Insanity in its medico-legal relations. / By A. C. Cowperthwait. / Title Contents
Insanity in its medico-legal relations. / By A. C. Cowperthwait.
Cowperthwaite, A. C. (Allen Corson), 1848-1926.
Philadelphia,: J. M. Stoddart & co., 1876.
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CRIMINAL RESPONSIBILITY OF THE INSANE,
EPILEPTIC INSANITY, 0..
TREATMENT OF THE INSANE, 0.
IN presenting these pages to the public, the author
does not flatter himself by thinking that he is bringing forward any strikingly new or original ideas in regard
to insanity; on the contrary, he has endeavored to incorporate, in as little space as possible, the ideas and observations of those who have already become eminent as alienist
physicians, with a somewhat extended experience of his
own, and thus to produce a work, which, while it may be
very brief, will contain those essentia
thorough knowledge of the whole of mental pathology,
and how greatly to be regretted, is the wide spread professional apathy and ignorance concerning it.
In the language of a recent writer: " Were the vast
array of incipient lunatics, who mingle unrecognized
among our large population, to be suddenly discovered,
the shock upon the community would be profound.
Nevertheless, it would be wholesome. If the world clearly
understood how much of the eccentricity and the moral
for those who are unequivocally insane, but also for those,
none the less unfortunate ones, who inhabit the borderland between mental health and mental disease, my object
will have been fully attained.
I desire to acknowledge my indebtedness to the following excellent works, which have assisted me in the prepar
ation of these pages, and without which no physician's
library is complete: "The Physiology and Pathology of
the Mind," by H. Maudsley, M.D.; also " Responsibility
The position of the medical man when called upon to
testify in an obscure case of mental disease, though an
unenviable one, is, nevertheless, one of the most important
and honorable in which it is possible for him to be placed.
Even in this enlightened day there are those who sneer
at the idea of calling a physician to decide the question of
insanity. A person in order to be insane, in their estimation, must either be a raging maniac, or, at least, be laboring
Then, as now, it must be the first duty of the medical
man to uphold the truth against error, even though he
thereby becomes a target for the rash and unjust censures
of an ignorant multitude. "A wretch foredoomed to insanity by mal-organization or hereditary defed," observes
Connolly, " or driven mad by poverty, or by disappointment a&ing on a distempered brain, has no other friends
in the world. The same courage which causes the physician to brave the dangers of pest
was one of faa to be determined by the jury on evidence.
Experts may testify to the conditions of mental disease as
they could not if such indications were matters of law."
Judge Doe further observes that legal tests of responsibility
have always been derived from medical authorities, who
profess to have founded their opinions on the observation
of fads. They are virtually the dida of medical men,
of experts-conflicting and liable to grow obsolete; and,
court for information, that necessity is now fully obviated by
the services of counsel and the testimony of experts. If
courts, instead of charging the jury to acquit the prisoner,
if they find he was unable to distinguish right from wrong,
or knew not that he was committing an unlawful ad, etc.,
should merely dired them to acquit if they believe the
criminal ad to have been the offspring of disease, it can
scarcely be questioned that much disatissfadion would be
2. He should be entirely independent, not allowing
himself to be too cordial with the counsel by whom he has
been called and for whose purposes, it is expeced that
his testimony will be of value.
3. He should never, from a dread of being thought ignorant of his profession, permit to be drawn from him a positive
and unqualified reply, when a modest doubt would better
express the extent of his knowledge; neither should he
ever give an opinion without mature consider
Pathology of Insanity.
may be given; but it should be borne in mind that it is the
whole evidence upon which an opinion is to be founded;
and, if that evidence is contradictory or deficient, the witness will best consult his own reputation, and promote the
ends of justice by candidly stating the fat.
Insanity, unquestionably arises from a morbid ation of
the brain, and is only a symptom of disease of that organ.
For this reason it is not a proper object for definiti
Pathology of Insanity.
veloped energy of nerve cell; but whatever be the real nature of the mind, it is most certainly dependent for its
every manifestation on the brain and nervous system.
It is interesting to note the intimate physiological relationship existing between the brain and other portions of the
nervous system, which indudively leads to the assumption
that the latter plays no small part in the creation of cerebral
manifestations, and that they hold within themselves, an import
Pathology of Insanity.
As we ascend in the mammalia, the hemispheres gradually enlarge backwards, and in the Ruminantia and Pachydermata slight traces of convolutions are found, which
become more fully developed in the Carnivora, and complete
in the apes and in man. The longer, more numerous and
complicated are these convolutions, the greater will be the
degree of intelligence, all other things being equal, and, as
these cerebral developments gradually ascend, with a correspondingly gradu
Pathology of Insanity.
specific function to perform in cerebral manifestations. It
is only by the acceptation and application of these physiological fats that we may safely proceed to investigate the
pathological conditions of mental force, and hold true ideas
as to the relations existing between the mind and nervous
system. What constitutes the mind, or the relations that
it holds to the body, whether material or spiritual, can
never be satisfatorily answered from a metaphysical rather
Pathology of Insanity.
immaterial principle. Yet we find that in diseases of other
organs, pathological changes are also often absent, though
the presence of atual disease in these cases is not questioned. Because no pathological changes are found, is no
sign that nerve element does not subserve mental funtion.
We know comparatively nothing of the intimate constitution of nerve element, for the reason that it has so far baffled human investigation, yet, because we do not see the
Pathology of Insanity.
quirements to give an opinion, are those who are most
certain of the invariable existence of organic change. It
is known that when a morbid poison a&s with its greatest
intensity, there are fewer traces of organic alteration of
structure found, than when the disorder has been of a
milder character; and so likewise, organic change of nerve
element in insanity, appreciable by the means of investigation which we now possess, may justly be expeted, only
when the degene
Pathology of Insanity.
sometimes approaching insiduously, at other times breaking out without any warning; its development presents
nothing strikingly peculiar, as it merges into its most dangerous form; neither does its termination in death or resolution, either suddenly or gradually, present any remarkable features, different from the same in other diseases.
Sometimes proceeding through successive stages to the
end with increasing severity, or interrupted by intervals of
a longer or sh
Insanlty.- Ciassifica lion. 2
out by the individual, although his intellect and his emotions are strongly exerted against it. Thus a person who
previously has not exhibited any very obvious symptoms
of mental derangement-though a careful inquiry will
invariably show that slight evidences of cerebral disease
have been present for some days-instantaneously feels a
morbid impulse to commit a murder or perpetrate some
other criminal act, and is forced to yield, notwithstanding
pleases him, and especially is he inclined to wander from
place to place, hoping for relief. He soon complains of
fullness in the head; he becomes exceedingly morose and
irritable, and his ideas seem strangely confused. His digestive functions become deranged; his kidneys do not adt
properly; the circulation and nutrition are interfered with;
he is not able to sleep at all; or, if he does catch a few
moments sleep, it is filled with agitating dreams; illusions
over the moral sentiments and a(ions, which are often
immoral and shamefully indecent. The patient becomes
eccentric and whimsical to an astonishing degree, and
finally delusions of an endless variety, and of the most
extravagant nature supervene, and rapidly succeed each
other. Simultaneous with these symptoms, or following
closely in their train, there commences an insiduously advancing paralysis. This is first noticed in the indistin&i
articulation, from paralysis
its victims mostly from the higher walks of life, confining
itself almost exclusively to the male population, and
scarcely ever occurring except between the ages of thirty
and sixty. It seems to arise mostly from alcoholic or
sexual excesses, or from severe and prolonged mental activity. Its duration is variable, lasting from a few months
to three or four years, or even longer; but whether progressing fast or slow, it is ever downwards, and, in most
three more acute attacks of derangement, these resembled
in character those that occur in early life rather than such
as are usually met with in adults. Between this mild form
of mental weakness at one end of the scale, and the extremest examples of dementia, in which mental power is
almost obliterated, at the other end, there are met with in
pra&ice, cases marking every shade of the gradation."
Every sort of delusion may be present, and an endless
variety of strange
it is often difficult to determine whether the morbid mental condition is the dire&Et result of a diseased brain, or
whether it is but the natural result of the existing predisposition. Dissipation may result in a morbid, demoralized
mental condition, manifesting itself through immoral conduct, obscene language, blunted feelings and degraded
desires. Sadness and depression of the mind may be
the natural result of natural causes. Family bereavement, business losses,
told, and which may be all true. If, after so doing, the information of the family is not considered reliable, the physician should not hesitate to inquire prudently and cautiously of.the neighbors and acquaintances of the family,
in order to become thoroughly satisfied as to the hereditary predisposition and previous attacks, which are two
most important diagnostic points.
The hereditary transmission of all forms of nervous disease, is an accepted fact, and though t
motor nerve centres, giving an entirely new train of symptoms. Several cases are recorded in which there was an
alternation between epilepsy and insanity, or chorea and
insanity, the one giving place to the other at more or less
regular intervals. Violent paroxysms of neuralgia have
subsided at the outburst of mania, and again returned as
the latter passed away. These observations not only show
the kinship existing between insanity and nervous diseases,
but robs the for
the sober man becomes disappointed, the prudent man rash
and extravagant, the moral or religious man dissolute, the
modest woman shamefully indecent, there can be little
question of the presence of cerebral disease; yet, as previously remarked, search should be made for any predisposing causes that might operate in a natural way to
produce these changes. They are but a lack of control
over the affective and intelle&tual faculties, which are by
nature depraved, and w
sume a quiet indifference, though it must be done in a
natural manner, or the unfitting mask will at once excite
the patient's suspicions. While, to all appearances indifferently conversing on the most foreign topics, the observing physician may study the physiognomy and gestures of
the patient, and find in them much valuable aid; the eccentricity of dress, from mere disorder to total nudity, or
absurd peculiarities of arrangement in shape or color, so
quiry on these and similar subjects, he certainly cannot
be the subject of mania; and if he has any delusions, he
must either retain the power of hiding them, or they must
exist in some obscure corner of the brain, from which they
are little likely to influence, with any force, the opinions,
the feelings, or the conduc."-Bucknill.
It sometimes becomes necessary to distinguish between
insanity and some other form of cerebral affection, which
is usually a matter of but
36 Insanity.- Criminal Responsibility of the Insane.
he may adopt the hint. The history of the case, and especially of the mode of occurrence of the disease, and of
the circumstance of its development, will most materially
aid the diagnosis. If there be no previous history to be
had, and if the patient refuse to converse, a long observation may be necessary to come to a decision. When a
man feigns madness so perfe~tly as to deceive an experienced observer, we may hold, I think, that he is not f
Insanity.-Criminal Responsibility of Insane. 37
of nervous communication unites in harmony man's whole
being, and, while the fun~lions of the brain are specially
connected with the mind, there is not an organ or tissue
in the body that does not bear a direct influence
upon that organ. Man, born with this higher principle of
mind or soul, giving him intellea and reason, and placing
him in the highest scale of animal creation, is destitute of
many of those instinaive faculties which belong to th
38 Insanity.-Criminal Responsibility of Insane.
possessed of a mean defective intellect, they are true moral
In proportion with this congenital weakness of the mind,
do we find, also, a physical degeneration, which may manifest itself in congenital deformity, scrofula or neurosis,
but which, in every case, leaves the impress of a low physical and mental capacity upon the physiognomy, constituting a family likeness by which they are distinctively
marked off from the balance of manki
Insanity.--Criminal Responsibility of Insane. 39
cerebral degeneracy until he passes the invisible line of
transition, and is diseased. During this evolution, he occupies the border land between crime and insanity, " near
one boundary of which," says Maudsley, " we meet with
something of madness, but more of sin, and near the other
boundary of which, something of sin, but more of madness. A just estimate of the moral responsibility of the
unhappy people inhabiting this border land, will assure
40 Insanity.-Criminal Responsibility of Insane.
In fact, as we look back over the various and conflicting
tests of responsibility that have been conceived and abandoned during the past century, we cannotbut admitthat they
are all unreliable, and that a real and positive test of responsibility-one that may be relied upon in every case, will
never be established. The only just test is " the inability
to control the action of the mind," and properly speaking,
this is no test at all, being only a
Insanity.--Criminal Responsibility of Insane. 41
Lane Theatre, in which he said: "I am bound to admit
that there is a wide distinction between civil and criminal
cases. If in the former a man appears, upon the evidence,
to be non compos inentis, the law avoids his act, though it
cannot be traced or connected with the morbid imagination, which constitutes his disease, and which may be extremely partial in its influence upon conduct; but to deliver
a man from responsibility for crimes, above all
42 Insanity.--Criminal Responsibility of Insane.
the mind commands them to sacrifice the lives of that family for some insane or delusive reason. As, for instance,
the case reported by Mittermaier, when he enquired of a
man in an asylum, who had killed his father, if he did not
know that parricide is a crime severely punished. "I know
it very well," he replied, "but God having sent me into
the world to punish great sinners, of whom my father was
one, I killed him according to the divine comma
Insanity.-Criminal Responsibility of Insane. 43
The individual may know the act to be contrary to law
and yet think the peculiar circumstances justify him in disregarding the law. He may think it is legally as well as
morally right to revenge some supposed defamation of
character, or injury to fortune, by taking the life of the
After the acquittal of McNaughton for the murder of
Drummond, in 1843, on the plea of insanity, the House of
Lords, evidently sympathizing with an ignor
44 Insaniiy.-Crimina/ Responsihility of Insane.
that were injuring his character, and destroying his peace,
which, had such been real, would not have justified the
crime of murder; Lord Denman, also, approved the acquittal of Oxford, who shot at the Queen because he supposed that killing the Queen was necessary in order to
accomplish a certain great benefit to the public.
" Such a remarkable doctrine as this," observed Ray,
"can have sprung only from the most deplorable ignorance of the menta
Insanity.-Criminal Responsibility of Insane. 45
In the case of State v. Jones, tried in the New Hampshire courts, judge Ladd commented upon this doctrine of
the English, judges as follows:'
"The doctrine thus promulgated as law has found its
way into the'text books, and has doubtless been largely
received as the enunciation of a sound legal problem since
that day. Yet it is probable that no ingenious student of
the law has ever read it for the first time without being
shocked by its exquisite
46 Insanity.-Criminal Responsibility of Insane.
when that is done, when it is certainly known that such a
case has arisen, the rule may be applied without punishing
a man for disease.... But it is a rule which can
safely be applied in practice, that we are seeking; and to
say that an act which grows wholly out of an insane belief that some great wrong has been inflicted, is at the
same time produced by a spirit of revenge springing from
some portion or corner of the mind that has not been rea
Insanity.-Criminal Responsibility of Insane. 47
shire) " if the killing was the offspring of mental disease
in the defendant; that neither delusion or knowledge of
right and wrong, nor design or cunning in planning and,executing the killing, and in escaping or avoiding detection, nor ability to recognize acquaintance, or to labor., or
to transact business or manage affairs, is, as a matter of
law, a test of mental disease; but that all symptoms and
all tests of mental disease are purely matter
48 Insanity.- Criminal Responsibility of Insane.
dloctors in the medical profession, that if the man has the least
taint of insanity entering into his mental structure, it discharges him from all responsibility to law. This is a monstrous doctrine, to which may be traced the fruitfulness ofcrime, and the immunity which have attended them in different parts of our country..........Did the
accused act in the matter from thought and design, and
understand right from wrong? Did he, by seeking co
Insanity.- Criminal Responsibility of Insane. 49
ist, or if existing, it is not inuch manifest, and has not
to all external appearances influenced the act, then it is
held that he should be responsible. Even further does socalled justice go; for, if the person has a most frightful
delusion, but it cannot be known that the crime is a direct
result of that delusion, then he must be responsible. With
a delusion to prove in general a diseased mind, who can
say there are not other delusions reignin
50 Insanity.-Criminal Responsibility of Insane.
not the disease," says Maudsley, " it is only the striking
symptom of the disease, and it is certain that the criminal
act may be the manifestation of the disease of which the
delusion is a symptom, and that no connection between
them may be detected by the looker-on, notwithstanding
the existence of a real pathological condition." The
courts of justice should not strive to trace a connection
between the delusion and the crime, both of which ar
Insanity.- Criminal Responsibility of Insane. 51
person can for a long time simulate sanity, when it is to
their interest to do so, there can be no doubt, and this fact
is used as an argument that the same strength of will by
which he thus controls his insane actions should make
him fully responsible for the act which he so cunningly
plans and consummates, knowing it all the time to be a
crime. It must be realized that this is all the result of
a diseased brain, and that it is not the individu
52 Insanity.- Criminal Responsibility of Insane.
wrong in the particular instance-should contrive the
means of murder, do it deliberately, and endeavor to escape
the consequences afterwards.' '-Maudsley.
Wharton & Stille relate the following case, which is a
striking example of the cool and daring cunning of insanity, and of the sense of responsibility that may accompany
"'A man named John Billman, who had been sent to
the Eastern Penitentiary of Pennsylvania for horse-stealing, murdered
]nsniy.CrmialReponsibility of Insane. 53
under circumstances which he detailed with great minuteness and zest. Inquiries were instituted, and it was found
that he had told the truth. The father had been found
strangled in his bed, the son had been arrested for the
crime, but so artfully had he contrived the homicide that
he had been acquitted by means of an alibi got up by
means of a rapid ride at midnight, and a feigned sleep in
a chamber, into which he had clambered by the wvindow.
54 Insanity.- Criminal Responsibility of Insane.
impulsive character of its paroxysms, becomes a most dangerous form of mental disease. It consists in an insane
impulse, acting upon a diseased mind, and which the latter
has not the power to resist. This impulse is usually either
of a suicidal or homicidal nature;. but it is those cases in
which develop the latter form, that most frequently demand
the attention of the expert.
It is surprising, how long a person possessed of a neurotic temperam