A treatise on medical jurisprudence of insanity: containing chapters on imbecility, nervousness, mental deficiency, drunkenness, delirium, and mental diseases in general

Preface

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 theirdisorder, 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 everything 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 therapeutics. Tn general treatises on legal medicine, this branch of it has always received a share of attenal PREFACE.

tion; but the space allotted to it is altogether too limited te 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 America 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. Conolly, late Professor in the London University, is worthy of especial notice in this connexion, for the re-

PREFACE, Vil markable ability and sound judgment with which allits views are conceived and supported. ‘Though not entirely nor chiefly devoted to the legal relations 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 state of a patient’s mind.” In the JupemeEnts of Sir John Nicholl, (contained in Haggard, Phillimore and Addams’s Reports) in the Ecclesiastical Courts, which, in their jurisdiction of wWILLs, 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 Hauptanwendungen auf die Rechtspflege, (Psychology in tts 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 connexion with its legal relations. Jt bears the impress of a philosophical mind, accustomed to observe the mental operations when under the

Vill PREFACE.

influence of disease; it contains a happy analysis of some states of mental impairment, and its doctrines are generally correct, and in many instances in advance of his own, and even 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 too little importance to its connexion with physical causes, and to the classification and description of its different forms by means of which they may be recognised 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 mentales, considérées dans leurs rapports avec la législation 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

PREFACE. ix philosophical views. In his Kxamen médical des proces eriminels des nommés Léger, Feldtman, Lecouffe, (1825), and his Discussion médico-légale sur la Folie, (1826), as well as a sequel to the last, entitled, Nouvelle discussion médico-légale sur la Folie, (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 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 consi-. dered 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 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 estax PREFACE, blish the legal relations of the insane in con- ‘formity 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 recognising 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, well-authenticated facts, and that as such, it was an imperative 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 ground on which those 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 tract of inquiry, it will, at the very least, have been followed by one beneficial result.

Eastport, March, 20th, 1838.

Contents

PRELIMINARY VIEWS e CHAPTER I.

Mental Disease in General . : CHAPTER II.

Idiocy . ‘ ‘ CHAPTER III.

Chapter I. Mental Diseases In General

§ 31. Correct ideas of the pathology of insanity are not unessential to the progress of enlightened views respecting its legal relations. If it be considered as withdrawn from the influence of the common laws of nature, in the production of disease, and attributed to the direct visitation of God ; if the existence of physical changes be overlooked or denied, and we are referred exclusively to some mysterious affection of the immaterial spirit, for its cause; then is it in vain to hope, that such a condition can ever be the object of discriminating, salutary legislation. In the '

prevalence of such views in past times, however, we may look for the cause of much of the error and absurdity, that pervade the law of insanity, and that :

are equally at variance with the principles of science and the dictates of humanity. It is an undoubted truth, that the manifestations of the intellect, and those of the sentiments, propensities and passions, or generally, of the intellectual and affective powers, are connected with and dependent upon the brain. It follows, then, as a corollary, that abnormal conditions of these powers are equally connected with abnormal conditions of the brain; but this is not merely a matter of inference. The dissections of : many eminent observers, among whom it is enough — to mention the names of Greding, Gall and Spurz- — heim, Calmet, Foville, Fabret, Bayle, Esquirol, and Georget, have placed it beyond a doubt; and no pathological fact is better established—though its correctness was for a long while doubted—than that deviations from the healthy structure are generally :

MENTAL DISEASES IN GENERAL. 63

_ presented in the brains of insane subjects. In the few cases, where such appearances have not been observed, it is justly concluded that death took place before the deviation was sufficiently great to be perceptible,—a phenomena, not rare in affections of other organs.

§ 32. These pathological changes are not sufficiently definite to admit of classification, or of practical application in the treatment of the various kinds of insanity. To us they are chiefly valuable, as showing the frequent liability to disease, either from excessive exertion or disuse of its own powers, or from its proneness to be affected by morbid irritations, that radiate from other parts of the body. We learn from them, also, that changes of structure may proceed in the drain, as in other organs, to an incurable degree, without giving rise to much, if any, very perceptible disturbance of its functions, until some striking and unexpected act leads the enlightened physician to Suspect its existence, and draws down upon the unfortunate subject the restraints and penalties of the law. § 38. A natural classification of the various forms of insanity, though of secondary importance in regard to its medical treatment, will be of eminent service to the legal inquirer, by enlarging his notions of its phenomena, and enabling him to discriminate, where discrimination is necessary to the attainment of important ends. The deplorable consequences of knowing but one kind of insanity, and of erecting that into a standard, whereby every other is to be compared and tested, are too common in the records of criminal jurisprudence; and it is time that it were well understood, that the philosophy of such a method is no better than would be that of the physician, who should recognise no diseases of the stomach, for instance, but such as proceed from inflammation, and reject all others as anomalous and unworthy of attention. The various diseases, included in the general term insanity, or mental derangement, may be conveniently arranged under two divisions, founded on two very different conditions of the brain: the first being a want of its ordinary development, and the second, some lesion of its structure subsequent to its development. In the former of these divisions, we have rprocy and 1MBEcILITY, differing from each other only in degree. The various affections, embraced in the latter general division, may be arranged under two subdivisions, MANIA and DEMENTIA, distinguished by the contrast they present in the energy and tone of the mental manifestations. Maniais characterized by an exaltation of the faculties, and may be confined to the intellectual, or to the affective powers, or it may involve them both, and these powers may be generally or partially deranged. Dementia depends on a more or less complete enfeeblement of the faculties, and may be consecutive to injury of the brain, to -mania, or to some other disease; or it may be connected with the decay of old age. These divisions will be more conveniently exhibited in the following tabular view. ( |

Defective

develop-

ment of

the facul- . ties.

1. Resulting from congenital defect.

development of the faculties, supervening in infancy.

1. Resulting from congenital defect. 2, Resulting from an obstacle to the IMBECILITY,

Iprocy.

supervening in infancy, : 1. General.

Intellectual { B|, Partial.

Lesion : MANIA,

the facul- A 1. General.

ties sub- Affective. {2 Partial.

sequent

to their j a develop- ; mene | Dann ae ae a eae ae

1. Consecutive to mania, or injuries of the brain. 2. Senile, peculiar to old age.

INSANITY. 2S ae Cc

2. Resulting froman obstacle to the development of the faculties, ee eee

MENTAL DISEASES IN GENERAL. 65

§ 34. It is not pretended, that any classification can be rigorously correct; for such divisions have not been made by nature, and cannot be observed in practice. Diseases are naturally associated into some general groups only: but if these be ascertained and brought into view, the great end of classification is accomplished. We shall often find them running into one another, and be puzzled to assign to a particular disease its proper place ; but since such is the order of nature, we must make the most of the good it presents, and remedy its evils in the best manner we can. The above arrangement, with the exception of some slight modifications, is that adopted by Esquirol, and has this advantage over some others, that it preserves the divisions made by nature, and will thus be serviceable to our present purpose, by dissipating some of the false notions, that prevail relative to the nature of insanity.

Chapter II. Idiocy

§ 35. Iviocy is that condition of mind, in which the reflective, and all or a part of the affective powers, are either entirely wanting, or are manifested to the slightest possible extent. As the organic defects, on which idiocy depends, are various in kind and degree, and also as it regards the parts of the brain affected, we should be led to expect, what observation shows — is actually the case, considerable variety in the manifestations of this condition, The individual may — hardly rise to the level of some of the brutes, his — movements being confined to the necessities of the — automatic life; or he may be capable of performing some useful services, of exercising some talent, or of — displaying some of the higher moral sentiments. In short, there is even more diversity, in the characters of the idiotic and imbecile, than in those of the sound, '

and this truth must not be forgotten, if we would avoid the flagrant error of regulating judicial decisions by rules, which, though perfectly correct in regard to one case or set of cases, may be wholly incorrect in regard to others.

The most striking physical trait of idiocy, and one ¥ seldom wanting, is the diminutive size of the head, particularly of the anterior-superior portions, indicating a deficiency of the anterior lobes of the brain. Its circumference, measured immediately over the orbital arch and the most prominent part of the

IDIOCY, 67 occipital bone, is fixed by Gall, whose observations on this subject are entitled to great confidence, at be- ‘tween 114 and 14S inches.* The brain consequently equals that of a new-born infant; that is, about one fourth, one fifth, or one sixth of the cerebral mass of an adult’s, in the full enjoyment of his faculties. The above is the only constant character observed in the heads of idiots;—their forms are as various as those of heads of the ordinary size. When idiocy supervenes in early infancy, the head is sometimes as remarkable for immense size, as in the former case, it is for its diminutiveness. ‘The cause of this enlargement is some kind of morbid action, preventing the development of the cerebral mass and producing serous cysts, immense dropsical effusions, &c. In idiocy the features are irregular ; the forehead low, retreating and narrowed to a point; the eyes are ~ unsteady and often squint ; the lips are thick, and the mouth being kept open, the saliva is suffered to escape, and their spongy gums and defective teeth are displayed; the limbs are crooked, and feeble and - limited in their motions. The senses are very imperfect at best, and often entirely wanting. Many are deaf and dumb, or blind. Many are incapable of perceiving odours, and have so little taste as to show no discrimination in their choice of food, swallowing whatever comes to hand. Their movements are constrained and awkward; they walk badly, easily falling down; and are constantly dropping whatever is placed in their hands. None are able to articulate more than a few words, to which they seem to attach no meaning; while the most of them utter only cries or muttered sounds. Some make known their most important wants by means of signs or

* Sur les Fonctions, p. 329.

sounds, that are intelligible to those who have the care of them. Idiots are generally affected with rickets, epilepsy, scrofula, or paralysis, and their whole physical economy indicates a depraved and defective constitution. Idiocy, as above described, is congenital, or begins at a very early period, and is incurable. Its wretched subjects seldom live beyond their twenty-fifth year, continuing all their lives in the same brutish condition, utterly unchanged by external circumstances, and scarcely indicating the species to which they belong, in their stupid, brutelike countenance, in their dull or glaring eyes, gaping mouth, their wildand hideous laugh, their inarticulate sounds, their obtuse sensations, and utter unconsciousness of social and domestic relations.

§ 36. In reasoning powers, idiots are below the brute. Unable to compare two ideas together, nothing leads them to act but the faint impressions of the moment, and these are often insufficient to induce them to gratify even their instinctive wants. It frequently happens, however, that some one or more of the intellectual faculties, always excepting the reflective, are manifested in more or less perfection. Among the moral sentiments, it is not uncommon to find self-esteem, love of approbation, religious veneration, and benevolence, bearing a prominent part, if not constituting the entire character, and thus producing a slight approximation to humanity. Rush* speaks of one who was remarkable for kindness and affection, and spent his life in acts of benevolence, “though he showed no one mark of reason. Dr, Combe+ saw two, who, though differing much, in other respects, agreed in evincing a strong predilec- —

* Medical Inquiries. + Observations on Mental Derangement, 243.

IDIOCY, 69 tion for religious worship, and for listening to sermons and prayers. Some can recollect names, numbers, or historical facts; some are capable of repeat- _ ing what they have frequently heard; others are able to sing afew airs, and even to play on musical instruments. Gall* saw one at Hamburgh, sixteen years old, who learned names, dates, numbers, history, and repeated them all mechanically, but was destitute of all power of combining and comparing his ideas, and was incapable of being engaged in any employment. Various propensities, such as the sexual feelings, cunning, and destructiveness, they often mani~ fest in an inordinate degree of vigour and activity.

§ 37. In that form of idiocy, called cretinism, which is endemic in the Alps and some other mountainous countries, opportunities of observing its phe- - nomena are offered on a grand scale. The difference in the degrees of this affection has led to its division into three classes, viz., cretinism, semi-cretinism, and cretinism of the third degree. In the first, life seems to be almost entirely automatic; most of its subjects are unable to speak, their senses are dull, if not altogether wanting, and nothing but the most urgent ealls of nature excite their attention. ‘The semicretins show some glimmering of a higher nature ; they note what passes around; they remember simple events; and make use of language to express their wants. They are capable of little else, however, for they have no idea of numbers, and, though taught to repeat certain passages, they learn nothing of their meaning. The actions of those of the third kind indicate a still higher degree of intellect; they havea stronger memory of events, and they learn to read and write, though with scarcely any conception of the

* Sur les Fonctions I, p, 193.

purposes of either. Particular talents are often displayed by them in a very respectable degree. Music, drawing, painting, machinery, &c., have each had its followers, in a humble way, among these cretins. In the construction of some parts of a watch, they are often employed in Geneva, and their work is characterized by neatness. Others have executed drawings of some merit, and some have even studied several languages, in which their acquisitions were by no means insignificant ; while others have even attempted poetry, though succeeding in nothing but the rhyme. Though, in all degrees of idiocy, the intellectual “powers are so deficient as hardly to be recognised, and therefore these distinctions can be of little practieal importance, yet they may serve to teach us how independent of one another are the various moral and intellectual faculties, and lead us to be cautious how we infer the soundness or capacity of the whole mind, from the perfection manifested by one or two of its faculties.

IMBECILITY. via!