of the persons that are sent to
asylums by judges and juries are mere impostors.
CasE XLVII.
The Barr Case.—Dr. Walter Channing reports the follow-
ing case of feigned insanity which created a great deal of
interest at the time of trial :*
“Tt is doubtful whether William Barr, the subject of this
sketch, feigned in the first place in order to be transferred to
the asylum. In all prisons there is a class of incorrigibles who
constantly chafe against discipline, and Barr was one of the
worst of this kind. Becoming unmanageable in the prison he
* Boston Medical and Surgical Fournal, May 23, 1878,
158 MEDICAL JURISPRUDENCE.
was sent to the asylum for the relief of the officials. The first
we hear of him is at Clinton State Prison, at Dannemora, N.
Y., to which he was sentenced in 1871 for ten years for high-
way robbery, and from which, after remaining nearly a year, he
was transferred to the State Asylum for Insane Criminals at
Auburn. Here he remained nearly two years, the last seven
months of this period being under my observation. From the
asylum he was sent to the Auburn State Prison, staying nearly
six months, when he again entered the asylum, remaining nine
days. He then returned to the prison again, where he staid
until some time after the homicide, which he there committed.
During this period he has a history for violence and intracta-
bility, but all the very conflicting evidence given upon the trial
furnishes no clear proof of insanity.
“In February, 1877, Barr murdered a prison keeper named
Casler, who, it is stated, had borne an unusually good reputa-
as a keeper, and beyond reporting convicts for bad behavior
had never had any trouble with them. ‘The circumstances of
the murder were substantially as follows :—
“Barr was one of a gang of convicts shoveling snow off the
sidewalk in front of the prison. The gang was in charge of
Casler. Whenever a woman went by Barr would stop and
smile at her ; he would also neglect his work and walk up and
down the sidewalk. He began after a while to throw snow in
the gutter, which the keeper told him not to do; he talked to
another convict, which the keeper also told him not do ; finally,
the keeper told Barr that if he did not stop he should send him
in, but Barr said he would go when the rest did. The keeper
wrote a note, which Barr probably supposed concerned him,
and sent it by another convict, and then turned his back to
Barr, and began talking to some passer-by. Barr ran up and
struck him with the edge of his iron shovel on the side of the
face. The blow knocked the keeper over. Barr followed it up
with three or four other blows and kicks, until another convict
told him that he would kill him (Barr) if he did not stop. This
threat made him desist, and he was taken into the prison.. The
keeper expired in a few moments.
“The murder created the most intense excitement in the town,
not only because of the brutal manner of the killing, but be-
cause the murderer had twice been an inmate of the Asylum
for Insane Criminals. The latter fact was noised abroad in the
papers. The feeling became generally prevalent that Barr was
insane, and public judgment was biased to a most unreasoning
extent by preiudice,
THE LEGAL RELATIONS OF INSANITY, 159
* He was indicted for murder, and in October last was ar-
raigned for trial. He made no reply when asked the usual
questions and his counsel interposed the plea of insanity as his
sole defense.” * * * A commission in lunacy to examine
into the mental condition of the prisonor was appointed.
‘After an extended investigation they found that Barr was sane
both at the time of the homicide and when they examined him.
It would appear at first sight that the finding of a commission
of experts might so definitely settle the question of insanity
that it could no longer be an element in the defense. If the
prisoner is insane he may be remanded at once by order of the
court to an asylum. By so doing the expense of a trial is
avoided. When, however, a commission finds the prisoner sane
the defense of insanity can still be used, and the finding of a
commission, beyond acertain moral weight it bears, is of no
service. |
“‘Barr’s counsel accordingly used insanity as his sole defense.
Portions of the evidence taken before the commission was read
simply as the testimony of certain persons. The trial lasted a
week. The jury stood at first nine for a verdict of guilty and
three for acquittal on the ground of insanity ; a verdict of
murder in the second degree was, however, finally brought in,
and Barr was sentenced to prison for life. He received his
sentence with stolid indifference. On being told that he had
got off very lightly he said he did not care. At the prison,
when received there from court, he was asked why he didn’t
recognize some of his old keepers ; he replied that he wasn’t
recognizing any one ¢hen.
““ Reviewing the evidence given in this case, it will first be
found that the reasons of the physician at the state prison at
Dannemora for transferring Barr to the asylum were contra-
dictory. He makes a diagnosis of one form of insanity, acute
mania of several months’ duration, and then says he was mel-
ancholic. He shows that Barr was insubordinate, violent and
noisy, but considering his low, brutal nature these acts are not
necessarily indicative of insanity. * * * He was afflicted
with a cerebral hyperesthesia, and was in a state of constant
nervous erethism, ready to explode at any moment.
“ The first year and a half of Barr’s residence at the asylum is
a blank ; we know only that he was still vicious and insubordi-
nate. During the seven months of my observation of him
there I always found a cause, however trivial, for his bad be-
havior. Generally when his passion subsided he would
acknowledge that he had done wrong, aid promise to be good,
150 MEDICAL JURISPRUDENCE.
‘and actually did better for a few days. Among the patients hé
had found several old pals. These he often incited to mischief,
and endeavored to make them join with him in fights and at-
tempts at escape, thereby showing a power or desire of com-
bining which in the lunatic would almost never be found. The
necessary lack of severe discipline at the asylum, the associa-
tion with the weak and sick insane, and all the surroundings,
so different from a prison, did much to develop the ungovern-
able elements in Barr’s character. He learned his vast power
of evil and freely exercised it, considering himself irresponsi-
ble because a lunatic.
“Leaving the asylum and going to the prison his conduct
does not improve ; he is called a ‘luny,’ and his behavior re-
garded as that of an insane man. He whistles on Sunday in
the chapel, but is not punished, as the warden says he is not
‘all right.’ (But only a short time before this a convict had
done the same thing, and said that the devil was in his cell,
and had been sent to the asylum. ‘There he confessed that
some feigners who had previously been in the asylum told him
how to ‘play crazy.’ Barr knew these same persons, and
without doubt also knew this recipe for insanity.) Finally,
after threats to kill several persons (he said he would get over
_to the asylum again if he had to kill a keeper) and various acts
of insubordination, the prison physician certifies that he is the
victim of melancholia and paroxysmal mania and again he
enters the asylum. ‘There no vestige of either can be discov-
ered ; he is bright, perfectly well, and tractable until some trifle
makes him angry. He thinks, however, himself, that he is
insane, and says his head is not right; but the insane do not
think themselves insane.
“Again he goes to prison, behaves somewhat better, and for
two months before the homicide the warden hears nothing of
his insanity. :
“The circumstances of the murder were horrible, but still
more terrible and unjustifiable murders have been committed
by sanemen. ‘The keeper had made Barr angry, and it was
natural that aman with his temper should raise whatever he
might have in his hand and strike with it. More might be said
on this point, but it seems unnecessary. Barr gives his reason
for having struck the keeper, saying that he would not be
imposed on, and the keeper was imposing on him.
“ After the homicide he no doubt has the old feeling that he is
regarded as insane, and he is still very violent and troublesome
when irritated. He now speaks occasionally of devils. At the
THE LEGAL RELATIONS OF INSANITY. 161
county jail he is at first troublesome, but on being punished
his manifestations of violence cease. ‘This change alone is
strong evidence of sanity. A person violent enough to be
yelling and whistling sufficiently loud to disturb the neighbor-
hood would be affected with violent mania, and punishing such
a person would have no other effect than aggravating the
symptoms. As the time of the trial draws near he becomes
quiet, and knows and talks with almost no one. If he does
talk it is to speak of devils. The idea of seeing spirits and
devils is one that generally occurs first to ignorant people.
Barr seems to realize that his knowledge is too limited to allow
him to feign the violent forms of insanity, and he therefore -
fixes on the stupid, quiet, non-committal form.
“The feigner generally mixes the appearances of several
forms with each other, so that an unnatural representation of
disease is Offered. He usually overdoes the phenomena of
mental disturbance. He believes that all must be reversed ;
instead of giving expression to delirious ideas he talks absurdly,
and conducts himself as if in insanity the greater part of the
intelligence and of the memory must be disturbed.’ * Barr is
interested in his trial, prepares himself daily for it, and is
impatient when it does not begin. Here is showing interest,
attention, and muscular activity ; but he gets into the court-
room and is too demented to answer the simplest questions, or
obey even the direction to stand up. At the same time he keeps
his body in perpetual motion, laughs and mutters to himself,
disturbs the order of the court, and creates a scene by a
tremendous struggle with his keepers ; here again he launches
into mania.
“The following extract from a caper of Barr with the
commission is very striking, resembling in many respects
reported conversation with other feigners:—
Q. How old are you? A. I don’t know, sir. Q. Were you born in this
country? A. I don’t know. Q. What is your name? A. Barr. Q.
What is your first name? A. William. Q. Your brother’s name? A. I
ain’t got no brother. Q. What was your mother’s name? A. I don’t know
sir. Q. You say you don’t know where you were born? A. No, sir. Q.
Do you mean tosay that? A. No, sir. QQ. Where were you brought up?
A, The devil is all the time talking tome. Q. Do you know Captain A (a
keeper at the prison)? A. No. Q. Do you know Captain B? A. I don’t
know any of them at all. Q. Doyou know Captain C? A. No. Q. Do
you know Cap‘ain D. A. Where? Q. Do youknow Captain E? A. No,
sir. QQ. Do you know your brother’s name now? A. You know the devil
is all the time talking to me about. Could hear him well enough, and I
Griesinger, page 120,
It
162 MEDICAL JURISPRUDENCE.
don’t want to hear. Thatis the matter. Q. You say the devils are all the
time talking to you? A. Yes, sir; youknow. Q. What dothey say? A.
They won’t let me rest. Q. Tell this gentleman what they say, and he will
write it down. A. I don’t want it written down. Q. Can you read or write ?
A. No, sir. Q. When did you forget to read and write? A. You willall write .
too. On another occasion he was again asked where he was born, and
replied, ‘‘I guess so; what do you want to talk to me for?” The question
was repeated, and he said, ‘“What are you talking to me for? There are
seven hundred thousand devils flying around all the time ; you know what
they say.”
“ Barr says that he cannot read or write, and with the excep-
tion of two questions answers all wrong. Some of his answers
are responsive, but many irrelevant and absurd. He knows his
own name, but neither his father’s nor his mother’s. - When
asked his brother’s name he 1s afraid, no doubt, that his brother
may be found, and says “I ain’t got no brother.’ When asked
if he knows certain persons he gives incorrect and different an-
swers. His replies are nearly all in the negative, as if he had
resolved to respond in that way. He also tries to drag in devils
in his irrelevant answers, but.he shows no originality in so do-
ing, always repeating almost precisely the same words. He
merely says that he sees or hears devils, but can go no further,
though especially interrogated to do so. In true mania the
lunatic under similar circumstances would rattle on with the
most perfect volubility, soon changing to other subjects prob-
ably, if the attack were acute; if chronic, talking rationally
and connectedly of his delusions, and even in many cases an-
swering other questions properly. Barr’s apparent delusions
and hallucinations cannot, therefore, for a moment be dignified
with the name of mania, and his absurd, almost always false,
but often responsive answers, instead of showing the mental
weakness, as loss of memory and attention, etc., of dementia,
indicate a consistent and well-sustained effort willfully and
wrongly to answer all questions. When he answers two ques-
tions correctly, giving his first and last names, he is evidently
surprised into so doing. Barr in court presents the picture, to a
limited extent, of advanced dementia and violent mania, in-
compatible, of course, in themselves. As expert testimony is
given, showing the inconsistency of his actions, he changes ac-
cording to what has been said. He has never looked any one
in the eye, but on hearing that real lunatics do so he does the
next day. Though too stupid to recognize any one, he eyes
‘persons he has known very sharply, doing this when he sup-
poses himself unobserved. If demented, his circulation would
be sluggish, his hands cold, etc.; if maniacal, more active
THE LEGAL RELATIONS OF INSANITY. 163
symptoms, slightly quicker pulse, loss of flesh and sleep, would
be present ; but his general health is good, his weight normal,
and he sleeps well. The latter fact is of special importance as
still further excluding mania.
But the other side of the picture is seen most distinctly when
Barr is in his cell at night. Here the most plain, positive, and
convincing proofs of Barr’s feigning are brought to light. The
poor lunatic, too demented to know his father’s name, his own
age, where he was born, etc., or to read and write, or to under-
stand what is said to him, or to recognize one person out of
many he has known, converses with the convict in the next cell,
an old friend, after the other prisoners are asleep. Sometimes
this conversation is prolonged until he tells the other ‘shut
up; I must goto sleep.’ Barr borrows papers of him, which
he reads, and tobacco and cigars, which he also uses. The
other convict writes him a note, and he replies, calling him by
his right name and signing his own. He finds out that the
other has ‘told on him,’ and he is angry. In these and other
ways he is the same old Barr, interested in what is going on,
enjoying the luxuries of life, at times irritable, but perfectly
rational and true to his own nature.”
CasE XLVIII.
The Waltz Case.—The Waltz murder case is one which
gave rise to much controversy some years ago. The facts of
the homicide and the subsequent behavior of the prisoner are
thus detailed by Dr. A. E. Macdonald.*
“On the first of May, 1873, Joseph Waltz killed an itinerant
knife-grinder who was stopping at his father’s house, and buried
the body, and part of the effects of the victim upon the farm.
The method with which the crime was planned and perpetrated,
and the care taken to conceal the evidences of it, all showed
coolness, cunning and deliberation.
“Sixteen days elapsed before the discovery of the murder and
of circumstantial evidence which seemed to implicate Waltz and
his father ; and during those sixteen days his conduct betrayed
no departure from his usual custom, and gave no eyidence of
non-possession of his faculties. ‘He made bargains, trans-
acted business, and kept careful accounts of his payments and
receipts. When the unmistakable evidence of his guilt was
communicated to him, and he found also that his father was
? Am. Psvcholosical Fournal Mav 1376
164 MEDICAL JURISPRUDENCE.
suspected of complicity in the crime, seeing that he could not
save himself, and desirous of saving his father (who had appa-
rently no connection with or knowledge of the murder), he
made a complete confession, and being taken to the farm,
pointed out the places of concealment of the body and of the
property, where they were then found. In this confession he
described minutely the details of his crime, relating how he
went to the woodshed for the hatchet, how he entered the room
where his victim was lying asleep, turning the lamp down and
placing it behind the head of the bed, so that the light might
not awaken him; how, ‘warned by the inward pleadings of
conscience,’ he restrained himself and withdrew from the
room. Ina short time he returned, cautiously as before, and
struck the man upon the head a single blow; then, as he still
breathed, and ‘doubting of its fatality,’ he struck him twice
again. He goes on to describe how he carried out the body,
and hid it in the barn, but, reflecting that it would probably be
discovered there, removed it, burying it near a fence and cover-
ing it with stones and subsequently taking it up, burying it in
the orchard, and plowing the lot so as to remove every trace.
He similarly disposed of the grinding machine anda other arti-
cles belonging to the deceased. In this confession he ascribes
his crime to the influence of evil spirits, controlling and direct-
ing him, and relates how he strove to resist their domination
and prayed for delivery from them.
“Shortly before the arrest of Waltz, and while search was
being made for him, some of the tools belonging to the mur-
dered man were found upon the road at a distance from the
scene of the murder, and upon a telegraph pole near by was
pinned a letter, which turned out to be an announcement that
the murder had been committed by a band of traveling high-
waymen who had since left for other localities. Upon exami-
nation, the handwriting of this document proved to be that of
Waltz, though somewhat disguised. In the confession from
which I have already quoted, he admits its preparation, and
describes a midnight journey for the purpose of placing it
where it was found. He also confesses to the robbery of several
school-houses at intervals prior to the murder, and to the fact
that after the latter he concealed the proceeds of these rob-
beries, “for fear they should make suspicion.’
“Being committed to await his trial for murder, six or eight
weeks passed without any noticeable change in Waltz’s de-
meanor ; he was quiet and well conducted, and no suspicion of
his insanity was excited. At the end of that period a length-
THE LEGAL RELATIONS OF INSANITY. 165
ened consultation with his counsel was held, and it is said to
have been concluded by one of them remarking, ‘Well, Joe, I
don’t see what we are going to do for you unless we try to make
you out insane.’ If this remark was really made, the hint was
not lost upon “ Joe.’ At any rate, he forthwith began to mani-
fest symptoms of insanity, real or pretended. A practical and
efficient means of determining the true character of these mani-
festations was adopted, a paper was prepared in which a list of
‘Signs of Insanity,’ some of them fictitious and some extrava-
gant, was given, and conveyed to Waltz by a person whom he
supposed to be friendly to him. ‘The paper read as follows :
““* SIGNS OF INSANITY.—A vacant stare at some part of the
room as though the person saw something; screaming aloud
occasionally as though they saw something like an enemy, an
angel, a demon, or something terrible, accompanied by appa-
rent fright. Skulking in a corner ; furious and breaking every-
thing to pieces within reach ; resisting every effort to quiet
them ; turning away the face as though not wishing to be seen ;
frothing at the mouth; tearing the clothes ; biting at their
clothes and even biting their own fingers. When lying down a
disposition to lie on the left side, or throwing the right hand
over the head.’
“Shortly after its receipt he faithfully reproduced the indica-
tions specified.
“At the trial of the case the facts of the murder and the part
Waltz assumed in it, were proven beyond cavil; and the ver-
dict turned upon the question of insanity. In the court-room
Waltz continued to present the supposititious evidences of in-
sanity which he had learned from the paper, and was at first
violent and furious. Later, upon its being whispered to him
by one of the physicians that he was overdoing the thing, and
hurting his case, he moderated his conduct, and was for two or
three days quiet and peaceable. Later still he was told that he
had gone to the other extreme and was too quiet, and there-
upon he became once more excited. Now this was pretty con-
clusive proof of the sham nature of his insanity, but, through a
legal objection, it was excluded, as it could not be actually
proved that he read the paper. And it is better that the ques-
tion should have been settled in a more scientific way, and one
more open and above board. Although a murderer is not per-
haps entitled to much consideration, still entrapping him into
exposure by a subterfuge, perpetrated under the false pretense
of friendship, cannot exactly comport with our notions of fair
play. The paper and evidence connected with or resulting
166 MEDICAL JURISPRUDENCE.
from it being excluded, the question as to his mental condition
was left to be decided by medical and general evidence. Of
the four physicians summoned by the prosecution, three were
positive in their opinion that the insanity was feigned, while the
fourth gave a simi‘ar though less positive verdict. Two phys-
icians appeared for the defense, and swore that they considered
the prisoner insane, but their evidence was less positive, and
not so well sustained, as that for the prosecution. The trial
occupied over a fortnight, and that fact and the additional one
that more than seventy witnesses were examined, would indi-
cate that every opportunity of adducing proofs of insanity was
fairly given. * * * After fifteen minutes’ deliberation the jury
agreed upon a unanimous verdict of * guilty.’
‘“A doubt as to the prisoner’s responsibility still existing in
some quarters, such representations were made to Governor
Dix as led him to appoint a commission of experts.
“They found the prisoner a young man of twenty-four, well
developed, and enjoying—as he had all his life enjoyed—good
physical health. The statements of his father and friends
showed that he had been steady and well conducted, fond of
reading, and very capable in farming and business affairs. No
singularities of conduct had ever been observed, and he had
never been suspected of insanity, or any tendency toit. When
the commissioners visited him, they found his cell well supplied
with papers, and containing a few books, including an English
Dictionary. Upon the wall were drawings of geometrical sym-
bols, and other figures, and passages of Scripture and scraps of
rhymes, some original and some quoted. Onaccosting him he
stared at his visitors, without replying, save by asort of guttural
sound. He then moved about from his bed to the floor, some-
times kneeling, and sometimes lying down with his face to the
wall. At first he gave no answer to questions, but afterwards
answered themin a confused way. For instance, he asserted
that he did not know his age ; didn’t know his mother’s name ;
didn’t know what church his father went to. He said he was
married to the Queen of the Lunarians who had come to his
cell one night, and being asked what he meant by ‘ Lunarians,’
he rephed it was something about the moon, and, taking the
Dictionary, turned to the word ‘Lunary.’ When questioned
about his trial, he said :
“* Twas tried tn summer ; wore an overcoat ; triedin an im-
mense crowd ; thousands of people ; not tn the court-house ; never
knew of a court-house ; never saw one ; went through the door
with supernatural strength ; counsel? counsel? I had no coun-
THE LEGAL RELATIONS OF INSANITY. 167
sel ; nozudge was there, but a man was on the throne, who talked
too much. He then said to one of the commissioners, ‘ You
are the governor, and to the other, ‘ You are a judge.’ He
denied ever coming to Catskill, or doing any business. Said
his mother bought his clothes for him. In reply to a question,
he said, ‘Z killed a man once, oh, yes, he was a good man, he
. never swore, never got drunk ; [ never made a confession.’
“Being finally told that there was no necessity in his feigning
and so stupidly, he instantly replied, ‘ Peigning ! Feigning
what?’ Being further told that his assumption of entire igno-
rance of the simplest things and complete loss of memory, were
inconsistent with his state of health, intelligent appearance, and
the books and papers he had about him ; as also with his being
engaged in writing in them and the prompt use of the diction-
ary, he said, “Are you strangers? I don’t know whether I
ought to talk to you.’ He then confessed to his feigning
and said he would tell all about it, and at once threw off
all simulation. Questioned as to the homicide, he repeated
the substance of the confession from which we have already
quoted, and was very anxious to be taken out and to the scene
of the murder, saying that he could explain the matter and
point out the localities so much better if he were on the spot.
He also described how he had accounted to his father for the
absence of a blanket which, being stained with blood, he had
buried with the body, by saying that Holcher (the murdered
man) had carried it away with him; how, upon the strength of
this tale, his father started by the road which Holcher was
supposed to have taken in order to procure his arrest; and how
he (Waltz)took advantage of his father’s absence to further de-
stroy the traces of his crime by burning the machine and re-
burying the body in a more secure place. He acknowledged
that he knew at the time of the murder that he was doing
wrong, but claimed that he was tempted and controlled by
spirits. Finally he offered to bribe the commissioners, saying,
‘If you help me with the Governor, I will give you all I have.
I have between four and five hundred dollars, and an interest
in the farm, and father will add to it.’
“ The conclusions reached by the commissioners after a care-
ful examination of the prisoner and consideration of the testi-
mony presented at the trial were summed up by them in the
following words :
“* From the foregoing voluntary and repeated confessions of
the prisoner; from the evidence adduced upon the trial; from
the statements of his father, and from a personal examination
168 MEDICAL JURISPRUDENCE,
of him under the light of past and present habitual demeanor,
there is no escape from the conclusion that the prisoner at the
date of the homicide committed by him, possessed all the ele-
ments of legal and moral responsibility, for he fully knew and
comprehended the true nature and consequences of the act he
was about to commit. He knew it to be both wrong in itself
and a wrong to his victim, since he successfully resisted its
commission for a while, by prayer and deliberation upon its
enormity, thus evincing, by this power to choose between two
courses of conduct, that he was a free moral agent. ‘Therefore
we are of the opinion that the homicide was the act of a sane
mind, knowing that the act it was about to commit was a crime;
intending so to commit it, and, with full power of refraining
from or executing its wicked purpose, deliberately preferring
to do the latter.’
“These conclusions, following and emphasizing those to the
same purport reached in succession by the physicians who ex-
amined Waltz before his trial, by the judge who presided there-
at, and by the jury which convicted, very properly led the
Governor to decline to interfere, and Waltz was duly executed
upon the anniversary of his crime. Upon the day before his
death, he added another link to the chain of evidence in favor
of his sanity by killing his keeper, in a manner showing pre-
meditation, caution, judgment and motive---the desire to
escape. The assault was made with a bar of iron, torn from
the floor and bent at the end to give it greater weight; the oc-
casion was sought when the keeper lay asleep on a lounge; the
pools of blood upon the floor were concealed by newspapers
spread over them; and Waltz, taking possession of the keeper’s
keys and revolver, was only prevented from using them to
effect his flight by the timely arrival of other officers.”
Persons feign insanity at times when they desire to avoid
meeting obligations they have contracted. Casper presents
two or three of these cases in the first of which insanity was
feigned to escape conviction for perjury. “The wife of a
merchant, L., had ordered clothes for her son in January, 1849,
and in a subsequent action for non-payment she declared on
oath that she had no remembrance of having given any such
order. ‘The circumstances occasioned a suspicion of perjury,
but in the course of the investigation Mrs, S. alleged that she
labored under a great weakness of memory. Charged with the
task of investigating this matter, the following question was
put me to answer, ‘is the memory of the accused in such a
state that it is with probability to be assumed that an order
THE LEGAL RELATIONS OF INSANITY. 169
given by herself during the year 1849 could be completely for-
gotten by the zoth of November, 1850, the day on which she
took an oath to that effect?’ Mrs. S. very soon betrayed her-
self, inasmuch as in the course of an apparently indifferent
conversation with me about matters wholly unconnected with
the investigation, she gave the readiest answers to questions
such as, how old her husband was, the ages of her children,the
diseases they had gone through, etc. Then I recurred to ‘the
unfortunate circumstances of this investigation, and its possible
lamentable results,’ and Mrs. S. did not fail to fall into this
strain and to describe most feelingly her unfortunate position,
her poverty, and the embarrassment in which she was placed by
the giving of this oath, evidently to procure a favorable opinion
from us. Consequently she herself involuntarily let drop the
pretext of a weakness of memory, and brought forward evident-
ly the true causa facinoris; she forgot herself, and ceased to
keep up her character! Of course the foregoing question was
negatived.”’
Doubtful cases of Feigned Insanity.—Sometimes we
encounter very trying cases, real insanity being mistaken for
feigning, but these examples are very rare. Casper refers to
the case of “a youth of eighteen, who had commited several
robberies, and was convicted of the crime of rape, under circum-
stances which brought his sanity into question. ‘The investi-
gation lasted for eleven years, during which period he was
removed from one prison or asylum to another, and no less
than twenty official medical reports were made on the state of
his mind, most of which agreed in the conclusion that his in-
sanity was feigned. The question was finally referred to the
Royal Scientific Commission for Medical Affairs, who reversed
former decisions, founding their opinions on the following facts,
viz.: persistent silence, lasting for fifteen months; continued
‘exposure of his body, without covering, to the cold, although
clothing was within his reach; vigilance kept up night after
night; complete rejection of food; swallowing of dirty water in
preference to clean, or of hard innutritious substances ; fre-
quent attempts to commit suicide by venesection; no betrayal
of himself on recovering from drunkenness or after inhalation of
chloroform; duration of all these symptoms for so long a period
(although the subject of them, if sane, must have known that
simulation was only lengthening the time of his imprisonment);
and, finally, the existence of unquestionable delusions.”
CHAPTER III.
HYSTEROID STATES, AND FEIGNED DISEASES.
Medico-legal Consideration of Hysteria.—-ysteria often
plays a part in the court-room and in the police station, and
very often is not recognized. Some one has said that
it is the first cousin of insanity, which is only too true,
and when responsibility is considered, we are furnished
with a perplexing psychological problem. In cases of black-
mail, pretended assaults upon the person, alleged burglary,
and a variety of other crimes, it will often be found that what
Lutaud defines as “a morbid excitement of the genital organs
and a derangement of the senses and imagination,” will often
explain the motive of the person who brings a charge.
Nature of Hysteria.—The true sign of hysteria is the
perversion of the affective faculties and ideation, and the need of
voluntary resistance. Le Grand du Saulle,-in an admirable
paper, says: “‘ Dr. Constans has not hesitated to represent the
greater part of the hysterical patients at Morzines as being
absolutely irresponsible for their actions. Now, an affection
which is but the expression of a peculiar susceptibility of the
negvous system, and not a mental disease, can very rarely over-
power moral liberty and exclude all culpability. Hysteria
shakes the cerebral edifice, exercises a powerful influence, if
you will, over the emotional faculties, and sometimes ends by
inducting a‘true lesion, but ordinarily the intellectual faculties
remain intact.” *
Most authors agree that the cases where irresponsibility is
greatest are those met with among young girls in whom the
melancholic tendency is hereditary, and in whom actual insanity
supervenes. In such cases the intellectual development is
arrested, and usually so at puberty or at some equally important
period.
Hysteria and Lust.—Cases are on record, and Tardieu
* On Partial Responsibility, etc. Translation in Psychological Journal,
vol. 16, p. 668,
HYSTEROID STATES AND FEIGNED DISEASES. 171
furnishes an example of women who prostitute themselves with-
out reference to the social condition of the male; and he fur-
nishes the case of a young Austrian noblewoman of great beauty
who offered herself to every man she met, even to the lowest
street character. She subsequently decapitated her child, and
did not appreciate the nature of her criminal act.
I have lately seen a young lady of excellent family the sub-
ject of hysterical insanity who offered her person to male ser-
vants, railway porters, and persons far below her socially, and
another case of the kind dependent upon some sexual irritation
caused the unhappy victim, the morning after her marriage, to
seek the caresses of her coachman. In both these cases there
was attendent intellectual perversion of other kinds which
rendered both the young women irresponsible for their conduct.
Hysteria Manifested in Religious Vagaries.—The
recent case of Lizzie Gannon is a curious example of what one
would rather look for in the last century than to-day. Lizzie
Gannon, a child of eight or ten years, became hysterical and
presented the various trance states which were exhibited by
Louis Luteau in France and other s#gmatised patients. A feature
of her condition was the worship of certain paper dolls, and when
the ministrations of a sensible Catholic priest were solicited, he
promptly took the things away from the child. The testimony
of several witnesses was printed in the New York Zimes of
April 7, 1883.
“The trial of the suit against Archbishop Williams and a
curate for alleged injury done the sick child Lizzie Gannon by
depriving her of paper images which she idolized as ‘ angels,’
was continued to-day in the Superior Court. Further evidence
was introduced by the prosecution to show that the girl’s
acutest sufferings were immediately subsequent to the loss of
these images. The mother of the girl was further examined,
also a couple of schoolgirls, a sister of the mother, the girl’s
father, and a few others who testified to an intimate acquain-
tance with the family. The principal testimony was that of
Mary E. Ryan, the sister of the sick girl’s mother. The witness
testified that she slept in the room with the child. The latter
was in the third trance when she first produced the ‘angels.’
Some time after the child showed her the box in which they
were kept. The child took them out and kissed them. Witness
said that she never saw any thing more beautiful. ‘They had
short, curly hair, and were about an inchlong.’ The child said
that ‘Frankie’ had sent them to her. ‘Frankie’ was the
Tz MEDICAL JURISPRUDENCE.
brother who had died and for years before his death was an
invalid requiring constant care. ‘This witness described in de-
tail the visits of Father Fleming, as others had done. The
priest refused to return the images which he had in his posses-
sion, because he said the Church condemned idolatry, and at
length refused to have any thing further to do with the case,
considering that some bad influences were at work. He de-
clared it to be a case for the insane asylum, Carney Hospital, or
the Sisters. This witness also told of the child seeing the vision
of the Immaculate Conception !
“William H. Gannon, the father of the child, testified at
great length of his interviews with the Archbishop, and his re-
peated demands for the child’s images, Concerning the effect
of the priest’s course upon the child, he said that she held her
voice until April, 1880. From the very first there were one or
two persons who could restore her voice temporarily. In De-
cember, 1880, she became totally speechless. ‘Then for a time
she lost her sight and hearing. Aftera while, he said, the thing
got into the papers and many people visited the house, among
them some Spiritualists. People made it a point to see if some
one could not take her by the hand and restore her voice alto-
gether. When Mr. Fleming took her by the hand she could
speak. They managed to discover a means of rousing her, and
she recovered her eyesight and hearing and the muscles of her
neck relaxed. At present she is without speech and cannot be
left alone; she cannot walk more than a quarter of a mile;
when she puts her head on a pillow she goes to sleep and can-
not be roused. She will not be left alone, and she manifests
the loss of her angels by trying to speak and in writing. The
want of them has a very depressing effect on her. The witness
declared that neither he nor his wife had any idea where the
images came from, but he thought the child was under a delu-
sion in respect to their supernatural origin. He insisted that
Father Fleming’s action with the images was the direct occa-
sion of his child’s extraordinary troubles. She had a slight de-
lusion about them before the priest came, and they were taken
from her in such a way as to increase the delusion. By proper
management of her case he believed she could have been cured
of her delusions.
“Dr. M. Hodges, the physician who attended the girl, was
called and testified. Her disease he pronounced to be pro-
found hysteria. The disease would probably be aggravated, he
thought, if she were surrounded by a superstitious atmosphere.
One of the traits of the disease was to deceive, but with no in-
HYSTEROID STATES AND FEIGNED DISEASES. | 173
tent on the part of the patient to deceive. He thought it
dangerous to accept as facts any statements made by a person
in that condition. It was not an uncommon phenomenon for
a person to lose power of speech for a longer or a shorter time.
He advised the removal of the child from her surroundings, but
this advice was not followed because the family thought they
could take better care of her at home. He was not prepared
to say whether the possession of the images would or would not
increase her superstitious delusion.
“Dr. Walter Channing, an expert witness, was of the opinion
that the child’s condition was aggravated by the action of the
priest and that it produced a ‘moral shock.’ ”’
Hysteria in Young Children.—In very young children
even the presentation of hysterical symptoms is often very
extraordinary. Recent and excellent illustrations of the dis-
ease originating before puberty are published by Dr. Butlin,
(London Lancet, Jan.17, 1871, p. 819,) who reported the cases
of three children who for a long time successfully malingered
so as to deceive their parents. The first of these cases was
a girl aged seven years, who successfully simulated epilepsy and
described her condition with great enjoyment. The case was
cured by a “few sharp smacks with a wet towel.” Rebecca
N., aged nine and a half years, who feigned unconsciousness
foralong time. She closed hereyes and apparently took no
notice of her family and for two weeks had to be fed with a
spoon. She would not get up, nor stand or walk and was a
constant source of trouble. Her father, who appeared to be a
sensible man, saw her get up and get something, and proposed
firm discipline, but the mother would not permitit. She there-
fore was kept at home and kept up her comedy for some time,
but was finally sent to the Children’s Hospital. Dr. Butlin de-
scribes her progress as follows : }
“About four weeks before admission her bowels were consti-
pated for about a week. At the end of that period she again
closed her eyes. Since then she had never opened them again,
and had only spoken three words. She could not stand, and
was subject to ‘dreadful fits of trembling.” Often she wept
quietly. She seemed to understand every thing that was said.
Her appetite was good. She was said to bea remarkably smart
child. Her general health was good ; her bowels were regular ;
the menses had not appeared.
“On admission she was found to be a fairly nourished girl.
She had a receding forehead, but her features were strongly
i74 MEDICAL JURISPRUDENCE.
marked, and she looked considerably older than she was. Her
face was pasty. She lay with both eyes closed, and the left
hand in front of them. The under lid did not cease to quiver.
The right hand lay across the chest, but raised up from it, and
underwent a continual shaking or vibrating movement. The
legs were drawn up and motionless. When the left hand was
removed from before the eyes the lids quivered, and at times
also the sides of the face, the movement being similar to that
produced by galvanism. Any attempt to separate the lids was
strongly resisted. She did not speak, but frequently nodded in
reply to questions. She bore a remarkably hard pinch on the
arm or leg without flinching or crying out, but the shaking
movements were increased, and the tips of the fingers became
covered with perspiration. When one arm was held the shak-
ing of the other became more marked. The gums were spongy,
the lips broken, the breath offensive, the tongue brown and
dry ; the pulse 116 and regular. She had a short hysterical
cough. ‘The inspirations and heart sounds, and the liver and
splenic dullness, were normal. The bladder was distended,
and on a vessel being produced she passed thirty-two ounces of
urine, acid in reaction, of a specific gravity of 1020, and de-
positing phosphates on being heated. She was ordered two
grains of calomel and ten grains of jalap powders and passed
a good night.
“On the following day she cried a good deal. The bowels not
having acted, the powder was repeated, and was followed on
the third day by copious evacuations. Whenever she awoke
from sleep, however suddenly, the eyes remained closed. She
was ordered to have a shower bath every other morning, and a
-draught consisting of eight grains of chlorate of potassium, a
drachm of tincture of valerian, and half an ounce of the infu-
sion three times a day. An aperient powder was given occa-
sionally in order to maintain the action of the bowels.
“Yay after day passed without any material alteration in her
condition, until, on the fifteenth day, the house surgeon, Mr.
Sankey, taking a galvanic battery to her bedside, told her that
it had become absolutely necessary to apply it until she re-
covered the power of speech. Having promised that as soon
as she had distinctly pronounced the word ‘mother’ he would
desist, he proceeded to apply the sponges, pausing every few
seconds to demand the repetition of the required word. After
about a quarter of an hour the girl’s patience began to be ex-
hausted, and she broke out into plaintive sobbing. The appli-
cation was however persevered in until, at about the end of half
HYSTEROID STATES AND FEIGNED DISEASES. 175
an hour, after two or three feeble articulations, she distinctly
pronounced the word. From that time her cure was virtually
effected ; she resumed the power of speech; and although, on
being placed out of bed she appeared to be quite unable to
stand, in the course of the afternoon she managed to walk about
the ward without assistance. Three days later the aid of gal-
vanism was again resorted to to induce her to open her eyes.
On the following day she read a book; in two or three
days more she was running about the garden with the
other children, and was shortly after discharged in good
health.”
“Case 3.—Florence B. , aged eleven years, ailing for
a twelvemonth, but had previously been a perfectly healthy
child. Her first symptoms were difficulty in walking and ina-
bility to hold herself upright. Then she began also to com-
plain of pains in the stomach. There was no history of any
injury. During the last five or six months she had been grad-
ually getting worse, until she lost the useof her legs. She was
not able to hold her water when sitting up. Her bowels were
never open without injections. She still complained of pains
in the stomach; but had very little pain in the back except
when she was moved. Her appetite was very good, and she
was in fair general health.
“When brought into the hospital she was fairly nourished, but
emitted a peculiar mousy odor, similar to that sometimes ob-
served in the insane. She was obviously very hysterical, calling
out as if in pain whenever and wherever touched. She knewa
great deal about what had been the matter with her, and re-
membered what the doctor, at home, said about ‘her com-
plaint.’ Her tongue was clean, pulse 100, and face pale. She
passed water without difficulty. Her appetite was good, and
she slept well, but generally with legs drawn up. She com-
plained of pain and tenderness in the abdomen. Her legs
were fairly nourished, and, on measurement, were found to be
of equal size. Her feet were cold. When made to walk she
raised her legs slowly and with apparent difficulty. Sensation
appeared to be still more impaired than motion, for she took
little or no notice when the feet and legs were punched or
pricked. No reflex movements could be excited. A sharp tap
on the sole of the foot caused pain in the abdomen, but very
little in the back. On examining the back, a very slight lateral
curvature to the right side seemed to exist in the lower dorsal
and lumbar regions, and some tenderness over the fourth and
fifth lumbar vertebra; but no prominence could be observed
176 MEDICAL JURISPRUDENCE.
either in this or any other part of the spine. She preferred to
lie on the left side.
“Although Mr. Smith suspected that her ailment was hysteria,
he thought it safer to commence treatment as if her symptoms
were due to a more natural cause. He therefore gave direc- |
tions for the legs to be galvanized daily, and ordered two
minims of the liquor strychniz in two drachms of steel wine to
be taken three times a day, as well as a pill containing a third
of a grain of extract of aloes, two grains of compound rhubarb
pills, and a sixth of a grain of nux vomica, to be taken once a
day. In about a fortnight she sat up in bed, having been
promised that as soon as she could stand she should walk in
the garden. She complained of very little pain either in the
abdomen or back ; her bowels were regular, and the expression
of resignation which her face had worn was replaced by a
bright and cheerful look. At the same time she seemed to
recover sensation in her legs, and for the first time gave evl-
dence of feeling the galvanic battery. On the twenty-eighth
day she began to walk about, and was very bright and talkative.
On the thirtieth she walked quite firmly and without any pain ;
she complained of no pain in the abdomen, and of very httle in
the back. On the thirty-second day she was running about
the garden playing with other convalescents, and in a few days
more was discharged.”
Hysterical Simulation of Real Diseases.—It is quite
common for hysteria to simulate real diseases. ‘The so-called
neuro-mimeses includes those disorders which are counterfeited
in the hysterical subject, and often in a manner to deceive the
most observant. The involuntary expression of suffering is
often free from any tinge of dishonesty upon the part of the
patient. We find simulated joint and spinal affections which
resist all remedies, and only disappear when moral treatment is
attempted. A young woman recently came under my charge
complaining of “‘ rheumatism ” and “ spinal disease.” She had
worn a complicated spinal brace, and had used embrocations for
the knee. When I removed the former I found no disease of
the vertebral column whatever, as evinced by external appear-
ance, and the rheumatic knee, “upon which she could not bear
her own weight ” was not swollen, red, tender, nor could I detect
any sign of rheumatism, In this order of hysterical troubles
belong the contractura and paralyses. The lay observer may
often have his sympathies aroused by the appearance of the
deformed patient. When such manifestations are claimed to
*
HYSTEROID STATES AND FEIGNED DISEASES. E77
be the result of injury, the examination of the medical man
cannot be too searching or sure, for often there are just suffi-
cient indications of organic trouble to mislead. It should not
be forgotten that these hysterical contractions are comparatively
rare among men, that in women they are usually connected
with ovarian neuralgia and spinal pain; that the contraction is
modified by diversion of the attention, that the mental condi-
tion is peculiar, and we are to look out for great self-absorption
and diverted emotions.
The influence of self-concentration in the production of dis-
ease is recognized by all who have occasion to treat nervous peo-
ple. The maladies in men are not serious and rarely arise above
the level of gastric disorder, but often an intractable voluntary
paralysis may be due to this complete concentration of the
patient’s attention upon some particular trouble.
Wynter,* in his clever little book discusses the possibilities of
morbid attention, “There is, however, a certain morbid atten-
tion, when directed towards supposed ailments of the body and
mind, which is to be especially deprecated. A man may so
concentrate his attention upon certain organs of the body as to
create disease in them. The hypochondriac, for instance,
never ceases to dwell upon the condition of his digestive
organs, and the consequence is that he directs so much nervous
energy to the spot as to cause congestion and actual disease.
We see no reason to doubt that mere disordered functions of
the brain may be converted by the same undue attention into
positive disorganization and mental disease. Hence overstudi-
ousness on these points is to be avoided. In the majority of
cases there is no danger of such a result, but in a person of a
highly nervous temperament it is different, and with them the
very first step towards health would be to enable them to get
rid of themselves.”
Paget, t who has with Skae called attention to the hysterical
production of real disease, thus speaks of the “ nervous-mimi-
ener:
“Some mimicries are essentially mental ; such, for instance,
as those in which patients, out of mere fear and keen attention,
acquire the pains of cancer, and localize them in healthy parts ;
and as nearly all mimicries or mental influence may be dis-
cerned, just as it may in nearly all real diseases in which con-
sciousness remains. An influence impossible to separate or
* Borderlands of Insanity, p. 22.
t London Lancet, vol. 2, 1872, p. 513.
I2
178 MEDICAL JURISPRUDENCE,
weigh, generally increasing with the duration of the disease,
yet not essential to it, whether it be real or mimic. But in all
mimicries-it is hard to discern any mental influence at all.
Some are imitations of disease very far from mental associa-
tions—the cases, for example, of intestinal distention, constipa-
tion of many days’ duration, constant vomiting and apepsia,
rapid heart’s action with slow breathing, largely-pulsating
arteries and phantom tumors. Some are found in common-
place, ignorant and slow-minded people who never saw or ~
heard of the diseases imitated in them. Some occur in chil-
dren who could neither imagine nor act what they tell and
show, though as they grow up they may become those in whose
successive mimicries the mental influence takes a constantly
increasing part. And, to end, whatever may be ascribed to
mental influence, it can produce mimicry of organic disease in
only certain persons whose nervous organs seem wholly prone
to this manner of disorder, and whose spinal and ganglionic
systems must be deemed erroneous, as well as, or more than,
their brains. For nervous mimicry is not very frequent among
the evidently insane, and among the sane there are many who
cannot bring about a mimicry of disease by any effort of im-
agination or direction of the mind. Among these I am happy
to count myself. I have tried many times carefully, and with
good opportunities, but have always failed.”
There are some physical symptoms that may appear anions
an occasional blunting of electric reaction, and the continuance
of the tendinous reflex. The skin of the anesthetic patient is
sometimes anesthetic and the sensory tests are blunted accord-
ingly. In cases where the tendinous reflex is exaggerated it
will be found that there has been well matured hysterical
paralysis for some time, and that the clonus of the heel is much
greater than in any form of myelitic paralysis, and there is no
atrophy. When an anesthetic is administered there is a dis-
appearance of the contracture in cases of hysterical paralysis.
Hysterical Traumatic Contractures.—Charcot has de-
voted much attention to the consideration of imitative hysteria,
of thé kind alluded to, and in a late paper has called attention
to the contractures of traumatic origin that may often be wit-
nessed. It is possible that we may be required to make a dis-
tinction in accident cases between cicatricial contraction as a
result of nerve wounding, and that of a more substantial sort
where perhaps a superficial wound has been made, and where
hysteria causation may give rise to a deformity, which may,
a ————— s
HYSTEROID STATES AND FEIGNED DISEASES. rj9
however, be recognized if proper tests are made. Charcot re-
fers to several young people who received slight wounds, in
themselves not being sufficient to cause contracture from tissue
changes, but where there was undoubted deformity, and the oc-
currence of general hysterical symptoms, such as convulsive
crises. One of his cases is that of a girl of sixteen, of frail
appearance, who is “ placidly hysterical.” She is an orphan,
and after her mother’s death, which was from consumption, she
entered a religious institution, and afterwards came under the
care of Charcot. There was a history of hereditary insanity
in her case, her father having died of general paresis, and she
had an idiot brother. She had never had hysterical convul-
sions, but mentally shows a certain weakness and wantonness.
Her left hand is the seat of a deformity which has lasted for a
year, but has lately become less pronounced. “The wrist is
free ; it is the same with the other articulations of the superior
extremity. The first phalanges are bent upon the metacarpus.
The other phalanges present but a slight degree of flexion.
The fingers thus uniformly bent, are crowded together, forming
a sort of cone, of which the summit corresponds with the ex-
tremity of the last phalanx. The thumb, in adduction, is
strongly forced against the index finger. It is easy to convince
ourselves that muscular rigidity is the sole cause of this deform-
ation, and that the articulations and the ligaments are not
affected. Attempts at reduction show this sufficiently. Chlo-
roformization would give us peremptory proof of it, but we
have feared any perturbation, which would prevent us from
studying this deformation de wzsu. On the other hand, we find
here the characteristics of the spasmodic contractura. If in-
deed the flexors are the most affected, and determine the im-
port of the deviation, the extensors are also involved ; for it is
as difficult to exaggerate the flexion as to produce the exten-
sion. This simultaneous action of the antagonistic forces is
one of the characteristics of spasmodic contractura. * * ¥*
The deformed hand is colder than the other, and shows a some-
what marked bluish tint, denoting a manifest trouble of the
vaso motors. There is atrophy, or rather a slight emaciation,
not only of the hand, but also of the other segments of the
limb. ‘The forearm and the upper arm are a centimeter less in
circumference than in the opposite member; it is not a ques-
tion of veritable muscular atrophy, but of emaciation due to
prolonged repose. We find besides a diminution of general
and special sensibility upon the entire half of the body in
which the deformation exists.”’ In this case, as well as others,
180 MEDICAL JURISPRUDENCE.
we are likely to detect limitation of the visual field, and hemi-
anesthesia, and the contracture itself is peculiar ; and in other
hysterical patients, where there is no suspicion of injury, it is
possible to produce it by excitations of various kinds. There
is often some ovarian trouble, and one of the peculiarities of the
deformity which Charcot strongly insists upon, is the perma-
nence and persistence of the contracture, which is different from
that of hemiplegia or that due to any other organic change, for
in hemiplegia, as well as in sclerosis, there is some relaxation
during sleep. In this case the wound was of the most insig-
nificant kind, the patient receiving more than a year before a
slight scratch upon the back of the hand over the second meta-
carpal bone, which healed in four or five days. The develop-
ment of the contracture was sudden and unattended by pain,
and persisted a long time after the healing of the wound. ‘The
contracture differed from that which we might expect from or-
ganic brain disease from the fact of its sudden appearance,
and although Charcot points out the fact that in descending
cerebral or spinal sclerosis we may find the same condition
produced as the result of a traumatism, “ there is not the same
disproportion between the lightness of the traumatic injury and
the intensity of the contracture, which has no longer the same
persistency after the cure of the peripheral irritation.”
Charcot suggests certain tests for the detection of simulated
contracture and that which undoubtedly originates in hysteria.
Fig. 4.
For this purpose he applies the myographium, and after attach-
ing a weight to the end of the fingers of the contracted hand,
it is found that in the diseased state the contracture is not over-
*
HYSTEROID STATES AND FEIGNED DISEASES, 181
come until the end of twenty or twenty-five minutes, the de-
scent of the fingers being accompanied by slight tremor of a
regular character, while the simulator is unable to keep his hand
in the same position for anything like the time above mentioned.
VYhe most satisfactory test however, is that which depends
upon the respiratory effort upon the part of the simulator in
his attempt to preserve the position of the hand. Fig. 5 shows
tracings made by means of the myographium, A. B. being those
of a patient ; and C. D. those of the simulator.
Fig. 5.
In courts of law the existence of this hysteroid state may
prove to be an important factor; and it will not do to take an
unscientific view of the patient’s state, although it may be
urged that the hysterical condition, especially if it reaches the
dignity of a diseased condition in which hemi-anesthesia with
visual defects and convulsive seizures are expressed, may in-
fluence our judgment in arriving at a conclusion as to the sus-
ceptibility of the patient to slight injuries ; the responsibility
of the defendant in such cases might be limited by the dys-
crasia of the plaintiff, and we cannot consider the case of a per-
son presenting contracture of this kind as the result of an in-
182 MEDICAL JURISPRUDENCE.
jury due to the carelessness of the defendant as we would
where a perfectly strong, vigorous person presented a tissue
change with contracture, as the result of mechanical nerve
lesion. It may be wise to regard with suspicion cases of
slight’ contracture without nerve wounding, or descending
neuritis among men, for so far the reported cases of pronounced
traumatic hysterical contracture have occurred among nervous
women.
Epidemic Hysteria.—Considerable medico-legal interest
arises in cases of epidemic hysteria, and we find that some
persons who may be thrown together may present a peculiar
form of hysterical trouble. In this condition a variety of pur-
poseless violent acts and breaches of the peace may be com-
mitted by individuals under the influence of religious excite-
ment. Hecker refers to a peculiar hysterical condition which
existed in the fifteenth century among the German nuns who
fell to biting each other, and the epidemic spread so that
eventually every religious orderin Europe followed the ex-
ample of the nuns of Saxony and Brandenburg. The sexual
excitement which grew out of the gatherings resulted in all
manner of outrages upon public decency. Many of the sub-
jects exposed themselves in a most indecent manner, tore their
hair and went howling about the country. It is probable that
as a result of the freedom from restraint and religious excite-
ment inseparable from camp-meeting and revivals a morbid
sexual state exists which leads to the commission of acts
that might often form the basis of medico-legal inquiry.
I have known of one isolated and clear example of
epidemic hysterical insanity in which two members of an unfor-
tunate family became the subjects of a condition bordering upon
hysterical mania. An hysterical girl was taken to the moun-
tain for her health, but no benefit was derived from the change
and she grew more violent and unreasonable. Her mother,
and a sister very nearly her own age, were her companions and
constant nurses. Upon their return journey to New York
the sister showed an unnatural excitement which developed
before they reached Troy into a veritable hysterical mania.
They became so raving and violent that the hotel proprietor in
that city turned them out of his house and put them on the
cars, but in Albany they again rested, and their sad condition
being mistaken for drunkenness, they were arrested, but were
finally released and again began their journey to New York, the
mother being now in a partially responsible state as she was half
*
HYSTEROID STATES AND FEIGNED DISEASES. 183
crazed by the excitement and disgrace. They finally reached
New York and went to a hotel where they staid for a night only
as one of the sisters tried to force her way through .the fan-
light over the door of her room and so alarmed the guests that
the police were called in and they were arrested and taken to
Headquarters. They were removed by some friends and I
subsequently examined them. The mental disorder in this
case was sexual and it became so much worse that the patients
were finally sent to an asylum.
In such cases as this the question of responsibility is an inter-
esting one, and it was evident that the final action of the
Albany judge who first thought the patients intoxicated, and
afterwards sent them out of town, went to show that the
behavior of the girls was not looked upon as criminal.
Hysteria with Destructive Tendencies.—A form of
hysteria bordering upon insanity which is happily rare is that
in which the individual wantonly destroys the clothing of other
people. This he does by means of sharp instruments, vitriol
and other corrosive substances. I know of one case of this
kind, the individual presenting undefined symptoms of intel-
lectual disturbance. He has several times been arrested how-
ever for secretly pouring sulphuric acid upon the dresses
of ladies in crowded thoroughfares. Ogston refers to the
‘“Piquers,” a class of men who wantonly cut the clothes of
women in the streets of Paris. He however believes as I do,
that ina number of cases a motive can be assigned for these
acts, and alludes to two cases—one that of a young woman
who manifested a tendency to break windows, and an-
other that of a man who amused himself by slyly snipping
ladies’ dresses with a small pair of scissors. In the latter case
beyond a taciturn misanthropic disposition and a slight de-
gree of imbecility no mental alteration was discernible.
The Desire for Notoriety.—There are various other
species of deviltry that are sometimes the expression of a peculiar
mental state which may be called hysterical. The case of “ Gen-
tleman Jo,’ a miserable weak creature who created a sensation
throughout the country by anonymous letter writing, is well
known. Onevery well-known clergyman of New York was
kept in a constant state of annoyance by the receipt of several
hundred letters and scurrilous postal cards within a few weeks
which led to the most humiliating contretemps. It was supposed
at first that the motive of the writer was blackmail, but though
184 MEDICAL JURISPRUDENCE.
one postal card intimated something of the kind, such a con-
clusion under the circumstance was absurd and out of the
question. The man was detected and taken to the Tombs,
where I examined him. I found him to be of the insane tem-
perament and of decided weak, hysterical mind. He was.con-
sumed with a vanity and desire for notoriety which I have only
seen equaled in the case of Guiteau the assassin. He presented
well marked hypochondriasm with sexual perversion, and
there was no motive for the letter writing. Coupled with
various indications of moral depravity, he was a petty thief.
He was found guilty and sent to state prison where he subse-
- quently died.
Winslow refers to the case of a man arrested and convicted
of murder, who was unquestionably of the class to which these
two men belonged, and the same degree of nauseating desire
for notoriety was exhibited :
“While in the cell at the Town Hall, he was gratified when
by his mimicry or other means, he could attract the attention of
persons in the office above. When being taken out on Mon-
day, he anxiously inquired whether there were a good many
people standing outside, intimating that he should shout out to
them if there were; and on finding nobody standing about,
he exhibited much " disappointment. While in the cab, and
also after being placed in the railway carriage, he persisted in
sitting close to the window, and seemed pleased at the slightest
notice. His utter insensibility of the awfulness of the crime
which he has committed, is, however, most strikingly illustrated
by a piece of shocking levity in which he also indulged in on
Sunday. The attention of several of the police officers, who were
in the receiving office, was attracted by bursts of merriment from
the prisoners, and on looking in the cell-yard, the officers saw
H. standing in a stiff upright position, slowly turning his head
backwards and forwards. In reply to an inquiry what it all
meant, the prisoner said : ‘I am only showing them how JI shall
look in wax work next fair.” This performance he went through
a number of times during the day, complying unhesitatingly
with every request to show them again.
The moral perversion which is attended by the commission
of impulsive acts by emotional persons of feeble will is sugges-
tive of an advanced degree of hysteria, which occupies an un-
defined “borderland ” between ordinary hysteria and actual in-
sanity of a definable type. Such cases are those which try the
alienist who attempts to say how far the mental condition inter-
feres with responsibility,
HYSTEROID STATES AND FEIGNED DISEASES. 185
Abominable Crimes.—Certain conspicuous degenerate
moral states in connection with hysteria as well as insanity are
manifested in sexual disturbances which lead the unhappy pa-
tient to commit crimes of the most beastly and brutal description.
I cannot but believe that a congenital state of mental weak-
ness is at the bottom of much of the unnatural impulses.
It is difficult to conceive that the vile assaults upon chil-
dren, and the peculiar inversion of the sexual feeling, arises
from any thing else than a congenital defect (“imbecility ”—
perhaps, for want of a better name) which has hysteroid mani-
festations, and a survey of the police court registers of a large
city, will disclose cases of the most interesting kind. In New
York are a large number of unfortunate men who prowl about
_the public squares at night soliciting members of their own sex.
These men delight to dress in women’s clothes and masquerade
in the streets. The case of Lord Clinton in London was sup-
‘posed to be almost unique, and the subject was considered too
filthy for discussion in the English papers. In this city during
the past few years I am informed by one of the most intelligent
police judges that a great many arrests have been made for
violations of public decency, and no less than six of these were
within the past year of men dressed in women’s clothes who
were engaged in soliciting for a purpose too vile to mention.
This sexual inversion has been described by several German
writers. The prisoners are usually young men of mincing gait
and manner, with soft high voices, wide lips and large thyroid
cartilages.
Pretended Suicide with Hysteria.—Pretended attempts
at suicide are quite common among hysterical females. Every
general practitioner has met with such cases, and sometimes it
may be a woman who keeps her household in a state of terror
by threats she never intends to consummate. Such cases as the
following reported by Ogston, are not of infrequent occurrence.
This author speaks of “‘a young married female, in the seventh
month of pregnancy, who was discovered to be secretly ad-
dicted to dram-drinking. Annoyed at being detected, she
pretended to be very ill, and to have swallowed arsenic to destroy
herself. It was found that she had bought three drachms of
this poison, and a small quantity was found in the bottom of a
teacup in which she said she had mixed it. The remainder of
the powder had been put away. The mildness of the symp-
toms, however, and the composure with which she complained
of her tortures, led her friends to suspect that she was feign-
186 MEDICAL JURISPRUDENCE.
ing. When examined by Christison, he could discover no
proof of poisoning, and her statements and answers to ques-
tions were such as to negative the fact of arsenic having been
taken. She gradually recovered from some febrile symptoms
which were present, and in two days admitted that she was
quite well, but continued to insist that she had taken the
poison.”
“In July, 1838, H. J., et. 25, went into a drug shop in
Union Street (Aberdeen), to purchase an ounce of laudanum.
Suspecting a suicidal purpose, the shopkeeper, instead of laud-
anum, gave the woman an ounce of tincture of rhubarb, which,
without the cheat being detected, was swallowed on the spot.
She then went to a second drug shop in the same street, with
the intention of procuring a second dose of what she had
asked for previously. She was, however, followed by the first
druggist and handed over to the police. When seen soon after
at the police office, the woman appeared to be excited, but
manifested at times a strong desire for sleep, though the pupils
were not contracted and the pulse was strong. Two hours
afterwards, in spite of attempts to keep the patient awake, she
had fallen into a deep sleep. Conceiving on this that it was
possible that the woman had had the opportunity of taking
laudanum before swallowing the rhubarb, though the pupils
remained natural, the contents of the stomach were drawn off
by the pump, but exhaled only a slightly spirituous odor.”
One lady I knew went to a strange hotel in an obscure,
back street, wrote several letters, zelegraphed to her husband, and
upon his arrival pretended to have poisoned herself, aileging
as her motive his cruel treatment and his attentions to other
women, of both of which he was innocent. She finally ve-
covered after imparting to me the fact that she had taken
nothing.
Self-Mutilation by Hysterical Patients.—Self-mutila-
tion is an occasional feature of hysteria, and possibly may in-
volve legal complications. Especially is such the case in suits
for damages subsequent to recovery. Helen Miller, whose
case is reported by Dr. Channing,* came under my observation
some years ago. She had committed thefts from doctors’
offices, and was arrested and sent to prison, While there she
began to feign insanity, and was sent to the Asylum for Insane
Criminals. She had been of hysterical habits, had eaten
opium, and was treated by one of. the physicians she had
* Am. Fournal of Insanity, January, 1878, p. 368.
HYSTEROID STATES AND FEIGNED DISEASES. 187
robbed, for dysmenorrhcea. Her first exploit in the asylum
was to prick her gums, and the blood therefrom was mixed
with urine and crumbled bread—so that an attack of hema-
temesis was suggested. She had several attacks of hysterical
dysmenorrheea, was irritable, depressed, and had fits of temper.
Then she began a system of self-mutilation which was some-
thing extraordinary. At various times she thrust pieces of glass,
splinters and other things into various parts of her body; cut
herself with pieces of tin and a broken bottle. Upon one
occasion she broke her chamber over her head. Dr. Channing
removed no less than ninety-four pieces of glass, thirty-four
splinters of wood, two tacks, four shoe nails, one pin and one
needle, at various times. In this case the woman’s pride seemed
to be that she was the object of surgical interest and of sympathy.
I saw her after her transfer to the Blackwell’s Island Asylum,
where she was sent after her second arrest for theft, as she had
been discharged from the Auburn Asylum when her first sen-
tence had expired. She was hysterical, but I found no real
intellectual derangement, and I should not consider her legally
insane.
A case is reported by Mr. Ferguson,* the patient being a
woman im St. Bartholomew’s Hospital.
M. W., a fresh colored, artless looking girl, spare but not
badly nourished, was admitted into the hospital with the
following history: About four years ago she was subject to
fainting fits, but has never appeared very excitable. Accord-
ing to her own account she had a fall last July whilst in
service, by which her left knee was injured, and was for some
time exceedingly painful. In this condition she was sent home,
and the knee was then poulticed. After a day or two a
needle was seen protruding over the patella; this her mother
removed. As the knee was now better she returned to her
situation ; but in about a fortnight, the same again commen-
cing to distress her, she was again sent home, and before long
five needles were removed from the same situation. After a
short time the arms and legs became similarly affected.
_ Things proceeding after this fashion, ror needles and pins,
many of large size, curiously twisted and deeply imbedded,
were removed by her usual medical attendant, Mr. Wicksteed,
of Walthamstow. Although some years ago she had a habit
of swallowing strange things—pieces of paper and the like—
she is sure she never swallowed any pins or needles, and can-
* London Lancet, July 20, 1872, p. 78.
188 MEDICAL JURISPRUDENCE.
not, she says, give any explanation of their appearance. Dur-
ing ‘her stay in the hospital in February last, ten needles and
pins were removed by Mr. Baker and Mr. Ferguson.
The facts that the right hand and arm presented two marks
only where needles had been withdrawn, whereas the left hand
and arm showed thirty-seven marks, that the girl was right-
handed, that all the pins were destitute of heads, together
with other circumstances, led to the conclusion.
Pretended Assaults.—The most striking changes of char-
acter are evinced by young girls whose disordered emotions
lead them to behave ina manner to impress all who see them
that they are possessed with a devil. Says Wilks,* “ When
you see a paragraph headed, ‘extraordinary occurrence,’ and
you read how every night loud rapping is heard in some part
of the house, or how the rooms are being constantly set on
fire, or how all the sheets in the house are devoured by rats,
you may be quite sure that there isa young girl on the premises.”
During the excitement, which is often epidemic, we are oc-
casionally startled by the recital of sensational stories with
which the press teems. Only within the past month two cases
of probable hysterical] troubles of this kind have obtained
wide publicity. One of these is that of a young girl in Rich-
‘mond, who claimed she was assaulted by burglars, but her
story was palpably false, and her state of mind grew out of the
general feeling of alarm that attends the commission of sev-
eral real burglarious attempts in the neighborhood.
A nurse girl some months ago declared that the child com-
mitted to her care had been stolen from her by men in the
street, and great consternation was caused by her story, that
she related on her return. ‘The friends of the girl, however, a
few hours afterwards, restored the child to its parents, and it
transpired that the woman had purposely left it with them.
Cases are detailed where women have set fire to buildings,
or the clothing of children, and wereunable to give any motive
for the crime. ‘There is another class of cases the subjects of
which claim they have been outraged or maltreated, and give
the impression that self-inflicted wounds were made by their
assailants, and as a result innocent persons are occasionally
arrested. In such cases local examination will rarely reveal
any indication of violence, but in cases of women of question-
able purity it is a difficult matter to swear positively from any
examination that their stories are not true.
* Lectures upon Diseases of the Nervous System, p. 367.
HYSTEROID STATES AND FEIGNED DISEASES. 189
Medical men are occasionally troubled by women who claim
that they have been maltreated or outraged. Such persons are
apt to trump up cases in Court and are ready litigants. The
charges against respectable persons rarely stand the test of care-
ful examination, and it will always be found that the stories
told are overdrawn and bear the manifest evidences of fraud
and exaggeration. A prominent practitioner of New York was
sued some years ago by an adventuress who claimed that she
had been poisoned by nux vomica. The evidence showed that
her pretended poisoning was of hysterical origin, and that she
had repeatedly made requests for money, threatening various
things should the doctor fail to accede to her demands.
A case where a young woman had claimed that she had been
outraged is detailed by Ross :*
“In December, 1876, a girl of eighteen was found one eve-
ning standing with her clothing wet and muddy, in an appa-
rently stupefied condition, in the closed doorway of a restaurant
in the center of Manchester, a few yards from where she was
lodging. She was taken home and to bed, and a medical man
was sent for. He found her to all appearance unconscious of
what was going on around her, and uttering some disjointed
and incoherent complaints of having been drugged and threat-
ened. He thought she was recovering from the effects of some
narcotic and did not at first pay much attention to her story.
The following day, however, she appeared worse, and in the
evening her condition was considered so critical that the police
were communicated with, with a view to her statements be-
ing taken down. She was visited by two experienced detect-
ives, who, seeing how matters stood, and having the doctor’s as-
surance that she was in a dying state, sent at once for a magis-
trate, before whom she made a solemn declaration to the fol-
lowing effect: She believed herself to be dying. On the pre-
vious evening a solicitor, at whose office she had called on busi-
ness, told her she must go into a convent, and gave her ‘some
sort of a dark, sweet drink’ which rendered her senseless. On
going down-stairs from the office she met a Jesuit father, whom
she had seen once before. This gentleman took hold of her
and pulled her along the street to a little house in acourt, where
there was an upper room with a bed init and across on the
wall. Having got her in the room, he said improper things to
her, and gave her a little cake which affected her directly. The
woman of the house came into the room and found her on the
* Vol. ii, p. 887.
1go MEDICAL JURISPRUDENCE,
floor, after which she somehow got outside, the priest following.
He again dragged her along in the dirt to the street corner
where he ran away.
“The solicitor and the priest, both of them well known and
highly respected, were thereupon placed under arrest in the mid-
dle of the night on a charge of having administered certain
poisonous drugs with intent to murder. The story was proved
to be purely imaginary, and the magistrates dismissed the case.”
Du Saulle relates the case of a young girl, who under the in-
fluence of hysteria made the most calumnious accusations
against the priests and against the members of a religious order,
whom she claimed to have outraged her. The father of the
girl killed himself in despair, and it afterwards transpired that
she was declared a virgin by the Faculty of Medicine of Mont-
pelier.
Chloroform and Hysteria.—Our services are sometimes
required in cases where it is claimed that chloroform has been
used in the perpetration of crime, either for the purpose of
facilitating robbery, or more rarely in cases where hysterical
women have made the claim that they have been outraged under
its influence. This is the case where nymphomania or eroto-
mania has existed, but very often the claims of such people will
not bear investigation. McIntosh in an article upon morbid
impulse refers to a woman who was the subject of excessive
nervous exhaustion, who “is never done talking of honorable
marriage and the husband she ought to have had, if she had
been permitted to remain outside the asylum, away from the
parties that administered chloroform and ether to her. In her
case there is hyperesthesia of the emotions, and her. impas-
sioned entreaties, tears and seizing of the hand betray the ardor
of her attachment.” The element of mystery and the popular
superstition regarding the use of anesthetics often lead to their
being referred to by women who claim that they are the sub-
jects of indecent assault. The papers were filled some years ago
with the remarkable declarations of a young woman, who lived
in an interior town in New York, and who claimed that while
alone in the house she was surprised by the entrance of masked
robbers, who bound and gagged her, and applied chloroform
upon a cloth to her face, and after assaulting her brutally she be-
came unconscious. The story was so palpably fraudulent that
it should have received little or no recognition by those about
her; but asin other cases of the kind we find sympathetic
friends, and a sensational press ever ready to believe in and
HYSTEROID STATES AND FEIGNED DISEASES, 19t
give publicity to the hysterical plaint of the impostor. In this
case the ropes that bound her were evidently applied by herself,
and the quantity of chloroform alleged to have been used, a
small bottle having been found, (which it transpired she had
bought herself), made her story appear at once manifestly
absurd.
Pretended Assaults by Dentists.—We from time to time
hear of cases in which women claim that while in the dentist’s
chair and under the influence of chloroform they have been in-
decently assaulted by the operator. Unfortunately for the den-
tist he has no witnesses to prove his innocence, and the unsup-
ported statement of the patient who is hysterical and labors
under an hallucination is often received by sympathetic jurors as
true ; for it cannot be conceived by them how any woman could
so forget herself as to makea charge of this kind, unless there was
some actual ground. Wharton and Stillé* report the case of an
eminent and highly respectable dentist who was charged with
rape upon a young lady of unimpeachable character, who was
engaged to be married. She testified that the doctor, who had
been her dentist for a number of years had previously always
behaved toward her like a gentleman. On this occasion the
tooth on which he was operating gave her much pain and the
dentist offered to put something in it to destroy the nerve or
give her ether as she wished. She told him she preferred the
ether, which was administered. She became somewhat under
the influence of it, but stated she did not lose consciousness,
but was unable to move. The dentist then felt her pulse and
passed his hand up her arm under her loose sleeve, and after this
put his hand on her breast under her dress; he then put it up
under her dress, then went before her, raises her clothes, sepa-
rated her feet, which were crossed, and drew her to the edge of
the chair and had intercourse with her in that position; during
all this time her eyes were closed. All of the above she testified
she could distinctly remember. The dentist then went to the
washstand, poured water into the basin, returned and put her
clothes down and lifted her back in the chair. After a few
minutes he told her that he would have to take one of her teeth
out, which he did after giving her ether at her request. After
hér return to consciousness she was introduced to another pa-
tient who had come in. Then after making an appointment for
another day with the dentist to have the teeth finished, bade
the dentist good-by and made no complaint until she had
* Wharton and Stillé Med. Jurisprudence, vol. ii, p. 245.
192 MEDICAL JURISPRUDENCE.
reachea home. In the evening she began to menstruate, and
before this she did not examine herself or her clothing, nor was
this done byany one. ‘Two or three days later her clothes were
examined by her mother and then washed.
The dentist was found guilty and sentenced to four years
and six months’ imprisonment ; he was however subsequently -
pardoned by the executive of the State, in consequence of the
large mass of testimony, presented by physicians and dentists
going to prove the entire possibility that the whole accusa-
tion grew out of an hallucination such as ether is able to
produce.
A case closely resembling that of Dr. B., occurred at
Montreal in 1858. A dentist was indicted for attempting to
commit a rape upon one of his patients under the influence
of chloroform. At the trial a witness testified that his wife was
under the strongest impression that she had been violated by
the prisoner while under the influence of chloroform: yet her
husband was present during the whole time she was uncon-
scious. The verdict of the jury was, “ guilty of an attempt to
commit a rape, with a recommendation to mercy :” (Boston
Med. & Surgical Journ., November, 1858, p. 287, and Wharton
& Stillé, vol. ii, p. 248.)
How much more just was the decision of the jury in the fol-
lowing case :—
“In the Midland* Circuit, Northampton, Eng., a sur-
geon’s assistant, Mr. George Howard, aged 32, was indicted for
having on September 11, feloniously and violently assaulted
and outraged Fanny Harriot Childs. It seems that the prisoner
had on the day before administered chloroform in his surgery
but did not succeed in producing unconsciousness. She called
the next day, and he then said he had some stronger chloro-
form, and again attempted to produce anesthesia. For a
whole hour she remained conscious, at the end of that time
Miss Fellows, the only other person in the room, went out.
On her departure, the plaintiff testifies that the prisoner got
down upon his knees and committed the offense with which he
was charged. While this was going on she was perfectly con-
scious but powerless. Miss Fellows returned in about fifteen
minutes, and found the plaintiff sitting in the chair in precisely
the same position in which she was left. She was then speech:
less. Soon after this the plaintiff was escorted home by Miss
Fellows and the prisoner, she walking between them. She was
oe
*British Med. Fournal, Nov. 17, 1877, page 709.
HYSTEROID STATES AND FEIGNED DISEASES, 193
unable to speak until she arrived at her home, and not till after
the prisoner left. She whispered, to her husband something
about his being a scamp, and later she made the complaint
about him to several.
“Dr. Benjamin Richardson, F. R. S., of London, who was
called for the defense, said that chloroform, laughing gas, etc.,
had been his special study. ‘There were four stages or degrees
in which chloroform operated. The first stage being one in
which consciousness was not actually lost ; there was little re-
sistance, and a desire for air. The second one was a stage in
which consciousness was lost, but operation was impossible ;
the patient often screamed often without provocation. The third
stage was that of complete unconsciousness. There was no
rigidity ; if the eye-ball were touched, the eye would not
flinch, and in that stage the administrator would say to the
surgeon: ‘You may go on.’ That was the last stage for
operation in a large number of cases. Judging by the descrip-
tion given by the prosecutrix of her own condition on the day
of the alleged assault, he believed she was in the second stage.
In his own experience, he had known persons in the second
stage subject to delusions as to what had taken place while
under the influence of chloroform. Dr. Richardson gave a
number of instances which had come under his observation ;
and stated that those delusions were the subject of some of the
earliest objections to chloroform. He mentioned the case of
a lady who, in the presence of himself, her father and her
mother, and a dentist’s assistant, while under the influence of
chloroform, brought a charge against the dentist who was ope-
rating upon her precisely similar to the one in the present case,
and continued firm in the belief that the charge was well
founded, long after the influence of the chloroform had passed
off, and probably still continued in the belief.
“ Other medical witnesses gave similar testimony regarding the
delusions of incomplete anesthetization. The jury gave a ver-
dict of acquittal. The justice then remarked that this was no
imputation on the veracity of the prosecutrix, who was un-
doubtedly under a delusion; and also that prisoner was en-
tirely cleared of any imputation in respect to the charge. The
prisoner was then discharged.”
Every physician familiar with the use of anesthetics, espec-
ially chloroform, knows that at a stage of the anesthesia the
patient is very apt to have erotic excitement, which may amount
to actual hallucinations, and in these cases the patient may be
perfectly honest in her belief that she has been outraged. Hap-
T3
194 MEDICAL JURISPRUDENCE,
pily, since the introduction of nitrous oxide gas in dentistry,
the effects upon the nervous system are more transient, and we
do not hear of so many accusations brought by hysterical or
designing females. The medical examination of such cases
tends to relieve any objective signs of the alleged assault,
whether it has occurred or not, and no reliance can be placed
upon the majority of the ordinary tests laid down by the text-
books.
We are to carefully investigate the patient’s history in all
such cases, her disposition, and anything that may lead us to
suppose she is the subject of hysteria.
Can Persons be Robbed While Under the Infiuence
of Chloroform ?—In cases where it is alleged that chloroform
has been used to facilitate robbery, we may safely doubt the
statements of the victim. It has been held by numerous
authors, that it is utterly impossible for a person while asleep
to be anesthetized without some resistance. The late Dr.
Stephen Rogers, some years ago, in an excellent article, ex-
pressed himself as follows :
r. “ As to its use to promote the greater security from the dis-
turbance of the sleeper, even were that practicable, the very
time that would be consuined in the gradual and cautious ad-
ministration of the vapor,—the only possible and theoretical
manner of accomplishing it—would so increase the danger of
detection, that few thieves would think of employing it.
2. “ During the course of the administration of chloroform,
whatever manner may be adopted, the patient or subject as a
rule becomes excited, often very violent and turbulent, with an
irrepressible propensity to sing and shout, which is often so
loud as to alarm the inmates of the whole house. He isina
state of wild, chloroformic intoxication. ‘The exceptions to
this rule are so few, that no prudent thief would think of run-
ning the risk of meeting one of these exceptions.
3. “Supposing the two preceding obstacles overcome, and the
victim thoroughly quieted into a narcotic sleep, a third and
very frequent complication arises. He begins to vomit, and
while he generally does not make much noise about it, still he
may, and he always requires attention, lest fatal strangulation
occur. It may be presuming too much to credit this class of
criminals with any care, whether their supposed chloroformed
victims die of strangulation or not, but I think that a common-
sense view of the case must lead to the conclusion that even
were chloroform an available agent in facilitating fobbery, the
HYSTEROID STATES AND FEIGNED DISEASES, 195
knowledge among the criminal classes that the abandonment of
their victim with a towel still over his face, and the habilities
of vomiting and strangulation would often add the crime of
murder to that of robbery, would have great effect in deterring
them from the further employment of it.”
Taylor, in his work upon poisons, refers to this subject, and dis-
believes the stories of persons who claim to have been suddenly
rendered insensible for the purposes of robbery or rape. The
strongest argument against forcible and sudden anesthesia
has been presented by Stevenson, of Guy’s Hospital, who found
that in more than two hundred cases where chloroform had
been administered to adults they were not rendered insensible
until eight or ten minutes, and has alluded to the fact well
known to medical men who have occasion to use chloroform, ~
that many individuals are able to stand immense quantities
without any appreciable effect.
Dr. R. M. Denig, in a paper on chloroform and its medico-
legal relations, read before the Columbus Pathological Society,
reported in the Ohio Medical Recorder, January 1877, gives
the results of a number (some 29) experiments on different
persons to learn if chloroform could be administered to anes-
thesia, to persons asleep without waking them. A certain
number of cases (about one-third) he succeeded in anesthetiz-
ing without waking them, but in order to accomplish this he
found great caution and great skill were necessary, and con-
cludes “that the expert ought in justice to declare that it is
possible, if it is zo¢ easy, to render a person insensible by chlor-
oform during a natural sleep, in order that he may be made
the victim of a criminal assault.”
Cases are adduced which show that the motives of the
alleged victims are of the most questionable sort, and that not
only is the claim of compulsory anesthesia made to cloak some
crime, but it is advanced, as I have said, by young women of
an hysterical turn of mind, or men of a similar temperament, as
a means of creating sympathy.
If among this latter class there 1s a strong temptation to
pose as heroes or heroines, or for the sake of newspaper no-
toriety.
A most remarkable case where the victims of a robbery
honestly believed they had been chloroformed, is the follow-
ing: In August, 1871, a house in Seventy-first street was
entered by burglars, who broke a pane of glass of a rear base-
ment window, pushed back the bolt and raised the sash. They
took from the dining-room a quantity of silver-plate, and enter-
196 MEDICAL JURISPRUDENCE.
ing the sleeping-room of the proprietor, rifled his pockets of
over one hundred dollars, and made off with his studs, sleeve
buttons, as well as some expensive wearing apparel of the ladies
of the family. They next entered the room occupied by two
young ladies, and collected a quantity of jewelry and money,
and left the house. It was claimed that allthe members of the
household had been drugged with chloroform, and they did not
awaken until late the next morning, and then they suffered
severely from the after effects of the drug. The story of the
chloroform poisoning seems to have arisen in the mind of one
of the young ladies, who was of a highly nervous temperament
and suffered from extreme emotional excitement, incident to
the adventures of the night. She alleged that chloroform had
been used, and she based her opinion upon the presence of fine
powder or dust, which was scattered upon the articles about the
room. As chloroform leaves no such deposit, the conclusion 1s
irresistible that the drug had not been used.
Many of the imaginative tendencies of young women of this
class arise from the exceeding sensational newspaper paragraphs
and flashy novels which they have read. An absurd instance
occurred in California, where a man was actually tried for rape,
and sentenced to imprisonment for several years, upon the
story of a waiter girl who slept in the same hotel. It appeared
from her statement, that the defendant learning that chloroform
might be introduced into the room by means of a key-hole,
procured a spray apparatus, with which he deluged the room
with the vapor of this anesthetic, producing insensibility of his
victim, and afterwards entering and committing the crime.
It appeared in evidence that an empty bottle labeled chloro-
form was found in his room, and this left no doubt in the minds
of the jury as to his guilt. Dr. Rogers, in referring to the case,
_says: “The totally absurd character of the allegation is ap-
parent to every one instructed and experienced in the use and
in the effects of chloroform. We will suppose, by the way of
illustration, that the occupant of such a room as this girl is said
to have slept in may be anesthetized unconsciously by the vapor
of chloroform thus introduced through the key-hole, though I
regard it impossible. But how is the operator, especially if he
be an ignorant hotel waiter, without the slightest knowledge of
chloroform, to know when unconsciousness is effected? How
is he to tell when the victim is ready for the breaking open of
the door? Would the most skilled administrator of chloroform
venture to fix the moment that the occupant of any given room
would be anesthetized by chloroform thus introduced into it?
HYSTEROID STATES AND FEIGNED DISEASES. 197
Would he dare to indicate the time which divides the period of
unconsciousness to all outer impressions and violence, or
perfect anesthesia, from that of fatal poisoning from chloro-
form? Could he tell the moment that it should be discon-
tinued in order to avoid this fatal consequence? I apprehend
that such as could would be difficult to find.
“Tt is therefore obvious, that if this hotel servant committed the
crime alleged under circumstances sworn to, it must have been
brought about by most extraordinary combination of accidents,
leaving out the question how he himself breathed, consumma-
ted his crime, in the same atmosphere, or rather chloroform
vapor, which rendered his victim insensible and kept her insen-
sible for an indefinite time.”
Dr. W. H. Devitt * is, however, of the opinion that anesthesia
may be produced by means of chloroform introduced into
sleeping apartments, and he relates the extraordinary instance
of a family of seven persons who were, in his opinion, at
least, so much under the influence of chloroform, introduced
into the room by means of balls of cotton saturated with it,
that they slept while the house was being entered by burglars,
who ransacked the house, and who even had the audacity to
take a lunch from the pantry.
We are sometimes called to see patients in an apparently un-
conscious state, the assumption being that they are under the
influence of chloroform. While we take into account that the
anesthetic state lasts but a comparatively short time after the
use of the agent has been discontinued, we are to appreciate
the fact that a certain amount of muscular rigidity exists
instead of the limpness and relaxation of chloroform narcosis,
and it willbe found upon touching the eye-ball that attempts
are made to close the eye, and to resent this interference, if the
patient be shamming, there will be an absence of the pulse
changes, and the patient will often be detected in casting
furtive glances about the room, when she thinks she is unob-
served. In addition there will be found an ostentatious display
of bottles, and if injuries are referred to, the marks will be of
the most insignificant kind, and probably produced by the
patient herself.
Hysteria in Men.—As hysteria occurs in males as well as
females the question may arise sometimes whether the symptoms
of so-called cases of insanity are not those of hysterical trouble
* Am. Foural of Medical Science, July, 1875, p 145.
198 MEDICAL JURISPRUDENCE,
after all. Wilks refers to the case of a man who had lost a
great deal of money in speculation, and who for a short time
became utterly unreasonable, but recognized his foolish indul-
gence in emotional excitement and his behavior, but could
not control himself, and indulged in involuntary laughter and
crying.
Charcot,* in an interesting clinical lecture, speaks of male
hysteria which he is not disposed to think a very rare af-
fection. 7
“Tt will not be out of place to say a few words concerning
the hysterical neurosis so far as it 1s shown in the masculine
sex. Hysteria is, incontestably, more frequently found in the
male than is generally supposed. ‘This subject of male hyste-
ria is one of those to which, of late years, doctors have given
much attention. No less than five inaugural dissertations re-
lating to the matter were presented to the Paris Faculty from
1875 to 1880. Already Briquet in his excellent book had
stated that for every 20 hysterical women—in Paris at least—
there was one man attacked by the same affection. This figure
appeared to me large. Nevertheless M. Klein was able to
bring together from these authors 77 cases of hysteria in the
male, to which he added 3 cases within his own knowledge ;
whence it was necessary to conclude that hysteria in the male
is really not a rare affection.
“A fact brought to light in the same work, is that when de-
veloped in man, hysteria is generally hereditary. This is found
to be the case in 27 out of 30 cases, and it is this matter of ma-
ternal heredity and of similar heredity (Aérédité sémilatre)
which leads to the saying that hysteria in the mother often en-
genders hysteria in the son.”
When the disease is presented by men the subjects are usual-
ly well developed and apparently healthy persons. In such
cases as this we are often called to decide the question whether
the troubles of the patient are or are not of grave origin.
Iwas calledsome years ago to see a man whom [| found to be
in a state of opisthotonus and it was at first supposed he had
taken strychnine. I found that there were none of the clonic
convulsions of strychnia poisoning, and after waiting a few min-
utes all fears of such a condition of affairs were dispelled by
his evident hysteria, and his speedy recovery when the use of
the actual cautery was suggested.
* Te Progrés Medicale, Jan. 20; Feb. 7, 1883; iV. Y. Med. Abst., March,
1883. :
HYSTEROID STATES AND FEIGNED DISEASES. 199
Hysteria in its Relations to Organic Disease.—Hys-
teria often exists as a symptom of organic disease of the nerv-
ous centers and we may do an alleged imposter injustice. As
a rule such hysteria is associated with hemiplegia or equally
well marked conditions.
Responsibility of the Hysterical Subject.—The deter-
mination of the responsibility of hysterical individuals is far
from easy. Du Saulle says: “Can we apply to the passions
the same rules as we can to madness? Evidently not. Vio-
lent passions influence the judgment, and even throw a false
coloring over it in a grievous manner, but they cannot annihi-
late it; they occasionally carry away the mind to form extrava-
gant resolutions, but on the brain no pathological trace can be
detected. I will grant that in the instances we are discussing they
might override the will, but moral responsibility is only lessened
but not removed.”
In his great treatise upon medical jurisprudence he arrives
at the following conclusions, which, from a medico-legal point
of view, are the following: “1. Hysteria as it is generally un-
derstood is not a disease in any way caused by continence; 2.
in hysteria the affective faculties are disordered in different de-
grees, but the intelligence remains intact in the great majority
of cases; 3. a feeble state of the will exists in hysteria and does
not compromise the moral liberty so far as the loss of con-
sciousness of the acts is concerned ; 4. hysteria of a high degree
brings with it a diminution of responsibility; 5. the mental de-
rangement known as hysterical insanity is a true disease, and
often dangerous; it is sometimes incurable, and necessarily
brings with it immunity from punishment.”
Punishability of the Insane.—The punishability of
hysterical patients cannot be positively fixed. In the epidem-
ical form of the disease wholesale punishment is the surest meth-
od of arrest, and in individual instances the same rule holds
good. ‘The hysterical girl who commits a wanton crime should
be the subject of punishment just as the vicious imbecile. The
knowledge of right and wrong exists—probably to a more
marked degree in these cases than in any other, and the woman
often calculates just how much mischief she may inflict upon oth-
ers. As to loss of voluntary control, that is a different matter.
When the hysteria is associated with marked intellectual and
moral perversion, with delusions and hallucinations, we must
approach the ground of responsibility with some caution,
200 MEDICAL JURISPRUDENCE.
FEIGNED DISEASES.
The subject of feigned diseases is one of decided importance
to medical officers, who are brought in contact with soldiers
and sailors and prisoners ever ready to shirk their work, or
to secure comfortable quarters in a hospital, or to furnish a
pretext for discharge from duty; and we find as well, as
I will show in considering cranial and spinal injuries, that
diseases are often feigned for the purpose of securing
compensation in court for trivial injuries. Ogston, whose
classical work is one of the best of modern times, speaks of
feigned and factitious diseases. According to his classification,
we may consider, “(1), feigned diseases strictly so-called, or
those which are altogether fictitious; and (2), factitious, or
those which are wholly produced by the patient, or at least at
his convenience. To these have been added by some writers,
(3), exaggerated disease, or those which existing in some degree
or form are pretended by the party to exist in a greater degree
or different form; and, (4), aggravated diseases, or those which
originating in the first instance without the person’s concurrence
are intentionally increased by artificial means.” As Ogston sug-
gests, this is a delicacy in distinction which is hardly warranted,
for a purely factitious disease may be exaggerated or aggravated
in a particular instance, while a person who simulates disease
may at the same time present features of a factitious disease.
The ingenuity of malingerers is almost incredible. Not only
may they resort, when occasion requires, to all manner of dis-
gusting performances, such as swallowing excrement or blood
or other offensive substances to carry out the particular réle
they wish to play, but they may also actually maim or injure
certain organs for the purpose of gaining their object. The
greatest difficulty in detecting impostures arises when we ex-
amine the subjective symptoms, and extreme caution is then
needed, besides the adoption of the most delicate tests, which
should be repeatedly made use of, until we are satisfied as to
what is the real condition of the patient.
Feigned Pain.—There is probably no symptom so com-
monly complained of and none so easy to present, as that of
pain. Being purely subjective the examining physician is fre-
quently tried to his utmost, and much depends upon his knowl-
edge of human nature and his perceptive faculties. The pain
of the simulator is unsubstantial and inconsistent asa rule with
that which would arise in any anatomo-pathologicual situation.
His attempts at localization therefore are very vague and un-
HYSTEROID STATES AND FEIGNED DISEASES, 20f
certain, or he, on the other hand, is almost too accurate in the
description of his sufferings. A neuralgia, for instance, is lo-
cated in a situation where no nerve trunk lies; or a sciatica
may be referred to the outside of the thigh, as it was by a wo-
man J examined the other day; or to some other equally
unlikely place. The neuralgia of the malingerer has no
paroxysms or intermissions, and is not attended by any of the
vascular cutaneous changes that so often exist in the genuine
disease. There are no points doloreux, or at least none that
correspond with the anatomical situation at which we would |
expect to find them. The pretender says that his pain is ag-
gravated by muscular movements, when, after all, such move-
ments ordinarily have nothing to do with the increase of pain
in the real affection. His expressions of suffering are much
more demonstrative when he has an idea that he is under ob-
servation, and when his attention is diverted he apparently suf-
fers but little or none, and often we are unable to find any facial
or other bodily indications of distress. Pressure, even of the
lightest kind, produces great torture for the simulator, just as
it does in hysteria, although the hyperesthesia of the former
is not real, nor is it associated in pure cases of malingering with
other symptoms, at least with other symptoms that are classical
and pathognomonic; yet when the same pressure is made and the
patient’s attention is diverted, he no longer complains of the
pressure made upon the original point of contact, but fixing
his attention upon a new point refers his suffering to the latter.
Direct questioning or hints skillfully thrown out may cause the
dishonest person to let his imagination run wild, and by encour-
aging the play of expectant attention, especially if the subject
be a woman, the deception becomes clear.
A tavorite seat of pretended suffering is the back ; and, as
I have already said, we often find that the dishonest individual
sometimes refers his pains to the abdomen as well. If we have
the simulator carefully watched, our suspicions will often be
confirmed, and it will be found that when he thinks he is not
under observation he will be able to do pretty much anything he
chooses ; but when he comes into court, or when he applies to a
medical officer for privileges he desires, his complaints are re-
doubled and sometimes very ridiculous. In this connection I
will mention the case of a woman who had been told that Pott’s
disease was accompanied by a tendency upon the part of the
patient to support the chin for the relief of the pain. Although
she had frequently been examined by medical men, nothing of
this kind had been found to exist. When she appeared in court
202 MEDICAL jtUIRISPRUDENCE,
during the trial ot her suit for damages, she studiously supported
her chin, but when she was in the corridors of the court house
and at home she neglected to maintain the deception.
The simulation of hip-joint disease is quite common, but
the pain is as a rule improperly reterred, and that in the
knee, which is one of the most important and constant accom-
paniments of real trouble, is not mentioned at all by the
impostor. So, too, when rheumatism is feigned, or in fact
where the pain of other inflammatory conditions is claimed
to exist, none of the signs of swelling, heat, or redness, will be
found, and movement of the limb is at all times unembarrassed.
A person who will complain of a back pain that may be
mistaken for that of spinal disease, and from the acuteness
of which we may suspect meningitis; will manifest none of
the rigidity and stiffness of movement which in ninety nine
cases out of a hundred is a characteristic of inflammation
of the spinal envelopes. ‘There are none of the constitutional
expressions or results of severe pain ; suchas sleeplessness and
increase of temperature; and the functions of the bowels and
kidneys are not affected. We neither find in the urine increase
of phosphatic matter nor the urates. The patient will often
complain that certain forms of movement cause intolerable
suffering and misery, yet we may ascertain that he or she may
make exertion of a much more severe kind, in which the same
muscles and the same parts are exercised without any of
the corresponding complaint. A young lady, desiring to
escape her piano practice, complains of pain in one arm and
shoulder, and gains the sympathy of her unthinking mother,
while the same day she may devote one or two hours to lawn-
tennis or use her hands in other ways and give no report of
pain.
Foderé refers to numerous cases where malingerers have
shirked their duty, alleging inability because of pain. He re-
ports the case of an artillerist who was brought to the hospital
at Martignes complaining of violent pain in the left leg,
which it 1s supposed resulted from exposure and lying upon
the damp ground. Treatment was indicated and followed
up ; blisters and other powerful agents were exhibited, and it
was supposed that his leg had become thinner and shorter than
the other. Finally he was discharged and left the hospital
upon acrutch. When he reached Marseilles he learned of his
discharge, and, unable to restrain his emotions and his great
joy, he threw away his crutches and walked briskly without
any limp or sign of trouble. He had, however, miscalculated,
HYSTEROID STATES AND FEIGNED DISEASES, 203
for he encountered the commandant of the fort, and was ar-
rested and imprisoned, and subsequently acknowledged his de-
ception.
The malingering patient will sometimes give a clue to his de-
ceit and the unsubstantiality of his symptoms by his disincli-
nation to have anything done for him, probably believing, as it
were, that the disappearance of his symptoms would be the loss
of his stock in trade. Occasionally the reverse is true, espec-
ially where a claim is made for damages, and in such cases the
impostors seek every occasion to express their desire for relief.
It is common for such a person to say: “I would give ten
thousand dollars if this pain were absent ;”’ and this is some-
times very ludicrous when it comes from the lips of a slatternly
boarding house keeper or a poor clerk who receives a few dol-
lars a week as salary.
Beck refers to the case of a girl fifteen years of age who
complained of a pain just back of the symphysis of the lower
jaw. The result was that she was taken from school and
she carried her point. When affected subsequently a strong
mental impression was made by Dr. Thompson who attended
her, and it was based upon the great antipathy she had toa
dog. She was informed that the only remedy remaining was to
rub the affected part over the back of that animal. The
result was complete and immediate cure, without recourse to
the prescription. But such cases as this are the ones most
easily detected.
Mr. Hutchinson Upon Malingerers.—Mr. Hutchinson
thus speaks of malingering, after laying down certain rules for
the detection of impostures, and advising those who meet such
cases that it is better for the time to assume that the patient’s
sickness is true than to make the mistake of overlooking a gen-
uine disease. “The importance of this rule,” says he, “can
scarcely be exaggerated in its application to the casualty room
of large hospitals. It is far better to allow nineteen knaves a
temporary success in their schemes than to refuse relief to one
really urgent sufferer. Cases come very frequently under my
notice in which great hardship would have been inflicted had
the suspicion of malingering been hastily acted upon. This
’ rule, however, must of course only be allowed to apply to mild
measures of treatment. Malingerers of a certain class, espec-
ially hysterical women, will often submit with eagerness to most
painful measures of treatment, or even to those which entail
permanent deformity. In all such cases the surgeon’s duty to
204 MEDICAL JURISPRUDENCE,
withstand the patient’s importunacy is clear. A manis at pres-
ent in one of the surgical wards who has had his fore-arm am-
putated for injury. He nowcomplains of a painful stump, and
avers that the pain is such as to prevent his rest night and day ;
he is most desirous that another amputation should be
performed. He is, however, apt to be dismissed, in the belief
that he has intentionally exaggerated his symptoms. The fol-
lowing reasons support this view: 1. He has not the slightest
aspect of suffering want of rest. 2. He complains of pain in
the muscles of the part removed, not in the skin, and whenever
his stump is examined, he always puts the remaining pairs of
muscles below the elbow into constant action, alternately relax-
ing and contracting them ina manner which can be no other
than voluntary. 3. He has never on any occasion given a cor-
rect guess as to the distribution of any one of the sensory
nerves of the fore-arm, but is obliged to refer the pain to the
whole hand and wrist. It is improbable that the median,
radial and ulnar should be neuralgic at the same time. His
case, however, confirms the remark that most forms of maling-
ering are based upon some real loss and often upon some real
disease still in existence ; they are intentional exaggerations,
rather than fictions pure and simple.” Hutchinson’s views are
undoubtedly correct, but so far as my own experience has gone ©
the primary injuries or conditions are in inverse ratio to the
complaints, and this makes the fraud, especially where there is
a well formed motive or object to be gained, more easy of de-
tection.
Real Disease Apparently Feigned.—An unfortunate
mistake to make is that of considering the symptoms of real
disease to be fictitious manifestations, and the books contain
examples where the patient’s subsequent history contradicted
the doctor’s original diagnosis.
Danger of making a hasty Diagnosis.—“ Dr. James
Johnson reports the case of a man who complained of in-
ability to move his shoulder joint without much pain; and
yet nothing could be seen externally for a month or six
weeks, during which time he was excused from duty. At
length the surgeon became suspicious, and finding that he still
made the same complaint, reported him, and he was flogged asa
skulker. Shortly, however, a deep seated abscess was discovered
in the shoulder joint, from which large quantities of pus were
evacuated and ankylosis of the joint followed.” The case
occurs to me of a person who was injured and examined by
HYSTEROID STATES AND FEIGNED DISEASES, 205
another physician. His primary symptoms, it is true, were not
those which would impress the careless observer. He com-
plained of ill-defined pains, formication and loss of power in
the lower limbs, and his gait was somewhat uncertain and
“ketchy.” The physician who examined him pronounced the
case one of imposture, but the appearance within two or three
years of very marked spastic paralysis, with aggravation of the
reflexes confirmed my original opinion of lateral scleros7s of the
spinal cord.
Feigned Spasmodic Affections.—It is rare for malinger-
ers to simulate chorea or other spasmodic disorders, and if they
do it will be found that the movements are chiefly of a voluntary
character, and the pretended malady is unaccompanied by any
evidences of valvular disease so common in true affection. The
reader is referred to the chapter on epilepsy and insanity for a
description of feigned disease of this kind.
Tetanus, hysteria and hydrophobia are imitated with more or
less success by the impostor, but a slight knowledge of the
symptoms of these diseases is all that is required to settle the
question of trickery. In the genuine diseases we find a rise of
temperature which cannot be discovered in the individual who
simulates ; and though the patient who feigns tetanus and hy-
drophobia may copy with some fidelity the opisthotonos which he
has heard is a conspicuous feature of these nervous disor-
ders, he nearly always neglects the throat symptoms, and the
muscular contractions are not consistent in their association
or extent with the rigidity which he attempts to exhibit.
_ Feigned Unconsciousness. — Unconsciousness is sometimes
feigned and so closely as to deceive the most watchful observer
although in many cases the activity of the pulse will betray the
lively emotional condition of the patient. It is possible for a
clever person to control the manifestation of the excitement
which is usually created by the appearance of a new person, es-
pecially a physician.
Voluntary Arrest of the Heart’s Action.—Beck
speaks of aman who could produce an apparent stoppage of heart
action when he feigned death.
The case of the negro Thomas White which is so admirably
described by Dr. Michel* is one of greatinterest. This man
was able to arrest his heart and pulse at the wrist by tak-
ing avery deep inspiration and suspending his breath. Dr.
* Boston Medical and Surgical Fournal, Oct. 31, 1878.
206 MEDICAL JURISPRUDENCE.
Michel also presents the case of the Hon. Col. Townshend re-
ported by Cheyne, and that of a Mr. Grew of Charleston.
“The case of the Hon. Colonel Townshend comes to
us through one of his physicians, Doctor George Cheyne,
author of a Treatise on Nervous Diseases, who was called with
Dr. Baynard to see this gentleman at the Bell Inn, upon his ar-
rival at Bath from Bristol. At one of their visits, while Mr.
Skrine, the apothecary, was present, the colonel stated that he
could de or expire when he pleased, and yet by an effort he
could come to life again, and asked an explanation of the phe-
nomenon ; but as he was weak and sick, these gentlemen with
reluctance assented to his making the trial. While he prepared
himself for so strange an exhibition Dr. Cheyne held the pulse,
Dr. Baynard examined the heart, and Mr. Skrine placed a mir-
ror to the mouth; the pulse sank untilit could not be felt, all
motion of the heart ceased, and not the least soil of breath on
the bright mirror was detected. Then each in turn examined
the arm, heart and breath, but could not discern the least symp-
tom of life. He remained in this condition for a half hour,
when the functions of respiration and circulation were gradually
reinstated.
“Some years ago I was invited by Professor Frost, then dean
of the medical college at Charleston, to meet the faculty by ap-
pointment to examine a Mr. Grew, in whom there was an ar-
rest of development of the sternum. Besides many interesting
facts concerning the play of the heart, which were readily de-
termined through the simple integumental covering which alone
separated us from that organ, we had an opportunity of witness-
ing a like experiment upon the suspension of this heart’s action
and subsidence of the pulse. When he took a deep inspiration
and then held his breath, the pulse grew weaker and weaker,
and finally stopped entirely, while the ear over the precordial
region could not detect the slightest impulse or sound. The
heart had ceased all action, and there was temporarily no pulse
throughout the system.”
It is important to recognize this trick, and I have several
times seen it attempted by medical students and others.
The Whittaker Case.—It is sometimes the object of ma-
lingerers to affect unconsciousness for the purpose of carrying
out some scheme to gain sympathy, and occasionally we find self-
mutilation to be a part of the plan. An interesting case of this
kind is that of the colored cadet Whittaker who was tried some
time ago in this city. Whittaker was one of the few colored
HYSTEROID STATES AND FEIGNED DISEASES, 207
cadets who went to West Point and one of the least intelligent.
He had repeatedly failed in his studies and upon the eve of an
examination which would undoubtedly result in his sus-
pension, he made a desperate attempt to gain the sympathy of
the country, as well as the opportunity to secure time for
extra study. As the medical counsel for the government I had
ample opportunity to examine not only the record of the Court
but I made a personal visit to his room at West Point. The
defendant was found early one morning in his dormitory, bound
to his bed with strips of cotton cloth, in an apparently uncon-
scious state. His eyes were closed and his pulse, which was ex-
amined, showed nothing unusual. There were slight cuts, one
upon the left ear and the other across the great toe. He re-
mained apparently oblivious of his surroundings and of the peo-
ple about him for some time, and finally opened his eyes and
in a dazed condition expressed great surprise. From his story
it appeared that he had been surprised several hours before by a
body of masked men who felled him to the floor, bound him, and
cut his ears and toe, and then after threatening him left the room.
The medical witnesses for the defense were of the opinion that
the threats of the assailants, the fears of the victim and the ex-
citement had resulted in the production of trance! Much care-
fully given evidence effectually disposed of this fanciful theory.
It was proved that none of the wounds were of a serious charac-
ter, in fact they were all painless and trivial, and unattended
by hemorrhage ; that on the toe hardly severed the skin. They
were in a situation in which he could have made them himself,
and the presence of a razor anda looking-glass on the floor near
him strengthened this belief. No marks of violence resulting
from a struggle were found, and the bandage was so loosely
applied and so flimsy that he might have readily applied it
himself, in fact a young officer went through the process of
tying and untying himself as Whittaker had probably done.
The room in which the alleged assault had taken place had
numerous openings communicating with other apartments, in
which many cadets were at the time, and any disturbance
would have been heard at once. A prominent feature of the case
was the production of a letter of warning sent to the prisoner
which it was alleged was written by Whittaker, and this drew
forth a fight between the experts in handwriting. |
After the trial I learned from an expert to whom several of
Whittaker’s letters had been sent for comparison, that among the
number was one which with the exception of the erasures and
interlineations, exactly resembled the “letter of warning” pro-
208 MEDICAL JURISPRUDENCE,
duced in Court. This was written by a young woman to the
prisoner, and it is presumed that the celebrated letter in evi-
dence was the joint production cf the two. The prisoner was
found guilty, but his sentence was modified.
Tests for Feigned Unconsciousness.—For the detec-
tion of shammed unconsciousness we are to apply tests of a
sensory character, and among these may be noted the faradic
current with the wire brush, the use of pins or needles, and per-
haps theactual cautery. The threatto use this last instrument
may be sufficient to bring the impostor to his wits. In a case
related by Smith, and quoted by Beck, Gavin and others, a
man named Drahe who had feigned total insensibility for
months and had refused to be made to see the error of his ways
by the introduction of aloes beneath his tongue, the shower
bath and electricity, promptly recovered when the hot iron was
suggested, the first indication of his altered emotional state be-
ing the rise in his pulse.
Sometimes the patient feigns unconsciousness for the purpose
of escaping punishment, and the case of Phineas Adams* a
deserter who remained apparently unconscious for over two
months, is one illustrating the difficulties that a determined
man will place in the way of the medical observer.
With Adams every species of revulsion was used, snuff was
blown into the nostrils, electric shocks used, pins were run under
the finger nails. It was even threatened in his hearing that an oper-
ation was to be performed for the purpose of removing his
_ scalp to see whether there was fracture of the skull or not. He
permitted himself to be cut into and gave no sign of suffering
except when the scalp was scraped, when he groaned. No re-
sults occurring from the treatment or examination, he was dis-
charged and sent to his father’s house. He was seen the day
after helping his father to thatch a rick. In feigned uncon-
sciousness the muscular condition must be observed, the state of
the pupils is also to be noted and the general condition of the
skin, pulse and temperature are to be investigated. The
sphygmograph may prove to be a useful instrument in some
cases.
Trance.—The medico-legal relations of trance have been dwelt
upon by writers upon Medical Jurisprudence, but it is very rare
that such an excuse can be given for the active commission of
acrime. It might be possible to account for the ignorance of
* Edinburgh Annual Register, Vol. 4, No. 2 and Beck.
HYSTEROID STATES AND FEIGNED DISEASES. 209
an individual by the fact of his being unconscious, or being
thrown into a state of suspended consciousness through fright
or a strong moral impression.
There is a case related which has some interest in the fact that
the patient claimed to be mesmerized when he committed a theft.
A young man had been arrested for stealing a sheet. When he
was brought into Court he seemed pale and unable to stand
without support, and his eyes were closed and he appeared to
be in a sound sleep, and apparently did not understand the
questions put to him by the magistrate. It was testified by the
police officer who arrested him that he had fallen into this
state after his arrest in the station-house, although before this
he had given an account of himself. Medical aid was sent for
but nothing could be done to arouse him from his sleep (?).
The prisoner had been arrested while trying to pawn the sheet
which had been stolen from his landlady who was a laundress.
One of the police officers knowing that a brother of the pri-
soner was a lecturer upon mesmerism sent for him, but the bro-
ther was unable to arouse him, although he answered questions
readily. Thebrother stated that the thief had been susceptible
for a long time to mesmeric influence and could by looking
steadily at one object for some time go into an unconscious
condition; that upon one occasion he became violent during an
attack and had to be restrained.
The prisoner subsequently recovered and was tried, mean-
while having gone without food for several days and had not
asked for nourishment of any kind. The plea that the
patient was incapable of knowing the difference between
right and wrong at the time of the theft was advanced, but
did not hold, for the man was sentenced to fine and imprison-
ment.
In this case the question of the criminal act arises, and its
execution seems to have little to do with expectant attention.
An act of violence, had it been committed, would have suggested
criminal irrresponsibility, but theft imples personal benefit.
The long continuation of the patient’s alleged mental state, and
his interval of lucidity when he told his story at the station-
house, threw suspicion upon his conduct. It is probable thatthe
verdict was a righteous one.
Feigned Somnambulism.—Feigned somnambulism is
more common than feigned trance and it may readily be seen
how a criminal surprised in the performance of a crime at night
may resort to this species of deception.
14 ;
210 MEDICAL JURISPRUDENCE,
Gavin * thus refers to an interesting case of feigned somnam-
bulism :
“ A remarkable case of feigned somnambulism is related by
Recherz and Kriiza. A rope-maker twenty-three years of age,
was often attacked with a profound sleep, in the middle of his
occupation, whether seated, standing, or walking; he then
knitted his brows, gradually closed his eyelids, and began to re-
peat everything he had done during the day, from his morning
prayer up tothe time of the occasion ; for example, he simu-
lated the movements of a man who puts on his stockings and
shoes, cleans his dress, etc. If the sleep overtook him whilst
walking in the country, he pursued his journey with as much
assurance as if he had been awake, avoiding persons and ob-
jects which could have hurt him, etc. The story is reported
with these circumstances and even others, without any suspic-
ion of the fraud. Now two circumstances alone among these
would have caused suspicion, the first is, that the man repeated
in his pretended accession, all that he had done during the
day ; a circumstance contrary to that which is observed in true
somnambulists, who only execute, in the accession, those things
which they have premeditated, or, which have previously
strongly occupied their thoughts. The second is that this
young man played a double game ; he repeated that which he
had done from the first part of the day upto the period of ac-
cession, then continued that which he was about to do when the
accession overtook him. The trick was finally discovered. The
man professed himself cured, when a physician, charged with
his examination, proposed to bandage his eyes, to ascertain if
he was still able in that state to execute actions which hitherto
had excited so much surprise.”
Where somnambulism has been simulated, according to Du
Saulle, it is for the purpose, first, of accomplishing an act it
would be difficult or impossible to execute at other times ; sec-
ondly, to escape a just punishment for a reprehensible or com-
promising act ; thirdly, to excite commiseration and to fraudu-
lently obtain assistance ; the falsehood and trick are not always
easily detected.
Feigned Locomotor Ataxia.—Locomotor ataxia has
been simulated and Lataud reports the case of a soldier who
attempted to avoid military duty by this method of deception.
In such cases it will be found that the tendon-reflex is present,
that no pupillary or optic nerve changes exist, and in all prob-
* Feigned Diseases, p. 112.
HYSTEROID STATES AND FEIGNED DISEASES, 2eEt
ability the patient will not bear such tests as being told to
walk in the dark or to stand with his eyes closed.
Feigned Paralysis.—It is acommon thing for persons who
claim that they suffer from injuries to sham paralysis, and the
form chosen is either paraplegia or local paralysis. In such
cases it will be found that there is usually more or less rigidity,
that there is no atrophy and that the electric currents will pro-
duce their customary reactions. Under the influence of an
anesthetic the patient will move the limbs and this is an im-
portant test, that however can rarely be employed except in the
public service. It sometimes happens however that an amount
of cunning will be shown, especially in cases where there are some
grounds for believing the person in earnest, which may throw
the medical man off his guard. As an interne I once treated a
patient who was brought to the hospital in a helpless condition.
He had received a bullet wound in the back while engaged
in a burglary, and upon his admission he could neither move
his legs nor feel the point of a pin. The bullet had entered near
the sixth dorsal vertebra upon one side but could not be found.
While under observation there were no vestca/and rectal symp-
toms and he had no erections. After a stay of several weeks’
there was no pathological -atrophy and the electric reactions
were good. Numerous consultations were held at his bedside
which he listened to and he seemingly took a great interest in
his case. He was finally carefully removed upon a stretcher to
the gaol to be cared for by the physician of that building and when
he left us could apparently not move his legs. The night after
his removal, however, he broke out of his cell, scaled a wall,
dropped to the ground and found his way to parts unknown.
In this case there was every reasonable ground to believe the
patient’s case was a serious one—though the absence of local
and general symptoms was suspicious.
Simulators are apt to keep their paralytic arms rigid or to re-
sist attempts made to bend them. Hutchinson has shown that
a healthy arm trembles when a heavy weight is attached to it,
which is not the case in paralysis.
Feigned Hemiplegia.—Gavin thus speaks of feigned hemi-
plegia :
“In suspicious cases of hemiplegia, our inquiries must em-
brace the origin of the attack, its nature and course. Whether
arising, 1, from apoplexy; 2, or likely to precede it; 3,
whether characterized by previous symptoms, such as pain in
the head, disorder of the intellectual powers, spasmodic twitch-
212 MEDICAL JURISPRUDENCE.
ings ; 4, whether gradually supervening in persons in advanced
life ; 5, whether preceded by a train of anomalous and perplex-
ing symptoms having a relation to chorea, or fits of an epileptic
character ; or, 6, whether succeeding at some period after the
receipt of an injury.
“ In the attack itself, if with the loss of voluntary power over
the upper and lower extremity, we do not recognize paralysis of
the side of the face, a drawing of the mouth to the sound
side, more or less upwards, a curve of the tongue when pro-
truded, convexity being toward the affected side ; an increasing
dilatation of the nostril of the sound side, which is not equaled
by that of the paralyzed, when a long inspiration is made; the
peculiar pointing of the foot when it falls, as it were, by its own
gravity ; adduction of the affected arm, and slight flexion of
the forearm, wrist, and fingers; we have every reason to be-
lieve the case pretended. .
“In pretended hemiplegia, asserted to be the result of aninjury
to the head, the simulator is not likely to be aware that the par-
alysis should occur on the side opposite to that injured.”
The London Lancet of February, 1872, page 219, contains
an extraordinary and amusing case of malingering so success-
fully carried out as to secure admission of the impostor into
many of the London and Provincial hospitals, and while thus
an inmate he was the recipient of marked attention and sympathy
from the hospital physicians and surgeons, and also what prob-
ably pleased him as much, considerable whiskey, brandy, best
wine, and table delicacies. He is described as a well-educated,
clever, intelligent man, with some knowledge of Latin and
Greek, as well as of modern languages. Hewould represent
himself as a chemist, medical man, engineer, in fact he was all
things to all men. He is described as follows: “ He isa stout,
good looking, short-necked man, reminding one rather forcibly
of the pictures of Henry VIII. His hair is dark brown,
short, and curly ; and he has the scar of a carbuncle in the cer-
vico-dorsal region of his back. Age, about forty-three.” He
would assume the role of a hemiplegic, or would intensely 1i-
terest professors and students by giving them an exhibition of
tetanus, with beautiful risus sardonicus. Professors would lec-
ture and students would take notes on his condition. “ More
than once (it is said) he has been attended all night by a dili-
gent student, who carefully recorded all the attacks of spasms,
etc
He usually succeeded in securing a good home in the hos-
pital for from one to two weeks, and at the first intimation that
HYSTEROID STATES AND FEIGNED DISEASES. 213
the imposition was detected he would abscond, and he some-
times even had the effrontery to threaten to complain to the
hospital authorities that he was ill-treated. At one time he
had a genuine carbuncle on the neck, and even then he did not
forget to have the tetanic spasms and opisthotonos, and “ground
his carbuncle against the pillow.” At this time, it seems, he
was seriously ill, and was prevailed upon to make his will, giving
to the hospital and physicians considerable amounts, after pro-
viding for his family. This generosity and gratitude on his
part of course had its effect upon those in attendance, and he
was fed on delicacies and wine, ad libitum. ‘The following
record from the note-book of one hospital where he was
an inmate, givesan example of his methods. “ Previous to the
appearance of the carbuncle he had enjoyed excellent health.
This afternoon, whilst riding in an omnibus, he was seized with
a violent spasm, having throughout the day felt considerable
irritation in the seat of the incision, and just previous to the
attack a tingling sensation down the spinal column.” From
that time for many days after he had attacks of tetanus, com-
plete in every particular. The slightest changes were noted,
and students sat up with him at night, recording the slightest
changes. After about two weeks he left the hospital in indig-
nation because the nurse said she thought he was shamming.
He here called himself Edward Mason, M.D. His motive was
a matter of mystery to the deceived. As a hemiplegic he was
also a success when he chose to take on this malady, the halt-
ing gait, the tongue deviating to one side when protruded, and
even the post-paralytic contractions were perfect, but a day or
so after he had left the hospital he might be seen walking per-
fectly.
Beck relates the following case:
“A dextrous deception was recently practiced upon the
Court of Sessions at Hackensack. A fellow who had been a
long while in prison, awaiting trial on an indictment for perjury,
a few days previous to the time appointed had a severe paral-
ytic stroke, which rendered one side entirely powerless. In
this helpless condition he was carried from the prison into
Court on a bed. The spectacle of an infirm fellow being,
trembling into the grave, on a trial for perjury, had a visible
influence upon the sympathies of Court and jury. The evi-
dence however was so unequivocal that the jury convicted him.
During the progress of the trial he became so faint that a
recess was granted, to. enable him to be reconveyed to his apart-
ment in the prison for revival; the prosecuting attorney kindly
214 MEDICAL JURISPRUDENCE.
lending assistance. The Court, in view of the prospect of his
being speedily called to a higher tribunal, instead of sentencing
him to the State prison simply imposed a fine of five dollars,
which his brother, who manifested the most fraternal solicitude,
paid, and conveyed him away in a bed, in a wagon. The next
day the prosecuting attorney encountered the fellow at the foot
of Cortlandt street in New York, who told him laughingly,
that he had recovered; and then dropping his arm and con-
tracting his leg, in true paralytic style, hopped off, leaving the
learned counsel to his own reflections.*
Bartholow relates the case of a malingerer who feigned
paralysis, and he detected the fraud by surprising the patient.
“In passing by a man in the hospital who professed to have
paralysis of the left arm, I suddenly seized the paralyzed limb
without his being aware of my intention, and threw it up.
Greatly surprised, and taken off his guard he exerted all his
force to prevent my raising the arm. His imposition was at once
detected.”
Simulated Contractures.—Contractures are often feigned
by malingerers, and a constant maintenance of the limb in one
position may give rise to a wasting which is suggestive of patho-
logical atrophy. There isa stiffness which, however, disappears
at night, and is always increased when the impostor believes he
is watched. Sometimes, however, it is impossible to divert the
patient’s attention, or to throw him off his guard. A case
which eluded detection for a long time is that of “a conviet who
was confined on board the Retribution hulk at Woolwich dur-
ing the period of his sentence, which was seven years. He
kept his right knee bent so as not to touch the ground with his
foot all that time, and he was on that account not sent to hard
labor with the other convicts. He was commonly employed in
executing light jobs, which he could do in a sitting posture.
When he moved from place to place he hopped upon the left
foot with the assistance of a stick. At the end of the seven
years he was discharged, and upon going away he very coolly
observed, ‘I will try to put down my leg, it may be of use to
me now.’ He did so, and walked off with a firm step without
his stick, which he had previously thrown away !”’
We shall sometimes find simulated contractures of the fingers,
neck, knees, etc., but, according to Le Grand du Saulle, we
shall find no lesion to explain the contracture, and if we put
* Beck’s Medical Jurisprudence, page 14, 1836 ed. from N. J, newspaper.
HYSTEROID STATES AND FEIGNED DISEASES. 215
the patient, when his inferior extremity is alleged to be
affected, upon a small elevated platform, we shall find that
he begins to tremble, and that he cannot keep up the decep-
tion.
Two cases are related by Beck, one of which was “a man
who was brought before a board of medical officers, for the
purpose of being invalided if found diseased. It was winter, and
the surgeon proposed that the hand, in its relaxed and useless
state, might be placed over the edge of the table round which
they were sitting, while the assistants should keep the arm and
and shoulder firmly fixed. In this situation, a red hot poker
was gradually brought under the hand. As it came nearer and
nearer, the hand gradually rose to the full extent of the power
of the extensor muscles.”
Another, “a most obstinate case, however, according to Mr.
Marshall, was that of a private, who for two years endured
everything that medical skill and suspicion could suggest. His
complaint was paralysis of the lower extremities. He was
finally sent home from the Mediterranean to be invalided.
While in the harbor an alarm of fire was given on board ship.
All hurried to the boat alongside, and on reaching the quay,
the passengers were mustered. It was found that the invalid
had saved not only himself, but his trunk and clothes.
Feigned Diseases Of Womb.—In certain rare cases we
find that diseases of the female organs are simulated for the
purpose of blackmail or divorce, and it is not uncommon for
women to introduce irritating substances into the vagina, thus
giving rise to leucorrhoea ; or they may complain of pain and
difficulty of movement.
Feigned Hemorrhagic and Cutaneous Conditions.—
Hemoptysis and hematemesis have frequently been pretended,
and persons have swallowed the blood of animals, which they
have subsequently ejected, or have pricked or wounded their
gums or mouth, so that a proper supply of blood should be
provided.
Cases of factitious dysentery are common, but asa rule the
character of the stools and the absence of mucus will throw
light upon the deception.
The ingenuity shown for the purpose of escaping werk
is great indeed. Not only do we find that by the appli-
cation of irritating substances the skin is denuded and
ulcers are produced, but we find that it is often rubbed
so that an open sore is created, It is not uncommon to
216 MEDICAL JURISPRUDENCE,
find malingerers producing a pseudo small-pox by the applica-
tion of Croton oil to the body, but it hardly need be said that
the absence of umbilication and other signs of the true disease
show its artificial production. Sponges saturated with dyes or
with blood have been introduced into the different cavities of
the body to give the idea of cancerous tumors or hemorrhoids,
and the books contain numerous cases where the guts of
animals have been introduced into the rectum for the purpose
of producing factitious prolapsus.
Feigned Diseases of the Eye.—Ophthalmia is artificially
produced by the application of irritant substances, or by the
removal of lashes from the lids, or by the introduction of
sand.
It may be well to attend to those who sham Jdlindness. Bella-
donna may be placed in the eye to produce pupillary changes,
but most frequently we have nothing to guide us but the
patient’s statement and behavior. The fraud will often be
explained by the method in which the patient holds his head,
or moves about, by closure of the eyes, or by his behavior when
suddenly confronted with some one he is interested in.
In some instances it is well to use spectacles in one side of
which a prism is fixed. If these are put on and he is told to
look at an object, of course the image will be doubled by the
prism. If he is thrown off his guard, as he may be in his
willingness to admit that he needs help in the way of glasses,
he may admit, as one impostor did, that he sees two
images, which, of course, will prove that his vision is unaffec-
ted. If he admits seeing only one object the test will be con-
clusive that he is dishonest.
Boisseau has given the following test for the detection of
amaurosis when the individual has both eyes open. If there
be a double image produced, when pressure on the angle of the
pretended amaurotic eye is made, we may rest assured that
there is fraud.
Feigned Deafness.—Deafness is often complained of by
impostors. Ogston mentions the case of a prisoner suspected
of shamming sudden and complete deaf-mutism. A bunch of
keys was dropped at his back from a high window, while he
was walking in the prison yard without any notice being taken.
When the same thing was being done in a case of congenital
deaf-mutism, the prisoner started in alarm and looked about in
all directions except that from which the sound came.
For the purpose of detecting feigned deafness and dumbness
HYSTEROID STATES AND FEIGNED DISEASES, 217
We may resort either to chloroform or other agents, in order to
disarm the patient and to pervert the volitional condition, or
we may produce a sudden shock upon the vocal organs, as has
been suggested by a writer in one of the English journals. In
this case a strong electric shock was applied over the larynx of
a boy, who had for some time deceived a large number of
people. I have upon several occasions resorted to this means
in hysterical girls, and in one case, that of a young woman
who had remained silent for over a month for the purpose of
escaping her duties at school and securing a trip to Europe, I
found that the application of the Faradic current, when unex-
pected, produced an instant return of speech and a vigorous
remonstrance from the pretender.
Much depends upon the way we approach malingerers who
feign deafness or dumbness. We are to watch their facial ex-
pression, and engage their attention in any way which seems
the most appropriate. The threat of an operation, or some pro-
position which materially affects the interests of the person may
cause him to betray himself. In a recent English case a
prisoner accused of murder pretended to be deprived of his
hearing and speech, and his pretended infirmity at first gained
for him the sympathy of every one in the court-room. The
man, however, refused to plead, but it subsequently transpired
that he was perfectly cognizant of his situation and the course
of the case, and he was finally convicted. Foderé relates the
case of a deserter, who was condemned to labor, and pretended
deafness, that he might escape his ordinary duties. Foderé,
suspecting the imposture, addressed him in an ordinary tone,
saying, “ you cannot persuade me that you are deaf, but if you
confess the truth, you shall have your discharge.” The man
immediately answered, “very well, I am not deaf.”
Numerous cases of pretended deafness are to be found in
works relating to military subjects. Mr. Marshall relates the
case of “a recruit from Cork, who joined the depot of the East
India Company at Chatham. He alleged that he had almost
totally lost the sense of hearing, and the testimony of his com-
rades from Ireland served to support hisstatement. Dr. Davis,
sergeant to the depot, admitted lim into the hospital, and put
him upon spoon diet. For nine days Dr. Davis passed his bed
during his visit to the hospital, without seeming to notice him.
On the tenth day he felt his pulse, and made signs to him to
put out histongue. He then asked the hospital sergeant what
diet he gave the man. ‘Spoon diet,’ repledthe sergeant. The
doctor affected to be ‘displeased, and in a low voice said, ‘are
218 MEDICAL JURISPRUDENCE.
you not ashamed of yourself? The poor fellow is almost
starved to death ; let him instantly have a beefsteak and a pint
of porter.’ The recruit could contain himself no longer. With
a countenance expressive of gladness and gratitude he
addressed Dr. Davis by saying, ‘God Almighty bless your
honor ; you're the best gentleman I have seen for many a day.’”’
Self-Inflicted Wounds.—Self-inflicted wounds are made
for various purposes, and as we have seen inthe Whittaker case,
such wounds may be inflicted for the purpose of attracting
sympathy, and for cloaking some criminal act that may have
been committed.
The case of Bolam, referred to by Taylor, who was tried for
the murder of a man named Milly, is one of great interest.
“Bolam was found lying in an apartment which had been
fired by himself, or, as he alleged, by some incendiary, and
near him was the body of the deceased, who had evidently been
killed by violence, the skull having been extensively fractured
by a poker lying near. The prisoner when found was either
insensible, or he pretended to be so. He stated that he had
been suddenly attacked by a man and knocked down by a
blow on the right temple; for attempting to escape he was
again knocked down. He then felt a knife in his throat, but
admitted that he did not put up his hands to protect it. His
hands were not cut. He remembered receiving some blows on |
his body ; then he became insensible, and recollected nothing
more. On examining his throat there was a wound an inch and
a half in length on the left side of the neck, a quarter of an
inch below the jaw ; it had punctured nearly through the true
skin, and was of inconsiderable extent. A small quantity of
blood which had flowed down on the inside of his cravat had
escaped from his wound. ‘There were many cuts on his coat
at the back and sides, through his waistcoat, shirt, and flannel
shirt, but there were no corresponding cuts or stabs, nor indeed ~
any mark of injury upon his skin. ‘The question was, whether
these wounds were inflicted by the unknown person who was
alleged to have fired the premises and murdered the deceased ;
or whether the prisoner had inflicted them on himself, in order
to divert attention and conceal the crime which he was accused
of having committed. No motive for the imputed crime was
discovered, but the medical facts relative to the self-infliction
of wounds were so strong that he was convicted of man-
slaughter. There was no doubt but that the prisoner had
inflicted the wounds upon himself in order to remove the
HYSTEROID STATES AND FEIGNED DISEASES. 219
suspicion that he had caused the death of the deceased.
They were superficial and involved no important organs, and
bore the characteristics which those only would have, which
had not been produced with a suicidal intention.”
A case which I remember is that of a bank cashier, who was
found gagged and tied, and wounded in a superficial manner,
while the funds of the bank were missing. It subsequently
transpired that the wounds were self-inflicted, and other pre-
parations were made for the purpose of diverting suspicion and
to screen him from the imputation of the theft, for which he
was responsible.
Sometimes persons who seek damages for alleged injuries -
will so mutilate themselves, or cut their clothing, as to make
their cases much more grave than they really are. Mr.
Scribner has told me of a case of this kind, where it had
been alleged that the patient’s left foot had been injured
by the wheel of acar, and sure enough the marks ofa slight
injury were there found. It occurred to the counsel for the
defense to call for the shoe, which. was unthinkingly produced
by the other side, who fell into the trap, and it was found that
the cut shoe belonged to the other foot!
Persons who have unsuccessfully attempted to commit
suicide occasionally attribute the infliction of their wounds
to another. In these cases the incisions are usually of slight
depth and evidently made by the person himself, for they are
always in front and, as a rule, made by the right hand. Taylor
calls attention to the fact that the hands are seldom wounded
in such cases, while in real homicidal attempts we find that
in the struggle with the assailant the hands are usually slashed
and cut.
In fraudulent cases, where violence is imputed to other
persons, excoriations and even skin lesions are alleged to be the
result of violence, we must be very careful to see whether
the cuts or rents in the cloth correspond with the actual
wounds, for impostors are very apt to produce holes or rents
in their clothing when removed from the body. A case is
related where a young man had unconsciously furnished evi-
dence against himself. He had charged aman with unlawfully
wounding him on the highway, and stated that the man had
stabbed him on the arm, cutting through his shirt and coat
sleeve ; but on examining the coat it was found that the cut
was confined to the cloth itself, and did not extend through
the lining ; besides this, there was no motive for the crime.
Tidy refers to the case reported by Marc of a man who had
~*«
220 MEDICAL JURISPRUDENCE.
an “idea of rendering himself so important to a relative as to
secure his gratitude, and pretended to have had a murderous
conflict with some assassins, although no dead bodies could be
found. His head was wounded longitudinally to the extent of
about one inch, and in direction from left to right. Only the
integuments were divided. His hat of soft velvet was cut off
for nearly three inches, and in adirection from right to left. A
cotton bonnet and a silk handkerchief which he wore under his
hat were also divided. ‘So powerful a blow as to divide all
these,’ says Dr. Marc, ‘should have inflicted a less superficial
lesion on the head.’ The knife used by him in killing the assassin
had a thick covering of blood, as if daubed on. Had he really
used it to stab through clothes and flesh, he would have rubbed
off some of the blood in withdrawing it, and what remained
would be in longitudinal striz.”’
Dr. Marc deemed the whole case pretended, the effect not
corresponding with the force of the ascribed cause.
CHAPTER IV.
EPILEPSY.
We are called upon from time to time to examine patients
who present epilepsy as a result of injury ; or whose mental con-
dition is such as to lead them to commit crimes; or again we
are required to give opinions upon the capacity of epileptics
who make civil contracts.
Traumatic Epilepsy.—In the matter of traumatic epilepsy
it behooves us to distinguish between paroxysmal attacks, which
originate from other causes than those which are alleged to have
existed, and the purely traumatic variety. The question may arise
in such cases whether or not there has been idiopathic disease
of long standing, which is connected by a dishonest patient with
the accident and may be made the basis of litigation; or
whether an incomplete form of the disease may be developed
by a shock or head injury. We are to determine as well, -just
how much the neurotic taint of the individual may have to do
with his aggravated condition. Traumatic epilepsy, as a rule,
is apt to be manifested by some dominant form of localized
convulsion which is more or less constant, and this is especi-
ally the case if there be evidences of injury of the vertex.
Cortical Epilepsy.—Depression of bone on the parietal
region is quite commonly attended by hemi-epilepsy, beginning
in one of the motor centers receiving its supply from the par-
ticular cortical center involved. There is a great irregularity
about this form of disorder, and rarely the periodicity found
in the idiopathic variety. The attacks are more readily pre-
cipitated by exciting causes which favor determination of blood
to the head than those of the other varieties. There may or
may not be symptoms of meningeal inflammation, but as a rule
sooner or later we find the indications of such a condition.
The comparatively rapid development of symptoms suggestive
of coarse cerebral disease is to be looked for. In an individual
who had plunged headforemost intoan elevator shaft, striking
his head upon the stone flooring ten feet below, I found besides
222 MEDICAL JURISPRUDENCE.
violent epilepsy the signs of rapid degeneration of the brain
mass. In afew months he complained of mental weakness, loss
of memory, and great headache as well as double optic neu-
RIES:
The complication of pain in such cases is quite common, and
this pain is severe, dull and throbbing. ‘Traumatic epilepsy, I
think, is often expressed by petit mal, but the violent attacks
are those most commonly found.
Head Injury in Epilepsy.—The head injury giving
rise to the disease need not leave behind any conspicuous
marks, although we find as a rule some scar or depression.
Nothnagel™ presents the case of a boy who feil a distance of
twelve feet upon his head. He was unconscious for fifteen
minutes, and after being roused was seized with an attack of
convulsions. His only wound was a small one of the scalp,
which rapidly healed, and for six weeks subsequently he appear-
ed to be in perfect health. He then had a second seizure, fol-
lowed by others, and has since had frequent paroxysms, which
succeed each other very closely, being separated by intervals of
only ten or twelve days. These are preceded by an aura and
begin by a turning of the head tothe left. Between the attacks
the patient has headaches and slight twitchings in the left half
of the face or upper arm. ‘The accident occurred when he was
eight years old, and when reported he was twenty-one.
His mental condition was one of failure, and his memory
was weak. ‘The only evidence of the injury was a small cica-
trix, “about the size of a lentil, corresponding to the right cor-
onal suture, and fourcentimeters distant from the median line.
This is not painful or adherent, and when touched either gently
or quite roughly no symptoms are manifested.”
This example is one illustrating the connection of local head
Injury with an undoubted lesion of a cortical center, and if it
had been a contested case no doubt could have arisen as to the
causation of the disease.
Reflex Epilepsy.—Experimental physiology and pathology
have shown that irritation or injury of distant parts have given
rise to epilepsy. Wounds of peripheral nerves have caused
the so-called “reflex epilepsy.” Injuries of the sciatic or tri-
geminal nerves are more apt to give this result than any others,
and sometimes when a wound has been made, the cicatricial con-
traction, such as was found in the cases of Lente and Schnee,
* Ziemssen’s Encyclopedia, vol. xiv. p. 208, Am. Translation,
EPILEPSY. 223
may be the focus of irritation. Such epilepsies are manifested
by a sensory aura originating in the cicatrix, and the motor
disorders are local or general. In nearly every case of this
kind the paroxysms do not occur until some time after the in-
jury. We should be very careful in these forms of epilepsy to
give a guarded opinion as to the prognosis, for an operation
may relieve the condition.
The prognosis of the ordinary form of epilepsy is bad, and
especially is this true of the idiopathic disease. A history of
hereditary influence is a most important one. ‘Traumatic epi-
lepsy has a more favorable prognosis, for the chance of relief
by an operation is by no means a poor one. In the light of
the modern advances in our knowledge of cerebral anatomy
and physiology the use of the trephine is more often followed
by good results if sagaciously applied.
Mental Condition of Epileptics.—The mental condition
of epileptics is most interesting: it is often difficult to de-
termine capacity, and there can be no doubt that there are
many cases of doubtful responsibility that may be explained
by a history of epilepsy.
The many peculiar mental states that occur in connection
with this disease are worthy of the closest study. Epilepsy,
after all, is a symptomatic condition itself, and one of import-
ance. Of late many curious forms of temporgry mental aber-
ration have been spoken of as epileptoid, and it will at once
be seen that in determining the capacity of an individual,
either in civil or criminal cases, it may be necessary to deter-_
mine the existence and influence of the epileptoid state. So
important is the influence of the disease that Lutaud says:
“Tout épileptique sans etre un aliéné est un volontier candidat
de la folie.”
We are to determine in cases submitted to us:
1. The influence of the epileptic state.
2. The post paroxysmal mental state.
3. The irregular or aborted epileptic state.
The mental condition of certain epileptics, when the disease
begins early in life, or is congenital, is one approximating imbe-
cility. The same may be said to be the case when the disease
has lasted for some years, and it is admitted by neurologists
that the lesser attacks (fet/t mal) predispose more to mental
degeneration than those more severe (grand mal). The victim
of epilepsy as a result of infantile brain disease often presents
one-sided paralysis with dwarfed limbs, and this may prove to
224 MEDICAL JURISPRUDENCE.
be a valuable indication so far as the duration of the malady is
concerned.
The epiletic is very apt to present, sooner or later, some men-
tal infirmity in connection with the paroxysms. Of 339 cases
of epileptic insanity, collected by Esquirol, 145 were dements,
176 suffered from mania which was partial, sub-acute or violent,
8 were idiots, and all but 60 manifested loss of memory.
The Post-Paroxysmal Condition.—The post-paroxys-
mal states are those which frequently form the basis of homi-
cidal acts, a species of ill-defined and temporary mania result-
ing ; at other times the patient may be peaceable and quiet.
The third class of cases includes those in which at periods
the man may, without any warning and while there is no par-
oxysm, do some violent act which he knows nothing about
afterwards. I have a patient under my care who occasionally
loses her consciousness and, though she does not fall to the
ground or show any spasmodic action at all, will occasionally
strike those about herand call them foul names. She has been
known to leave her house and walk several blocks, and to sud-
denly recover her senses in a shop. There are undoubtedly many
cases in which crimes are committed under such circumstances
as these, a murderer for instance being entirely unconscious of
his crime until after it is committed. A patient under treat-
ment some years ago was a peaceable, quiet man ; he was a de-
voted husband and father. He had suffered from epilepsy for sev-
eral years, and had both well marked attacks of grand mal and
in addition seizures of an incomplete character. While at the
table one day he suddenly changed color, and made a violent
demonstration towards his wife, who rushed from him through
the open door and down into the street. He followed immedi-
ately behind her, and holding a pistol against her body dis-
charged it, killing her instantly. He recovered almost at once
and was stricken with horror to find his clothes covered
with blood, and his dead wife lying at his feet. No attention
was paid to the evidence given in court as to his disease, and
he was sentenced to imprisonment for life. His epilepsy has
increased since his incarceration.
Clymer upon Responsibility.—In an admirable paper
Dr. Meredith Clymer * traces the mental condition of the epi-
leptic as follows:—‘In most instances,” he says, “an uneasy
*Medico-Legal Reports, vol. I, p. 446.
EPILEPSY, 225
depressed and irritable state of the mind, immediately precedes
an attack, and there is constantly some disturbance of the
affective and intellectual faculties manifest directly after it,
which may persist during a large part or the whole of the inter-
val between the fits. The affective faculties chiefly suffer. The
disposition is apt to be moody, suspicious, wayward, spiteful
and wrathful. Offense is readily taken ; there is a fancy to
tease and annoy and be troublesome, and a dread of insult and
injury. The moral qualities are perverted, and the sense of
propriety, decency or duty is obscured or lost.
“The physical derangements to which the epileptic is liable
are exhibited under various expressions. In many cases there
is gradual failure of intelligence ending in total mental annihila-
tion, others show anomalies of character and disposition which
hardly go beyond harmless eccentricities of conduct, or at most
involve a change of temper and habits.- In some there may
be an extreme perversion of affective life, and occasional ex-
plosion of automatic temper fits, in which he loses his knowl-
edge of himself, but is generally content to unpack his mind
in words, ‘—tantum maledicit utrique, vocando. Hanc, furiam ;
hunc, aliud, jussit quod splendida bilis,’ or there may be those
terrible outbursts of maniacal fury accompanied by homicidal
or suicidal impulses or both.”
The Character of Congenital Epileptic¢s.—The varie-
ty of epileptic states when the disease is not suspected isa great
one. Maudsley™* thus refers to the genesis of the state, analyz-
ing the mental condition of children :
“In children, as in adults, a brief attack of violent mania,
a genuine mania transitoria, may precede or follow, or take the
place of an epileptic fit; in the latter case, being a case of
masked epilepsy. Children of three pr four years of age are
sometimes seized with attacks of violent shrieking, desperate
stubbornness, or furious rage, when they bite, tear, kick and do
all the destruction they can ; these seizures, which are a sort
of vicarious epilepsy, come on periodically, and may either
pass in the course of a few months into regular epilepsy, or
may alternate with it. Older children have perpetrated crimes
of a savage and determined nature—incendiarism, and even
murder—under the influence of similar attacks of transitory
fury, followed or not by epileptic convulsions. It is of the
utmost importance to realize the deep effect which the epilep-
* London Lancet, July, 1870, p. 646.
I5
226 MEDICAL JURISPRUDENCE.
tic neurosis may have on the moral character, and to keep in
mind the possibility of its existence when a savage, apparently
motiveless and unaccountable crime has been committed. A
single epileptic seizure has been known to change entirely the
moral character, rendering a child rude, vicious and perverse,
who was hitherto gentle, amiable and tractable. No one who
has seen it can fail to have been struck with the great and
abrupt change in the moral character which takes place in the
asylum epileptic immediately before the recurrence of his fits ;
in the intervals between them he is often an amiable, obliging,
and industrious being, but when they impend he becomes sul-
len, morose, and most dangerous to meddle with. Not an
attendant but can then foretell that he is going to have his fits,
as confidently almost as he can foretell that the sun will rise
next day. Morel has made the interesting observation, which
is certainly well founded, that the epileptic neurosis may exist
for a considerable period in an undeveloped or masked form,
showing itself, not by convulsions, but by periodic attacks of
mania or by manifestations of extreme moral perversion, which
are apt to be thought willful viciousness. But they are not;
no moral influence will touch them; they depend upon a mor-
bid physical condition, which can only have a physical cure;
and they get their explanation, and indeed, justification, after-
wards, when actual epilepsy occurs.”
Hughlings Jackson on Epilepsy.—There are light epi-
leptic seizures considered by Hughlings Jackson, which are ex-
pressed by the performance of subsequent automatic acts, and
these are worthy of the closest study because of their medico-
legal interest. Jackson considers four classes of cases. First
—Those in which eccentric or grotesque acts alone are mani-
fested. Second—Those in which marked complexity of action
directly complicated the epileptic attacks. Third—Those that
might have a bearing in civil actions, but without criminal im-
portance; and a fourth set of cases which are manifested by
violent acts, which give rise to the question of criminal re-
sponsibility. «Among the first group occur those cases of de-
cided absent-mindedness which lead the individual to do ab-
surd things. Jackson relates the case of an epileptic who,
when in an omnibus, blew his nose on a piece of paper and
when he left the stage gave the conductor £2 ros. instead of the
twopence-halfpenny which constituted the regular fare. This
man was an epileptic and he probably had a shght attack of pe/zt
mal immediately before the occurrence. I have at present under
EPILEPSY. 227
charge a patient who has frequent attacks of petit mal, and
sometimes at the table rubs her hair with her bread, and does a
variety of eccentric things which are often preceded by a well-
recognized facial spasm or change in color, but more often not.
The second class of cases includes individuals who
perform unconsciously a number of elaborate and compound
actions. During the attack itself the individual may go through
with a variety of unconscious performances for which he should
not be held responsible and the nature of these depends very
much upon the disposition and education of the person. I havea
.patient who when seized will immediately barricade the doors
of the room in which he may be and upon the entrance of a
member of the family, whom he evidently does not know, will
advance in a threatening manner, and, if not held, commits
a violent assault; after the return to consciousness the pa-
tient will have no recollection of the attack, and upon the oc-
casion when the doors were barricaded he expressed great sur-
prise at seeing the chairs piled one upon another.
_ Jackson relates the case of a man who detailed the features
of one of hi§ seizures as follows:
He says: “I felt symptoms of an attack, and sat down, I
believe, on a chair against the wall. And here my recollection
failed ; the next thing I was conscious of being in the pres-
ence of my brother and mother (who had beer sent for, as
they lived opposite) ; and I have since been informed by my
sister-in-law that she came into the kitchen and found me
standing by the table mixing cocoa in a dirty gallipot, half filled
with bread and milk, intended for the cat, and stirring the mix-
ture with a mustard-spoon, which [ must have gone to the cup-
board to obtain.”
Lighter Grades of Epilepsy.—In these seizures the fact
appears that the more light is the fit the more complex is the au-
tomatic state, and it can not be disputed that many so-called
criminal actions are the result of trifling masked attacks which
were entirely unrecognized. Jackson saw a boy, a boot-black,
who once after a seizure threw his blacking-box at a police-
man and was arrested and fined ; and upon another occasion
he got into a violent altercation with a gentleman in the street,
who, according to his story, had offered him five shillings to
clean his boots. This boy ultimately became an inmate of an
insane asylum.
Testamentary Capacity and Epilepsy.—The wills of
epileptics are sometimes contested. ‘There are few cases, how-
228 MEDICAL JURISPRUDENCE.
ever, where sufficient attention is paid to the inter-paroxysmal
state—which after all is the important question to consider. I
append two American cases where the wills of epileptic per-
sons were sustained.
CAsE X LIX.—WILL MADE BETWEEN Two EPILEPTIC ATTACKS,
CONDITION OF TESTATOR’S MIND NOT NECESSARILY UN-
SOUND. WILL ADMITTED.
Matter of Ross, + 12N. Y. Weekly Digest, 34.
On April 29th, 1879, the testator, who had been subject to
attacks of acute mania, superinduced by epileptic convulsions,
was committed to a lunatic asylum. He was discharged May
12, 1879. The Superintendent of the asylum testified that tes-
tator’s mental condition was then good and that between the
epileptic attacks he was of sufficient mental soundness to under-
stand what he was doing. On May 21, 1879, testator executed
his will. His family physician testified that he was then of
sound mind and memory and capable of making a will. ‘Tes-
tator was again attacked with an epileptic convulsion on June
II, 1879, and died June 24th, 1879.
Held, that testator was sane at the time the will was made.
CasE L.—EPILEPSY COMPLICATED BY PNEUMONIA. CopI-
CILS MADE WHILE SUFFERING FROM ALLEGED DELIRIUM.
WILL NOT SUSTAINED, BUT FINDING AFTERWARDS RE-
VERSED. No EVIDENCE OF IMPAIRED CAPACITY.
Brown
US. 94 Illinois R., 560
Riggin,
Elizabeth M. Riggin was on Nov. 14, 1868, at the age of
62, attacked with an epileptic fit, and rendered uncon-
scious ; an attack of pneumonia supervened the epileptic fit
accompanied with high fever and occasional delirium, during
which she would be unconscious. Previous to her illness she
was intelligent and cultivated, robust and strong, though ner-
vous. She was regarded as a gifted and brilliant woman.
Witnesses on both sides, who were present during her illness,
stated that while occasionally out of her mind, at other times
EPILEPSY, 2209
she was rational and intelligent, her mental condition being
clearly the result of delirium attendant on high fever. No
witness claimed that she had wholly lost her reason at that pe-
riod. On Nov. 23, 1868, she executed her will. Between that
time and her death, which occurred in July, 1875, she executed
three codicils. Each of the witnesses to the will and codicils
testified to the sanity and intelligence of deceased at the time
of executing them. On the trial of the issues in the Circuit
Court of St. Clair County in April, 1877, before a jury, it was
found that the will and codicils were not those of the testator,
Elizabeth M. Riggin. That is to say, that she was insane at
the time she executed them and they were therefore null and
void. On appeal to the Supreme Court of Illinois this finding
was reversed.
The responsibility of epileptics who commit offenses against
the laws, should be determined by careful inquiry into their pre-
vious life, the existence of disease and the nature of the crime.
rhe discovery that the patient’s progenitors have been insane,
that if she be a woman she has suffered from migraine pre-
viously, or from menstrual difficulties, will, perhaps, supply aclew
to follow up. There may bea history of “fainting attacks,”
that if closely investigated, will be found to have been of an
epileptic nature, and some one may remember a head injury or
an attack of sunstroke.
Le Grand du Saulle suggests the following medico-legal appli-
cations in relation to epilepsy :
When the character and habits of the patient are full of
strange anomalies, and there are startling and sudden impulses,
the responsibility should be questioned.
The patient who has clearly committed an attempt when not
suffering from an attack, is partially responsible, but he has
the right, after examination into his mental state, to an exten-
uation of the penalty, and in some way proportionate to the
degree of moral resistance which can be opposed.
A motiveless crime, committed under the immediate influ-
ence of an epileptic paroxysm, is evidence of absolute irrespon-
sibility.
When the crime committed by the epileptic is deliberate, and
bears upon its face its explanation, the author is irresponsible.
When a crime is not to be accounted for, and completely in-
consistent with the antecedents of one whois not known to be
epileptic or insane, and when it is accomplished in a moment
of fury, then we should examine whether there are aborted or
nocturnal attacks of epilepsy,
230 MEDICAL JURISPRUDENCE,
Incamplete attacks of epilepsy, or epileptic vertigo, should
be suggestive facts in determining the intellectual, moral or
affective standing of the individual.
“ Georgét not only commends these verdicts of acquittal,
but, also recommends that for acts committed in the intervals
of calm, the epileptic should be punished less severely than
ordinary criminals.
‘This opinion has been again concurred in by M. Bottex, in
reference to two patients—one of anaturally mild temper, who
put to death in a paroxysm of fury, a woman who made certain
representations to him ; and another, constantly dull and stupid,
who was offended by the coquettish dress of a young girl of
fifteen, and stretched her dead at his feet with a blow of a
goyarde. The latter, freed without trial, was placed in an asy-
lum as a measure of public security” (de Boismont).
In some cases of epileptic insanity there is a state of mental
disturbance, after the attack, when the patient becomes the
subject of religious delusions.
Of fifty cases reported by Addison, thirteen patients were
always irritable and vicious ; thirteen were vicious only defore
the fit and twenty-six after the fit, and in four there was no
mental change.
In epileptic insanity we should look out for the signs of
previous attacks, such as scalp-wounds, burns, and other evi-
dence of injuries that may have been received during a parox-
ysm. The occurrence of limited spasms, vertiginous attacks,
paralyses, the history of syphilis, and the question of heredity
should be considered as well.
In many cases the epileptic paroxysm is always attended
with homicidal attempts, and the patient may appeal to by-
standers to take charge of him when he has an aura. Sucha
case was reported by Marc, the patient being a peasant, aged
twenty-seven, who had epilepsy for nineteen years. When he
felt a warning he would ask for protection, saying: ‘“ When the
feeling comes over me I must kill some one, if only a child.”
Maniacal rage of short duration is often epileptic in charac-
ter, and its true character is often mistaken.
The cases of epileptic insanity with homicidal tendencies are
numerous. The following is one of a common type, and was
reported by Dr. Gray:
“Man, single, aged eighteen, reads and writes, smokes, tem-
perate, native New York, not hereditary. Was subject to at-
tacks of epilepsy from the age of twelve years. The fits varied
in frequency from one a month to several daily, and their dura-
EPILEPSY. 231
tion from five to fifteen minutes. After the occurrence of the
disease he made little progress in his studies. There was also
a marked change in his character, he lost self-control, had pe-
riods of excitement, and was at times ugly, was emotional
and governed by his passions. He had been sent on two occa~
sions to a hospital for treatment without any benefit. His father
was a carpenter, and though he was not capable of learning the
trade he acquired some manual skill, and occasionally did work
for a widow who kept a variety store near his residence. He
was fixing some shelving for her, when about mid day she was
found murdered in her store ; her body was much mangled by
having been cut with a hatchet. Search was made and the pa-
tient was arrested as he was walking the street, his hands and
clothes stained with blood. His epileptic and irresponsible
condition was proved, and he was sent to the asylum by order
of the Court. He remained some twenty months, and during
this time improved materially. His seizures were infrequent,
and he gained in mental strength. At this time he eloped from
the asylum through the connivance of his friends and enlisted
in the army.”
Insane impulses may exist in insane epileptic patients and
not be directly connected with the paroxysms. A patient at
the Utica Asylum had the following history :
“Man, aged twenty-five, uneducated and vicious. Had epi-
lepsy induced by intemperance. Became quarrelsome, consid-
ered himself injured, and in a rage would attempt to stab those
whom he disliked. At time of admission to the asylum exhib-
ited no marked mental aberration. Soon began to become dement-
ed; was always a dangerous man ; invariably made his attacks
in the day time and on persons whom he disliked, and never
threatened or used violent language. The homicidal tendency
was not constant, but at times attended with strong suicidal
disposition, which occurred independently, so far as could be
observed, of his epileptic seizures. He was discharged after
some years, demented and harmless.”
Realization of Crime by the Epileptic.—The epileptic
often realizes the terrible nature of his impulses and begs for
protection ; and in his sane state realizes with redoubled force
the horrible character of what he has done and what he may
do. He is also tortured with the knowledge that his mental
perversion will not be appreciated by others. He may suffer
from ordinary epileptic attacks which are not connected with
any homicidal tendencies, but finally, under the influence of
232 MEDICAL JURISPRUDENCE.
perhaps an epileptic hallucination, may commit some act
of violence which to the layman has apparently nothing to do
with his previous trouble.
Nocturnal Epilepsy.—The epileptic may give no indica-
tion of his real condition, the attacks perhaps being entirely
nocturnal, and he as well as others may be in total ignorance
of the existence of the disease. If such a person commits a
crime it is hardly necessary to say that its connection with epi-
lepsy will be disregarded unless the character of the violent
act be in itself suspicious. Upon careful inquiry it may be
found that the individual has had unconscious passages of urine
in his bed or his pillow may have been found stained with
blood. An examination may reveal cicatrices suggestive of
tongue biting—in fact there may be every reason to believe
that he has had well marked epileptic attacks occurring during
the night. Clymer refers to the cases reported by Duménil
and Morel; the first of a soldier who struck his superior offi-
cer and who was subject to sudden fits of passion upon slight
provocation, and it transpired, from the statements of those
who slept with him, that he had had epileptic attacks at night
for several years. In a case of my own the patient occasion-
ally found herself in the morning lying at the foot of the bed
with the bed clothing twisted about her, and upon several oc-
casions her tongue was sore, and her mouth contained blood.
Subsequently she had well marked attacks in the day-time.
I have spoken of the detection of nocturnal epilepsy by the
appearance of blood upon the pillow, and by involuntary dis-
charges of urine. A case reported by du Saulle is of consider-
able medico-legal interest, the subject being a young man, an
army officer, who was accused of desertion before the enemy,
and his punishment would have been severe indeed if it had
not been for the fact that his conduct was explained by epi-
lepsy, which had not been detected, and was not suspected
until the fact was ascertained that he had incontinence of urine
and nocturnal attacks.
Tardieu refers to cases where the connection of nocturnal
discharges of urine with epilepsy was clearly established, and
relates the case of an elderly woman, whose friends sought to
place her under restraint, because she made motiveless assaults
upon them ; but an examination of her mental condition failed
to reveal any sign of disease. Her intelligence was ordinary,
her memory being alone affected, and after a long examination
Tardieu had almost made up his mind she should not be commit-
EPILEPSY, 233
ted, when he accidentally learned that she had a vesical trouble.
His suspicions were excited, and after a series of questions he
ascertained that she had for a long time complained of inconti-
nence of urine, migraine, and undoubted vertigo of an epileptic
character, which had lasted for fifteen years; and it was be-
yond dispute that her attacks of violence were epileptic.
The case is related by du Saulle of an English lord, who was
shot in a drawing-room in London, by one of his secretaries,
who was laboring under a fit of irascibility. No explanation
eould= be given, for this conduct, and Lord ——— could
not think of any provocation, for he had always been
on the best of terms with the young man, and there never
had been any misunderstanding. The author of the crim-
Wal act. was arrested in’. Paris, as he was about -to
leave a well-known restaurant, and du Saulle was re-
quested to examine him. The man was twenty-seven years old,
had passed his urine in bed two or three times a month, his
father had died of chronic alcoholism, and a younger brother
had committed suicide. He declared that he had no knowl-
edge of what had passed and expressed great happiness at not
having killed Lord ————,, whom he had always respected and
loved. The accused presented numerous traces of tongue-
biting, and du Saulle diagnosticated nocturnal epilepsy. ‘The
young man afterwards became insane, and was treated by
English physicians for his trouble.
Epilepsy and Hallucinations.—The crimes committed
by epileptics are often prompted by hallucinations. I have, in
another place, alluded to those sensory forms of epilepsy in
which hallucinations take the place of the ordinary disturbance
of motility, and it is easy to conceive how the insane condition
may cause the individual to convert these into delusions.
Brierre de Boismont refers to the case of “An epileptic who
after abandoning himself to great violence in a church, went
into a field and killed three persons. On coming to himself he
exhibited the greatest sorrow. In his frenzy he imagined he
saw flames. His sequestration was very judiciously ordered.”
The Question of Memory in Relation to Epilepsy.—
As I have shown in a previous case, the epileptic may commit
the most terrible crimes during a paroxysm and yet be subse-
quently entirely unconscious of what he has done.
Delaisauve reports the following case :
“Joachim Haeve, for a long time an epileptic, atrociously
234 MEDICAL JURISPRUDENCE,
murdered, July 19, 1826, a girl named Lange, aged eleven
years. She was gathering wood in the court yard with the
murderer’s nephew, when he descended in his shirt, turned
back to strike his nephew, who offered him something to eat,
but not succeeding pursued the other child, who had fled from
fear. The presence and the cries of the mistress of the estab-
lishment, far from serving to intimidate him, seemed only to
increase his fury and to excite him, under a ferocious impulse,
to repeat useless mutilations of the body.
“The individual, naturally mild and peaceable, had always
manifested an affection forchildren. Ties of kindred and of
friendship united him to the family of Lange, against whom
besides he had no subject of animosity. Series of attacks
intensely severe succeeded each other. It was proven that, on
the 16th and 17th, two days before the catastrophe, he had had
several ; on the r8th he exhibited a strong repugnance to food ;
on the morning of the 18th a witness saw him in bed in pro-
found stupor, and breathing stertorously, which led to the
belief that he had just passed through a paroxysm.
“Haeve had but a vague remembrance of the scene which
had transpired. He could recall only the feeling of disgust he
experienced the night before for nourishment,—of some soiled
linen which he had carried to his sister-in-law,—and of resting
in the evening before his door half dressed ; and according to
his own statement, this species of dullness always followed his
convulsive attacks. He recovered his moral equilibrium
slowly ; and even when lucidity seemed restored, the least
attempt to rise or to dress himself brought on exhaustion,
cephalalgia, and loss of perception.”
The ability of the patient to remember the nature of the
crime is not always lost. In cases of aborted epilepsy it may be
so—(that is in cases in which the patient immediately before
and after the crime was apparently sane)—but in the mania of
epilepsy we find numerous cases of patients who have detailed
their actions. |
“Josephine D , subject In consequence of repeated
epileptic attacks to habitual dullness, who had taken a young
girl of six years into a lonely place, strangled her, and after-
wards stolen her ear-rings. This unfortunate person herself
detailed the circumstances of her crime.” This woman was
acquitted (de Boismont).
Epilepsy and Marriage.—The following case, which is
well known in the literature of medical jurisprudence is one in
EPILEPSY. 235
which a marriage contract, entered into by a lunatic who had
murdered his father-in-law during the ceremony, was set aside :
The patient was a shoemaker 20 years of age whose
epilepsy began some years before, having been brought on
by injury due toa fall. At first the attacks were attended by
but slight mental aberration, but later he became maniacal for
a period of two or three days when the paroxysms occurred, and
would make threatening demonstrations. At this time he re-
solved to marry and two days before the time agreed upon for
the wedding, severe pains in the head warned him of an
-approaching attack. He requested a physician to bleed him,
as this operation had usually given him relief at previous
times. The physician declined to do so. He was however
bled two days later, a few hours before the ceremony, without
beneficial result. During the ceremony he seemed moody and
_ reserved, said nothing but “yes.” The pain in the head increased
in severity so that he, on returning to the house of his father-
in-law, was obliged to go immediately to bed. While the
guests were at dinner he became very violent, rushed into the
dining room, and attacked and chased several of the guests out
of doors. He then obtained a knife, said he must kill them all,
and succeeded in killing his father-in-law before he was over-
powered. :
After three days the delirium passed off, and he then could
remember nothing that had transpired after the marriage cere-
mony. He was committed to anasylum and the Court was ap-
_ plied to to nullify the marriage upon the ground that he was
insane at the time the ceremony was performed, the counsel
taking the view that the headache, the moodiness and taci-
turnity were evidence that his mind was at this time diseased.
The Court declared the marriage invalid.
Unsuspected Epilepsy and Divorce.—The existence of
epilepsy which has been concealed by the subject from the
other contracting party, may arise in proceedings for divorce.
. A case apropos is related by Trosseau of a lady who was
aroused at night by the restlessness of her husband, who vio-
lently attacked her and she was obliged to call for assistance.
This occurred again, and by means of a light she was enabled
to see the patient in the midst of a severe epileptic attack, and
he would again have done violence if not restrained. In this
case the patient had but an indistinct idea afterwards of his
condition, but he admitted having had other attacks previous
to his marriage of a vertiginous character. Hence it seems to
236 MEDICAL JURISPRUDENCE.
me there should be no reasonable excuse for denying a
divorce, especially if the patient was cognizant of his previous
disease, and neglected to communicate his knowledge to his
wife.
Horrible Nature of Crimes.—The crimes of violence
committed by the epileptic insane are nearly always of amost
horrible nature, and while the ordinary maniac or melancholic
may kill some one in obedience to the dictates of a delusion,
the method employed is usually commonplace, and there
seems to be no delight in the contemplation of the death of
the victim. The murderous expression of the psychical state
of the insane epileptic is usually in some unnecessary and ill-
directed way.
A curious case came before a commission a few years ago
in New York, the prisoner being an Irish woman named
Jumish who placed her infant child upon a red hot stove. She
was indicted and tried and sent to the State Asylum at Utica.
She had been an epileptic for nine years and had had an
epileptic convulsion one hour before the deed.
The Walworth case. — The somewhat famous trial
of young Walworth for the murder of his father, occu-
pied, they attentions of the: qcourtss aeiew sycarsmacommioe
son being found guilty after the defense of epileptic in-
sanity was urged. The elder Walworth was a man of un-
governable temper, and was exceedingly abusive and violent
to his wife who was the mother of a large family of children, the
eldest of whom was the parricide, Frank. After a serious
domestic scene the murdered man came to New York and was
followed by the son who first went to a boarding house where
his father had been in the habit of staying, and, not finding
him there, went to the Sturtevant House from which he
dispatched a note inviting his father to callupon him. The latter
came the next morning, and going to his son’s room was shot
by him during an altercation, and, after the deed had been ac-
complished, the murderer rushed down to the clerk at the desk,
telling him what he had done, and afterwards sent a telegram to
his uncle stating that he had shot his father three times, and
asked the uncle to take care of his mother. He then proceeded
to the station house in Thirtieth street and surrendered himself,
giving up his pistol and acknowledging the act, alleging as
an excuse, that his father had threatened to kill his mother and
her children. His manner was perfectly calm and collected
EPILEPSY. 237
and his subsequent bearing in court was dignified and unruffled.
He had always been a boy of good morals and was intelligent
and universally liked. Theson had been present at more than
one quarrel between the father and mother and at these times,
according to the testimony of the mother, “he showed extreme
pallor, and I noticed a pinched look on his features expressing
severe suffering, both mental and physical ; it alarmed me so
much that I did not, on his account, afterwards tell him; he
was very quiet and simply said ‘ That this must not be!’ On
this occasion, in January, as soon as I myself recovered, I no-
ticed the same symptoms ; when he came in he had his hand
on his father’s shoulder, and said, ‘Be quiet father;’ there
was no further violence by his father; after the first occasion
I rarely spoke to Frank of his father; we very rarely spoke of
him; on a few occasions during the first few months when I
was receiving Mr. Walworth’s letters, I saw him reading them,
and noticed some of the same symptoms each time ; afterwards,
when I ceased to receive them, I frequently noticed similar
symptoms without knowing the cause, and thought his health
was affected; once I saw him most violently affected, as I
knew next day by receiving the letter which he had read ; I
called up one of the children saying: ‘Frank is sick;’ I went
up and found him with his body rigid and this pallor of which
I have spoken ; I applied such restoratives as I could, and he
shortly fell into a profound sleep for an hour ; I noticed similar
symptoms on various occasions, in greater or less degree ; he
was, before I let him know about his father, a very gay, joyous
boy; after that he was at times very quiet and abstracted ;
there was a notable failure of his memory ; we used to laugh
at his absent-mindedness ; he would go to his room for some
article of dress to go out and come down without it ; go down
street and forget his errand, and after locking up the house
would go round to lock up again, sometimes two or three
times ; he was abstracted at the table; several times screams
from his room woke me up and I went to his door; his pillow
was stained at times; I saw Frank the Monday he left Sara-
toga; I noticed his extreme paleness then; noticed his great
paleness ; when he was in his fits of abstraction he generally
had a sad look ; he was always courteous to others, but before
this he was lively; he was not subject to fits of anger ; his
character, so far as I know, was invariably good, both as to
amiability and uprightness ; there was nothing to call a vice,
or, in the ordinary sense, an irregularity in him; he was
always amiable and kind in the family, but not demonstrative ;
238 MEDICAL JURISPRUDENCE.
he had never in my hearing uttered any threats against his
father.”
Several physicians were called by the defense as well as ser-
vants and others, to prove the existence of epilepsy, and it ap-
peared that he had nocturnal attacks, that blood-stains had been
found on the pillow, that he had convulsions and frothings at
the mouth while at Saratoga, and that on one occasion while
playing ball he became insensible for half an hour. A friend,
Dr. Grant, testified to the existence of attacks which were
apparently epileptic and were connected with strange alterations
of behavior.
Dr. John P. Gray gave general testimony regarding epileptic
insanity, and believed the prisoner to be irresponsible. Dr.
Parsons was called for the people, as were Drs, A. O. Kel-
log and Meredith Clymer. Their testimony was substantially
to the effect that the homicidal act in this case was not per-
formed while the prisoner was in an epileptic condition, and
that he did not suffer from epileptic mania at the time. The
prisoner was found guilty of murder in the second degree, and
he was sentenced to State Prison for life. He was, however,
subsequently transferred to the Utica Insane Asylum and dis-
charged.
Although in this case there is an undoubted history of epi-
lepsy which had lasted for years, and the boy’s character had
undergone a decided change, there was nothing in the nature
of the homicide to lead us to believe that the crime was exe-
cuted while the prisoner was in an irresponsible condition, or
was influenced by a paroxysm. There is no evidence that his
mental state at the time of the murder was that known as the
post-paroxysmal ; on the contrary, there is the history of mo-
tive, premeditation and deliberation. The pistol was brought
from. Saratoga for the purpose, the father was entrapped and
lured to his destruction, and the behavior of the prisoner sub-
sequent to the killing was not that of an irresponsible indi-
vidual.
In such cases as this, therefore, we are to distinguish between
crime that is the direct result of the epileptic attack, and crime
that may be performed through motives of an ordinary kind,
even though the person has had epileptic seizures at other times,
and it does not follow that the disease in question must neces-
sarily make the subject irresponsible.
Feigned Epilepsy.—Epilepsy is a disease that is feigned
yery often by sailors, soldiers and convicts who wish to shirk
EPILEPSY. 239
work and gain the comforts of the hospital. Mendicants
and impostors are also apt to impose upon the charitable, and
it occasionally happens that instances occur of some import-
ance, where the turning point in a law case is the question of
epilepsy. The epileptic paroxysm may be counterfeited by a
clever person, or one who is familiar with the features of the
disease, so that the casual observer may be deceived, but such
is not the case when the bystander happens to be a medical man.
There are certain changes that are clearly involuntary, and can-
not be produced by any effort of the patient. The pupils, during
genuine epilepsy, are dilated, and the pulse and coloring are
peculiar. The lividity, dusky pallor or suffusion cannot be
shammed, and the epileptic is apt to indulge in movements
which are in no way like the clonic convulsions. A sign no-
ticed by some observers and declared to be pathognomonic, is
the flexure of the thumb in the palm; the fingers holding it.
down. This, however, is by no means constant. Browne re-
fers to a German case, where the threat of a medical officer
stopped the recurrence of attacks in a patient who was sham-
ming. I have known of cases where the impostor has actually
suffered all manner of injury rather than confess, and the noted
Clegg, “the dummy clencher,” threw himself in one of his pre-
tended attacks, from a corridor in gaol to the floor, a distance
of nearly twenty feet. Of course such utter disregard of self
as this is apt to deceive almost any one. The simulator is apt
to betray his knowledge of the supposed behavior of the true
attack, and occasionally overshoots the mark. Percy reports a
case where the pseudo-epileptic demanded in a loud voice the
instruments necessary to remove his testicles : asupposed popu-
lar method of curing the disease.
Sometimes the impostor will produce frothing by the inser-
tion of a piece of soap in his mouth. In suspected cases it will
be well to smell the prisoner’s breath or examine the froth.
If watched closely the malingerer may look about him, or
show some interest in the effect his’actions produce. In many
instances the false epileptic closes his eyes.
The physical peculiarities of the genuine epileptic are very
decided, both in the interparoxysmal condition and during the
seizure. The epileptic usually presents an expression of stu-
pidity and his eyes are vacant and dull. His lips are swollen,
and both these and the tongue may be found to be the seat of
cicatrices indicative of formerinjury. His head and face often
present the evidence of previous falls, and if the case bean old
one the facial folds will be found to be deepened. The ex-
240 MEDICAL JURISPRUDENCE.
tremities are cold and the venous circulation stagnant. Some-
times we will find the existence of crops of acne the result of
bromism. His manner betrays lassitude and he has little mus-
cular force. He is inclined to stoop, to shuffle along and be
quiet and morose. Gavin alludes to the harsh voice, “ the en-
largement of the alae of the nose, the thinness of the arms and
legs xs
“When the fits have been frequent, the anterior part of the
inferior incisors are found obliquely worn down. In a real
and most severe case of epilepsy occurring in a criminal at
Paris, the teeth were found worn at every point where the upper
had come in contact with the lower jaw. The lower incisors in
particular were extremely worn at their fronts, and yet the in-
dividual was only twenty-two years of age. The pupils are
dilated and the conjunctiva blanched and humid. The simu-
lator can imitate none of these appearances.”
If the character of the pulse is carefully noted, it will be found
that in true epilepsy itis hard and slow, and inthe feigned dis-
ease it is full and quick, as a result of the muscular exertion.
Voisin Upon the Sphygmsgraph and Epilepsy.—
Voisin has shown that in true epilepsy the sphygmographic
tracing shows a few seconds before the attack of grand-mal
a change which consists in a decrease in height of curves, which
are more round and closer together. When the attack super-
venes, two or three little successive undulations in the ascend-
ing stroke, afterwards a series of slightly elevated curves. The
curves are more marked, and present a superior convexity, which
give the idea of the half of a circle; then, at the end of several
minutes the lines are lengthened perpendicularly to a height
three or four times creater than before the attack.) Uhesdura;
tion of this pulse-form varies from half an hour to an hour and
a half, sometimes several hours after the attack. *
Clegg, the “‘ Dummy Chucker.’’—Dr. Carlos MacDon-
ald relates the case of Clegg, the “ dummy-chucker,” a clever
impostor who feigned epilepsy for some yéars so successfully
as to deceive the police and many well-informed physicians.
The following abstractt is from Dr. MacDonald’s paper.
Clegg had in England carried on his impostures for many years
quite successfully.
“ After his discharge from prison Clegg returned to his na-
* Annales d’ hygiene, etc., 1868.
+ Boston Med, and Sure. Yournal, Tan. 6. 1881.
EPsLEPSY. 241
tive city, immediately robbed his aunt, fled to London, thence
to Glasgow, where he robbed a house of four hundred pounds,
and then sailed for America. Landing in New York he re-
commenced dummy chucking, which, he says, was something
new to the ‘crooked people’ of that city. He joined a gang
of pickpockets, and operated in New York, Philadelphia, and
Boston. Large retail houses afforded a rich field, lady cus-
tomers being especially victims during their consternation at
sight of a well-dressed young man writhing onthe floor. The
ferry-boats, when crowded, offered excellent opportunities.
On one of these occasions a kind-hearted physician came to
his assistance, and meanwhile was relieved of his watch. Un-
aware of this, the doctor, on landing, called a cab and took
the scamp to his own office, where, after considerable effort,
he succeeded in ‘restoring’ the patient, about the same time
discovering the loss of his watch. Clegg expressed great sor-
row and denounced the outrage, but the doctor consoled him-
self by the reflection that the loss of the watch was of little
consequence compared with the life he had been instrumental
in saving. Clegg admits that for once his conscience smote
him, and avers that he really tried to get the watch for the
purpose of restoring it to its owner, but it was ‘sold’ before
he got back to the city again. On another occasion he feigned
a fit on a Fulton ferry-boat, and was taken in an ambulance to
Bellevue Hospital. After pretending to sleep for an hour or
two at the hospital he ‘ recovered ;’ but the authorities were
suspicious and detained him, as the nurse informed him, for
the purpose of having him examined by one of the physicians
of the Hospital for Epileptics. In due time the physician
from the epileptic hospital arrived, and Clegg, who was on the
alert, hearing the nurse say, ‘There comes the doctor,’
feigned a fit, and was in ‘ convulsions’ when the latter reached
his bedside. The doctor, after watching him a few moments,
depressing his eyelids, trying his pulse, and observing the
numerous cicatrices on his face and forehead, expressed the
opinion that it was a case of epilepsy, and Clegg was dis-
charged.
“Subsequently he was sent to Blackwell’s Island Prison for
stabbing aman. Here the chief of staff of Charity Hospital
pronounced him an epileptic. His next commitment placed
Clegg in Sing Sing Prison. Here his ‘dummy chucking’ be-
came the means of his transfer to the Asylum for Insane Crim-
inals at Auburn. At this place Dr. MacDonald, on assuming
charge, found Clegg in a strong room and in restraint, He
16
242 MEDICAL JURISPRUDENCE.
was said to be ‘subject to terrible fits... Dr. MacDonald or-
dered his release from restraint, requesting notification should
a fit occur. Shortly after he was called. He found Clegg on
the floor, his face distorted and livid, saliva, frothy and bloody,
oozing from the mouth; body apparently violently convulsed.
Two patients were holding his limbs. He seemed to be having
a series of rapidly recurring convulsions, each one commenc-
ing with marked muscular rigidity, the head being drawn to
one side, the body twisted upon itself. Thoracic muscles rigid,
respiratory movement almost completely arrested. This teta-
noid condition was quickly followed by one closely resembling
‘clonic convulsions : there were alternate contractions and re-
laxions of different portions of the body, during which his
head was frequently brought into such violent contact with the
floor as to abrade the scalp ; his tongue was wounded ; respir-
ation jerking and noisy, and at each expiration bloody saliva
was forcibly ejected from his mouth. Pulse somewhat accel-
erated ; eyes turned upward as far as possible ; pupils moder-
ately dilated. (It should be stated that the room was partially
darkened by a window screen, kept locked. This would ac-
count for the dilatation of the pupils.) ‘His hands were
tightly clenched, but I observed that the thumbs were not closed
within the hands, also that the finger nails were not livid, and
when I forced his hands open he immediately closed them again.
Zz here were also no visible indications of relaxed sphincters. ‘The
“clonic convulsions ” were followed by a condition of muscular
quiet, immobility, and stupor, lasting for a few moments, dur-
ing which he would occasionally open his eyes and gaze around
in a confused and stupid manner, when, suddenly, another
“spasm ” would supervene. The series of seizures lasted about
an hour, followed by a pretended sleep, after which Clegg ap-
peared to be mentally confused for a day or two, and com-
plained of headache and physical weakness.*
“On this occasion Dr. MacDonald intimated, in Clegg’s hear-
ing, that he was an impostor, although he confesses he was not
positive at the time, but deemed it safe to assume from his his-
tory that the rogue wasshamming. Attendants were instructed
to impress upon his mind that the doctors regarded him as a
fraud. The next time Dr. MacDonald met Clegg he accused
him of feigning. The man stoutly denied it, calling attention
to the scars on his head and face, asking if the doctor thought
he would purposely hurt himself like that, and adding that he
had been subject to fits since he was three years old. The
doctor’s suspicions were again awakened by the next fit. which
EPILEPSY. 243
began soon after he entered the ward. THe again said the fellow
was shamming, and that, while his acting resembled epilepsy,
it lacked certain characteristic features, the absence of which
stamped it as counterfeit. Clegg subsequently told the doctor
that this announcement staggered him. ‘For,’ said he, ‘I
have studied the subject in books, have seen a great many epil-
eptics in fits, and have practiced it for fifteen years, until I
thought I knew every symptom of it.’ After he had recovered
from this ‘ attack’ the doctor watched him on occasions when
Clegg was unaware of his presence, and was struck with the
cheerful and vivacious aspect of the man’s countenance, as
compared with his facial expression during the ward visits.
Clegg could easily assume the peculiar indescribable look ha-
bitual to epileptics. This, together with the cicatrices on head
and face, might easily deceive even a skilled observer.
“By this time Dr. MacDonald felt justified in insisting upon
a confession from Clegg, who still denied feigning, but with
less emphasis, until, the doctor forcing him still more, he laugh-
ingly admitted that the fits were simulated, but mildly urged
that he was a victim of veal epilepsy. This Dr. MacDonald
refused to admit, and threatened him with unsparing punish-
ment in the event of another ‘fit.’ After brief reflection
Clegg said, ‘Well, I guess it’s no use, but you are the first
doctor that ever tumbled to me.’ His countenance then un-
derwent a decided transformation, the epileptic look vanishing
at once. He was transferred to Auburn Prison as xot insane,
and was released in December, 1876. He next went to Bos-
ton, where he resumed the practice of ‘dummy chucking’ in
connection with a gang of pickpockets, and afterwards followed
the Marquis of Lorne to Canada, chucking dummies in the
crowds that gathered. Returning to New York, he was sent to
_ Sing Sing for burglary, and there played epilepsy, which again
sent him to the Auburn Asylum as an ‘epileptic imbecile.’
Meeting Dr. MacDonald in the ward, he threw off his epilep-
tic mask, laughing heartily. On this occasion, at the request
of the doctor, he feigned a fit, first borrowing a pocket-knife,
with which he calmly cut the side of his tongue; then, utter-
ing the ‘epileptic cry,’ fell violently upon the floor in a ‘ con-
vulsion.’ He afterward repeated the fit in the presence of
two other physicians.
“Clegg made a practice, while in prison, of complaining of
vertigo, tinnitus aurium, etc., between the paroxysms. When
asked what remedy he had taken he always replied, ‘ Bromide,’
knowing that was ‘the medicine the doctors give for epilepsy.’
244 MEDICAL JURISPRUDENCE,
Realizing that if he fell in such a manner as to avoid injury
suspicion would be aroused, he never selected a ‘soft place’
on which to fall. Reynolds* remarks that ‘ choice of locality
(for falling) does not prove that epilepsy is feigned; the ab-
sence of choice, on the other hand, is presumptive evidence
that it is genuine ; and this in proportion to the danger or the
privacy of the locality in which the fall occurs.’
““* Cicatrices on the skin of the face,’ says Gavin, ‘made
with the design of presenting incontestable proofs of anterior
falls, never exist without tending to deceive the medical man.’
Clegg sets a high value upon the scars upon his head and face,
acquired through falls. He says they have often served as aids
in diagnosis to examiners who have pronounced him ‘an epil-
epticen
“In conclusion,’ says Dr. MacDonald, ‘these are the
grounds upon which the opinion that Clegg was not an epilep-
tic was based: First, he was a convict, sentenced to hard
labor,—this furnished a strong motive for feigning, and sug-
gested suspicion ; second, the occurrence of a paroxysm during
my visit to the ward ; third, the readiness with which he spoke
of his complaint, and called attention to the cicatrices on his
face and head ; fourth, the marked change in his facial expres-
sion when he supposed he was unobserved ; fifth, during the
spasms the thumbs were not closed within the palms, the nails
were not livid, muscular rigidity could readily be overcome, and
the hands, after being forced open, immediately closed ; sixth,
the sphincters were not relaxed ; and, seventh, there were no
ecchymoses, extravasations, or minute petechial spots observa-
ble upon forehead, throat, or chest. ‘The presence or absence
of pallor was not determined by observation in Clegg’s case,
nor was any value attached to the condition of the pupils.
“As regards the question of pallor, Dr. MacDonald agrees
with those who maintain that it is not a constant symptom at-
tending the onset of epileptic seizures. Reynolds speaks con-
fidently of its absence in some instances. In a total of forty-
five observations recorded by him, ‘ pallor was observed in but
little more than one-fourth of the cases.” Owing to its exceed-
ingly evanescent character, its presence can be determined only
in cases observed from the very commencement of the attack.
My experience leads me to conclude that, as a rule, in general
practice, persons suffering from epileptic attacks do not come
under medical observation until the * pallid stage’ has passed.
* Epilepsy, its Symptoms and Treatment, page 285.
EPILEPSY. . 245
Of course it cannot be feigned ; and while its recognition
might warrant the dismissal of suspicion of shamming in a
doubtful or suspected case, its absence in a given case would
by no means justify a verdict of feigning.
“Respecting the condition of the pupils during an epileptic
attack authorities are also divided, some claiming that the iris
expands, a few that it contracts, while others declare that it
oscillates. Zhe tmportant point relating to the condttion of the
pupils in epilepsy, as regards tts diagnostic value, ts that
during a paroxysm they are tnsusceptible to the influence of light.
This fact would be of great service as a means of diagnosis of
feigned epilepsy, but for the difficulty of determining its pres-
ence or otherwise in a person violently convulsed.”
The Case of Max Klinger.—As I have said there are cases
where the defense of epilepsy is a somewhat difficult one, the
courts refusing to take into account what seem to be problemati-
cal excuses for the prisoner’s conduct. The case of Max Klinger,
a boy of 18 years, is reported by Dr. Banding. Klinger wasa
tailor apprentice to his uncle, whom he murdered. The victim
was engaged making a fire in the stove when Klinger approached
him from behind and fired a pistol, which he held close to his
head, killing him instantly. When the murdered man’s wife
rushed into the room she was struck down by the boy, who
escaped, after taking what money he could lay his hands on.
He was arrested and confessed his crime,alleging as the motive
that the uncle had angered him. The prisoner was convicted.
It transpired subsequently, that when in Germany the prisoner,
when a child, had a fall from a height of thirty feet, which
rendered him insensible, and produced a wound followed by
depression of the skull which has existed since. After his fall
he had been subject to fits and suffered from temporary insani-
ty, and that there was a strong family history of insanity and
epilepsy. As the result of this fresh evidence a new trial was
granted, but the prisoner was again convicted. Dr. Clymer in
commenting upon this case alludes to many contradictory and
inconsistent features, showing that at best the existence of epi-
lepsy was doubtful. It did not appear that the prisoner had
actually had an epileptic attack upon the morning of the mur-
der. In fact there was no evidence at all except that given by
a fellow prisoner that he had had one before or after the mur-
der. Clymer alludes to the ingenuity and shrewdness of the
prisoner as manifested in his written account of his disease,and
I may be pardoned for repeating it. It will be seen that the
246° MEDICAL JURISPRUDENCE,
patient “ throws all responsibility for the crime on his epileptic
disorder.”
“This event would not have happened,” the prisoner writes,
“if I had not received the sickness just on the 29th November,
1869, (the day of the murder), for I do not think that I will
get the sickness on account of all these troubles. I had often
said it in German that I should get the sickness about this time,
and nobody should enter the room until I locked the door my-
self, for I get so crazy that I do not know what I am doing.
It is dangerous for any one to be seen by me when I get the
sickness. The doctor in Germany said to my parents that I
would become dangerous during my sickness. I am very sorry
that I was so unfortunate. I had the sickness on the 25th
November, and, unhappily, the boss entered ; I saw him, he
came toward me and looked at me, when I struck at something ;
then I saw that he wanted to come at me, and wanted to hold me
and I got so intensely crazy that I did not know what I was
doing. How I got the revolver in my hand I do not know nor
how he lay there. Then she ran towards me and wanted to
strike me. I did not know with what I struck her. But when
I came to my senses I saw what I had done and was scared,
and I left immediately. If I had premeditated this, I would
have sent my clothes to some place. I kept the pistol by me
every morning because we had in our neighborhood about ten
Indians. Every morning I was first in the store and was afraid
of these fellows.”” The above statement is clearly suggestive
of rank deception. It is entirely at variance with the declara-
tion made by him after, that he was angered and committed
the crime out of revenge, and shows a memory of all the cir-
cumstances which is quite unusual in epileptic homicide. In
fact, it would appear that the murder was a cool and premedi-
tated one, for he had stated to the coroner that he had made
up his mind to kill his uncle the night before.
Deliberation is inconsistent with epilepsy, and just as in the
case of Walworth it appears that crimes may be committed by
epileptic persons who are perfectly responsible and where there
isno direct connection between the paroxysmal condition, either
masked or pronounced, and the consummation of the crime,
Epileptics rarely use concealment, and their impulsive acts are
executed as freely in open daylight as at any other time, or in
the public thoroughfare as frequently as elsewhere. Other cases
have been decided in the same manner as those of Walworth and
Klinger, and that of Roegiers was one of the same kind in which
there was well marked premeditation in the commission of 4
EPILEPSY. 247
homicide, and though the prosecution admitted the existence
of epilepsy in the defendant, he was promptly convicted. In
this case, however, the patient was evidently irresponsible, for
his attacks of epilepsy were associated with periods of maniacal
excitement, when he would threaten and warn those about him;
and it was testified that Roegiers had gone so far as to sharpen
a knife upon a grindstone, exclaiming from time to time, “I'll
have your head.” He subsequently sought his victim and
brutally murdered him.
Homicidal acts may be committed by insane persons in whom
epilepsy has been a feature of the disease, but where there is no
reason to believe the crime is a feature of an epileptic seizure,
under the influence of hallucinations such acts are committed,
and sometimes there is great premeditation and concealment of
plans.
Such a case is related by Brierre de Boismont :
“The lunatic who some years ago killed Dr. Geoffroy, chief
physician of the Avignon Asylum, was epileptic and subject to
hallucinations. Several days before the murder he heard a
voice which said to him, ‘Kill the doctor; if you don’t, you'll
be unlucky.’ His conduct established, in the clearest manner,
that he had contrived his plans and acted with judgment, facts
of which we have repeated proofs. When the doctor came he
complained of a pain in his foot, begged him to examine it, and
while the medical man was stooping, seized him round the body,
and plunged into his left side a piece of iron that he had sharp-
ened some days before for this purpose. Although it was cer-
tain that he had meditated upon his project, and waited for a
favorable moment to put it into execution, his antecedents and
the examination left no doubt as to the derangement of his
faculties and his continuous state of madness; he was not,
therefore, brought to trial.
Occasionally we find that homicidal assaults are made upon
superintendents of asylums and others by epileptics which are
chiefly dictated by motives of revenge, growing out of their de-
tention. In such cases the commission of violence may not be
dictated by delusions, hallucinations or any insane impulse,
CHAPTER V.
ALCOHOLISM.
The relations of alcoholism to crime are very intimate, as the
records of every prison will show—its connection with insanity
is too well known to need mention. It is not surprising, there-
fore, that the attention of both civil and criminal courts is
directed so often in those channels which lead to the deter-
mination of the responsibility of the victims of drink.
Divisions of Aleoholism.—It was Dr. Magnus Huss who
first systematically studied the effects of alcohol upon the ner-
vous system, and it was he who made the division of acu¢e and
chronic alcoholism. He as well as Thorneuf* considered three
varieties of alcoholism :
1. Acute alcoholic intoxication, in which the effect is always
immediately linked to the cause, and the duration of which is
dependent upon the existence of the cause.
2. Subacute alcoholic intoxication supervening to the imme-
diate action of the cause, usually melancholic in character.
3. Chronic alcoholic intoxication, which results in organic
changes in the brain and nervous system, with accompanying
insanity.
Of 350 lunatics treated in Charenton near Paris, when Dr.
Thorneuf was an interne, the insanity in 102 cases was due to
alcohol ; of these,
15 per cent. were of delirium tremens,
6 s ‘drunken mania.
I was of congestive mania.
34 Bi were of general paresis.
m4 id “folie circulaire.
(i$ (73 3
2 dementia.
and the remainder presented epileptiform convulsions and
anomalous psychical symptoms.
Development of Alcoholism.—The early stages of alco-
holism and the immediate pathological and physiological effects
*Annales Medico-Psychologique, 1859, p. 365.
ALCOHOLISM, 240
of alcohol are too familiar to need extended description. The
physical aspect of the drunkard is also too well known. He
presents the evidence of deficient motility which varies from
muscular feebleness to tremor and actual paralysis. This loss
of tone is shown in an unsteady gait, a jerkiness in the move-
ments of his hands, and a lost sense of localization. He pre-
sents a tremor which is general, but more marked in the hands
than elsewhere. The hand-grasp is feeble and he may drop
any object he takes up. His facial muscles are flabby, and in-
nervation is defective. Various defects in sensibility are pre-
sented, and anesthesia of the extremities exists, or there may
be a well marked hemianesthesia in advanced cases associated
with color blindness, and such ocular changes as atrophy of the
optic nerve. Sensation is often delayed, and when a pin is in-
serted into the skin he does not detect the irritation for some
time. His reflex excitability is often blunted, and the special
reflexes are diminished. Digestion is poor and the bowels
are relaxed, the food passing in a partially digested state. The
urine is scanty and loaded with urates, or it may contain
albumen in considerable quantities.
Mental State.—Intellectually the patient presents striking
manifestations. There is a gradual alteration in habits and
morals. Intellect is sometimes blunted, but as a rule there is
a perverted condition which is shown in depression and actual
melancholia, with delusions of persecution—and _ self-abnega-
tion. Suicidal tendencies arecommon. Hallucinations are the
rule, and they may be of the most extraordinary description.
Patients hear voices and see horrid reptiles, as insects, toads, or
vile creatures of every kind. These hallucinations are peculiar
to alcoholism. The patient suffers from insomnia and is disturbed
by hallucinations at night. Memory is enfeebled and there is
finally a pitiable weakness of all the intellectual powers, amount-
ing to dementia. A permanent weakened condition follows,
perhaps one or more attacks of delirium tremens, and the trans-
ition stage 1s marked by early changes of temper and habits.
The patient becomes “ pusillanimous, distrustful and vindic-
tive.”
The hallucinations of the victim of acute alcoholism give him
a sense of space, and he rushes ahead notwithstanding the ob-
stacles which he encounters. He may walk along roof ledges
or sit or stand in open windows without fear.
Actions as Influenced by Hallucinations.—The acts
committed by a.person who suffers from acute alcoholism are
250 MEDICAL JURISPRUDENCE.
of the strangest nature, and are unexpected and startling, and
the explanations given by him are often curious. The patient is
constantly under some fear or dread. It may be that he imag-
ines that he has committed some horrible crime, and seeks the
protection of the police, and it is estimated by Dagonét that,
after the celebrated Troppmann murder, a great number of
persons of dissipated habits in Paris surrendered themselves to
the authorities.
Insane Drunkards.—Wynter speaks of a class of peo-
ple—those who really need the protection of the law, and who
are to all practical intents and purposes insane. They drink
furiously and to great excess without any regard to the conse-
quences. No obligation is too sacred for them to break, and
when insanely drunk, no crime too horrible to commit.
“The most common and, as regards society and themselves,
the most terrible of these minor offshoots of the insane diathe-
sis, are the moral diseases, such as dipsomania, or drink mad-
ness. To the ordinary observer the dipsomaniac is nothing
more than an utterly reckless person, who is determined to ob-
tain drink, regardless of consequences. He is confounded
with the ordinary drunkard, and his infirmity is looked upon as
a simple vice. But, in reality, the two cases are utterly unlike.
Whilst in the case of the ordinary toper drink is only the ac-
companiment of the festive board; in the dipsomaniac it is a
secret vice. He will indeed avoid drinking in company, and
assume the virtue of temperance all the time that he is madly
looking for liquor; and when he cannot obtain it, will drink
even “shoe-blacking and turpentine, hair-wash, or any thing
stimulating,’ says Dr. Skae. There is one feature in the dipso-
maniac which is very observable ; he is invariably good tem-
pered when not suffering from the physical depression which
follows the indulgence of his desire. My own experience of
cases under my charge, and which I have watched narrowly,
leads me to the conclusion that the dipsomaniac is, without ex-
ception, a happy-go-lucky sort of person, with whom the world
appears to go smoothly. The worst feature of the disease is
the very small percentage of cures which are obtained. Among
women there appears to be more chance than among men, as
the irresistible desire, in some cases, leaves them after a cer-
tain period of life. But their case isrendered the more dis-
tressing, as it usually happens that the most refined natures,
under such circumstances, are transformed into the lewdest and
the most shameless of their sex.”
ALCOHOLISM, iF |
Epileptiform Attacks.—Epileptiform attacks are often a
grave feature of advanced alcoholism, and are always a serious
phase of the disease. They are violent and occur usually in
groups, one immediately after the other. Axenfeld refers to a
condition of delirium following a more or less prolonged col-
lapse, to which he has given the name “ Larvated Epilepsy.”
The cases I have met with were characterized by a much more
deep and protracted form of stupidity than is usually seen in non-
alcoholic epilepsy, and the subsequent sleep stage was longer and
more profound. Tongue-biting iscommon. The attacks may oc-
cur five or six times a day, and may be associated with, or fol-
lowed by hallucinations, mild delirium, a temporary loss of
memory, or a transient aphasia which lasts as a post-epileptic
condition. ‘The effect of repeated convulsive attacks upon the
general nervous system is debasing, and there is a feebleness
both of mind and body which is distressing; in a late
stage there will be irregularity of the pupils, embarrass-
ment of speech, and a condition suggestive of general
paresis. Hereditary influence is a bad feature of this form of
alcoholic disease.
Impulses in the Alcoholic Epileptic.—Epileptic at-
tacks of alcoholic origin are quite apt to be preceded or fol-
lowed, according to Dagonét, by very decided intellectual per-
version, excitement and homicidal and suicidal tendencies, the
result of delirium, and when the delusion has subsided the
patient has no remembrance of his mental disturbance. Ac-
cording to this writer the impulses are transitory. He refers
to the case of a man who had drunk a glass of absinthe in the
day time and another in the evening, and at the moment of
getting into bed was seized with a kind of delirious frenzy.
He left his house, armed himself with a hatchet and went to
his sister’s house for the purpose of killing her, but when he
arrived there he changed his mind, threw away the weapon and
returned to his lodgings. He could not at first recall what had
transpired while he was under the influence of the delirium.
Eight days afterwards he again resorted to the absinthe, and
dreamed that he had killed his brother, and he afterwards re-
tained the most vivid impression of the dream. He subse-
quently developed all the symptoms of acute alcoholism—the
spasmodic movements of the muscles of the face, trembling,
cephalalgia, hallucinations, and numerous others. We should
carefully weigh the possibility of masked or irregular attacks
of an epileptiform character in all cases of homicide, even when
252 MEDICAL JURISPRUDENCE.
the crime has been committed subsequent to, or preceding the
attack of delirium tremens.
In France the complication, according to Magnan, arises
from inordinate indulgence in absinthe, but Dagonét holds a
contrary opinion. It would appear that the absinthe has no
specific influence, as in this country where very little absinthe
is used, there is much epileptic alcoholism.
Loss of Memory in Alcoholism.—The relations of
changes in memory are interesting. According to Dagonét
this faculty remains confused for a long time, but clears little
by little. The loss of memory occurs in two ways—as a
consequence of alcoholic epilepsy, and as a result of acute al-
coholism of great intensity.
The patients cannot furnish any explanation of their con-
duct. All they preserve is aconfused memory. Forgetfulness
is inseparable from the loss of consciousness which belongs to
profound drunkenness. ‘The drunkard is of course not in a
state to comprehend what goes on about him, and cannot ex-
plain the motives which led him to commit acts he sub-
sequently regretted.
Alcoholic Trance.—Many cases have been reported in
which individuals in a peculiar trance state due to alcoholic
excitement have committed outrageous acts which they are
entirely unconscious of afterwards. In these instances there
has been no history of profound intoxication, but often the
quantity of alcohol has been inconsiderable. The mental
state after recovery has been quite active and Dr. Mercier has
expressed his astonishment in a case where the man had com-
mitted a purposeless act, while he was stupid and incoherent,
but subsequently developed a most remarkable control over
his faculties. In a discussion upon Motet’s paper upon this
subject read before the International Medical Congress Dr.
Mercier® said :
“Alcoholic mania, although very transitory, might be very
different from delirium tremens. Another case was that of a
man who was crying out in the streets that people were
taking his life by means of the telegraph wires. He was then
in a state of acute mania, with delusions, and on the following
morning he was completely well. In this case also the man,
being a teetotaler, had suddenly taken a considerable dose of
alcoholic liquor.”
* Sournal of Mental Science, Oct., 1881.
ALCOHOLISM. 5623
“ Dr. Maudsley suggested whether, in these cases of moral
transition, there might not have been a strong hereditary
epileptic tendency. It occurred to him that in these cases of
genuine acute mania of a transient kind, during which the per-
son was unconscious, or would forget afterwards what he was
doing, that kind of a mania might be a sudden outbreak in
consequence, perhaps, of the patient’s having drunk too much.”
Dr. Crothers, a fertile writer upon alcoholic insanity, sums
up his conclusions in regard to the trance state which may
arise from inebriety and illustrates them by a case which I
present :
‘“‘t, The trance state is a common symptom of inebriety, in
which the patient is without consciousness and recollection of
present events, and gives no general evidence of his real con-
dition. This may last from a few moments to several days.
“2, This state is clear evidence of profound disturbance
of the higher brain centers, and is of necessity followed by
impaired judgment and lessened responsibility.
‘3. This trance state will always be found associated with
a particular neurotic condition, either induced by alcohol or
existing before alcohol was used. In all chronic states of in-
ebriety it will be found present in a greater or less degree.
The first fact is supported by the evidence found in the his-
tory of every case of inebriety.”
TRANCE FOLLOWING INEBRIETY—AUTOMATIC RECOVERY.
“A railroad conductor, aged 45. Parents farmers, and healthy ;
no evidence of inherited disease. He grew up a strong, ro-
bust boy, and at twenty-two went on the railroad as baggage-
master. Ten years later he married and was promoted to a
conductor. He was, up to this time, temperate and regular in
all his habits, using no spirits except beer at long intervals.
A few months after his promotion to conductor, his train ran
down an embankment and was wrecked. Many lives were lost, |
and he was greatly excited, fearing the censure of the company
and public, remaining at the scene of the accident over twenty
hours without rest or food. He then went home and drank
spirits to profound intoxication, remaining in bed two days be-
fore he went to work again. From this time he began to use
brandy, and occasionally was intoxicated at home at night.
Two years after he complained of restlessness and inability to
sleep at night ; for this bitters were prescribed, which brought
relief. His disposition began to change, and he became more
254 MEDICAL JURISPRUDENCE,
excitable and impatient of opposition. A year or more after
he began to drink regularly when the work of the day was over,
and by nine or ten in the evening was heavy and stupid from
the effects of spirits. He was very exact and methodical in
all his habits, drinking beer through the day, and never vary-
ing the routine of his life or work from any cause. When
thirty-six years old, he complained of blanks of memory, or
periods in which he could not remember, terminating suddenly,
leaving him in some strange position with all the past a blank.
His usual habit was to drink in the evening, either at home or
at the club, come home always at ten o’clock, and retire, get
up next morning at 4 a. M., and take his train a little later.
These blanks would come on in the evening and break up at
some point on the road the next day ; or they would last until
- late in the afternoon, on his return trip. He would then show
much anxiety to know what had taken place in meantime, fear-
ing he had made some mistake, and inquiring minutely of his
wife and some intimate friends. These blanks increased, and
were noted by his brother-in-law, a physician, as follows: He
would come home at night heavy and stupid, not unconscious,
apparently, but still and quiet ; sleep soundly until morning,
get up at the regular hour, talk but little, take breakfast as
usual, go out on his train, read the paper, attend to all the du-
ties of his business in a quiet mechanical way. If any thing
unusual happened he seemed to be more indifferent, and acted
with judgment and caution. All at once he would seem to
awaken, his manner would be nervous, and his eyes would in-
dicate alarm, he would look over his change and tickets, and
inquire of any one who was intimate with him as to what had
taken place, having no idea of any thing from some time in the
evening before. He would remember some question or topic
of conversation that occurred in the company in the past even-
ing, and be ready to go on with the conversation, only the cir-
cumstances had changed, and the interval was a blank. This
state would alarm him, and he would drink less for a few weeks.
He never was delirious, but complained of heaviness and desire
for sleep. When hewas sober he would be nervous and irritable,
and then use spirits to steady his nerves.
“The treasurer of the road noted this condition, in his inabil-
ity to make out the returns when his trip was over. He would
count and recount his money, then give it up, saying. his head
ached and he could not get it correct ; the next day it would
be satisfactorily settled. The blanks increased in length, and
would last from the evening until the return from his daily trip
ALCOHOLISM. 255
the next day, twenty hours or more. During this time he would
not seem to be in any way different to the train men. Once,
when an accident had occurred, he recovered his senses, and
was unusually excited ; on other occasions he would have men
put off the train, and pass through exciting scenes, yet have no
memory of them, and be unable to make upa report,except from
the assistance of a brakeman. He tried to break up the use
of stimulants, but failed, saying he would become insane if he
stopped; then he diminished the quantity, but always came
back to the usual amount, which was followed by more or less
stupor at night. Both his wife and brother-in-law noted these
trance states, and fully verified his statements of no recollec-
tionof events. He seemed to be more suspicious as he grew older,
and urged that every thing be put in writing. On the road in
this state, if he was asked for a favor he put it down on paper,
and urged that others do the same to him. When not in this
condition, he was quite careless about little things, but when he
became exact and very particular his friends knew that he was
not able to comprehend his state. He rarely drank except
when at home, and whenever he felt that he had used more than
he could bear, went quietly to bed ; always seeming to have an
inner consciousness of his situation, seen in the caution which
he displayed to keep from observation. For over three years
these blanks continued, sometimes every week, then at longer
intervals, but steadily increasing in duration, and becoming
more prominent in the heavy stupid air and manner of doing
business. He resigned and spent a year on the farm, using
less alcohol and recovering rapidly. He is now in business,
and has had no blanks for two years, but at times after he has
drank two or more glasses of beer his memory is confused for
an hour or more.”
Changes in Character.—The effects of alcohol are rarely
the same in different individuals, and no rule will work uni-
versally. Some men lose their business capacity, while others
become pugnacious or irritable, and at the same time are ener-
getic and show little sign of weakness. Some drinkers succumb
almost immediately to small quantities of stimulant, while
others seem to be little affected.
Heredity.—The abnormal craze for drink is often the
direct result of the insanity or intemperance of ancestors.
Even when carefully environed, the trouble breaks out, and
several members of the same family are apt to be affected. In
such families the children of decent parents may reproduce the
anh MEDICAL JURISPRUDENCE,
ted
behavior of maternal or paternal grandfathers. ‘Vicious ii-
stincts and alcoholism go hand in hand; one brother may
become a thief, who does not drink—another may commit no
greater crime than those of a light sort arising from his drunk-
enness.
Dr. Bucknill considers that insanity may directly follow
drink ; or that it may arise from some other influence such as
mental strain, which causes drink-craving. Drink concurring
and continuing with other causes and producing a progressive
effect, the end of which is the evolution of madness.
Fixed Ideas.—Fixed ideas are all of a horrible nature.
The victim of alcoholism firmly believes that he is the object
of attack of a well organized conspiracy—that he is to be pois-
oned or killed. He is often impelled in consequence to attempt
homicide or suicide. These delusions may be connected with
jmaniacal excitement. Sometimes they may be of an expanded
character. The extravagant ideas of the patient suggest general
paresis very strongly, and in fact this disease may and
often is a direct outgrowth of the alcoholic state. Irregular
forms of alcoholism are quite likely to be called general paresis,
but there is a difference.
Delirium Tremens and Responsibility.—Delirium Tre-
mens has been advanced as a defense very often in murder cases,
and in the case of the Queen vs. Burns Baron Bramwell charged
the jury to acquit if they believed the prisoner to be suffering
from a delusion, which if true would have justified him in the
act. If through drink his mind had in their opinion been
substantially impaired, they were to acquit him which they
did. |
The distinction between delirium tremens and temporary
madness induced by intoxication, is laid down in the United
States vs. Drew, 5 Mason, 28 and (in England) in John Bur-
roughs’.case, tLewin, C. C.075) slnethejatterecases Llolray as
J., said: “‘ Drunkenness is not insanity, nor does it answer to
what is termed an unsound mind, unless the derangement
which it causes becomes fixed and continued by the drunken-
ness being habitual, and thereby rendering the party incapable
of distinguishing between right and wrong.”
ALCOHOLISM.
\
257
Diagnosis between Alcoholism and General Para-
lysis.—The following table, prepared by Thorneuf, sums up
the diagnostic points.
Alcoholic Insanity complicated with
paralysts,
Headache.
Active hallucinations affecting all
the senses, disordered vision (illu-
sions).
Delirious conceptions depending
upon hallucinations ; ideas of perse-
cution, tendency to suicide, evil in-
stincts, consciousness of degradation.
Embarrassed speech depending
somewhat upon fear, upon startings
of the muscles of the face and espec-
ially upon tremulousness of the
tongue.
Feebleness little marked of the in-
ferior members ; equal on both sides.
Trembling of the hands and the
_ arms more marked in the morning ;
formications, cramps and startings of
the tendons of the fore-arm.
Pupils nearly always dilated.
Anesthesia of the extremities of
the limbs extending generally in the
superior limbs to the elbow, and in
the inferior to the knee.
Sleep disturbed with dreams, some-
times sleeplessness.
Diminution of appetite, acid eructa-
tions, vomiting of mucus in the
morning.
Dimunition of the generative func-
tions, frigidity.
Readily cured or modified.
Occasional supervention of dehirium
tremens.
General paralysis.
Generally no headache.
Enfeeblement of the understand-
ing, rarely hallucinations.
Ideas of grandeur and contentment:
Embarrassed speech depending
upon feebleness of the conceptions
and paralysis of the muscles of the
face.
Feebleness of the inferior members,
more marked generally upon one side
than the other.
Nothing appreciable in the superior
limbs, sometimes default of co-ordin-
ation.
Pupils often unequal, often con-
tracted.
Sensibility normal, or obtuse over
the whole surface.
Sleep generally normal.
Appetite augmented.
Augmentation of the generative
functions.
Progress of the disease ordinarily
rapid, always fatal.
Tendency to congestions, and to
epileptiform attacks.
Responsibility and Alcoholism.—Mere drunkenness
does not bring with it immunity from punishment.
When the drunkenness of the criminal leads
is not so lenient.
The law
him to commit an act as the result of an illusion, hallucination
or delusion, the matter is different.
It must be shown that he
actually suffers from disease of the mind. Under this head we
find some cases of chronic alcoholism, of dipsomania and of
acute alcoholism with delusions and hallucinations, The
rf
258 MEDICAL JURISPRUDENCE.
delusion or hallucination must moreover exist, or in some
way be connected with the act. If the person defends
himself from imaginary enemies he will be clearly irrespon-
sible.
Taylor says in this connection: “If the drunkenness has
produced a diseased state of the mind, then a criminal act per-
petrated by the person might admit of exculpation either on
the ground of insanity or of the want of sane consciousness at
the time of the act; but the difficulty is to prove in such cases
the existence of actual disease to a sufficient degree to render
the person irresponsible in a legal sense. Where it is a ques-
tion whether the accused was actuated by malice or not, a jury
may under certain circumstances be required to take the fact
of drunkenness into their consideration, and this may have
some influence upon their conduct.”
It may be held that the crime committed by a voluntary
drunkard is an aggravated one, but the fact that the man
was drunk at the time the crime was committed should be con-
sidered in relation to intention or malice. Browne refers to the
case of King vs. Thomas, in which it was decided that drunken-
ness is no excuse for any crime a man may commit ; still where
_ provocation by a blow has been given to a person who kills an-
other with a weapon which he happens to have in his hand, the
drunkenness of the prisoner may be considered on the question
whether he was excited by passion or actuated by malice ; and
it was further held that it may be considered on the question
whether expressions used by the prisoner manifested a deliber-
ate purpose, or were merely the idle expressions of a drunken
man,
Le Grand du Saulle on Responsibility.—Le Grand du
Saulle says of the responsibility of drunkards: “ With respect
to my personal opinions upon drunkenness, they are as follows :
The inveterate abuse of alcoholic lhquors should continue
almost entirely without influence over responsibility, until there
is manifested and confirmed and persistent mania. Habitual
drunkenness ought neither to augment nor extenuate the con-
sequences of the act committed, but it may to a considerable ex-
tent diminish or altogether do away with the suspicion that the
immediate drunkenness has been contracted for a culpable
end. It is with difficulty one can understand that the habit of
getting drunk should become, on the part of magistrates, an
object of gracious consideration when their office is to repress
scandal and to punish immorality.”
ALCOHOLISM. 259
CasE LI.—MurRDER—PLEA OF INTOXICATION IN MITIGATION
—PROOF OF PLOT MADE WHILE SOBER—CONVICTION.
Hamlin
US. 48 Conn. Reports, 92.
The State,
Hamlin was convicted of murder in the first degree. He
and one Allen made an attempt to escape from the State
prison, and in the attempt killed a watchman named Shipman.
He then petitioned for a new trial on the ground of newly
discovered evidence of his intoxication at the time of the mur-
der. It appears that they had for some time previous made
preparations for the escape by bribing one of the watchmen,
that they had afterwards decided to escape by attacking the
guard and making a bold dash, and that they had waited for
two hours for an opportunity to make the attack. It is claimed
that while thus waiting the prisoner drank some liquor and
became intoxicated. In refusing the petition the Supreme
Court of Errors held, that conceding that Hamlin was intoxi-
cated when the attack was made, he had previously partici-
pated in all the preparations therefor even to the extent of
taking human life, they having armed themselves; that in
view of these facts the attack and its consequences were pre-
meditated and the intoxication at the time of the murder could
be of no avail as a mitigating circumstance.
Case LII.—MvurRDER—DEFENSE OF ALCOHOLISM—CONVIC-
TION.
Henry A. Schlencker
US. 9 Nebraska Reports, 241.
State,
The prisoner on Oct. 10, 1878, while intoxicated, went to a
house of ill-fame to see one Florence Booth whom he requested
to lie down with him which she refused to do. A quarrel
then ensued and he shot and killed her and then shot himself,
but subsequently recovered. He was convicted of murder in
the first degree and sentenced to be hung, but obtained a re-
prieve and was granted a re-hearing. The defense set up was
insanity superinduced by alcoholism. Several witnesses testi-
fied that on the day of the murder and for some time previous
the prisoner “acted strangely ; was drinking ; was not in his
right mind; had eaten nothing ; was excited ; walked hastily ;
acted queer ; tried to run against us; acted funnier than he
260 MEDICAL JURISPRUDENCE.
ever did before ; looked fierce ; had fits; looked dreamy, as if
there was something on his mind, etc.” M.C. Keith a practic-
ing physician testified that he examined prisoner after the
shooting ; “his blood was thin, red, arterial, and smelt of al-
cohol;” he believed from his condition that he had been
drinking constantly for from three to six months ; believed him
to be, but would not swear that he was, suffering with chronic
dipsomania or oinomania, which would induce him at the time
of the frenzy to kill even his best friend ; his eyes were protu-
berant; believed from his appearance he had just passed
through a paroxysm of madness; a person in this paroxysm
knows nothing ; does not realize his condition; has a desire
to destroy life.” The State produced a number of witnesses
who testified with regard to prisoner’s actions before and on
day of murder. He seemed perfectly sane; walked straight ;
his face looked natural ; appeared to be all right; saw him on
witness stand on Sep. 30; he was a little excited then ; noth-
ing peculiar in his actions; should say he was sane from his
general appearance.
On appeal to the Supreme Court the conviction was af-
firmed.
Case LIII.—WILLFUL MURDER, DEFENSE INSANITY. — PRIs-
ONER INTOXICATED AT TIMES.— FEIGNED INSANITY.—
CONVICTION.
State
US. 51 Vermont R. 296.
Edwin C. Hayden,
Prisoner who had been separated from his wife by reason
of his intemperate habits, on August 30, 1876 called upon his
wife who was living at the Derby Line Hotel in Derby Line
with her sister and sister’s husband for the purpose of effecting
a reconciliation. He was somewhat intoxicated and received
no encouragement. The next morning, having announced his
intention to shoot his wife, he again called to see her, but,
being very intoxicated, was refused admission to her rooms,
and went away. Hesoon returned, however, and endeavored
to force his way into his wife’s room but was resisted by her
brother-in-law, whom he shot and then forced the door of
the room and shot his wife. After his arrest he said he hoped
she would die and he was ready to be hung. This evidence was
not controverted by the prisoner, but a plea of insanity was
put in, It was claimed that when he was under the influence
ALCOHOLISM, 261
of liquor he was subject to emotional insanity. It was shown
that several of prisoner’s ancestors had been insane; that while
in jail his conduct was strange and unaccountable and that
he was sick and prostrated. (On behalf of the state a doctor
who had examined him in a jail and to whom prisoner had
explained his symptoms stated that he believed prisoner
was shamming). It was also claimed that the manner of the
shooting was proof of his insanity. Three witnesses testified
that they knew prisoner, had seen him sober, had seen him
excited, and also intoxicated, but believed him to be sane, but no
further evidence was produced except the opinions of experts,
based on the facts, which were to the effect that prisoner was
not insane.
Prisoner was convicted and on appeal to the Supreme Court
the conviction was affirmed.
A recent Nebraska case* in which intoxication as a defense
was urged is that of the State of Nebraska vs. Schleucher in
which the prisoner murdered a woman while intoxicated. The
judge held that “settled insanity, produced by intoxication,
affects the responsibility the same way as insanity produced
by any other cause; but insanity immediately produced by
intoxication does not destroy responsibility when the patient
when sane and responsible made himself voluntarily intoxi-
cated.”
In the same case it was held that the fact that the prisoner
was in a drunken state when he committed the homicide does
not in itself render the act of shooting the deceased any the
less criminal nor is it available as an excuse.
As an illustration of insanity directly due to drink when
the question of responsibility is doubtful, I may quote the fol-
lowing history:
“Man, aged 37, single, laborer, intemperate, had suffered
from several attacks of acute mania, arising from the use of
liquor, and occurring after a protracted debauch. Was first
admitted to Utica Asylum two years previously and was
then violent, destructive, sleepless and acutely maniacal, and
had committed violence by knocking a woman on the head
with a club. He soon became quiet and returned home, where
he continued well till present attack. He drank to excess during
the interval, and three weeks before second admission became
maniacal and threatened to kill various persons. He set fire
to the house of his brother-in-law, whose family was asleep
* Referred to in Boston Med. & Surg. Fournal, Jan. 29, 1880.
262 MEDICAL JURISPRUDENCE.
below and was aroused by the noise of the fire. His sister
attempted to go up the stairs, when she was opposed by the
patient who struck at her with an ax. This fortunately
glanced off without inflicting serious injury. He was arrested,
securely restrained and brought to the Asylum. He recovered
after six months. Has since had another attack, and is now in
the Asylum.”
The neurotic criminal often “nerves himself up’”’ and seeks
in alchohol an agent not only to steady him for the performance
of his crime, but to obscure his conscience. Parrish, who has
had alarge experience in such cases, presents in a recent work*
two or three cases, an important example being the following :
““Aged 29, clerk. Drinks to excess occasionally. Latterly
the occasions have been so frequent, that he has !ost his
situation. Upon further acquaintance with this youth I found
him honorable and honest, when sober, an excellent clerk,
obliging, and given to no other habitual vice, than excessive
smoking. He is sensitive, and has recently become suspicious
to a degree that makes intercourse and conversation with him
a very delicate matter. At times he was overtaken with an
impulse to commit an act that was in violation of his conscience
and moral sense, but which seemed to be irresistible. The
very conflict with himself and his temptation aggravated his
nervousness, and he became willful, obstinate, profane, and
restless to a degree that was irrepressible. In this stage of
extreme irritability, he would resort to whisky in great modera-
tion. Unlike the dipsomaniac, who drinks without hmit, and
without thought, he drank with great caution, taking a little,
with short intervals between. As the circulation began to
create a glow throughout his whole capillary system and his ex-
treme nervousness began to yield to a state of comparative
calm, the period of deliberation was reached, and, keeping
himself at this level by repeated draughts of liquor, at suitable
intervals, he was enabled to plan and execute. His offense
was always the same, and after it was done he suffered re-
morse and sorrow, and till the next overpowering impulse
posessed him he was prudent, sober and correct. This young
man afterwards settled in business and became a useful citi-
zen. His friends consider him a “reformed drunkard,” and
he is willing to accept the title. He is however a reformed
criminal, if the propensity to crime isin subjection ; but he was
never an inebriate in its actual physiological sense.”
* Alcoholic Inebriety.—p. 26, Phila, 1883.
ALCOHOLISM. 263
Another case is that of aman, age 41. An agent fora large
mercantile firm, who, with a clear head and steady hand, ex-
ecuted a forgery, and then deliberately got drunk to partially
obscure from his mind thoughts of the deed, but more especially
to furnish his friends witha plea for committing him to an inebri-
ate asylum, the officers of which were unconsciously instrumental,
for the time, in aiding a criminal to escape the just sentence of
the law. I am not aware that this man was ever intoxicated af-
terwards, while previous to this time he bore a reputation for
sobriety. He was not an inebriate but a criminal, and yet
the fact of being sheltered for a short time within the walls
of a Sanitarium gave him an opportunity to pass, on his
discharge, for a reclaimed victim of the bowl, which he pre-
ferred.to the shame of being a forger.
“Another case that came under my observation, but not
under my care,” says Parish, “was a convict in a State Peni-
tentiary for the third time, for manslaughter. Notwithstanding
his homicidal tendency, which seemed to be inherited, he
acknowledged himself a coward, and it was always with much
fear that the impulse to kill was associated. Instead of the
daring and even rashness of some homicides, he trembled with
terror as the impulse to destroy life seized and possessed him.
The conflict between the impulse and the timidity and dread,
which were almost simultaneous in their approach, made him
nervous, irritable and angry. Under these conditions, he
resorted to the liquor in such carefully graduated quantities
as he imagined would secure care and deliberation in the
‘ prosecution of his purpose. His purpose was to select a
victim whom he could manage with ease, always keeping him-
self in the attitude of self-defense, that he might evade the ex-
treme penalty of the law for murder. He could, while his own
anger and irritability were under control, excite his antagonist
to threats or attempted assault, during which period he would
calmly and surely inflict the fatal wound, under the pretense of
saving his own life. This sort of proceeding had been practiced
with success three different times, on which account he had
spent most of his adult life in prison, and before his term ex-
pires he will probably die in his cell. He described to me with
evident clearness, and certainly with considerable self-satisfac-
tion, the details of his proceedings, and manifested no evidence
of remorse on account of his guilt. The cause of his crime on
the prison docket was “ intemperance,” and he was willing to
accept this record as true, because it was written, for he did not
appreciate the enormity of his crime nor the guilt of a criminal,
264 MEDICAL JURISPRUDENCE,
He should not have been so registered, He is not a drunkard
but a murderer ; the criminal intent was in his mind; the ob-
jects of his assaults were selected, and plans laid to decoy and
irritate them before he drank the whisky te aid his brutal in-
stinct and nerve him for the fulfillment of his diabolical pur-
_ pose. He represents a class, and I doubt not, if a careful anal-
ysis was made of the character and habits of convicts now in
confinement, the discovery would be made, that many whose
crime-cause is stated to be intemperance, would be found to be
like the one just stated—temporary drunkards for a criminal
purpose.”
Alcoholism and Civil Action.—In civil cases the law
is not so stringent as in criminal. Habitual drunkards are de-
prived of their rights by commissions, and the individual is not
liable for contracts made by him,
‘*¢ Habitual Drunkards.’’—It is a difficult matter to de.
termine what constitutes “habitual drunkenness.” In the case
of Blancy vs. Blancy (126 Mass. Repts., 205), a decision, was ren-
dered in an action for divorce on the ground of habitual drunk-
enness It was proved: that defendant for 12 or 15 years past
became grossly intoxicated at least three times a year and re-
mained in that condition from 7 to ro days each time: that
when these spells came he was sent to an inebriate asylum
where he remained until they passed: that between the spells
he would drink nothing but that any excitement would make
him drink.
Held, on appeal to the Supreme Court that this was sufficient
proof of habitual drunkenness.
In the case of Wheeler vs. Wheeler (53 Iowa, 511), a di-
vorce was granted the plaintiff who was the victim of the hus-
band’s violence during his drunken excesses, although at other
times he was sober and was able to conduct his business.
Plaintiff and defendant were married in 1859. Previous to
that time defendant was addicted to liquor and was frequently
drunk. After his marriage he became an habitual drunkard and
his wife sued for a divorce on that ground and also because of
inhuman treatment. The divorce was granted.
Although he was always sober during business hours, he was
habitually drunk at other times, and when in that condition
abused his wife, calling her vile names and openly charging
her with unchastity.
On appeal the Supreme Court affirmed the decree of divorce.
ALCOHOLISM. 265
Commitment of Drunkards.—The commitment of an in-
ebriate may often lead to very disagreeable results—the medi-
cal men or the friends being sometimes sued by the person im-
prisoned. The case of Jason L. Blodgett reported by Dr.
_ Fisher* is so interesting that I may be pardoned for referring
to it rather extensively, using the doctor’s language.
“A suit was brought two years ago in the Massachusetts Su-
preme Court by Jason L. Blodgett against his divorced wife,
Major Jones, now on the Board of Police Commissioners of
Boston, and Drs. Fisher and Youngman, for a conspiracy to
imprison him in the Taunton Lunatic Hospital on the false
charge of insanity; also for assault and battery in caus-
ing his arrest ; and for taking his property, ruining his busi-
ness, and causing great damage to his reputation and feelings ;
for all of which damages to the extent of $15,000 were claimed.
His legal adviser at first was William H. Towne, who after-
wards called to his assistance Edward Avery. The defendants
were represented by Edward P. Brown. At the first trial the
plaintiff’s petition was dismissed for informality and illegal
contents. Major Jones was excused, as having had nothing to
do with the particular commitment complained of, the plaintiff
having been sent to Taunton twice ; and Mrs. Blodgett, having
been his wife at the time of the alleged offense, could not be
proceeded against. This left the two physicians standing alone ;
and, after six months, the case was called again, unexpectedly,
at theclose of the summer vacation, when police officers, who
were important witnesses, were absent. The wife, whose tes-
timony was almost absolutely essential to the defense, had hid-
den herself from her divorced husband in the far West, and
could not be compelled to attend or obtained as a witness
without great expense. The plaintiff told a story, based on his
confused recollection of events, and deliberately false in some
parts, which was contradicted by the defendants, who offered
to put in as the basis of theircertificate information received
upon ‘due inquiry,’ as well as the result of personal exami-
nation. This hearsay testimony, though required by law as
‘part of the foundation of the certificate, was not admitted
in its support at this time, and the wife being absent,
essential facts were kept out of evidence. The rulings of Judge
Endicott were in every other way favorable to the defendants.
The jury disagreed, as the foreman afterwards stated to Major
Jones, by permission of the court,—nine for the defendants
* Boston Med. & Surg. Fournal,,” June 6, 1881.
266 MEDICAL jURISPRUDENCE.
and three for the plaintiff, on the question of ‘lack of due in-
quiry’ only. No suspicion of a conspiracy was entertained by
any juryman.
“The case was again called last spring, the wife still being
absent. The plaintiff, with one or two unimportant exceptions,
_ was his own witness, and made the same or similar false state-
ments as before, showing clearly on the stand to medical ob-
servation the unreliable and irresponsible nature of his mental
operations. ‘The case was classified as dipsomania on all the
certificates offered, of which there were three. The following
is a brief sketch of the plaintiff’s history :—
“At the time of the trial he was a man about forty years of
age, of evidently neurotic constitution, impulsive, excitable,
with a loose way of expressing himself, said to have been char-
acteristic of him from youth. One witness testified that he
had always been given to telling untruthful and inconsistent
stories. Hewas reported to have had an aunt who was insane.
His father was aclergyman, and both his parents died in his
early youth of consumption, leaving him in charge of his rela-
tives. He was a bad and irregular scholar, though quick-
witted enough for mischief. At the age of puberty he showed
a proneness to premature vicious conduct of various kinds.
He is said to have begun to drink by sprees at the age of fifteen
years. He had some good traits and impulses, but was early
the slave of his appetites, and was cursed with a craving for
drink. His sister says he was a good brother when sober, -but
a‘ perfect devil’ when drunk.
‘He was in frequent trouble on account of his scrapes, both
in the country and in Boston, until the war broke out,
when he enlisted. Having previously lost the sight of one eye,
it was still further injured by a thorn, and was enucleated. He
was then put on an army freight train as conductor or brakeman,
and continued to serve until the close of the war. After the
war he was employed on railroads at the West, leading a life of
active dissipation, according to his own admission to a witness. —
In 1875 he came to Boston, claiming to have reformed, and
that he was the possessor of a largesum of money. In this be-
lief a widow of the former proprietor of certain Turkish baths
in Boston—herself being the owner at that time—married him.
His fortune proved mythical, and his wife was obliged to pay
for his wedding suit and for the wedding journey; she gave
him a gold watch, and supported him ever afterwards, except for
the small value of his services in the baths. He obtained con-
trol of all her property, and in a very short time developed a
ALCOHOLISM. 267
tendency todrink by sprees, in which he was ugly,
violent, and dangerous, threatening his wife in parti-
cular. He was seldom seen drunk in the ordinary way, but
was exalted and maniacal, acting more or less au-
tomatically, and failing to remember his conduct and
conversation afterwards. It is but charitable to suppose that
this accounted for his wholesale denial of numerous facts testi-
fied to by a score of witnesses on the stand. Ina year or two
he had spent all his wife’s property and destroyed her business
by his drunken conduct.
“My attention was first called to him October 12, 1875, by
Dr. A. N. Blodgett, his wife’s physician, but not related to
either party. _Dr. Blodgett, being in attendance on the wife,
found the husband in a state of delirium from drink, in which
hallucinations of snakes in his bed were prominent. He
thought he saw the devil in the looking-glass; threatened to
kill his wife ; threw furniture violently about the room; and
did not recognize Dr. Blodgett, but violently assaulted him
several times. Policemen were called, and he was taken to
the tombs. The next morning application was made by Dr.
Blodgett to the Board of Directors for Public Institutions for
his commitment to Taunton as insane. Having learned his
previous history, I agreed that he might be a dipsomaniac, but,
the present attack resembling in some of its features delirium
tremens, advised that he should be sent to Deer Island. He
did not have a perfect attack of that disease, and was dis-
charged in two or three days, apparently rational.
“ He was again arrested January 31, 1876, for violent conduct
while drunk, and released on promise of good behavior, but
was re-arrested the same day, fined three dollars and costs for
being drunk, ten dollars and costs for assault on a female em-
ployed at the baths, and was bound over for six months to
keep the peace. Was sent to jail, and Major Jones, as bail
commissioner, signed the bond on which he was released.
June 24, 1876, was arrested again, but let off on promise of
good behavior. Again on November 8, 1876, he was arrested
as insane. Complaint having previously been made to the
board of directors, I was sent with Dr. Youngman to interview
- Blodgett. Learned that he had been very violent at the baths,
smashing up furniture and frightening bathers and employes.
Found him at home, an officer bringing him up from the cel-
lar, where he had retreated, having an ax in his hand. His
wife had fled from the house, and the other inmates were
locked in their rooms. He was in a very ugly, sullen mood,
, 268 MEDICAL JURISPRUDENCE.
having been drinking heavily. He denied, as was his custom,
ever drinking to excess or using violence to any one. He had
recently had a spasm of religious interest ; went into a prayer-
meeting at the Young Men’s Christian Association, and offered
any brother twenty-five dollars to convert him. A member
went home and prayed with him, but was turned out by Blod-
gett because he ‘didn’t pray worth adamned cent’! Nosign of
delirium tremens was present at this time, and it was determined
to send him to Taunton as a dipsomaniac, with a view to a suffi-
ciently long detention for his improvement or cure. He made
no objection and asked for no hearing, thus acquiescing in his
commitment.
“Having remained at Taunton afew weeks, he was discharged
on application of his counsel, Mr. Towne, and was sober and
well behaved for a considerable period after it. He admitted,
in an interview with Major Jones, his irresistible disposition to
drink, and that he presumed the allegations of violence were
true, but that he did not remember what occurred at certain
periods of his drinking spells. He had also consulted a rela-
tive in reference to some cure for his entire loss of self-control
in reference to drink. He joined the church of which his
wife was a member, and behaved well till August, 1877. From
August to December he had three sprees, in which his conduct
was erratic and violent. For instance, he would rush down
Washington Street in the evening with a roll of bills in his
hand, flourishing them about, and followed by a crowd of men
and boys. He would buy a pie, order a hack, and send the pie
home alone in the hack. On several occasions he used vulgar,
profane, and threatening language to ladies at his wife’s board-
ing-house. December 10, 1877, complaint having been made
to the board of directors, he was examined at his boarding-
house by Dr. Youngman and myself. We found him in bed,
nervous and confused, as if from a prolonged debauch. I
talked with him half an hour, explained to him my theory of
his case, told him I thought nothing but prolonged detention
would do him any good ; that as he had improved after a few
weeks in Taunton a year would do him still more good. He
denied drinking more than was good for him, but said he would
stop at once if we would not certify in his case. I told him if
he was arrested again for violent conduct I should certify.
This interview, he testified, was only a few minutes long, and
he could remember but one thing that was said. Two days
after he was arrested at the baths for furious conduct towards
his wife and other ladies, and for trying to kick over a hot stove.
ALCOHOLISM. 269
He was sent to Taunton December 12, 1877, and asked for no
hearing at this time.
“Remaining in Taunton about three months and a half, he was
discharged March 26th, and rearrested for throwing a bottle at
some one at the baths March 3oth, four days after. The next
morning he showed very little effect from liquor when seen at
the tombs, the period of indulgence having been brief. He
demanded a hearing at once, and a certificate pro forma hav-
ing been signed to bring his case before Judge McKim, he was
released on promising good behavior. In April a libel for
divorce was filed by his wife, alleging brutal and violent con-
duct, with gross and frequent intoxication. Blodgett appeared
in the anteroom of the supreme court in his usual peculiar con-
dition, insulted several ladies there with obscene talk, undertook
to conduct his own defense, and harangued the court in such
strange and familiar language that the judge told him he must
be either drunk or crazy, and granted the divorce. His wife
then left him for the West, in a penniless condition, and he
soon found a lawyer willing to take his suit against the alleged
conspirators. ‘This idea of a conspiracy was, I think, in part,
a vague delusion growing out of imaginary wrongs, and in part
a foolish attempt to rehabilitate his fortunes and revenge him-
self at the same time by a suit against his assumed enemies. A
few weeks before the final trial he was arrested for drunkenness
in Waltham, and boasted, in his loose way, of the immense busi-
ness he was doing, and the money he was going to make out of
the doctors.
“At the last trial, before Judge Lord, the preceding facts and
many others of similar import were proven. ‘Twenty police-
men testified to Blodgett’s habits of drunkenness, eccentricity,
and to his violent actions. They all agreed that he was different
from ordinary drunkards in his talk and conduct, and was regard-
ed as crazy and dangerous when in liquor. This opinion
was sustained by many sober witnesses who knew him. well,
and by his own confessions to Major Jones, as well as his appear-
ance on the stand. He there denied in a wholesale way all
excessive drinking and all acts of violence, only to be contradic-
ted by many reliable witnesses. He might, perhaps, truly have
said that he remembered no acts of violence, as I have no doubt
his conduct was automatic. Judge Lord allowed the facts ob-
tained by ‘due inquiry’ to be testified to in full, the other side
failing to object.
“A number of experts were called by the defense Drs. Walker,
Brown, Gage, Russell, Denny, Jelly, Folsom, Channing, Day,
(270 MEDICAL JURISPRUDENCE.
Blodgett, Fisher and Youngman, gave their definitions of dip-
somania and testified to the propriety of treating it in hospitals
for the insane, in the absenceof other special institutions.
These gentlemen substantially agreed in affirming the existence
of sucha disease and in the necessity of so treating it.
“The plaintiff called on his behalf Drs. Henry G. Clark, J. P.
Treadwell, and Horace Chase. Dr. Clark thought a dipso-
maniac must be a person who on drinking a single glass must
inevitably go on to complete intoxication. He thought Blodgett
did not fall within this definition. He was obliged to admit,
however, that he had recently said that Blodgett was ‘crazy
drunk’ and properly sent to Taunton, but was kept too long ;
and that he had certified within three months in the case of a
dangerous dipsomaniac committed to Danvers. Dr. Treadwell
gave his views at length, and thought the part of the testimony
he had heard did not warrant calling Blodgett a dipsomaniac.
Dr. Chase’s testimony I did not hear.
“Judge Lord’s charge to the jury was satisfactory in every
way to the defense, and was an admirable statement of the
rights and liabilities of physicians certifying in cases of insanity.
It deserves reproduction asa whole, but I will give only a very
brief abstract of it. Judge Endicott had said in substance at
the previous trial that it was evident from the testimony that
there was such a disease as dipsomania ; that the line between
it and ordinary vicious drinking was a narrow one, which only
qualified medical men could safely draw; and that a lunatic
hospital was a proper place for its treatment. Judge Lord,
however, told the jury to reject the technicalities of the doctors,
and charged that if mental unsoundness of any kind existed it
was an end of the case; that if physicians honestly believed
the party to be insane, although they may have been misled or
mistaken, they were not responsible. They were obliged by
law to make “ due inquiry” of the parties most likely to possess
the facts relating to insanity, and nearest by ties of relation-
ship or affection to the patient ; but they could not take sworn
evidence in the case, and must act according to their best judg-
ment upon the facts obtainable. Their certificate was not re->
quired by law to be under oath, and was merely the necessary
means of bringing the case into the jurisdiction of the proper
court, after which they were not responsible for the action of
the court, unless it could be shown that they willfully gave false
testimony, or grossly and criminally neglected to inquire into
the facts of the case. In the words of thecourt, “If capable
physicians should act recklessly, disregarding the rights of the
ALCOHOLISM. 27%
party, and send him off to a hospital without any evidence at all,
then they would be responsible. But if, on the other hand,
they made the inquiry which the circumstances of the particu-
lar case called for, then although subsequent events may show
that that inquiry might have been pursued further, if they
acted in good faith, thatis their protection.’ The jury return-
ed averdict for the defendants.”
So far as the making of contracts is concerned the law does
not interfere when there is rational consent, but when the
drunkard is in such a condition when he makes a contract
having no intelligent idea of what he is doing, such a contract en-
tered into by him cannot be considered valid or binding. Mar-
riages made when the individual is utterly unconscious of what
he is doing, are of course null and void.
Testamentary Capacity.—The will of a confirmed drunk-
ard will stand in law, provided the person who made it is notina
condition to be so unreasonable and irrational as to be unable to
exercise any thing like healthy judgment. A man may be a hard
drinker, and make the will after a debauch, but unless its char-
acter is so absurd as to betray mental unsoundness he cannot
be reasonably deemed irresponsible. In a recent case in which
I appeared, the testator was a man of bad habits, who drank im-
moderately and steadily. Evidence was produced to prove that
he had done all manner of foolish things before and after the
will was made, but no evidence was brought forward to show
that at the time the paper was signed the testator was in any
condition to prevent him from fully knowing the nature of
what he was doing.
We are to consider in such cases the degree of the drunken-
ness, the habits and physical condition of the person.
The will of a man of bad habits is often contested, it being
asserted that his alcoholic dissipation renders him incom-
petent. But though an individual may be outrageous in
his ordinary conduct, a great deal more is required than
these exhibitions to indicate that he has not the power of
mind to make a will. Such a case fell under my notice
two or three years ago, the testator being a man of mid-
dle age, who had for months been addicted to drinking,
although in a periodical way. A vague history of bad temper,
broken sleep and many extravagant acts, none of which, how-
ever, were necessarily manifestations of insanity, were testified
to by the contestants, and one physician gravely asserted that
a proof of his mental perversion consisted in the irritability of
272 MEDICAL JURISPRUDENCE,
his throat during the time he was making medicated applica-
tions to the same. He was alleged to have declared that “he
could not retain any thing upon his stomach,” that “he resorted
to memoranda that he should not neglect his engagements,”
that “he abused the doctor who had treated his wife during
her last illness, and threatened him with violence,” that “he com-
plained of being homesick ;” and various persons who had seen
little of the testator testified to having observed him drunk on
several occasions ; that “he was extravagant, and bought large
quantities of oranges,’ which, however, were for his sick wife ;
and that he “talked wildly about his business.”’ It appeared, on
the other hand, that he was able to attend to his affairs for some
time before his death which was not due to alcoholism; that when
he made his will it was ata time between two of his sprees,
and that there was no want of sagacity or any irregularity
shown in the disposition of his property. In this case, as in
many others, the popular ideas of insanity are apt to be thor-
oughly ventilated, and it is strange that this kind of testimony
should receive any attention whatever in courts of law. Itisa
very easy matter to exaggerate the disorderly behavior of an indi-
vidual who is in no sense insane. The “excitement” alluded
to by interested witnesses is probably nothing more than a mod-
erate emotional exhilaration, and the business schemes which
attract the wonderment of those who wish the will broken,
ordinarily display a mind of unusual shrewdness. The specu-
lations nearly always turn out well, and the despondency does
not rise above the dignity of an ordinary attack of the blues. In
the above case the husband’s devotion to his dying wife
seemed to have astonished those persons who appeared
upon the side of the contestants ; and this peculiar behavior,
which was regarded by them as evidence of mental unsound-
ness, consisted in such kindly offices as removing her to the
window, so that she might get the fresh air, and bringing her
fruit ; and though his exuberation of affection might have been
that which is so often intensified by occasional libations, it was
in this case nothing unusual. It did not appear that there was
any thing in the character of the will that indicated insanity ;
that it was legally witnessed, and made at the time when the in-
dividual was perfectly sober, and was therefore very properly
admitted to probate.
In another case of a different kind, the patient had for sev-
eral years indulged in large quantities of alcohol, and it was
common for him to shut himself up in the room with a box of
champagne and not leave until he had recovered from the
ALCOHOLISM. 293
effects of the intoxication produced by the dozen bottles he
finished one after the other in rapid succession. ‘This man for
several years before his death drank all kinds of liquors to ex-
cess, squandered his money, giving large amounts to persons
who had little or no claim upon him, and betrayed a change in
character which was remarkable when contrasted with the
regularity and sobriety of previous years, Within a short time
before his death he manifested symptoms of the inevitable dis-
eases which are due to excesses of this kind, and he finally suc-
cumbed to cirrhosis and died comatose. When supported in
bed and surrounded by those to whom he left his money, he
made awill and died afew hours afterwards. This will was
very properly contested by his brother, and it was admitted to
probate by the Surrogate, though the decision of the latter was
subsequently reversed. Itis quite likely here that the man’s
mental condition was one which even some time before his de-
mise would prevent him from properly recognizing the objects
of his bounty, and render him an easy prey to designing
persons ; but a will made under more outrageous circumstances
it is difficult to conceive of, for he was literally in acondition of
extremis when his name was signed to the document.
Case LIV.—ALcoHo.Lic INSANITY WITH GENERAL DELUSIONS
Not AFFECTING TESTAMENTARY CAPACITY.
Lee
US. 31 N. J. Equity Reports, 633.
Scudder,
Betsy Marsh died April 7, 1876, aged 65 years. She was
eccentric in dress and coarse in language. She died after a
short illness, of a disease of the brain, not determined, which
gave rise to frequent delusions. These delusions only appeared
occasionally. On the 3d of April, 1876, she executed her will,
and stated in answer to a question that she knew what she was
doing, and later in the same day sent for a Dr. Kinch, who had
drawn her will, to make some alterations init. These altera-
tions were never made, for the next day she was found intoxi-
cated in the woods, and from that time she was very ill until she
suddenly died on the 7th of April. It was testified that de-
ceased was of sound mind at the time the will was executed ;
that her delusions were only intermittent, resulting from her
disease, and that they consisted of presentiments of death, and
18
(274 MEDICAL JURISPRUDENCE.
did not relate to any person who might have been an object of
her bounty.
The will was admitted in the Union County Orphans Court,
and on appeal to the Prerogative Court this action was affirmed.
In chronic alcoholism with organic brain diseases the question
of responsibility naturally arises. In most cases of advanced
structural disease the character of the testator undergoes a
series of changes which render him weak, vacillating, childish
and without vigorous memory. At such times it is extremely
probable that the patient is a prey to designing relatives, and
suffers enfeeblement of the will.
Care should be taken not to confuse the mental impairment
of old age or eccentricity with the peculiarities of disposition
and habits resulting from chronic alcoholism.
Alcoholism and Life Insurance.—Litigations frequently
arise between life insurance companies and the heirs of
deceased persons who have either drunk to excess or who have
died from alcoholism. In most of the policies, there is a clause
which explicitly states that excessive indulgence in alcohol or
any drug that tends to materially shorten life must vitiate the
contract. In some instances the patient withholds his bad hab-
its from the company, in others the formation of the bad habit
arises sometimes after the application for the policy ; and again
the question of heredity arises, and the patient makes his dec-
laration entirely ignorant of any family taint or predisposition
to drink. It sometimes happens that policies are transferred,
and the individual subsequently drinks himself to death—thus
inflicting a loss upon the assignee, and perhaps giving rise to a
suit brought against his executors. ‘The question of alcoholic
indulgence in this connection gives rise to a number of possi-
bilities. The individual may be a hard drinker and yet show
no signs of drunkenness, and may drink to excess,- and _ pre-
sumably to a degree to shorten life, still it will be exceedingly
difficult to prove this. |
Several English companies refused to pay premiums to the
families of hard drinkers, and in court the family were able to
show that the decedents had never been thought drunk. When
asked to define drunkenness, the Judge stated it was a state in
which a man loses his reason and the use of his legs, and is
incapable of responding to questions when addressed. ‘This is
a most general definition, when we bear in mind the variety of
conditions in which the same state of affairs exist.
CHAPTER VI.
SUICIDE.
Medico-Legal Questions Arising in Connection
therewith.—The medical man is often expected to make ex-
aminations of dead bodies and to testify in court in regard to
suicide, and the duty is by no means a light one, for it may in-
volve very serious responsibilities. The question that may
arise is, whether suicide or homicide has been committed.
He is also called upon to consider cases of life insurance ;
for it is not uncommon nowadays for persons to insure
in heavy amounts, and then make away with themselves, so
that their families may be provided for, or their creditors may
be paid. -In a class of cases, which must hereafter arise in
greater numbers than they already have in the courts, it be-
comes our function, since the laws are so strict in regard to
the punishment of would-be suicides, to pronounce upon the
responsibility of the individual who has been arrested while
making an unsuccessful attempt to do away with himself. In
such examples as the life insurance cases, the question of in-
sanity comes up, and we are to decide the criminal and civil
obligations that may be submitted to us in court, so far as the
mental condition of the suicide is concerned.
Principal Modes of Death.—Under the first head ;
namely, cases in which a doubt exists whether the crime should
be designated suicide or homicide, it behooves us to carefully
investigate the mode and cause of death; the presence of
wounds or contusions, and the situation of such injuries; the
question also arises whether the wounds were inflicted perhaps
on a body already dead for the purpose of directing sus-
picion and baffling detection. In cases of drowning the evi-
dences of a possible struggle must be looked for, and regard
should be paid to the place chosen for the deed. Where death
has been brought about by poison, we are to determine the
character of the poison used, and its effects in point of time as
contrasted with the evidence of those who last saw the patient
276 MEDICAL JURISPRUDENCE,
alive. We are also to ascertain the possible motive of the sup-
posed suicide, his relations to his family, and in fact all the cir-
cumstances of the individual’s life.
Wounds Inflicted by Suicides.—The wounds made by
the suicide are rarely incised, and stabbing is very uncommon.
The exception however to this rule is where the method has
been throat-cutting ; and it is exceedingly difficult to differ-
entiate the wounds that have been inflicted by a murderer or
a suicide; both may be made with the razor, and by the
latter such is usually the case. In both instances there are a
series of preliminary cuts, known as fentative, which are to be
found at the place of commencement of the major incision.
Direction of the Wound.—We are to determine in
doubtful cases the side of the neck at which the wound
starts, and we are generally able to detect the beginning, the
center, and termination of the incision by the varying depth.
Ogston states that the commencement of the incision has but
one point, while the latter part ends in a bifurcation or several
divisions. The tentative cuts, as I have said, are those which
may be found near the commencement of the wound, and do
not connect with the large incision, but may be superficial, and
above or below it. The deepest part of the wound is usually
at the commencement.
Fig. 6.
Suicidal Cut-Throat.
(Ogston.)
It is important in cases of suicide to notice that the wound
SUICIDE. 277
usually runs from left to right, except in rare cases where the
patient is left-handed ; while the reverse is ordinarily the case
in murderous wounds.
_Asarule it may be assumed that in wounds of the throat
inflicted by suicides, especially those who know nothing of the
anatomy of the parts, the point of commencement of the wound
is usually higher than the termination. It is often difficult,
however, to determine this question with any degree of cer-
tainty, and curious instances are brought forward in which
suicidal attempts have been made not only by left-handed
persons, but by those who held a knife in each hand and make
a double wound. In such a case as the latter, of course, we
would, under ordinary circumstances, be utterly powerless to
speak with any measure of positiveness.
Number of Wounds.—In suicidal cut-throat there is usu-
ally more than one wound, and this is more frequently so
either in timid persons or those who are more or less under the
influence of drink, and this is apt to be the case although a
man may be wrought up to steadiness with alcohol and may
make a deep unwavering cut.
Casper relates the following cases in which the difficulties in
judging of the character of a wound by the direction are shown :
“Upon one and the same day we dissected the bodies of two
men, one 21 years of age and the other 50, both of whom were
well known to have killed themselves by cutting their throats
with a razor, the former three and the latter two days previ-
ously. I relate these two cases because, in the first place,
although they were both indubitably cases of suicide, yet the
wounds were perfectly horizontal, so that it was perfectly impossi-
ble to say where the wounds had commenced and where they
ended. Further, there was this peculiar circumstance in relation
to the body of the older man, that even the hands had been
washed before it came before us for examination, and in respect
of the younger man, that his /ef¢ hand was completely besmeared
with blood, the right much less so; further that the left hand
was quite spasmodically contracted, the right not. These ap-
pearances induced us to suppose that the incision must have
been made with the left hand, and this supposition was subse-
quently ascertained to be correct by the inquiries of the police.”
Homicide Distinguished from Suicide.—In these cases,
also related by Casper, the evidences of homicidal acts are
distinguished from those of a suicidal character: “Some time
back the body of a man was found lying on the high-road, The
278 MEDICAL JURISPRUDENCE.
throat was severely cut, and he had evidently died from hemor-
rhage. A bloody knife was discovered at some distance from the
body ; and this, together with the circumstance of the pockets of
the deceased having been rifled, led to a suspicion of murder.
This idea was confirmed when the wound was examined. It
was cut, not as is usual in suicide, by carrying the instrument
from before backwards, but as the throats of sheep are cut. The
knife had passed in deeply under and below the ear, and
had been brought out by a semi-circular sweep in front, all
the great vessels of the neck, with the cesophagus and
trachea having been divided from behind forwards. The
nature of the wound at once rendered it improbable that it
could have been self-inflicted ; and it further served to de-
tect the murderer, who was soon afterwards discovered, and
executca,.
“With reference to the extent of the wound, the cele-
brated Earl of Essex’s case has often been quoted. He
was found dead in the Tower in 1683, and it was the
generally received opinion that he had been murdered by per-
sons hired by the Duke of York, afterwards King James II.
Upon examining the wound, it was found that the jugular
vessels, trachea, and cesophagus, were cut through to the
very neck-bone. The verdict was suicide. In 1688 the
matter was revived, and before a committee of the House of
Lords, it was proved that the razor which the wound was in-
flicted was found on the left side of the body, while it was
known that the Earl was left-handed. The edge of the razor
was found notched ;' and it was also proved that the cravat
worn by the deceased was cut through, and his right hand
- was wounded in five places.
“The committee made no report. Lord Delamare under-
took to draw it up, but before he did so, Parliament was
prorogued. Bishop Burnet, who has given the particulars of
the case with great minuteness, says he had no doubt that the
Earl of Essex committed suicide. He was subject to fits of
deep melancholy, and maintained the lawfulness of suicide,”
Location of the Suicidal Wound.—The location of
the suicidal wound is a matter of a great deal of importance.
It is, of course, unlikely that the back would be found to be
the site chosen, while writers upon medical jurisprudence gen-
erally admit that the suicide very rarely inflicts a wound upon
the left side of the body. Self-inflicted injuries are usually
upon the front of the body. .
SUICIDE. 279
Seat of Wounds.—The suicide is very apt to choose
certain situations which would not naturally be selected by the
murderer for the infliction of violence. Thus we find that they
very often place the muzzle of the pistol’ into the mouth, or
fire so that the ball passes evenly through either temple. They
select the most vulnerable or vital point. Pistol wounds are
very rarely made by suicides in other parts than the head, ex-
cepting, perhaps, the region of the heart. But the murderer,
if he selects the head, usually fires from behind ; or if he aims
at the trunk his ball enters at some point where the suicide
would never think of wounding himself, or perhaps where he
could not if he would.
Contusions Unusual.—Contusions are very rare among
suicides, unless they be due to injuries received just after the
fatal act has been committed ; as when the victim falls upon
the rocks or from a height; but under such circumstances no
reasonable doubt can be entertained as to their origin and na-
ture, for they are not in situations where they undoubtedly
would be if self-inflicted. Of course, reasonable doubt
may sometimes arise when different sides of the arms or
legs or irregular parts are conjointly injured, where there has
been a fall. In multiple injuries inflicted by an assailant there
will be some regularity in the distribution of the contusions.
It has been said by Ogston that very severe contusions by such
weapons as an ax or hammer, or some other ponderous instru-
ment, are more often suggestive of murder than suicide, and it
is impossible to arrive at any conclusion as to their being due
either to suicide or accident.
Position of the Weapon.—The presence of a weapon,
either in the hands of a suicide or near him, strengthens the
probability of a self-perpetrated crime ; though, as we all know,
the pistol may be placed in this position by a cunning murderer
to conceal his act. In the suicide we will probably discover a
spastic contraction of the fingers or a naturalness in their po-
sition which could not be arranged or effected by another per-
son. So, too, it sometimes happens that the suicide provides
himself with a gun, and his position with reference to the instru-
ment may settle the question of self-murder. Concealment of
the: body, removal of the weapon, or, as it occasionally has
happened the placing of a weapon near the body in sucha
position that the suicide could not have reached it, or
where he could not haye thrown it, suggest homicide most
strongly.
280 MEDICAL JURISPRUDENCE.
Accomplishment of Suicide by Men and Women.—
Men and women commit suicide in different ways. It is quite
rare to find a woman who has shot or stabbed herself. We do,
however, find that if the self-inflicted wound has been made by
her, it, as a rule, consists in the opening of a vein with a pen-
knife or pair of scissors, or some small weapon. Women usu-
ally make away with themselves by poison or by drowning, or,
rarely, by hanging; while men in many cases seek the pistol,
razor or the knife.
Suicide by Drowning.—Suicide by drowning is.a quite
common method, and we are very often required to distinguish
between accidental and suicidal death.
In cases where murder has been committed it is a somewhat
common occurrence to find that the victim has first been mur-
dered and the body then thrown into the water for the purpose
of giving the impression that the victim has taken his own life.
In this case if the body bears wounds, we are to determine whe-
ther such wounds are post-mortem or if they have been pro-
duced just before death ; in the latter case an assault will be
suggested.
Multiple Attempts.—lIn rare instances, however, suicides
have been known to stab or shoot themselves before resorting
to the water; but here we will often find that the situation of
the injury is inconsistent with murder, and it is probable that
the pistol or knife will be found near the body of the victim.
Post-mortem wounds are usually of a character which suggests
the improbability of self-infliction. Violence, such as a fall
upon the rocks, or that which would occur as a consequence
of the body being dashed against a dock or crushed beneath
shipping, will sometimes produce quite suspicious cuts and
blows. Ogston refers to a double dislocation, resulting from
forcible contact with the bottom ofa large ship, the body having
been in the water some time. In other cases of this kind
we usually find multiple injuries, for the severe force that
produces such a notable accident would give rise to minor frac-
tures and dislocations as well. Ogston-also relates an instance
where a female suicide received a laceration of the perineum
by the forcible separation of the thighs on coming in contact
with the water. The collision with some obstacles in his way,
when falling into the water, may also cause formidable injuries,
which may be imputed to violence the victim has received at
the hands of another person.
Deliberate Preparations — Rope Tying. — Suicides
SUICIDE. 281
sometimes tie themselves up so that their attempt shall not
miscarry, and this may perhaps suggest when the body is found
that a homicide rather than a suicide has been committed.
Such a method of disposal of the body by a murderer is unusual,
however, and a careful examination of the knots and turns in
‘the rope will indicate that they have been made by the person
himself before taking his own life.
“A man, with his wife and child, was reduced to great distress.
On acertain day he took an affectionate leave of his family, de-
claring he would not return until he had procured some em-
ployment by which he would be able to buy bread for them.
On the following day he was found drowned in the New River,
with his hands and legs tied. A card with his address was
found in his pocket.”
Casper also relates the following interesting history, when the
person had been murdered and then tied up and the theory of
‘suicide was disproved by the head injuries :
“Tn April, 1848, an unknown body was taken out of the
Spree, which was, however, soon recognized as the body of
a shipmaster, who disappeared from his vessel on the evening
of—say the 18th of March, 1848, and had not since been seen.
A well-grounded suspicion of robbery and murder was directed
against the servant of the deceased, who, on the morning of
the 18th of March, when no man in Berlin could foresee the
dreadful termination of the day, had locked up a consider-
able sum of money for his master, which was missing from the
broken chest on board the ship, and part of which, along with
articles of clothing belonging to the deceased, was found with
the servant, who, however, obstinately denied his guilt. For
the accusation, it was a most probable supposition, that the
servant, on the evening of the 18th of March, when the fires of
riot raged in Berlin, had taken advantage of the general anar-
chy and confusion to perpetrate a robbery and murder, which
he might hope would remain undiscovered at such a time.* * *
“ But to return to the dissection, at which of course we had not
the slightest suspicion of these discoveries. The body when taken
out of the water had on a thick brown cloth overcoat, a handker-
chief and several rags were wound round the head, and tied with a
cord round the neck, the legs were also tied together with a
string. The body was already grayish-green, consequently far
advanced in putrefaction. (The temperature of the spring had
been with us continuously high). The bluish-green and swol-
len tongue protruded from between the toothless jaws. No
mark of strangulation could be seen upon the neck.
282 MEDICAL JURISPRUDENCE,
“But there were important cranial injuries, one three cornered
one with blunt ragged edges over each eyebrow, and one an
inch long on the right parietal bone ; in at least two of these
wounds ecchymoses were brought to ight by incisions. When
the epicranial aponeurosis, covered with half coagulated blood,
was torn off we found a complete smashing of the whole skull,
including even the dasts crantt! The brain, a (bloody) pap,
as is always the case in bodies so far advanced in putrefaction,
could no longer be investigated.
“The lungs, especially the right one, were distended with
black and not very fluid blood; the trachea and larynx were
blackish-blue from putrescence, and empty ; the heart was per-
fectly empty, as were also the large thoracic vessels; the
stomach empty, as was also the urinary bladder; of course in
such a degree of putridity the vena cava was likewise empty,
and except the advanced degree of putrescence of all its organs
there was nothing else remarkable in the abdomen. It was, as
is evident, a very plain case. It was just as difficult to under-
stand why a suicide should have so bound and tied his head
and legs, even if he could have done so before throwing him-
self into the water, as to conceive what could have induced a
third party to do so, when his intention was simply to throw
the man into the water and drown him. There were certainly
no proofs found in the body of death from drowning, and the
advanced stage of putrescence would have rendered these very
uncertain even had the man been actually drowned—but it was
easy to prove that this shipmaster had not been drowned, but
had been killed by the fearful cranial injuries inflicted on him,
and afterwards bound up and thrown into the water, since the
ecchymoses found proved that these injuries must have been
inflicted during life, and thus rendered untenable the assump-
tion that they might possibly have been accidentally inflicted
on the corpse while floating in the water. Moreover, the na-
ture of these important cranial injuries, particularly the fracture
of the daszs craniz, always necessarily presupposes the employ-
ment of the utmost violence by means of blunt weapons—we
adduced as examples of such an ax, hammer, club, etc.—such
as could not possibly happen by simply floating against piles,
or by being struck by stones or rudders. Accordingly—apart
from the then statutory questions—we assumed that the de-
ceased had not been drowned, but had been killed by (absolute-
ly fatal) cranial injuries, and only thrown into the water after
death, and that these cranial injuries had been inflicted with
very considerable violence, and with a blunt weapon,
SUICIDE. 283
“So much for our task; the reader will perhaps be interested
in the following appendix. Every body was fully convinced of
the guilt of the accused, and yet the verdict was as it ought—
‘not guilty!’ For the identity of the body was doubtful, as
first appeared at the time of the public oral trial. The widow
of the murdered man, living in a small provincial town, was
summoned to the trial in order to confirm supplementarily the
identity of the body from the articles of clothing, and the ex-
ternal description of the body contained in our protocol of the
inspection—she had not been summoned for this purpose at
the discovery of the body, because it was at that time wholly
unknown. She recognized the articles of clothing, but when
questioned about the color and condition of the hair, eyes,
and teeth, etc., of her husband, this very feeble minded woman
gave indistinct and wavering answers. Thus, as we said, it ra-
mained doubtful whether the body of the murdered man was
that of shipmaster K., and therewith fell the proof that the ac-
cused, his servant, had murdered his master.”
In some cases we shall find evidences of disease which has
given rise to delirium leading to the act of self-destruction, and
I regard such help as very important. The appearances of
inflammation of the brain, effusion of lymph, and signs of men-
_Ingitis are too important to be overlooked.
Condition of the Organs of Circulation.—Writers upon
medical jurisprudence suggest that the condition of the organs
of circulation will often enable us to arrive at a correct idea as
to the condition of the person just before death, and the ques-
tion whether .there has been a struggle; we are also to take
into account the degree of cerebral congestion. In cases
where death has presumably occurred before the body was
thrown into the water we of course find none of the physical
evidences of death by drowning, which a struggling man makes
who is at first in possession of his senses.
Suggestion of Putrefaction.—Caspar refers to the many
difficulties that may beset us in our attempt to unravel the mys-
tery that belongs to many doubtful suicides. He speaks of the
post-mortem changes that are to be found when a body has re-
mained a long time in the water, is consequently putrified, and
where there has been an escape of blood into the cellular tis-
sue, and he tells us how easy it 1s to mistake such conditions,
as well as those post-mortem elevations of the scalp which de-
pend upon effusions of blood as the result of putrefactive de-
composition, for injuries supposed to have been inflicted by
284 MEDICAL JURISPRUDENCE,
other persons. It is never safe to testify too positively in re-
gard to the state of the body of those not recently drowned,
and it is just such cases in regard to which ignorant people
are inclined to form hasty opinions.
Weights in the Pockets of Deceased.—It is held by
some authors that the presence of stones in the pocket of the
suicide, where there are no marks of violence upon the body,
is suggestive of suicide, although it is not uncommon for a
murderer to attach weights to the body of his victim; but in
the latter case we shall probably find that there are some evi-
dences of a struggle.
Suicide and Drunkenness.—We are also to be on our
guard in regard to the fact whether the drowning has been the
result of adrunken spree. The presence of written matter upon
the person of the suicide, or notes in his diary, of course need
hardly be mentioned as suggestive hints which should enable
us to form an opinion.
Suicide by Hanging.—French medical literature abounds
with cases in which the question of suicidal hanging arises, and in
this connection some examples are reported of murderers who
have first disposed of their victim, and then suspended him to
give the idea that he had taken his own life. Such examples are
rare in this country, and it is only in those cases where the
victim has first been poisoned, that the diagnosis of the mode
of death might be obscured. Even in some instances the“pos-
sible detection of its presence might be easy, but a mur-
derer would not resort to so clumsy a method, for he would not
be sure of the duration of the effects of the poison before death
actually occurred. In mostof the reported cases there are head
injuries that could not be self-inflicted. It is undoubtedly the
fact that sometimes the suicide resorts to several methods before
he ends with hanging to make sure. Taylor says :—‘‘ The dis-
covery of a person dead from hanging is presumption of suicide
all other circumstances being equal.’’ He, however, makes
certain exceptions, which are:—‘1. The fact of the person
hanging being feeble, and the assailant a strong man; 2 The
fact that the person hanging has been stupified by narcotics, or
intoxicated, or has been worn out and exhausted in a struggle ;
3. In all cases when a number of men are arrayed against one
(Lynching.)”
In homicidal hanging there are usually some marks resulting
from a struggle with the assailant, although this is by no means
SUICIDE. 285
necessarily so. Tayloriefers tothe case of a woman who hung
her husband who while lying asleep was approached by his
wife who managed to twist a rope about his neck and tie it to
a beam raising his head. The husband who went to bed sober
denied all knowledge of the murderous attempt when he was
resuscitated. The wife was drunk and Taylor thinks the man
must have been likewise, and this author does not believe that
any attempt of this kind could have been carried out unless
such was the case.
Fig. 7.
Suicidal Hanging.
(Taylor.)
No reliance can be placed upon the statement of some au-
thors who believe that a differential sign between suicidal and
homicidal hanging is that in the latter two marks of the rope
will be found upon the neck of the dead body.
Careful autopsical investigations may reveal in suspected
cases the marks of homicidal violence, rupture of the internal
organs for example.
The Case of the Due de Bourbon.—Winslow, in his
“Anatomy of Suicide,” relates the following cases, the first of
which is the celebrated case of the Duc de Bourbon:
“On the 27th August, 1830, the duke was found suspended
in his bedroom, in the Chateau of St. Leu. An inquest was
286 MEDICAL JURISPRUDENCE,
held the same morning on the body, and from the evidence of
the witnesses, as well as from the reports of the physicians and
surgeons who examined it, a verdict was returned to the effect
that the duke had committed suicide in a fit of temporary in-
sanity. This event did not excite much notice until the con-
tents of his will were made public. The deceased, it appears,
had made his will in favor of the Baroness de Feuchéres, a female
who had lived with him for some years, bequeathing to her the
whole of his immense estates, and leaving the Duke d’Aumale,
the youngest son of the king of the French, residuary legatee.
The Princes de Rohan, heirs by collateral descent to the
deceased, thus finding themselves deprived of an expected
inheritance, attempted to set aside the will, alleging that undue
influence had been exercised over him. The cause came on
for hearing before the First Chamber of the Civil Tribunal of
Paris, in December 1831, and excited considerable attention,
not so much in consequence of the dispute concerning the
validity of the will, as of the question which was raised during
the trial—whether the duke had committed suicide, or whether
he had been murdered, and afterward suspended im order to
defeat thevends of justices Whe facts“of thegcase collected
from the procés verbaux, are as follows:
“The deceased had naturally partaken of the alarm which
had diffused itself throughout France in consequence of the
events of the revolution of 1830. Some of his most intimate
friends declared that for some time previously to his death, his
mind had been filled with the most gloomy forebodings as to
what this new order of things would bring about. On the
morning of the 27th his servant went as usual to his bedroom
door about eight o’clock ; but receiving no answer on knocking,
he became alarmed. Madame de Feuchéres then accompanied
the valet to the door of the room which was fastened on the
inside; and receiving no reply after calling to the duke in a
loud voice, she ordered it to be broken open. On entering the*
apartment, the body of the deceased was found suspended
from the fastening at the top of the window sash by means of a
linen handkerchief, attached to another which completely
encircled the neck. The head was inclined a little to the
chest ; the tongue protruded from the mouth; the face was
discolored ; a mucous discharge issued from the mouth and
nostrils ; the arms hung down, the fists were clenched. The
extremities of both feet touched the carpet of the room, the
point of suspension being about six feet and a half from the
floor ; the heels were elevated, and the knees half bent. The
SUICIDE. 287
deceased was partly undressed: the legs wete uncovered and
had some marks of injury on them. Among other points of
circumstantial evidence, it was remarked that a chair stood
near the window to which the deceased was suspended, and
the bed looked as if it had been lain on.
“The medical witnesses, who examined the body soon after
its discovery, stated that they found it cold, and the extremi-
ties rigid, from which they inferred that the deceased had been
dead eight or ten hours. This would have fixed the time of
his death at midnight of August 26th. The body underwent
a second examination, a report of which was furnished to the
legal authorities on the following day. Five medical men were
present at the inspection; and they gave it as their opinion
from the post mortem appearances: 1. That the deceased had
died by hanging; and, 2. From the absence of all marks of
violence or assistance about the person or clothes of the
deceased, and other facts, that he had destroyed himself. They
considered that the contusion on one arm and the excoriations
observed on both legs, must have arisen from the rubbing of
these parts against the projecting rail of the chair near the
window. ‘The mark on the neck of the deceased they described.
to be large, oblique and extending upwards to the mastoid
process.
‘“‘ General evidence was given to show that the Duke had medi-
tated self-destruction, and had conversed about it with some of
the witnesses. On the morning of the 28th, some fragments of
paper which had been written on were taken from the grate of
his chamber ; these were carefully put together by one of the
legal inspectors ; and among a few disjointed sentences, indi-
cating despair and a dread of impending danger, were the fol-
lowing :— ‘It is only left for me to die in wishing prosperity to
the French people and my country. Adieu forever!’ Here
followed his signature and a request to be interred at Vin-
cennes, near the body of his son, the Duke d’Enghien. It is
necessary to observe that no noise or disturbance was heard in |
the bedroom on the night of the deceased’s death.
“On the other hand it was contended that the duke was not
unusually melancholy before his death ; that the supposition of
suicide was inadmissible in a moral point of view, and indeed,
was physically impossible, from the circumstances. One per-
son argued that he could not have made the knots seen in the
handkerchief ; another that he could not have reached so high
above his head to have suspended himself, and that the chair
could not have been used in any manner to assist him; whilea
288 MEDICAL JURISPRUDENCE.
third affirmed that a person might be suspended in the position
in which the body was discovered, without death ensuing. The
circumstance of the door being fastened on the inside was
accounted for by supposing that the bolt had been pushed to
from the outside. The duke had been heard to condemn sui-
cide; he had made an appointment for the following day ; and
had attended to many little circumstances, such as winding up
his watch the night previously and noting his losses at play ;
facts which were forcibly urged as being opposed to the sup-
position of his having destroyed himself.
“To combat the medical evidence, it was assumed that the
deceased was strangled or suffocated, and was afterwards
hanged by assasins. Several schemes were devised by the med-
ical witnesses on this side of the question, to account for the
manner in which the supposed murder was committed.
“ According to some, a handkerchief might have been tight-
ened round the deceased’s neck by one assassin, while another
forcibly held his legs under the bedclothes, by which the lesions
already described would have been produced, or instead of be-
ing strangled by a handerchief, he might have been suffocated
by a pillow placed over his mouth. The body might then have
been dragged across the room to be suspended ; and if during
this time the hand of one of the assassins had been rudely
thrust between the cravat and the neck, the excoriation and
mark seen on the skin might be accounted for. The counsel
for the appellants remarked that the want of a line in writing,
to withdraw from all suspicion, his attendants and even Madame
de Feuchéres, was remarkable, as this /atter precaution had sug-
gested itself to almost every suicide. He condemned those en-
gaged in the anatomical examination of the body, as having
been guilty of culpable mismanagement. He ridiculed the
idea that the duke, as reported by the two physicians consulted,
had probably come to his death through asphyxia by strangu-
lation. He contended that all the appearances on the skin of
the neck, where no ecchymosis, as zs usual in persons hung
alive, was visible, showed that death had preceded the hanging of
the body.
Beck reports a case of a suicide, and the punishment of an
innocent person for supposed murder: “ Marc Antoine Calas
was the son of John Calas,-a merchant of Toulouse,
aged seventy years, of great probity and a Protestant.
He was twenty-eight years of age, of a robust habit,
but of a melancholy turn of mind. He was a student of law,
SUICIDE, 289
and becoming irritated at the difficulties he experienced (in
consequence of not being a Catholic) concerning his license,
he resolved to hang himself. This he executed by fastening
the cord to a billet of wood placed on the folding doors which
led from his father’s shop to his store room. ‘Two hours after-
wards he was found lifeless. The parents unfortunately re-
moved the cord from the body and never exhibited it to show
in what manner his death was accomplished. No examination
was made. The people, stimulated by religious prejudice, car-
ried the body to the town-house, where it was the next day ex-
amined by two medical men who, without viewing the cord or
the place where the death had been consummated, declared
that he had been strangled. Onthe strength of this, the father
was condemned by the parliament of Toulouse, in 176:, to be
broken on the wheel. He expired with protestations to heaven
of his innocence.
“ Reflection, however, returned when it was too late. It was
recollected that the son had been of a melancholy turn of mind ;
that no noise was heard in the house while the deed was doing ;
that his clothes were not in the least ruffled ; that asingle mark
only was found from the cord, and which indicated suspension
by suicide ; and in addition to these, that the proper dress for
the dead was found lying on the counter.
“Voltaire espoused the cause of the injured family and attract-
ed the eyes of all Europe to this judicial murder. The cause was
carried up to the Council of State, who on the 19th of May,
1765, reversed the decree of parliament and vindicated the
memory of John Calas.”
Suicide by Poisoning.—Suicide by poison, as I have
said, is more commonly resorted to by women than by men;
and oftentimes there is no difficulty in determining whether
the method of death was suicidal or homicidal. As a
rule, the poisons used by suicides are those which would not
be selected by a designing murderer, and especially true is this
among the lower classes. Inthe city of New York, Paris green,
which is bulky and undisguisable, is employed very much more
often than any other substance for the purpose of self destruc-
tion, and laudanum perhaps comes next. The mineral acids
and oxalic acid, as well as other irritant substances, are fre-
quently made use of for the purpose. As most of these poisons
do not kill immediately, we are often enabled to watch the
patient, and consequently learn the nature of the crime; foras
a rule a period of regret and remorse attends the commence-
290 . MEDICAL JURISPRUDENCE.
ment of disagreeable effects, and in the majority of cases the
would-be suicide appeals piteously for help.
The doubtful cases are those where narcotics are admin-
istered and where unconsciousness rapidly supervenes. The
selection of the poison should be taken into account and may
have a modifying influence upon the opinion of the expert.
It is not rare to find a certain epidemic character in the oc-
currence of self-destruction, and I have known of several per-
sons who used some unusual poison, the fashion having been
set by a suicide the circumstances of whose crime were widely
spread inthe newspapers. Thus the daily press may teem
with cases of poisoning by cyanide of potassium or chloroform,
or perhaps some well known rat-poison, all occurring within a
short time.
- Sometimes, as I have said, a person will disavow his inten-
tion of committing suicide. Such a case is reported by Caspar,
the subject being a strong, healthy apprentice, sixteen years
old, who had declared during an illness that some one had given
him sulphuric acid to drink instead of a dram. The circum-
stances that there were no marks of cauterization on the lips,
and that the appearances on dissection betokened that no in-
considerable quantity had been swallowed, prove indubitably
that this statement was untrue, and that his illness and death
had been voluntarily induced, The tongue was white, and the
epithelium were easily scraped off. Besides, very active appear-
ances of deep tissue changes and perforations of the pharynx
and stomach, and a collection of grumous blood were observed,
and there were other evidences.
Evidences of Pre-Existing Disease.—We are to ex-
amine into the possibility of some serious form of bodily injury
or disease. While suicide is extremely rare among consumptives,
we often find it resorted to by the victims of alcoholism in its
various forms, neuralgia and other conditions of the nervous
system attended by great pain and suffering. A perfectly well
and happy man is very unlikely to commit suicide, and where
an allegation of self-destruction is made, especially by interest-
ed persons, it is but natural that we should be suspicious.
Hallucinations and Suicide.—Hallucinations very often
lead to the commission of suicide. Much has been said about
their influence, as well as that of other forms of insanity upon a
previous page, but I may be pardoned for referring to an inter-
esting case at this place in illustration of a very common
incentive, It is related by Brierre de Boismont ;
SUICIDE. 291
‘*A man employed in a tobacco manufactory began by re-
proaching himself for embezzlement. He struggles against
this idea, but it will not quit him; he thinks then that he sees
at every instant the police around him, who come to hurry him
away to the scaffold. Wishing to spare his wife this shame, he
remained an entire night, while she was asleep, with the razor
at his throat. Fortunately the thought changed ; perhaps he
yielded to a gleam of reason, to an instinctive movement of af-
fection ; he threw away the deadly instrument. The next day
he was brought to the establishment in which I was physician.
For two days he had been unceasingly pursued by the same
vision. I had just quieted him, when in about a quarter of.an
hour he was found drowned in a small garden tub, from which
he was extricated with difficulty. If this man had cut his
wife’s throat and killed himself afterwards, the cause of this
fearful tragedy would have been attributed to any but the nght
motives.”
The Love of Notoriety.—It is well known that an all-
absorbing love of notoriety may lead the person to take his own
life. Forbes Winslow collects a number of cases which are not
without interest.
“The man who was killed by attaching himself to a rocket,
and he who threw himself into the crater of Mt. Vesuvius, were
no doubt stimulated by a desire for posthumous fame.
“Some years ago, a man hung himself on the threshold of
one of the doors of the corridor at the Wdtel des Invalides. No
suicide had occurred in the establishment for two years pre-
viously ; but in the succeeding fortnight five znvalids hung them
selves on the same cross-bar, and the governor was obliged to
shut up its passage.” .
Relation of Life Insurance to Suicide.—The relation
of suicide to life insurance is one occasionally giving rise to
law-suits, for it is no unusual thing for a person to heavily
insure his life, and then under the pressure of impending ruin
make way with himself, so that his family may be provided for.
It is true that but few of such cases have been contested in the
courts, and the point at issue has been the question of the in-
sanity of the suicide. While it is difficult to imagine that any
earthly ends of a sordid nature are greater than the love of
life, still we must confess that the same motive that leads a
soldier into battle, or to enter a forlorn hope where death is
certain, may in another and a dishonorable way be productive
292 MEDICAL JURISPRUDENCE,
of an act of felo de se ; and in the majority of cases reported
there is no reason to suppose that the insured is not in his right
mind.
One of the earliest cases of suicide attempted for the purpose
of defrauding a life insurance company was that of “ Borrodaile
vs. Hunter,” which was tried in England in December, 1841.
The Rev. William Borrodaile had insured his life for the sum
of one thousand pounds in the London Life Association, on
February 16, 1841. He made deliberate preparations, and
climbed over the parapet of Vauxhall Bridge, threw himself
into the river and was drowned. The suit was brought to re-
cover the sum of the policy, and was contested by the insurance
company. The Rev. Mr. Borrodaile had always been a man
of happy and even temperament, conscientious, and respected
by every one. A year or so before his death he became res-
ponsible for a tax collector, who shortly afterwards turned de-
faulter, and this action so shocked the reverend gentleman that
he settled into a condition of melancholy, was greatly depressed,
evinced loss of memory, was reserved, taciturn, and suffered
greatly through physical changes, loss of sleep, and was to all
practical purposes not in his right mind. He told the wife of
the tax collector that he did not know sometimes what he was
doing or where he was going, and appeared to have lost all
control over himself. So great was his want of confidence
that he begged his brother-in-law not to leave him. His altered
demeanor was conspicuous, he no longer paid attention to his
religious duties, and went through those required of him ina
mechanical way, and was seemingly in a daze. On the day of
the suicide he appeared to better advantage, and left the house
dressed for traveling, ostensibly to see his wife. He was ata
neighboring village, but expressed his intention of returning in
time for dinner at six o’clock. He, however, never returned
to his home. The policy was contested by the company, and
it was alleged that a provision of the same had been violated,
the insured having died by his own hand; that in addition,
there was nothing in his behavior to prove him to be of unsound
mind. The charge of Justice Erskine in this case is one that
has been often referred to since. He says: “ In this case there
could be no dispute as to the facts, but the question resolved
itself into adry point of law, on the fiuding of the jury whether
a party who dies by his own hand, unconscious of right and
wrong, thereby avoids the policy.” “ There could be no doubt
that the insured’s throwing himself into the water was his own
voluntary act, but whether he had the will to destroy himself
SUICIDE. 293
knowing what the consequences of throwing himself into the
water would be, was a question which he must leave to them
(the jury) to decide upon the evidence.” The verdict was en-
tered for the defendants, with leave to move to enter it for
plaintiff. This verdict was arrived at by the jury, who decided
that Borrodaile had shown no previous evidences of insanity
before the suicidal act which he had eventually committed for
the purpose of destroying himself, and “that he was not capable
of judging between right and wrong at the time that Mr. B.
threw himself from the bridge with the intention of destroying
himself.” A year later an appeal was taken from this finding,
Sir Thomas Wilde moving that a verdict be entered for plain-
tiff, and contending that “after all, the jury had found that
Mr. Borrodaile was non compos mentis :’’ and argued that the
condition of the policy, by which it was provided that the
policy should be void in the event of the party dying by his
own hand, must be construed to mean “in the event of the
party’s becoming fe/o de se.” The court granted a rule to show
cause. Mr. Sergeant Channell a few months later answered,
that the deceased had thrown himself from the bridge with the
intention of destroying life, and knew that his act would have
this result. He therefore “contended that if the insured by
his own agency produced death, the policy was void, and the
verdict ought to remain with defendants. On the other hand,
it was urged that the legal result of the verdict excluded inten-
tion in any sense which could make the policy void, and that
it was equivalent to a verdict of mon compos mentis. It was
finally decided that a verdict should be entered for plaintiff.
In this case, I am convinced that there was little doubt of the
insured’s insanity ; but as a rule such cases will not bear the
test of criticism.
An American case of some interest is that of “ The St. Louis
Life Insurance Company vs. Graves,’ the facts in brief being
the following: Leslie C. Graves married Mary E. Searles, both
being residents of Lexington, Kentucky ; and shortly after this
marriage he insured his life for her benefit in the above com-
pany for the sum of $5,000. Four months after the date of the
policy the insured was found dead and alone in his livery
stable, and by his side was a pistol he had borrowed from a
friend. The widow brought an action, averring that the fatal
shot was the result of a momentary paroxysm of moral insanity,
* N. Y. Daily Transcript, March 7, 1871, and Medico-Legal Suc. Re-
ports, Ist Series.
294 MEDICAL JURISPRUDENCE,
and he had been deprived of self-control. It was proved by
the defense that Graves had for a day nerved himself up
with liquor, and when he borrowed the pistol and when he did
the deed he was wrought up to a pitch of reckless courage.
The judge to whom the case was appealed reversed the finding
of the jury in the woman’s behalf, holding that the act was vio-
lent and premeditated notwithstanding there was evidence to
show his amicable relations with his family, and the absence of
what might appear as sufficient motive.
A case is related of ayoung man who applied to a dispensary
physician, and asked this officer to insert his (the young man’s)
name in the death certificate of the next person who died in
the hospital, so that it might be used in obtaining the payment
of a policy.
He was reduced in his affairs and wanted money to start in
business, and had no means to support his family. He hada
a policy on his life, which his wife would get on proof of his
death. He committed suicide a few weeks after this request.
There is no reason to suppose this individual was insane.
Browne refers to the law as follows: “An insurance company
is not liable on a policy, if the person insured voluntarily
deprives himself of life, and it seems to have been held over
and over again in this connection that voluntary suicide can
be committed by a person who is insane, and that the
mere act of suicide itself gives no indication of the mental
condition of the person who kills himself. The real ques-
. tion to be decided in all these cases 1s whether the insanity
was of such anature as to deprive the individual of all voli-
tion, or that the act of self-destruction was not the result of
the will and intention of the party adapting the means to the
act, and contemplating the physical nature and effort of the
ahead Se
A case of suicide, in which the question of life insurance
arose, is reported by du Saulle, and is of some interest. “ On
the seventh day of September, 1858, at seven o’clock in the
morning, a pistol shot startled the stragglers upon one of the
boulevards of Paris. From the window of a carriage smoke
was seen to issue, and when the coachman stopped and opened
the door, he found in a corner of the carriage the dead body of
aman ina sitting posture. The left half of the skull was
removed by an explosion of a double-barreled shot-gun placed
between the victim’s legs. This man who died almost instan-
* Cooper vs. Massachusetts Mut. Life Ins. Co. 102 Mas. 227.
SUICIDE. 205
taneously, had insured his life some time before for the con-
siderable sum of 150,000 fr., and the companies refused to pay,
because the death of the deceased had been voluntary and not
accidental. In alluding to thiscase, ‘there will be no object,’
says Tardieu, ‘to reproduce here the motives deducted from
our observations and experiences that we have repeated in the
same carriage wherein the body was found, which we con-
sider to raise the supposition of an accident, or to conclude a
suicide. We have satisfied ourselves in regard to the direction
of the wound on the head, and the obliquity which existed in
the position of the weapon in relation to the sides of the car-
riage. Weshall demonstrate in the most positive manner that
the attempt was premeditated, and voluntary, and that death
was not the result of an accident, but a suicide.’ On his side
Brierre de Boismont ‘sought to establish that many of the
individuals who committed suicide preserved in the midst of
their preparations a coolness and indifference which was re-
markable, and which he was unable to find in the bearing, in
the letters, and in the last acts of the individual in question ;
which was moral proof that he was not himself in his last
hours.’ The insurance companies were condemned to pay the
amount of insurance.”
Homicide or Suicide in Life Insurance Cases —
The question of fraud sometimes arises when the insured seeks
to create the impression that he is the victim of an assault.
On the twelfth day of October, 1840, a broker was found
strangled in a carriage, on the road to Stettin. The bad con-
dition of his affairs, it was thought, had led him to commit
suicide. The position of the body, which had the hands
crossed behind the back, the traces of robbery, led the
tribunal to recognize the evidences of a violent death, and a
judicial investigation was ordered ; however without any result.
The broker had an insurance upon his life for the sum of 4o,
ooo fr., which would have been sent to his family only in case
that death had not been the result of suicide. The officers of
the bank of Gotha presented themselves before the justice,
and proved that .the broker had really committed suicide.
They exhibited an autograph letter of the deceased, in which
the motives that impelled him to commit the crime were shown,
and the means to which he had resorted. The result of this
document. was that the broker had sacrificed his life, so .
that the family might be provided for and saved from com-
plete ruin. It appeared from this letter that a friend was after
296 MEDICAL JURISPRUDENCE.
death to place him in the attitude he was found, for the pur-
pose of supporting the idea that he had been assassinated, (du
Saulle).
Tardieu reports an extraordinary example of homicidal spec-
ulation, which occurred in Sweden several years ago, in which
a French company came very nearly being swindled. A life
insurance was taken on the 26th of March, 1856, on the life of
H., a servant, for the benefit of S., a commission merchant.
H. was an unfortunate drunkard, who hung himself, but was
rescued and saved by S. This fact gave the idea of specula-
tion, and a veritable tacit contract was made with H., who
promised to drink large quantities of brandy in the morning
and evening, and to go without nourishment. The life of H. was
prolonged through the agency of S., who, fearing the payment
of a new premium, had had violent scenes with the former.
H. died finally on the 31st of August, 1856, poisoned by
arsenic. S. was accused and brought before the tribunal at
Stockholm and acquitted for want of proof. ‘Three years later
the civil tribunal of the Seine threw aside the policy of insur-
ance, and exonerated the company from all payment.
It occasionally happens that the religious faith of the insured
person is questioned, for the purpose of proving his sense of
moral responsibility.
Doubtful Cases.—In disputed cases of suicide in this con-
nection we must carefully investigate the history of the
patient’s previous life, his behavior for a short time before
the deed, and his treatment of his family. It need not fol-
low that every insured man who has a policy and commits
suicide does so for the purpose of getting money for his
family. Where suicide is committed by such a person under
the influence of a delusion of an entirely extraneous character,
or where it does not appear that the question of gain enters at
all, there can be no dispute as to the fact that the policy should
be paid, any more than if he died of any ordinary disease, even
though he has signed a policy which contains a clause such as
is found in those of nearly every company. Hereditary influ-
ences and other causes for which he is not responsible, may
produce sucha mental perversion as to completely destroy the
individual’s sense of right and wrong and his voluntary con-
tole iianappens from time to time that persons who are
insured for large amounts die very suddenly after the policy
has been taken out, under circumstances which, to say the
least, are suspicious. But here, too, it does not do to be too
SUICIDE, 297
‘precipitate in the formation of an opinion, or too hasty in ex-
pressing it. A celebrated case was tested some years ago in an
interior town of this state, and although it was shown that the
insured, who had taken a policy upon his life of over $100,000,
had been a few months before financially embarrassed to a
serious extent, and died after a few days’ illness; no causes
other than those of a natural character could be found for his
death, notwithstanding a most searching post-mortem examina-
tion was made, at which the physicians of both sides were
present. In this case all manner of reasons were assigned for
the gentleman’s rather sudden demise by the opposing side,
and it was even held that he had choked himself to death by
means of a piece of rope. However, no evidences of asphyxia
were found, and the crease which, strangely enough, some of
the medical men present found about his throat, was proved
beyond doubt to be due to accident. In some cases when
no satisfactory cause of death can be determined, we should
at as early a moment as practicable determine by every means
in our power the condition of the abdominal and thoracic
organs, as well as of the brain, for sometimes where no appar-
ently sufficient lesion can be detected to account for the death
a further search may disclose a minute clot either in the
medulla, or a lesion may exist on other parts of the brain,
which may be at first confused with post-mortem changes.
It sometimes happens that frauds are perpetrated upon the
insurance companies, that dead bodies are procured and so
placed as to lead to the suspicion that suicide has been com-
mitted, the companies being deceived as to the person’s
identity. I refer the reader to works of a larger scope in
which the ‘examination of the dead is considered.
From time to time the question arises, whether 2 man who
commits suicide for the purpose of escaping some hopeless
physical infirmity annuls his policy in so doing. In the case of
“Tsett vs. The American Insurance Company” this was the
case, and the jury were told that they must find a verdict for
the company, if they were convinced that the suicide was
aware of the fact that the discharge of a pistol in his hands
would produce his death, even though he destroyed his life be-
cause he was desirous of escaping some physical infirmity. Chief
Justice Miller in his charge laid down the principle, that “ itis not
every kind or degree of insanity which will so far excuse the
party taking his own life as to make the company insuring him
liable. To do this the act of self-destruction must have
been the consequence of insanity, and the mind of the
298 MEDICAL JURISPRUDENCE,
deceased must have been so deranged as to have tnade
him incapable of using a rational judgment in regard to
the act he was committing. If he was impelled to act
by an insane impulse which the reason which was left to
him did not enable him to resist, or if his reasoning powers
were so overthrown by his mental condition that he could not
exercise his reasoning faculties on the act he was about to do,
then the company was liable. On the other hand, there is no
presumption of law prima facie otherwise that self-destruction
arises from insanity ; and if you believe from the evidence that
the deceased, although excited or angry or distressed in mind,
formed a determination to take his own life, because in the
exercise of his usual reasoning faculties he preferred death to
life, then the company is not liable, because he died by his own
hand within the meaning of the policy.”
In regard to the punishment of those who unsuccessfully
attempt suicide, we must be governed entirely by the circum-
stances which surround the commission of the important act,
and if we find that its attempted execution is such as to sug-
gest an abnormal degree of moral depravity or eccentricity, a
great doubt of the sanity of the would-be suicide must natu-
rally arise. I do not think there can be any doubt that where
the subject resorts to sensational and odd methods, this view
of the case is the right one. In such cases as that which
occurred in Kentucky a few years ago, where the individual
spent several days and much labor in the preparation of a
guillotine, and afterwards hired a room in the hotel, where he
shut himself up and was found decapitated, the manner in
which the suicide was consummated suggested irresponsibility
upon the part of the victim. Suicides for notoriety, examples
of which I have detailed, belong to this class. A case in
which no doubt of the patient’s mental condition should arise,
is recorded in a French journal of a man who, discovering that
his mistress was unfaithful to him, called his servant to him,
and told him that he intended to kill himself, expressing the
wish that after his death his fat should be converted into a
candle, which should be lit and carried to his mistress. He
then wrote a letter, in which he told her that as he had long
burned for her, she might now see that his flames were real,
for the candle by which she read the note was composed of
his miserable body. After this he committed suicide. Wins-
low, who mentions this case, refers to that of a blacksmith,
who charged an old gun barrel with a brace of bullets, and,
putting one end in the fire of his forge, tied a string to the
SUICIDE. 299
handle of his bellows, by pulling which he could make them
play whilst he was at a convenient distance ; kneeling down he
then placed his head near the mouth of the barrel, and
moving the bellows by means of the string they blew up the
fire, he keeping his head with firmness and horrible de-
liberation in that position till the further end of the fire
was so hot as to kindle the powder, whose explosion drove the
bullets through his brain. There are numerous cases of this
kind, which might be narrated, but are out of place in these
pages.
The examples which interest us especially in regard to the
punishability of the individual are those where the person at-
tempts his life to escape ill health, disgrace, impending finan-
cial ruin, and poverty. ‘These are too common to need more
than cursory mention, and it cannot be denied that nearly al-
ways they are the result of a low moral tone, which does not
bring with it any suspicion of irresponsibility. Prompt and
vigorous punishment is the most effectual remedy ; and espec-
ially is this the case where the suicide is one of a number oc-
curring: in the course of what may be called an epidemic.
The low grade of moral courage which springs perhaps from
slight physical suffering, which the individual does not fight
against, and a loose mode of living, lacking the restraints of
wholesome self-discipline, make this crime fearfully com-
mon, and undoubtedly lead to a disregard of the value of
human life, which in other individuals takes the form of homi-
cide.
Responsibility of Stuicides.—The humane views of
Winslow are certainly too sentimental to meet the requirements
of the society of to-day, and his apology for the suicide belongs
to an age when almost every species of wickedness was condoned
and explained by moral insanity. I quite agree with Beccaria,
that any punishment “ which does not come from absolute ne-
cessity is unjust,” and that crimes are only to be estimated by
the injury done to society, and that the end of punishment is
to prevent the criminal from doing further injury, as well as to
induce others to refrain from committing similar offenses.
Winslow’s view is that “the unfortunate individual by the very
act of suicide places himself beyond the vengeance of the law ;
he has anticipated its operation ; he has rendered himself amen-
able to the highest tribunal, namely: that of his Creator ; no
penal enactments, however stringent, can affect him.” This
statement cannot apply toall cases, as I have shown by the
300 MEDICAL JURISPRUDENCE.
examples where the attempt has been made to defraud insur-
ance companies ; and it cannot be denied that there is a large
number of individuals whose motives, while not those of men
of good judgment or sound sense, are almost the same as those
of criminals who murder for petty sums, or who steal for the
purpose of having themselves fed and sheltered in a prison.
CHAPTER VII,
CRANLAL INJURIES.
Preliminary Anatomical Considerations. The Skull.
—The skull may be roughly described as “an egg-shaped case
with a flattened under surface, the forepart of which gives attach-
ment to the face. The sides, the top, and the back of the case are
formed by flat bones, consisting for the most part of two layers,
an outer and an inner table, with spongy tissues known as dip-
lée between them; but where the walls are very thin there is
but a single layer. ‘The vault of the skull presents but two
minute and inconstant openings, the parietal foramina, for the
passage of small veins; but the base contains many openings
andis of quite a different structure ; in parts of it the bones
are hollowed into mere shells, forming chambers communicat-
ing with the pharynx and lined with mucous membrane; in
parts the bones contain cancellated tissue, such as is found
elsewhere, and again parts are made of solid bone. ‘The base
is decidedly the weakest part. (Dwight.)
The membranes of the Brain.—Within the interior of
the cranium is the brain, composed of the cerebrum and the
cerebellum, beneath which le the pons and medulla, and these
are practically surrounded by three membranes, the thickest
and coarsest of which is the dura mater, which lies next the
bony surface of the cranium, and which is prolonged in broad
folds forming supports for the soft structures which it encloses,
there being a longitudinal extension between the two hemi-
spheres of the cerebrum, (falx cerebri), and we find at right
angles to the falx another prolongation which dips transversely
downwards forming a partition between the posterior lobes and
the cerebellum, (tentorium). A small fold in the median line
runs from the posterior surface of the tentorium to the for-
amen magnum.
The Sinuses.—Running through the membrane are several
important canals or s¢muses which receive the venous blood and
meet at the base of the skull communicating with the jugular
302 MEDICAL JURISPRUDENCE.
veins principally. This membrane is tough and resilient and
admirably protects the nervous organs.
The dura mater is plentifully supplied by nerves from the
fifth pair, from the pneumogastric, from the third, and it also
receives sympathetic fibres.
The pain in meningitis, therefore, arises from involvement
of the first-named nerve, and the choked disk so common with
meningeal affections is due to lesion of the recurrent branch of
this nerve as well.
Arachnoid.—Beneath the dura mater is the arachnoid,
which covers the convolutions and contains ‘spaces for the
accumulation of cerebro-spinal fluid; that beneath the arach-
noid being called the sub-arachnoid space, and that outside the
sub-dural space.
Pia Mater.—The most delicate of the three membranes is
the pa mater, which immediately invests the brain and contains
in its meshes a very great number of small arteries and veins
which are concerned principally in the blood supply of the
cortex.
It would be going too deeply into the subject to minutely
describe the anatomy of this membrane ; suffice it to say that
it is reflected at various situations into the substanee of the
brain, forming at different points the choroid plexus, the velum
interpositum, and it ramifies in other directions to form the
walls of the fourth ventricle, and to enter the lateral ventricles.
The Cerebrum.—The cerebrum is composed of two hemi-
spheres and has an external investment of gray nervous mat-
ter rich in cells and having sensory functions of a higher kind,
and bloodvessels and an internal collection of white matter
composed of conducting fibres bound together by connective
tissue, these fibres passing downwards through and between
large bodies composed of gray matter and reinforced by other
fibres from the cerebellum pass below, partially crossing in
the medulla oblongata, the conductors from one hemisphere
going in part to the opposite side of the body and wice versd.
The Gray Matter.—The investing layer of gray matter
or cortex has been found to have various psycho-motor func-
tions which are seated in circumscribed areas in the different
convolutions of the brain. The most important of these is the
speech center located anteriorly, laterally and near the lower
part of the brain in the third frontal convolution. About the
fissure of Rolando which runs from the great longitudinal fissure
CRANIAL INJURIES, 303
downwards towards the fissure of Sylvius are centers which pre-
side over the movements of the arms, legs, certain muscles of the
face and eyes ; and in the angular gyrus there is one, injury of
which results in blindness. There are other centers situated
at the lower surface of the brain concerned in taste and smell.
Injury of the cortex at other points may give rise to very
little trouble. But when the above-mentioned centers are
involved we are furnished either with limited convulsions, par-
alyses or sensory disturbances..
When the masses of gray matter situated at the base of the
brain are affected by injury or disease, very important altera-
tions of function are manifested, and a limited lesion will
cause extensive disturbance.
The White Matter.—The white matter or conducting
substance is much more tolerant, and very extensive disorgan-
ization may exist without any corresponding loss of function.
The Medulla Oblongata.—Posteriorly and beneath the
brain is a small mass of nervous tissue, the medulla oblongata,
in which arise many of the cranial nerves ; and injury here is apt
to be followed by important forms of paralysis of the organs of
the face, or by death as the result by reason of the disturbance or
abolition of function of the pneumogastric nerve which plays so
important a part in the innervation of the heart and other organs,
The Cerebellum.—The cerebellum is situated behind
and beneath the cerebrum, and is composed of gray and white
matter, and it has been found that injury or disease of this
body is apt to be followed by pain, inco-ordination of move-
ment, vomiting and visual disturbanees.
The above brief description of the coarse anatomy of the
brain is but fragmentary, and the reader is referred to any of
the treatises upon neurological subjects for more explicit infor-
mation.
Subjective Symptoms.—The chief subjective symptom
of head injury is that of pain which is diffused or localized. It
varies from the slight ache which follows the course of the
eyes to the tearing, violent agony of meningitis orirritation. In
cerebral abscess it is often intense and accompanied by throb-
ing, while mental labor, or causes which favor determination of
blood to the head, increases all varieties of pain having this
region for its seat. Neuralgia is far less common than some
undefined forms, but a not unusual symptom of concussion
especially is the existence of vagrant flying pains which are
304 MEDICAL JURISPRUDENCE.
neuralgic in character. A sense of pressure over the orbit is
quite frequently the source of complaint, while sub-occipital or
mastoid pain is of common origin in basal fracture, meningitis,
and lesion the result of contrecoup.
We often find as a result of cranial injuries certain spinal
symptoms which may occur either from transmitted violence, or
from an extension of an inflammation lhghted up at the point
of injury.
Ocular Symptoms.—These are of a most variable kind,
and the muscles of the eyeball or the fundus of the eye may be
affected. In meningitis, or in disease attended by effusion of
serum or pressure changes there may be well marked choked
disk. In softening the signs of optic neuritis are quite common
and in association with sclerosis of the brain consecutive to
commotto cerebri we find atrophy of the optic disk.
In case of general compression the pupils will be dilated, or
if the pressure be partial and confined to one side we will find
the pupil of that side dilated.
The Differential Diagnosis of Concussion and Com-
pression by the Ophthalmoscope.—Bouchut claims that
ophthalmoscopic examination is the most certain way of de-
termining the difference between concussion and compression
of the brain. If concussion only exists, there are no abnormal
appearances presented.
“In contusions of the brain, on the other hand, with or
without consecutive inflammation, as well as in the case of
serous or hemorrhagic effusion into the cavity of the cranium,
symptoms of a more or less intense congestion are observed in
the neighborhood of the ophthalmic vessels, since the disturb-
ance of circulation within the skull is necessarily transmitted
hither. The optic nerve is swollen, appears flattened, uniformly
reddened, sometimes more intensely injected. Its contour is
less sharp, and it is the seat of serous swelling, which, passing
over the neighboring portions of the retina, covers the border
of the papilla to a greater or less degree. From these symptoms
Bouchut was enabled, in four cases cited, to establish a
certain diagnosis which the other clinical symptoms had failed
to make good.”
- Sometimes ocular disturbances of previous existence may be
improperly referred to the particular accident.
In Page’s table appears this case in which ocular symptoms
-were alleged to have followed a concussion received in a rail-
road accident.
CRANIAL INJURIES. 305
“Male patient, aged 14. Stunned by severe wound and
blow over left eyebrow. In bed fourteen days having much
pain in head. When he began to move about he found he
could not see so well as before with his left eye, although for
a fortnight he had been able to see quite well. Right eye
lost, but not removed, four years before from blow. Examina-
tion of left eye revealed distinct evidences of old choroido-
retinitis. Without going into all the pathological changes
discovered, the conclusion arrived at was that the- earlier
attacks had been very mild, and being peripheral had caused
no noticeable change of vision, and that the shock of the
blow had aggravated the disease and favored the occur-
ence of opacities in the vitreous. All parts of the equator
were equally affected, which seemed to be against the likeli-
hood of the changes having been solely produced by concus-
sion.
“Date of settlement 12 months after the accident. Last
heard of 4% years after accident. Condition then—general
health good ; eyesight unchanged. No evidence of injury to
spinal cord or membranes.”
Kind and Direction of Violence.—Guthrie has shown
that violence applied to the front part of the head is much
more apt to be attended by serious results than when the force
is applied elsewhere, a fact confirmed by Crichton Browne*
and others.
“Injury to the forehead,” says Browne, “is exceedingly
. perilous ; injury to the side of the head less so,” but he differs
from Guthrie believing that the injury to the back of the head
is almost as hazardous as in front. Our knowledge of cerebral
physiology teaches us that in the middle and anterior part of
the brain are exceedingly important centers which, when the
seat of injury or disease are apt to be followed by various dis-
turbances of important functions. -Of course there are ex-
ceptions, and I have known of several cases where large parts
of the anterior lobes, or tracts of the cerebral cortex were
destroyed without the production of.any lesion whatever. One
case J can recall was brought to the New York Hospital—a young
man who had fallen upon his head, fracturing the temporal and
parietal bones, and there was a depression of the fragments
deep into the region which is divided by the fissure of Rolando.
When the bones were elevated large masses of cerebral sub-
stance were injured and torn, and, strange to say, no paralysis
* West Riding Reports, Vol. ii. p. aa.
-
206 MEDICAL JURISPRUDENCE.
followed. Large masses of the anterior lobes have been
removed without peril to the patient, and the celebrated Massa-
chusetts case in which one frontal lobe was destroyed by pre-
mature blast and the passage of the “ tamping iron” through
the skull is of this kind. Guthrie has told us that splinters of
bone of considerable size may be lodged in the posterior part
of the brain without detriment. It would be going too deeply
into the field of neuro-pathology to consider fully the symptoms
that follow special injuries, but it may be stated that as the re-
sult of a@rect injury and contrecoup a variety of changes may be
produced.
Contrecoup.—In four marked cases of the latter injury
at the West Riding Asylum, where the force of a blow upon
one part of the skull was transmitted to a point opposite—
“severe epilepsy with dementia has been noticed as the conse-
quence of a fracture, with depression of the skull, or violent
blow at the upper part of the frontal bone at a point as nearly
as possible opposite to the medulla oblongata.”’ Browne is in-
clined to attach much importance to blows in the frontal region
as a cause of epilepsy and epileptic dementia. So far as my
personal experience goes I am inclined to believe that there is
a site which is more important. Blows over the fronto-
parietal region are, I think, a fruitful cause of epilepsy.
Varieties of Injury.—Much depends upon the force and
direction of the blow and the region injured. Quick localized
blows are less apt to produce coutrecoup than diffused force.
Comparatively light blows may produce extensive injuries,
More or less general symptoms are :
1. A fracture and pressure upon the membrane and brain
substance.
2. Concussion and diffused lesion.
3. Contrecoup and resulting lesions.
4. Meningitis asa result of force applied externally without
fracture.
Fracture of the Skull.—Fractures of the skull are
common and the resulting symptoms are of the most variable
kind. Holmes divides cranial fractures into those of the
vault and those of the base; and there is another
division which includes the complicated cases. We find
that fractures of the vault are direct, and that there is
usually a simple fissure or comminution; but the former is
more apt to extend than the latter. There is displacement in-
wards of the fragments to a variable degree; and it does not
CRANIAL INJURIES, 307
follow that both tables need be depressed ; and the inner may
be the seat of the fracture, while the outer table remains un-
harmed. Sharp blows with pointed instruments are apt to pro-
duce such fractures. There is much variation in the position
of the fragments ; sometimes they are depressed in the center
and splintered, and Holmes refers to a form of fracture in
which the depression was caused by an “oval piece of bone,
which was not only driven down, but. split longitudinally in
two fragments which slanted towards each other, the depression
being much greater at the center than at the circumference.”
“Such a fracture is commonly produced by some heavy body
with a sharp margin applied with great force, as a horse-shoe.”
The most ordinary form of fracture, according to Holmes, is
that where the fragments depressed are triangular, their points
being pressed downwards and their bases even with the surface
of the skull. Fractures of the base are usually the result of
falls, the patient very commonly alighting upon his feet, and they
are generally limited. We find very often that the middle part, of
the petrous portion of the temporal bone, and those parts lying
immediately in front of the foramen magnum are most com-
monly injured, while those posteriorly situated are next in
order, and fractures of the anterior parts come last. There are
certain parts that are very susceptible to injury and fracture,
the basilar process of the occipital bone, the wings of the
sphenoid and the orbital plate of the frontal suffering from
comparatively slight violence. When the bones about the fora-
men magnum and just anterior to it are found fractured, it is
quite possible that the pressure has been brought to bear
antero-posteriorly.
Undetected Fractures.—Fractures of the skull may often
remain undetected during the life of the individual, and with
the production of very slight symptoms, this being especially
the case when the vault is affected. An interesting case illus-
trating the mistakes in diagnosis that may arise through the
carelessness of the examining surgeon, but one most unique in
its way, is that “of a woman who was admitted into the Hotel
Dieu, with a wound in the temporal region, accompanied by a
profuse bleeding. A fragment of bone several lines in length
was found deep in the wound, and quite loose. This was re-
moved, and the finger then passed through an opening, the cir-
cumference of which was unyielding. The case was at once
thought to be one of compound fracture, with the separation
of some fragments, but it was soon remarked by a by-stander
308 MEDICAL JURISPRUDENCE.
that the fragment of bone removed was dry and quite white as if
it had been macerated. This led to a more careful examina-
tion of the wound, and it was discovered that the supposed
hole in the skull was nothmg but a laceration of the temporal
fascia, and the fragment, the innocent cause of the error,
turned out to be simply a piece of bone, which, lying on the
ground, had been driven into the temple when the patient fell.”
Injury of Cranial Nerves as a Result of Fracture.
Injury of the cranial nerves is not an uncommon accident in
connection with partial fractures. We frequently meet with
deafness as a result of fracture at the base and various symp-
toms indicative of local nerve traumatisms are to be found di-
rectly after a serious cranial injury. When the fifth pair is
involved the symptoms may be like those of the following case,
reported by. Holmes: |
“A man, aged 35, having the day before been buried by
some earth falling upon him, was admitted into the Hopital St.
Antoine, in June, 1854, in a state of perfect insensibility, and
with such profuse bleeding from the nose that it became neces-
sary to plug his nostrils. The ocular conjunctiva, especially
on the left side, was distended with blood, and so, too, were
the eyelids. He gradually recovered and then paralysis of
various nerves became evident at different periods. The right
upper lid and eyeball lost all power of motion. A few days
afterwards and paralysis of the right side of the face was ob-
served. It was not quite complete, but both sensation and
motion were manifestly affected. ‘Ten days after the patient
had been in the hospital, the conjunctiva of the right eye was
cedematous and much chemosed ; the cornea could be touched
freely without flinching ; it had lost some of its transparency
and at its lower part there was a yellow spot like an interlamel-
lar abscess. ‘Towards the end of the month the cornea pre-
sented a slight ulceration opposite to the yellow spot and the
facial paralysis was even more marked. Matters went on much
in the same way during the month of July, with more ulcera-
tion, however, about the eye and less paralysis of the face.
Early in August the cornea gave way, and the aqueous humor
escaped. Later on in the month the patient began to improve.
Subsequently the right cornea cicatrized and he could see from
the upper part, and ultimately both sensation and motion were
restored to the right side.”
Concussion.—Concussion of the brain is apt to produce
a general disturbance of function—The shock may be fol-
CRANIAL INJURIES, 399
lowed by unconsciousness, vertigo, confusion of ideas, with
nausea and vomiting perhaps, dilatation of the pupils, chilliness
of the surface and a weak, small pulse.—This may pass off
leaving the patient nervous: and irritable and perhaps with
headache—or it may be followed by severe cerebral disturb-
ances, the result of an ensuing cerebritis.—The after-symptoms
may develop most insidiously. A slight concussion may pro-
duce few or no effects but within a variable time, from a few
hours to several days, an alarming train of nervous symptoms
arises which deepens until the patient finally presents all the
evidence of cerebral softening—The Commotio cerebri of cer-
tain writers is a condition of this kind.
Cerebral Irritation—A form of trouble following con-
cussion of a light grade is called by Erichsen cerebral
irritation. The patient is partially conscious and in a half dazed
condition with half or firmly closed eyelids. His pupils are
contracted. He hes in a constrained position, usually upon
his side with his thighs and his legs flexed and his hands
clenched. The surface is cool and the pulse is slow and weak.
He may remain in this condition for several weeks before there
is a slow return to the normal state, and cerebral excitement is
succeeded by prostration and stupidity.
This condition may be the starting point of serious cerebral
mischief which may subsequently develop in the most insidious
manner. .
The books contain many cases of trivial blows being fol-
lowed by remote symptoms indicative of transmitted violence
and prominent among them is the abolition of functions of any
one of the special senses. Blows upon the forehead have pro-
duced not only epilepsy but loss of smell and taste.
Concussion and Meningitis.—Huguenin calls attention to
the meningitis that may follow concussien without any exter-
nal injury. This is however not common, but when it occurs
is preceded by the symptoms of cerebral irritation, by deepen-
ing coma and by great slowness of the pulse in the beginning.
Sexual Perversion in Head Injuries.—Brown-Sequard
and others have shown that injury to the brain is apt to be fol-
lowed by sexual perversion, loss of power to cohabit and local
neuralgia. Curling and other writers have presented cases that
prove beyond doubt that in some instances head injuries are
followed by atrophy of the testicles. Such troubles are
usually the result of blows or falls upon the back the head.
g10 MEDICAL JURISPRUDENCE,
Diabetes is occasionally produced by concussion, but there is
more often slight albuminuria.
Affections of Intellect from Head Injuries.—Intel-
lectual changes of slow growth often follow slight shocks. These
are seen in the departure from former habits and tastes,—mo-
roseness or excitability, immoral tendencies and mental weak-
ness are induced, and the person may become a whining
wreck. ‘These changes exist in a light degree or there may be
actual insanity of a marked grade, Gall reports the case of a
man who was injured by a falling tile which penetrated the
brain. Before the accidenthe was an amiable steady man,
afterwards he was quarrelsome and flew into a rage at little
things. Browne reports the case of a patient under his obser-
vation.——
““W. H. about whom I was consulted some time ago, was a
steady and respectable tradesman until he fell from some steps
while cleaning a shelf in his own shop, and was stunned for a
few seconds. From that time he underwent a change. Heno
longer attended to. business to which he had been formerly de-
voted ; he speculated and lost his savings; he manifested an-
tipathy towards his wife and two out of his five children, and
he saw his whole family reduced to penury, through his own
rashness and neglect without displaying any compunctions.
When complete pecuniary ruin had been effected he suddenly
became himself again, and resumed industrious ways, but ever
since he had attacks of restless exitability, with hatred of his
wife and children twice or thrice a year. He is at all times in-
' telligent, rational and free from delusions, and when at his best
period, joins his relatives in deploring the sad visitations to
which he is lable.”
Condition of Duality.—Dr. Charles H. Hughes in a very
interesting paper™ alludes to the peculiar mental state of
duality which sometimes follows head injuries ; acondition in
which one hemisphere apparently fills a vicarious office. He re-
fers to a case presented by Joffe and gives the main points
of the history which is the following.—“ He was a married man,
aged 53, healthy in childhood and youth, in manhood had
headache and giddiness, was a soldier 14 years ; in encounters
with smugglers, received several cuts in the head. His temper
was irascible, he was fond of drink, had hemorrhoids and
constipation for ten years. Disposition serious. His memory
* American Yournal of Insanity, 1875.
CRANIAL INJURIES. 311
failing, he became unfit for service and was discharged in 1861.
His pecuniary circumstances caused him great anxiety, and in
the same year, (1861) he exhibited unmistakable signs of men-
tal disturbance. He continually employ ed the expression ‘we’
—‘we will go,—‘'we will run,—‘we will do it,’ etc. The
‘other’ man pulled his ear, plucked his arm, etc. His left
arm had spasmodic twitchings. He invited himself to dine
with his sister, saying that the ‘other man’ compelled him to
be her guest. While eating he said, ‘I have eaten enough but
the other has not.’ After the meal he ran out of the house, when
arrested, said the ‘ other’ was to blame, he was doing what
he could to make him stop. Tried to murder a child, as-
signing a similar cause for the attempt. He rolled into the gut-
ter thinking he was wrestling with ‘the other,’ and finally at-
tempted to commit. suicide, imagining he was_ killing
‘the other.’ This brought him to the hospital. The confor-
mation of head was normal, pupils contracted unequally, re-
action to light in both limited. Hearing normal, but saw small
animals, insects, etc., with left eye, and vision dim in right
eye. Tearing pains in left ear and side of face. Physiognomy
anxious and expressive of suffering. Skin dry and tempera-
ture and sensibility of body natural. Pulse “seventy-eight.
Reflex movement to tickling soles of feet prompt. No digestive
trouble. -
‘The other’ person was in his left side under his skin. He
called himself the right D (D was his name,) the left
D was a rascal and caused all his misfortunes. He some-
times presented the picture of anxiety, dripping with sweat, and
holding fast his shirt with both hands, in order as he said to
make himself stop. He had violent impulses to motion, lasting
an hour or two, occurring several times in the course of six
weeks, which were probably epileptic or epileptoid seizures.
After conversing some time, long enough probably to weary
and morbidly disturb the sound hemisphere, his ideas grew
confused, and it was impossible to gather any sense from what
he said.
“He died of dysentery, and during the progress of the dis-
ease had no apparent delusions. ‘The autopsy revealed a
thickened dura mater. On the left side of the falx, there was
a lamina of bone half an inch long and a quarter of an inch
broad. The membrane along the course of the vessels
were opaque, infiltrated with serum; their veins quite full.
Convolutions of the anterior lobes, especially the left lobe, very
much thinned on the convexity—/e/t anterior lobe, half an inch
312 MEDICAL JURISPRUDENCE.
shorter than the right. Anterior half of ventricle of this side ©
was adherent and hard. Optic thalamus and corpus striatum
atrophied—especially the latter. Brain moist, anemic, tough.
Ependyina of the lateral ventricles thickened and granulated,
corresponding to the thinned convolutions of the anterior lobe.
The cortex_was thinned, and the adjacent medulla was indur-
ated to the touch.’”’
In some cases the blow may result in a pathological condi-
tion of primary congestion and distension, subsequent ane-
mia and distension of the perivascular spaces, and a resulting
mental weakness, occurs.
e
%
Pachy-meningitis and Cranial Injuries.—Inflamma-
tion of the membranes of the brain or meningitis may be con-
fined to the dura mater (pachy-meningitis) or it may involve all
the coverings of the brain. The conspicuous symptom is pazz,
which is localized, perhaps, at first, and diffused afterwards.
It is dull and severe, and as arule worse at night. The pain
is usually most severe at the vertex, and is increased by intel-
lectual work, excitement, heat or any cause that will induce
a determination of blood to the head. It may be associated
with localized or general convulsions if the cerebral tissue be-
neath be involved, and if the inflammation be severe or exten-
sive there will be a general disturbance of the intellect, char-
acterized at first by delirium or mania if the inflammatory pro-
cess be acute, and afterwards by stupidity and perhaps de-
mentia.
The mental troubles vary greatly, in some cases there may
be only a slight apathy, loss of memory and lack of concentra-
tion, which interferes with the capacity of the person to en-
gage in business or apply himself in any way requiring serious
attention. ;
Sometimes mental disease follows some years after head in-
juries, when no reason exists in the beginning for the anticipa-
tion of subsequent mischief.
A gentleman consulted mea few years ago fora nervous
trouble that threatened to ruin him, and chief among his symp-
toms were those of a mental nature. He had been well and
happy until a year before I saw him, and then he became
irritable, morose, took unreasonable dislikes, and abused his
family. At this time he had an epileptiform attack, with great
headache, limited to the left side of the head. His speech
was embarrassed, and he became neglectful of his business,
and constantly made errors in his accounts. His left pupil was
CRANIAL INJURIES, 313
dilated, and there was a slight loss of power Upon the right
side. His habits had always been good, and there was no
cause discoverable. Quite accidentally I found a scar upon
the left side of his head, about four inches above the ear, and
upon questioning him I found that ten years before he had been
assaulted on board a vessel. He had had but little suffering
at the time, and as he thought recovered entirely. In this case
no intimation of the trouble occurred until the development of
the nervous symptoms in 1877.
Remarkable Case of Head Injury with Mental Dis-
turbance and Epilepsy.—A case of mental disease, following
a most extraordinary bullet wound of the skull, fell under my ob-
servation two or three years ago, and the miraculous recovery
from the immediate effects of the wound are remarkable, and
the case is a useful though rare example of how comparatively
favorable the prognosis may sometimes be in serious wounds of
the head.
Fig. 8.
W. T.S. received a bullet wound, in the battle or the Wil-
derness, May 6, 1864, which penetrated the mastoid process of
the left temporal bone. He remained insensible only for an
hour. The missile was extracted several hours after, and was
found to be a flattened minie ball. He was entirely speechless
and semi-conscious for several days, and could not utter a com-
plete sentence fora month. The wound discharged pus and
small fragments of bone, and there was an escape of these sub-
stances from the meatus as well for some time. He found that
he was paralyzed upon the right side, and he could not walk
for a month after the accident. About ten years after the in-
jury he began to have epileptic convulsions, which recurred
irregularly every four or five months, but they have increased
so that he now has them every few weeks, and they are pre-
314 MEDICAL JURISPRUDENCE,
cipitated by bodily fatigue or excitement, as well as by ex
tremes of temperature, and they have been excited by irritation
of the bottom of the large opening which is now very con-
spicuous. ‘This opening is found just back and beneath the
left ear, and consists externally of an orifice 1 centimeter in
breadth and 1-3-r10 centimeters in length ; at its inferior border
it is 2-7-10 c.m. above the lowermost point of the mastoid pro-
cess. Making a close examination it was found that a deep
cavity projected inwards 3-5-10 centimetres, having a diameter
of about 3 centimeters. Fig. 8.
At its fundus there was a granulating surface and a small
quantity of pus. The left side of the face was paralyzed, pto-
sis of the left eye was present, hearing on the left side is com-
pletely gone, the sense of smell 1s impaired, and the tongue when
protruded points to the right side. He has deep pain all over
the head, some impairment of vision in the left eye. Tendon re-
flex is increased on the right side, and the dorsal clonus is de-
cidedly active. Sensation is diminished on the right side of the
body, and there is asubjective sensation of coldness. His men-
tal condition has undergone a most extraordinary change, and
while in the field he was a courageous quiet soldier, he became
excitable, erratic and lost to shame, so far as some of his habits
were concerned. He took to drink, and his excesses were much
like those of the dipsomaniac—there being periodical debauches
during which he would commit all manner of excesses, fre-
quently being arrested. During the past four years he has upon
several occasions become maniacal and attempted violence. He
was destructive, and made assaults upon his immediate family.
I saw him two years ago, and at my advice he went voluntarily
to an asylum.
Affections of Memory after Cranial Injuries.—
Mr. Joseph Bell, in a very interesting article upon the loss of
memory occasionally following cranial injuries, refers to a
number of cases where loss of memory occurred after very
trivial scalp wounds. He tabulates these defects as follows :
““z, An instantaneous unconsciousness ; that is to say, loss
of recognition of one’s individuality, followed by giddiness,
stupidity, foolish talking, etc., which may pass off sooner or
later, but still is in immediate relation to the accident, and
gradually disappears. 2. A set of phenomena very various in
nature and amount, beginning a few hours after and depending
on structural and inflammatory changes in the cranial con-
tents; feverishness, delirium, dreams, etc., passing off into
~-
CRANIAL INJURIES, 315
fever or lapsing into coma, from compression; if from hemi-
plegia, these may be very rapid; if from meningitis, they may
be slower, but are to be counted by days and weeks. 3. A
state of phenomena of a much lighter and more dangerous
character; beginning with structural changes in the cranial
contents in the direction of atrophy or softening, where you
may have delusions, loss of memory, paralysis and dementia.”
Bell alludes to numerous cases where in addition to the
above the patient had forgotten entirely, not only the circum-
stances connected with the accident, but “a certain length of
time, varying in different cases from minutes up to hours and
even days, with all its actions, pains and pleasures before the
accident happened.” A recognition of this condition of affairs
is of immense importance in those cases where the testimony
is given concerning the details of the accident, and a strong
point is very often made (and sometimes unjustly admitted in
court) that the story of the patient is false, because he can not
remember the manner in which he was injured or his behavior
at the time ; and it may perhaps be insisted that he was drunk,
when such was not the case,
Bell reports the following example, which I reproduce :
“Case 1. A. W., a very able and learned man, nearly 50, of
abstemious habits and in perfect health, was rendered tem-
porarily unconscious (for probably not above five minutes)
while receiving two severe scalp wounds in occipital region by
upsetting of acoach. He volunteered to me, three days after
the accident, a question, including an expression of surprise,
as to how I explained the fact that he had lost memory, not of
what happened after the accident, but of the few minutes
which had passed before it.
“Case 2. W. B., et. 19, intelligent lad in business, was
rendered unconscious for about twenty minutes by a severe
concussion, the result of a railway accident. On coming to
himself, remembers nothing whatever of accident or of occur-
rences before it, such as his walking down to the station and
getting into carriage. JVofe. This condition I have observed
frequently after railway accidents attended by concussion.
The patients can neither understand the mental condition nor
explain how it happened to them, and thus very often, from
discussing the prior phenomena with friends and fellow-suffer-
ers, having no distinct recollections of their own, get com-
pletely confused, contradict themselves in the witness-box,
and are credited sometimes with imposture, and sometimes
with shamminge.
316 MEDICAL JURISPRUDENCE,
Case 3. A young miner, who sustained an extremely severe
and complicated fracture of vault of skull, with cerebral
hemorrhage and many days of unconsciousness, on recover-
ing, which he did completely, found that though the accident
happened on Monday morning, he having gone to his work
perfectly sober and in absolute health, he had completely lost
from his life the whole Sunday, which he had spent visiting his
sweetheart, and the greater part of Saturday evening and after-
noon. No suspicion of intoxication or narcotics could ex-
plain away an hour of his loss.
“Case 4. A very intelligent foreman in a brewery fell down
a deep well, striking the sides in his fall, and having serious
scalp wounds and concussion. He, on his recovery, is so much
puzzled and amazed by the loss of memory of the events
which preceded the injury, that he actually makes guesses at
his proceedings, but fails to explain to his own satisfaction, or
that of any body else, what it was he was doing to the well
and its rope. This man’s case also illustrates very well one of
the uncommon sets of mental phenomena following accident,
which I have classed as 2, depending on structural or inflam-
matory changes, which are to be measured by days. After
coming out of his comatose condition, he for several days was
odd, speaking sensibly enough, but with an uncomfortable
plainness of speech ; as, for example, he stated his belief that
my head nurse and I were a set of duffers because we kept
him on low diet. During this period he did not recognize his
own wife, nor did not know he had such. a relation, and so on.
But mark the difference. All these delusions are forgotten
on his recovery, or remembered only to be laughed at—every
thing in the past is now recalled, except the lost hour or two
immediately preceding the accident.”
The mental disturbance which follows head injury is some-
times of a violent kind, and is manifested in acts of violence.
Dr. Gray reports the case of a man who killed his wife about
one year after the receipt of his head injury. The patient
was ‘“‘aged 40, widower, eight children, iron worker, no educa-
tion, uses liquor and tobacco, native of England, not heredi-
itary. About a year before the homicide, he had his skull
fractured by the fall of some bricks. He was treated in the
New York Hospital, and discharged from there six months
before his admission to the Asylum. Previous to the injury
he had borne a good character and was a mild and inoffensive
man. After leaving the hospital he suffered much from head-
ache, of a severe character, situated near point of fracture.
CRANIAL INJURIES, 317
He lost memory and became excessively irritable and violent
if crossed or opposed in any way, and was sleepless. Three
months before his admission, he killed his wife during a par-
oxysm of excitement, by striking her repeatedly with a chair.
He was arrested and lodged in jail, but denied any knowledge
or recollection of the crime. He did not manifest any reali-
zation of the occurrence until some time after, and when it
had been frequently told him. He was sent from jail to the
asylum, on the order of the County Judge. For a long period
he suffered from headache and was at times irritable, but
manifested no tendency to commit violence. He was emo-
tional and sensitive to the remarks of other patients ; although
able to do light work, any unusual exertion or exposure
brought on a return of the headache. He became more equa-
ble in his feelings, and feeble-minded, remained in the asylum
four years, when he eloped. He bas since died.”
The Courts are not disposed to recognize what is legally
known as “distress of mind’’—that is to say the annoyance
and discomfort which a healthy person may experience. It 1s,
therefore, important for the plaintiff to prove that his mental
disturbance is the result of brain disease.
Case LV.—HeEApD INjuRY. CLAIM FOR DAMAGES FOR Dis-
TRESS OF MIND NOT THE Direct RESULT oF ACCIDENT.
DENIAL.
City of Salina
US. 27 Kansas Reports, 544.
Prosper,
Thompson Prosper was injured on the night of April 29,
1878, in the city of Salina, by falling through an excavation
on one of the sidewalks in said city. His injuries consisted
of a fracture of the skull and left knee pan. He brought suit
and on the trial the jury in their verdict awarded him among
other damages $1,284 for physical and mental suffering. The
city appealed to the Supreme Court, and, in reversing the
judgment, that court held that no damages can be recovered
for mental suffering except where it is the natural consequence
of the physical injury.
Compression of the Brain.—Compression of the brain
may be immediate from the sudden rupture of a vessel,
or it may follow concussion. The symptoms are progressive
in their development, increasing as the hemorrhage continues
318 MEDICAL JURISPRUDENCE,
and bear a relation tothe injury. There is a condition of
stupidity which deepens into coma, paralysis and incontinence
of urine and feces. The pulse is hard and full, the pupils are
contracted or dilated and they may be of different size. Con-
vulsions are sometimes found as asymptom. In some cases
there may be purulent infiltration and the formation of ab-
SCeSSES.
When the skull is not actually fractured but when the soft
parts are torn, a meningitis may arise from the extension of an
inflammation with purulent formation. Venous thrombosis
may be followed by extension of the morbid process. If there
be a pouring out of blood between the internal surface of the
skull and the dura mater, a general meningitis is apt to fol-
low with fatal result.
Contusio Cerebri.—Actual injury to the brain substance
(contusio cerebri) may occur without any external fracture, but
may result from a splintering of the inner table, and the exter-
nal violence may be slight. Wemay have transmitted violence,
most likely if the head rests on a hard substance, and it be
struck a dull and heavy blow on the opposite side. In such
cases we have a contrecoup, which results in basal injury.
Limited injuries are apt to produce convexity troubles and
slight meningeal hemorrhages. We are to make use of these
distinctions in medico-legal cases, for early symptoms suggestive
of vertical irritation are indicative of a light concentrated
- blow ; this is especially the case if thereis a limited hemiplegia.
In basal injuries, from presumably heavy blows, we find pre-
dominant symptoms of cranial nerve paralysis and disturbance
of the medulla oblongata.
An injury upon the left side of the head anteriorly is apt
to produce aphasia.
Blows on the Side of the Head and Deafness.—
Blows upon the sideof the head occasionally produce deafness.
Such a case I examined a few months ago. The man had
fallen into a deep hole, striking the left side of his head. He
immediately became deaf, and a few months later, blind in the
left eye. There was subsequently a decided hemiparesis of the
other side of the body.
Convulsions in Paralyzed Limbs.—Convulsions in
paralyzed limbs indicate a lesion in the motor centers in the
frontal and parietal lobes. Especially valuable are such indi-
cations when new parts are progressively involved.
| CRANIAL INJURIES, 419
Latent Disease in Cranial Injuries.—The mistake
that may sometimes be made of overlooking latent disease
is a very grave one. Especially is this the case where the sub-
sequent death of the individual complicates matters. Abscess
and tumor may exist for a long time without giving rise to any
very serious manifestations of trouble. A lght headache, slight
mental changes, irritability and loss of memory may be all that
we find, and suddenly, without any warning, the patient may
drop dead; and upon autopsical examination the true na-
ture of his disease becomes apparent. Not only in the matter
of feigning do we consider such troubles, but in their connec-
tion with homicide. Upon many occasions persons have
been arrested and convicted for causing the death of an-
other, though upon inquiry it appears that the injury in-
flicted was insufficient to have caused the death of the sup-
posed victim. Numerous examples are referred to, where in a
brawl or ina simple assault, a man drops dead after having
been lightly pushed or struck. It then becomes our duty to
determine the degree of responsibility of the indicted person,
and we shall seriously neglect our duty if we do not insist upon
a post-mortem examination of the body of the deceased. We
may then find the evidences not only of cerebral disease, but of
pulmonary, cardiac, and vascular troubles as well.
Head Injuries in Children.—Christison refers to the
interesting case of a woman who had lost several children within
a period of afew years, and no reasonable cause could be as-
signed for their deaths. These children were all under four-
teen, and their demise was followed by a sickness attended by
headache, vomiting and other mischief. A medical investiga-
tion disclosed the fact that there were evidences of cerebral
hypertrophy, which was probably the cause of the death of all
the children. In this case the woman was arrested upon sus-
picion. I have myself known of examples where the same med-
ico-legal point might have arisen, where in a phthisical family
several children died within a comparatively short time of
tubercular meningitis of a speedily fatal character, and where
the question of criminal intent, under certain circumstances,
might have very reasonably arisen.
Head injuries in children may develop in scrofulous subjects,
a condition resembling tubercular meningitis, but we must be on
our guard in such cases to throw out the possibility of the dis-
ease occurring without such a cause ; and be able to determine
the existence of hereditary neurotic taint. Blows and falls often
320 MEDICAL JURISPRUDENCE.
precipitate the disease in the children of tuberculous parents.
Blows: upon the back of the head are especially apt to produce
tubercular meningitis, the symptoms of which—sub-occipital
headache, hallucinations, staggering gait with atendency to fall
backwards, retraction of the head, ocular symptoms, delirium,
coma, and death, are suggestive.
Changes in the display of mental disturbances occur as a re-
sult of varying pathological processes. An exacerbation of
excitement follows a temporary vascular change, or a short lived
inflammatory process.
Complication with Other Diseases.—Cranial injuries
have been reported as occurring in phthisical patients who
have died from the original disease within a short time after the
injury, and in one case the man was beaten about the head
and chest, and there was slight hemorrhage at the time. He
died ten months after the blow upon the head.
A most recent case, which illustrates the possibility that
cerebellar symptoms following a blow may be due to some pre-
existing disease, which perhaps the violence has developed, is
that reported by Dr. Fraser.*
The patient was aman who had received a fracture of the
parietal bone by a brick that had fallen from a great height.
He was at first insensible, but was able in the course of three
weeks to return to his work. He suffered, however, from occi-
pital headache of a severe character, and during the next
fifteen months was deaf, and with this there was some ambly-
opia and a variety of symptoms suggestive of mental enfee-
blement. He was stupid, of slow thought, and greatly depressed.
A few months later his gait became ataxic, he had an inclina-
tion to fall backwards, and he presented the “circus move-
ments” described by some authors as suggestive of cerebellar
disease. In addition, there was double optic neuritis, with
vertigo and vomiting, and difficulties in co-ordination. Subse-
quent examination revealed the existence of, well marked
syphilitic indications, such as nodes, eruptions, and cicatrices,
and it was determined to try the effect of specific treatment.
Under the use of large doses of iodide of potassium his trou-
bles diminished in severity, and he rapidly revovered. In this
case it is very probable that the blow was an exciting cause of
cerebral syphilis. Although the situation is not favorable for a
contrecoup that would give rise to cerebral disease, it is possi-
* London Lancet, May 12, 1883.
CRANIAL INJURIES. 320
ble that a diffused meningeal inflammation and deposit of
gummatous matter took place as an extending lesion, and had
the case given rise to medico-legal complications the question
of limited criminality might justly have been urged.
Otitis in Cranial Injuries.—In certain cases of aural
disease a slight injury may precipitate death. Cases of otitis
media have been reported in which the aural discharge had
ceased after the person had either been struck with the fist or
had received some equally trivial injury. In one such case a
patient died comatose within one month after an injury and a
cranial abscess was found which undoubtedly resulted from the
disease of the ear. -In this case the patient was struck in the
chest and, in attempting to resent the injury, hit his head
against a door.
Brain Abscesses.—The tendency of severe brain injuries
may be to the formation of an abscess, which may burst in-
to the ventricles, and be discharged through the ear, as occur-
red in Mr. Hawkins’ case, where there was a copious discharge
a few weeks after a head injury. Many injuries giving rise to
head symptoms are quite likely to cause a variety of inflamma-
tory action, in which there is extensive accumulation of serum,
which distends the ventricles and infiltrates all the cranial tis-
sues. Abercrombie reports cases, which shuw that the symp-
toms appear gradually with a slow formation of effusion, but
that sometimes the latter may be very rapid and the symptoms
correspondingly prompt in their expression.
Alcoholism in Cranial Injuries.—The patient’s previous
habits may aggravate an injury which ina healthy man would
produce little or no mischief. Cases are reported where in a
drunken state a person has received a slight head injury which
was followed by death and yet no cerebral lesions directly due to
the wound were found. Sir Charles Bell reports sucha case, the
victim being a woman of bad habits who while being remonstrated
with by her husband, a good-tempered, industrious man, suddenly
died from a cerebral hemorrhage. The husband struck her in the
struggle, but not a blow of any force, and after death no scar or
superficial extravasation was found. Bell testified that the con-
dition of intoxication and the general diseased state of the vessels
predisposed to the rupture, and that the blow was the exciting
cause. ‘The prisoner was acquitted.
Beck in commenting upon the above case, says; “It may,
322 MEDICAL JURISPRUDENCE.
however, be urged that the tendency of the remarks in the text
is to exonerate all and every one from the consequences of in-
juries inflicted on the intemperate. Not so, if these injuries are
recent, and if they cannot be confounded with the effects of
natural disease, they are to be estimated lke all other wounds.
Severe blows, followed rapidly by convulsions, coma and death,
and exhibiting on dissection effusion of blood upon the brain
without any other disease of that part, present a very conclusive
case of the effects of violence.”
It may sometimes be necessary to distinguish the state of un-
consciousness that results from concussion and drunkenness,
‘This is sometimes an extremely difficult matter, for alcoholism
as well as concussion may be followed by secondary results.
‘Great care should be taken to investigate the patient’s behavior
and condition previous to the supposed accident, the presence
of the fumes of alcohol and the manner of the injury. If death
has taken place, alcohol may be found in the stomach. In
some cases it may be well to examine the urine by the bichro-
mate of potassium test, and if death has ensued, we may look for
the appearance of renal and hepatic degeneration as well as for
diseased cerebral vessels and meninges.
When the patient has received an injury when intoxicated
the question may be extremely difficult to decide.
The Complication of Erysipelas.—The complication of
erysipelas is one that is of some interest when it occurs in per-
sons who have received head injuries. In one such case, that of
a woman who had been struck with a smoothing iron and who
afterwards disregarded her injury and drank to excess, a fatal
attack of erysipelas occurred. It was shown that the wound
which simply involved the scalp at first, had taken on a violent
inflammatory action which resulted in perforation; that she
was able to go about for over a month, attending balls and in-
dulging in her trade—that of a prostitute—and that her erysi-
pelas and not her wound was the cause of her death. It was,
further shown that at the time there was an epidemic of erysi-
pelas in Edinburgh. The prisoner was found guilty simply of
assault.
* Dr. Dunlop, who reported the case, calls attention to the.
fact that no evidence to prove the exact date of the commence-.
ment of the erysipelas was to be had. It was unfortunate, for
* Edinburg Med, and Sure. Fournal, vol, 21, p. 488, and Beck’s Medi--
cal, Jurisprudence, vol. 2, p. 305.
CRANIAL INJURIES. 323
it might have shown whether the erysipelas began in the wound
as it always does in the traumatic variety, or elsewhere, as is
usually the case in the idiopathic form.
Trivial Blows and their Occasional Results.—Cases
are reported where a very trivial injury has given rise to grave
head symptoms. Falls from inconsiderable heights, from a
chair or some slight elevation, have resulted in fracture of the
base of the skull. Casper speaks of a woman who fell ina cup-
board and a fracture of the petrous portion of the right temp-
oral bone was the result. In old persons such accidents are by
no means uncommon and care should be taken in medico-legal
cases not to confuse them with cerebral hemorrhage or other
conditions.
Unconsciousness without Apparent Marks.—It occa-
sionally happens that a person is found unconscious after an as-
sault and no external mark of injury is discovered. The patient
may subsequently die and post-mortem examination reveals a
fracture of the skull with extravasation. Itis highly probable in
such cases that what 1s known as a sandclub is used—a bag made
of some cloth or cotton stuff and filled with sand. This sus-
picion is increased by the presence of ecchymosis beneath the
site of the blow and fracture at the base, for the violence is
transmitted in most cases by contrecoup.
As an illustration of how trivial head injuries may sometimes
have a fatal terminatiou, I may refer to the case reported by
Mr. Ashmun,* in which a small stone was thrown, striking a
man upon the side of his head and causing death in ten minutes.
“ There was no external bruise and no fracture. Thecranium
was found to be extremely thin, and the ventricles were filled
with coagulated blood, and the pia mater and vessels of the
brain were gorged with blood.” ‘The dura was healthy. The
verdict was manslaughter, which Ashmun thought was too
severe.
I may refer in this connection to a case reported by O’Hal-
loran, of a man who received a blow upon the head with a
cudgel, which left some headache and fullness, but there was
nothing else for many months, when an elevation appeared at
the seat of the injury, of considerable size, and when this was
opened there was found beneath an aperture in the cranium the
size of a half crown, and beneath, the dura mater was found
covered with pus, and this part subsequently became the seat of
* American.Jurist, vol. 15, -p. 108,
324° MEDICAL JURISPRUDENCE.
a fungous growth. Numerous cases of this kind are detailed by
Abernethy, Norris and others, in which a serious injury was
masked by a premature closure of the wound, and the real
condition of affairs was not discovered until later.
Howship refers to the case of a boy who received a blow
on the head with a ruler, which was followed by a small dis-
charging sore that healed at the end of six years. Then
the boy’s sight was impaired and he manifested epilepsy.
After his death, which resulted from trephining, evidences of
chronic inflammation of the brain and its membranes were
discovered beneath the point of injury. Abernethy, in re-
ferring to these cases, states that very often the disease is
confined to the inner table and extends inwards, producing
cerebral disease.
Taylor relates some cases where boys who had had their
ears boxed, and where no undue violence had been -used, died
shortly afterwards. The case of “Regina vs. Hopley” is
one of these. The boy’s stupidity, which was the result of dis-
ease, affected intellectual development. He presented no un-
usual symptoms of critical disease up to the time the flogging
was administered, but three years after the punishment he
died. Taylor also refers to the case of a boy who received two
slight blows on the face. He went to his work the next day,
but complained of pain in his head, which increased so that two
days afterwards he was obliged to give up everything and take
to his bed. His condition became worse and death followed in
fourteen days. At the post mortem the only morbid appear-
ance found was a small tumor in the dura mater over the post-
erlor face of the petrous portion of the right temporal bone.
It was held. by those who made the examination, that the boy’s
death had not resulted from the violence, that the tumor was of
long growth ; and that some time before the injury he had com-
plained of pain in his head, and that the slight violence could
hardly have affected this deep-seated lesion.
A case may be cited of a man who was struck upon the
face with the palm of the hand without the production of local
effects. Within a few days he complained of very severe pain
in his head and at the end of the thirteenth day he sought medi-
cal aid. The following day he became much worse and died
rathersuddenly. No signs that could be traced to the accident
were found at the autopsy, but attached to the petrous portion
of the temporal bone was found a small tumor the size of a
hazelnut. It afterwards transpired that the man had com-
plained of pain for over a year,
CRANIAL INJURIES. 325
Head Injury as the Result of a Fall upon the
Feet.—In very rare cases a fall upon the feet has been known
to produce a fracture at the base, and this was the cause of the
death of the Duke of Orleans.
Blows with the Fist.—Blows with the fist produce ecchy-
mosis, wounds if produced are small and rarely divide the skin
in a clean cut manner and are not usually followed by very
grave cerebral conditions, excepting, perhaps, when the blow
is inflicted behind the ear.
Considerable care must be exercised in examining the heads
of persons who have received blows, and the appearance of
the swelling and ecchymosis must be closely investigated.
Collections of blood beneath the scalp are always taken for
graver injuries, and there may be a depression in the center,
which in many instances has deceived the physician who imag-
ined it to be a fracture of the skull. Harrison cautions the
observer against mistaking the throbbing of the lump, which may
be after all transmitted, for that of the pulsation of the brain,
which does not exist. These points are important to remember
in courts of law, where the testimony of a medical witness 1s to
the effect that there was a fracture of the skull, and his evi-
dence, which is perhaps the result of an erroneous conclusion,
should be carefully sifted. There are numerous cases of death
from concussion, where there is neither fracture of the skull,
effusion of blood, nor any observable injury. A number of these
cases are reported by the older writers, where a blow by the fist
has been the cause of almost immediate death, where there
has been nothing to account for the same, except the violence
itself. Case of this kind is reported by Harrison. ‘“ George
Macclish and John Macvey were tried in Glasgow, on the 29th
of December, 1831, for the assault and murder of William Car-
lyle, on the September preceding. Carlyle and a friend, while
on their way home late at night, were met by seven or eight
men standing at the corner of a street who accosted them.
A quarrel was the result, when Macclish struck Green, the
friend of Carlyle, knocking him down, when he arose and was
again knocked down by Macvey. When he recovered he looked
about for Carlyle, who also had been knocked down by Mac-
clish, and he was found dead. Carlyle’s head contained a con-
siderable effusion of blood beneath the skull, with extravasa-
tion of blood on the brain. In this case the medical witnesses
were unable to agree whether the blows or falls were the cause
of death, and there being no proof of malice the prisoners
326 - MEDICAL JURISPRUDENCE.
were acquitted of murder, but were found guilty of culpable
homicide and were sentenced to fourteen years’ imprisonment.
Numerous cases of death of this kind, the subjects being prize
fighters, have from time to time been brought forward, and in
many instances death had followed blows upon the ear and at
the back part of the head. In fact it may be said that in these
instances an inconsiderable amount of violence is likely to be
followed by a fatal result.
Rare cases have been reported, in which there has been
atrophy and absorption of bone, without any destruction of
the integuments, as the result of a fall. Such a case is detailed
by Howship, in which the right parietal bone was injured, but
there was no external wound. Some weeks subsequently, how-
ever, the pulsation of the brain could be perceived at the point
of injury, and the child became paralytic.
Prognosis of Cranial Injuries.—The prognosis of cra-
nial injuries is very uncertain ; forms in which fracture is pro-
duced are extremely unfavorable, and the presence of
symptoms of meningitis, or purulent encephalitis are equally
bad. The duration of the primary unconsciousness has
much to do with the subsequent improvement or the re-
verse, and the symptoms of compression are especially of serious
import. The nature of blow should be taken into account—
whether it is made bya dull heavy instrument or by one
with a sharp-cutting edge—and in the latter case if there is no
fracture the patient’s chances are better. Blows upon the ver-
tex or over the ear are bad and in the latter case an otitis with
subsequent cerebral symptoms may follow.
Patients may receive comparatively serious accidents and yet
be immediately able to seek assistance. A case is mentioned of a
laborer who was struck upon the head with a pick-ax, the point
entering the brain to the depth of the left lateral ventricle,—yet
he walked a mile and a half to the hospital.
We cannot always say that such and such an injury is
necessarily fatal, for there are important exceptional cases
where extensive destruction of tissue has taken place without
apparently shortening the life of the individual, and there are
numerous cases where bullets and other missiles have become
encysted. I know of a distinguished judge who carries in
his brain to this day, a bullet which penetrated the cranium
during the civil war, and *Elliot reports the case where a bul-
let remained in the brain for sixty-five years! The patient in
* Edinburg Med. and Surgical Fournal, Dec. 1880.
CRANIAL INJURIES. 327
this case was a man who was shot in the eye, the bullet lodging
probably in the occipital lobe.
In some of these cases in which the patient temporarily sur-
vives the accident, the prisoner may be convicted simply of
assault, and when death does occur, it is often supposed to be
from other causes.
Contusions and their Results.—The consequences of
contusions of- the scalp have been sometimes severe, and, as
I have mentioned, not only may epilepsy follow such injuries,
but we often find cases of trigeminal neuralgia of an extraor-
dinarily severe character arising subsequent to a blow upon the
head and superficial wounding. It has been shown by the statis-
tics in the Medical and Surgical History of the War of the Rebel-
lion, that contusions of the scalp as produced by projectiles are
quite likely to be followed by the most serious consequences
and severe intra-cranial trouble. When the cranial bones are
subjected to violence, we may find that a slight blow, not suf-
ficient to cause fracture, may sometimes give rise to such injury
that necrosis of the part follows, and exfoliation and discharge
of bones takes piace after some time. Of course the force
exhibited may produce death of the external table of the skull
alone, or of the internal as well. The local pain that some-
times exists for a long time after an injury need not be men-
ingeal in character, but may symptomatize an inflammation of
the cranial bones which are beneath the seat of contusion.
_ We find in such cases that there is usually some thickness or
hypertrophy beneath the cicatrix, and that slight pressure may
cause a great deal of suffering. Under certain circumstances
we find that the diploé may be the seat of inflammation as the
result of head injury ; in such cases the symptoms are insidi-
ous in their development, and we are apt to find meningitis
and serious ““ouble.
The Progn. 3 of Traumatic Inflammation.—In-
juries followed by ‘nflammation of the brain give rise to pro-
nounced symptoms w..ich rarely appear before a week at least.
Yet if there is a conspicuous rise of temperature serious mis-
chief may be expected, it is therefore safe for the medical man
to be exceedingly careful lest he may say that because the blow
is not immediately followed by bad symptoms, that the injury
is not a serious one, or that the secondary condition is purely
the result of the patient’s carelessness, or that it is due to an-
other cause,
328 7 MEDICAL JURISPRUDENCE.
In advanced cases we are are to give a very guarded prog-
nosis, but there are cases in which there can be little doubt as
to the progress and termination of the symptoms. When, for
instance, there is a well-developed series of progressive symp-
toms indicative of structural degeneration, consisting, perhaps,
of paralysis with contractions and increased tendinous reflexes,
optic neuritis with choked disc, convulsions, tremor increased -
with voluntary effort, mental impairment with loss of memory,
the case is hkely to terminate fatally in a comparatively short
time.
An interesting point is the possible distinction between trau-:
matic inflammation of different kinds. Holmes considers this
matter very fully, and does not believe that, for instance, in the
one case it can be said that the brain is alone affected, and in
another that the membranes are. We are to be guided largely
by the time of appearance of such symptoms as evidence of
the injury. Holmes points out that inflammatory symptoms
are apt to be of very early development after fracture, within a
few hours or a few days; while with contusion several days
are apt to elapse before the inflammatory symptoms make
their appearance; and in cases of another kind, where there
has been trouble, it may often be several weeks after the
subsidence of light symptoms before the expressions of grave
cranial trouble are presented. So far for the probable kind
of injury.
As to localization the matter is perhaps more difficult. For
we have to deal with pathological processes, which are often
extensive and advancing.
Head Injuries and Pyemia.—Head injury may be fol-
lowed by pyemia, and this is the case more often in slight trau-
matisms where perhaps the only trouble may be a scalp wound
or contusion. In 328 cases reported in the “ Medical and Surgical
History of the Rebellion” of contusions as the result of gun-
shot, the head being the seat of injury, but one case of pyemia
was reported, which shows the complication is not so frequent
a one as where other parts of the body are wounded. The loca-
tion of extravasations of blood in the cranial cavity, but more
often beneath the arachnoid, vary greatly. The symptoms are
usually those of compression, and if the collections be not
too great» we may find, as the brain accommodates itself
to pressure, that there is a remission. Sometimes this
lightening up of the trouble may follow the use of the
trephine ; or, as in the case reported by Holmes, the escape of
CRANIAL INJUIIES, 329
blood from a vessel in the neighborhood. “In the year 1859
a man was struck with a spade, just over the anterior inferior
angle of the right parietal ; and when he came to St. George’s
Hospital a few minutes afterwards, a compound fracture, with
depression of a small piece of the skull, was detected. But
there was no cerebral symptom whatsoever. Shortly after-
wards, however, the patient became heavy and stupid; and
coma was gradually supervening, when Mr. Kidd arrived, and
at once proceeded to remove the depressed bone, whereupon a
jet of blood spurted out from a large branch of the meningeal
artery, and all the symptoms of compression were immediately
relieved.”
The Nature of Extravasations.—The nature of the
collection of effused blood which is found extravasated in the
cranial cavity is to be determined with regard to the time of the
injury. Blood when recently poured out is bright and clotted,
and at a later stage is darker and more firm, after two weeks it
becomes yellow, and later on a well organized fibrinous mass
remains.
Influence of Head Injuries upon Previously Exist-
ing Mental Disease.—It not infrequently happens that a
blow upon the head will in individuals of weak mind, or in
those who have suffered for years from some form of disease,
produce a sudden improvement or restoration.
Sir Astley Cooper tells of a sailor who remained in a stupid
state after acranial injury for fully a year, and was then suddenly
restored by the operation of trephining. Cases of this kind
have a dramatic significance which has led novelists and play-
wrights to make use of them. The books contain instances of
persons suddenly deprived of consciousness in the midst of
a pursuit, and some time after taking up the thread of thought
after sudden restoration.
Abercrombie tells of a lady who had an apoplectic attack in
the midst of a game of cards. The first words she uttered after
she recovered her consciousness some days later were “ What
is trumps ?”’
In such cases there is a prolonged compression of the brain
and in medico-legal cases the question of curability arises—
whether or not proper surgical treatment might effect a cure.
Pritchard relates the case of three idiot brothers. One
received a blow upon the head and afterwards seemed to un-
dergo a very decided change for the better in his mental
condition, and ultimately became a clever barrister, while
330 MEDICAL JURISPRUDENCE. ,
his brothers remained imbecile. Cases of insanity have been
caused by blows upon the head, and the same thing is true
with epilepsy.
Affections of Speech as the Result of Head In-
juries.—A ffections of speech as a result of head injuries are
common enough. Dr. Hoy,* of Racine, Wisconsin, reports
three interesting cases, in the first of which a fracture of the
skull occupying the anterior superior angle of the left parietal
bone existed. The immediate insensibility disappeared after
the use of the trephine, but returned a few days afterwards and
was due undoubtedly to the pressure of retained blood, and
this was verified by the removal of the stitches, when the
‘patient’s mind again became clear. The doctor found that by
making pressure with his thumb over the opening he could at
will temporarily suspend the faculty of speech.
The third case was that “of aman livingin Vermont who was
standing near his mill bantering with his son about shooting a
kingfisher that was perched on a dry snag that was projected
from the water in the pond. The son fired, and the rifle-ball,
a small one, missed the bird, ricochetted and struck the father
near the middle of the forehead. He dropped instantly, and
for a long time it was thought impossible for him to recover ;
but time wore on, and he still lived, a mere animal, incapable
of speech, for fifteen years, at which time there appeared a
slight elevation of the skull at the crown of the head. Dr.
Mussy was called and trephined the spot, when he was enabled
to remove the flattened ball that had remained so long within
the skull, In afew minutes the old man called out, ‘“ Zeke,
you dog, you missed it!” ‘“ Missed what ?” asked the doctor.
“Why, the kingfisher!’’ This was the first word spoken since
the accident, and he could not understand that the report of
the rifle was not still reverberating over the water at that mo-
ment. Zeke was married, had a family and was living in the
West. The father had grown gray, and all was changed. A
Rip Van Winkle in reality.”
Insanity during litigation.—It occasionally happens
that the plaintiff in a suit for damages for physical injury may
subsequently become insane. Such a case (Martin vs. Penn.
R. R. Co.) in which I appeared as medical witness, was tried
a few months ago.—
The plaintiff was injured in a collision between two steam-
* Fournal of Mental and Nervous Diseases, New Series, vol. ii., p. 2.
CRANIAL INJURIES, 331
boats and was wedged between the seats in the cabin of the
ferry boat in which he was at the time. His momentary inju-
ries were seemingly trivial the most severe of which was a blow
upon the head, but his sufferings later were very great. <A few
months after the accident he became morose, nervous, indiffer-
ent, and violent towards his family, and finally it was found
necessary to confine him in an asylum for the insane. In the
meantime his suit was tried and he was brought into court.
His behavior upon the witness stand and during his private
examination was strikingly suggestive. He claimed that the
motions of his counsel were improper and that he did not need
damages. He also had the most magnificent schemes and
ideas of his wealth and the delusion that he was in personal
communication with God. In this case the question arose,
whether an insane man was competent to bringa suit. The ap-
peal was decided in his favor and the matter was compromised.
ae
CasE LVI.—RAILWAY INJURY.—RELEASE OF DEFENDANTS
DISPUTED ON GROUND OF INSANITY OF PLAINTIFF.—CON-
TRACT DECLARED VALID, PLAINTIFF BEING CONSIDERED
RESPONSIBLE AT TIME IT WAS MADE.
George
US. 34 Arkansas Reports 613.
St. L. M. & S. Ry Co.,
On Nov. 17, 1876 plaintiff while riding as a regular passen-
ger on a train of the defendants, traveling from Little Rock to
Texarkana was injured severely on the head in an accident to
said train, which injury caused him great pain. On Nov. 29,
1876, while still suffering from said injury, he, in consideration
of the sum of $100 signed a release to the defendant company
for all damages caused by said injury, but when he recovered
from the effects of the injury and was informed by his wife
that he had signed a receipt he had no recollection of it and
went to the agent of the company to see the receipt, but his
request was refused. He made no offer to return the $100
but claimed that he never received it, that he had no recollec-
tion of signing the release. On the trial the attending physician
testified that his injury consisted of a severe scalp wound ; that
his mind was clear on Nov. 29; and witnesses of the transac-
tion testified, that, though plaintiff was confined to his bed
when he signed the release he seemed to know what he was doing,
332 MEDICAL JURISPRUDENCE.
that he appeared to be perfectly sane ; that there were several
members of his family present ; that an offer of $60 was made to
him, but he refused to take less than $100. On the other hand
the keeper of the hotel to which plaintiff was brought after the
accident testified that plaintiff was confined to his room until
January 6, 1877 ; that he saw plaintiff daily until December 6,
1876 ; that sometimes he seemed rational and sometimes he
talked at random and flighty. Under a charge that it was
‘plaintiff’s duty to offer to return the money if he wished to re-
pudiate the contract the jury found for defendant.
On appeal to the Supreme Court the judgment was reversed
and the case remanded for trial on the ground that if plaintiff
was insane when he signed the release, it was a question for the
jury whether he was in ignorance of the existence of the release
when he brought suit.
Watson*™ says:—‘‘In criminal trials for the infliction of in-
juries upon the head, in which the injured individual is able to
be a witness, it is obvious from the disordered state of the intel-
lectual faculties, and particularly of memory, arising from con-
cussion, that his evidence should be taken with extreme
caution in regard to circumstances which happened at the time
of the injury and indeed it should only be received in so far
as it is coroborated by other testimony.”
Post-Mortem Determination of Suicide or Homi-
cide.—It is a matter of importance to determine whether the
fractures of the skull which are found are the result of violence
inflicted during life or afterwards ; and very often this is an im-
portant element in fixing the guilt or innocence of the suspected
person. Casper, who has conducted a number of experiments
on dead bodies, found that it was avery difficult matter to
produce fracture of the skull by ordinary blows and that only
powerful blows were followed by fissures in the occipital, or
parietal, or “more frequently in the squamous portion of the
temporal bone. The dead scalp seems to have considerably
more power of resistance than the living one, and after its re-
moval fissures of the bones are more easily produced by
similar blows.”
It is to be determined sometimes, whether the evidence of
fracture of the skull that may be found in human remains are
ante- or post-mortem, or if the latter, how produced. Dr. S.
E. Stone ¢ presented to the Norfolk District Medical Society
* Edinburgh Med. & Surg. Fournal, vol. 52, p. 109.
+ Boston Med. & Surg. Fournal, Dec. 26, 1876.
CRANIAL INJURIES. 333
a skull presenting a well-marked fracture at the base. The
skull belonged to a skeleton which was found near a brook in
Walpole. It was prone and partially concealed beneath a
hedge, the right arm was raised in advance of the head which
pointed to the brook. “The left arm lay under and across
the body. The right leg was extended, and the left flexed be-
neath it. No part of the skeleton was below the level of the
ground and no stone or other hard substance could be found,
with which the body could have come in contact in falling in
such a manner as to produce the fracture. The clothing, with
the exception of the feet, upon one of which was found a shoe
and stocking, and upon the other a stocking only. The
other shoe was found near the head, while the clothing lay
mostly beneath the body. But little flesh was left upon, the
bones, and this was converted into adipocire. The locality
where the skeleton was found was a most unfrequented spot,
known to but few persons. The fracture extended from a
point an inch to the left of the occipital protuberance, in a
nearly straight line to the posterior condyloid foramen, and
then at an oblique angle forward to the outer edge of the pos-
terior foramen lacerum.”’
Fig. 9.
The questions to be decided were whether the fracture had
resulted from the expansion caused by the freezing of water
which had accumulated in the skull after the disappearance of
soft parts, or whether it had been produced by violence be-
fore death. Dr. Stone believed in the latter theory, holding
that if water had frozen, the expansion would have been exert-
ed upon all sides and separation of the bone at the sutures
334 MEDICAL JURISPRUDENCE.
would have taken place instead of the fracture of a strong
bone. The position of the body favored the former theory
however.
Orbital Wounds.—Several cases of orbital injuries with
fatal results are reported by Orfila, Beck, and Smith. McClane
the actor, was tried for the murder of another actor by thrusting
his stick at him, the point of which entered the orbit. Such
injuries, as I have said, in exceptional cases may not be fol-
lowed at once by death. A patient I saw in consultation with
Dr. Noyes of this city was a man who had been wounded while
hunting, and it was some weeks before the serious nature of his
orbital wound was fully recognized, when upon examination a
long piece of iron from the stock of the gun, four or five inches
in length, was found to have entered the orbital cavity, and
was imbedded in the right frontal lobe. This patient lived for
several months after the explosion of his gun.
Prognosis in Relation to Degree of Skull Injury.*
—Dr. Ashurst presents two cases of compound fracture of the
skull in children, which shows that ‘‘ the amount of damage
done to the brain is apt to be inversely proportionate to that
inflicted upon the skull. In one of the cases a little girl was
injured by a heavy body falling from a great distance with
great momentum, the separation and removal of a large portion
of bone, the occurrence only of “cerebral irritation,” the force
of the blow being expended upon the skull, and in this case
the patient’s convalescence was uninterupted and her recovery
was attended by no cerebral impairment. ‘The second case in
which the injury was slight, the blow having been inflicted
with a shovel, presented but a very slight fracture. Dr. Ash-
urst says: “ There were at first absolutely no symptoms of
intra-cranial lesion ; and when the occurrence of suppuration
between the inner and outer tables at the seat of fracture gave
rise to convulsicns, and required the application of the trephine,
the membranes of the brain were found entirely intact, and
with the elevation of the depressed portion of bone the con-
vulsions instantly and definitively ceased. Yet, at the moment
of injury, the skull measurably resisting the force of the blow,
its effects were transmitted indirectly (by the contrecoup or
‘““counter-stroke”’ of the older writers) to the substance of the
cerebrum itself, where at a very considerable depth some slight
laceration or contusion of the brain-substance occurred,—lacera-
* Philadelbhia Medical Times, Dec. 23, 1866, p. 123.
CRANIAL INJURIES. 335
tion so slight as to give no sign of its presence until several
weeks afterwards, and yet sufficient to prove the starting-point
of the large abscess whlch ultimately brought the case to a
fatal termination.” x
Bullet Wounds and their Results.—The occurrence of
brain symptoms after the receipt of bullet wounds of the head
may not be immediate, on the contrary, several weeks or a inuch
longer time may ensue before cerebral mischief follows. I know
of a man who attempted suicide by firing four small Smith and
Wesson balls into the head—one just above the right ear,
another above this, and two through the frontal bone. The
patient appeared very comfortable, ate, slept, and talked ration-
ally until the twenty-eighth day, when a rise of temperature
followed by headache, delirium, and coma took place, and he
died one week later. Taylor speaks of a child who was acci-
dentally injured by a pistol shot, which traversed both hemi-
spheres. No symptoms manifested themselves for twenty-six
days, and the child died on the twenty-ninth day.
Hernia Cerebri in Relation to Prognosis.—I was
called several years ago to see a child, who while playing ina
closet, dislodged a large pistol, which exploded. The ball
entered the forehead, shattering the frontal bones, and as a
result there was an extensive hernia cerebri. If was not until
two weeks afterwards that cerebral symptoms manifested them-
selves, and the patient died a few days subsequently.
Dr. Bush’s Case of Pistol Wound of Brain with
Recovery.—Dr. Bush, of Boston, records an _ interesting
case of a patient who recovered after a pistol wound of the
head.
“G. B., a stout German lad, sixteen years old, weighing one
hundred and sixty pounds, had always been well, previous to
receiving the injury about to be described.
“On June 29th, while playing with a younger companion,*
the patient was shot in the head, and immediately fell to the
ground insensible. He was lying upon a sofa, breathing
heavily, with a slow pulse, the mouth drawn to the left, and the
left arm and leg paralyzed. It was with difficulty that he could
be roused.
“Upon examination a small round wound, with inverted
edges, was found in the forehead, over the center of the right
* Boston Med, and Surgical Fournal, Jan. 12, 1882, p. 29.
336 MEDICAL JURISPRUDENCE.
eye and an inch above the eyebrow. Blood was oozing from
the wound. Without the use of force, simply by its own
weight, a probe passed into the wound, penetrated backwards
to the depth of two inches. The opening in the skin was then
enlarged so as to admit the tip of the little finger, and with
this a circular hole could be felt in the skull.
‘““Two hours after the receipt of the injury he became per-
fectly unconscious, and could not be roused. Both pupils
were dilated, the right fixed, the left responding to light, and
later there was vomiting. * * * Cerebral substance in masses
as large as a split pea were noticed coming away with the
blood. Upon examining the opening in the skull with a probe,
small particles of lead were removed.
“The next day, June*zoth, the pulse was go, the temperature
to1.2° F., the tongue coated, and the mind sluggish, but he
would respond when spoken to. He complained of pain in the
head, which was intensified by motion. Vomiting occurred at
intervals. The right pupil was largely dilated and did not
respond to light. He stated that he could not see out of his
right eye. Ten grains of bromide of potassium were given
every three hours. * * *
“On July 3d there was a sero-purulent discharge from the
wound, the pulse was roo, the temperature was 102.4° F., and
the pain in the head was increasing. ‘The wound was cedema-
tous and its mouth was covered by a slough.
“On July 5th, one week from the time he was shot, the head-
ache was of periodic character, and was only noticed over the
right side of the forehead. With the right eye he could now
just distinguish objects, but could not see clearly, things ap-
pearing as if seen through a mist. * * *
“On July 8th sight in the right eye was perfect, the headache
was slight and local.
“On July roth the seat of the cephalalgia changed from the
from the front to the back part of the head.
‘“‘T have previously stated there was hemiplegia ; there was
loss of both motion and sensation, and the skin of this side was
colder than the other. Upon tickling the sole of the left foot
the right leg would be drawn up. He also experienced spas-
modic pain from left hip to the heel, and was able to move the
leg for the first time since the receipt of the injury. The right
pupil was still not so sensitive to light as the left, and the
mouth not so much drawn o the left as before. It was forty-
one days from the time of the accident before he could move
his arm, and up to this time he could not sit up in bed without
CRANIAL INJURIES. SOL
experiencing nausea, or feeling as if “ sociething was rolling
about in his head.” * *
“Now, four ae after the injury, he has no cerebral symp-
toms, the paralysis has disappeared, save in the flexors and
extensors of the hand, but there is yet little strength in the
muscles of the arm and leg, so that he cannot walk far, for
fear of falling; he creeps about the floor, and even goes up
and down-stairs on his hands and knees. He can walk when
any one supports him.” *
Prognosis of Penetrating Wounds of Skull.—
Dr. Wharton,t of Philadelphia, presented recently an analysis
of 316 cases in which foreign bodies were lodged in the brain.
The following figures are interesting:
Recovered : ‘ ‘ ’ ; 160 Cases
Died . ; ; . 156
The foreign body removed in. ; Boot"
we these cases 34 died.
The foreign body was allowed to remain in. ee 4 to eras
of these 122 died,
i 88 recovered.
The foreign body penetrated the frontal bone in 132 “
of these 58 died,
74 recovered,
The Hoveien body penetrated the parietal bone in 58 “
of these 27 died,
Ps 31 recovered.
The occipital bone penetrated in . , ga
i of these 16 died,
A 7 recovered.
The foreign body entered the temporal bonein . 31 “
of these 12 died, .
Ig recovered.
Wounds of the orbit were most fatal.
* Seven months after the receipt of injury, the patient had perfect use of
both the arm and the leg of the side which was affected. He could walk
without any support, and had complete control of the muscles of the arm
and hand.
t Phila. Medical Times, July 19, 1879, p. 493-
338 MEDICAL JURISPRUDENCE.
The statistics of the Medical and Surgical History of the
Rebellion show, that of 186 cases of penetrating wounds of
the cranium, ror died, and it is further shown that in the 85
cases where the intruding body was removed 43 recovered.
When the balls remained in the head there is the history of
epilepsy and other cerebral symptoms, paralysis, head pain ;
and in but four of 19 cases no bad results ensued.
Gross* has presented figures showing the mortality from
gunshot wounds of the skull and proves that by proper surgical
treatment the larger proportion recover.
“Of 224 depressed gunshot fractures of the skull, and in go
operative measures, of these 45 or 50 percent. died. Of 134
instances, on the other hand, in which the treatment was pure-
ly conservative and antiphlogistic, and in 43 of which the signs
of compression were very doubtful, 61 recovered, and 73, or
54.47 per cent. died; or if the doubtful cases, which resulted
in ro deaths, be excluded, 91 cases of compression from de-
pressed fractures, treated expectantly, afford 63 deaths, or a
mortality of 69.23 per cent., a result in favor of operation by 19
per cent:””
In murder cases this matter frequently arises in connection
with the question of whether or not the patient received proper
treatment after the injury. Of course, with the best treatment
fatal results are extremely probable, and each case dif-
fers.
Possible Method of Infliction.—In cases of murder
it is important to know in what manner the injury has
been inflicted, the weapon used ; and it is often extremely diffi-
cult to arrive at the true statement of facts. Casper refers to
the case of a child who was found dead ina thicket. The
mother was an unnatural one, and it transpired that she mal-
treated it upon every occasion and fed it upon potato parings
and other refuse. She frequently punished it, and one witness
testified that the child had been badly beaten the night before its
death. ‘The woman seized the child and knocked its bare head
four or five times upon the floor, and hurled it into the middle
of the room. ‘The mother testified that she gave the child a
“few slaps,” that it began to whimper and groan, that she had
placed it in bed where it slept quietly, and finally died in about
an hour and a half. She put the child in a basket, and left
the house, telling her husband on her return without the child,
that she had left it at a friend’s house. She took with her a
* American Fournal of Medical Science, July 1873.
CRANIAL INJURIES. 339
“potato grubber” to lead people to suppose she was going to
dig potatoes. At the autopsy sixty-two ecchymoses were found
upon the chjld’s head, and a stellate fracture of the occipital
bone extending to the foramen magnum was found; as well as
a fissure of the right parietal bone, hyperemia of the brain and
an extravasation of blood at the base.. The statement of the
woman that she had given the child only one slap on the side
of the head was disbelieved at once, bécause of the existence
of the extensive fractures, and the inference was that some
blunt instrument had been used. The inquiry in this case was,
whether the cause of death was from the violent mauling of the
child and pounding it had received, or whether the potato
grubber had been used, and, although it was conceded that the
parietal fracture might have been thus produced, it transpired
that the child, after the mother’s ill-treatment referred to above,
sat up and showed signs of intelligence for some time; it was
the use of the “potato grubber” that resulted in the more
serious fracture of the occipital bone and the death of the
child.
The Character of the. Wound.—Macewen,* has written
an interesting paper upon the relation of wounds to the instru-
ments inflicting them, and as his remarks are applicable to head
wounds as well as others, I present his conclusions :
“1. Blunt instruments sometimes produce scalp wounds hav-
ing straight outlines and sharp clean edges, which in these re-
spects could not be distinguished from wounds produced by
sharp-cutting instruments.
“2. Scalp wounds, which exhibit entire hair bulbs projecting
from the surface of their sections, have been produced by a
blunt instrument.
“3. Wounds, exhibiting nerve filaments or minute blood ves-
sels bridging the interspace between the lips of the wound, to-
ward the middle of the depth of the section, while the tissues
have receded all round them below as well as above, have been
produced by blunt non-penetrating instruments.
“4. When a wound, even with sharp well-defined margins,
bears in contour a resemblance to an osseous ridge in close
proximity, there is a probability that it was produced by a blunt
instrument through forcible impact against the underlying os-
seous ridge.
“5. Cuz hairs found in the immediate vicinity of a wound are
* Glasgow Medical Fournal, Jan., 1879.
34° MEDICAL JURISPRUDENCE.
valuable aids in determining whether a sharp or a blunt instru-
ment has been made use of.
“6. As tothe diagnosis between wounds produced by instru-
ments of the knife kind and other sharp-edged substances,such
as glass, earthenware, etc., no dependence can be placed on the
mere regularity of outline or sharpness of edge, or the re-
verse.
‘“‘7 Sharp clearly-defined wounds in certain cases present
peculiarities in their terminations which may be sufficient to
enable a probable diagnosis as to whether they were produced
by a knife or a portion of glass or earthenware.
“8. The same instrument, used by the same person in deliv-
ering several successive blows, may produce wounds of differ-
ent character.”
Accidental Homicidal Injury.—It may be necessary
in some cases to determine whether death results from
a fatal wound, from an accidental fall, or by the patient
being hurled against a wall. Ina general row or disturbance
it is often important to consider whether the individual was
accidentally killed or maliciously struck upon the head by
another. As Casper has shown, if most of the participants are
drunk very little reliance is to be placed in-their stories. In
such cases we are to carefully determine the nature of the
wound. If it is associated with others, it may or may not be
the cause of death. The character of the fracture, and the evi-
dence of violence are to be investigated. It may appear that the
pathological appearances are too violent to have originated in
an ordinary fall or vice versé. ‘The sharpness of the edge of
the wound should be examined, and its shape in relation to ob-
jects that might have inflicted it. In cases where people are
injured in brawls, I agree with Beck that it is always best to
“lean towards the accused, unless the proof of malice is con-
clusive.”
Civil Suits for Damages.—Medical men are called
upon to express opinions and give testimony regarding personal
examinations they may have made, not only in criminal
questions, but in civil suits as well. In certain accident
cases the claim is made that the plaintiff has received a blow
upon the head which has given rise to permanent injury. Some
times the cause of such injury is due to the fall of building ma-
terial, at others the plaintiff has himself fallen from an insecure
sidewalk, vehicle or elevator, and of course a suit for damages
is the result. The injured person may present himself for ex-
CRANIAL INJURIES. 341
amination, with a well marked history of nervous symptoms di-
rectly traceable to the blow or fall, or he may bear suggestive
scars, or very often his unsupported story is all we have to guide
us. Itisnot rare to find fraud and imposture. In one case I was
called to examine a well-marked migraine, connected beyond
doubt with menstrual irregularities, were said to be due toa
head injury; in another the claim for excessive damages
was made by aconfirmed epileptic, whose disease had existed
for years, and who insisted that his disease was received by and
followed an accident.
Infanticide by Head Injury.—We are sometimes
obliged to determine the significance of cranial injuries
as the result of infanticide, and are to distinguish be-
tween cases where a child has been killed by its inhu-
man mother, and those where an accident shortly after birth
has been the cause of death. It will not do to disregard the
fact that fractures of the skull may occur during labor, as the
result of the use of the forceps or of mechanical obstruction,
the mother perhaps, having a deformed pelvis; but these are
rare, and when they occur it is almost always possible to find
the method of causation, either by examination or by the testi-
mony of the physician. The victims of infanticide usually pre-
sent other signs of violence than fractures, which differ from
those that are produced, for instance, by the forceps, from the
fact that they are attended by excessive laceration of the brain
and other local injuries. Fractures produced by forceps are
- due primarily to defective ossification, and the anterior cranial
bones are involved, while, as Ogston has pointed out, the occi-
pital bone usually escapes. Two or three cases are presented by
this author which are of interest. In one it was found that in
addition to fractures of the parietal and frontal bone the sides
of the head and face were flattened, and the marks of large shoe
nails were visible on one cheek. The mother had killed her
child by trampling it in the cow-house where it was born.
CHAPTER VIII.
SPINAL INJURIES.
General Anatomy of the Spinal Column.—The spinal
column consists of a number of closely articulated bones be-
ginning at the base of the skull and extending downwards,
terminating in the coccyx. The bones are bound together by
ligaments and muscles, and form a canal in which he the
spinal cord and its coverings. The bones of the spinal column
are of five divisions—cervical, dorsal, lumbar, sacral and
coccygeal. ‘Those above being the cervical, seven in number ;
those next below being the dorsal, of which there are twelve,
the next lowermost are the lumbar, of which there are five,
while below are the sacrum and coccyx which in the adult
are practically two bones. The vertebre have peculiar charac-
teristics, especially the cervical and lumbar, the latter being
the largest, while the dorsal are comparatively small, but they
increase in size from above downwards. The dorsal vertebre,
it will be remembered, furnish articulations for the ends of the
ribs, At the posterior part of the spinal column will be found
spinous processes more or less pronounced ; that of the seventh
cervical being known because of its great development as the
vertebra prominens.
Ligamentous Attachments.—Laterally the vertebre are
provided with transverse processes which serve as points of
attachment for ligaments, and in the dorsal region contain ar-
ticulations for the tubercle of the corresponding rib. In the cer-
vical region the two upper vertebrz are very important because
of the duties they perform. The first or atlas supports the skull ;
it is divided by a transverse ligament into two segments, one
receiving the odontoid process of the axis, and the posterior is
filled by the spinal cord. The second cervical vertebra or axis
articulates with the atlas by means of the odontoid process
which projects upwards through the opening before described,
and below with the next cervical vertebra by means of facets.
All of the vertebrae are separated by discs of cartilage
which are undoubtedly provided to prevent the transmis-
sion of shock. The spinal cord which is contained in the
SPINAL INJURIES. 343
spinal canal extends below as far as the first lumbar vertebra,
and from it pass nerves to each side of the body to the ex-
tremities and trunk. In the cervical region a number of the
nerves after leaving the cord join to form the brachial plexus
which is formed by the juncture of the four lower cervical and
the first dorsal nerves; these further divide up into three
trunks which supply the shoulder and upper part of the chest
and the arm and forearm. Inthe lumbar and sacral regions
we find other great branches which supply the pelvic organs
and the lower extremities.
Localization of Spinal Injuries.—A reference to the
appended cut, which is taken from Gower’s, will enable the
reader to understand the nerve supply, and it will be recog-
nized at a glance how the injury of a particular part of the
spine may produce various alterations of function in remote
parts.
Investing Membranes of the Cord.—The spinal cord
is surrounded, as is the brain, by the pia mater, arachnoid
and dura mater, and there is communication between the
ventricular spaces of the brain and the arachnoid cavities
in the spinal canal, so that the cerebro-spinal fluid may accu-
mulate or be diminished in quantity under varying conditions.
The dura mater is separated from the wall of the bony canal
by areolar tissue and vascular plexuses, and contains perfora-
tions through which the spinal nerves pass on their exit to
- other parts of the body. Filaments pass to the cord from the
arachnoid to keep it in its place. The nerve roots consist of
two from each segment, an anterior and posterior, which go
to form the main trunk. At the lower part of the cord the
nerve roots descend almost vertically to pass out of the various
foramina of the sacrum, while the cord ends in a bundle
of filaments which compose the cauda equina.
Anatomy of the Spinal Cord.—At two important
points in the cervical and lumbar region, we find enlargements
of the cord which correspond to the emergence of important
bundles of nerves going to the upper and lower extremities,
while in the dorsal region the cord is of comparatively small
size. The spinal cord consists of various bundles of fibres
going to and coming from the brain, and a central collection
of gray nervous substance which at its anterior part contains
large cells, having a special motor and trophic function,
while posteriorly there are prolongations of gray matter which
344
Motor.
2 We 5 y ‘
A : ; Se anasiold
A NY : rapeziuB.
St bia | :
o Z| eMLB) neeng df Diswhitasta
ak ‘ae re |JSimaiis
meee Arm mus:
7 ‘A ony LZ) nang
| WT [04) s---n ID (alnar lowest)
| Vea
ay | narenserennanr
5.
srewceesnceeseaser 4
SS 5 it
Tatercostal
f Ge tecenseceroreg | \ Muscles,
) 2 2
i os one
Re
seeccecccsecsucees
Abdominal,
‘Muscles
In ewavec seconds:
G
Js tem reeeucoves.
scccsececeve
Extensors, knee
}aaductors
Abductors ep
Extensora(?)
Plexors, knee (?)
eats cncnccevcecseess
‘Muscles of Jeg
moving foot
——
= es mocescodpaseteeesucceneon
ee rit ee eee
} erineal and ‘Anal
muscles
Fig. ro.
MEDICAL JURISPRUDENCE.
Sensory. Reflex
} eck aod Scalp
Weck and Shouftiz
Shoulder
Arm,
Handi
Scapulase
| Front of Thorax
Ensiform area
Abdomen ;
(Umbilicus 10th)
ED upper
part
Groin and serotum
Abdominad
(front)
outer aide. Cremasterid
Thigh; front Enee reflep
bile aula ese
eg, inner side ere
Buttock, lower Glateal
part
Back of Thigh
mal, except | Ankle clonua
Foot | immer part Plantap
Perineurn and
Anus
ieee from ¢c6ccy® |
to anus, |
Scheme of Spinal Symptoms,
(Gower.)
SPINAL INJURIES. 345
play an equally important part of a sensory nature. The
white matter which surrounds the central gray substance and
is composed of nerve fibres is divided up into regions which
have special functions, and these are designated as columns;
and in each half of the spinal cord which is divided by an an-
terior and posterior fissure, we find an anterior column, a_lat-
eral column, and a posterior column. Roughly speaking we
find that the two former are concerned in the transmission of
motor impulses, while the latter are devoted to the conduction
of sensory impulses. That the emergence of motor impulses
takes place in the anterior nerve roots, and the conduction is
efferent ; while sensory impressions are carried ¢o the cord by
the posterior roots, and are further conducted by the posterior
columns, and in the dorsal region by the lateral columns. _
Pathologically considered, we find that disease of the an-
terior columns and the nerve cells of anterior gray matter, is
followed by paralysis and muscular wasting; that disease of
the lateral columns, by loss of power and by rigidity, contrac-
tions, and increased reflex excitability ; and that degeneration
Bf the posterior columns is manifested by sensory disturbances
as anesthesia, pain; and loss of co-ordinating power. We also
find that disease at different levels of the spinal cord gives rise
to special symptoms dependent upon the involvement of vari-
ous important nerves supplying particular organs. Thus dis-
ease of the cervical region is very likely to produce ocular
difficulties, interference of the action of the diaphragm, par-
alysis of motion and sensation of the upper extremities and
of the shoulder and neck; disease of the dorsal region pro-
duces more or less paralysis of motion and sensation, of the
intercostal muscles and thoracic walls, so that difficulty of
breathing results, and in the lumbar region we find paralysis
of the lower extremities and of the bladder and bowels, with
more or less disturbance of sensation, and with affections of
the various reflexes of the lower extremities.
The medico-legal importance that may be attached to spinal
injury is immense, and probably the greater proportion of
actions for damages that arise in our courts are based upon
alleged injury to the vertebral column and its contents.
Forms of Injury.—Let us see how trausmatisms are
likely to produce mischief. Brodie* considers the surgical
accidents of the spinal column to be as follows:
1. Fracture without displacement.
te
* Med, Chir. Trans. vol. xx., p. 120, and p. 3.
346 MEDICAL JURISPRUDENCE.
2. Fracture with depression or displacement, causing pressure
on the cord.
3. Fractures complicated with dislocation.
4. Dislocations not complicated with fracture.
5. Extravasations of blood on the surface of the membranes
of the spinal cord.
6. A narrow clot of extravasated blood is sometimes dis-
covered within the substance of the spinal cord.
7. Laceration of the spinal cord and its membranes,
8. The minute organization of the spinal cord may suffer
from a blow inflicted upon the spine even where there is nei-
ther fracture nor dislocation, and where the investing mem-
branes do not appear to participate in any way in the effects
of the injury.
Manifestation of Symptoms.—All of these conditions
are likely to be found as the result of injury, and as a result we
are furnished with a train of symptoms which vary as to sever-
ity and prognosis. In some instances the symptoms are of
immediate appearance, and subside gradually ; in others there
is a progressive disease of the spinal cord due to so-called
compression myelitis. We find as a consequence various sen-
sory, motor and trophic disorders which are manifested in
anesthesia, or hypereesthesia, paralysis, spasms or contracture,
and atrophy. ‘These may appear gradually one after the other,
or almost simultaneously, and depend upon the extent of the
injury and destruction of the cord.
Fracture without Displacement.—Fracture without
displacement may occur in various situations, but the most
common site is the dorsal region.
Dislocation.—Dislocation may occur immediately as the
result of violence or as the result of bone disease, with the
destruction of vertebrze, and this is of secondary causation.
The most common site is the cervical region when the disloca-
tion follows the accident at once, or when there is caries the
dorsal vertebre are dislocated more often than the others.
- A blow upon the back of the neck without external marks of
injury may give rise to serious bone injuries, such as fracture
and consecutive atrophy, so that at a remote time, perhaps,
evidences of very serious spinal disease of a progressive char-
acter may result in the patient’s demise. I have seen three
cases in which the injury in the cervical region which at first
was considered trivial developed finally in two in caries
SPINAL INJURIES, 347
and dislocation of these vertebre, and in the third, where a
fracture of the transverse process of the axis occurred so that
the most intense cervico-brachial neuralgia was produced.
Case LVII.—In one of these cases, J. B. M., a blow was -
received from a club in-the hands of a highwayman, and
beyond the production of a short period of unconscious-
ness succeeded by headache, vertigo and pain, loss of
power and numbness in the arms and hands which
_moderated and disappeared within a few weeks; no more
serious symptoms existed, and the would-be assassin received a
comparatively light punishment. In the course of a year, how-
ever, the pain in the arms returned, and with it there was a
loss of power connected with very great wasting of all the mus-
cles of the arms. I first saw him in April, 1880, two years
after the injury, and found beyond the atrophy, which was
extreme and involved a great loss of substance of the posterior
cervical muscles, and left deltoid, there was a peculiar deformity
resulting apparently from the anterior dislocation of the third
or fourth cervical vertebra so that a depression existed and the
thyroid cartilage was very prominent, and the chin was thrown
upwards and forwards. The upper extremities in which he
told me the wasting began, present the appearance of those in a
person suffering in an advanced form of progressive muscular
atrophy. There is a tendency to flexion of the fingers and
great hollowness of the palms, the flexor tendons being quite
prominent and the interosseous spaces are deepened. He can- |
not put the left hand upon the top of his head, and when he
raises either hand there is aggravation of the severe pain which
he constantly complains of. His co-ordinating power and
sense of localization are affected, and he can “do nothing
without the aid of his eyes.” Hecannot pick up a pin nor
touch his nose even when his eyes are opened, tactile sensation
is not good, the tendinous reflexes are everywhere exaggerated,
he is irritable and annoyed by noises and is inclined to cry
upon the slightest provocation. The pupils were contracted
when I last examined him, and did not respond readily. A
significant feature of the case is the pages he experiences
when swallowing.
Fracture Complicated with Dislocation.—It occa-
sionally happens, as in the case reported by Sir Charles Bell,
that peculiar injuries may give rise to extraordinary spinal
symptoms, and in some cases the fall of a person who has been
assaulted may account for a vertebral dislocation, which it is
348 MEDICAL JURISPRUDENCE.
supposed could have been produced in no other way than by |
the direct effect of the injury itself. In Bell’s case “a man
was making a violent effort to impel a wheelbarrow from the
street upon the raised foot-pavement, when the wheelbarrow
suddenly went before him and he fell with his chin upon the
curbstone. He was dead in a few seconds. The processus
dentatus was found to have crushed the spinal cord, the lga-
ments having given way.”
Cooper reports an accident of the same kind, not immediately
fatal, as the result of a fall, in which the first cervical vertebra
was broken.
Potts’ Disease.—The production of Potts’ disease is due
to falls, blows upon the back or mechanical violence usually
directly applied, or, it may be due to disease of bone without
any noticeable injury.* The distinguishing feature of Potts’
disease is the existence of kyphosis or bending of the vertebral
column so that a deformity results, the anterior part of one or
more of the vertebre (the bodies) being.destroyed, and in con-
sequence the spinal processes are thrown out posteriorly so
that a peculiar and familiar deformity results. As a conse-
quence of such disease the spinal cord and its membranes are
impinged, especially at the anterior point, and what is known
as compression myelitis results.
Compression Myelitis——The commencement of the dis-
ease is indicated by pain which is due to irritation of the
meninges and posterior nerve roots so that there is great ten-
derness, darting pains, upon movement of the spine and
when the erect position is kept. In the latter case the weight
of parts above presses the diseased vertebree together, and the
pain is explained in this way. After a short period of sensory
irritation we find that there is loss of power due to the pressure
made upon the anterior part of the spinal column. The skin
is at first the seat of hyperzesthesia, and subsequently of anzs-
thesia, which is found in isolated areas, and perhaps eventually
becomes general. There is atrophy, the response of the
muscles to electricity is very feeble, and the initial loss of power
is afterwards succeeded by a rather pronounced paraplegia
without rigidity, the muscles being flabby, but after a time they
grow more rigid as the lateral columns of the spinal cord suffer,
the tendon reflexes being exaggerated. There is much irregu-
* In young persons generally. In older persons the disease is almost
always traumatic.
SPINAL INJURIES. 349
larity about the manifestation of the motor symptoms, and it will
be seen that such must be the case from the unequal pressure
made upon the contents of the spinal canal. The striking fea-
tures of compression myelitis are the reflex symptoms; and
tremors, jerkings and active dorsa] clonus are produced by the
slightest form of excitement. The functions of the bladder
and rectum are disturbed, and incontinence of urine and feces
takes place.
According to Erb the cases may be divided into two classes
as to recovery. Some patients under proper treatment show
signs of improvement and slowly recover, while others grow
steadily worse and cystitis and bed-sores, exhaustion and death
follow. In cases of Potts’ disease there is usually some projec-
tion of the vertebra at a very early period, and when the patient
stands erect a more or less conspicuous prominence is found
corresponding to the seat of disease, and pressure produces
great pain.
The situation and character of the deformity in Potts’ dis-
ease and its association with changes in the posture and move-
ments of the patient should be critically investigated in instances
where suit is brought for damages, for unprincipled indivi-
duals who coach a plaintiff are very apt to furnish him with
suggestions which though at first sight indicate veritable
vertebral disease, are out of consonance with the behavior of
the pretender. In one outrageous case with which I am familiar
a prominent seventh cervical spine was the alleged angularity,
but was in no sense the result of disease ; and it may be wise
in view of the possibility of this claim being urged in other
cases, to call attention to the fact that in many hysterical and
anemic women as the result of debility and relaxation to find
the vertebra prominens more than ordinarily conspicuous, and
perhaps we may discover that tenderness which is so universal
in cases of spinal anemia.
Dr. Gibney, of New. York, has written extensively in his
practical way upon doubtful cases of Potts’ disease, where the
early symptoms have not only been mistaken for those of other
troubles, but where temporary functional troubles have been
dignified as true cases of vertebral disease. In undoubted
caries of the vertebre, and especially the traumatic variety, par-
ticularly when thé upper vertebre are affected, we find paralysis
to be an early and pronounced symptom. Of one hundred
and eighty-nine cases collected by Gibney, in which the verte-
brz above the middle dorsal region were involved, sixty-two
instances of paralysis occurred. It must be remembered that
350 MEDICAL JURISPRUDENCE.
in the majority of the cases, especially those occurring early in
life, there is a strumous element which predisposes.
Case LVIII.—In a rather interesting case recently tried in
this city, it was alleged that a gentleman who had been injured
was the subject of Pott’s disease resulting from a sprain, which
was produced by his attempt to control a pair of spirited horses
when his wagon ran into a hole in one of the public thor-
oughfares. ‘The accident occurred upon a rainy night, and he
was exposed for many hours to the rain, his clothes became
wet through, and he did not change them for some time after-
wards. His only injury, so far as was shown by the evidence, was
a sprain, caused by his being drawn half way across the dash-
board. From the time of the accident he complained of severe
spinal pain, which, however, was not localized until a few days
subsequently. I found, however, when I examined him that he
had pain at several points in the spinal column, more
intense, perhaps, in the lumbar region. Within a few weeks
he began to develop symptoms indicative of locomotor ataxia,
and at the time of the trial he presented the classical features
of that well-known disease, his tendon reflex, however, being
exaggerated, suggesting invasion of the lateral columns of the
spinal cord. A distinguished physician who had attended him
in the beginning claimed that he had an angular projection, but
neither Drs. Hammond, Clymer, Stimson or myself could find
the least deformity, and taking into account the fact that
although the malady had existed forso long a time there
was no paralysis whatever, we excluded the idea of Pott’s dis-
ease, and practically agreed that it was a hybrid form of scle-
rosis, traceable entirely to the exposure on the night of the
accident.
In cases where Pott’s disease has been claimed to be due to
an injury of the back, it commonly happens that there has been
trouble before the accident, and though in very rare cases an
inflammatory process beginning in the joints as the result of a
sprain may be found, it is not common for any extension to
take place.
Extravasation in the Membranes of the Cord.—
5. Extravasation into the membranes of the cord may follow a
fracture or severe shock, such as a fall upon the buttocks or
upon the back, or in consequence of wounds made by sharp
instruments. The appearance of symptoms is immediate, and
if the hemorrhage be extensive the patient may be deprived of
SPINAL INJURIES, 351
power, and there is paralysis of the body belowthe level of effu-
sion. In some cases the appearance of symptoms is gradual and
marked by pain and rigidity of the back, pain in the legs,
anesthesia, or, perhaps hyperethesia; darting pains, formica-
tion and other symptoms of irritation of the posterior nerve
roots. The loss of power which follows is of a light grade,
unless there be compression-myelitis and invasion of the
spinal cord. The functions of the bowels and bladder are
affected and reflex excitability is usually lowered. We may
localize the hemorrhage by the existence of spinal tenderness,
and by the involvement of the upper extremities, the presence
of pupillary changes, headache, respiratory embarrassment,
etc., when the cervical region is involved. The prognosis is
not necessarily bad unless there be extending inflammation to
the cord. A serious feature of the trouble is the existence of
the clot in the upper part of the cord. The prognosis is then
apt to be exceedingly bad.
Sir Astley Cooper reports the case of “a boy, aged twelve,
who received a violent jerk of his neck by a cord thrown over
his head as he was swinging forwardin aswing. He felt no bad
effects at the time, but afterwards his limbs became weak and
his neck stiff. In eleven months this increased to palsy, and
he died at the end of twelve months after the injury. A large
quantity of extravasated blood was found in the spinal canal
betwixt the bone and the theca vertebralis.”’
Clot in the Cord Itself.—6. When the spinal cord is in-
volved and contains a clot, the symptoms are much more se-
vere and dangerous and much more likely to be followed
by permanent symptoms, indicative of degeneration. The
early symptoms need not necessarily be alarming and may
be of a light grade; but in the midst of an apparent
amelioration after injury, a sudden paralysis may make its ap-
pearance, and in this case it is probable that a secondary pro-
cess of softening has caused the rupture of a blood vessel. The .
paraplegia resulting from spinal apoplexy is usually complete,
if the escape of blood be at all considerable, and its extent
depends very much upon the seat of the lesions. At a high
level we may have the respiratory and oculo-motor symptoms, as
well as those indicative of disturbance of the medulla, and as a
consequence we find marked temperature changes and affec-
tions perhaps of the cranial nerves; if the hemorrhage be
small and confined to a limited portion of the spinal cord, of
course there need be little more than local degeneration and its
352 MEDICAL JURISPRUDENCE.
consequences. Wilks refers to a case in which a blow upon
the spine caused simply an effusion of blood into the gray matter
of the cord and the primary symptoms were those indicative of
sensory disturbance, and hecalls attention to the well recog-
nized fact that very light ruptures of bloodvessels in this re-
gion are apt to be followed by extension of the lesion, and con-
sequently of the symptoms.
Laceration of the Spinal Cord and its Membranes.
—v7. Laceration of the spinal cord and its membranes is a very
rare accident and probably never occurs without vertebral injury.
It is possible for penetrating wounds to produce such mischief
and as a consequence we are almost immediately furnished
with a train of such manifestations as spinal hemiplegia or par-
aplegia, the former resulting from a one sided wound which
produces severance of the motor tracts with disturbance of
sensation upon the other side of the body. In fact, whether the
one sided injury to the spinal cord depends upon penetrating
wounds or lateral fractures with displacement of fragments,
the symptoms are apt to be those of the peculiar paralysis orig-
inally described by Brown-Sequard.
In all cases of spinal injury the appearance of symptoms of
course depends upon the degree to which the spinal cord is im-
pinged upon, either by the products of inflammation started in
the meninges or coverings, or in the cord itself. Dislocated
or fractured vertebrz are very apt to be followed, at first, by
meningeal symptoms, such as pain and nerve irritation, and,
afterwards by the production of symptoms referable to the cor-
tex of the spinal cord ; and among the later we find, as a rule,
that the earliest is an affection of motor power, which is suc-
ceeded perhaps by rigidity and contractures, and by an increase
of the reflex excitability of the tendons. When the inflamma-
tion of the spinal cord is consecutive either to disease or
thickening of the meninges or extensive laceration of the cord
itself, and extends transversely across the spinal cord, we then
find total abolition of motion and sensation ; paralysis as well of
the bladder and bowels, and disappearance of reflex excitibality.
Spinal Concussion.—8. Concussion of the spinal cord if
at all serious is apt to be followed by symptoms which
develop very quickly, and in consequence we find back pain
referred to the dorsal or lumbar region, the back of the legs or
thighs ; a want of power, an atony of the bladder and rectum,
and various ocular symptoms. There is rigidity of the back
and the .slightest movement causes intolerable pain, and ordi-
SPINAL INJURIES. 353
s
nary walking causes great suffering. If the patient be told
to jump he will complain of increased -pain, caused by the jar,
and he suffers after the slightest motion. The loss of
power is extremely variable and may vary from simple weak-
ness to complete paraplegia, and electrical reaction of the mus-
cles is abased or lost.
Erb’s Classification.—Erb* makes the following divisions
regarding the appearance of symptoms:
“A. General and very severe symptoms at the instant of
injury. Death in a short time. Severe form of shock,”
(Immediate complete paralysis. Disturbance of consciousness,
involuntary discharges, depression of pulse, and arrested respi-
ration. Speedy death in afew days. Usually from crushing
or other severe injuries. )
“B. Severe symptoms at the moment of receiving the injury.
Curein a short time. Slight shock.” (No loss of consciousness,
usually paraplegia, pains, anesthesia, increased reflexes, rapid
inprovement in a few days and speedy recovery.) |
“C. Severe symptoms at the first, followed by a protracted
illness of some years’ duration ; recovery in most cases.” (Shortly
after accident progressive paralysis following weakness of all
extremities, pain in back, girdle band, light anesthesia, mental
disturbance, vomiting. Slow and gradual improvement.)
“D. Very slizht symptoms at the beginning ; a severe progres-
sive spinal disease develops after a longer or shorter time. Result
doubiful,”’ (Primary nervous disturbances of a light grade,
weakness, mental confusion. After a short time severe symp-
toms develop. Emotional depression, bad sleep, weakness
and ataxia of legs, pain and paresthesia, weakness of bladder,
atrophy, with pronounced meningo-myelitis.) ”
The above are the varieties collected by Erb, and the symp-
toms are familiar and well marked. He is disposed to take a
rather favorable view, except in those cases in which bed sores
and other serious evidences of cord disintegration are expressed.
Case LIX.—A gentleman sent to me recently by Dr. How-
ard of Montreal, presented grave symptoms of speedy develop-
ment as the result of an apparently trifling spinal concussion
which seemed almost out of proportion to the injury. The Rev.
Dr. L.,a heavy man weighing 212 pounds, while walking upon a
wooden sidewalk caught his toesin a hole and fell somewhat vio-
* Ziemssen’s Cyclopedia, vol. xiii p. 350, Am, translation.
354 MEDICAL JURISPRUDENCE,
e
lently. This was about eighteen months agoand since that time to
the present (Jan. 1883), a train of very serious expressions indic-
ative of resulting organic disease, have made their appearance.
He did not lose consciousness after the fall but felt dizzy and
sick for ten minutes or so, and beyond a slight bruise of the
left hand, which he had thrown out to save himself, he suffered
but little inconvenience. About three wecks after the accident,
however, he began to feel cramps in his left hand, the fingers
becoming rigid, as well as great pain in the back especially in
the lumbar region, but subsequently it extended upwards.
This was associated with paroxysms of intercostal neuralgia
with attacks of coughing and desoin de respirer, which at times
amounted to distressing dyspnoea. When I first saw him in
January there was some loss of power in both lower extremities
especially the left, and he walked with difficulty. There was
no anesthesia but paresthesia upon the line of the last dorsal
vertebra, the legs were generally atrophied and his gait was
characterized by ataxia, rather more marked on the right than
the left side. His superior extremities were involved and the
left hand and arm are especially weak and it causes him great
distress and pain to raise them; he can not button his clothing
nor use his hands in the execution of delicate acts. There is
no lost sense of localization, the tendon reflex seems to be
unaffected. Galvanic and Faradic action are disturbed and
but few of the muscles of the upper extremities respond to
stimulation. His breathing is very shallow and rapid, and his
voice is dry and husky and it is an effort for him totalk. No
evidences of disease were found on examination of the heart
and lungs, and the pelvic organs are affected to a slight degree ;
he is troubled with tympanites. There are so far no cerebral
symptoms and no morbid ophthalmoscopic appearances. Intel-
lectually he has not suffered, but he tires easily and can not
apply himself to his work.
Trophic Changes after Spinal Concussion.—Trophic _
changes are apt to be presented, which are rare however, but of
great interest. |
Case LX.—A patient recently placed himself under treatment
for the relief of nervous sufferings following an accident in 1879.
He was thrown from a wagon, striking upon his left side and cut-
ting and bruising the leg and thigh of that side and wrenching
the right leg, and back. According to his statement he was
not at first insensible but fainted and remained unconscious
for afew minutes ; his injuries were comparatively trivial and
SPINAL INJURIES. 355
he resumed his duties in his regiment in two or three days, do-
ing ight work. Within a short time he became nervous and
unable to sleep as he had before the accident, and was obliged
to come East. Since July, 1879, he has suffered from various
symptoms following concussion such as pain through the lower
part of the spine, over the first and second lumbar vertebre
which sometimes extends upwards or about the body; he has
in addition dull pain at the back of the head but no vertical
pain, and none in the arms; he has sciatica from time to time as
well as pain in the ankles, more especially the left. It is im-
possible for him to get a comfortable position and he sits on
one side of the chair. He cannot rise from his chair without
great difficulty and there seems to be not only aggravation of the
spinal pain but some loss of poweras well. There is difficulty in
going up stairs, and he usually does so laterally, the right leg being
put in advance of the left. He limps slightly with the left leg,
which is decidedly weaker than the right, and when tested the
electrical reaction is diminished but there is no atrophy. The
left tendon reflex is absent and the right is exaggerated. He
co-ordinates well and can stand with his eyes closed. He can
not turn over in bed without first sitting up and he has very
great difficulty in arising from the recumbent posture. There
is some incontinence of urine proceeding from atony of the
bladder, and this fluid is loaded with lithates. There is consti-
pation. He has had vertigo and blurring of vision but no ocu-
lar changes are to be discovered. His speech is somewhat
affected, there being a clumsiness as well as actual transposi-
tion of words. By far the most interesting feature of the case
is the manifestation of trophic changes. The skin was white
and soft before the accident ; within a year a peculiar bronz-
ing and mottling appeared about the ankles, which were covered
with freckles, there being more perhaps on the left side than
the right, and there is some swelling.
This patient has received very little benefit from treatment
of any kind, and it is very probable that he has a serious
organic change of both brain and spinal cord; his recovery
is very doubtful.
Fatal Cases of Spinal Concussion.—The two following
cases reported by Wilks are examples of the same form of
spinal concussion and in both instances the patient died :
“ Joseph P—, zt. 32. He was a railway porter, and whilst
engaged in pushing a railway truck along the line, he suddenly
came to an ash-pit, when, for fear of falling, he made a jump
356 MEDICAL JURISPRUDENCE.
into it, and ricked his head. He seemed for a moment to be
powerless, but soon resumed his work. On the following day
he continued also his work as usual. On the third day, whilst
walking along the Borough, he suddenly fell in the street, and
was unable to rise, owing to the weakness of his legs ; this in-
creased during the next two days, when he was brought to the
hospital. He was then completely paraplegic, had no power
over his bladder and bed sores were already appearing. Sub-
sequently the chest became affected, and he died in six weeks
after the accident. The spinal cord appeared quite healthy to
the naked eye. When examined by the microscope, some fatty
granules were found in parts, but the change from the normal
appeared very slight.”
“Wm. A—, et. 21. He fell on his back more than a year
before his death, and then had symptoms referable to concus-
sion of thespine. He gradually recovered and resumed his
work, when symptoms of paraplegia slowly came on. These
gradually increased, so that for about four months before his
death his legs were completely paralyzed; then his arms be-
came affected, and subsequently his eyesight. The intellect
quite clear. After his death, when the the cord was removed,
it appeared at first healthy as regards its general look and its
firmness. A section, however, showed the presence of disease
extending its whole length, and passing through the -pons to
the corpus striatum. There was no disintegration or soften-
ing, but a remarkable change had occurred from the presence
of a translucent albuminous material within its substance. This
was for the most part situated toward the surface of the cord,
so that a section showed its circumference converted into a
gray translucent material. The contrast between the original
white medullary matter within and the adventitious substance
around it was very great. In some places the latter had pene-
trated more deeply, so as to involve the gray matter of the
cord. ‘The pons varoli had on its surface two or three patches
of the same material, and passing into the substance to the ex-
tent of about one-eighth of an inch, and on the corpora striata
and thalami optici, especially the former ; there were some
similar patches of translucent matter on the surface. These
did not penetrate deeply, and were not observable in the in-
terior. In this case death was due immediately to suppurative
nephritis.”
Leyden presents a case* of which mention may be made.
* Archiv. fiir Psychiatrie, etc.,vili,, 1878, page 31., and Boston Med. and
Surgical Fournal Aug. 22, 1878,
SPINAL INJURIES. 357
Its interest lies in the fact that the patient presented con-
cussion symptoms followed by acute myelitis and pachymen-
ingitis which proved fatal.
“ The patient, a healthy man of forty years, was severely bruis-
ed, in 1873, by being shaken about in a railway carriage, which
had shipped off the track, and was dragged along by the engine
for a short distance. His principal symptoms from that time
onward were pain in the left shoulder, and paresis of the left
arm, both of which continued until his death, though not to
the same degree as at first ; occasional attacks of pain in the
sacral region, and in the back of the neck, and between the
shoulders ; “ girdle-sensation ;” until finally, in January, 1876,
he had a sudden attack of acute myelitis, which proved fatal.
The diagnosis made was myelitis due to pressure of a tumor in
the lower part of the cervical enlergement of the cord. The
autopsy confirmed the diagnosis, showing the tumor to be the
result of chronic peripachymeningitis.”
Locomotor Ataxia as the Result of Spinal Concus-
Sion.—* Petit alludes to locomotor ataxia that may be caused
by traumatism, and details among others the case of a man
who received a kick from a horse. He was unconscious for some
hours, but no immediate bad symptoms followed. A year later
he began to suffer from cramps, pains, and tingling in the legs,
and afterwards from incontinence. I have seen several cases
which were quite decided in their expression, and in each instance
some serious shock or blow was described. In one case the
patient fell from an open window and the sensory symptoms made
their appearance within a few weeks, and afterwards there was
ataxia, disappearance of the patellar reflex and ocular troubles.
Gowers ¢ refers to the possibility of a general myelitis resolv-
ing itself into a localized degeneration of the posterior
columns.
Postero-Lateral Sclerosis.—Dr. Edes has published four
cases which illustrate the frequent occurrence of degeneration
of the postero-lateral columns of the cord as a result of spinal
concussion. He noticed in these cases a very decided increase
in the tendon reflex, ankle clonus, as well as contractions and
other troubles. One of his cases is that produced :
“T. D., laborer, fell down-stairs eight days before his en-
* Revue Mensuelle, tome ili., 1879, p- 209.
+ Br, Med. Fournal, vol. i., 1879,p. 304.
358 MEDICAL JURISPRUDENCE.
trance into the hospital, and thinks he struck on his head, but
has no bruise anywhere. Immediately after the fall he lost
the use of both arms and hands. He can now move his right
elbow a little. His legs are rather weak, so that he staggers on
attempting to walk. There has been twitching of both legs for
the last two days. The next day after entrance he did not
sleep well. He complained of pain darting down the arms,
which, he says, began immediately after the accident. The
muscles react well to the faradic current. The paralysis dis-
appeared rapidly and almost completely, and it was after his
officiation for some time as a volunteer nurse, and about two
months after the accident, that it was found that the tendon
reflexes of the upper extremities were greatly exaggerated,
moderate taps upon the tendons of the biceps, triceps, supina-
tor longus, deltoid, pectorales, and even the sterno-mastoids
exciting decided, and in some instances, very active responses.
Patellar tendon reflex somewhat increased; no ankle clonus.
He was discharged relieved.”
The Possible Complication with Lead Paralysis.—
In certain injury cases the defense may be presented that
the patient’s symptoms are in reality due_to lead poisoning,
the result of his trade—and in such a case I appeared some
years ago. In apposition to my case is that reported by Dr.
Edes * in which the symptoms were largely complicated by
those of lead poisoning. In this case, however, the major
symptoms were due to the accident.
“D. H., aged twenty-six, lead-worker, fell backward down-
stairs while drunk. When admitted to the hospital the next
day had cellulitis of the right leg, and various bruises on both
legs. Four days after he was unable to move the right leg, and
there was incontinence of urine. Two days later the left leg
would not move. He had lost more or less strength in his
hands. Two months afterwards it was noted that the legs
“draw up” at night, and he has difficulty in straightening
them. He has pain in the back of the neck and between
shoulders. ‘There was considerable muscular atrophy in the
left hand, less in the right. Reflex and tendon reflex about
normal. ‘Ten days later the ankle clonus was very well marked.
The patellar reflex was attended with several vibrations.
There was no (slight?) olecranon tendon reflex. From this
time his condition continued about the same, although he him-
self thought he improved. Attempts at voluntary movement
* Boston Med. & Surg. Fournal, Sept. 21, 1882, p. 265.
SPINAL INJURIES. 359
were attended with strong spasmodic movements in both legs,
which could easily be excited also by the usual procedure for
obtaining ankle clonus.
“He was discharged from the hospital not relieved. In this
case the postero-lateral degeneration may perhaps have been
secondary to some more limited injury at first, say, for instance,
small hemorrhages.
“This man had a lead line on his gums, and lead was at one
time found in his urine. This point is interesting in connec-
tion with a possible affection of the anterior horns and the
atrophy of the muscles of the hands noted early in the case.”
Case LXI.—A man while sitting in a street car received a
severe spinal injury by reason of a collision with a heavy
wagon. The pole of the wagon was forced through the back
of the seat, striking him squarely in the middle of the back. He
subsequently developed a meningo-myelitis with great pain,
irregular paraplepia and atrophy of the muscles of the lower
extremities. When he sued for damages, evidence was brought
forward to show that his occupation had been that of a painter.
He had not worked at his trade for a long time before the trial
yet one of the witnesses thought he discovered a lead line. I
could not find any such change, but did find that his teeth were
carious, and that he did not clean them, and the result was
a spongy condition of the gums. His motor symptoms and
atrophy were confined to the lower extremities, a very uncom-
mon situation in lead disease, and there was no anesthesia. His
reflexes were exaggerated, and his upper extremities were
involved. I subsequently learned that though he did not
work at his trade after the trial, the symptoms advanced.
The verdict was rendered for the plaintiff.
Suits for Damages.—Suits for damages instituted by
persons who have been injured in railway accidents have
during the past twenty years been exceedingly common, and
often of great interest. Much of this arises from the express-
sion in many cases of symptoms indicative of disease of the
nervous system of a very peculiar nature, first recognized and
described by Mr. John Eric Erichsen, a distinguished London
surgeon. Mr. Erichsen’s book has figured in many of the law-
suits that have since been brought both in England and this
country, and at least, (putting it at a low figure,) twenty millions
of dollars have been paid to persons claiming to have received
spinal concussions since its appearance, In this country the
360 MEDICAL JURISPRUDENCE.
wrecking of an excursion train on one of the New England
Railroads—the Revere disaster—entailed a loss to the Eastern
P.ailroad in judgments, settlements, and legal expenses of half
a million of dollars, and another accident cost the Old Colony
Railroad $395,000.
In similar cases Immense sums of money have been paid by
sympathetic juries. In England the sum of £16,000 was
awarded to one claimant, while in this country to Harold the
sum of $30,000 was allowed by a Brooklyn jury.
The very nature of the irregular group of symptoms
encourages fraud and rascality. Dr. Hodges in two ad-
mirable papers calls attention to the fact. that in “twenty-
one cases where the so-called symptoms of concussion of the
spinal cord were alleged to be present, which have been under
my personal care, ten are believed to have been deceptions,
and in six the diagnosis, as regards deception was doubtful.
Of 26 similar cases observed by Rigler, seven were found who
simulated, and in 13 the diagnosis in regard to fraud was
doubtful. Of 49 cases, therefore, it would appear that 36 or
three-fourths of the whole number were really or probably
deceptions.”
In my own experience the proportion has been equally great,
The fact remains that after sudden and violent shock to the
human body, even though there may be no apparent external
marks or wounds a train of symptoms, indicative of profound
functional disturbance may remain for a variable time, and
may be followed by unmistakable organic disease of the spinal
cord or brain.
The peculiar transmission of a concussion is very often
somewhat remarkable. So far as is known, the disease known
as railway spine, does not follow the hurling of a passenger
against the seat or woodwork of a car, so much as it does the
undefinable molecular change which is supposed to occur
when the car in which the person is sitting is suddenly stopped
when under way and going at the rate of from 20-40 miles an
hour.
Embranlement.—What the French call embranlement
immediately follows the complete arrest of motion.
It may happen, however, from the transmitted force of a
collision with another train which may run into one stationary,
that a person sitting near the end of the stationary train furthest
* Hodges Boston Medical and Surgical Fournal, Ap. 28, 1881.
SPINAL INJURIES. 361
temoved from the point of collision, suffers a spinal concussion
sufficient to give rise to spinal injury.
A gentleman I saw who was injured in the H. R. R. R. acci-
dent, at Spuyten Duyvel, sat in the smoking car, the eighth car
from the end, yet when the collision occurred he was thrown
forward against the seat before him and then backward, receiv-
ing a spinal shock sufficient to give rise to objective as well:
as subjective symptoms. ‘This, however, is not often the case
nor is it when the person is asleep as was my patient. Much
damage may occur from an apparently trifling accident. Mr.
Charles Francis Adams. Jr., relates the circumstance of three
gentiemen leaving a rear car of a train which had run into an-
other, and going to their homes in perfect ignorance of the
accident at the time, while in the front cars there was great
loss of life.
The immediate nervous effects are often violent. I saw
some time after an accident a strong man who had escaped
from a wrecked car. Though an hour had elapsed, his nerv-
ous prostration was great, his hands and feet were icy cold;
his whole body was agitated by tremor, and _ respiration and
circulation were very much disturbed.
Lighter Forms.—An interesting case of the lighter form
of spinal concussion is related by Bernhardt*.—“A stout,
healthy man received a violent concussion in a railway-accl-
dent, remaining senseless for some time, and being confined
to his bed for three weeks with scalp-wounds, etc. When he
was able to get about, he complained of general loss of strength,
and of weak vision ; during the first few weeks, of double
vision. Examination at this time showed him to be in good
general condition. He complained of headache, especially in
the region of a scar some two inches in length over the left
parietal bone. He was not particularly sensitive to blows on
the head. He was more easily disturbed and depressed in
spirits than previously. He was exceedingly sensitive to heat,
which made him giddy and caused a throbbing in the scar. He
could not bear the noise of wagons etc., and was unable to ride
in any conveyance. Stooping or looking up or suddenly to
one side made him giddy. He could read, but only for a short
time, as the letters soon began to swim before his eyes. The
pupils were similar and reacted to ight, which was unbearable
if bright. The movements of the ball were perfect. No change
* Berliner Klin. Wochenschrift, 1876, p. 275 August g. Abstract in
Phila, Med. Times, 1876.
362 MEDICAL JURISPRUDENCE,
visible with the ophthalmoscope. Hearing good ; no buzzing in
the ear. Taste and smell normal. Nothing abnormal in the
region of the remaining cranial nerves, nor in that of the facial,
trigeminal, or hypoglossal. Pressure over the spinous processes
of the vertebrz is only painful towards the lower part of the
neck. Subjectively, a feeling of tension was experienced in
the loins ; rising and sitting down could be accomplished with
difficulty. Movements in the upper extremities were free, but
there was a loss of motor power; the outstretched fingers
trembled ; it took him a whole day to write a letter, the fingers
trembled so when used. ‘The patient could stand with the
feet together, even when the eyes were shut, and could also
walk, but slowly and with careful steps. The left leg was
slightly dragged. He could only stand a short time on either
leg alone. All movements could be performed with the limbs,
but a very little hindrance sufficed to stop them. The left
seemed to have less power than the right. No disturbance of
sensibility. The patient was aware of even slight movements,
and localized correctly. He could perceive, if his bare feet
touched the ground, what the nature of this was. His urine was
normal, and passed without difficulty by a little extra exertion.
He could only retain his stools (otherwise normal) for a very
short time. In a somewhat similarcase which came under Dr.
B.’s notice, no symptoms of brain-trouble were observed for a
week subsequent to the accident. This patient suffered greatly
from hyperesthesia. In commenting upon these cases, Dr.
Bernhardt alludes to the difficulty of making an exact diag-
nosis regarding the portion of the brain most affected. He also
suggests the treatment advisable, and points out the importance,
from a legal point of view, of the fact that one of the patients
went about his ordinary occupations for a week subsequent to
the railway-accident before any brain-symptoms developed
themselves.”
Pulse Changes.—The pulse of spinal concussion is of-
ten changed in character and becomes weak, irregular and
greatly excited. JI saw a patient with Dr. Charles E. Lock-
wood of this city, who presented a remarkable change in this
respect.
Casemix lir—=
Dr. Lockwood furnishes us with the following report from
his history-book.—‘‘ On December 1, 1881, I was called to see
Mr. W. W. R., who gave the following history:—While traveling
from Washington to New York on a train on the Pennsylvania
SPINAL INJURIES, 363
failroad on the morning of Nov. 30, 1881, he had occasion to
enter the water-closet of the car in which he was, and while
there in a standing position, adjusting his clothes, a collision
occurred between the train on which he was and one following.
He stated that he was first thrown forward, then backward, and
then forward again, his abdomen striking upon the upturned
edge of the cover of the seat of the water-closet, which, having
been raised was in a position perpendicular to the horizontal
plane of the seat; he stated that he vomited blood mixed with
bile for about two hours, suffered much from pain, faintness, -
and was bathed in a cold perspiration which saturated his un-
derwear. When he reached Jersey City he was seen by Dr,
Watson who prescribed for him. He then came over to New
York feeling a craving appetite, ate some solid food which he
vomited soon after, and then took the cars to his board-
ing-house, where he endeavored to write some letters but was
compelled to go to bed owing to pain in his back.
“When I saw Mr. R. on Dec. 1, he was suffering from general
hyperzesthesia over the whole body but especially over the arms,
legs, abdomen and back, severe aching pains in abdomen and
back, and he was unable to move from the recumbent position
without suffering from attacks of nausea and retching ; he had
passed his urine and there was no paralysis or loss of sensa-
tion and there had been no movement from the bowels.—
Pulse 72 in a minute, and axillary temperature 98%°. Mind
clear and hopeful. On Dec. 2, he seemed to feel dull and
weak, Pulse, 66. Temp. in axilla 974, Resp. 18.—Was unable
to take any solid food, and even milk and lime water in small
quantities brought on attacks of retching; passed his urine
only once in 24 hours ; quantity, about 80z. Spoke of having
slight cramping tn his toes, as though one were crossed over the
other; urine examined chemically and microscopically and
no. evidence of kidney disease found; specific gravity, 1020,
acid, no albumen or casts. Matters continued about as de-
scribed until Dec. 6, when the pulse was about 76 and inter-
mitted three times in a minute and he complained of feeling
slight tingling in the ends of fingers. Suspecting trouble
of spinal cord I asked Dr. Walter H. Gillette to see him in
consultation on Dec. 7, when a diagnosis was made of con-
cussion of the spinal cord. I saw Mr. Randall twice daily
from Dec. 2 to Dec. 19, 1881 and once daily with one
exception from last mentioned date to Jan. 11, 1882; during
that time his symptoms have been generally as follows:
bowels sluggish and not inclined to move except after medi-
364 MEDICAL JURISPRUDENCE.
cine, urine passed with some hesitation and difficulty and at
infrequent intervals, sometimes only once in 36 hours ; skin of
hands dry and whitish-looking, showing malnutrition, prickling
of ends of fingers, a continual “buzzing sensation ” as he ex-
presses it, in the fingers and toes, but which he has become so
accustomed to that he does not notice unless spoken to about
it ; twitchings of muscles of calves of legs, especially right leg ;
burning aching sensation in the back, especially that portion
between shoulder-blades and over lumbar region ; low tempera-
ture from Dec. 2 to Dec. 11, ranging at about 97? in axilla and
on Dec. 11 and Dec. 15, being about 98% inthe rectum, not
having been taken in rectum on other dates. Pulse intermittent,
sometimes there being as many as ten intermissions in a minute;
the intermissions were noticed first on Dec. 6, and continued un-
til Dec. 11, there having been none from Dec. 1 to Dec. 6; from
Dec. 11 to Dec. 29, pulse was regular, since which time it has
at times been regular and again intermittent ; he has had hal-
lucinations and has been somewhat delirious at times, especially
in waking from sleep; his memory is defective, and he has
complained of confusion of mind and inability to concentrate
his thoughts; has suffered from restlessness and inability to
sleep at night. Dr. Hamilton saw the patient with me on
Dec. 24, 1881 and Jan. 9, 1882, and confirmed the diagnosis of
concussion of the spinal cord; at the present time his condition
is about as follows: he suffers occasionally, more especially
after any exertion, from twitching of posterior muscles of legs,
pain in the back, numbness and tingling of fingers and toes,
stands and walks with difficulty, being liable to fall unless sup-
ported, bowels sluggish, urine passes at times slowly and at
times more freely. Pulse about 78 and intermittent, tempera-
ture about normal; pupils unequally dilated, tendon reflex in-
creased in both legs.”
Ocular Symptoms.—The ocular symptoms following spinal
concussion or more serious spinal injuries are exceedingly in-
teresting but by no means as common as Erichsen would have
us believe. It was Gowers* who first called attention to the
serious changes that may exist at the fundus oculi as the re-
sult of a railroad injury ; but in this case the patient received
a blow upon the left side of the forehead which rendered him
insensible for five minutes. He was laid up three weeks and
suffered from spinal and head pain and general nervous dis-
turbances. Paige, who refers to the case, says that he present-
* Medical Ophthalmoscophy, 4. ed., p. 348.
SPINAL INJURIES, 365
ed six months after the accident loss of vision in the left eye
to a great degree, limitation of the field, and slight changes in
the optic discs. In two cases I have detected well-marked
optic neuritis andin one there was commencing atrophy in both
eyes, with Argyle-Robertson pupils, but both of these patients
presented organic spinal symptoms. In many cases we find
temporary functional disturbances of accommodation, which,
however, need not be viewed with any seriousness. Among
these are patients who really possess slight asthenopia which
may be due to the general condition of bodily weakness,
but this is all. Such patients are unable to concentrate
their attention when reading, and such an effort produces head-
ache. Sometimes we find that the disturbance is entirely due
to a hypermetropia which is a congenital condition, and is in-
creased by the patient’s nervous exhaustion. In cases of
fraud it may be found that the alleged defect is due to cataract
or some condition entirely foreign to the case.
Bogus Cases.—lIn contrast to the cases I have just detailed,
and who, strange to say, made no attempt to bring suit or
obtain compensation, are those which are familiar to every
physician who has occasion to examine persons who present
themselves after almost every railroad accident with doleful
stories of suffering and injury which are far more often im-
aginary than real. I have seen many of these cases at the
solicitation of the railroad companies, and have repeatedly
heard the same story of deception.
The Effect of a Verdict.—In the great majority of cases
a good verdict brings with it a complete cure, and patients who
have been brought into court upon a litter surrounded by tear-
ful and interested friends and attentive physicians, whose cases
have been dramatically described to the jury, leave the court
room and a few days or weeks after the swindle engage in their
regular pursuits as if nothing had happened. It is to be re-
gretted that in such cases physicians have been found who have
been willing to testify to the existence of serious organic dis-
ease of the nervous system when no evidence of such was pre-
sented except the patient’s unreliable and prejudiced state-
ments. This class of cases is divided into two sub-divisions.
Hypochondriasis and Spinal Concussion.—Those who
suffer from a hysteria or hypochondriasis which in one way is
a diseased condition, and does not necessarily carry with it
intentional dishonesty, and under these circumstances a fair
366 MEDICAL jURISPRUDENCE,
verdict, directed rather to compensate for the injury of mind,
should be given.
Fraudulent Litigation.—Another division of the above
may be made, in whose ranks are to be found a variety of
impostors as motley and disreputable as Falstaff’s army. No
one but the medical officer of a railroad can conceive of the
cunning deviltry which enters into the machinations of one of
these disreputable claimants when backed up by an equally un-
scrupulous attorney. Careful detective espionage will reveal the
fact that this paralytic (?) is about his business ; that he is con-
sulting with his friends at the porter house when he imagines he
is not under observation ; and that perhaps he may be engaged
in such amusements as horseback riding, base ball playing, or
the like, when it has been claimed that he is paralyzed, or that
he suffers from an inflammation of the spinal cord which pre-
vents him from moving his body !
Instances of Deception.—In one of these cases, that of a
man who claimed that his injuries were immediate, and that he
was unconscious at the time of the collision, it transpired sub-
sequently that he not only loitered about the wreck but that he
walked home and attended to his daily pursuits without seem-
ing discomfort. In another case the individual was paid a
largesum of money, and it was afterwards proved that he had
not been upon the train at all.
I was called a few months ago to examine a man whose com-
plaints were especially heartrending and unfortunate, but whose
bodily condition did not bear out his story. ‘This man’s
physicians claimed that after the accident he had developed a
degeneration of the brain and spinal cord, but on good author-
ity I learned that the same claim had been made by him sey-
eral years before after an accident on another road, and an
equally unfavorable condition of affairs was alleged to exist.
Case LXIIIL—
One of the most audacious instances of swindling I have
ever known occurred as the result of the 42d street accident
upon the Elevated Railroad. A young girl presented her-
self at the office of the company, presenting beside a vague
series of symptoms suggestive of spinal concussion, a peculiar
depression of the sternum which she claimed was a traumatic
result of the collision. Upon the statement of her physician,
whom she had deceived, three thousand dollars were given her,
SPINAL INJURIES. 367
fifteen hundred of which were deposited in the bank in her name
and the balance devoted to the payment of doctors’ bills and
and other expensess It was found within a year that the girl
had not been upon the train at all, that the depression of the
sternum had been made by an instrument like a brace and bit,
held against the chest, and used in the process of artificial
flower-making, a trade she had been engaged in for some time,
and that her other symptoms were pure inventions. Her father,
who had coached her in her réle of deceit, was arrested, con-
victed and is, I believe, now in Sing Sing.
Exaggeration.—As I have said, the mental condition of
many of these patients is purely hysterical, and from constant
concentration of attention upon themselves and the expectancy
of a verdict, a state of real suffering is produced which is striking
and peculiar. While every muscle of the body may preserve
its integrity of function, and no organ suffers pathological
change, we find an emotional derangement which cannot be
shammed, and there is a depression in some cases amounting
to simple melancholia. With a few suggestions from Mr. Erich-
sen’s book and a knowledge of how some friend was affected in
another accident, a patient is ever ready to believe in, and com-
plain of a variety of aches and pains which are purely imaginary.
By the statement of these patients, and authors who have
described them, it is found that “‘constant pain in the back,”
fatigue of the muscles, of the legs especially, headaches, “ inca-
pacity for mental work,” confusion of ideas, “loss of memory
and weakened vision” are characteristic symptoms of spinal
concussion,
Hysteria and Spinal Coneussion.—The unprejudiced
physician will find, if he believe that these conditions really exist,
that there are as well many other symptoms which are conspic-
uous in anemic and hysterical persons who perhaps suffer from
pelvic disorders, but depend in the case of the litigant upon ner-
vous excitement and exhaustion and are entirely independent of
any violent influences. Careful questioning may determine the
existence of pain and tenderness over the seventh cervical spine,
of ovarian tenderness; perhaps of digestive disorder, of the
globus hystericus in some cases; and of pallor and other well-
known manifestations of functional nervous disturbance.
In one of Page’s cases the claim was made that the seventh
cervical vertebra was unduly prominent, and the result of an
injury, the patient having received a bruise upon the lower part
of the back. Two years after the accident she was perfectly
368 MEDICAL JURISPRUDENCE.
well. Not only may the person who is so eager for pecuniary
balm attempt to palm off long existing troubles for genuine in-
juries, but he may invent the most outrageous and improbable
pretexts for pressing his suit. With such patients a loss of pro-
creating power, or pretended injuries to the organs of genera-
tion are often claimed, while no such impairment really exists,
and the matter is made more difficult by the absolute refusal of
the patient to submit to any examination by the defendant’s
physicians, and in this she receives occasionally the support of
the Court. A ridiculous side of the question is often presented
after the disposal of the case, and, unfortunately, after a sym-
pathetic jury have given a sentimental verdict. In one case
with which I am familiar, it was claimed that the shock had
produced an incurable dislocation of the uterus and that the
woman would never again bear children, a few months how-
ever, after a handsome verdict, she became a mother. It
sometimes happens that the influence of uterine disturbance
will greatly increase the nervous excitement and prejudice the
minds not only of experts for the plaintiff but the jury as well.
In a woman, the subject of miscarriages, this question arose.
And Dr. Page, who reports the case, stated that though she was
pregnant at the time of the accident the labor was not inter-
fered with, but that she subsequently had several miscarriages
and much nervous suffering, which she believed to be due in
great part to the exhaustion attendant upon frequent gestation.
It seems that the jury were inclined to take his view of the
case, for they gave her but one-sixth of the amount asked for.
Erichsen is disposed to take a grave view of a complication of
pregnancy, not so much in regard to the immediate but remote
effects of the concussion. So far as my own experience is
concerned, I have found little to warrant the belief that the
functions of the organs of generation in women are affected
in any serious way by a trouble of this kind. This is true also
in regard to the other sex, although claims are constantly made
in the courts that all manner of disturbances and great en-
feeblement follow spinal concussion. In cases of injury to
the spinal cord attended by organic involvement above the
splanchnic nerves such changes may follow, but these are very
rare. Care should be taken not to accept the statement of the
patient as conclusive that vesical irritability or incontinence
are due to nothing else than the injury, for in many of these
cases there may have been previously existing cystitis, and in one
I examined I found that the man had been buying and using a
well known and popular specific known as Bethesda water while
SPINAL INJURIES, 369
in other cases a history of urethritis with its attendant conse-
quences was ascertained. In men past middle age it may be
well to find whether or not there is an enlarged prostate.
Insanity and Spinal Concussions—It is sometimes
urged that patients become insane as the result of spinal inju-
ries. While I am perfectly willing to admit that organic
spinal disease may by extension produce mental aberration, I
have yet to see the case of insanity due to the effects of spinal
concussion. I have no doubt that fear and mental shock inci-
dent to the excitement of a collision may give rise to derange-
ment of the mind and grave hysteria and hypnotic states may
be induced.
A case related by Page is that of a strong and healthy man
zet. 30, who was in a collision, and who presented the usual
signs of having received a sprain of his back and some general
shock to his nervous system. He lay for a long time in
a hypnotic state, alternating with fits of violence and passion.
When -he awoke from this, he became the subject of a
delusion that he was poisoned, and was accordingly, about
ten months after the accident, removed to an asylum. He
remained there about six weeks; and while an inmate he
adopted a peculiar gait, which lasted up to the time when
his claim was settled two years after the accident, and
which formed the ground of a very serious view that he had
received a permanent damage to his spinal cord. His mode of
walking was thus described when he came out of the asylum:
“He puts the weight of his body on two sticks placed in ad-
vance of him, and draws each leg alternately forward with the
foot much everted. When about to advance one leg he twists
the other inwards on the toes, so that the latter point forwards
instead of outwards. He keeps the knees quite stiff. In this
way he shuffles along with great rapidity. As he stood with
his back against the wall, he was asked to lift up his knee, but
he professed utter inability to do so.”’ Very careful examina-
tion was made at this time as to the nutrition and state of the
legs, and a report shortly afterwards by a very able physician
runs thus: “ The reflex irritability and Faradic excitability of
the muscles of the lower extremities are normal ; there is an
entire absence of affection of the bladder or rectum, or of any
trophic change such as muscular atrophy and bed-sores. There
is also an entire absence of muscular tension, rigidity, con-
traction, or deformity in the lower limbs. Examination did ,
not enable me to determine whether any affection existed on
370° MEDICAL JURISPRUDENCE.
the sensory side, as the patient absolutely refused to answer
any questions. On the whole, my opinion of the case is that
it is an example of many recorded instances in which a slight
and unimportant injury develops various emotional and hys-
terical symptoms.” At a final visit made to him before his —
claim was settled, he complained more than ever of pain in his
back, and called out loudly when touched upon his clothes.
While sitting in his chair he could move his legs in any direc-
tion required of him, though much persuasion was necessary to
get him to move them at all. He suddenly vomited during
our visit, without any precedent sign of nausea or retching.
Asked to walk across the room he essayed to do so after the
manner already described. There was no tremor of the legs
during progression, and nothing like ankle-clonus or the gait
which is seen when there is secondary degeneration of the
cord. Subsequently, on being asked to go into the next room
he began to do so, but almost immediately fell down flat on the
floor, whence he was lifted and carried away. A very large
claim for compensation was preferred, and was arranged two
years after the accident, not, however, without a resort to liti-
gation. He shortly afterwards left the house in which he had
been living, and for some time it was not known where he was.
Forty-two months, however, after the accident he was fortu-
nately seen by one of the medical men who had visited him
during his long illness, and he found him in perfect bodily
health and vigor and father of another child. It should be
stated, as having an important bearing on the case, that the
man’s previous history was bad. He was always very irascible
and some years previous to the accident he had been laid up
with sunstroke. There wasalso some doubtful history of in-
sanity in his family.”
The Loss of Memory.—The loss of memory complained
of by the litigious sufferer is nearly always a volitional defect,
and a case is related where the patient was utterly unable, ac-
cording to her own story, to remember any of the details of
her previous life and zot even her name, Yet she recounted with
great minuteness all the circumstances of the accident and
showed intellectual vigor which, to say the least, was suspicious,
The real state, in ninety-nine cases out of a hundred, is that
we so often find in hysteria and- hypochondriasis. Emo-
tional depression, manifested by whining complaints, lachrymose
concentration upon the possible termination of the suit and the
frequent repetition of the story of the accident, show the bur-
SPINAL INJURIES. 371
den of his thoughts. I have never witnessed really insane
symptoms in uncomplicated spinal shock and I do not believe
such are ever presented except where there has been head in-
jury or advancing degeneration of the spinal cord.
Hemoptysis with Spinal Concussion.—In opposition
to the case I have mentioned in which hemorrhage from the
lungs occurred at the time of the accident, is one reported
by Page, in which a malingerer claimed that a profuse hemop-
tysis had occurred after a slight collision. A man of forty-five
received a slight blow on the knee and another on the sternum,
began to complain of nerve symptoms two weeks after the acci-
dent and took to his bed where he remained for two months.
His complaints were very much out of proportion to his
actual suffering. The blood he raised evidently came from
very congested fauces. Eleven months afterwards a settlement
was made with the railroad company, and two years after-
wards it was ascertained that he had been at work for a long
time, and was apparently in perfect health.
Sprains and their Results.—As the result of an acci-*
dent we may be furnished with symptoms of pain which may
be due to injury of parts outside of the vertebral column and
arise from sprain or muscular contusion.
Sprains of the spine are much more apt to follow injuries in
which the body is twisted than where the force is directly ap-
plied. In the former case the pain will be diffused and general,
while of course local blows will give rise to corresponding pain
and stiffness. Occasionally we may find symptoms which are
indicative of temporary disturbance of the functions of the
spinal cord. A violent wrench may perhaps stretch the spinal
herve roots, causing painful symptoms, but I have never seen
more than this, although Holmes reports a case in which there
was some disturbance of motion. His case may be presented
for the purpose, if nothing else, of showing how easy it is to be
deceived by a collection of symptoms which rapidly disappear,
but which may perhaps be referred to grave disease of the cord
itself.* “A man, aged 31, while engaged in amusing his infant
on the floor, and stooping on his hands and feet, was
springing forward when he tripped and rolled over with
his head under him. The weight of his body came with
an impulse on his neck and gave him much pain from
the twist it caused. He lay motionless on his back for
* A System of Surgery, etc., Vol. 1, page 789, American Edition.
372 MEDICAL JURISPRUDENCE,
teh minutes. When he attempted to move either his arms
or legs, he found himself unable, and he had a sense of
numbness and pricking throughout the body. His legs gave
way under him as if he were intoxicated, when trying to stand.
On being brought to the hospital it was necessary to carry him
into the ward. When lying on the bed he moved both upper
and lower extremities, but in a feeble and forced manner.
Sensation was not lost, only impaired ; he was able to tell cor-
_ rectly what part of his body or limbs were touched. Within
_ twelve hours both motor pewer and sensation were restored,
and the paralytic symptoms did not afterwards return. He
complained of acute pain in the neck, which was aggravated by
the slightest motion of the head, and they therefore kept his
head perfectly still. He lay in bed with his neck sunk ona
low soft pillow, propped around with sandbags. On examining
the neck the chief tenderness was at the site of the fourth cer-
vical vertebra, and there deeply seated swellings could be per-
ceived. The treatment consisted principally in the enforce-
ment of absolute rest for the neck, with the application contin-
aually of iodine, a plastic shirt or support reaching from the
shoulder to the back of the head having been prepared. He
was allowed in a month to leave us, and he could then perform
the nodding but not the rotatory motions of the neck. When
trying the latter he turned his whole body around. In nine
weeks the movements of the body seemed to be quite restored,
but he was kept in the hospital for precaution’s sake three
weeks longer. He returned to his occupation, that of a shoe-
maker, and called several times subsequently to show that he
was well.”
Serious falls and injuries may give rise to sprains, which are
perhaps followed by swelling or even by ecchymosis, but very
often there is no vertebral or spinal disease ; and it does not
do for us to too hastily form a bad prognosis in cases of this
kind.
A veritable lumbago of traumatic origin may be caused in
the same way that it is by afall upon an icy pavement. In
some cases we find muscular rupture which may follow the re-
sistance dependent upon a fixed attitude the individual may
assume when he sees that acollision is inevitable. The separa-
tion of muscular fibres or ligamentous attachments give rise to
localized obstinate pain, which is aggravated by pressure or
movements of a particular kind, such as bending over or twist-
ing the body. I can recall two cases where very great suffering
followed a separation of some of the attachments of the spinal
SPINAL INJURIES, ane
muscles from the vertebral processes; and in one of these
cases a very extensive rupture followed an accident which
resulted from the front wheels of an ambulance dropping sud-
denly into a deep hole, and as a consequence an army officer
who occupied the rear seat was thrown violently upwards and
forwards, so that his héad struck the top. Recovery followed
a period of great suffering. In another case a woman fell into
asewer opening and the result was a considerable rupture of
the fibres of the latissimus dorsi and the trapezius, resulting
in impairment of the movements of the arms and head. She
was unable to use her arm and could not attend to her house-
hold duties; she received handsome compensation from the
city. In such cases as these large verdicts should not be ex-
pected, for beyond the immediate pain and possible swelling
and discoloration and subsequent temporary incapacity, there
is very little chance of permanent after-effects, and juries
should not be prejudiced by the complaints of the patient,
which may become tinged with hypochondriasis.
The Fear of Moving.—Page refers to the fear of moving
which may result from a constant dwelling upon a slight
painful disturbance. “Ask any man,” says he, “who has
had a severe lumbago, whether from a sprain, from rheu-
matism, or from cold, if he has not at the same time felt a
strange sense of difficulty in moving his legs. Brisk walking
becomes impossible ; the effort to put one leg before the other
must be unnaturally great; fatigue comes on early and the
patient complains to you that his legs feel weak and as if he
could hardly move them. Free micturition may likewise be
interfered with from lack of the natural support and help which
the lumbar muscles provide when this act is being performed.
Constipation arises from the same cause. Thus it becomes
nothing more nor less than natural for the friends to say that the
patient is paralyzed, and paralyzed from severe injury to the
spine. If we do not avoid this fallacy and do not correctly
interpret this state of things, we shall add greatly to the dread
which, after railway collisions, may be very real, that ‘ paraly-
sis Is going to supervene.’”
He relates this case: “A man who had received such
injuries as we have described, and was confined to bed in con-
sequence, needed three persons to help him out of bed every
time he wanted to pass water during the day. To himself it
appeared wholly unaccountable and extraordinary that when-
ever he woke in the night he could jump naturally out of bed
374 MEDICAL JURISPRUDENCE.
without any help for the same purpose. It need hardly be said
that the case was perfectly genuine.”
Pain and its Character.—Great care should be taken
not to confuse the vague symptoms, among which is a spinal
pain that may arise from lithzemia; and it is quite probable in
some subjects that anxiety, voluntary inaction and perhaps a
tendency to the gouty vice may account for many of the symp-
toms alleged to be due to the injury. We are tocarefully note
the relation of the pain, whether it be increased by movements
or by the assumption of the erect position ; whether it be asso-
ciated with sciatica, whether paresthesia, or if it is aggravated
by changes in temperature. We should always bear in mind
that a severe injury of the spinal column and its contents is by
no means easily produced because of the provisions made by
nature for the protection of this part of the body. Not only,
as it has been seen, is the spinal cord surrounded by fluids and
tough membranes, but it is inclosed by elaborately connected
bones separated by pads of cartilage which act as buffers,
obviating the transmission of any severe shock and it is pro-
tected behind by large masses of muscle and fascia.
Although such an accident is improbable, the theory has
been advanced by Hilton that when an individual falls back-
ward, the spinal cord obeying the law of gravitation, may be
thrown backwards, dragging the finer sensitive and motor
nerves, giving rise to abnormal sensations of a light grade, and
such may be the case with the history of a blow. In other
cases, as Page has shown, an injury of the sensory nerves
outside of the spinal canal may account for much of the pain
that may be supposed to be of intra-spinal origin.
Pain Rare in Organic Disease.—Gower’s observa-
tions upon the connection of pain with spinal disease are ex-
ceedingly practical. He calls attention to the fact that its
existence in connection with abdominal and cardiac affections
is so common and misleading that when uncomplicated its
diagnostic value is not as great as it is usually supposed to be ;
and it is no exaggeration to say that of a hundred patients who
complain of spinal pain, in ninety-nine there is no disease of
the spinal cord. This coincides with my own observations, and of
a large number of patients that have come under my charge
from time to time, I have found that uncomplicated disease of
the cord itself was not attended very often by local tenderness,
while in meningitis or vertebral disease the reverse was true.
SPINAL INJURIES. 375
Surgical Accidents.—In some cases of spinal injury,
it will be alleged that a shortening of one lower extremity has
been caused, and in a case I examined recently with Dr. Pea-
body this was claimed to be the fact. It however transpired
that all the trouble had been referred by the patient to what
she was told was the unsound limb, although we did not find
any paralysis of either, or any thing to account for the shorten-
ing. To our surprise we found that the left limb was three-
quarters of an inch longer than the right ; but upon consult-
ing various statistics it appears that a large number of. per-
fectly healthy persons present this congenital defect, so it
must be borne in mind in these cases that after all such dis-
-crepancies often have nothing to do with disease.
Dr. Page’s Tables.—Page has tabulated 234 cases of
spinal injury received in railroad accidents, and it is curious to
note that the large majority of these are tinged with a coloring
of imposture, and it would appear that in cases where the
largest damages were asked for, and where litigation was most
bitter, the suspicion of malingering was generally evident. In
many of these persons there existed other diseases, and just how
much the symptoms were due to other agencies than the injury
itself it 1s difficult to say. Case II. for instance suffered from
sciatica, rheumatism and aortic regurgitation. This patient,
soon after the settlement of the case, even after showing some
improvement, was found dead in his bed; and his death was
undoubtedly due to cerebral embolism. Several of the liti-
gants had been hard drinkers before the various accidents,
and many of the nervous symptoms were undoubtedly occa-
sioned by acute alcoholism. And in a case reported by Dr.
Fletcher, that of a man who died twelve months after an acci-
dent, which was ascribed to be the cause of his death, it was
clearly proved that both before and after the alleged injury he
had several attacks of delirium tremens. In another individ-
ual, the subject of a diabetes which ultimately carried him off,
it was claimed that the symptoms of this disease were entirely
due to the shock. Page states that the diabetes was not of
that traumatic variety described by Dr. Buzzard.
Bright’s Disease and Spinal Injuries.—A bad injury
may be alleged to be the cause of renal disease. When the
lumbar region is involved there may be hematuria. In some
cases, where spinal injuries have thus resulted, and where
there is advancing renal disease, we must not be too ready to
connect such a condition directly with the fall, for there may
376 MEDICAL JURISPRUDENCE.
have been pre-existing nephritis or other renal difficulties.
‘Le Gros Clark is disposed to disbelieve in the existence of dis-
ease of the kidneys as a consequence of injuries to the spine.
Holmes speaks of a case in which a gentleman claimed com-
pensation for injuries which he declared to be the result of a
railway accident. He asserted that he suffered from Bright’s
disease of the kidneys, which was directly produced by a blow
upon the back, and the injury consisted in “a bruise over the
right ilium and the side of the loins. As he walked some dis-
tance for his pleasure and took a long journey shortly after-
wards, it may be inferred that the contusion was not severe.
On the following day he observed blood mixed with his urine,
and he continued for four more days to pass blood. On ex-
amining the urine at that time, his medical attendants found
albumen contained in it, and they particularly stated that the
quantity of albumen was larger in proportion than could be
accounted for by the presence of the blood. During the whole
period from the date of the accident to that of the trial, eleven
months, the urine was found to contain albumen, and the
view contended for by the witnesses in his favor was, that albu-
minuria had been caused by injury inflicted on the right kidney
in the collision. On the part of the railway company, it was
asserted that previous to the accident the gentleman had been
subject to eczema, and that shortly before it he had been
cured under treatment ; accordingly the medical witnesses on
that side, the writer being one, argued that albuminuria was
known to follow eczema on its being cured, and for that and
other reasons which could not be stated they expressed a strong
opinion that the plaintiff was suffering from the disease when
he met with the accident, and that the injury could not have
brought it on. The jury nevertheless awarded heavy damages
for the sufferer.” :
In conclusion I may again refer to the behavior of many
of the patients who bring suits for imaginary injuries, and I
cannot use more forcible words than those of Page:
“With glib facility of tongue he talks of the frauds which
are so notorious upon railway companies, but his own char-
acter is, and always has been, above suspicion. His com-
plaints are many and grievous, but yet he would not make
them worse than they are, bad enough though they be to keep
him from his 4vork, which his doctors urge him to resume.
Occupation is impossible ; he cannot leave the house; and his
SPINAL INJURIES, syed
religious sense is shocked that for so long he has not been to
church. Hecan bear nonoise. He cannot read, and his only
diversion is to hear his Bible read to him by his children or
his wife. He is pleased to see you, for he knows how deep
and true an interest you take in his wretched state; and he is
ever ready to fall in with—but not to adopt—the suggestions
you may make for his comfort and the improvement of his
health. Once more, as you leave him, he assures you with
Pharisaic unction, that he is not as other men, and that he
would be the last to try and make money out of the affliction
with which he has been visited. His speech always betrays
him, and exposes the pious fraud.”
Fraudulent Pension Claims.—Pension boards are some-
times petitioned by individuals who claim disability arising
from disease or injury of the nervous system due to accident
or exposure in the line of duty. I have lately heard of a man
who - during the War of the Rebellion was struck upon the
buttocks by a piece of shell, but his immediate injuries were
slight. A few years ago, after a period of good health, he de-
veloped spinal symptoms, indicative of myelitis and became
paraplegic. The claim of the man and his physicians was that
the injury was the direct cause of the present disease, which it
is claimed is primarily vertebral. I am told that the recent
symptoms were sudden in their onset and symptomatic of
disease of a part of the cord that could not possibly have been
injured in the accident.
All manner of bogus attacks of paraplegia are alleged to
result from spinal injuries by veritable “old soldiers,” but
often it is possible to find the history of alcoholism, syphilis,
or subsequent exposure, or the symptoms will not bear close
examination, and come under the class of cases so often
claimed to be the result of “spinal concussion,”
MEDICAL JURISPRUDENCE,
378
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379
SPINAL INJURIES.
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INDEX.
Abscesses, Brain..... Pawnee
Aphasia, Medico-Legal Rela-
TONG. OFS ib 625, Sen cee ieee a's 6
Aphasia with Responsibility...
Alcoholic Epileptics, Impulses
A RSs lidas «alate. & aide es Ne
MTCOHOUEI, «<5 fad wel ee
and Civil Actions. .......
and General Paresis, Diag-
nosis DetwWeen. . 0. 4. aie
and Life Insurance.......
and Responsibility... ...
Character Changes in ....
Development’ of... osia2 .s:2-
DOEVISIONS OE fo 05 ps 2 tas ots
Epileptiform Attacks in...
ised: ideas ies shensaas
Hallucinations of........
PlSreGily. Ii. 2/3505 asses
in Cranial Injuries.......
Loss of Memory in.:..5.:.
Diehial State IMs oii tele»
Testamentary Capacity in.
Arrest of Heart’s Action, Volun-
RAE Y ota ae os 58s edie 350.8 ei vine
Assaults, Pretended’..........
Pretended, by Dentists....
1 oa Rs CS lg 9 faa
Brain Apscestes 4 os. cuks saute
Compression of the.......
Breach of Promise and Insanity.
Bright’s Disease and Spinal In-
GUNES ieee waren «dca wharves ee
Capacity, Testamentary.......
Cerebral Erritatian.. 6.06. csisede sis
Serer, CantwMie sav sie ic weiss
Cerebri,
Children, Hysteria
Young: ss «
in Very
eeeeeeeaee et @s eee
317
117
173
Chloroform and Hysteria...... 189
ANG KODDELY 0 b.662 06.5 2 EQ3
Civcalar Insanity a.94.0 00513 ae 42
Glassitication of Babs <3 64 oso 353
Clegg The Impostor, Case of... 240
Clymer upon the Responsibility
Of Ppilepaess 5 a. sa-nigieds ae’ 224
Commissio de Lunatico Inquir-
SHUG ie 4 2.5. edness wet as ep . 145
Commitment of Drunkards.. 208
Of Lamaties: 3. o. tes ves arese 143
Concealed Insanity. . wi. 53.3 50% -I51
Concussion and Compression.. 304
and Meningitis, . «008.60: 309
ry) ds oa 3) rs ae 309 317
SPIMALG so sa epee OR od wae 352
Fatal Caces Gfus.cc. s dsvcioe 355
Trophic Changes in..... - 354
Congenital Viciousness........ 29
Contracts, Btsiness . . «sve o's 112
made by the Insane..... = ae
Contractures, Hysterical...... 178
SIMEQILER. as vere t.034 id 213
CORCECOUD eat as ewe 323 306
Contusio: Gerebat. oj<'o iia ee.8/9 318
Convulsions in Paralyzed
DAS Ss rae ale io «oven paeenrare 318
Cortical Emile psy iz. o were vce oie 221
Gounsel, CHGS! OF oie xis: spaccc0 tne 71
Cranial ‘lajurness.s¢ svinhisctu ss 301
Anatomical Considerations
WIL. sca Seas cate am eras 301
Affections of Intellect and. 310
Condition of Duality and.. 310
Deasiness ands. isdvcue ds 318
Rrysipelas 4nG.. &ac.asee es 322
Meninottis and «4.5 vise dos 312
Sexual Perversion in...... 309
Complicated with other
RSC ABOM, dn wnt te aacleceiats 320
Kind and Direction of Vio-
LGNGG: 1, 00's 3. 6's ote euges
iv INDEX.
Cranial Injuries, in Alcoholism 321 ,; Disease Apparently Feigned...
1 Children ont oo ascent et B10:1| “Wiseases| Weloned 5 sack. e. sists
Latent; Disease ini. v5.0. 319 of the Womb, Feigned....
Obitisiin ies Gites sins mikes 32i | Dislocation of Vertebre......
Symptoms -Of7 73.4. esac 303 | Disposing Mind, The Test of a.
lia Vialwte <5 oer 823 «| aDivorce and -Epilepsy 4-4 saaecL
and Epilepsy, Case of..... 313 and Insanity.....
and Memory. . stern Gta || uties- of the Medical Expett..
and Previous Disease.. 329 | Drunkards’, Commitment of..
and, PyeMIlatin sy wcas tan 328 Habitial: cence ae:
and Speech. tiajeg eate-chewia see 330 Insanes. ove.. 0c on tae eee
Extravasation in..... .... 329 Responsibility,of. 7.05...
from Blows with the Fist... 325 | Drunkenness and Suicide......
Infanticidesby.. 3%. .ees- 341 | Duality, Condition of, and Cra-
Prognosis Of jsqcxs- oss haere 326 hial:Injuries:; ars. <- oe tee
without External Lesion... 323 | Duc de Bourbon, The Case of..
Cranial Nerves, Injury of...... 308 | Eccentricity in Relation to
Cranial Wound, Character of.. 339 Testamentary Capacity....
Cretinisin ancl ee Ce eee 26 4 -Heenbranlement, .s« 10.2 see
Crimes, -Abominablez.sn..4o7 184 | Epidemic Hysterian otc.
Crimes, Undue Influence in Epilepsy... -eictek.on Baie me eee
Relation tos.c31s tage ete se 100 and Cranial Injury, Case of
Criminal Acts, Relations of to and. Divorcett sass tee
SlGeDc; ioe re ieee eee ee 48 and Hallucinations...
Criminal Responsibility of the and: Marriages.S aaisiaasmier
Deat-and Dumber neers 129 and Somnambulism.......
Cutaneous Conditions, Feigned 214 and Testamentary Capacity
Damages, Civil Suits for, in and the Sphygmograph....
Cranial injuries: vss weet os 340 Corticalit. 3.88 de iocidee. &
Deaf and Dumb, the Responsi- PCIONE Catch ete predeton eet
DULY OL ce. se eek ees 126 Head. Injury ani seme
Deafness and Cranial Injuries.. 318 Hughlings Jackson on....
Peroied 28 ee smerceate es pce 215 Lighter Grades of, sacar
Delirium as distinguished from Medico-Legal Applications
Manila 2-3": Ga stesietaeeeet 42 in Relationitossees-. se.
Delirium Tremens and Respon- - Memory in Relation to.°..
Sibilityea\y seek ve seam este 256 Mental Condition of......
Delusionss243 3.53.4 eon a peer Se Dae bt Nocturnaluiinviteesciesteles
Concealed! <n sm vaeeune <1 76 Reflexavesoaks Weoree.
not necessarily Expressed i in ‘ETaUMAtIC..<. 4 caheien sites
Conversation.........s» 76 | Epileptic Insane, Crimes of...
of Grandeur... .< a cea 45 | Epileptic, Realization of Crime
Dementiags aves acc cictek ssl Ae eS bythe 20), is etree ae
ana Oldg@Age seni e ese eas 79 | Epileptics, Character ‘of Con-
COMpletes es scare: ee srewen ney penital:.<4..c ccna eseelecehns
RCIONEC so tes ee ae ee ete re sel57 Clymer on Responsibility
Partials ass ae staat RV Of J ddvincet css eae eS
Secondary ise. os peice vvieta 9 20 Responsibility-ofses sas
DCILIG esis os cin as © .se. 27 | Epileptiform Attacks in Alco-
Desire for Notoriety etoseienatewe Wee 182 holism s.ti5.4s.e2ie' da Se mle ete
Destructive Tendencies, Hyste- Erb’s-Classificationa at: s.cclesis
TIAAWILIisieier els atoyein shat see ay hs 182 | Erysipelas and Cranial Injury. .
Diagnosis Hasty, Danger of. 203 | Examination of the Patient....
Dipsemania..... S sfesewee cetase s/99 ) duxtravasationslilesthenmi. ens
203
214
235
118
264
310
221
313
234
227
240
238
222
229
233
223
222
221
231
225
224
229
INDEX.
branes of the Cord......... 350
Expert, Duties of the Medical. 71
Eye Diseases, Feigned........ 215
Feigned Cases of Spinal Con-
GUSIIOR.G Vion) vas Perea ee 365
Dleatnessneos iets ties 215
Demontias ais 6s sade .'s 3% 157
ASO SS" ste a QUd vee 199
Diseases of the Uterus.... 214
Hye obiseasess «ese ake ok 215
ELPUCDSY sree oo, 3 Ree e's 238
Hemorrhagic and Cuta-
neous Diseases. oo .... 6% 214
Fhemipleria sate ea cates 210
BHOCY vigor. wos tok 84 tact 156
EMeCI LY e306 adler Ti es cd's 156
PASAY Ores odie e-2's UL 152
Insanity, Doubtful Cases
BPs ae wasn Seowe ee cole 169
Locomotor Ataxia........ 209
EAMED od Starerssc PAP ete oe t 155
MIGIABCHONS, 2 ec ace oa 156
PRs od, b Biers ABO 199
Paralysis...... Suda acd ee 209
Somnambulism........... 208
Spasmodic Diseases...... 204
Unconsciousness: 2.6.2... 204
Unconsciousness, Tests for 207
Fixed Ideas in Alcoholism..... 256
MONG sCIPENIAITE, «4: o:0! sis telna a 6 42
Practures of the Skull:....:... 306
Fracture of the Spine without
Displacement [22s s0 a < ra'ss 346
Genius and Insanity.......... 69
GuttenaCase, THE. 2620 oses.s 62
General Paresis and Alcoholism,
Diagnosis between......... 257
Paresis of the Insane .... 44
Hemoptysis with Spinal Con-
CE 5) Calan net ee ee a ae 371
Hemorrhagic and Cutaneous
Conditions Feigned........ 214
Hallucination and Suicide..... 290
Homicide as the Result of. 36
PAQUMCIBALIONS 0 9)4°5.5 o 2 6c ba \siee 6 73
and Epilepsy... 0.0 6.00% 233
Disorderly Conduct Ex-
plained by....°.. rece 74
Of Alcoholistysi...660.6% . 249
Handwriting of the Insane.... 112
Head Injury in Epilepsy...... 222
Heart’s Action, Oats Ar-
rest of. . MK Pk Ee 204
Hemiplegia F eigned. . - 210
Heredity in Alcoholism.......
Hereditary Influence. os. 04...
Prema, -CereDi ley. ste aus ss ass
Hip Joint Disease, Simulated. .
Homicide as the Result of
Hallncination.. sie Fs 62.5504
Distinguished from Suicide
Homicidal Injury, Accidental. .
Insanity Reasoning.......
Mania. isis sacs aos :
Mania with or without De-
hisions, - 243. (0 Usk ee
Homicide or Suicide, Post Mor-
tem Determination of.......
through Insane Inspiration.
Hutchinson upon Malingerers..
Hypochondriasis and ge is
BiG LAGE. sews aes oe wa
and Pretended Suicide....
and Spinal Concussion....
EE DIGEMC fa ct sists foce
in its Relation to Organic
NISCASE Mere 5 hai os eae
in Very Young Children...
Manifested in Religious
WaQaHOS 4 Oc 'o55 3S eee
Medico-Legal Considera-
SOW Offi sci cs cceunmn ete
Hysterical Patients, Self-Mulila-
HEOUNIDY « fet w ous s hen ce
Simulation of Real Diseases
Subject, Responsibility of
CiGy sc a5 ae cca te oe ee
Traumatic Contractures..
Tdioey 02505 2 ets che Se ee
WEGNER. i563 ss be eet Cate
Idiots, Head Configuration of..
Idiot, Legal Status of the.....
TWUGtONS 6:5 ack ee meee sees .
EPADGCUNY 25 5. ctatejalendy, cate adore .
Feigned...........++.. ar
Responsibility in Relation
LO deiss Fo 02 ia 's'a se sitio aes :
sanity. . Geis eau se wie Aah weds 816
leptic. .. 2... eee eee sees eee
Vi INDEX.
Infanticide by Cranial Injury.. 341
Influenhce; 2 Under. shail ciao 96
Tjuries Cranial atone iets 301
Cranial, in Children...... 319
Cranial Symptoms of..... 303
of Cranial Nerves........ 308
Homicidal, Accidental.... 340
Skull, Prognosis of....... 334
Insane, Contracts made by the. 78
Cunmingot: the ss css cures + 38
Arunkardss. s: <= Ro sifaas 250
General Paresis of the.... 44
Handwriting of the....... 112
Inspiration, Homicide
COTOUG TI temariatne o oleoie 3 4!
Post Mortem Examination
ORV epee cise he chars cess 52
Punishability of the....... 198
Puerperal, Crimes of the... 43
Insanity and Breach of Promise. 117
BUGS DLV OT Cease aicine sete « 118
and: (xeniUS 52 <ccetaletielers:s 69
and Life Insurance....... 122
and: MartiaG@rs cits ayes sis0 116
and Spinal Concussion.... 369
CirctlareGan nc. ober ee 42
Classification: o£: Gitce..: <a. 18
Goncealedic ize: cent alctae os ae I51I
DéhinitionzOnes > sation ee 2 17
Dissolution of Partnership
by. Reasonvota. sce... 3 115
Doubtful Cases of Feigned. 169
During Litigation........ 330
Epilepticw at. etaccusiatss 6 230
EpllepuceCrmes ote... 236
Peignedigi cist sick ereiels ss -ote 132
General Consideration of.. 17
General Indications of.... 18
Homicidal Reasoning..... 40
Impeachment by Reason
Of a axeave lo eakconeqmr otras T16
Tnipul sive trsseacedused wens 136
in Relation to Theft...... 142
Legal Relations of....... 61
Moralcand: Partials ay. s c.<s 20
Somatic Classification of.. 20
‘The: Border Land-ofs s.. «. 62
The Popular, versus the
Scientific View of....... I51
Intellect, Affections of, and
Cranial Tajuries. iodine ce ¢ 310
Entervals; lucid acmmcaniies cece ¥ 7]
Jackson, Hughlings, on Epilepsy 226
Kleptomania Seeiesies Oras ee ES
Legal Relations of Insanity.... 61
Statasof* the Idiots 777.2% 126
Lead Paralysis and Spinal Con-
CUSSION =. sores atone otle te 6355
Legatelerins: sear sheet veee 72
Pests oe eee ee Aarne et OL
Life Insurance, and Alcoholism 274
and Insanity. Sree eotstea ol 122
ANG SUICIDE. «cise ete te cles 291
Locomotor Ataxia, Feigned... 209
as the Result of Spinal
Concussion eetees eee oo 357
Lacid@intervais. +. oe ee oo a7
Lunatics, The Commitment of. 143
Etist and Etysteriass< a erates 170
Malingerers, Hutchinson upon. 202
Mania oo sates ee tee 30
Acute and Chronic, Dis-
tinction between .t-. 7.5 42
Delirium as distinguished
FrONTE AEG tee eee 42
Feigned®’. tt tiee. eaeae 155
Homicidal ssc 0 2 eens 35
Reasoning ss. e's. sielewts te 76
Swicidal. see ee Ar et)
Marriage and Epilepsy....... 234
and: Insanity 2% sce: otal < 116
Max Klinger, The Case of.... 245
Medico-Legal Consideration of
Hysteria toes can cite cc ote 170
Relations of Aptasiae oF. 107
Questions of Suicide...... 275
Melancholiavi...'. cece otters Soa eat
Pei ged yin. ere eager 156
Memory and Cranial Injury... 314
In Relation to Epilepsy... 233
Loss of in Alcoholism..... 252
Loss of, in Spinal Concus-
STOW nec hoe Cereal ttice 370
Men; Hysteriatin scccmocran's 196
Meningitis and Concussion.... 309
and Cranial Injuries...... 312
Mental Condition of Epileptics. 223
State in Alcoholism....... 249
Monomania sow ssa ees. ate Saco
Mutilatron se arcc aes 6 te Saeeckp
Myelitis from Compression.... 348
Nocturnal Epilepsy. ........+. 232
Notoriety Love of, by Suicides. 291
The Desire for....,... Hen FOP
Nymphomaniay <2. cisoees « <
Ocular Symptoms of Spinal
Concussion i ae het 364
Old Age and Dementia....... 79
INDEX. Vili
Otitis in Cranial Injuries...... 321
Cirhital WoGldsen <ccccixasadiss 334
Ordronaux on Responsibility... 135
Organic Disease, Hysteria in its
FCO 10.6 oa.e-s4. 09 0'& tae e 197
Page’s Table of Spinal Injuries 375
Pain and Spinal Disease....... 374
in Spinal Injuries....... = 374
POUTROG 6: a5 sig da 46,5.0/8 ee BOD
Paresis, General, Disputed Cases
Glas chs teniesk xh Suetaieicthe s 46
of the Greiey .04,9+60- ae ae
Periods of Remission in.. 46
Paralysis Feigned...... Saws , 209
Partnership, Dissolution of by
Reason of Insanity.. ...... 115
giaveteal Rests. ss 06 ss'se 5-5 70
Poisoning, Suicide by......... 289
Post-Paroxysmal Condition.... 224
Post-Mortem Examination of
PNG IME ARO Sioa hier tacodee «482
Petes) SCASE. occ cucealebe'e we 348
PICMSCHANON. . sreics 60 «ease os 37
Pretended Assaults..... Secee mop
Assaults by Dentists...... 190
Puerperal Insane, Crimes of
PGMS aba aetevemaise Cece atu 43
Pulse ‘Changes in Spinal Con-
BN ioc xtc ws Bu: cues boven 362
Punishability of the Insane... 198
Pyemia and Cranial Injury.... 328
PE PPOUIG Acct s oncfeiaiesiesnccce | 52
Reasonmo Maniasesc.cisesne 76
IRENE, TPUCDSY . 6 beads esses’ 222
Responsibility, American De-
cisions in Regard to...... 134
and Alcoholism......... «v259
RAE: WH si o2'05 wwe ses 102
and Delirium Tremens.... 256
Criminal, of the Deaf and
in Relation to Imbecility.. 130
of Drunkards, Le Grand du
SIIB ORES aiece Mina. 60-62 0 256
“es eee ee 299
of the Deaf and Dumb.... 126
of the Hysterical Subject.. 198
CREATES EN wa ne ade se 2 135
The English Test of,..... £32
Right and Wrong, The Test of 134
Robbery and Chloroform..... - 193
SaEYVIAGIS: om sec heeds case sees. 35
Sclerosis, Postero-Lateral ‘and
Spinal COHCUSSION:, o«. 6 ce0se/357
Sexual Perversion and Cranial
EMjMVES PUI .< dot SURE Shae 309
fhe tiba ned ae UNS. ceee ee 48
Self Inflicted Wounds ........ 217
Self-Mutilation by Hysterical
PARENTS 23 j:6 5 Uae Cb ikce saaceae 185
Simulated Contractures....... 213
Hip Joint Disease........ 201
Simulation of Disease, Hysteri-
GAL sractisic saved afta ee es et EO
Skull; Fracturerofstaigiadses: 306
Injury, Prognosis of...... 334
Penetrating Wounds of... 337
Spasmodic Affections Feigned. 204
Spinal Concwssiem 2 Jo). ese 3952
and) Elystébiae. . st2325%,.3 367
and Hypochondriasis..... 365
and Tiisaniby hy Ris Fhe 369
and lead Paralysiss.....4. 358
and Suits for Damage..... 359
Fatal Cases Of. 4..085 << ec 355
Heigned@ CASGS 7a J:2stes 2 ois 365
Hemoptysis* with.-.)s605 5.2 371
Lighter Horns of... o2...5% 361
Locomotor Ataxia a result
BRS 9 wich ise nche ae aa 357
Loss of Memory in....... 370
Ocular Symptoms of..... 364
Pulse Chiangesrin® wc. . 24. 362
Trophic Changes in...... 354
Spinal Cord, Clot in the... 351
Extravasation in the Mem-
BEAMCS Olive 509) og on BY 6 350
General Anatomy of...... 342
Pacers OF. side ace. 352
Spinal Disease and Pain.. 374
Fracture Complicated with
Diisloestion. ses ade ee 347
Spinal -Dmputies.s.68 cae 342
and Bright’s Disease.... 375
smnel Pass sod cre 6 Heo orneees 374
Localization of..... Panes 343
Page's Tables Of; '. is 0 375
Dislocation with.\.i.. 06-346
POMS OF 0 Je oso oka a eae 345
SMM pene OF fas. oF ais c.«, nce 346
MIPAUING? | vied alien «Gases 371
Spine, Fracture of without Dis-
PiACOMCNl Lee ead v cd os 346
SILOM S65 osc wid ww. a lea etal ea ts 184
Somnambulism and Epilepsy.. 49
Peres slids pales 208
Subiective Symptoms in Cranial
Vili
Injuries 2.110 aces eres
Suicidal Attempts, Persistence of
BVEATALG y opete vtete eteto = oiert ake
by-Drowmng cesses
by -Hangina si). cn. ee
by Men or Women.......
bys Poisoning ss...
Deliberate Preparations...
Direction of the Wound in
Distinguished from Homi-
CLAGTES sy de wade trees eke te
Multiple Ace Macnee
Number of Woundsin....
or Homicide, Post Mortem
Determination of.......
Pretended, and Hysteria. .
Pre-existing Disease in...
and Love of Notoriety....
Contusions in..... Siete os
Modes of Deathvin =<...
Responsibility2Ot 9 s-6
Wounds Inflicted by....,.
fardieu's. Formulas. 0.04 sss
ACIS < se Gallvse earths. + eetwte 6
Testamentary Capacity..... =
INDEX.
303 and. Epilepsyst asco east 227
36 Eccentricity in Relation to go
oe in. Alcoholisinec fas aeste ce ply
278 | Test of a Disposing Mind..... 80
279 of Responsibility, the Eng-
275 Lishive gunn CE Sat ae 132
284 of Right and Wrong.,.... 134
290 of Feigned Unconscious-.
291 TESS pats cet a ase eee 207
280 ce gal rl atias 4 estore enero ye 61
284 Phiysicales ace. eemectoe 70
280 | Theft, Insanity in Relation to. 142
280 Wl" Uva nCe cutee tareteaausts tates see 207
280 Alcoholi¢uus acute ire oe 252
270 >| -Traumatic= Epilepsy t.s. + sss 221
ANiCKS Of; CONNSE! Sint scien cee 71
277 | Unconsciousness, Feigned..... 204
200 4 Undue In fitence 22h tear 96
283 in Relation to Crime.... 100
280 | Viciousness, Congenital....... 24
277 | Voisin on the Sphygmograph
and mip epsy. 12 5. t eee 240
B3O" | Walt Ze C ase a eae mite ateinieteeicte 163
134 A> Walworth Casese bev. tacsice 236
290° | Weak. Mindednesss 20.50.50. </.1-1. 24
2or 4 Whittakert Casey ares ices ceser 205
279 | Wounds, Bullet and _ their
275 Results sacs caecee secs oe 335
299 Orbitalyicnols te eae 334
276 Penetrating of the Skull... 337
69 Possible Method of Inflic-
72 tion asetcte eres A AOS 338
79 eli: Inilicted Scici6. etemelemnc ey,
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