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20, the pulse 64; impaired coördination, with to and otherwise trying to arouse her, he rea feeling of wretchedness and a copious perspi- ceived no reply, but, upon turning up the ration."
light, he noticed that she was lying in a On one occasion, and in the case of melan- cramped position, with her knees drawn cholia before referred to, the patient was ordered towards the chin, and that she had convulsions. oth of a grain of the hydrochlorate at bed- When I reached her bedside, I noticed chotime, which was followed by the Thoth within reaic movements, or convulsions, resembling an hour. The reason for this was from the those produced by strychnia; these movements fact that she was more excited during the day would last about three minutes, and recur at than usual, which excitement was due to the short intervals, but they were unlike those of appearance of her monthly flow. The both was strychnia in not being excited by touching or given at 10 o'clock P.M., her usual bedtime, pinching the patient. The pupils were widely but, as she could not be persuaded to go to bed, and fully dilated, the pulse 72 and compreson account of the fears she had of sudden death, sible, the respiration 14. I do not know the saying if she did go to sleep she would never temperature, as I did not have a thermometer awake again, and, as she continued to persis- with me, but the extremities felt cold to the tently walk her apartments and thus fight off touch. There was a complete loss of voice. sleep, I thought it best to give her an addi- The convulsions had disappeared within an tional dose of a īžoth, providing it was neces- hour, and I was enabled to tell, by holding sary.
my ear close to her mouth, some few things she Some time after taking the first dose she became said, such as “ water.” After the convulsions quieter, and when the hour had expired she was had disappeared and the voice had become in bed, but awake. The tioth was given, and more distinct, there were illusions and hallucinashe was soon in the arms of Morpheus. About 3 tions. The muscular system was in a complete o'clock in the morning the family was aroused state of paresis; but, while all these alarming by a noise below, and upon going down stairs symptoms were present, the heart remained the patient was found staggering about the room steady, there was no alteration in its rhythm, no much after the fashion of a man who has just intermission whatever, either half or complete, arrived from his club, and is trying to make as and the respiration was but very little lowered. much quiet noise as possible. I was sent for, The faculty of comprehension, although imand upon examining the patient found her paired, was sufficiently preserved to compretemperature normal, pulse 76, respiration I did hend the meaning of a request. Again, she not take, pupils dilated. The voice was not could be aroused with but very little effort. On hoarse, but articulation was impaired; there the following morning she was able to walk was impaired coördination, in fact, her whole about her room, and by the time the evening general appearance and actions were those of a hour had arrived all signs of the drug had gone. drunken man. This condition was not fol
fol- Now, in summing up the physiological aclowed by any perspiration, as far as I was able tions of the drug as studied from the cases mento ascertain from the statement of the patient, tioned, we have a remedial agent, which, when and likewise that of her mother. I had her taken in small doses and dissolved in water, returned to bed, and within ten minutes she makes very little, if any, impression on the was asleep again, and continued so to remain sense of taste. It diffuses into the blood with until 8 o'clock the next morning, when all rapidity, causing at first a slight increase in the the effects of the drug had disappeared, except pulse rate and respiratory movement, the respithe dilated pupils, which also had gone by 2 ration being increased in greater proportion o'clock in the afternoon.
than that of the pulse. Another female patient of the melancholic There is a feeling of warmth, a glow, which type, who was unable to sleep, took by mistake is caused, no doubt, by a greater amount of on her part, the 36th of a grain. The dose oxygen being taken into the lungs by the inwas taken about 11 o'clock P.M. She con- creased respiratory movement. There is a versed with her husband for awhile and then sparingly increased flow of saliva, with a feelfell asleep. At or near twelve o'clock the hus- ing of well-being. This is the stage of exciteband was aroused from his slumbers by her ment, and, after it has passed, the pulse and reshead falling upon his face, and upon speaking piration are normal again. The pupils, how
ever, remain dilated by its action upon the sym- | being the best drug to use in the insomnia of pathetic, which nerves pass through the oph- insanity, but I have received good results from thalmic ganglia to the ciliary muscles and its use in sleeplessness, no matter from what axis. Its action upon the vaso-motor nerves
arise. The insomnia of alcohol. is, no doubt, the cause of its hypnotic, or sleep- ism is with its use, as a rule, quickly disproducing properties. These nerves govern pelled. In these cases it will give better reand control the calibre of the bloodvessels, sults if the portal circle and alimentary canal therefore by its action upon this system it are unloaded previous to its use. causes a contraction of the arterioles, and the An habitual drunkard, who after a prolonged amount of blood supply to the brain is dimin- debauch was tremulous and unable to sleep for ished. The sleep produced is calm, dreamless, a period of five days, was given in six hours, and refreshing. It is unlike the sleep of a nar- and in divided doses, the th of a grain. In cotic, as the patient can be easily aroused, and a few hours after it had been taken he fell will quickly and without difficulty fall asleep asleep, and so continued to remain for eight again. There is no nausea or constipation pro hours, while the tremulous condition and duced by it, no habit is formed, and, unlike “ horrors" had disappeared before. The inmost drugs of its kind, whether they be hyp- somnia did not return. This patient told me notic or narcotic, that condition of things that he never had in his whole experience with known as tolerance is not established. Some alcoholic stimulants received such quick and other of its cerebral effects when large or full permanent relief from medicine. It is comdoses have been taken are marked and notice. paratively free from danger in this class of able. Its action upon the muscular system, cases, where, from the habits of the individual, causing an incoördination and paresis, is no there are reasons to suspect a fatty heart. doubt due to its effect upon the motor nerves, In the treatment of hysteria it is a boon. In whose normal excitability it suspends, chiefly a case which came under my notice, the sympproducing the effect mentioned. The convul- toms simulated hernia to such a degree that I sions which result from a large dose are spinal, thought she was the victim of a concealed for, in the case mentioned, where convulsions oc- hernia. I gave by the hypodermatic method curred, I did not notice any twitching of the three-quarters of a grain of morphia sulphatis, muscles of the face, but they were more par- guarded with atropia, all within an hour and a ticularly confined to the hands and forearm, half, without relief or abatement of the sympwith a tendency to draw the knees towards the toms. I then resorted to the use of chlorochin. It, therefore, excites an aggravated re- form, a few inhalations of which brought the flex sensibility of the nerves, supplying the return of her senses, and she pleaded with me muscles concerned in the movement. The not to give any more, her reasons being that sensory nerves are also affected by large doses, she had near died in a dentist's chair from its so far as slight irritation is concerned, such as effects. pinching, pricking the patient with a pin, or The next time I was called, which was pulling the hair. The sense of hearing is some- within a day or two of her period, the same what diminished, but by speaking to the sub- symptoms were present. I used the hyoscine jects in a raised voice, which need not be of a hydrochlorate. The oth of a grain dose was high pitch, they will understand and compre- sufficient to cause sleep within twenty-five minhend the meaning of a request. The volun- utes, and the hernia, which had only existed tary muscles are not affected. Hyoscine hy- in her mind, was reduced before this time. drochlorate is in all probabilities eliminated by In hypochondriasis, attended with excitethe kidneys, as I have seen no case in which ment, the doth of a grain dose will antagonize the bowels were disturbed or the skin acted the condition present and produce a quiet state upon. It may, however, be eliminated by the of things. This same dose will, in the mabreath, as the alkaloid when free is very vola- jority of cases, if given at bedtime under the tile.
above circumstances, produce sleep. Therapeutically, hyoscine and its salts are a In a case of gastritis of the chronic type, where boon in the treatment of the insane, either in the patient had been unable to sleep for months, the stage of excitement or as a hypnotic. It that is to say, without the use of large doses of not only has gained for itself the reputation of l opium, etc., was given Tigth of a grain of the hydrochlorate regularly at bedtime, and after practical alienists; and a tendency not only a period of fourteen days he was able to gain to direct the psychiatric expert to explain the the normal amount of sleep without any further disturbed mechanism of the mental process, use of drugs. In this case the habit was broken but also to abide by his opinion whether the up, the only bad results being the continued accused was suffering from incapacitating weakdilatation of the pupils, which remained four or ness or derangement of mind caused by disfive days after the withdrawal of the remedial ease. We would express as strongly as possible agent.
our opinion that the loss of self-control caused Some of the effects of hyoscine are antago- by mental disease ought to remove responsinized by chloral. In the case mentioned bility. where the 35th of a grain was taken, by a mis- When we are called upon to give an opinion take on the patient's part, producing convul- before an inquisition, it is as to whether a man sions, loss of speech, illusions, and hallucina- is capable of taking care of himself and his tions, chloral was used in ten-grain doses every
affairs. Respecting testamentary capacity, fifteen minutes until the convulsions had disap- whether a man was capable of making a reasonpeared, which was within an hour after the able will, and in criminal trials, whether the first dose of chloral had been given. After the act was the product of mental disease. convulsions were suspended the chloral was It will be our object in this paper to lay given in ten-grain doses every hour until ninety down a series of propositions as to what constigrains had been taken. Now the chloral an- tutes incapacity, and as to what the real test of tagonizes the hyoscine by diminishing the ex- irresponsibility is. The medical profession citability of the spinal nerves, while hyoscine have sufficient power and influence, if they excites and aggravates them. It seems to me would unite, to make a radical change in the that when an excessive dose has been taken, rules which constitute the law of insanity in that is, one sufficient to produce death, anima relation to crime. tion would be suspended by failure of the res- The present law of New York and of many piratory apparatus, for both in large and small other States, makes the want of ability to disdoses the hydrochlorate acts with more force criminate between right and wrong the test of on the respiratory movement than on the heart. mental unsoundness. Nothing could be more Under these circumstances faradism, so ap- absurd and unscientific, and unreconciled to plied as to excite the muscles concerned in the the present state of medical science. Especially movements of respiration, would go far to pre in the late case of Dr. Beach, of Towanda, vent death by antagonizing the action of the Pa., do we see a miscarriage of justice in conhyoscine.
demning to death a man who was as clearly 619 East Tenth Street, Wilmington, Del.
out of his mind, according to the history of his
life, furnished by the writer to the governON THE NECESSITY FOR ADDI
mental authorities of that State in an effort 10 TIONS TO THE MEDICAL JURIS- within the walls of any asylum in the State of
save his life, as any of the patients confined PRUDENCE OF MENTAL DIS
Pennsylvania. There was a remarkable herediEASES.
tary predisposition to insanity in the prisoner's BY EDWARD C. MANN, M.D.
ancestors, on both the paternal and maternal Member of the New York County Medical Society, New York side. Dr. Beach had twelve blood relatives Medico-Legal Society, etc.
insane or idiotic. He had been markedly inHE true clinician and practical alienist sane since he was eighteen years old. The
has the liveliest interest in procuring for writer made the strongest personal appeal for medico-legal science that influence for the con- Dr. Beach's life, and also obtained from sevsideration of the mental condition in the adjudi- eral physicians of good standing certificates of cation of legal questions which it ought to re- their treating Dr. Beach while insane, but it ceive, considering the great progress made in availed nothing. psycho-pathology. There is a very gratifying After the execution the brain was removed disposition on the part of judges of United and sent to Dr. C. K. Mills, of Philadelphia, States Courts to-day not to withhold their con- and the result of his examination confirmed fidence from the psychological deductions of the life history of the man.
We are glad that there is one judge in the affecting the mind deprives a person of a deState of Pennsylvania, Hon. H. J. Reeder, termination of his choice to do or to abstain of Easton, who is enlightened enough when from a particular act, there is loss of responsisuch unfortunates are brought before him to bility entailed in that person by reason of physcharge the jury that “if the act was the pro- ical disease, viz., insanity. duct of mental disease, they should return a The primary part of any case of the proseverdict of not guilty on the ground of insanity.” cution, in any case where insanity is alleged as We trust the time is not far distant when every a defence, to be established to the satisfaction judge, in every State, will charge substantially of the jury beyond any reasonable doubt is, the same thing. A man may know right from that a person accused shall be possessed of an wrong, and yet he may be perfectly insane, intact intellect, shall have shown evil design, and laboring under such a degree of mental and that he has not been deprived by disease disease that he is utterly unable to resist or of the power of choice, or of moral liberty, and strive against his impulses.
that the act was not the outcome of disease; and Judicial decisions will never obliterate the the sanity of the prisoner's mind is to be made facts of psychiatry. A punishable action does not out affirmatively by the prosecution as a part exist, if at the time the action takes place the per- of their case. petrator is in a condition of unconsciousness or Disease of the mind may deprive a man of disturbance of mind by disease, which would understanding or of liberty of will, and may exclude a free determination of will. A sane make him, therefore, incapable of appreciating man is one whose senses. bear truthful evidence, the obligation of law, and should deprive him whose understanding is capable of receiving of his liability to punishment for violating laws that evidence, whose reason can draw proper which, by reason of diseased intellect, emotion, conclusions from the evidence thus received, or will, he may not have the capacity to obey. whose will can guide the thought thus obtained, In respect to a given act, such a man has not the whose moral sense can tell the right and wrong normal consent of his will. Lord Hale says: of any act growing out of that thought, and “The consent of the will is that which renders whose act can at his own pleasure be in con- human actions either commendable or culpable; formity with the action of all these qualities. as where there is no law there is no transgresAll these things unite to make sanity. The sion, so, regularly, where there is no will to absence of them is insanity.
commit an offence there can be no transgresThese rules should be accepted by the light sion or just reason to view the penalty or sancof our modern mental pathology as amendments tion of that law instituted for the punishment to existing laws:
of crimes or offences; and, because the liberty If the jury in any case believe, from all the or choice of the will presupposeth an act of the evidence in the case, that a given act was com- understanding to know the thing or action mitted by the prisoner in a state of insanity, chosen by the will, it follows that, where there they should acquit him on that ground. is a total defect of the understanding, there is
To connect threats with an overt act, the no free act of the will in the choice of things or jury must find that they were uttered ma actions." Therefore, no man can commit a liciously, seriously, with the intent to execute crime unless he has the control of his will. An them in accordance with the purpose expressed unwarrantable act without freedom of will is by the prisoner in a stare of sanity; and that no crime at all. the overt act occurred in pursuance of those An individual should be exonerated from threats.
liability for his act where, although he knew Under any circumstances the jury must find, right from wrong, he was overborne by an imin any given case, that any threats and acts in pulse he could not control-where he saw the question were the product of a sane mind. wrong, perhaps, but had no power to abstain
If there is a lack of malicious purpose, of from the act. depravity of heart and a diseased understand- In any given case, even if the evidence as to ing or will, there is a lack of the essence of the insanity of an individual should leave it in crime.
doubt as to whether he was insane or not at the When there is a defect of mind the will does time of the commission of the alleged act, the not join with the act. If disease of the body individual is entitled to an acquittal. If the jury entertain a reasonable doubt as to the per- | disease as to deprive the mind of its controlling fect sanity of an individual at the time of the and directing power. commission of the alleged act respecting such Judge Edwards has said, “In order to conact, they are bound to acquit him.
stitute a crime, a man must have memory and If an individual is, as the result of disease, intelligence to know that the act he is about to temporarily thrown into a state of excitement commit is wrong; to remember and understand in which he is divested of his reason and judg. that if he commits the act he will be subject to ment, and is deprived of his mental power to punishment; and reason and will to enable him an extent placing him beyond the range of self- to compare and choose between the supposed control in reference to the particular act charged advantage or gratification to be obtained from against him, so that he could not possibly re- the criminal act, and the immunity from punishstrain himself from the commission of the actment which he will secure by abstaining from alleged against him at the very time of its com- it. If, on the other hand, he has not intellimission, he is entitled to an acquittal. Was he, gence and capacity enough to have a criminal at the very time of the perpetration of the deed, intent and purpose, and if his moral or intelrendered by disease incapable of reasoning lectual powers are so deficient that he has not upon what he did, or of refraining from the sufficient will, conscience, or controlling power, commission of the deed ?
or, if through the overwhelming violence of In moral insanity, or affective insanity, the mental disease his intellectual power is for the affections, passions, and emotions are affected time obliterated, he is not a responsible moral by disease, while the intellect may be, as far agent, and is not punishable for criminal acts.” as we can discover, unimpaired. The mental | It will be seen that the learned judge had very diseases to which these terms of moral or affec- correct conceptions of mental pathology, as in tive insanity are applied, are real, undoubted these remarks he includes intellectual insanity, diseases of the mind, controlling human action. moral or affective insanity, and temporary inBucknell and Tuke, of England, in their sanity. He correctly recognizes that the permanual of psychological medicine so held. ception, emotions, and the will may be affected
The knowledge of right and wrong with re- as distinct from the intellect. Also, that the abgard to any particular act is no test at all of in- sence of the power of self-control, the result of sanity or mental responsibility. Fully one-half disease, is an essential element in responsibility. of the insane in asylums to-day perfectly ap
There should be immunity resulting from a preciate this difference as well as sane persons recent or sudden cause, which may deprive an do.
individual of the power of choice, of moral “No act done by a person in a state of in- liberty, or of mental freedom in regard to a sanity can be punished as an offence, and no given act. insane person can be tried, sentenced to any In a given case, if an individual at the very punishment, or punished for any crime or of time of the commission of an act alleged against fence while he continues in that stale." (See him, from causes operating for a considerable Revised Statutes.)
length of time beforehand, or recently or sudInsanity being thus established as an absolute denly occurring, is mentally unconscious of the bar to a criminal prosecution, which forbids nature of the act in which he was engaged, he responsibility for a crime or offence committed is legally irresponsible for it. The state of while in that state, it is immaterial how long mind at the time of an act is to be looked at the insanity exists before or after the commis in determining the character of such an act. sion of the act. It is enough that it existed at | To put such a test to a jury as the ability or cathe time of its commission. If mind is oblit-pacity to distinguish between right and wrong
is erated or diseased for any length of time, how- no standard as to whether a man is or is not ever short, it is a good reason for recognizing sane or insane. Most of the insane, when they unaccountability.
commit crime, are carried away by ungovernIf some controlling disease is the acting able feelings, and most of them can distinguish power within any individual which he cannot between moral right and wrong. They are, resist, that individual is not responsible. We nevertheless, totally irresponsible, criminally, must remember that the moral as well as the for their actions. intellectual faculties may be so disordered by When the mind is in a state of frenzy a man