ment, even although he then laboured and acted under the influence of an insane delusion. And accordingly the answer to the second question expressly says, "that before a plea of insanity should be allowed, undoubted evidence ought to be adduced that the accused was of diseased mind, and that, at the time he committed the act, he was not conscious of right or wrong." 'Nothing could justify a wrong act, except it was clearly proved the party did not know right from wrong. If that was not satisfactorily proved, the accused was liable to punishment." But farther, and conclusively as to a large class of cases, to the 4th question, "If a person under an insane delusion," &c.-the reply is such as to leave no room for doubting-" If the delusion was only partial," &c. ; to which is added, almost unnecessarily, one would imagine, “If the accused killed another,” &c. The 5th answer strikes me as being somewhat ambiguous, or, rather, not in strict connexion with, or appropriate to, the question, which relates to the medical opinion itself; whereas, the Judges, in the first place, say that "the question could not be put to the witness in the precise form stated; " and then, that "when the facts were proved and admitted, then the question, as one of science, could be generally put to a witness, under the circumstances," &c. Now, what are these? The medical man is said to be "present during the whole trial and the examination of all the witnesses;" while, what is asked of him -not, be it observed, in any precise form-is simply "his opinion as to the state of the prisoner's mind at the time," &c. or, "whether the prisoner was conscious at the time," &c. or, whether he was labouring under any, and what delusion at the time. But, according to the supposition of the question, the medical man must have had the facts before him (he having been present, as above stated), or, in other words, the facts are supposed to be proved and admitted. When, then, do the Judges mean he is to be asked his opinion? Observe the very question, which is not to be put in the precise form, &c. In short, no small explanation is needed in the whole affair-more light, with greater distinctness of language; and I, for my own part, though willing to concur with Lords Brougham and Campbell, in saying that the House and the country were under great obligations to the Judges for the care and attention they had given to the subject, cannot honestly congratulate them on account of clear and satisfactory results.* * It is proper to mention that there are different versions of the opinions—a circumstance in itself unhappy, and calculated to bewilder the public mind, already distracted enough on this highly painful topic. In order to mitigate, or, rather, entirely arrest the censure which might visit daring opposition to the decrees of certain eminent legal authorities, I avail myself of some of the sentiments uttered, on a remarkable occasion, by the Hon. Thomas (afterwards Lord) Erskine. They are, in themselves, exceedingly cogent. He is alluding to Lord Chief Justice Hale, who held, that prisoners should be acquitted only when a total and permanent want of reason was proved; and to Mr. Justice Tracey, according to whom, a man, to be exempted from penal consequences, must be one that is totally deprived of his understanding and memory, and does not know what he is doing any more than an infant, than a brute, or a wild beast! Now, how did the eloquent and justly-successful advocate meet these sad dogmas? "If a total deprivation of memory (he of course comprehends 'understanding') was intended by these great lawyers to be taken in the literal sense of the word: if it was meant that to protect a man from punishment, he must be in such a state of prostrated intellect as not to know his name, nor his condition, nor his relation towards others; that, if a husband, he should not know he was married, or, if a father, could not remember he had children; nor know the road to his house, or his property in it,-then no such madness ever existed in this world." Again. "In all the cases which have filled Westminster Hall with the most complicated considerations, the lunatics and the other insane persons who have been the subject of them, have not only had memory, in my sense of the expression; 433 We are again indebted to Dr. Pliny Earle for the subjoined analysis, published in the last number of our able contemporary, the " American Journal of Medical Science," of the reports of the principal American Asylums for the Insane. Commencing with the Maine Asylum, it appears that the number of Deaths from apoplexy, 4; consumption, 3; general paralysis, 6; pneumonia, 1; and laryngitis, I. No epidemic prevailed, and no suicide occurred during the year. We commend to the physicians of other asylums the method pursued by Dr. Harlow, in reporting the complete list of patients. The following is a synopsis of it. they have not only had the most perfect knowledge and recollection of all the relations they stood in towards others, and of the acts and circumstances of their lives, but have in general been remarkable for subtlety and acuteness. He Erskine knew perfectly well, as matter of fact, that persons, truly and fully answering to the requirement of law-namely, being "wholly deprived of understanding and memory"-not knowing what they are doing any more than infants, than brutes, or wild beasts," scarcely ever appear in any court whatever. says, indeed, "these cases are not only extremely rare, but never can become the subjects of judicial difficulty. In other cases, reason is not driven from her seat, but distraction sits down upon it along with her, holds her trembling upon it, and frightens her from her propriety," an admirable and strikingly characteristic portrait of the malady, at least in one of its forms. (See more in "State Trials," vol. xxvii., Hadfield's Case.) I shall again and again have to trace the same features without dread of rebuke. 1. Of the Maine Insane Hospital, at Augusta, for 1853. 2. Of the Massachusetts Lunatic Hospital. at Worcester, for 1853. 3. Of the New York Insane Asylum, at Utica, for 1853. 4. Of the Bloomingdale Asylum, New York City, for 1853. 5. Of the New Jersey Lunatic Hospital, at Trenton, for 1853. 6. Of the Pennsylvania Hospital for the Insane, near Philadelphia, for 1853. 7 of the Pennsylvania State Hospital, at Harrisburg, for 1853. 8. Of the Western Asylum of Virginia, at Staunton, for 1853. Of these, 71 were homicidal, and 129 suicidal; yet no accident has ever occurred from either of the former, and but two of the latter have destroyed themselves at the asylum. One of the homicidal men, removed from the institution against the advice of its officers, killed a man with an axe, in September, 1853. Another wing for female patients is to be added to the establishment. 2. The Massachusetts State Lunatic Hospital went into operation in 1833. Under the energetic executive guidance of the late Dr. S. B. Woodward, it soon became very extensively known; and it has generally been esteemed, even to a comparatively recent period, not only as one of the best conducted, but also as one of the best constructed establishments of the kind in the country. But its Trustees now assert, in their report prefixed to that of Dr. Chandler, that it "has not only ceased to be regarded as a model institution, but it has fallen into the rear-rank in the march of improvement." The halls are "low studded, being only eight and a half and nine feet high. They are warmed by furnaces, which are very dangerous, and now nearly worn out. Their ventilation is so imperfect as not to deserve the name. The frequent occurrence of erysipelas is but one of the indices" of these defects. "There are forty-eight strong-rooms, or cells, nearly all of them constructed of solid masonry, with iron doors.' Some of them "are totally unfit for human habitations. There is an entire want of suitable yards (airing courts) connected with the buildings." دو For these reasons, the Trustees, after having visited twenty-six public institutions, ten of them for the insane, in several of the States, recommend the construction of another establishment, and the evacuation and sale of that which now exists. "The Superin Let us follow these gentlemen in their tour of observation. tendents of the Lunatic Hospitals laid us under particular obligations for their generous courtesy, and the very frank and unreserved manner in which they exhibited their establishments, together with their methods of management and modes of treatment, pointing out improvements and criticizing defects. * * * No cell was found without a wooden floor, a wooden door, and plastered or ceiled walls. There is not a brick and mortar cell, with iron doors, in either of the public establishments of the great States of New York and Pennsylvania, nor in the New Jersey State Lunatic Hospital, the design of which is quite generally regarded as a model. 'In the large establishment on Blackwell's Island, containing at the time of our visit, 574 patients, but two were found locked up, and those only temporarily, for a part of the day. The Superintendent, Dr. Rawney, stated that half-a-dozen strong rooms would be sufficient for that establishment, as not more than five or six a day were ever locked up, and those only for a few hours at a time. These rooms were used as sleeping apartments, and did not differ materially, in size, form, and appearance, from the other rooms occupied by patients, except the doors, which were stronger. These remarks in reference to the strong rooms are applicable to all the other establishments visited by us. In nine hospitals out of New England, containing about 2250 patients, the number found under restraint, by being locked up, was only six. In one instance only had that restraint been continued more than two days, and that one had not exceeded a week. "In the State Hospital, at Utica, but one person was found under restraint, and that one was confined in what they called a chicken-coop bedstead. There, they were in the process of demolishing their strong rooms, as useless. Their hospital was built some ten years after ours, and their strong rooms were comfortable apartments compared with ours, having wooden floors and plank doors, and were each furnished with a bedstead and bed. "There are no more perfectly warmed and ventilated establishments in the country than the New York Hospital, the Pennsylvania Hospital, the New Jersey State Lunatic Hospital, the State Lunatic Hospital at Harrisburg, and the State Lunatic Hospital at Utica. In all these establishments, steam is the agent employed, and it gives perfect satisfaction. The plan at Utica, being the most recent, is believed to combine more of modern improvements than any other. The Hospital at Utica, in all its appointments, may justly be regarded as a model institution, although its ground plan, in our opinion, is inferior to that of Trenton and Harrisburg." That the buildings of the Massachusetts Hospital are very defective as compared with those of the institutions of recent origin, there can be no doubt; but it is very evident that the Trustees have placed those defects in as bold relief as possible, by exhibiting them in the light of the broadest contrasts. In reference to the practical application of the doctrines of Pinel, the Trustees make the following remark :-- "Dr. Tuke, being the Superintendent, and possessing the whole control, found but little difficulty in testing them in practice at the York Retreat." No "Dr. Tuke," and no man named Tuke, was ever Superintendent of that Institution. We never heard, in England, of any Doctor Tuke.* This is not the first time, however, that a myth of that name has been introduced into the profession, by persons on this side of the Atlantic. Samuel Tuke, for many years one of the Trustees of the Retreat, and well known by his publications upon insanity, was a tea-merchant, in York. Of the occupation of his ancestor, who was a member of the first Board of Trustees, we know nothing. We now come to the report of Dr. Chandler. Patients in the Hospital, Dec. 1, 1852 Men. Women. Total. 264 268 532 Admitted in the course of the fiscal year 288 Whole number Discharged, including deaths. Remaining November 30, 1853 Of those discharged, there were cured Died No patients were received excepting such as were sent by order of the Courts, or by the Overseers of the Poor of towns. The Hospital was intended for a number of patients not exceeding 400; yet, at one time in the course of the year, there were 567. Of the 520 at the close of the year, 216 were foreigners; that is, not natives of Massachusetts; and of the latter number, 140 were Irish. "The Irish," says the report, "are almost invariably State paupers. Only three instances have come to my knowledge of their bills, or any part of their bills, having been paid by themselves, or by their friends." Causes of Death.-"Marasmus, 78; consumption, 58; apoplexy and palsy, 53; maniacal exhaustion, 49; epilepsy, 45; disease of heart, 20; discase of brain, 20; suicide 19; lung fever, 18; diarrhoea, 18; erysipelas, 15; old age, * Dr. Pliny Earle is not aware that there is a Dr. Tuke residing near London. + In one table the report gives but 491. The number of admissions in 1835, is stated in one place as 113, in another, 119. This discrepancy affects the whole number, making it but 4458, if the 113 be correct. We have quoted from the table in which the number of each sex is given. 13; typhus fever, 11; dysenteric fever, 9; inflammation of the bowels, 8; dropsy, 8; hæmorrhage, 6; gastric fever, 5; cholera, 4; cholera morbus, 4; chronic dysentery, 4; mortification of the limbs, 3; disease of the brain from intemperance, 3; bronchitis, 3; hydrothorax, 3; congestive fever, 2; convulsions, 2; land scurvy, 1; concussion of brain, 1; disease of the bladder, 1; fright, 1; rupture, 1; asthma, 1; cancer, 1; pleurisy, 1; jaundice, 1; chorea, 1." Dr. Chandler gives a table, in which 406 of the patients who died are included, showing the relationship of insanity to longevity. Its substance is as follows: Average age of 201 males when attacked. Average duration of insanity before admission, 201 males Average duration of life after admission, 201 males 260 Years. Months. Days. 42 8 10 39 1 10 40 11 1 9 24 Average duration of life after admission, 205 females 416 314 Average age at death, 201 males "The chance of life," says the report, "for persons in health at corresponding periods, as calculated and acted upon by life-insurance companies, is four times greater than is here exhibited for the male, and more than five times greater for the female. This shows pretty conclusively that insanity, when not recovered from, tends to shorten life." 3. The movement of patients at the New York State Asylum, in course of the fiscal year ending November 30, 1853, was as follows: Deaths from phthisis, 11; exhaustion, 7; general paralysis, 5; epilepsy, 3; exhaustive manía, 2; apoplexy, cerebral effusion, tumour of brain, pericarditis, hypertrophy and dilatatation of heart, typhoid fever, dysentery, chronic diarrhoea, phlegmonous erysipelas, erysipelas from wounds received prior to admission, contusions received before admission, 1 each. "The seven cases reported as having died of exhaustion, were wasted by disease or vicious habits. Three of them, at the development of mania, had been purged, blistered, and profusely bled, and were brought to the Asylum on beds. This injudicious treatment cannot be too strongly condemned. The recuperative powers in these were so far exhausted, that no amount of care, stimulation, and nutrition could arouse them. It may be proper to state that a number of persons received in a state of extreme feebleness, after long nursing, watchfulness, and free stimulation, recovered." |