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."

An habitual drunkard, who after a prolonged debauch was tremulous and unable to sleep for a period of five days, was given in six hours, and in divided doses, the th of a grain. In a few hours after it had been taken he fell asleep, and so continued to remain for eight hours, while the tremulous condition and "horrors" had disappeared before. The insomnia did not return. This patient told me that he never had in his whole experience with alcoholic stimulants received such quick and permanent relief from medicine. It is comparatively free from danger in this class of cases, where, from the habits of the individual, there are reasons to suspect a fatty heart.

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 cause it may arise. The insomnia of alcoholis, 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 blood vessels, 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 amount of blood supply to the brain is diminished. The sleep produced is calm, dreamless, and refreshing. It is unlike the sleep of a narcotic, as the patient can be easily aroused, and will quickly and without difficulty fall asleep again. There is no nausea or constipation produced by it, no habit is formed, and, unlike most drugs of its kind, whether they be hypnotic or narcotic, that condition of things known as tolerance is not established. Some other of its cerebral effects when large or full doses have been taken are marked and noticeable. Its action upon the muscular system, causing an incoördination and paresis, is no doubt due to its effect upon the motor nerves, whose normal excitability it suspends, chiefly producing the effect mentioned. The convulsions which result from a large dose are spinal, for, in the case mentioned, where convulsions occurred, I did not notice any twitching of the muscles of the face, but they were more particularly confined to the hands and forearm, with a tendency to draw the knees towards the chin.

In the treatment of hysteria it is a boon. In a case which came under my notice, the symptoms simulated hernia to such a degree that I thought she was the victim of a concealed hernia. I gave by the hypodermatic method three-quarters of a grain of morphia sulphatis, guarded with atropia, all within an hour and a half, without relief or abatement of the symptoms. I then resorted to the use of chloroform, a few inhalations of which brought the return of her senses, and she pleaded with me not to give any more, her reasons being that she had near died in a dentist's chair from its effects.

The next time I was called, which was within a day or two of her period, the same symptoms were present. I used the hyoscine hydrochlorate. Theth of a grain dose was sufficient to cause sleep within twenty-five minutes, and the hernia, which had only existed in her mind, was reduced before this time.

It, therefore, excites an aggravated reflex sensibility of the nerves, supplying the muscles concerned in the movement. The sensory nerves are also affected by large doses, so far as slight irritation is concerned, such as pinching, pricking the patient with a pin, or pulling the hair. The sense of hearing is somewhat diminished, but by speaking to the subjects in a raised voice, which need not be of a high pitch, they will understand and comprehend the meaning of a request. The voluntary muscles are not affected. Hyoscine hydrochlorate is in all probabilities eliminated by In hypochondriasis, attended with excitethe kidneys, as I have seen no case in which ment, the th 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 boon in the treatment of the insane, either in the stage of excitement or as a hypnotic. It not only has gained for itself the reputation of

In a case of gastritis of the chronic type, where the patient had been unable to sleep for months, that is to say, without the use of large doses of opium, etc., was given th 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 the normal amount of sleep without any further use of drugs. In this case the habit was broken up, the only bad results being the continued dilatation of the pupils, which remained four or five days after the withdrawal of the remedial agent.

Some of the effects of hyoscine are antagonized by chloral. In the case mentioned where the th of a grain was taken, by a mistake on the patient's part, producing convulsions, loss of speech, illusions, and hallucinations, chloral was used in ten-grain doses every fifteen minutes until the convulsions had disappeared, which was within an hour after the first dose of chloral had been given. After the convulsions were suspended the chloral was given in ten-grain doses every hour until ninety grains had been taken. Now the chloral antagonizes the hyoscine by diminishing the excitability of the spinal nerves, while hyoscine excites and aggravates them. It seems to me that when an excessive dose has been taken, that is, one sufficient to produce death, animation would be suspended by failure of the respiratory apparatus, for both in large and small doses the hydrochlorate acts with more force on the respiratory movement than on the heart. Under these circumstances faradism, so applied as to excite the muscles concerned in the movements of respiration, would go far to prevent death by antagonizing the action of the hyoscine.

619 East Tenth Street, Wilmington, Del.

to direct the psychiatric expert to explain the disturbed mechanism of the mental process, but also to abide by his opinion whether the accused was suffering from incapacitating weakness or derangement of mind caused by disease. We would express as strongly as possible our opinion that the loss of self-control caused by mental disease ought to remove responsibility.

When we are called upon to give an opinion before an inquisition, it is as to whether a man is capable of taking care of himself and his affairs. Respecting testamentary capacity, whether a man was capable of making a reasonable will, and in criminal trials, whether the act was the product of mental disease.

It will be our object in this paper to lay down a series of propositions as to what constitutes incapacity, and as to what the real test of irresponsibility is. The medical profession have sufficient power and influence, if they would unite, to make a radical change in the rules which constitute the law of insanity in relation to crime.

The present law of New York and of many other States, makes the want of ability to discriminate between right and wrong the test of mental unsoundness. Nothing could be more absurd and unscientific, and unreconciled to the present state of medical science. Especially in the late case of Dr. Beach, of Towanda, Pa., do we see a miscarriage of justice in condemning to death a man who was as clearly out of his mind, according to the history of his life, furnished by the writer to the governmental authorities of that State in an effort to within the walls of any asylum in the State of save his life, as any of the patients confined Pennsylvania. There was a remarkable hereditary predisposition to insanity in the prisoner's ancestors, on both the paternal and maternal Member of the New York County Medical Society, New York side. Dr. Beach had twelve blood relatives insane or idiotic. He had been markedly inHE true clinician and practical alienist sane since he was eighteen years old. The

ON THE NECESSITY FOR ADDITIONS TO THE MEDICAL JURIS prudence OF MENTAL DIS

EASES.

BY EDWARD C. MANN, M.D.

Medico-Legal Society, etc.

That the liveliest interesira procuring for writer made the strongest personal appeal for

medico-legal science that influence for the consideration of the mental condition in the adjudication of legal questions which it ought to receive, considering the great progress made in psycho-pathology. There is a very gratifying disposition on the part of judges of United States Courts to-day not to withhold their confidence from the psychological deductions of

Dr. Beach's life, and also obtained from several physicians of good standing certificates of their treating Dr. Beach while insane, but it availed nothing.

After the execution the brain was removed and sent to Dr. C. K. Mills, of Philadelphia, and the result of his examination confirmed the life history of the man.

We are glad that there is one judge in the State of Pennsylvania, Hon. H. J. Reeder, of Easton, who is enlightened enough when such unfortunates are brought before him to charge the jury that "if the act was the product of mental disease, they should return a verdict of not guilty on the ground of insanity." We trust the time is not far distant when every judge, in every State, will charge substantially the same thing. A man may know right from wrong, and yet he may be perfectly insane, and laboring under such a degree of mental disease that he is utterly unable to resist or strive against his impulses.

affecting the mind deprives a person of a determination of his choice to do or to abstain from a particular act, there is loss of responsibility entailed in that person by reason of physical disease, viz., insanity.

The primary part of any case of the prosecution, in any case where insanity is alleged as a defence, to be established to the satisfaction of the jury beyond any reasonable doubt is, that a person accused shall be possessed of an intact intellect, shall have shown evil design, and that he has not been deprived by disease of the power of choice, or of moral liberty, and that the act was not the outcome of disease; and the sanity of the prisoner's mind is to be made out affirmatively by the prosecution as a part of their case.

Disease of the mind may deprive a man of understanding or of liberty of will, and may make him, therefore, incapable of appreciating the obligation of law, and should deprive him of his liability to punishment for violating laws which, by reason of diseased intellect, emotion, or will, he may not have the capacity to obey. In respect to a given act, such a man has not the normal consent of his will. Lord Hale says: "The consent of the will is that which renders

Judicial decisions will never obliterate the facts of psychiatry. A punishable action does not exist, if at the time the action takes place the perpetrator is in a condition of unconsciousness or disturbance of mind by disease, which would exclude a free determination of will. A sane man is one whose senses bear truthful evidence, whose understanding is capable of receiving that evidence, whose reason can draw proper conclusions from the evidence thus received, whose will can guide the thought thus obtained, whose moral sense can tell the right and wrong of any act growing out of that thought, and whose act can at his own pleasure be in con-human actions either commendable or culpable; formity with the action of all these qualities. All these things unite to make sanity. The absence of them is insanity.

If the jury in any case believe, from all the evidence in the case, that a given act was committed by the prisoner in a state of insanity, they should acquit him on that ground.

To connect threats with an overt act, the jury must find that they were uttered ma liciously, seriously, with the intent to execute them in accordance with the purpose expressed by the prisoner in a state of sanity; and that the overt act occurred in pursuance of those threats.

Under any circumstances the jury must find, in any given case, that any threats and acts in question were the product of a sane mind.

If there is a lack of malicious purpose, of depravity of heart and a diseased understanding or will, there is a lack of the essence of crime.

When there is a defect of mind the will does not join with the act. If disease of the body

as where there is no law there is no transgression, so, regularly, where there is no will to commit an offence there can be no transgression or just reason to view the penalty or sanction of that law instituted for the punishment of crimes or offences; and, because the liberty or choice of the will presupposeth an act of the understanding to know the thing or action chosen by the will, it follows that, where there is a total defect of the understanding, there is no free act of the will in the choice of things or actions." Therefore, no man can commit a crime unless he has the control of his will. An unwarrantable act without freedom of will is no crime at all.

An individual should be exonerated from liability for his act where, although he knew right from wrong, he was overborne by an impulse he could not control-where he saw the wrong, perhaps, but had no power to abstain from the act.

In any given case, even if the evidence as to the insanity of an individual should leave it in doubt as to whether he was insane or not at the time of the commission of the alleged act, the 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 act, they are bound to acquit him.

In a given case, if an individual at the very time of the commission of an act alleged against him, from causes operating for a considerable 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 unaccountability.