MENTAL UNSOUNDNESS
In the whole range of medical jurisprudence there is no subject more
interesting, more difficult, or more important than the diagnosis
of insanity, and its relation to the criminal responsibility of
individuals. It is impossible, in the short space at our disposal, to
do more than to offer a few remarks which may assist the student in the
elucidation of some of the most important cases which may engage his
attention.
=Legal Definitions.=--Three forms of mental disorder are recognised in
law:
1. _A nativitate, vel dementia naturalis_--idiocy or imbecility.
2. _Dementia accidentalis, vel adventitia_--acquired general
insanity, either temporary or permanent, lunacy.
3. _Dementia affectata_, acquired madness from intoxication, &c.
(See “Delirium Tremens,” p. 205.)
Under the term lunacy are included the mania, monomania, and dementia
of medical writers. Another term frequently used in legal proceedings,
the meaning of which it is not easy to give, is “_non compos mentis_,”
_unsoundness of mind_. According to the late Forbes Winslow,
“unsoundness of mind is not lunacy” in the legal acceptance of the
phrase. This term was first used in a Statute passed in the reign of
Henry VIII., relating to the punishment of treasonable offences, and
is defined by the early law text-books to be strictly one who _gaudet
lucidis intervallis_--a definition not psychologically exact. The
phrase “unsoundness of mind” was first used by the late Lord Eldon to
designate a state of mind not exactly idiotic, and not lunatic with
delusions, but a condition of intellect occupying a place between the
two extremes, and unfitting the person for the government of himself
and the management of his affairs.
The above definition has been acted upon by other judges--Lyndhurst,
Brougham, &c. As a rule, a medical witness will consult his own
interest in not attempting to define insanity, bearing in mind the
philosophic caution of Polonius, who, when addressing Hamlet‘s mother,
says--
“Your noble son is mad:
Mad call I it; for, to define true madness,
What is‘t but to be nothing else but mad?”
To the legal mind, the chief character of insanity is the presence of
_delusion_; but this view is far too restricted. It was first advanced
by Erskine in the trial of Hadfield. Before that trial the doctrine
was that every man was responsible for his acts, unless he was totally
deprived of his understanding and memory, and did not know what he was
doing, “no more than an infant, than a brute, or a wild beast” (R.
_v._ Arnold). In the case of Bellingham, the knowledge of “right” and
“wrong” in the abstract was the test of mental unsoundness; and, as in
the opinion of the judge and jury he was held to be capable of solving
this metaphysical problem, Bellingham was duly hanged.
Since the trial and acquittal of MacNaughton on the ground of insanity,
the doctrine of the knowledge of abstract right and wrong has been
changed to a knowledge of right and wrong in relation to the particular
act of which the person is accused, and also at the time of committing
it.
It has also been held that, on the assumption that a person labours
under partial delusion only, and is not in other respects insane, he
must be considered in the same situation as to responsibility as if
the facts, with respect to which the delusion exists, were real. For
example, if, under the influence of delusion, he supposes another man
to be in the act of attempting to take his life, and he kills that man,
as he supposes, in self-defence, he would be exempt from punishment.
If his delusion were that the deceased had inflicted a serious injury
on his character and fortune, and he killed him in revenge for such
supposed injury, he would be liable to punishment. “Here,” says
Maudsley, “is an unhesitating assumption that a man, having an insane
delusion, has the power to think and act in regard to it _reasonably_,
... that he is, in fact, bound to be reasonable in his unreason, sane
in his insanity.” Yet this was the doctrine laid down by the judges
in answer to certain questions propounded by the House of Lords after
the acquittal of MacNaughton (see Maudsley‘s _Responsibility in Mental
Disease_, pp. 88 _et seq._).
As laid down by English lawyers, madness absolves from all guilt in
criminal cases. Where the deprivation of the understanding and memory
is total, fixed, and permanent, it excuses all acts; so, likewise,
a man labouring under adventitious insanity is, during the frenzy,
entitled to the same indulgence, in the same degree, as one whose
disorder is fixed and permanent (Beverley‘s Case, Co. 125, Co. Litt.
247, 1 Hale 31). “But the difficulty in these cases is to distinguish
between a total aberration of intellect and a partial or temporary
delusion merely, notwithstanding which the patient may be capable of
discerning right from wrong; in which case he will be guilty in the eye
of the law, and amenable to punishment.”[17]
[17] Archbold‘s _Criminal Cases_.
Lord Hale, who first pointed out the distinction to be drawn between
total and partial insanity, offered the following as the best test
he could suggest: “Such a person, as labouring under melancholy
distempers, hath yet as great understanding as ordinarily a child of
fourteen years hath, is such a person as can be guilty of felony.” (On
this subject, see R. _v_. Ld. Ferrers, 19 St. Tr. 333; R. _v_. Arnold,
16 St. Tr. 764, &c.)
To excuse a man from punishment on the ground of insanity, it
appears that it must be distinctly proved that he was not capable of
distinguishing right from wrong, and that he did not know, at the time
of committing the crime, that the offence was against the laws of _God_
and _nature_ (R. _v_. Offord, 5 C. & P. 186).
I shall here quote from Macdonald‘s _Criminal Law of Scotland_:
“Insanity or idiocy exempts from prosecution. But there must be an
alienation of reason such as misleads the judgment, so that the person
does not know ‘the nature of the quality of the act’ he is doing, or if
he does know it, that he does not know he is doing what is wrong. If
there be this alienation, as connected with the act committed, he is
not liable to punishment, though his conduct may be otherwise rational.
For example, if he kill another when under an insane delusion as to
the conduct and character of the person--_e.g._ believing that he is
about to murder him, or is an evil spirit,--then it matters not that he
has a general notion of right and wrong. For, in such a case, ‘as well
might he be utterly ignorant of the quality of murder.’ He does the
deed, knowing murder to be wrong, but his delusion makes him believe he
is acting in self-defence, or against a spirit. Nor does it alter the
effect of the fact of insanity at the time, that the person afterwards
recovers.... But the alienation of reason must be substantial. Oddness
or eccentricity, however marked, or even weakness of mind, will not
avail as a defence. Even monomania may be insufficient as a defence,
where the delusion and the crime committed have no connection, or where
the person, though having delusions, was yet aware that what he did was
illegal.”
Mere moral insanity--where the intellectual faculties are sound, and
the person knows what he is doing, and that he is doing wrong, but has
no control over himself, and acts under an uncontrollable impulse--does
not render him irresponsible (R. _v_. Burton, 3 F. & F. 772). Some
medical writers contend that there are two forms of insanity--moral and
intellectual. The law only recognises the latter, owing probably to
the difficulty of distinguishing between so-called moral insanity and
moral depravity. Taylor says: “Further, until medical men can produce
a clear and well-defined distinction between moral depravity and moral
insanity, such a doctrine, employed as it has been for the exculpation
of persons charged with crime, should be rejected as inadmissible.”
The day may not be far distant when the term “moral depravity” will
be unknown, and future generations, ceasing to believe in absurd
superstitions, will come to look on crime as the result of disease
of the brain, and learn to treat, instead of to punish, the morally
diseased. (For a full discussion of this subject the reader is referred
to the works of Dr. Henry Maudsley.)
The fact of the sanity or insanity of the prisoner at the time the
crime was committed is left to the jury to decide, guided by the
previous and contemporaneous acts of the party; and it has been laid
down by Lord Moncreiff in Scotland, and Lord Westbury in England,
that the mental soundness or unsoundness of any individual is to be
decided by the jury on the ordinary rules of every-day life, and that
on these principles they are as good judges as medical men. The whole
tendency of legal practice, when dealing with the plea of insanity, is
to entirely ignore the medical evidence. On the question of medical
evidence in cases of insanity, Doe J., of New Hampshire, remarks: “At
present, precedents require the jury to be instructed by experts in
new medical theories, and by judges in old medical theories,” and that
in this “the legal profession were invading the province of medicine,
and attempting to install old exploded medical theories in the place
of facts established in the progress of scientific knowledge. If the
tests of insanity are matters of law, the practice of allowing experts
to testify what they are should be discontinued; if they are matters
of fact, the judge should no longer testify without being sworn as a
witness, and showing himself qualified to testify as an expert.”
=Lunacy--What Constitutes?= (8 and 9 Vict. c. 100, secs. 90 and
114).--Imbecility and loss of mental power, whether arising from
natural decay, or from paralysis, softening of the brain, or other
natural cause, and although unaccompanied with frenzy or delusion of
any kind, constitute unsoundness of mind, amounting to lunacy within
the meaning of 8 and 9 Vict. c. 100 (R. _v_. Shaw, 1 C.C. 145).
The above is the last definition of lunacy up to 1875; but as the law
on this subject is so constantly changing, the student will find it
best to consult the _Law Reports_ from time to time. (See the account
in the case of R. _v_. Treadaway, _Law Reports_. Also the _Lancet_, on
the same case, vol. i. 1877.)
For some valuable remarks on the subject of the irresponsibility of
madmen, the student is referred to the works of Maudsley, Pritchard,
Ray, Hoffbauer, Georget, and others.
The following suggestions are offered for consideration on this subject:
1. Was the act an isolated event in the life of the culprit? Has it the
appearance of spontaneity, or was it the culminating point of a life
spent in so-called criminal acts?
2. _Absence of a motive for the committal of the deed._--The absence
of an _apparent_ motive is no proof of an unsound mind; the moving
principle may be _“the conscious impulse to the illegal gratification
of a selfish desire_.”
3. _The presence or absence of a well-concerted plan of action is
a diagnostic sign of little value._--Casper remarks that “only in
one case can the examination of the systematic planning of the deed
afford any information, and that is when these plans and preparations
themselves evince the stamp of a confused intellect, and betray the
hazy consciousness, the mental darkness, in which the culprit was
involved.”
4. _A dominant delusion may be so concealed as to be for a time
undiscoverable._--The case of the man who gave no indication of his
madness till he was asked to sign the order for his release, when
he signed _Christ_, is an example how carefully a delusion may be
concealed even during a most careful examination. Questions directed to
this point showed that he laboured under all the errors which such a
delusion might suggest.
5. It may “easily be conceived that insane persons, whose unreason
affects only one train of thought more or less restricted, yet labour
in other respects under disorders of feeling which influence their
conduct and their actions and behaviour without materially affecting
their judgment: and that many of such deranged persons, who often
conduct themselves tolerably well in a lunatic asylum, and while living
among strangers with whom they have no relations, and against whom
they have no prejudices or imaginary reason of complaint; subjected,
besides, to the rules of the house and to an authority that nobody
attempts to dispute; would, nevertheless, if restored to liberty
and residing in the midst of their families, become insupportable,
irritable at the slightest contradiction, abusive, impatient of the
least remark on their conduct, and liable to be provoked by trifles to
the most dangerous acts of violence. If, under such circumstances, a
lunatic should commit any act of injury or serious damage to another,
would it be just to punish him; because it cannot be made apparent that
the action has any reference to, or connection with, the principal
delusion which is known to cloud his judgment, it being apparent that
his moral faculties have undergone a total morbid perversion?”
6. _Insanity with Lucid Intervals._--Haslam, Ray, and others appear
to deny the possibility of lucid intervals; but M. Esquirol, on the
other hand, fully recognises the existence of this form of insanity.
In a legal sense, a temporary cessation of the insanity constitutes
a lucid interval, but the cessation must be complete, and not merely
a remission of the symptoms. The interval must be of some duration;
and when continuous insanity has been proved, the onus of proving a
lucid interval in civil cases rests with the party trying to support
the validity of a deed executed during the alleged interval. “If
you can establish,” says Sir W. Wynne, “that the party afflicted
habitually by a malady of the mind has intermissions, and if there was
an intermission of the disorder at the time of the act, that being
proved is sufficient, and the general habitual insanity will not affect
it, but the effect of it is this--it inverts the order of proof and
presumption; for, until proof of habitual insanity, the presumption
is that the party agent, like all human creatures, was rational; but
when an habitual insanity in the mind of the person who does the act is
established, then the party who would take advantage of the fact of an
interval of reason must prove it.” In civil cases the law recognises
the validity of wills made during lucid intervals, and has even taken
the reasonableness of a will as a proof of a lucid interval.
7. Have measures been taken by the culprit to escape punishment?
The classification of insanity adopted here is that given by Ray, and
is sufficient for all practical purposes:
{ 1. Resulting from
{ congenital defect.
{ 2. Resulting from an
{ obstacle to the
{ Defective { _Idiocy_ { development of the
{ development { { faculties supervening
{ of the { { in infancy.
{ faculties. {
{ { { 1. Resulting from
{ { { congenital defect.
{ { { 2. Resulting from an
{ { _Imbecility_ { obstacle to the
{ { { development of the
{ { { faculties supervening
{ { { in infancy.
INSANITY. {
{ Lesion of { { 1. Intellectual--
{ the faculties { { (_a_) General.
{ subsequent { _Mania_ { (_b_) Partial.
{ to their { { 2. Affective--
{ development. { { (_a_) General.
{ { { (_b_) Partial.
{ {
{ { { 1. Consecutive to mania,
{ { { or injuries of
{ { _Dementia_ { the brain.
{ { { 2. Senile, peculiar to
{ { { old age.
DEFECTIVE DEVELOPMENT OF THE FACULTIES
Under this heading may be included idiocy, cretinism, imbecility,
feeble-mindedness, and moral imbecility.
=Idiocy= is congenital, and was defined by Esquirol thus: Idiocy is
not a disease, but a condition in which the intellectual faculties are
never manifested, or have never been developed sufficiently to enable
the idiot to acquire such an amount of knowledge as persons of his own
age, and placed in similar circumstances with himself, are capable of
receiving. Idiocy commences with life, or at an age which precedes
the development of the intellectual and affective faculties, which
are from the first what they are doomed to be during the whole period
of existence. Since the days of Esquirol, much improvement has been
made in the care and treatment of the idiot; and it appears that he is
capable of some, though in most cases slight, mental culture. The cases
in which improvement takes place probably belong to imbecility, leaving
the _idiot_ in the same condition as described by Esquirol.
=Cretinism= differs from idiocy in being endemic; it is also more
curable, or at least more susceptible of improvement, than the latter.
In the idiot the malady is congenital; the cretin, on the other hand,
may to all appearances be free from disease for a time. “Every cretin
is an idiot, but every idiot is not a cretin; idiocy is the more
comprehensive term, cretinism is a special kind of it.” The enlarged
thyroid gland, high-arched palate, and brown or yellow colour of the
skin, are characteristic of the cretin. Local causes are at work in the
production of cretinism; _e.g._ defective function of the thyroid gland.
The idiot is usually cunning, mischievous, and dirty in his habits.
The derivation of the word idiot, from the Greek, ἰδιώτης --_a private
person_, or _an ill-informed ordinary fellow_--is peculiar. A person
suffering from any form of mental unsoundness, and thereby rendered
incapable of taking care of himself or of his property, was formerly
called by English law “an idiot,” and this word was not infrequently
joined with “fatuus” in old writs.
=Imbecility.=--This is a minor form of idiocy, and may or may not be
congenital. It admits of considerable degrees of intensity. Imbeciles
exhibit mental defection, rendering them incapable of managing
themselves or their affairs, and imbecile children are incapable of
being taught to do so.
=Feeble-mindedness= is a lesser degree of mental defection than
imbecility. It may exist from birth or an early age. Such persons
require care and control for the protection of themselves and others.
They may be incapacitated from acquiring the knowledge imparted in
ordinary schools.
=Moral imbeciles= exhibit moral defects which render them vicious in
behaviour, and they often exhibit criminal tendencies, which are not
affected by punishment.
CARE OF MENTALLY DEFECTIVE PERSONS
The Mental Deficiency Act of 1913 provides for their care. Such a
person may be either sent to an institution or placed under special
guardianship by the parent or guardian, if an idiot or imbecile;
or by the parent when, though not an idiot or imbecile, the person
affected be under the age of twenty-one years. If in addition to being
a defective, the person is neglected, abandoned, or without means of
support; or cruelly treated, guilty of a criminal offence, or liable to
be sent to an industrial school, or under imprisonment, detained in an
industrial school, inebriate reformatory, or institution for lunatics,
or habitual drunkard within the meaning of the Inebriates Act; or
in whose case proper notice has been given by the Local Education
Authority; or who is in receipt of relief at the time of giving birth
to an illegitimate child, or pregnant of such child.
=Certificates required.=--In the case of a parent or guardian who
desires to place a mentally defective person under guardianship, _two
medical certificates_ are necessary, one of which must be from a
medical man approved by the Local Authority or Board. If the person be
not an idiot or imbecile, the certificates must be signed by a Judicial
Authority, after such inquiry as he thinks fit. A defective to be
dealt with otherwise than by parent or guardian, is so under an order
by a _Judicial Authority_ on a petition presented under the Act, an
order of a _Court_ if guilty of a criminal offence, or an order of the
Secretary of State if detained in prison, a criminal lunatic asylum, or
reformatory.
The order of a Judicial Authority may be obtained by petition of any
relative or friend, or an officer of the Local Authority authorised
under the Act for the purpose. Two medical certificates must accompany
the petitions, one of which must be signed by a medical man approved
by the Local Authority or Board; or, when a medical examination cannot
be carried out, a certificate to that effect must be presented, and
a statutory declaration made by the petitioner and one other person,
who may be one of the medical certifiers, stating the class to which
the defective belongs. Upon receiving the certificates the Judicial
Authority interviews the defective. When the petition is presented by
a parent or guardian, the Judicial Authority, if satisfied, may issue
an order for the defective to be placed in an institution or appoint
a guardian. If the petitioner be not parent or guardian, consent in
writing of one or other must be obtained, without which the order must
not be made, unless the parent or guardian withhold their consent
unreasonably or are not to be found. If the Judicial Authority be not
satisfied, he may postpone the order, or refuse it.
When the order is made by a Court, the Court must be satisfied, on
medical evidence, that the person is a defective.
Two medical certificates are necessary when the Secretary of State
makes an order.
The order remains in force for a year, may be renewed for a second
year, and then for periods of five years.
GENERAL SYMPTOMS OF INSANITY
The onset of insanity may be gradual or sudden. More commonly the onset
is gradual, and manifested by alterations of emotion and conduct, which
may for a considerable period precede any impairment of intelligence.
Periods of depression may alternate with periods of excitement.
Irritability and instability of temper manifest themselves, and lead
relatives and friends to become suspicious of the change that is the
herald of serious mental impairment. Lack of interest in environment,
business, or the usual pleasurable pursuits, also a tendency to
personal seclusion manifest themselves, and changeability of the
affections, more often to those nearly related, are not uncommon.
Sooner or later the capacity to conduct business and allied pursuits
becomes enfeebled, and the power of judgment lessened; depression
begets apprehension and a dread of impending ruin in this world or
in the world to come. Marked indecision and vacillation of action is
quite common. Delusions follow, mostly of persecution, in the form of
attempts to cause ruin or poisoning. Delusions associated with the
special senses are common, particularly of hearing, supposed voices
urging the committal of certain actions, or expressive of derision; of
vision, by which objects are seen which are non-existent; of taste,
imparting the idea of poisoning; of touch and pain, invoking peculiar
sensations; of smell, conveying the idea that food, the body, &c.,
exhale disgusting odours.
Associated with the onset of insanity, and remaining permanently,
are three special distortions of perceptions--viz. _illusions_,
_hallucinations_, and _delusions_. So long as the first two can be
reasoned upon and rejected, judgment remains. At one or other time
the afflicted person becomes so affected by them that they become
realities, and are accepted as true and existent; then the judgment is
perverted, and the person is said to suffer from a delusion.
_Illusions._--An illusion is a false perception, a perversion of
the senses, a mockery, false show, counterfeit appearance. The false
perception is, however, invoked by some external appearance.
_Hallucinations._--Hallucinations are perverted sensations and
perceptions, for the production of which no external impulse is
present. The person may complain of seeing horrible reptiles around,
which are not present. So long as the reasoning faculties are capable
of dispelling the alleged reality of the hallucination and rejecting
it, it remains but an hallucination.
If, however, it becomes accepted as a reality and the person becomes
obsessed thereby, it becomes a delusion.
_Delusions._--A delusion is a chimerical thought, an affection of the
mind. It implies a disordered intellect. Delusions generally concern
the insane person, his power, soul, &c. A delusion is a perverted
idea of the mind in which there is belief in non-existent things or
occurrences. Delusions may be based upon previous hallucinations, or
arise out of erroneous conceptions.
MANIA
=Mania= is the result of a morbid condition of the brain, and to
express which “the term raving madness may be used with propriety,
as an English synonym for mania. All maniacs display this symptom
occasionally, if not constantly, and in greater or less degree.” Like
other diseases, mania observes the same pathological laws. There is a
period of incubation, during which the true state of the patient is in
most cases misunderstood, or not appreciated. Mental exaltation may
exist from the first onset of the disease, or the attack may be ushered
in by a stage of gloom or despondency. The general health shows signs
of impairment, the liver becoming sluggish, and the bowels confined or
relaxed. In some cases a febrile condition of the system is among the
premonitory symptoms of an attack of mania. The physical health is not
usually much affected during the paroxysm.
Dr. Conolly remarks that “even acute mania is not always accompanied
by the ordinary external signs of excitement. It would seem as if we
had yet to learn the real symptoms of cerebral irritation. Certainly,
in recent cases of mania--cases which have lasted more than six weeks,
and in young persons in whom I have seen the maniacal attack pass
into dementia--I have known the most acute paroxysms of mania exist,
rapid and violent talking, continual motion, inability to recognise
surrounding persons and objects, a disposition to tear and destroy
clothes and bedding, without any heat of the scalp or of the surface,
without either flushing or paleness of the face, with a clean and
natural appearance of the tongue, and a pulse no more than eighty or
eighty-five.”
This may occur in some cases, but in the majority there is always some
amount of physical derangement; the system, however, gradually becoming
tolerant of the undue excitement to which it is subjected.
Following the classification adopted, Intellectual Mania will now be
briefly considered under its two divisions--_General_ and _Partial_.
=General Intellectual Mania.=--By many medical writers general
intellectual mania is divided into mania and melancholia. The mind
in the former type of the disease is involved in the most chaotic
confusion possible, and there is also considerable bodily derangement.
The moral faculties become more or less affected, and the patient‘s
social and domestic relations are greatly altered. At one time he
is subject to violent fits of immoderate laughter, at another he is
gloomy and taciturn; sometimes quiet and tractable, at others wild
and excited, necessitating close confinement. He is haunted by wild
delusions, which at times take entire possession of him, and under
the influence of which he acts in the most extraordinary manner. In
the latter--melancholia, or mania with depression--delusion may be
absent, or, rather, for a time undetectable. The sufferer is gloomy,
and troubled with unhappy thoughts, which sometimes lead him to
self-destruction. He is sleepless, and rejects his food as unnecessary.
He may be aroused for a short time by questions addressed to him,
his replies to which are usually given correctly, most frequently in
monosyllables; but the moment his questioner leaves him he relapses
into his former gloomy state.
=Partial Intellectual Mania.=--The term _monomania_, first suggested
by Esquirol, is now generally given to this variety of insanity. The
patient, in the simplest form of this disorder, becomes possessed of
some single notion, which is alike contradictory to common sense and
to his own experience. Thus, he may fancy himself made of glass; and
influenced by this idea, he walks with care, and in dread of being
broken by contact with other bodies. In the case of an inmate at
the City of London Asylum, the presence of a weasel in the stomach
was stated by one woman. Esquirol mentions the case of a woman with
hydatids in her womb, who believed that she was pregnant with the
devil. Most of these strange fancies appear to be dependent on errors
of sensation.
Monomaniacs are ready enough to declare their predominant idea; yet
at times, and that without the occurrence of a lucid interval, they
will as carefully conceal it. “In the simplest form of monomania, the
understanding appears to be, and probably is, perfectly sound on all
subjects but those connected with the hallucination. When, however, the
disorder is more complicated, involving a longer train of morbid ideas,
we have the high authority of Georget for believing that, though the
patient may reason on many subjects unconnected with the particular
illusion on which the insanity turns, the understanding is more
extensively deranged than is generally suspected.”
MORAL MANIA
Pinel first drew attention to this form of madness. Pritchard defines
it as “consisting in a morbid perversion of the natural feelings,
affections, inclinations, temper, habits, and moral dispositions,
without any notable lesion of the intellect or knowing and reasoning
faculties, and particularly without any maniacal hallucinations.”
It is divided into--_General_ Moral Mania. _Partial_ Moral Mania.
=General Moral Mania.=--“There are many individuals,” says Pritchard,
“living at large, and not entirely separated from society, who are
affected in a certain degree with this modification of insanity. They
are reputed persons of a singular, wayward, and eccentric character. An
attentive observer will often recognise something remarkable in their
manners and habits, which may lead him to entertain doubts as to their
entire sanity; while circumstances are sometimes discovered on inquiry
which add strength to this suspicion. In many instances it has been
found that a hereditary tendency to madness has existed in the family,
or that several relatives of the person affected have laboured under
other diseases of the brain. The individual himself has been discovered
to have suffered, in a former period of life, an attack of madness
of a decided character. His temper and disposition are found to have
undergone a change, or to be not what they were previously to a certain
time; he has become an altered man, and the difference has perhaps
been noted from the period when he sustained some reverse of fortune
which deeply affected him, or the loss of some beloved relative. In
other instances, an alteration in the character of the individual has
ensued immediately on some severe shock which his bodily constitution
has undergone. This has been either a disorder affecting the head, a
slight attack of paralysis, or some febrile or inflammatory complaint,
which has produced a perceptible change in the habitual state of his
constitution. In some cases, the alteration in temper and habits has
been gradual and imperceptible; and it seems only to have consisted in
an exaltation and increase of peculiarities which were always more or
less natural and habitual. Persons labouring under this disorder are
capable of reasoning, or supporting an argument upon any subject within
their sphere of knowledge that may be presented to them; and they often
display great ingenuity in giving reasons for the eccentricities of
their conduct, and in accounting for, and justifying, the state of
moral feeling under which they appear to exist. In one sense, indeed,
their intellectual faculties may be termed unsound--they think and act
under the influence of strongly excited feelings; and persons accounted
sane are, under such circumstances, proverbially liable to error,
both in judgment and conduct.” (For interesting cases of this form of
madness, see Ray‘s _Jurisprudence of Insanity_.)
=Partial Moral Mania.=--In the case of the unfortunate sufferers from
this malady, one or two only of the moral powers are perverted.
This division admits of several subdivisions:--
_Kleptomania._--A marked propensity to theft. “There are persons,”
says Rush, “who are moral to the highest degree as to certain duties,
but who, nevertheless, lie under the influence of some vice. In one
instance, a woman was exemplary in her obedience to every command of
the moral law except one--she could not refrain from stealing. What
made this vice more remarkable was, that she was in easy circumstances,
and not addicted to extravagance in anything. Such was the propensity
to this vice that, when she could lay her hands on nothing more
valuable, she would often, at the table of a friend, fill her pockets
secretly with bread. She both confessed and lamented her crime.”
_Pyromania._--This consists in an insane impulse to set fire to
everything--houses, churches, and property of every kind and
description.
_Erotomania and Nymphomania._--This is known as amorous madness,
and consists in an inordinate and uncontrollable desire for sexual
intercourse. The unfortunate victims of this disease often express the
greatest disgust and repugnance for their conduct.
_Homicidal Mania_--In this form of madness the propensity to homicide
is very great, and in most cases uncontrollable. In the case of the
notorious Deeming, hanged in Australia in 1892 for the murder of his
wife, an appeal was made from the finding of the Colonial Court by
which he was tried to the Privy Council, on the ground of his being
affected with homicidal mania. The plea was not sustained. (See the
case of Henrietta Cornier, given by Pritchard, Ray, and others.)
The following suggestions may be of assistance in forming a diagnosis
as to the existence or non-existence of this form of madness:--
1. Previous history of the individual.--_Melancholy,
eccentric, morose, &c._
2. Absence of motive.--_Gain, jealousy, revenge, hatred, &c._
3. A number of victims are often sacrificed at one
time.--_The murderer, on the other hand, seldom sheds
more blood than is necessary for his success._
4. Proceedings of the murderer before and after the
crime.--_Absence of attempts at concealment or escape
on the part of the madman._
5. Character of the victims.--_Not infrequently, in the
case of madmen, their victims are those whom, when sane,
they loved most, and to whom they were most attached._
_Suicidal Monomania, or the Propensity to Suicide._--Much discussion
has arisen on this subject. Suicide is not always the result of
unsoundness of mind. Some, like M. Esquirol, are inclined to consider
suicide as always a manifestation of insanity. In the present day, the
dislike of coroners‘ juries to bring in any other verdict but that of
“suicide whilst in a state of unsound mind” is proverbial.
MELANCHOLIA
This condition is associated with mental depression and delusions.
In its simple form, marked depression of spirits, apprehension of
evil, sleeplessness, loss of appetite, and impaired alimentation with
constipation are evident.
Delusions of ruin, of the committal of acts contrary to the laws of
God and man--“_the unpardonable sin_”--a marked inaptitude to carry on
the ordinary duties of life, indecision, and often unutterable misery,
are commonly exhibited. The delusions are fixed and may be multiple.
They may comprise persecution, by friends or others; that things are
happening which powerfully influence the person‘s life and body, or,
as is often the case, concern religious matters, and everlasting
punishment.
Suicidal tendencies are often present, and depend largely upon the
misery associated with the condition. Melancholics often conceal this
tendency, or may exhibit it in varied ways so as to hide the method
which has been definitely decided upon. Thus a person so afflicted may
be found in possession of poison at one time, a pistol at another, a
knife at another, when the real intention is that of drowning. Thus
it is necessary to keep an extremely careful watch on melancholics.
Homicidal tendencies are not common. In some cases the melancholia is
combined with _marked agitation._ The face depicts misery, the eyebrows
raised, and the person moves about incessantly, picking up objects and
replacing them, moaning and uttering the same phrases expressive of
misery and hopelessness, wringing the hands, and rocking the body to
and fro.
In other cases _stupor_ is predominant, and the person sits in silence
and in the same attitude. Some resent interference, others are easily
persuaded by their attendants to do certain acts, but when done relapse
again into stupor. They manifest extreme apathy. Suicidal tendencies
are a pronounced feature of such cases.
Melancholia and mania may alternate periodically, with lucid intervals
intervening. The term _circular insanity_ has been applied to this
alternate character of the disease.
DEMENTIA OR FATUITY
=Dementia= consists in a failure of the mental faculties, not
congenital, but coming on during life. “A man,” says Esquirol, “in a
state of dementia is deprived of advantages which he formerly enjoyed.
He was a rich man who has become poor. The idiot, on the contrary,
has always been in a state of want and misery.” In this state there
is always more or less coherence, and maniacal paroxysms are not
infrequent. In mania, incoherence may be present, but then it is
characterised by sustained and violent excitement. In dementia, on
the other hand, there is apparent torpor and exhaustion of the mental
faculties. Closely allied to this form of mental unsoundness is that
interesting disease known as “=general paralysis of the insane=,” or
perhaps a better term, _progressive paralysis of the insane._ It is
considered by some to precede the psychical derangement, a contrary
opinion being held by others. General paralysis may accompany any of
the forms of mental derangement, but it is generally preceded by a
stage of melancholy. As the paralytic affection becomes more marked,
there is a concurrent loss of memory and incapability of mental
association, and all sense of duty is lost; the patient becomes
careless as to his person, and dirty in his habits. He expresses
himself as possessed of great property, and boasts of the wonderful
deeds that he can or has accomplished. Gradually he sinks into a state
of complete mental and physical decay. He cannot give expression to
his thoughts, and has to be fed, the food being pushed into his mouth.
The symptom which first attracts the attention, and which is perhaps
the first order of sequence, is a modification in the articulation.
“This is neither stammering nor hesitation of speech. It more closely
resembles the thickness of speech observable in a drunken man. It
depends upon loss of power over the co-ordinate action of the muscles
of vocal articulation.” If the tongue be now examined, it will be
found that when it is protruded it is not inclined to one side, but
that it is tremulous, and is protruded and withdrawn in a convulsive
manner. Griesinger was the first to call attention to the fact, and his
statement has since been confirmed, “that this motory disorder is at
the commencement not so much paralytic as convulsive in its nature.”
The gait becomes unsteady, the patient walks stiffly, and stumbles
over the slightest unevenness in the floor. Step by step the paralysis
progresses, till at last the unfortunate sufferer takes to his bed, on
which he may lie for months. Sometimes, especially during the earlier
stages, he may suffer from terrible delusions, from maniacal paroxysms,
or from epileptic fits, the latter possessing certain peculiarities.
The tongue during the fit is seldom bitten, which is so commonly the
case in epilepsy; and the convulsions are not so general, being limited
more to one side than to the other. It is also remarkable that each fit
is in most cases followed by an increase of the mental derangement.
Pritchard recognises four stages of dementia or fatuity:--
_First Stage._--Forgetfulness and impaired memory. This is common
to old age. In most cases passing events produce little, if any,
impression, whilst the past is remembered with tolerable freshness.
_Second Stage._--Incoherence and unreason, characterised by a total
loss of the reasoning faculty.
_Third Stage._--Incomprehension. The person so affected is quite
incapable of comprehending the meaning of the simplest question; and
should he attempt to reply, his answer is generally remote from the
subject.
_Fourth Stage._--Inappetency. The animal instincts are lost. The
unfortunate sufferer lives, and that is all, being scarcely conscious
of life. Organic life is all that is left.
DELIRIUM TREMENS. SIMPLE DELIRIUM. SOMNAMBULISM. SLEEP-DRUNKENNESS.
=Delirium Tremens.=--A temporary form of insanity, the result of
excessive indulgence in spirituous liquors. The drunkard, under the
effects of intoxication, “can derive no privilege from a madness
voluntarily contracted, but is answerable to the law equally as if he
had been in full possession of his faculties at the time” (1 Hale 32;
Co. Litt. 247). The intoxication of the defendant may be taken as a
mitigating circumstance, showing that the deed was unpremeditated. A
person rendered incapable of using his reason by intoxication brought
about by others, is not liable for his actions.
=Simple Delirium.=--Acts performed during attacks of certain
diseases--fever, sunstroke, &c.--accompanied with delirium, do not
render the individual liable to punishment; and wills made during the
continuance of the disorder, if they contain no statement inconsistent
with the known wishes and desires of the party during health, are
valid, the law looking more to the good sense of the will as a proof of
a lucid interval, than to the proved existence of such lucid interval.
=Somnambulist, &c.=--This is an abnormal mental state, closely
allied to that artificially produced and known under the names of
mesmerism, hypnotism, electro-biology, &c. It is commonly known as
“sleep-walking.” In this condition the mind appears to become enslaved
by one train of ideas to the exclusion of all others; the somnambulist,
thus deeply bent on the accomplishment of a definite end, takes no heed
of those objects which are in no way connected with the dominant ideas
in his mind. Hence, he walks safely past dangers which, when awake,
would disconcert his judgment and weaken his will. Somnambulism appears
also to be closely connected with epilepsy. In 1878, a man named
Fraser was tried in Glasgow for the murder of his child by beating it
against the wall. He was acquitted on the ground of being unconscious
of the nature of his act by reason of somnambulism. He had sprung
from an epileptic and insane stock; his mother died in an epileptic
fit, and some of his other relatives were insane. Thus it appears,
if the somnambulism be proved, the accused is exonerated from any
responsibility connected with the act for which he is being tried. So
also, if a person be suddenly aroused from a deep sleep--_somnolentia_
or _sleep-drunkenness_--the question may be raised as to his
responsibility for an act committed at the moment of awakening (R. _v._
Milligan). There cannot be a doubt but that if a person be suddenly
aroused whilst dreaming, he may unconsciously commit acts, the outcome
of his dream, which, unless the possibility of this condition be
recognised, may entail severe punishment on him. This state is closely
allied to that mental condition which sometimes occurs in epileptics
immediately after a fit. But in this, as in cases of somnambulism, the
facts of the case would have to be most carefully scrutinised.
The following hints may be of use as a guide in determining the
responsibility or not of the accused:--
1. The person must be shown to have a general tendency to
deep and heavy sleep, out of which he can only be aroused
by a violent and convulsive effort.
2. Are there any circumstances which, happening before
the individual went to sleep, would produce a train of
disturbed thought not entirely composed by sleep?
3. Did the act occur during the usual hours for sleep?
4. Was the cause of the awakening sudden, and does the act
bear throughout the character of unconsciousness?
5. What were the subsequent acts of the accused in relation
to the deed? Did he try to evade responsibility? This
must not have too much stress laid upon it, for the
wretchedness of the sudden discovery may so overcome him,
that he may seek to shelter himself from the consequences
of an act for which he is legally but not morally
responsible.
THE RESTRAINT OF THE INSANE AND DIRECTIONS FOR SIGNING MEDICAL
CERTIFICATES.
No person can be put under restraint unless the conditions required by
the Lunacy Acts are fulfilled. The Acts of Parliament for this purpose
are the Lunacy Act of 1890 (53 Vict. c. 53) and that of 1891 (54 and
55 Vict. c. 65). Lunatics may be put under restraint by the following
procedures, according to the particular case:--
Reception Order on Petition.
Urgency Order.
Order after Inquisition.
Summary Reception Order.
Order for Lunatics Wandering at Large, and for Pauper Lunatics.
Reception Order by Two Commissioners.
=Reception Order on Petition.=--This is usually the procedure for
private patients. The order for petition may be obtained from a
specially appointed Justice of the Peace, Judge of County Courts, or
Magistrate. A petition for the order must be presented to the Judicial
Authority by the husband, wife, or relative of the alleged lunatic;
if any other person apply, the reasons for this must be given. A
petitioner must be twenty-one years of age or over, and must have seen
the alleged lunatic _within fourteen days_ before its presentation. A
_statement of particulars_ and two medical certificates must accompany
the petition. The proceedings are private, and no one except the
petitioner, the alleged lunatic, and any one person appointed by
him, and the two medical men who have signed the certificates, may
be present, unless by permission of the Judicial Authority. If the
Judicial Authority be satisfied, he may make the order at once, even
without seeing the patient, or he may appoint a time within seven days
for inquiries and consideration. He may visit the alleged lunatic.
At the time of consideration of the petition he may adjourn it for not
more than fourteen days, or he may make the order at the time. He may
summon further witnesses, or dismiss the petition, giving his reasons
for so doing in writing.
A reception order is valid for seven days from its date, unless the
lunatic is certified by a medical man to be unfit for removal, when the
order is extended until a medical certificate of fitness for removal is
obtained, which is valid for three days.
The medical men signing the certificates must not be in partnership,
as principal and assistant, or have any direct or indirect interest in
the patient or his keeping (16 and 17 Vict. c. 96, sec. 4). They must
make separate visits at different times for the purpose of examination.
Each medical man must have examined the person within seven clear days
before the presentation of the petition.
Each medical man must write clearly and in the proper place on the
certificate: (1) The facts observed by himself as evidence of insanity,
and (2) the facts observed by others as evidence of insanity. The name
of his informant must be given.
One of the certificates should, whenever practicable, be under the hand
of the usual medical attendant (if any) of the alleged lunatic. If not
practicable, the reason must be given by the petitioner to the Judicial
Authority.
Neither of the certifying medical practitioners may be the father or
father-in-law, brother or brother-in-law, sister or sister-in-law,
partner or assistant of the other of them.
Great care should be taken to follow carefully the marginal directions
on the certificate form. The most trivial omission will invalidate the
certificate. The omission of the name of the street and number of the
house is sufficient to set it aside. A medical man should remember
that, although his certificate may have passed the scrutiny of the
Commissioners, it is liable to be made the subject of discussion in
a Court of law, and in cross-examination he will have to support the
statements therein made.
The following certificate properly filled up by Dr. Millar of Bethnal
House Asylum, is given in his book on _Hints on Insanity_, and may be
taken as an example of a correct certificate at that time, the present
form being slightly different:--
MEDICAL CERTIFICATE PROPERLY FILLED UP
1. _Here set forth the_ I, the undersigned,
_qualification entitling the_ _John Millar_, being a (¹)
_person certifying to practise_ _Licentiate of the_
as a physician, surgeon, _or_ _Royal College of Physicians_,
apothecary. _Edinburgh_,
2. Physician, surgeon, _or_ and being in actual practice as
apothecary, _as the case_ a (²) _Physician_, hereby certify
_may be_. that I, on the _third_ day of
_November, One thousand eight
hundred and eighty-eight_,
at (³) 600 _Cambridge Road_,
3. _Here insert the street and_ _Bethnal Green_, in the county of
_number of the house (if any_), _Middlesex_, separately from any
or other like particular. other medical practitioner,
personally examined
_James Thompson, sen._, of
4. _Insert residence, and_ (⁴) 600 _Cambridge Road_,
_profession or occupation_ _Bethnal Green_, _gentleman_,
_(if any)._ and that the said _James Thompson,
sen._, is a person (⁵) _of unsound
5. Lunatic, _or_ an idiot, mind_, and a proper person to be
_or_ a person of unsound mind. taken charge of, and detained
under care and treatment; and that
I have formed this opinion upon
the following grounds, viz.:--
6. _Here state the facts._ 1. Facts indicating insanity
observed by myself (⁶)--
_He is incoherent in his
conversation, violent in his
conduct, and quite unable to
take care of himself_.
7. _Here state the information,_ 2. Other facts (if any)
_and from whom._ indicating insanity
communicated to me by
others (⁷)--
_His son, James Thompson, jun_.,
_informs me that he has_
_threatened to commit suicide_,
_and has twice attempted it_
_with a razor._
(Signed) Name--_JOHN MILLAR_.
Place of abode--_Bethnal House_, _Bethnal Green_.
Dated this _third_ day of _November_,
_One thousand eight hundred and eighty-eight_.
Table relating to “Facts” of Insanity,
(compiled from Millar.)
+----------------------------------------------+
| Facts offering no Evidence of Insanity. |
+----------------------------------------------+
| 1. Refuses to take her medicine and resists |
| in every way; closes her teeth; threatens |
| to strike every one near her; obliged to |
| use the strait-waistcoat. |
| |
| 2. Violent in her temper, and very abusive. |
| |
| 3. Moody and irritable temperament, and of |
| weak memory in many particulars. |
| |
| 4. General restlessness of manner; considers |
| himself heavily involved in debt to many |
| thousand pounds; says he has been ruined |
| by the Government, and that he intends |
| prosecuting the Admiralty for £5000 damages. |
+----------------------------------------------+
| Vague and Irrelevant Facts. |
+----------------------------------------------+
| 1. She is suspicious of her husband; says he |
| keeps bad company; she is most irritable and |
| jealous, and takes stimulating drinks to a |
| dangerous and exciting extent. |
| |
| 2. Obstinate; has the manner and appearance |
| of an insane person; complained of her head; |
| refused her food, and would not go |
| downstairs; melancholy. |
| |
| 3. He has imperfect sight; good hearing and |
| taste; he is unable to speak; his gait is |
| ape-like, and the skull-bones seem to have |
| fallen together from the want of cerebral |
| development. He will occasionally slap his |
| face and strike his hands; sometimes makes |
| a howling noise. |
| |
| 4. She is very good-tempered; but day and |
| night she talks almost incessantly; |
| occasionally sings. She says she comes from |
| Otaheite, and relates stories of those |
| around her doing absurd things. |
+----------------------------------------------+
| Good Facts. |
+----------------------------------------------+
| 1. She states that she is a lost person and |
| without hope of forgiveness; that she will |
| be taken to prison, and die a miserable |
| death; that the devil whispers in her ear |
| that she has committed the unpardonable sin. |
| |
| 2. Great taciturnity; complete seclusion |
| from society; aversion to cleanliness; |
| wandering about the streets at improper |
| hours. |
| |
| 3. He states that he is a Prince of France; |
| that he possesses a palace, and has recently |
| had two fortunes left him (he cannot tell by |
| whom)--one of £400,000, the other of |
| £600,000; that he is going to Liverpool, a |
| distance of 150 miles, with a horse and |
| cart, which will take him four hours to go, |
| and eight to return. |
| |
| 4. Inability to hold any rational |
| conversation; her manner and conduct are |
| totally at variance with her usual habits. |
+----------------------------------------------+
The following are examples of “Facts” sent back to be amended by the
Commissioners--the emendations in italics:--
1. Incoherence, perversion of facts, delusion. _Fancies
that he possesses large amounts of money which people
have secreted from him._
2. Says her sister lives in Chiselhurst, and she fears she
is dying. She took great notice of my feet, and remarked
that they were very large. Query by Commissioner--Are
these delusions? _Her sister does not live at Chiselhurst,
and is perfectly well; my feet are not large._
3. General restlessness of manner; considers himself heavily
involved in debt to many thousands of pounds, _whereas
his debts do not amount to a few hundreds_; says he
has been ruined by the Government, _whereas he has
only been dismissed from his appointment on account
of his incapacity_; and he intends prosecuting the
Admiralty for £5000 damages, _he having no real ground
of action_. (This was twice sent back for correction,
the first correction being--_By these statements I
was satisfied that the patient was of unsound mind, and
by his general conduct during examination._ Finally
amended as given above.)
[Sidenote:
(_a_)--a Justice of the Peace for ____, _or_ His Honour the Judge of
the County Court of ____, _or_ ____ Stipendiary Magistrate for ____.
(_b_) Full postal address and rank, profession, or occupation.
(_c_) At least twenty-one.
(_g_) Some day within 14 days before the date of the presentation of
the petition.
(_h_) Here state the connection or relationship with the patient.
(_k_) Full Christian and surname.]
53 Vict. c. 5.--Sched. 2, Form 1.
PETITION FOR AN ORDER FOR RECEPTION OF
A PRIVATE PATIENT
In the Matter of_______________________________
a person alleged to be of unsound mind.
_To_ (_a_)____________________________________
____________________________________
____________________________________
The Petition of_________________________________________
of (_b_)_________________________________________
_________________________________________
in the County of________________________________________
1. I am___________(_c_) years of age.
2. I desire to obtain an Order for the Reception of
________________________________________________
as a person of unsound mind, in the Haydock Lodge Licensed House,
situate at Newton-le-Willows, Lancashire.
3. I last saw the said__________________________________
at______________________________________________________
on the (_g_)_______day of________________ 19_______
4. I am (_h_)_______________________________ of the
said____________________________________________________
(or if the Petitioner is _not connected_ with or related
to the or Patient, _state as follows_:)
I am not related to or connected with the said__________
________________________________________________________
The reasons why this Petition is not presented by a relation
or connection are as follows:
The circumstances under which this Petition is presented by
me are as follows:--
5. I am not related to or connected with either of the persons
signing the certificates which accompany this petition as (_where
the petitioner is a man_) husband, father, father-in-law, son,
son-in-law, brother, brother-in-law, partner, or assistant (_or
where the petitioner is a woman_) wife, mother, mother-in-law,
daughter, daughter-in-law, sister, sister-in-law, partner,
or assistant.
6. I undertake to visit the said________________________
__________________________personally, or by some one specially
appointed by me, at least once in every six months while under
care and treatment under the order to be made on this petition.
7. A statement of particulars relating to the said_____________
______________________________________accompanies this petition.
_If it is the fact, add_: 8. The said_____________________
has been received in the Haydock Lodge Licensed House,
Newton-le-Willows, under an Urgency Order dated the____________
_______________________________________________________________
The petitioner therefore prays that an order may be made in
accordance with the foregoing statement.
=Signed= (_k_)_______________________________________
Date of Presentation of the Petition, this____________
day of___________________ 19_________
[Sidenote: (_a_) Name of Patient.
(_b_) To be signed by the petitioner.]
53 Vict. c. 5, s. 31.
When neither Certificate is signed by the Usual Medical
Attendant.
I, the undersigned, hereby state that it is not practicable to
obtain a Certificate from the usual Medical attendant of (_a_)
__________________________________________________________________
for the following reason, viz.:--
(=Signed=) (_b_)______________________________
_______________ 19____________
Form 2.
STATEMENT OF PARTICULARS REFERRED TO IN THE
ANNEXED PETITION
_If any particulars are not known the fact is to be so stated._
[Where the patient is in the petition or order described as an idiot,
omit the particulars marked ►]
The following is a Statement of Particulars } __________________
relating to the said } __________________
Name of patient, with Christian name at } __________________
length } __________________
Sex and Age __________________
► Married, single, or widowed __________________
► Rank, profession, or previous occupation } __________________
(if any) } __________________
► Religious persuasion __________________
Residence at or immediately previous to } __________________
the date hereof } __________________
► Whether first attack __________________
Age on first attack __________________
When and where previously under care } __________________
and treatment as a lunatic, idiot, or } __________________
person of unsound mind } __________________
► Duration of existing attack __________________
Supposed cause __________________
Whether subject to epilepsy __________________
Whether suicidal __________________
Whether dangerous to others, and in } __________________
what way } __________________
Whether any near relative has been } __________________
afflicted with insanity } __________________
Names, Christian names, and full postal } __________________
addresses, of one or more relatives }
of the patient } __________________
Name of the person to whom notice of } __________________
death to be sent, and full postal } __________________
address, if not already given } __________________
‡Name and full Postal Address of the } __________________
usual Medical Attendant of the Patient } __________________
‡When the Certificate is not signed by
the usual Medical Attendant, the Certificate
on the other side must be filled out.
[Sidenote: (_a_) _When the petitioner or person signing an urgency
order is not the person who signs the statement, add the following
particulars concerning the person who signs the statement._]
Signed (_a_)
_Name, with Christian
Name at length_________________________________
_Rank, Profession or
Occupation_ (_if any_)____________________
_How related to, or
otherwise connected
with the Patient_______________________________
53 Vict. c. 5. s. 7 (4).
=When a previous Petition has been dismissed=.
[Sidenote: (_a_) Name of Patient.
(_b_) Name of asylum, hospital, licensed house, or single charge.
(_c_) Justice of the Peace for ———, or Judge of County Court of ——, or
Stipendiary Magistrate for ———]
I, the undersigned, hereby state that a former Petition for
Reception of (_a_)___________________________________________
into (_b_)___________________________________________________
was presented to__________________________________________________
(_c_)________________________________________________________
in the month of________________ 19_______, and dismissed.
Herewith is a copy (furnished by the Commissioners in Lunacy)
of the statement sent to them of the reasons for its dismissal.
Signed________________________________________
________________ 19________
Note.--_This Copy is to be obtained from the Commissioners
in Lunacy by the Petitioner at his own expense._
An Order for Reception of a Lunatic is to be obtained upon a private
application by Petition to a Judge of County Courts, or Stipendiary
Magistrate, or Metropolitan Police Magistrate, or specially appointed
Justice of the Peace. The petition is to be presented, if possible,
by the husband or wife, or by a relative (_i.e._ a lineal ancestor
or lineal descendant, or lineal descendant of an ancestor not more
remote than great-grandfather or great-grandmother) of the Lunatic,
and is to be accompanied by a Statement of Particulars and two
Medical Certificates on separate sheets of paper. One of the Medical
Certificates accompanying the Petition must, if practicable, be by the
usual Medical Attendant of the Lunatic; if not by him, the reason must
be stated (see Form above). If a previous Petition has at any time been
dismissed, the facts relating to its dismissal are to be stated in the
fresh Petition (see Form above); and the Petitioner must obtain from
the Commissioners in Lunacy a Copy of the Statement sent to them of the
reasons for its dismissal, and present this copy with his Petition. The
Reception Order (which will not remain in force for more than seven
days after its date), the Petition, the Statement of Particulars,
and the Medical Certificates must be sent to the Superintendent or
Proprietor of the Asylum, Hospital, or House where the Patient is to be
received.
[Sidenote: (_a_) _Insert residence of patient._
(_b_) County, city, _or_ borough, _as the case may be._
(_c_) _Insert profession or occupation, if any._
(_d_) _Insert the place of examination, giving the name of the street
with number or name of house, or should there be no number, the
Christian and surname of occupier._
(_e_) County, city, _or_ borough, _as the case may be._
(_f_) _Omit this where only one certificate is required._
(_g_) A lunatic _or_ an idiot, _or_ a person of unsound mind.
(_h_) _If the same or other facts were observed previous to the time
of the examination, the certifier is at liberty to subjoin them in a
separate paragraph._
(_i_) _The names and Christian names (if known) of informants to be
given, with their addresses and descriptions._
(_k_) _Strike out this clause in case of a patient whose removal is not
proposed._
(_l_) _Insert full postal address._]
53 Vict. c. 5.--Sched. 2, Form 8.
CERTIFICATE OF MEDICAL PRACTITIONER
In the Matter of_________________________________________
of (_a_)_____________________________________________________
in the (_b_)_____________________ of_________________________
(_c_) _______________________________________________________
_______________________________________an alleged lunatic.
I, the undersigned, ______________________________________________
do hereby certify as follows:
1. I am a person registered under the Medical Act, 1858,
and I am in the actual practice of the medical profession.
2. On the_______________________ day of ________________ 19__
at (_d_) _______________________________________________
in the (_e_)___________________ of _____________________
_________________(separately from any other practitioner) (_f_)
I personally examined the said ___________________________________
and came to the conclusion that ____ he is (_g_) ____________
and a proper person to be taken charge of and detained under
care and treatment.
3. I formed this conclusion on the following grounds, viz.:--
(_a_) Facts indicating insanity observed by myself at the
time of examination (_h_), viz.:--
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
(_b_) Facts communicated by others (_i_), viz.:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
4. The said __________________________________________________
appeared to me to be[18]..................in a fit condition of
bodily health to be removed to an asylum, hospital, or licensed
house (_k_).
5. I give this certificate having first read the section of the
Act of Parliament printed below.
=Signed=____________________________________
of (_l_)_____________________________
=Dated= this __________ day of ________ 19__
[18] _Or_ not to be.
[Sidenote: Lunacy 8.
53 Vict. c. 5, ss. 4, 11, 16, 28, 29.]
_Extract from section 317 of the Lunacy Act, 1890._
Any person who makes a wilful misstatement of any material
fact in any medical or other certificate or in any statement or
report of bodily or mental condition under this Act, shall be
guilty of a misdemeanour.
[Sidenote: (_a_) A Justice for --, specially appointed under the
Lunacy Act, 1890, _or_ the Judge of the County Court of --, _or_ the
Stipendiary Magistrate for--
(_b_) _Address and occupation._
(_d_) _Name of petitioner._]
53 Vict. c. 5.--Sched. 2, Form 3.
ORDER FOR RECEPTION OF A PRIVATE PATIENT, TO BE MADE
BY A JUSTICE APPOINTED UNDER THE LUNACY ACT, 1890,
JUDGE OF COUNTY COURTS, OR STIPENDIARY MAGISTRATE
I, the undersigned _______________________________________________
being (_a_) _________________________________________________
__________________________________________________________________
upon the petition of _____________________________________________
of (_b_) ____________________________________________________
in the Matter of _________________________________________________
a person of unsound mind, accompanied by the Medical Certificates
of _______________________________________________________________
and ______________________________________________________________
hereto annexed, and upon the undertaking of the said (_d_)
__________________________________________________________________
to visit the said ________________________________________________
personally or by some one specially appointed by the said (_d_)
__________________________________________________________________
once at least in every six months while under care and treatment
under this Order, hereby authorise you to receive the
said _____________________________________________________________
as a patient into your Licensed House (_e_).
=And= I declare that I have [_or_ have not] personally
seen the said ____________________________________________________
before making this Order.
=Dated= this __________________ day of ________________ 19___
=Signed= (_a_) _________________________
_A Justice for _________________________________
appointed under the above-mentioned Act [or the
Judge of the County Court of_____________________
or a Stipendiary Magistrate_].
=Urgency Orders.=--Where it is urgent that an alleged lunatic (not
a pauper) must be put under restraint as soon as possible, he may
be received upon an _urgency order_, without petitioning a Judicial
Authority, accompanied by a _statement of particulars_ and _one
medical certificate_. The order should be made by the husband, wife,
or a relative of the alleged lunatic; if this be not possible, the
reasons must be stated. It may be signed before or after the medical
certificate, and before or after a petition order has been made.
If before, it must be noted in the petition; if after, a copy must
accompany the petition. No person may sign an urgency order if under
twenty-one years of age, and must have seen the alleged lunatic within
two days before the date of the order.
The urgency order remains in force seven days from its date, during
which period the procedure for a “Judicial Order on Petition” is
carried out. If the petition has been presented and the order is for
some reason or other deferred, then the urgency order remains in
force. The medical examination for certification must have been made
not more than two days before reception, and reasons must be given why
“it is expedient” that the alleged lunatic should be put under control
“forthwith.”
[Sidenote: (_a_) House, _or_ hospital, _or_ asylum, _or_ as a single
patient.
(_b_) _Name of Patient._
(_c_) Lunatic, _or_ an idiot, _or_ a person of unsound mind.
(_d_) _Some day within two days before the date of the order._
(_e_) Husband, wife, father, father-in-law, mother, mother-in-law, son,
son-in-law, daughter, daughter-in-law, brother, brother-in-law, sister,
sister-in-law, partner, or assistant.
(_If not the husband or wife, or a relative of the patient, the person
signing to state as briefly as possible_--1. _Why the order is not
signed by the husband or wife, or a relative of the patient._ 2. _His
or her connection with the patient, and the circumstances under which
he or she signs._)
(_f_) Superintendent of ____ the ____ asylum, ____ hospital _or_
resident licensee of the ____ house (_describing the asylum, hospital,
or house by situation and name_.)
Lunacy, Nos. 4 & 2.
(33 Vict. c. 5, s. 11.)]
53 Vict. c. 5.--Sched. 2.
FORM OF URGENCY ORDER FOR THE RECEPTION OF A
PRIVATE PATIENT, WITH MEDICAL CERTIFICATE
AND STATEMENT ACCOMPANYING URGENCY ORDER
Forms 4, 2, 8 and 9.
I, the undersigned, being a Person Twenty-one years of age,
hereby authorise you to receive as a Patient into your (_a_)
House (_b_) _________________________________________________
__________________________________________________________________
as a (_c_) __________________________________whom I last saw at
____________________________________________________________________
on the (_d_) __________________ day of_______________ 19____
I am not related to or connected with the Person signing
the Certificate which accompanies this Order in any of the
ways mentioned in the Margin. (_e_) Subjoined (_or_ annexed)
hereto is a Statement of Particulars relating to the said __________
(=Signed=) _____________________________________
_Name and Christian Name_ } _______________________________
_at Length_ } _______________________________
_Rank, Profession, or Occupation_ } _______________________
_(if any)_ } _______________________
_Full Postal Address_ _____________________________________
_How related to or connected_ } ___________________________
_with the patient_ } ___________________________
=Dated= this _______________ day of __________ 19____
STATEMENT OF PARTICULARS REFERRED TO IN THE
ANNEXED ORDER
_If any Particulars are not known,
the Fact is to be so stated._
(Where the patient is in the petition or order described
as an idiot, omit the particulars marked ►.)
The following is a Statement of Particulars } ____________________
relating to the said } ____________________
Name of Patient, with Christian Name } ___________________________
at length } ___________________________
Sex and Age __________________________
Married, Single, or Widowed ______________________________________
► Rank, Profession, or previous Occupation } _____________________
(if any) } _____________________
► Religious Persuasion ___________________________
Residence at or immediately previous } ___________________________
to the date hereof } ___________________________
► Whether First Attack ________________
Age on First Attack ________________
When and where previously under Care } ________________________
and Treatment as a Lunatic, Idiot, or } ________________________
Person of Unsound Mind } ________________________
► Duration of existing Attack ____________________________________
Supposed Cause ___________________________________________________
Whether subject to Epilepsy ______________________________________
Whether Suicidal _________________________________________________
Whether dangerous to Others, and in } ____________________________
what way } ____________________________
Whether any near Relative has been } _____________________________
afflicted with Insanity ... ... } _____________________________
Names, Christian Names, and full Postal } ________________________
Addresses of one or more Relatives } ________________________
of the Patient } ________________________
Name of the Person to whom Notice } _________________________
of Death to be sent, and full Postal } _________________________
Address, if not already given } _________________________
Name and full Postal Address of the } __________________________
usual Medical Attendant of the } __________________________
Patient } __________________________
=Signed= _________________________________________
When the Petitioner or person signing an Urgency Order is =NOT=
the person who signs the Statement, add the following particulars
concerning the person who signs the Statement.
Name, with Christian name at length ______________________________
Rank, profession, or occupation (if any) _________________________
How related to or otherwise connected } __________________________
with the patient } __________________________
[Sidenote: (_a_) _Insert residence of patient._
(_b_) County, city, _or_ borough, _as the case may be._
(_c_) _Insert profession or occupation, if any._
(_d_) _Insert the place of examination, giving the name of the street,
with number or name of house, or should there be no number, the
Christian and surname of occupier._
(_e_) County, city, _or_ borough, _as the case may be._
(_f_) _A lunatic_, an idiot, _or_ a person of unsound mind.
(_g_) _If the same or other facts were observed previous to the time
of the examination, the certifier is at liberty to subjoin them in a
separate paragraph._
(_h_) _The names and Christian names (if known) of informants to be
given, with their addresses and descriptions._
Lunacy, Nos. 8 & 9.
(53 Vict. c. 5, ss. 11, 28, 29, 32 and 33.)]
53 Vict. c. 5.--Sched. 2, Form 8.
CERTIFICATE OF MEDICAL PRACTITIONER
In the Matter of _________________________________________________
of (_a_) ____________________________________________________
in the (_b_)________________________ of _____________________
(_c_) _______________________________________________________
an alleged lunatic.
I, the undersigned _______________________________________________
do hereby certify as follows:--
1. I am a person registered under the Medical Act, 1858,
and I am in the actual practice of the medical profession.
2. On the ________________ day of ___________________ 19 ______
at (_d_) ______________________________________________
in the (_e_) ________________ of ______________________
I personally examined the said _____________________________
and came to the conclusion that ____ he is (_f_)_______
and a proper person to be taken charge of and detained under
care and treatment.
3. I formed this conclusion on the following grounds, viz.:--
(_a_) Facts indicating Insanity observed by myself
at the time of examination (_g_), viz.:--
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
(_b_) Facts communicated by others (_h_), viz:--
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
[Sidenote: (_i_) _If an urgency certificate is required, it must be
added here.--Form No. 9._
(_k_) _Strike out this clause in case of a private patient whose
removal is not proposed._
(_l_) _Insert full postal address._
53 Vict. c. 5.--Form 9.]
(_i_) STATEMENT ACCOMPANYING URGENCY ORDER
I certify that it is expedient for the welfare of the said ________
_______________________ (_or_ for the public safety, _as the
case may be_) that the said ____________________________________
should be forthwith placed under care and treatment.
My reasons for this conclusion are as follows: ____________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
4. The said _______________________________________________________
appeared to me to be [‡ _____________] in a fit condition of bodily
health to be removed to an asylum, hospital, or licensed house
(_k_). (‡) Or not to be.
5. I give this certificate having first read the section of the Act
of Parliament printed below.
=Dated= this ________________ day of _________________________
One thousand nine hundred and ______________
(=Signed=) _____________________________
of (_l_) _____________________________
_Extract from section 317 of the Lunacy Act, 1890._
Any person who makes a wilful misstatement of any
material fact in any medical or other certificate,
or in any statement or report of bodily or mental
condition under this Act, shall be guilty of a
misdemeanour.
=Orders after Inquisition.=--This constitutes a legal investigation
as to whether or not a person is capable of managing his or her own
affairs, and whether restraint is necessary. It is conducted before a
judge, with a jury if the alleged lunatic demand one, unless the judge
is satisfied by personal examination that the lunatic is not mentally
competent to understand the demand for a jury. In such a case the
medical man is only concerned as a witness.
According to circumstances the alleged lunatic may be kept under
restraint, or remain at liberty with the control of his or her affairs
under a “Committee of Estate”; or, if declared sane, set free and with
control of his estate.
=Summary Reception Orders.=--When a lunatic is not under proper
control, and if without relations or friends, and there be no one who
will sign a petition for detention, or when a lunatic is uncared for,
cruelly treated, and is found so by a medical practitioner, his duty
is to inform a constable, relieving officer, or overseer of the parish
of the fact. The official will then make a statement on oath to a
Judicial Authority, who will direct two medical practitioners to make
the necessary examinations, and if satisfied he will issue an order for
the removal of the individual to an asylum. The procedure followed will
then be the same as for a “petition for reception.” Under a summary
reception order the Judicial Authority may place the person under the
care of a relation or friend, or the visitors of the asylum in which
the person is intended to be, or is placed.
=Lunatics Wandering at Large.=--Every constable, relieving officer,
or overseer of a parish who knows of a person, whether pauper or not,
who is deemed to be a lunatic and wandering at large, shall apprehend
and take such person before a Justice, or if the Justice receive
information on oath, he may have the person apprehended and brought
before him. The Justice has the person medically examined, and if
certified a lunatic to the satisfaction of the Justice, he may issue an
order for detention; if the medical man certify that the person is not
fit for removal, the removal is postponed until the person is certified
fit for it.
The above proceedings are not necessary if it be considered a matter of
public safety and for the good of the alleged lunatic that immediate
detention be carried out. The constable, relieving officer, or overseer
of the parish may remove such person to the workhouse of the union
in which the person is, and detain him for not more than three days.
Before the expiration of that time the necessary proceedings under the
Lunacy Act must be taken.
=Reception Order by two Commissioners.=--Any two or more Commissioners
in Lunacy may visit a pauper lunatic or an alleged lunatic not detained
in a workhouse or lunatic asylum, and if satisfied after certification
by a medical man that the person is a lunatic, order removal to an
asylum.
=Pauper Lunatics.=--A medical officer of a Poor Law Union who has
knowledge that a pauper within his district is alleged to be a
lunatic, shall notify the relieving officer or overseer of the parish
where the pauper resides of the fact, who within three days shall
notify a Justice, who will interview the alleged lunatic and call
in a medical practitioner to examine and certify. If the Justice be
satisfied that the person be a lunatic, he makes an order for removal
to an asylum. One medical certificate only is necessary.
=Escape of Lunatics.=--An escaped lunatic may be retaken at any time
within fourteen days without a fresh order.
=Discharge of Lunatics.=--The reception order remains in force for
periods of one, two, and three years, and then for periods of five
years. At the end of any of these periods the Lunacy Commissioners may
continue the detention of the lunatic, if satisfied by certification
from the medical man of the institution, or the usual medical attendant
of the lunatic, that the patient remains of unsound mind and further
detention is necessary.
The petitioner of the reception order may request the discharge of a
patient. The discharge may be refused if the medical man in charge
certifies the lunatic dangerous and unfit to be at large, unless two of
the visitors to the asylum or the Commissioners visiting the asylum or
house give their consent in writing.
Two Commissioners--one medical, the other legal--may order the
discharge of any patient.
When a patient recovers, the medical attendant of the institution
notifies this to the petitioner or person responsible for the payment
on account of the patient. Should the patient not be removed within
seven days of such notice, the patient may be discharged “forthwith.”
PROCEDURE IN SCOTLAND
Idiots and imbeciles under eighteen years of age may be received into
training schools without the legal procedure which obtains in England
and Wales. They are sent to these institutions as lunatics, however,
under the usual legalities, in order that the Government grant may be
obtained. When over eighteen years of age, if sent to institutions
other than training schools, they are classed as lunatics, and the
necessary legal procedure is followed.
=Insane persons whose malady is not confirmed= may be cared for
privately for a period not exceeding six months. The certificate of one
medical practitioner only is required.
_Insane persons_, pauper or not, can be placed in an asylum by order of
the Sheriff, by petition and two medical certificates. The inspector of
the poor acts as petitioner for paupers.
In cases of urgency a _certificate of emergency_ from one medical
practitioner is required, along with a request from the petitioner, to
the superintendent of the asylum.
A person who is _prodigal_ or _facile_ can be restrained from
alienating his property by guardians appointed by the Court.
When a lunatic is found to be incapable of administering his or her
estate, the Court appoints a Committee of Estate.
PROCEDURE IN IRELAND
The procedure differs in pauper and private cases.
=Pauper patients, not dangerous.=--In order to detain such a pauper
there must be a declaration of insanity and destitution, with the names
and addresses and descriptions of two relatives of the person, given
before a magistrate. A magistrate and a clergyman or poor-law guardian
must certify that they have personally inquired into the case. One
medical certificate is necessary. The applicant must remove the patient
when called upon.
=Paying patients who are not dangerous=, for admission to a district
asylum, are under more stringent regulations. A declaration that they
are unable to pay the expenses necessary for support in a licensed
house must be made before a magistrate; further, that there is no
friend who can undertake this; and a statement of the length of time
the patient has resided in the country. A magistrate and clergyman must
certify that they have investigated the case. One medical certificate
must be signed by two practitioners. A guarantee for the payment must
be given, and also to remove the patient when called upon. The sanction
of an inspector of lunatics must be given.
For admission into licensed houses, charitable institutions, and single
care, an order by a relative or connection of the lunatic is required
with two medical certificates, unless urgent, when one is sufficient,
but a second must follow within fourteen days.
LIABILITIES OF PERSONS SIGNING LUNACY CERTIFICATES
A medical practitioner is bound to certify as to the sanity of a
person. If, however, he undertakes to fill up the certificates
necessary for the detention of an alleged lunatic, he becomes
responsible to the authorities for the correctness of the certificates,
and if he make a wilful misstatement of facts he is guilty of a
misdemeanour. The medical practitioner may have an action brought
against him by the lunatic when recovered or discharged. The most
vindictive feelings may be entertained against the medical man. In such
a case, if the medical man proves his “good faith” and the exercise of
“reasonable care” in his examination and certification, he receives the
protection of the Court.
LIABILITIES OF PERSONS RECEIVING INSANE PATIENTS
In the case of Nottidge _v._ Ripley and Nottidge, the Lord Chief Baron
having been understood to intimate an opinion that no person ought
to be so confined unless he is dangerous to himself or others, the
Commissioners pointed out that the scope of the Lunacy Acts is not thus
limited. They said:
“The object of these Acts is not, as your Lordship is aware, so much
to confine lunatics, as to restore to a healthy state of mind such of
them as are curable, and to afford comfort and protection to the rest.
Moreover, the difficulty of ascertaining whether one who is insane be
dangerous or not is exceedingly great, and in some cases can only be
determined after minute observation for a considerable time.
“It is of vital importance that no mistake or misconception should
exist, and that every medical man who may be applied to for advice on
the subject of lunacy, and every relative and friend of any lunatic,
as well as every magistrate and parish officer (each of whom may be
called upon to act in cases of this sort), should know and be well
assured that, according to law, any person of unsound mind, whether he
be pronounced dangerous or not, may legally and properly be placed in a
county asylum, lunatic hospital, or licensed house, on the authority of
the preliminary order and certificates prescribed by the Acts.
“Upon the whole, it appears that the power to restrain and confine
a lunatic is limited at common law to cases in which it would be
dangerous, either as regards others or himself, for the lunatic to
be at large; but that the power to place and detain a lunatic in a
registered hospital or licensed or other house, under an order and
medical certificates duly made and obtained in accordance with the
Lunacy Acts, is not so limited.”
The terms of the Lunacy Act, 1890, are as follows:
“Subject to the exceptions in this Act mentioned a person
shall not be received or detained as a lunatic, as a single
patient, unless under a reception order by a judicial
authority.” “Every person who, except under the provisions
of the Act, receives or detains a lunatic or an alleged
lunatic in an institution for lunatics, or for payment takes
charge of, receives to board or lodge, or detains a lunatic
or alleged lunatic in an unlicensed house, shall be guilty
of a misdemeanour, and in the latter case shall also be
liable to a penalty not exceeding fifty pounds.” “Except
under the provisions of this Act, it shall not be lawful for
any person to receive or detain two or more lunatics in any
house, unless the house is an institution for lunatics or a
workhouse.” “Any person who receives or detains two or more
lunatics in any house except as aforesaid shall be guilty of
a misdemeanour.”
It is therefore unlawful to receive a lunatic or alleged lunatic except
by reception order. Only one can be received into a private house, and
a reception order is required. No medical man should receive a lunatic
into residence without the necessary reception order. All the statutory
regulations are demanded for a single case, and the private house is
subject to visitation and inspection.
It is also important to remember that if any one receive a person not
insane at the time, but who subsequently becomes insane, he renders
himself liable to prosecution, unless he procure the necessary medical
certificates and order (R. _v._ Wilkins).
=Is a Lunatic a competent Witness?=--Mr. Fitzjames Stephen maintains
(_Criminal Law_) that madmen are competent witnesses in relation to
testimony as in relation to crime. If they understand the nature of an
oath, and the character of the proceedings in which they are engaged,
they are competent witnesses whatever be the nature or degree of their
mental disorder. An idiot shall not be allowed to give evidence (Co.
Litt. 6 b; Gilb. Ev. 144); a lunatic during a lucid interval may do so
(_Id. Com. Dig. Testm._ {A}). When a lunatic is tendered as a witness,
it is for the judge to examine and ascertain whether he is of competent
understanding to give evidence, and is aware of the nature and
obligation of an oath; if satisfied that he is, the judge should allow
him to be sworn and examined (R. _v._ Hill, 2 Den. 255; 20 L.J. [M.C.]
222).
=The Civil Rights of Lunatics.=--If an individual be suffering from
such mental disease as to render him incompetent to manage his own
affairs, the law steps in to protect him and his property from injury.
But the power so used does not necessarily imply that he is deprived of
his personal freedom, but merely such restraint as is necessary for his
protection.
Many lunatics, under the protection of the Court, live in their own
houses with large establishments. A person so protected by the law is
said to be subject to an “interdiction.” In these cases a commission is
usually granted by the Court of Chancery, and a writ known under the
name of “_de lunatico inquirendo_” issued, after certain legal matters
of detail are settled, and affidavits from medical men certifying to
the insanity of the party have been filed.
The tests of insanity in these cases differ from those required in
criminal cases, where the knowledge of right from wrong is imperatively
demanded. The mental defect must not be the result of ignorance or want
of education, and at one time commissions were only issued when it was
shown that lunacy and idiocy alone existed, imbecility or mere weakness
of mind not being deemed sufficient to deprive a man of his civil
rights, or to place him under the protection of the Court.
To so great an absurdity did this lead, that the man suffering
from a delusion sufficient to be comprehended under the legal term
“lunacy” was protected, whereas the feeble-minded were left without
interference, though needing it more. The cost of these commissions
sometimes reached almost fabulous sums. The expense has been somewhat
lessened by recent enactments, and the process simplified--the Lord
Chancellor having it in his power to direct an inquiry before two
Commissioners, thus dispensing with a jury. (See the 16 and 17 Vict. c.
70, and 25 and 26 Vict. c. 86.)
In Scotland, however, the law is far more simple. The cognition
proceeds on a _brieve_ or writ addressed to the Lord President of the
Court of Session, and directs him to inquire “whether the person sought
to be cognosced is insane, who is his nearest agnate, and whether such
agnate is of lawful age.” “And such person shall be deemed insane if
he be furious or fatuous, or labours under such unsoundness of mind as
to render him incapable of managing his affairs.” “The trial is before
a judge of the Supreme Court and a special jury. If the insanity be
proved, the nearest agnate--relation by the father‘s side--is by law
entitled to the guardianship.” No one not a near relative can institute
these proceedings.
In Scotland also, the trial by jury may be avoided by applying by
petition to the Court of Session for the appointment of a judicial
factor or _curator bonis_. Of this appointment the alleged lunatic
is informed, which, if he please, he may oppose; medical evidence is
received, and on this the Court rests its decision--the usual course
being to remit the case to some competent person to make inquiry, take
evidence, and report. The Commissioner is usually the Sheriff.
=Examination of the Insane.=--A few words of caution need here be
said. Medical men will consult their own dignity and that of their
profession by remembering that in cases of alleged insanity, as in
fact in all other cases when their opinion is sought, they are not
justified in taking sides. Their evidence will be the more valuable in
proportion to the care they take in examining into the facts of the
case, and the good sense and judgment shown in their examination of the
patient. To distinguish between the mistakes, the result of ignorance
and want of education, and those the result of a feeble mind, is of
primary importance. It is no sign of insanity in an uneducated farmer
that he knows not the _pons asinorum_. All cases should be tested by
considering the surroundings and possible degree of culture of a person
placed under like conditions as the party under examination. Has he
shown himself capable of an average amount of culture? or is his mental
condition inferior to what one might legitimately expect under the
influences to which he has been subjected? The medical examiner should
also direct his attention to this important point, setting aside all
legal and medical theories of insanity, viz.--“Is the case of _such
mental disorder_ as to create _an incapacity for managing affairs_.”
TESTAMENTARY CAPACITY
A medical practitioner may be called upon to give evidence as to
the capacity of a testator to make a valid will. An ordinary person
witnessing a will does so to fact only, but if a medical man do so it
implies that he was of the opinion that the testator was fit to make
a will and of a sound and disposing mind. In making an examination of
a person for fitness to make a will, the medical man must endeavour
to find out if the testator understands the nature of his action, and
all the details associated with it; also if he knows the nature and
amount of his property, and the claims or otherwise of those who may
become beneficiaries under it. Further, has he such a delusion as may
influence his will in disposing of his property, and bring about a
disposal of it which, if the mind had been sound, would not have been
made.
A person may have a delusion or delusions without interfering with the
making of a will. If the “disposing mind” be left intact, testamentary
capacity is upheld. In severe illness and old age the mind may be
so disturbed, without true insanity being present, that a person is
rendered incapable of making a will. In all such cases the medical man
should be sure of his ground before granting, if requested, that the
patient is capable or otherwise. It is a good plan, when examining a
patient as to testamentary capacity, to have the will produced, and
privately read it out to the person and ask if it be correct, then to
have the person repeat the dispositions of the will, and see if they
coincide with the contents of the document.
People who are aphasic may make wills which are valid. Difficulties
arise in cases of sensory aphasia.
RESTRAINT OF HABITUAL DRUNKARDS
An habitual drunkard, as defined by law, is “a person who, not being
amenable to any jurisdiction in lunacy, is notwithstanding, by reason
of habitual intemperate drinking of intoxicating liquor, at times
dangerous to himself or herself, or to others, or incapable of managing
himself or herself or his or her own affairs.”
Before placing such a person under restraint in a licensed retreat the
person‘s consent must be obtained. The patient must make an application
to a Justice of the Peace, and supported by a declaration from two
persons stating that the applicant is an habitual drunkard within
the meaning of the Act. If the justice be satisfied, he can make out
an order for detention. The order is valid for any time mentioned in
the application not exceeding two years. The patient can be detained,
forcibly if necessary, and if escaped may be arrested and taken back.
SECTION II
TOXICOLOGY
CHAPTER I
DEFINITION OF A POISON--SALE OF POISONS--CLASSIFICATION
OF POISONS--ACTION OF POISONS--GENERAL EVIDENCE
OF POISONING--GENERAL TREATMENT IN CASES OF POISONING
--GENERAL METHODS OF EXAMINATION FOR POISON
Toxicology is that division of Forensic Medicine which takes into
consideration the modes and actions of poisons upon the living body,
the treatment of their effects upon the body, and the methods of
detecting them when occasion requires.
=Definition of a Poison.=--Neither the law nor medicine defines a
poison. The popular definition is to be avoided, viz., that, a poison
is a substance capable of acting injuriously on the body when taken or
administered in a small dose.
Husband defined a poison as “_any substance which, introduced into the
system or applied to the body, is injurious to health and destroys
life, irrespective of temperature or mechanical means_.”
Taylor and Stevenson define a poison as “_a substance which when
absorbed into the blood is, by its direct action, capable of seriously
affecting health or destroying life_.”
There are substances, however, which do not require absorption into
the blood in order to exert their deleterious action, _e.g._ the
corrosive acids and alkalies; but, although the chief action is a local
one in most cases, some absorption does take place and is evidenced
in systemic effects, and are so classified as poisons differing from
powdered glass, which acts mechanically only and is not a poison in the
true sense of the word.
Winter Blyth considers that “_a substance of definite chemical
composition, whether mineral or organic, may be called a poison if it
is capable of being taken into any living organism, and causes, by its
own inherent chemical nature, impairment or destruction of function_.”
According to Luff a poison is “_a substance which, either by its direct
action upon the skin or mucous membranes, or after its absorption into
the blood, is capable of injuriously affecting health or destroying
life_.”
Letheby defines a poison as “_anything which otherwise than by the
agency of heat or electricity is capable of destroying life, either by
chemical action on the tissues of the living body, or by physiological
action from absorption into the system_.”
The law does not recognise the manner in which the substance acts, nor
the result; the legal standpoint is the _intent_ of the administrator
qua administrator. The law is as follows: “_Whosoever shall administer
or cause to be administered or taken by any person any poison or other
destructive thing with intent to commit murder shall be guilty of a
felony_” (24 and 25 Vict. c. 100, sec. 11).
Section 22. “_Whosoever shall unlawfully apply or administer to or
cause to be taken by, or attempt to apply or administer to, or attempt
to cause to be administered to or taken by, any person, any chloroform,
laudanum, or other stupefying or overpowering drug, matter, or thing,
with intent, in any of such cases, thereby to enable himself or any
other person to commit, or with intent, &c., to assist any other person
in committing any indictable offence, shall be guilty of felony._”
Section 23 enacts that, “_Whosoever shall unlawfully administer to, or
cause to be administered to, or taken by any other person, any poison
or other destructive or noxious thing so as thereby to endanger the
life of such person, or so as thereby to inflict upon such person any
grievous bodily harm, shall be guilty of a felony_.”
Section 24. “_Whosoever shall unlawfully or maliciously administer to
or cause to be administered to or taken by any other person any poison
or other destructive or noxious thing with intent to injure or aggrieve
or annoy such person shall be guilty of a misdemeanour._”
Section 25. “_If upon the trial of any person charged with the felony
above mentioned the jury shall not be satisfied that such person
is guilty thereof, but shall be satisfied that he is guilty of the
misdemeanour above mentioned, then, and in every such case, the jury
may acquit the accused for such felony and find him guilty of a
misdemeanour._”
=Administration of Noxious Drugs.=--The law throws on the medical
witness the responsibility of the definition of a _noxious thing_, and
whether it was given in excess, or liable to cause annoyance or injury
to health. At a Bodmin Assize, Lord Chief-Justice Cockburn, after
consultation with Mr. Justice Hawkins, delivered an important judgment
on the subject. A man was charged with having administered cantharides
with criminal intent. The judges ruled that there must not only be
an administration of a noxious drug with a guilty intent, but the
drug must have been administered in such quantities as to be noxious,
whereas the dose here given was too small to be seriously deleterious.
Distinction was drawn between a drug like cantharides, which is only
noxious when given in excess, and strychnine, a well-established
poison. Acquittal was therefore directed. In the case of R. _v._ Cramp,
the prisoner was charged with having administered half an ounce of
oil of juniper with intent to procure abortion. He was convicted, but
appealed on the legal ground that the substance must be noxious in
itself, and not only when given in excess. Lord Coleridge ruled that
“if a person administers with intent to produce miscarriage something
which _as administered_ is ‘noxious,’ he administers a ‘noxious thing.’”
=The Sale of Poisons.=--The law, by the Pharmacy Act, 1868, and its
amendments, restricts the sale of poisons to pharmaceutical chemists,
chemists and druggists, and registered medical practitioners. The Acts
define and indicate by schedule “Poisons within the meaning of the
Act.” The Schedule of Poisons, as amended in the “Poisons and Pharmacy
Act, 1908,” and “Additions to Schedule 1913,” is:
SCHEDULE OF POISONS
[_As amended by Orders in Council_]
Part I
Arsenic, and its medicinal preparations.
Aconite, aconitine, and their preparations.
Alkaloids.--All poisonous vegetable alkaloids not specifically named
in this schedule, and their salts, and all poisonous
derivatives of vegetable alkaloids.
Atropine, and its salts, and their preparations.
Belladonna, and all preparations or admixtures (except belladonna
plasters) containing 0.1 or more per cent. of belladonna
alkaloids.
Cantharides, and its poisonous derivatives.
Coca, any preparation or admixture of, containing 1 or more
per cent. of coca alkaloids.
Corrosive sublimate.
Cyanide of potassium, and all poisonous cyanides and their
preparations.
Emetic tartar, and all preparations or admixtures containing 1 or
more per cent. of emetic tartar.
Ergot of rye, and preparations of ergots.
Nux vomica, and all preparations or admixtures containing 0.2 or
more per cent. of strychnine.
Opium, and all preparations or admixtures containing 1 or more
per cent. of morphine.
Picrotoxin.
Prussic acid, and all preparations or admixtures containing 0.1 or
more per cent. of prussic acid.
Savin, and its oil, and all preparations or admixtures containing
savin or its oil.
Part II
Almonds, essential oil of (unless deprived of prussic acid).
Antimonial wine.
Cantharides, tincture and all vesicating liquid preparations or
admixtures of.
Carbolic acid, and liquid preparations of carbolic acid,
and its homologues containing more than 3 per cent.
of those substances, except preparations for use as
sheep wash or for any other purpose in connection with
agriculture or horticulture, contained in a closed
vessel distinctly labelled with the word “poisonous,”
the name and address of the seller, and a notice of
the special purposes for which the preparations are
intended.
Chloral hydrate.
Chloroform, and all preparations or admixtures containing more
than 20 per cent. of chloroform.
Coca, any preparation or admixture of, containing more than 0.1
per cent. but less than 1 per cent. of coca alkaloids.
Diethyl-barbituric acid, and other alkyl, aryl, or metallic
derivatives of barbituric acid, whether described
as veronal, proponal, medinal, or by any other
trade name, mark, or designation; and all poisonous
urethanes and ureides. [_Added March 12, 1913._]
Digitalis.
Mercuric iodide.
Mercuric sulphocyanide.
Oxalic acid.
Poppies, all preparations of, excepting red poppy petals and syrup
of red poppies (_Papaver rhœas_).
Precipitate, red, and all oxides of mercury.
Precipitate, white.
Strophanthus.
Sulphonal, and its homologues, whether described as trional,
tetronal, or by any other trade name, mark, or
designation. [_Added March 12, 1913._]
All preparations or admixtures which are not included in
Part I. of this schedule, and contain a poison within
the meaning of the Pharmacy Acts, except preparations
or admixtures the exclusion of which from this
schedule is indicated by the words therein relating to
carbolic acid, chloroform, and coca, and except such
substances as come within the provisions of Section 5
of this Act.
Memorandum.--Special importance attaches to the last paragraph of Part
II. of the schedule, as the effect of that paragraph is to include in
Part II. many preparations and admixtures of vegetable drugs which
contain poisonous alkaloids, although the drugs containing them are not
specified in the schedule.
With those in Part I. a registration of the sale is compulsory, the
purchaser must be known to or introduced by some person known to the
vendor, and the purpose for which the poison is required, the date,
the name and amount of the poison sold, the name and address of the
buyer, and the entry must be signed by the purchaser and introducer.
All substances in Parts I. and II. must be labelled by the vendor
with a label bearing the name of the poison, the name and address
of the seller, and the word “Poison”; but with those in Part II. no
registration as in Part I. is required. In the sale of arsenic both
the seller and purchaser must sign the entry, and the introducer must
witness it. No arsenic can be legally sold to a person under the age of
twenty-one years; nor may it be sold in quantities of less than 10 lbs.
unless mixed with soot or indigo--one ounce of the former, or half an
ounce of the latter, to each pound of arsenic. If quantities of over 10
lbs. be sold, and the soot or indigo would render it unfit for use in
the way desired, then they may be omitted (_Arsenic Act_, 1851).
=Classification of Poisons.=--A good and scientific classification
of poisons is still wanted. The following simple general division,
depending upon the chief effect, may be taken as guides by the student:
(a) _Corrosives_--Local corrosion.
(b) _Irritants_--Gastro-intestinal irritation.
(c) _Neurotics_--Altered action of the nervous system.
1. INORGANIC
_Corrosive_--Sulphuric acid, &c.
_Irritant_--Arsenic, &c.
2. ORGANIC
_Irritant_--Savin, Cantharides.
_Affecting Brain_--Opium.
_Affecting Spinal Cord_--Strychnia.
_Affecting Heart_--Digitalis.
_Affecting Lungs_--Carbonic acid.
(Guy.)
IRRITANTS
{ Acid poisons--Sulphuric acid, &c.
_Mineral_ { Alkaline poisons--Caustic soda, &c.
{ Non-metallic--Phosphorus, Iodine, &c.
{ Metallic--Arsenic, Antimony, &c.
_Vegetable_--Savin, Elaterium, &c.
_Animal_--Cantharides.
NEUROTICS
_Cerebral_--Opium, Hydrocyanic acid, Alcohol.
_Spinal_--Strychnia, Nux vomica.
_Cerebro-spinal_--Conium, Belladonna, Aconite.
_Cerebro-cardiac_--Calabar bean, Digitalis.
(Taylor.)
The subjoined classification is based upon that adopted by the late
Professor Sir Douglas Maclagan. Where the poison acts in such a manner
as to place it in two or more groups, I have fully described it in one,
merely drawing attention to it under the others:
DIVISION I
CHEMICAL
{ Acids.
_Corrosive_, { Alkalies.
{ Caustic salts.
_Vulnerant_, Glass, Needles.
DIVISION II
VITAL
_Irritant_, Metalloid, Phosphorus, Iodine.
“ Metallic, Arsenic, Antimony, Mercury, &c.
“ Vegetable, Gamboge, Elaterium, Colchicum, Squill.
“ Animal, Cantharides, Ptomaines.
_Narcotic_, Somniferous, Opium.
“ Deliriant, Hyoscyamus, Belladonna.
“ Inebriant, Alcohol, Cocculus Indicus, Chloroform,
Ether, Cannabis Indica.
_Sedative_, Cardiac, Digitalis, Aconite, &c.
“ Cerebral, Ether, Chloroform, Hydrocyanic acid.
“ Neural, Conium, Aconite.
_Excitomotory_, Strychnia, Ergot.
_Irrespirable Gases_, Carbonic acid, Carbon monoxide,
Coal gas, Chlorine.
_Toxicohæmic or Septic_, Snake venom, Ptomaines, “Toxins.”
=Action of Poisons.=--Amid the difficulties which surround this
subject, three points appear to have been clearly made out: (1) That it
is necessary for all poisons to enter the blood before their specific
action can be produced. (2) That poisons possess an elective affinity
for certain tissues and organs. Thus, arsenic, however introduced
into the system, as a rule attacks the stomach; and this peculiarity
of action closely allies it to the poisons of typhoid, scarlet fever,
smallpox, &c., which appear to have, respectively, an elective affinity
for the glands of the intestines, the throat, and the skin. (3) That
the habitual use of a poison in medicinal doses does not ensure a
perfect toleration on the part of the system with regard to the action
of the poison, for sooner or later a complete cachexia is produced,
showing that the poisonous effect of the drug is not arrested.
Besides the above, there are also certain conditions connected with
the action of poisons: (1) The poison is absorbed and distributed by
the blood. (2) A portion is eliminated by the fluid secretions and
excretions. (3) Another portion is for a time deposited in the tissues
and organs of the body. These processes are of necessity simultaneous.
The channels of entrance and exit are as follows: Of entrance we
have--(1) _The blood-vessels as a result of wounds_--more important
in a physiological than a medico-legal question. (2) _The skin and
cellular membrane._--Absorption by the skin is modified by the
condition of the part, and also by the form in which the drug is
applied. Thus the skin of the arm-pits and groins is more absorbent
than the palms of the hands. Watery solutions are not so effective
as oily preparations, and the application of the drug in fine powder
is more effectual than a watery solution of it. This is explained
by the presence of a natural oily, unctuous substance on the skin,
which prevents the direct contact of the watery solution, but if the
solution be allowed to evaporate on the part, the substance thus left
in minute division is then readily absorbed. The danger of allowing
strong solutions of corrosive sublimate to evaporate on the head in the
treatment of certain skin eruptions is thus explained. (3) _The lungs
and air-passages._--Absorption by these organs is most active, hence
the intense rapidity in the action of aerial poisons. (4) _The stomach
and intestines._--Poisons introduced into the stomach or intestines
take longer to arrive at the special organs on which they act than by
the other channels of entrance. They are absorbed by the capillaries
into the mesenteric veins, and before passing to the heart, by which
they enter the general circulation, they pass through the liver, where
they are in part excreted in the bile or deposited in the gland. The
absorbing power of the stomach is modified by its fulness or emptiness,
and poisons not soluble in water may be rendered so by the gastric
secretion.
The avenue of entrance may materially modify the action, and some
poisons which act rapidly when entering by a wound, are inert when
taken into the stomach. Snake poisons when given by the mouth are
entirely harmless. Hydrogen sulphide is more toxic when inhaled
than when taken in solution. This, though true in some cases, does
not always occur; and the inertness of these poisons, it has been
suggested, may be due to the elimination of them being as rapid
as their absorption, so that a poisonous dose never enters the
circulation. The intestines absorb more rapidly than the stomach, and
this must be borne in mind when administering powerful drugs _per anum_.
Of the channels of exit we have: (1) _The kidneys._ (2) _The lungs._
(3) _The bile._ (4) _The milk._ (5) _The saliva._ (6) _Mucous
membrane._ (7) _The skin._
We know not the cause, but certain poisons appear to select a
particular route for their exit--thus iodide of potassium leaves by
the urine; mercury and its salts by the saliva; arsenic and eserine,
the active principle of the Calabar bean, in small quantities, by the
stomach, &c. We are, however, prepared to show that all poisons must
enter the blood before they produce their effects, and that almost
simultaneously with the entrance of the poison into the blood a process
of elimination begins, and that fatal effects depend upon absorption
taking place more rapidly than elimination. On the amount also of the
poison absorbed do its fatal effects depend, and not on the quantity
actually taken. Whilst absorption and elimination are both going on,
some of the poison is being deposited in the organs and tissues of the
body. As proofs of these statements it has been shown that poisons
have been detected in the blood, and that urine, saliva, and milk,
fluids secreted from it, may contain portions of the poison taken, and
produce dangerous symptoms when given to other animals. Poisons applied
to the brain tissue, or to nerve trunks, do not produce symptoms,
and the action of a poison may be arrested for a time by compressing
by a ligature the main vessels of the limb under the skin of which
the poison has been injected. After death no trace of the poison may
be detected, the quantity taken being just sufficient to produce a
fatal result, or elimination may be so rapid that, although death was
directly due to the poison, any remains of its existence cannot be
made out. This occurred in the case of Dr. Alexander, who died from
an accidental dose of arsenic, all the arsenic being eliminated in
_seventeen_ days--in another fatal case, in _seven_ days. (Taylor)
As evidence of the diffusion of poisons the following table may be of
use:
{ Dilatation of the pupil in poisoning by
Physiological. { belladonna, hyoscyamus, &c.
{ Contraction of the pupil in poisoning by opium,
{ Calabar bean.
{ _Taste._--Bitter taste of the secretions. Strychnia,
{ picrotoxin. The milk of animals fed on wormwood
{ may become bitter; on colchicum,
Physical. { poisonous.
{
{ _Smell._--Prussic acid, tobacco, conium, &c.
{
{ _Colour._--Skin blackened by nitrate of silver,
{ given internally.
_N.B._--By the aid of the spectroscope the salts of lithium
and thalium have been detected in the liver and
other tissues.
Recapitulation of the Mode of Action of Poisons, and the Causes which
Modify their Action.
MODE OF ACTION
I. LOCAL
1. Corrosion of the part }
to which the poison } Strong acid, alkali, &c.
is applied. }
2. Inflammation as the }
result of irritants } Arsenic, cantharides, &c.
applied to a part. }
3. Effects on the nerves } Dilatation of the pupil by belladonna,
of motion and sensation. } tingling of the tongue and skin by
} aconite, paralysis by conium.
II. REMOTE
1. Common--not to be distinguished from the effects of injury or
disease.
2. Specific--peculiar to the poison itself.
(1) General--affecting the whole system.--Antimony.
(2) Partial--acting on a particular organ.--Antimony.
MODIFYING CAUSES
{ 1. Quantity of the poison increases its rapidly
{ fatal action.
{
1. Quantity. { 2. Action changed by the size of the dose. Thus,
{ oxalic acid in large doses acts as a corrosive;
{ in small doses on the heart, brain, or spinal
{ cord.
{ _Solubility_ increases the activity of poisons.
{ _Chemical Combinations._--Baryta is poisonous,
2. Form. { sulphate of baryta is inert.
{ _Mixture._--Dilution may retard or accelerate
{ the action of a poison.[19]
3. Point of application--Skin, lungs, mucous and serous membranes.
{ _Habit_--generally lessens the action of
{ poisons, e.g. _arsenic-eater, morphine-taker_.
4. Condition of { _Idiosyncrasy_--increases or may lessen the
the body. { action of poisons.
{ _Disease_--generally lessens, but in some cases
{ increases the action of poisons.
[19] Dilution lessens the activity of some poisons, by prolonging
the time necessary for their absorption; but in the case of powerful
irritants, which act through the blood, moderate dilution increases
their activity, by enabling them to enter the vessels more easily.
Oxalic acid is an example of the effect of dilution as a modifying
agent in its action. A small concentrated dose acts as an irritant;
diluted, it is soon absorbed, and quickly causes death.
GENERAL EVIDENCE AND DIAGNOSIS OF POISONING
It will now be necessary to consider briefly the general evidences of
poisoning, in order to determine whether a death alleged to be due
to poison is not really the result of disease. For convenience of
description, this subject will be divided into five sections:
1. Evidence from the Symptoms.
2. Evidence from the _Post-mortem_ Appearances.
3. Evidence from Chemical Analysis.
4. Evidence from Experiments on Animals.
5. Moral Evidence.
1. =Evidence from the Symptoms.=--As a general rule the symptoms come
on suddenly while the person is in apparent health, except in cases of
slow poisoning, when the poison may be so administered by frequently
repeated and small doses as to simulate disease, and the physician is
more easily misled than when a single large dose is given. In cases of
suspected homicide this suddenness in the accession of the symptoms
is particularly to be noticed, and we may have to decide as to the
probabilities of accident, suicide, or homicide. Here collateral
evidence must be our guide. The slowness, obscurity, and irregularity
of the symptoms are more in favour of homicide than either accident or
suicide. But it must also be borne in mind that the invasion of many
diseases is sudden, as is the case with cholera, gastritis, and some
others.
Certain conditions of the system more or less modify the effects of
some poisons. Thus, sleep delays the action of arsenic; and this may
also be the case with other poisons. Intoxication has also been said
to exert a retarding power over the action of certain poisons. This is
probably more apparent than real, the fact being that the symptoms in
the cases observed are masked.
Much more important, however, is the influence of disease. Large doses
of opium are well borne in mania, delirium tremens, dysentery, and
tetanus; whereas it is well known that even small doses of mercury in
cases of Bright‘s disease of the kidney, or in children recovering from
any of the eruptive fevers, have produced dangerous salivation.
The symptoms of poisoning go on from bad to worse in a steady course;
but there may be remissions, followed, under treatment, by their
entire disappearance, no ill effect remaining. Remissions are most
likely to occur in slow poisoning with the metallic irritants, from
fear of detection or cunning on the part of the poisoner to imitate
the progress of disease. In nervous affections, all the symptoms must
be taken into consideration, and these will be found to differ from
those of any known poison. The history of the case should also have due
attention paid to it.
In poisoning, the symptoms appear soon after food or drink has been
taken. This is open to the objection that apoplexy has occurred
immediately after a meal. The probative value of the above statement
is, however, increased if several persons have been similarly affected
after partaking of the same dish, especially if the symptoms followed
within a short time--under four hours--of the meal. But it must also be
remembered that all persons are not affected alike by the same poison.
Again, the diagnostic value is weakened if it can be proved that the
person or persons affected have taken nothing in the way of food for
two or three hours previously.
_The flesh of animals poisoned by accident, or intentionally, may
seriously affect those who eat it._--As a case in point may be
mentioned the injurious effects produced in some persons who had
partaken of the Canadian partridges imported to this country some years
ago, and which had probably eaten some poisonous berries during the
severe winter of that year.
Poisons may be introduced into the system otherwise than by the mouth;
that is, they may be placed in the vagina or rectum, or inhaled when
volatile poisons are used. Sometimes a poison has been introduced
into the medicine, or a poisonous draught substituted for the one
prescribed. In any case, where suspicious symptoms suddenly occur, the
poison has most probably been taken in from half an hour to an hour
previously, and it is of special importance to note the period of time
that may have elapsed between the accession of the symptoms and the
last meal, or administration of medicine.
When called in to a case of suspected poisoning, and in many cases
where no suspicion at the time arises, the medical attendant should pay
attention to the following points: