the cavities filled with serum, probably due to his mode of death; but this passive venous engorgement has been absent as present in several post-mortems of such cases.

The thoracic cavity:-lungs, both the seat of extensive tubercular degeneration, remains of old adhesions in the pleure -heart enlarged.

Abdominal cavity:-liver normal-mesenteric glands tuberculous stomach and intestines congested-spleen congested and enlarged-kidneys both the seat of chronic interstitial nephritis the peripheral blood vessels generally degenerated. The blood making, purifying and circulatory organs generally, except the liver, were all in an advanced stage of disease; so that for months and possibly years the nutrition of the nervous system must have been much impaired, so that the higher centers, those that give expression to the mental manifestations could not possibly have performed their functions properly. The important part of the nervous system that regulates the supply of blood to these centers being impaired, there must have been a very variable condition of these centers-now supplied with too little blood-now supplied with too much blood-their functional manifestations must have exhibited just such a cyclical history as was present in the case.

Such was the extent of the disease in these important organs, that a little patience on the part of the commonwealth (a few months only) would have placed his exit from the world in the hands of a higher power than that of the court which tried him.

In closing his admirable paper, Dr. Hughes says that the insane, like the sane, though on the whole more truthful than the latter, are not always altogether what they seem. In acting out their real psychic impulses, they are sometimes more crazy than they appear, and sometimes appear more sane than they really are. We have generally to scrutinize the insane character closely to comprehend it.

Esquirol, remarking on the value of constant observation in order to become familiar with the subject, expresses very nearly the truth we must live with them to fully know them. Simulation of insanity may extend in action beyond actual

psychical effect or result of disease of the brain, just as disease of the stomach, lungs or other organs may effect in a greater or less degree all healthy function. Only death obliterates and destroys function, while disease, short of death modifies and perverts organic activity.

Is there anything in the nature of insanity as we recognize its different forms, incompatible with simulation? I think not, except it be in proving an advanced general mania and dementia. And from this cursory survey of the field, which grows wider as we survey it, I conclude that it is not only not impossible for the insane to simulate insanity for a purpose in any but its graver forms of proven general mental involvement, but that they do sometimes actually simulate acts and forms of insanity for which there exists no pathological warrant that can be discovered in the real disease by which they are affected.

In conclusion then, it is necessary for the medical expert, not only to show that a given case is one of simulation, but he must show that it is not simulation of insanity of the insane.

INSANE SUICIDE, INSANE HOMICIDE,
OR MURDER, WHICH?

BY JAS. G. KIERNAN, LATE OF THE WARD'S ISLAND, AND COOK COUNTY INSANE HOSPITALS.

The dramatis persona in the tragedy I am about to analyze were thus: One was an intemperate Scandinavian of American stock, who had committed crime under somewhat extenuating circumstances, and, being friendless was railroaded to the penitentiary in short order, thereby impoverishing his mother, who became a pauper after a life of laborious toil. She was a cleanly, thrifty person, destitute of pauper characteristics. The other person was a man whose mother had been insane before his birth and had so remained for thirty years thereafter.

He also had a paternal cousin who was insane with an hereditary type of insanity.

The alleged homicide had been sent to the penitentiary under the following circumstances: He had been robbed in a low boarding-house during the night by his room-mate, who disappeared. He found a pair of trousers containing a watch, which he seized upon. The landlady claimed it, he disputing her claim on the ground that he was entitled to keep it since he had been robbed. On his trial he insisted on pleading guilty of taking the watch as a return for his money which had been stolen. He treated the judge and jury with insolent indifference and was speedily adjudged guilty and sent to the penitentiary. His mental condition here is said to have been normal, but as ten congenital lunatics who attempted or succeeded in committing suicide were regarded as sane up to their attempts, the alienist expertness of the penitentiary officials was to be left out of consideration, more especially as the prison physicians were shown on cross-examination to be destitute of the most ordinary knowledge of anatomy, having been appointed chiefly for secret society and political

reasons.

My own examination of the accused resulted as follows: He had one or two fits indicating epilepsy, when about 15 or 16 years old. On one occasion he started for bed, but immediately turned and ran down stairs and fell insensible at the foot of the stairs in a fit. After he came to his senses in about 15 minutes, he was frightened. Two weeks later he thought he saw'a man at the head of the stairs when he started to bed; he turned, frightened, and would not go up for some time. With these exceptions there was nothing strange about his actions observed except that he was irritable. He lived with his parents (who were ignorant people) and worked in iron.

At my examination the epileptic pallor was well marked; the sides of the head were more than normally different, the pupils were dilated and morbid. There was greater sensitiveness on one side than on the other.

I found on one examination, little peculiar marks, trifling bits, on the base of the neck, which were unmistakable signs

that he had just got over an epileptic attack. He evidently had had one during the night. His conversation at one examination was peculiar. He had erratic religious notions, holding that the devil alone was responsible for the acts of the world. He used as an argument in favor of that, "Let not your right hand know what your left hand doeth," which seemed a very strong point with him. He said he was not a crank and would not be made out a crank.

Dr. Hosmer discovered many of these phenomena and also the hallucinatory delusions of the prisoner that rats brought him messages from the devil. Drs. Alexander, Curtis, and Oakes testified to having observed about the same facts, as did also Dr. S. V. Clevenger.

The significance of the tirade and convulsive phenomena just described may be judged from the fact pointed out by Forbes Winslow and others, that the premonitory symptoms of the fit are generally accompanied by terror. A child subject to epilepsy, for several hours before the attack rushes about the house in great terror. The peculiar pupils are regarded by the leading authorities as characteristic of epilepsy. The diagnosis of epilepsy is certain if peletchiæ be found. This is a symptom not to be premised and characterized. The asymmetry of the skull is also confirmatory of the diagnosis, as well as the lack of sensation, and the other symptoms mentioned.

The phenomena of epilepsy are as follows: There are two phases of epilepsy. In one case the loss of consciousness is of greater duration than in the other. One is called grand mal, or greater evil. The other is called petit mal, or the little evil.

Very few people would notice an attack of petit mal. The man might be sitting playing cards. Suddenly his pupils would dilate, his hands might drop. The cards might drop out of his hands, he would grow pale, then all would be over. He might pick up his cards and go on perfectly unconscious of the attack. He will still perform seemingly conscious and sensible acts; without knowing it might repeat something long passed. Petit mal is the most dangerous type of the disease. The attack is very sudden and leaves in the same way. As a rule an epileptic knows nothing of what he does during a

seizure, but has been totally unconscious. Insanity is likely to precede, take the place of, or succeed a fit. The insanity is especially likely to be of the mild types.

When epileptics are violent, they are extremely so; are most destructive and commit the most atrocious crimes. One epileptic chopped a man to pieces. No one had noticed but that he was all right, except a little foolish once in a while until after he had committed the act, when they found out he was an epileptic. An unsuspected epileptic mother chopped the head and arm and one leg off her child and when she came to was overcome with grief to find her child so mutilated. Another unsuspected epileptic woman baked her baby in a pan unconsciously. Excessive religious excitement, and unconscious praying is at times a marked symptom of epilepsy. An epileptic could seemingly have a plan and execute it.

Many cases of unsuspected epilepsy are brought to the asylums which evince no symptoms, and their epilepsy is first discovered by the physician, although by their surroundings they were not suspected of being epileptics. The German authorities state that a large proportion of criminal lunatics are epileptics, but never suspected of being such till after the commission of some crime. Epileptics often pass through life without any suspicion of epilepsy; being looked upon merely as a little foolish. When an act is done they know nothing of it, often saying "I've been asleep," or "I didn't know it." An epileptic is generally one of the most unfeeling and selfish of patients, and between the violent attacks may seem a little irritable but work on without attracting any attention. Epilepsy is more apt to show itself about the age of puberty. Then it often does not occur for sometime; there may be a long interval between fits.

Of the circumstances attendant on the death of the deceased the best summary is given by Judge Mulkey, rendered in reversing the verdict of the jury, as against the evidence:

"The homicide occurred in cell 310, at Joliet, May 30, 1883. The deceased and accused were cell-mates and occupied the same cell. As the deceased and accused were alone in the cell at the time, it might be assumed as reasonably