A treatise on the medical jurisprudence of insanity

Preface

TO THE FIRST EDITION.

Few, probably, whose attention has not been particularly directed to the subject, are aware how far the condition of the law relative to insanity is behind the present state of our knowledge concerning that disease. While so much has been done, within a comparatively short period, to promote the comfort of the insane, and so much improvement has been effected in the methods of treating their disorder, as to have deprived it of half its terrors, it is both a curious and a melancholy fact, that so little has been accomplished towards regulating their personal and social rights, by more correct and enlightened principles of jurisprudence. While nations are vying with one another in the excellence of their public establishments for the accommodation of this unfortunate class of our fellow men, and physicians are every year publishing some instance of an unexampled proportion of cures, we remain perfectly satisfied with the wisdom of our predecessors in every thing relative to their legal relations. This, no doubt, is mainly the fault of medical men themselves, who have neglected to obtain for the results of their researches, that influence on the law of insanity, which they have exerted on its pathology and therapeu-

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Preface To The First Edition

tics. In general treatises on legal medicine, this branch of it has always received a share of attention ; but the space allotted to it is altogether too limited to admit of those details which can alone be of any really useful service ; and it is one of those branches on which the author is usually the least qualified by his own experience, to throw any additional light. Insanity itself is an affection so obscure and perplexing, and the occasions have now become so frequent and important when its legal relations should be properly understood, that an ampler field of illustration and discussion is required for this purpose, than is afforded by a solitary chapter in works of this description.

Notwithstanding the great prevalence of insanity in Great Britain, and the vast amount of property affected by legal regulations and decisions respecting it, yet the English language does not furnish a single work in which the various forms and degrees of mental derangement are treated in reference to their effect on the rights and duties of man. Dr. Haslam's tract on Medical Jurisprudence as it relates to Insanity (1807), which was republished in this country in 1819 by Dr. Cooper, in a volume of tracts by various English writers on different subjects of medical jurisprudence, though abounding in valuable reflections, is altogether too brief and general, to be of much practical service as a book of reference. Among a few other works more or less directly concerned with this subject, or in which some points of it are particularly touched upon, the Inquiry concerning the Indications of Insanity (1830), by Dr. Qonolly, late Professor in the London University, is worthy of especial notice in this connection, for the remarkable ability and sound judgment with which all its views are conceived and supported. Though not entirely nor chiefly devoted to the legal rela-

PREFACE TO THE FIRST EDITION.

vii tions of the insane, yet the medico-legal student will find his views of insanity enlarged and improved by a careful perusal of it ; and every physician will do well to ponder the suggestions contained in the chapter on the " Duties of medical men when consulted concerning the slate of a patient's mind." In the Judgments of Sir John Nicholl (contained in Haggard, Phillimore, and Addams's Eeports), in the Ecclesiastical Courts, which in their jurisdiction of wills have frequent occasion to inquire into the effect of mental diseases on the powers of the mind, are also to be found, not only some masterly analyses of heterogeneous and conflicting evidence, but an acquaintance with the phenomena of insanity in its various forms, that would be creditable to the practical physician, and an application of it to the case under consideration, that satisfies the most cautious with the correctness of the decision.

In Germany this branch of legal medicine has received a little more attention, and in a work, entitled, Die Psycologie in ihren Havptanwendungen auf die Rechtspflege [Psychology in its chief Applications to the Administration of Justice), by J. C. Hoffbauer, a Doctor of Laws and Professor in the University of Halle, and published in 1809, we had, till quite recently, the only complete and methodical treatise on insanity in connection with its legal relations. It bears the impress of a philosophical mind accustomed to observe the mental operations when under the influence of disease ; it contains a happy analysis of some states of mental impairment ; its doctrines are generally correct, and in many i instances in advance of his own, and even of our time. Hoffbauer, however, not being a practical physician, was less disposed to consider insanity in its pathological than in its psychological relations, and consequently has attached viii

PREFACE TO THE FIRST EDITION.

too little importance to its connection with physical causes, and to the classification and description of its different forms by means of which they may be recognized, and distinguished from one another. It is also too deeply imbued with the peculiar metaphysical subtleties in which his countrymen are so fond of indulging to suit the taste or convenience of the English reader. It has been translated into French by Dr. Chambeyron, with many valuable notes by Esquirol and Itard.

In France, M. Georget has cultivated this field of inquiry with a success proportioned to his indefatigable zeal and diligence; and his various writings will ever be resorted to by future inquirers, as they have been by the author of the present work, as to a fund of original and interesting information. Having long been devoted to the study of insanity, and especially to the observation of the manners and character of the insane, he was peculiarly well qualified to treat this subject in a spirit corresponding to the present condition of the science. His work entitled, Des Maladies meniales considerees dans leurs rapports avec la legislation civile et criminelle (1827), is an admirable manual, and though but a humble brochure, it yet abounds with valuable information, and is pervaded by sound and philosophical views. . In his Examen medical des proces criminels des nommes Feldtman, Legcr, Lecovffe (1825), and his Discussion mtklico-lcgale, sur la Folic (1826), as well as a sequel to the last, entitled, Nouvelle discussion medico-legalc sur la Folic (1828), he has collected accounts of numerous criminal trials in which insanity was pleaded in defence of the accused, and has taken the occasion to discuss the many important questions to which they give rise. In the course of these discussions there is scarcely a dark or disputed point in the whole range

PREFACE TO THE FIRST EDITION.

ix of the subject, which he has not examined with great ability ; and if he has not always settled them satisfactorily to the unprejudiced inquirer, he has at least afforded him the means of forming more clear and definite views.

On becoming aware of the deficiency in our medical literature, of works on insanity considered exclusively in its legal relations, it was the author's first thought to make a translation, either of Hoffbauer's or Georget's work, but considering that the numerous notes which would be required in order to bring it up to the present state of the science, and adapt it to our own laws, would prove inconvenient and embarrassing to the reader, besides not fully accomplishing the object, he was induced to abandon this project, and, as

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the only means of fairly developing the subject, to prepare an original work, — original, strictly in plan and in many of its general views only, — for the materials have been necessarily drawn, in a great degree, from other sources than the author's own experience. The main object which he proposed to himself was, to establish the legal relations of the insane in conformity to the present state of our knowledge respecting their disease. In furtherance of this object, he has given a succinct description of the different species of insanity, and the characters by which they are distinguished from one another, so that the professional student may have some means of recognizing them in practice ; and thence deducing, in regard to each, such legal consequences as seem warranted by a humane and enlightened consideration of all the facts. He is well aware that he has presented some views that will not, at first sight, meet with the cordial assent of all his readers. He can only say in justification, that they have appeared to him to be founded on well-observed, wellauthenticated fact's, and that as such, it was an imperative

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PREFACE TO THE FIRST EDITION.

duty required by the claims of humanity and truth, to present them in the strongest possible aspect. Before being condemned for substituting visionary and speculative fancies, in the place of those maxims and practices which have come down to us on the authority of our ancestors, and been sanctioned by the approval of all succeeding times, he hopes that the grounds on which these alleged fancies have been built, will be carefully, candidly, and dispassionately examined. Of the manifold imperfections of his work, no one can be more sensible than the author himself; but if it succeed in directing attention to the subject and putting others on the track of inquiry, it will, at the very least, have been followed by one beneficial result.

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PREFACE

TO THE FOURTH EDITION.

Since the first edition of this work was published, no part of Medical Jurisprudence has received so much attention, in one way or another, as that which relates to Insanity. During that period have appeared several works especially devoted to it, among which that of our own countrymen, Wharton and Stille, possesses superior merits, while the cases in which it has been discussed in English and American courts, greatly outnumber the whole amount of those which had been previously recorded. In preparing the present edition of this work, however, it has formed no part of my purpose to notice all, or a considerable number of such cases, but I have rather sought, by means of some additions prudently made, to indicate the progress of the science, to supply important omissions, and to place some views in a stronger light. I take the opportunity to state, that an increased practical acquaintance with the subject, while it has occasionally led me to more precision and accuracy of statement, has not weakened my belief in those doctrines which have been regarded as peculiar to this work. On the contrary, every year's experience has only strengthened the conviction, that much of the common law relative to insanity, whatever other support it may have, has no foundation in the facts of science.

Providence, March 1, 1860.

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