Transactions of the International Medical Congress of Philadelphia
We have received the Transactions of the ” Independent Medical Congress,” held at Philadelphia during the year 1876, edited by Dr Ashliurst.
This compilation is at the same time comprehensive and interesting, and discusses fully the Papers read in the individual Sections during the Congress.
The various divisions of the Sections are classed as follows : 1. Medicine. 2. Biology. 3. Surgery. 4. Dermatology and Syphilography. 5. Obstetrics. 6. Ophthalmology. 7. Otology. 8. Sanitary Science. 9. Mental Diseases.
We propose to briefly review the transactions in the latter section as bearing on psychology.
The President of the “Section on Mental Diseases” was Dr Gray, of New York, editor of the American Journal of Insanity; and the Vice-presidents Dr G-rissom, of North Carolina; Dr Isaac Ray, of Philadelphia; Dr Walter Kempster, of Winnebago, Wisconsin.
With such names it is not to be wondered at that the Papers placed before the Section were complete and interesting. The first communication was by Dr Kempster, on ” The Microscopic Study of the Brain.” The morbid changes which take place in the meninges are carefully considered. We are told that ” of the membranes investing the cerebral mass, the dura mater is the least liable to general hystological change, general paresis being the only disease in which it is found to be uniformly altered.” This opinion entirely coincides with the genera] view taken of cerebral diseases in this country. The morbid appearance of the pia mater and arachnoid are carefully considered in detail.
Nerve-fibres, we are told, are most liable to become hyper- trophied or atrophied, but in order to detect this the fibres must be examined very shortly after death.
A very interesting case is given of hypertrophy of nerve- fibres in a person, aged 47, who had been maniacal for a year. ” Twenty measurements of nerve-fibre were made soon after the patient’s death, giving results as follows :?One field contained a number of fibres of an inch in diameter; several fields showed fibres of an average diameter of of an inch, others a gain of -^–30” of an inch ; while, in one instance, the entire field was covered with fibres ranging from ^ to ^ of an inch. The largest fibres were found arranged in parallel bands. The same group of fibres, measured at different places, gave the same general results, the fibres ranging from to ^ of an inch in diameter. The portions measured were taken from different parts of the brain, and there was no great difference observed in the several fields as to size. Atrophy of the nerve-fibres from pressure of adjacent growth, or from prolonged capillary engage- ment, is of common occurrence in cases of chronic insanity, particularly in elderly people; so considerable is this atrophy at times that it is difficult to distinguish the tubular membrane, nothing but the axis-cylinder being clearly marked.”
The various changes in the ” neuroglia” are described as also in the nerve-cells.
The author concludes a most valuable addition to the subject by describing the microscopic appearances of the brain found in the various forms of insanity.
Dr Ray gives us an interesting Paper on ” The Respon- sibility of the Insane for their Criminal Acts.” He draws special attention to the case of McNaughten, tried for the murder of Mr. Drummond, and acquitted on the ground of in- sanity. This was one of the first trials in which the plea of insanity was urged in criminal cases. Dr Ray says : ” He was acquitted on the ground of insanity, but the public rebelled so strongly against the verdict that the matter was brought before Parliament, which instructed the law judges, twelve in number, to confer together and decide what the rule should be in cases of this kind. They agreed upon the rule put forth by Hoffbauer, as above described, and accordingly it was announced au- thoritatively as the law of the land.” Whilst on this subject it may be as well to remind our readers of the following little episode:?” Honour to whom honour is due.”
At the trial of McNaughten for the murder of Mr. Drummond, Dr Winslow, who was known to be in court, but who had not been summoned on either side, was asked by the judge to enter the witness-box ; and after he had given liis evidence in favour of the insanity of the luckless murderer, Lord Chief Justice Tindal interposed and stopped the case, as his evidence, com- bined with that of a previous witness, Mr. Aston Key, proved beyond all doubt the insanity of the murderer. From that time Dr Winslow was constantly summoned as a medical jurist in cases of doubtful insanity, and has been instrumental in saving many a poor irrational lunatic from the last terrors of the law. The opposition which he had to encounter before he could get this plea of insanity established is well-nigh incredible, save to those who know how conservative our lawyers are, and how jealous they manifest themselves of any intrusion on their pre- rogatives, and also how unthinking and unreasonable, for the most part, public opinion is when its feelings are strongly excited. On this matter we will let the doctor speak for himself:?
“A man commits a murder. He is tried for the crime. The plea of insanity is raised in his defence, upon what is con- ceived to be sound evidence, of the existence of mental derange- ment at the time of the murder. The attempt thus made to protect the criminal immediately rouses public indignation. Such an excuse is not in many instances listened to, and the unfortunate medical witnesses who have been called upon to exercise an important, and often thankless duty in support of the plea, are exposed, for giving an honest expression of opinion, to the most unmeasured ridicule and vituperation. In defending the memory of the suicide from the disgrace that would accom- pany a verdict of felo-de-se, the evidence of the medical man proving insanity is regarded with great respect, and treated with profound deference; but in his efforts to save a lunatic from the agonies of a painful death upon the scaffold, on evidence much stronger than was adduced before the previously mentioned Court, the expert is exposed to unmitigated abuse. Instead of being considered as an angel of mercy engaged in the exercise of a holy and righteous mission, he is viewed with suspicion, and often treated with contumely, as if he were attempting to sacrifice instead of to save human life. Again, the attempt to prove sanity and mental capacity at a Commission of Lunacy, with the object of preserving intact the liberty of the subject, and establishing his right to an unfettered management of his property, is applauded to the very echo; but any endeavour to excuse, on the plea of insanity, the crime of some unhappy wretch alleged to be an irresponsible lunatic, in order to rescue him from penal servitude, or from the hands of the executioner, is denounced, in unqualified language, as a most monstrous, unjustifiable, and iniquitous interference with the course of justice. The excuse of insanity will not, in many cases, under these circumstances, be tolerated by a portion of the press. The public mind is violently shocked at the commission of a horrible and brutal murder. The act is viewed as one of great and barbarous atrocity, apart altogether from its concomitant ex- tenuating medico-psychological considerations. The cry is for ‘ vengeance!’ The shout is, ‘ an eye for an eye!’ ‘ a tooth for a tooth!’ ‘ blood for blood !’ forgetting in the paroxysm of indignant emotion and frenzy of excited feeling engendered by the contemplation of a dreadful violation of the majesty of the law, that justice must be tempered with that Divine mercy which sanctifies and enshrines The throned monarch better than his crown.
And is the attribute of God Himself.
These words were written ex animo pleno, and are evidently dictated by sad experience. However, Dr Forbes Winslow had the satisfaction before his death of seeing his views generally accepted, and the plea for which he had so valiantly striven now passes unchallenged in our courts of law. Other physicians have since written on the same subject, but joalmam qui meruit fevat; and we repeat, it is to Dr Forbes Winslow that the honour of first establishing the plea in England is due.
Dr Winslow, shortly previous to the trial of McNaughten, had published his u Plea of Insanity in Criminal Cases,” and which had formed the subject of much comment.
Dr Ray goes deeply into a consideration of this, criminal responsibility, and admits the well-known difficulties of making the plea of insanity in criminal cases as effective as it should be. With regard to the removal of these difficulties, Dr Iiay says, in conclusion: ” Let me say, in the first place, that if courts are to continue to measure the exculpatory effects of insanity by certain arbitrary tests, they are bound to avail themselves, as did Lord Hale, of all the existing medical knowledge on this subject. Instead of repeating, one after another, rules and distinctions, of which the sole claims to respect consist in the fact of their having been uttered before, it is their duty to learn as much as possible of the nature of insanity from the only true source of knowledge?the practical observation of the insane. Have we not a right to ask the judges to make themselves acquainted with the nature of insanity by all the means within their reach, so that, instead of directing the jury by a servile repetition of something that others have said before them, with no other authority than the fact that it has been said, they shall present only the established facts of science and such considera- tions as are naturally suggested by them ? Let it be remem- bered that we are dealing with a branch of medical jurisprudence, and therefore that the study here recommended belongs as well to the lawyer as to the physician. I do not suppose, indeed, that the soundest instructions would always be followed by a proper verdict, for juries are too fond of manifesting their independence by disregarding whatever may conflict with their own foregone conclusions. But it would remove somewhat the distrust now felt of judicial decisions in which the advancement of knowledge is entirely ignored, and would prepare the way for a better and more satisfactory administration of justice.”
We commend a careful perusal of Dr Ray’s paper to all interested in the criminal responsibility of the insane. Dr Hughes contributes a valuable Paper on ” Simulation of Insanity by the Insane,” and illustrates his Paper with some interesting cases.
The volume concludes with an interesting Paper by Dr. Nichols on ” Provision for Subjects of Chronic Insanity.” We would wish, in conclusion, to draw attention to a carefully written and complete Paper, by Dr Bartholow, on ” Modern Life and Nervous Diseases,” which caused a lengthy discussion. The whole volume of Transactions is worthy of careful perusal, and will be a valuable addition to the library of the medical practitioner.
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