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THE LEGAL VIEW OF INSANITY.
104 Wimbledon meeting, I enclose a letter on the subject ad. dressed by me to the Secretary of State for War.* There has been no wish on the part of the National Rifle Association to cast the slightest slur upon the Volunteer Medical Department, neither have we in any way done so. In each of the at Wimbledon we have one responsible head, and THE annual meeting of this Association was held at the departments we thought it desirable to adopt the same system as regards Royal College of Physicians on the 13th inst., Dr. Wood being our medical arrangements. the president of the year. It was resolved that the place of Under these circumstances, as our medical staff was to conmeeting for the next year should be Edinburgh; and Dr. sist of an army and a volunteer assistant-surgeon, with a super. senior surgeon or surgeon-major, the rules of the Browne, one of the Commissioners in Lunacy for Scotland, intending service necessitated his being selected from the medical dewas unanimously elected president. The other officers of the partment of the regular army. This is the only change made Society were reappointed: Dr. Robertson and Dr. Maudsley, in the last year’s arrangements. the editors of the Journal; Dr. Paul, the Treasurer; and Dr. I must now request you to give publicity, in the next number of the Fifteen members hon. new yourjournal, to this letter and enclosure; and at the same time Harrington Tuke, secretary. I must express my surprise that an article, commenting hostilely were admitted; and the following gentlemen were elected upon our supposed medical arrangements, should have appeared honorary members: Drs. Lasegue, Jules Falret, and Legrand in THE LANCET of Saturday last, when Mr. Wakley had been du Saulle, of Paris ; Dr. Biffi, of Milan; Drs. Schlager and informed by myself on the Wednesday previous as personally Leidesdorf, of Vienna; Dr. Bulckens, of Gheel; John Blake, to what our actual arrangements were. Esq., M.P.; and W. H. Wyatt, Esq., J.P., chairman of the 1 remain, Sir, your obedient servant, committee of Colney Hatch Asylum. Camp, Wimbledon, July 10th, 1865. ELCHO. The reports of two committees, one on the question of the dated the 10th of this communication July, Superannuation Allowance to Medical Officers of County Asy- wasz* Although only delivered by Lord Elcho’s camp messenger on Thurslums, the other on the Statistics of Asylums, were presented and adopted. The former strongly recommended that every day evening, July 13th-too late for insertion. effort should be made to obtain the abolition of that objectionLet us briefly notice the circumstances which the volunteer able clause in the Act of Parliament by which it is now misunderstood." They are the following :enacted that the retiring pension of an officer in a county surgeons " An announcement in the f’olunteer Gazette of the 1st lst. asylum shall be determined, not by the committee of visiting justices who have the control of the asylum, but by the whole inst., that "this year the military authorities have offered to body of the magistrates of the county at quarter sessions. take the medical arrangements under their superintendence, The report on statistics recommended a uniform plan of taking and to provide a regular military hospital on the ground, them, and presented appropriate tables. under a surgeon-major aided by two assistant-surgeons of the On the motion of Dr. Maudsley, it was unanimously remedical staff." Although two numbers of the journal solved that the name of the Association should be changed to army ’’the official organ of the volunteer force," have since quoted, and it was that of the "Medico-Psychological Association;" provided in a code of revised rules adopted that any legally appeared, its columns have contained no contradiction of a. qualified medical practitioner should henceforth be eligible as statement which Lord Elcho declared at the meeting to be " a member. erroneous," and not to have emanated from the Council. An important discussion on the insane in workhouses folThe " official organ," therefore, is allowed to perpetuate by lowed ; the meeting finally adopting unanimously a resolution, its silence an erroneous announcement which it had made by Dr. Boyd, ’’ that the treatment of the insane now proposed without authority. in workhouses is not satisfactory, and that it is desirable to have the care of all the insane poor of the counties transferred 2nd. Dr. Westmacott had been informed late in June by to the visitors and superintendents of the county asylums."" executive officer of the Council, that his services Dr. Robertson then read a paper " On a Recent Attempt Captain Page, would not be required on this occasion at Wimbledon. His at the Comparative Statistics of Bethlehem Hospital and of letters to Lord Elcho upon the subject remained unanswered the English County Asylums,"in which he pointed out how fallacious were the statistics with regard to the number of till the evening of Saturday, July 8th, when the camp had been recoveries and the rate of mortality at Bethlehem as given formed and the hospital was on the ground. On the following in the last report of the hospital, and how erroneous were the morning only did he receive a proposal from Lord Elcho to take conclusions attempted to be drawn from them. at Wimbledon. A meeting of volunteer surgeons had A lively discussion ensued, the general result of which was duty meantime been publicly announced for the Monday. It is to show how little reliance can be placed on asylum statistics as they are at present made out, and to confirm Dr. Robertsatisfactory to find that these proceedings represent "no wish son’s special strictures. on the part of the National Rifle Association to cast the Dr. Davey showed the model of a bed which he believed to slightest slur upon the Volunteer Medical Department," and be most suitable for paralytic and helpless cases; and Dr. we have much in giving publicity to Lord Elcho’s Maudsley exhibited, on behalf of Dr. Willett, an ingenious explanation. Atpleasure the same time we cannot help a feeling of instrument for administering nourishment to those insane who complete bewilderment upon one point. If such be the method persistently refuse food. A paper by Dr. Belgrave " On the Remarkable Effects of adopted by the Council for indicating satisfaction, how do Bromide of Potassium in Lowering the Pulse and Allaying they proceed when it is necessary to express an opposite Maniacal Excitement" closed the business of the day. feeling ? In the evening the members and their friends dined together With regard to the latter portion of Lord Elcho’s letter Mr. at the Langham Hotel. Amongst the visitors were Dr. Jenner, Dr. Sieveking, Dr. Garrod, Mr. Erichsen, Dr. Radcliffe, and Wakley’s remarks upon the subject have already appeared in our issue of last week.-ED. L. Dr. Webster.
THE
ASSOCIATION OF MEDICAL OFFICERS OF ASYLUMS AND HOSPITALS FOR THE INSANE.
Correspondence.
THE LEGAL VIEW OF INSANITY.
of THE LANCET. SiK,—At Winchester, on July 16th, George Broomfield was "Audi alteram partem." found guilty of murder. He was ably defended by Mr. Coleridge, Q.C., on the ground of insanity. It was proved in MEDICAL ARRANGEMENTS AT WIMBLEDON. evidence that two years previously he had been shot in the head, and had since been a "changed man;" that he had To the Editor of THE LANCET. delusions and suicidal impulses ; and that at this moment he SiR,-As much misunderstanding appears to prevail as to This letter appeared in the report of the proceedings at the Meeting of what has been done by the Council of the National Rifle Volunteer Surgeons which was published in THE LAjfCM of last week.Association in the matter of the medical arrangements for ED. L. ,
,
the
To the Editor
105 is half dead from the effects of a shot-wound inflicted upon himself. The counsel for the Crown made no attempt to rebut HOW WERE THE FRACTURES OF THE ORBITAL PLATES OF THE FRONTAL BONE OF THE LATE the evidence of Dr. Tweed, and that of a crowd of other witPRESIDENT LINCOLN PRODUCED? nesses who deposed to the insanity of the prisoner; nevertheless the learned judge, in his summing-up, told the jury that To the Editor of THE LANCET. "it was not every aberration of mind that would free the priSiR,—In the record of the post-mortem examination of the soner-it must be such an aberration of intellect as to disable late President Lincoln, drawn up by Acting Assistant-Surgeon him from distinguishing between right and wrong." Under of the United States Army, (vide THE LANCET, June Taft, this ruling the jury returned a verdict of " guilty," and the it is stated that the bullet-a round one-entered the 17th,) whose own lunatic was " I to wish criminal, only plea poor bone one inch to the left of the longitudinal sinus, occipital sentenced to is be die," duly hanged. and was found imbedded in the right anterior lobe of the The same eloquent counsel, before the same judge, will, on in behalf of Miss Constance Kent. It is brain, behind, but not in contact with, the orbital immediately Saturday, plead possible that in her case the defence of insanity may be set up, plate. The following facts are given :and may be equally justified; nevertheless it is clear that, " The hole made through the occipital bone was as cleanly whether insane or not, she must be condemned to death on cut as if done with a punch. The orbital plates of both orbits her own confession, by making which she herself shows her of comminuted were the seats fracture, the fragments being full appreciation and knowledge of the difference between the forced and dura mater and there must be mistake as some inward, covering them remaining right wrong. Surely grave to the value of a test that inevitably sends the possibly insane uninjured. The double fracture was decided to have been daughter of an insane mother to die upon the scaffold. That caused by contre-coup. "-Philadelphia Medical Reporte1’. it is practically fallacious must be shown by the fact that, standFor the production of fracture by contre-coup it is absolutely ing by her side, condemned in the same week by the same that force be transmitted from the spot struck; and judge, will be found another unhappy homicide, admittedly necessary if no such transmission took place in the case under considera, to under mental disease from suffering arising physical injury the brain, and yet to be executed because no one can give evi- tion, it is clear that the fractures cannot be regarded as exdence as to his want of knowledge of the difference between amples of fractures by contre-coup. Now it is stated that the the right and the wrong. of the bullet’s entry was only half an inch in diaThe conflicts of opinion between law and medical knowledge, aperture and as cleanly cut as if done with a punch. These facts meter, and the jarring of legal dogmas with scientific truths as to the resulted from there having been no transmission of force. The are be of the to but insane, deplored; responsibility deeply there is another aspect of the case of almost equal importance. following words of mine (British and Foreign Medico-Chirurgical If Mr. Justice Keating should draw the attention of thei Review for July, 1864, p. 213) explain the reason why. Home Secretary, as Mr. Baron Martin did in the case of Victor " The bullet going at full speed affords no time for the part Townley, to the possible existence of insanity in one or both of which it strikes, and puts into motion, to transmit motion to these criminals, their lives will be spared; otherwise the law the surrounding bone, and hence merely cuts out a piece of will take its inexorable course. It is obvious that under this form of procedure, the judge bone its own size ; whereas the bullet whose rate of velocity is has in every case, in which a capital crime has been committed low allows time for the part which it strikes to communicate by a lunatic, the power of life or death in his own hands ; he force to, and set in motion, a considerable portion of the conmay charge the jury in such a way as to almost compel their tiguous bone not struck ; and consequently, the lower the rate verdict of guilty, and then privately inform the authorities at of velocity the larger will be the wound, for as more time is the Home Office that the convict is insane, and that his case more particles will be set in motion." given, requires further investigation. the fractures of the orbital plates could not Consequently Is it not contrary to the spirit of our law, is it not repug- have been by contre-coup, as there was no transmisproduced nant to our feelings of justice, to inflict capital punishment sion of force. upon a man already suffering under the most terrible affliction Prof. Longmore, in a communication to THE LANCET of that can befall humanity ? June 17th, considered that the fractures were caused by the In these remarks I do not wish to reflect upon the judges, brain being driven, by the impetus communicated to it from. but upon the law, which, in this instance, appears to me to be the bullet, against the orbital plates. altogether anomalous. The issue, one of life or death to the am of opinion that the fracture of the right I, however, prisoner at the bar, should depend upon the jury; and the orbital plate was produced by the direct action of the bullet, questions for them to decide ought to be-first, whether the and that the left orbital plate was broken by an extension of prisoner alleged to be insane is guilty upon the evidence, and the fracture into it from the adjoining plate. The fact of the secondly, whether it is proved to their satisfaction that he is dura mater covering the orbital processes not being injured not of sound mind. proves nothing, inasmuch as it is, I should suppose, well known Under the present system the last issue is practically left that when a spent bullet strikes a bone protected by a cloth, with the judge, who may or may not think it expedient that skin, or membrane, the bone is often fractured, whilst the lunatics should be put to death; and as on this question judges covering remains uninjured. It was assumed that because the may differ, like other men, the infliction of capital punishment bullet was not found in contact with the orbital plate, it had, in any particular case of homicidal lunacy is uncertain. The therefore, never struck that bone. The bullet, however, was sanity or insanity of the prisoner is not decided by the jury; discovered in the very position I should have supposed; for I they are directed only to try an issue which no finite mind can have ascertained from repeated experiments on the dead body, determine-namely, whether a lunatic at a particular moment that when a round ball is fired from a pistol, at the distance of had a mind sufficiently sound to know the difference between only a few feet from the head, it makes a clean-cut aperture of the right and the wrong. entry, traverses the brain, strikes a spot on the inner surface The question as to the infliction of capital punishment is of the skull immediately opposite the aperture of entry, and distinct from that of capitally punishing lunatics. If there be then, recoiling into the brain, remains imprisoned in the craeven a doubt as to Miss Kent’s condition of mind I hope her life e nium. The conical bullet, however, fired at a short distance will be spared. As to poor Broomfield, the law may surely forego with a full charge of powder, from a revolver, not only geneits vengeance ; it can serve no purpose to strangle to death a rally enters the head, but also makes its exit from it. Inasman admitted to be the victim of a mysterious disease, which much, therefore, as the injuries sustained by the late President affects, more or less, the intellect, the moral feelings, and the Lincoln were exactly similar to those which follow the use of will, because it is imagined that so much of these remains to a similar weapon on the dead body, I am unwilling to believe him that his mind can tell the difference between right and that there was any departure from well-ascertained causes and wrong. There is little doubt that he does know the difference results, and that any apparently inexplicable circumstance between right and wrong. But his mind and will are diseased ; arose from some imperfection or want of minuteness in making he could not restrain his suicidal impulses-he could not over- the post-mortem examination, rather than from any deviation come delusive impressions; and it is almost certain that mental in the action of physical laws. disease led him to commit a cruel and useless homicide. 1 am, Sir, your obedient servant, I am, Sir, your obedient servant, W. F. TEEVAN, F.R.C.S., B.A., HARRINGTON TUKE, HARRINGTON M.D. Albemarle-street, July 18th, 1865. TUKE, M.D. Surgeon to the West London Hospital. Portman-square, July, 1865.
THE
ASSOCIATION OF MEDICAL OFFICERS OF ASYLUMS AND HOSPITALS FOR THE INSANE.
Correspondence.
THE LEGAL VIEW OF INSANITY.
of THE LANCET. SiK,—At Winchester, on July 16th, George Broomfield was "Audi alteram partem." found guilty of murder. He was ably defended by Mr. Coleridge, Q.C., on the ground of insanity. It was proved in MEDICAL ARRANGEMENTS AT WIMBLEDON. evidence that two years previously he had been shot in the head, and had since been a "changed man;" that he had To the Editor of THE LANCET. delusions and suicidal impulses ; and that at this moment he SiR,-As much misunderstanding appears to prevail as to This letter appeared in the report of the proceedings at the Meeting of what has been done by the Council of the National Rifle Volunteer Surgeons which was published in THE LAjfCM of last week.Association in the matter of the medical arrangements for ED. L. ,
,
the
To the Editor
105 is half dead from the effects of a shot-wound inflicted upon himself. The counsel for the Crown made no attempt to rebut HOW WERE THE FRACTURES OF THE ORBITAL PLATES OF THE FRONTAL BONE OF THE LATE the evidence of Dr. Tweed, and that of a crowd of other witPRESIDENT LINCOLN PRODUCED? nesses who deposed to the insanity of the prisoner; nevertheless the learned judge, in his summing-up, told the jury that To the Editor of THE LANCET. "it was not every aberration of mind that would free the priSiR,—In the record of the post-mortem examination of the soner-it must be such an aberration of intellect as to disable late President Lincoln, drawn up by Acting Assistant-Surgeon him from distinguishing between right and wrong." Under of the United States Army, (vide THE LANCET, June Taft, this ruling the jury returned a verdict of " guilty," and the it is stated that the bullet-a round one-entered the 17th,) whose own lunatic was " I to wish criminal, only plea poor bone one inch to the left of the longitudinal sinus, occipital sentenced to is be die," duly hanged. and was found imbedded in the right anterior lobe of the The same eloquent counsel, before the same judge, will, on in behalf of Miss Constance Kent. It is brain, behind, but not in contact with, the orbital immediately Saturday, plead possible that in her case the defence of insanity may be set up, plate. The following facts are given :and may be equally justified; nevertheless it is clear that, " The hole made through the occipital bone was as cleanly whether insane or not, she must be condemned to death on cut as if done with a punch. The orbital plates of both orbits her own confession, by making which she herself shows her of comminuted were the seats fracture, the fragments being full appreciation and knowledge of the difference between the forced and dura mater and there must be mistake as some inward, covering them remaining right wrong. Surely grave to the value of a test that inevitably sends the possibly insane uninjured. The double fracture was decided to have been daughter of an insane mother to die upon the scaffold. That caused by contre-coup. "-Philadelphia Medical Reporte1’. it is practically fallacious must be shown by the fact that, standFor the production of fracture by contre-coup it is absolutely ing by her side, condemned in the same week by the same that force be transmitted from the spot struck; and judge, will be found another unhappy homicide, admittedly necessary if no such transmission took place in the case under considera, to under mental disease from suffering arising physical injury the brain, and yet to be executed because no one can give evi- tion, it is clear that the fractures cannot be regarded as exdence as to his want of knowledge of the difference between amples of fractures by contre-coup. Now it is stated that the the right and the wrong. of the bullet’s entry was only half an inch in diaThe conflicts of opinion between law and medical knowledge, aperture and as cleanly cut as if done with a punch. These facts meter, and the jarring of legal dogmas with scientific truths as to the resulted from there having been no transmission of force. The are be of the to but insane, deplored; responsibility deeply there is another aspect of the case of almost equal importance. following words of mine (British and Foreign Medico-Chirurgical If Mr. Justice Keating should draw the attention of thei Review for July, 1864, p. 213) explain the reason why. Home Secretary, as Mr. Baron Martin did in the case of Victor " The bullet going at full speed affords no time for the part Townley, to the possible existence of insanity in one or both of which it strikes, and puts into motion, to transmit motion to these criminals, their lives will be spared; otherwise the law the surrounding bone, and hence merely cuts out a piece of will take its inexorable course. It is obvious that under this form of procedure, the judge bone its own size ; whereas the bullet whose rate of velocity is has in every case, in which a capital crime has been committed low allows time for the part which it strikes to communicate by a lunatic, the power of life or death in his own hands ; he force to, and set in motion, a considerable portion of the conmay charge the jury in such a way as to almost compel their tiguous bone not struck ; and consequently, the lower the rate verdict of guilty, and then privately inform the authorities at of velocity the larger will be the wound, for as more time is the Home Office that the convict is insane, and that his case more particles will be set in motion." given, requires further investigation. the fractures of the orbital plates could not Consequently Is it not contrary to the spirit of our law, is it not repug- have been by contre-coup, as there was no transmisproduced nant to our feelings of justice, to inflict capital punishment sion of force. upon a man already suffering under the most terrible affliction Prof. Longmore, in a communication to THE LANCET of that can befall humanity ? June 17th, considered that the fractures were caused by the In these remarks I do not wish to reflect upon the judges, brain being driven, by the impetus communicated to it from. but upon the law, which, in this instance, appears to me to be the bullet, against the orbital plates. altogether anomalous. The issue, one of life or death to the am of opinion that the fracture of the right I, however, prisoner at the bar, should depend upon the jury; and the orbital plate was produced by the direct action of the bullet, questions for them to decide ought to be-first, whether the and that the left orbital plate was broken by an extension of prisoner alleged to be insane is guilty upon the evidence, and the fracture into it from the adjoining plate. The fact of the secondly, whether it is proved to their satisfaction that he is dura mater covering the orbital processes not being injured not of sound mind. proves nothing, inasmuch as it is, I should suppose, well known Under the present system the last issue is practically left that when a spent bullet strikes a bone protected by a cloth, with the judge, who may or may not think it expedient that skin, or membrane, the bone is often fractured, whilst the lunatics should be put to death; and as on this question judges covering remains uninjured. It was assumed that because the may differ, like other men, the infliction of capital punishment bullet was not found in contact with the orbital plate, it had, in any particular case of homicidal lunacy is uncertain. The therefore, never struck that bone. The bullet, however, was sanity or insanity of the prisoner is not decided by the jury; discovered in the very position I should have supposed; for I they are directed only to try an issue which no finite mind can have ascertained from repeated experiments on the dead body, determine-namely, whether a lunatic at a particular moment that when a round ball is fired from a pistol, at the distance of had a mind sufficiently sound to know the difference between only a few feet from the head, it makes a clean-cut aperture of the right and the wrong. entry, traverses the brain, strikes a spot on the inner surface The question as to the infliction of capital punishment is of the skull immediately opposite the aperture of entry, and distinct from that of capitally punishing lunatics. If there be then, recoiling into the brain, remains imprisoned in the craeven a doubt as to Miss Kent’s condition of mind I hope her life e nium. The conical bullet, however, fired at a short distance will be spared. As to poor Broomfield, the law may surely forego with a full charge of powder, from a revolver, not only geneits vengeance ; it can serve no purpose to strangle to death a rally enters the head, but also makes its exit from it. Inasman admitted to be the victim of a mysterious disease, which much, therefore, as the injuries sustained by the late President affects, more or less, the intellect, the moral feelings, and the Lincoln were exactly similar to those which follow the use of will, because it is imagined that so much of these remains to a similar weapon on the dead body, I am unwilling to believe him that his mind can tell the difference between right and that there was any departure from well-ascertained causes and wrong. There is little doubt that he does know the difference results, and that any apparently inexplicable circumstance between right and wrong. But his mind and will are diseased ; arose from some imperfection or want of minuteness in making he could not restrain his suicidal impulses-he could not over- the post-mortem examination, rather than from any deviation come delusive impressions; and it is almost certain that mental in the action of physical laws. disease led him to commit a cruel and useless homicide. 1 am, Sir, your obedient servant, I am, Sir, your obedient servant, W. F. TEEVAN, F.R.C.S., B.A., HARRINGTON TUKE, HARRINGTON M.D. Albemarle-street, July 18th, 1865. TUKE, M.D. Surgeon to the West London Hospital. Portman-square, July, 1865.