According to Dr. Ray, if moral insanity be pleaded in defense, proof of the fact must be found in the antecedents of the prisoner, the manner of committing the crime, his mental or bodily condition, all the circumstances, in fact, connected with the act. ("An Examination of the Objections to the Doctrine of Moral Insanity," by Isaac Ray, M.D., American Journal of Insanity, vol. xviii., p. 112.)

Dr. Tuke, admitting that no absolute rule can be laid down to differentiate moral insanity from moral depravity, insists that each case must be decided in relation to the individual himself, his antecedents, his education, surroundings, and social status, the nature of certain acts, and the mode in which they are performed, along with other circumstances fairly raising the suspicion that they are not under his control. In no other form of insanity is it so necessary to study the individual, his natural character, his organization, and his previous diseases. ("Moral or Emotional Insanity," D. Hack Tuke, Journal of Mental Science, vol. xxxi., p. 174.)

Emotional insanity as a defense has generally been presented under the form of the so-called "mania transitoria," an instantaneous temporary madness which begins "in the eve of the criminal act and ends when it is consummated." (Depue, J., State vs. Grave, 5 N. J. L. J. 54.) The acceptance of this theory by juries as an exculpation of the accused may be regarded in certain cases at least as a proof of their sympathy with him, and of their consequent determination to acquit. ("The Case of People vs. Eratus F. Pierce," American Journal of Insanity, vol. xxviii., p. 399; Cole's Trial, 7 Abb. Pr., N. S., 321.)

The utterances of the law on this subject, so replete with difficulty, cannot receive a complete acquiescence on the part of the jurist. An unwillingness to admit that the facts of insanity were to be learned from science and learned opinion, rather than from ordinary evidence, like an ordinary fact (Lord Chancellor Westbury, Debate of March 11, 1862, Hansard's Debates, third series, vol. clxv., p. 1297), has, as an error, its parallel in the intrusion made by the law into the domain of mental pathology itself. The writings of the earliest authorities and some of the judicial utterances of later days, by their attempted classifications of mental disease, and dogmatism as to its essential nature and characteristics, have, under the name of the law, perpetuated or given longer life to scientific errors or the imperfect science of the time, as witness the description drawn between madness and lunacy, the imputing to insanity delusion as its essential and necessary characteristic, and the drawing of fixed legal consequences from the fact of delusion itself. It is submitted that with the particular forms of insanity and its essential characteristics as a disease the law has nothing whatever to do. The effects of the various manias, of epilepsy, the probable limit and effect of delusions, the relation of the insane impulses to the human will, the question as to the existence and nature of an insanity purely emotional and moral, are, and must remain, facts of mental pathology to be proved or disproved as facts, and not to be dogmatically affirmed or denied, and to be viewed only in relation to the legal question of responsibility. As to this it may fairly be asked whether the action of the House of Lords in relation to McNaghten's Case has not justified the apprehensions of Mr. Justice Maule, in unsettling rather than settling, the law by the suggestion of

doubts rather than the solution of them, thus affording matter for bitterest controversy between the professions of law and medicine, a controversy that extends even to the present time. A complete and unassailable canon of responsibility is perhaps yet to be formulated, but its establishment cannot lead beyond the threshold of the difficulties of fact that must always confront the human tribunal.

APHASIA AND OTHER AFFECTIONS OF SPEECH.

BY

CHARLES K. MILLS, M.D.

HISTORY AND LITERATURE.

THE medico-legal aspects of aphasia and other affections of speech have not escaped investigation and discussion, but they have received little attention from English and American writers, and, compared with the immense literature of the general subject of aphasia, but little from writers of other nations. Much of the work published has been in the nature of records, with comments on particular cases which have come before a court or other tribunal; and in few, if any, of these contributions has any systematic effort been made to classify for medical purposes the now well-recognized forms of aphasia. In papers dealing with the general phenomena and mechanism of speech, important medico-legal points are developed in a casual and incidental manner, as in the writings of J. Hughlings Jackson,* Charcot, Lichtheim,‡ and Ross;§ and to some of these references will be made in the course of this article. In the second edition of Bateman's treatise on aphasia,|| a new chapter on the jurisprudence of aphasia is introduced, in which some original observations are given, and references are made to the work of French and German authors.

Bateman¶ cites some cases of interest. In 1743, for example, a resident of Münden, Hanover, applied to the government for permission to make a will by signs in favor of his wife, and the court acknowledged the validity of the act. Another aphasic for five years discharged the functions of mayor and municipal councilor, by writing his name to necessary documents with his left hand. In the same way he also wrote a holographic will, which was sustained. These and other cases are referred to by Legrand du Saulle. Bateman refers to several cases in which the wills of deaf-mutes were recognized as valid by the court because it was proved that they understood the contents of the will, either through gesture and pantomime alone, or by these and written language combined. He also records the case of a man, sixty-three years old, who was engaged

*

Hughlings Jackson, Brain, October, 1878, and July and October, 1879.

+ Charcot, Le Prog. Med., 1884, and Medical Press and Circular, London, 1884. Lichtheim, Brain, January, 1885.

Ross, Aphasia, etc., London, 1887; New York, 1890.

Bateman, Aphasia, etc., London, 1890.

¶ Ibid.

to be married and was suddenly seized with right hemiplegia and aphasia, and wished to make a will in favor of the lady whom he intended to make his wife. The document was written by one of his medical attendants. The testator's mark was made and the will attested by witnesses. He communicated his wishes by making signs for writing materials. His wishes were then interpreted by means of signs and written down on a card. He held up his hand, extended his five fingers, and he was asked if he meant "thousand"; he bowed assent. He then closed his hand and opened it the same way, implying ten; this operation was repeated until it amounted to thirty, then he dropped his arm down. Testator was then asked whether he wished Miss R. to have £30,000, and he nodded his head. When asked if Miss R. was to have this sum absolutely, he signified dissent; but on being asked if it was to be hers for life and afterward to revert to his family, he bowed his head. Unfortunately the testator's mark was made in the middle of the card instead of at the bottom or foot, and so did not satisfy the provisions of the statutes relating to wills, and the testament was therefore refused probate.

In Dumas's Count of Monte-Christo is an interview with a motor aphasic which might have answered as testimony in court in a case in which the question was that of testamentary capacity. The old Bonapartist, Noirtier, paralyzed and profoundly aphasic, angered at his son and daughterin-law, determines to change his will. His son, his granddaughter, and his old servant could understand and communicate with him through an arranged system of signs-by his closing his eyes for "yes," by winking them when he meant "no," and when he had some desire or feeling to express, by looking upward. He signifies his desire for a notary by indicating to his granddaughter, who recites to him all the letters of the alphabet, that he wishes "n" and "o" in succession; then with a dictionary he picks out the word "notary." Two notaries are brought and read the formal copy of the will, and then test Noirtier by much the same method as Bateman relates was employed in the case above cited. Several sums are named before the aphasic, who signs "no" until the question is asked, "Do you possess 900,000 francs?" In answer to this he closes his eyes in assent. He finally succeeds in making a will, of the validity of which the notaries are thoroughly satisfied, although other characters in the story are not equally satisfied with its contents.

At the meeting of the British Medical Association, 1889,* Dr. Drysdale, of London, cited the case of a celebrated civil engineer who had right motor paralysis and aphasia, but who wrote his own checks, copying them from a former signature of his own, and who for many years was a senior partner of the firm. His partners, however, did all the work. In this case the gentleman retained enough intelligence to play whist with the cards spread out before him, and left a will which was not contested. Professor Gairdner, at a former meeting of the British Medical Association, had mentioned the case of a Scottish judge affected with aphasia who had continued in office for some years, and sat on the bench while suffering from a form of this malady.

Legrand du Saullet has extensively discussed the subject of aphasia

• New York Medical Record, September 28, 1889, p. 360.

+ Legrand du Saulle, Gazette des Hôpitaux, June and July, 1868; and ibid., vol. lv., In this series of lectures other references are as follows: Ch. Sazie, Troubles Suntec bucks, chans l'Aphasie, Paris, 1879; Finance, Etat Mentale des Aphasiques: Con

and aphasics considered from the medico-legal and other points of view. He holds that when the lesion of aphasia is confined exclusively to the third left frontal convolution, intellectual disturbance is slight; but according as it has extended to the motor zone, or to the prefrontal region, will paralysis or disorders of the intelligence appear; also that most aphasics have a certain measure of dementia as well as of paralysis, but that the intellectual disorder observed in aphasics is most variable, sometimes not interfering with the important events of life, at others so wrecking the intellectual faculties as to cause mental incapacity and irresponsibility. Among aphasics impatience and anger are common; their moods are very changeable; want of attention is one of their most marked traits; memory and recollection are less alert, some aphasics exhibiting decided loss of memory. He insists that aphasia is compatible with intelligence, but that this is always more or less weakened by the loss of language. If the brain lesions are extended and multiple, pronounced weakening and even abolition of memory may be observed. Incoherence of ideas when present is not by any means on a par with incoherence of language. To lesions of the prefrontal regions he relates the loss of memory and attention, the incoherence, hallucinations, and deliriumprobably only a partial truth. He speaks of hallucinations as frequent among aphasics, the most common being those of hearing and sight; sometimes these hallucinations are of a character that may lead to crime, or may make the aphasic suspicious of others. He admits three categories of aphasics-those in whom intelligence is intact, but slightly touched; those in whom it is manifestly changed; and those in whom it is entirely abolished. A physician called to give an opinion on an aphasic should give attention to the smallest particulars. He has need also to use all his care and knowledge in scrupulously reviewing every one of the different forms of language employed by an aphasic. It is always well to make the patient count, to ask his age, to test him with money, etc.

Gallard, in a volume of clinical lectures delivered at La Pitié, has one chapter on aphasia and aphasics discussed from the medico-legal point of view. His conclusions with reference to the interdiction of aphasics are: (1) If the intelligence of the aphasic is completely obliterated, or if in preserving his lucidity he cannot manifest it by written language, pantomime, or speech, he should be interdicted; (2) if the intelligence of the aphasic, not being completely alienated, has not all its brightness, and can only be incompletely manifested, he should be provided with a judicial counsel; (3) if the aphasic possesses his intelligence, and if he can manifest it sufficiently, whether by word, by writing, or by signs, he has no need of judicial protection, and should be free to manage himself and his affairs.

The Parish will case is perhaps the most famous American medicolegal case in which the mental power of an aphasic was the main point at issue. Henry Parish made his first will when fifty-four years of age,

sidérations Médico-Légales, Paris, 1878; Legrand du Saulle, Etude Médico-Légale sur l'Interdiction des Aliénes et sur le Conseil Judiciaire, Paris, 1881, p. 212; J. Lefort, Rémarques sur l'Interdiction des Aphasiques," Bulletin de la Société de Médecine de France.

*

Gallard, Clinique Médicale de La Pitié; analyzed in Le Journal de Médecine et de Chirurgie Pratiques, vol. xlviii., pp. 377-380.