~< CCCcC «rc- «^7- C Cc re ?■<• OCT" ^ <^ ■« c c;rc C c ccC <^ etc c. C C CC CC c d c^c <<. ■ c <:._■ c c c c C CC c c C_ CC ... : cc: < r-cr^. •• CO < ;: c ' -CC <2 ' Cc^ ^ cc e Cc><somania, Bruhl-Cramer should claim to be first to describe the disease. He termed the disease trunkrsucht. Hufeland wrote an introduction to the work and intro- duced first the word dipsomania from the Greek dijjsa, thirst, and mania. A number of other writers might be cited who confirm the views already given of the existence of a dipsomania. "We will leave the Continent and notice a few English works, then one or two American. Among the British w^riters, Taylor may be mentioned as a prominent medico-legal writer. He recognizes and ad- mits the existence of a dipsomania, but treats only of the legal relations. Forbes Winslow has described the disease in the Journal of Psychological Medicine^ 2d series, vol. ii., p. 483, in 1?^62, in a review of a reprint of the work of Salvatori. Wins- low quotes Prof. Christison, agreeing with him in saying that the work of Salvatori is the best that he is acquainted with npon the subject of dipsomania. Backnill and Tuke^ Manual of Insanity, p. 218, confirm the views of those who maintain the existence of a dipso- mania. They regard as the prominent feature of the dis- ease the irresistible propensity to drink. Of American writers we find some who mention dipso- mania — others who completely ignore it. Beck only hints at it; Wharton and Stille are silent upon the subject, al- though they have a perfect mania for manias. Ray con- tains a discussion, chiefly relating to the legal relations of the subject. Other views are given on pages 488-9 of his 1 6 Dipsomania and Drunkenness. work, but which are alreodj quoted, in those giveu of Esquirol, Marc, &c. The work contains nothing new upon the subject, but is valuable in that it brings together the views of others in an original manner. We might present an innumerable number of views con- tained in medical journals, dictionaries, &c., but it would add little to the value of the article — they being mere reit- erations of the views long since put forth by classic writers. 2. The Existence of Dipsomania as Proved by the Evidence of the alleged Dipsom.aniac. MclSTish, p. 163, Anatomy of Drunkenness^ relates the conversation held with a dipso- maniac, with whom he remonstrated. The dipsomaniac replied: "My good friend, your remarks are just; they are indeed too true, but I can no longer resist temptation. If a bottle of brandy stood at one hand, and the pit of hell yawned at the other, and I were convinced that I would be pushed in as sure as I took one glass, I could not refrain. You are very kind ; I ought to be grateful for so many kind, good, friends, but you may spare yourselves the trouble of trying to reform me; the thing is out of the question." The books are full of like cases — but it is very difficult to say how much reliance can be put in the word of these men. Destitute of all moral principle, many of them have no regard for truth, honor, or even common decency. The old Adam of man's fallen nature forms in all these cases a strong element. Drink they ivilly their own desires being above all else, declaring that they '^ would drink if the devil stood over them," or as another one said to me a few years since: "If a jug of whisky stood at the depot, (that is, half a mile off,.) and there was a row of cannon constantly firing Ohio State Medical Society. 17 from each side of the way, across it, I would risk my life to get the whisky." A fellow said to me while I was en- gaged upon this paper that he " wished I could give him something to make him decent." He had been drinking constantly for three weeks — his father was a drinker — the son inheriting a moral nature of a very low grade — with an unremitting thirst for drink, laziness, and a general state of good-for-nothingness. His passions were never restrained, nor his desires quenched, but he was reared simply to be a curse to both society and his friends. Many men may be seen in every community where liquor has been drank for several generations, who declare that they are unable to refrain from drink — yd they do for months when it is to their interest to do so ; as when the prospect of a wealthy bride, or other consideration is presented. They all declare that they are unable to withstand the sensation — the something which impels them to drink. Before they have drank to such an extent that brain and nerve disease are developed to a degree sufficient to dethrone the Will, they can in nearly every instance pause — even if the dis- ease, or rather vice, is inherited. But too often they have no desire to pause; they declare in one breath that they are going to end their drunkenness, that they do not wish their children to grow up knowing their father was a drunkard, and with the next breath demand more liquor and drink to drunkenness — turbulent, boisterous, a terror to all peace- able citizens, thej^ continue on until death removes them out of the way — leaving if they have children, offspring from which the various classes of idiots, insane, paupers, and criminals of all grades may be developed. 3. With this vast array of evidence, the accumulated wisdom, experience, and labor, of men devoted to mental science, are we convinced that a condition exists which is 18 Dipsoi7ia7iia a7id Drunkenness. truly a dipsomoiiia — a mania for drink? Does the experi- ence and judgment of each one confirm the views present- ed? We have examined many authors — not one dissents from the assertion that there is a dipsojnania. The only dif- ference of opinion is concerning its nature — the degree of mental derangement — whether it is a mental disease, or only a physical condition, and the mental phenomena but symptomatic. As we shall endeavor to show in our paper upon the monomanias^ that there are certain physical con- ditions common to all these forms of disease, alleged to be insanity — we shall not exhaust the subject at present lest we destroy the interest in our paper, II. The Nature of Dipsomania is set forth by Marc as follows: "The dipsomania that some writers have called intermittent, and which to my mind is the result of a vicious habit, without any other cause than lohat idleness, sensuality, imitation and dissoluteness of morals have contributed to it." His original language can not be exactly expressed in English, I have given the sense of it. It reads: ^'la dipso- manie que quelques auteurs ont appele^ intermittente, et qui, a mon avis, est la suite dhme habitude vicieuse, sans qu^aucune autre cause que la paresse, la sensualite, Vimitation et la disso- lution des moeurs y aient contribueJ' Koesch says, memoir, p. 335, "The moral state of a man habituated to drink, or as expressed by Clarus, of a dipso- maniac, is assuredly not normal, as I have above declared. ISTevertheless, as a degeneration of morals, and of a nature that accompanies, not a real disease of the mind, and which hinders not the man from distinguishing the just from the unjust (good from evil), and from preserving some empire ■^Appointed to report at Ohio State Medical Society, Toledo, June, 1874, upon MONOMANIA. OJiio State Medical Society. 19 over himself, responsibility is not modified, and for grave reasons is not abolished, the dipsomaniac, as all other im- moral Dien, is responsible for the actions he commits when not drunk." We quote this to shovr that this eminent writer did not raise dipsomania in the rank of mental diseases, above common drunkenness; that while he admits the existence of the disease, he regards it rather as a cice than a disease worthy of the rank of true insanity. According to Erdman, "Dipsomania ought to be consid- ered as a mental affection, with absence of free will, and which can be compared with some reason to the uterine furor." Tardieu^ speaking of the nature of dipsomania, says, "It is certainly very difficult to trace the line which separates the monomania of drunkenness from the debauchery which results from a violent passion and a vicious impulse. Some excellent minds are not disposed to see in dipsomania a true partial insanity, — (H. Royer Collard). Whatever it may be we can not refrain from remarking, that in all cases this instinctive depravity delays not to result in a weak- ening and derangement of the intellectual faculties which degenerates often into general delirium. Sometimes the unfortunate and disgraced, despairing of their power to conquer the desire which impels them, end their days by a violent death." Dr. Tuke, Manual, p, 218, says of the nature of dip- somania: "This is a form of mental disorder, which, in an espeeial manner, requires to be discriminated from what may be termed a mere physiological condition, in which the human animal chooses to indulge in alcoholic bever- ages to excess. On the one hand, the admission of this disease into the department of mental pathology, does not 20 Dipsofuania and Drunkenness. need to make us conclude that there is no such thing as in^ temperance withf»ut disease; and on the other, the fact that the abuse of alcoholic drinks has oftentimes no disease to plead in its excuse, must not lead us to the opposite extreme of denying that a truly diseased cerebral condition may ex- ist, the result of which is inebriety. How then shall we distinguish the two conditions, when the result — intemper- ance — is the same in both ? ''First — by observing whether there are any symptoms present which can be referred to primary disorder of the nervous system, that is to say, other symptoms than those which as in ordinary drunkenness can be readily accounted for by the prolonged indulgence in alchoholic drinks. The family psychological history, again, is of great importance. Cases in which an insane parent has a drunken son, point strongly, of course, to disease. The development of the appetite for stimulants in early life is another indication in the same direction. But, to come more closely to the cir- cumstances attending the habit itself. The prominent feature of this propensity is its irresistibility; the thirst for drink is the tyrant which overbears all the higher emotions and blindly leads the oinomaniac to a course against which his reason and his conscience alike rebel. ''^Dt. Hutchinson was among the first to draw special at- tention to this disease. After observing that there are in- dividuals who, at the festive board, invariably become excited, if not intoxicated, but are otherwise habitually sober, and in the course of a year drink much less than others who never appear to be under the influence of stim- ulants, and that others indulge in their potations in a reg- ular manner and daily consume a larger quantity of liquor than is consistent with good health and sobriety, he proceeds: "All these, however, possess self-control, and can at any Ohio State Medical Society. 21 time refrain from stimulants ; but those afflicted with the disease can not do so, however convinced they may be of the impropriety of yielding to their propensity, or how de- sirious they may be to subdue it. " The disease appears in three forms, — the acute, the periodic, and the chronic. The acute is the rarest of the three. We have seen it occur from hemorrhage in the pu- erperal state, in recovery from fevers, from excessive vene- real indulgence, and in some forms of dyspepsia. '•^ The 'periodic or paroxysmal form is much more frequent than the acute. This is often observed in individuals who have suffered from injuries of the head; females during pregnancy, at the catamenial period and afterwards, and in men whose brains are overworked. Like the form about to be mentiqned, it is frequently hereditary, being derived from a parent predisposed to insanity, or addicted to in- temperance. In such cases the probability of cure is very small. The individual thus afflicted abstains for weeks or months from all stimulants, and frequently loathes them for the same period. But by degrees he becomes uneasy, listless, and depressed, feels incapable of application, and restless, and at last begins to drink till he is intoxicat- ed. He awakes from a restless sleep, seeks again a repe- tition of the intoxicating dose, and continues the same course for a week or two longer. Then a state of ap- athy and depression follows, during which he feels a loath- ing for stimulants, is the prey of remorse, and regrets bit- terly his yielding to his malady. This is followed by fresh vigor, diligent application to business, and a determined resolution never again to give way. But alas! sooner or later the paroxysm recurs, and the same scene is re-enacted; till ultimately, unless the disease be checked, he falls a vic- tim to the physical effect of intemperance, becomes maniacal -- Dipsomania and Drunkenness. or imbecile, or affected with the form of the disease next to be mentioned. " Of all the forms of oinomania the most common is the chronic. The causes of this are injuries of the head, dis- eases of the heart, hereditary predisposition, and intemper- ance. This is by far the most incurable form of the malady. The patient is incessantly under the most overwhelming desire for stimulants. He will disregard every impediment, sacrifice comfort and reputation, withstand the claims of affection, consign his family to misery and disgrace, and deny himself the common necessaries of life to gratify his insane propensity. In the morning morose and fretful, dis- gusted with himself and dissatisfied with all around him, weak and tremulous, incapable of any exertion either of body or of mind, — his fi.rst feeling is a desire for stimulants, with every fresh dose of which he recovers a certain de- gree of vigor both of body and mind, till he feels compar- atively comfortable. A few hours pass without the craving being so strong; but it soon returns, and the patient drinks till intoxication is produced. Then succeeds the restless sleep, the suffering, the comparative tranquillity, the ex- citement, and the state of insensibility; and unless abso- lutely secluded from all means of gratifying the propensity, the patient continues the same course until he dies or be- comes imbecile." Dr. John E. Tyler^ in his yearly report for 1866, as super- intendent of the McLean Asylum, speaks of the nature of of dipsomania, as follows: " It sometimes happens that after a fever, or other severe illness, or after a fall or blow upon the head, or after a se- vere domestic afi3.iction or bereavement, or a sudden loss of property, a person always temperate is seized with and yields to an impetuous desire to drink ardent spirits. Thus? Ohio State Medical Society. 23 lamented as much by the individual as by his friends, but by successive indulgences which he can not refrain from, and from which if he is not prevented by others, he reaches the sad mental and moral condition of the inebriate. ^ "^ Such deserve but do not have sympathy, inasmuch as mental disorder precedes and causes the excess." Dr. Anstie, in Reynold's System of Medicine, in his ar- ticle upon Alcoholism, says: "It is in truth rather a variety of constitutional insanity than of alcoholic disease, but as their outbreaks owe many of their characteristic symp- toms to the influence of drink, the disease requires notice in a treatise on alcoholism." LeviUe, p. 249, Z>e la Folie des ivrognes, Paris, 1825, pre- sents the following upon the nature of dipsomania, and as Hufeland's description: " Prof. Hufeland gives the following description of dip- somania : Unsteadiness of nervous system ; lassitude of the members ; various illusions of the external senses ; altered sensibility of the optic nerves ; trembling of the hands, and great timidity. The disease is consecutive to a first con- dition provoked by alcoholic drinks and fixes itself upon the abdominal viscera ; there is fever, colic, and disagree- able sensations in the abdomen ; that which does not belong to deliriuin tremens. Dipsomania is symptomatic, the de- lirum which characterizes it is like to that which accom- panies certain fevers, and of which the principal cause is located in the apparatus of the digestive organs ; it dimin- ishes after the ingestion of spiritous liquors and reappears when their efiect ceases. Recovery obtains but when vom- iting supervenes." Hufeland, in 1819, in his preface to Bruhl-Cramer, says of dipsomania, " it has the greatest analogy to nymphomania." The fact that it is not developed but with those addicted 24 Dipsomania and Drunkenness. to some extent to the use of strong drink allies it closely to the more common forms of drunkenness. All men do not drink continuously who have a thirst for liquor — a great part of all drinkers drink more or less peri- odically — Bruhl-Cramer says, Sec. 7: " The moral causes appear to operate but when the frequency of previous ex- cesses have created a predisposition to dipsomania ; at least I have not knowledge of one single case of dipsomania where the individual had not before committed excesses with strong drink." Salvatori says: " The principal predisposing cause is a great excitability of the nervous system ; another cause is the habit of frequently abusing wine; it is that which en- genders the excessive excitability of the nervous system, which seems to be the principal element of the disease." He does not consider dipsomania as an idiopathic mental affection but as a material affection of the body, which re- sults in a weakness of intellect and insanity. He says: "The disease is located in that part of the nervous sys- tem situated in the hypochondriac region, and that which we usually designate under the name of the abdominal ganghonic system ; dipsomania ought then to be considered a^ a species pathologically belonging to the class we call common hypochondriacs and hysteria." Bruhl-Cramer also declares that it is a disease purely physical. To this we assmt, and as we find with the hyster- ical and hypochondriacal perverted tastes, so we have with dipsomania. With persons of a weak nervous system we readily find local disturbance become general in its influ- ence. A weak,' unstable nerve-center is always an excitable one. The desire is great for something that will suppress the unpleasant sensations. The local irritation is followed by sympathetic intellectual disturbance. Ohio State Medical Society. 25 Bagonet, Traite des Maladies 3Ientales, p. 288, says of delirium tremens: " This form of alienation ought not to be confounded with dipsomania, a variety of monomania, which is characterized by irresistible tendencies, violent im- pulses for drink, and which we will further describe.'^ Marce, as we have already seen, regards dipsomania as an instinctive monomania. He says, however, p. 387, " We designate under the name dipsomania a particular form of instinctive monomania^ which consists in an irresistible de- sire to drink alcoholic liquor." Descuret^ La 3fedecine des Passions, says: "Drunkenness is sometimes continuous, but the most often it is intermit- tent. It is, in effect, with many individuals, that they are intoxicated but in the spring-time — others in the winter — some only certain times in a month or week." Ksquirol treats of dipsomania as monomania d'ivresse, and declares that these individuals are impelled by an irresist- ible force into abuse of alcoholic liquors. He says, p. 370, Tome I. des Maladies ITentales, after relating illustrative cases: " After the preceding facts, who can deny that there exists a mental malady of which the character in general is an irresistible force compelling the abuse of strong drink?" He regards the periodic character as evidence of insanity from the fact that the individuals affected, in general, drink periodically and have a thirst for drink but when there is a predominance of nervous symptoms — when these subside the thirst for liquor is gone. Morel, Des Mcdadies Mentales, p. 418, thus expresses his views of the nature of dipsomania: " That which it is proper to say of the irresistible propensity to drink alco- holic liquor, can and should be applied to other diseased conditions which, with some physicians, form distinct pa- thological entities: I wish to speak of the monomanias, 26 • Dipsomania and Drunkenness. suicidal and homicidal, of incendiarism and kleptomania. It is also as impossible for me to make a special disease of this irresistible force that bears the individual to drink as it has been to find a distinct mental affection in that blind instinct, in that something indefinable lohich forces certain in- dividuals to murder. Suicide, incendiarism, theft, the de- praved tendencies for drink and the consequences of it, are the facts which the most commonly lead to judicial inves- tigations with the insane. ISTow my firm conviction is that all these acts are the symptoms of a mental disease of which the true pathological characters can be demonstrated." Again he says, " It is not necessary to create a special form of mental disease, a monomania of which the prin- cipal character will be an irresistible tendency to drink." Falret, Traite des Maladies Mentales, does not regard dip- somania worthy of being ranked as an entity in mental diagnosis, nor does he favor the designation of it as a monomania. Greisinger we quoted, he regards dipsomania as a symp- tom rather than as a cause of periodic insanity. Dr. Ray speaks of these cases as being the subject of vice. After giving cases to illustrate the nature of the malady, he says, p. 498, Jurisprudence of Insanity: " These phenomena strongly remind us of some of the manifes- tations of moral mania, and if further evidence is necessary to convince us that they are both connected w^ith similar pathological conditions, it is abundantly furnished in some other phenomena of drunkenness. It is now well under- stood that this vice assumes sometimes 2u j^^viodic character, persons indulging in the greatest excesses periodically, who are perfectly sober during the intervals which may continue Ohio State Medical Society. 27 from a month to a year. From a state of complete so- briety, they suddenly lapse into the most unbounded in- dulgence in stimulating drinks, and nothing but absolute confinement can restrain them." Guy^ Forensic Medicine, p. 171, says of the nature of dip- somania: "A craving after spirituous liquors is one ot the recognized forms of unsoundness of mind (dipsomania); while in others it is merely a leading symptom of a more general disorder, in some cases the craving after alcoholic liquors is intermittent, showing itself only at intervals." By the comparison of views of writers we have made we observe that it is clearly established that dipsomania is a physical disease; the j^hysical condition one of impaired vi- tality, with consequent exaggerated or perverted desires. All authors unite in the fact that the all-essential feature of the disease is a craving for strong drink. From this we infer that the nutritive functions make a demand for some- thing that will supply the apparent loss of vitality or give impulse to what remains. In our opinion it is but a modi- fied and exagerated desire. But what is a desire ? To show the relation of the disease in question to a desire in a nor- mal state, we must first fully comprehend the relation exist- ing between sensation — desire — emotion, and the will. Desire is a state of suspense, existing between a motive on one band and execution or action on the other. Bain, in his Mental Science, defines a desire: "The state of mind where there is a motive to act — some pleasure or pain, actual or ideal — without the ability." Again, "When a pleasure prompts us to work for its continuance or in- crease, and when we at once follow the prompting, there is no place for desire. "^ "^ In desire, there is the 28 Dipsomania and Drunkenness, presence of some motive, a pleasure or a pain, and a state of conflict in itself painful." There are various modes of escape from the conflict and unrest of desire. The first is /orceoJ gMzesce/zce; to which are given the fa- miliar names — endurance, resignation, fortitude, patience, contentment." With this we may add the remedy is a vol- untary one. It requires an exercise of. will power to sup- press the impelling force of the desire. The emotion aris- ing, that is a sensation giving rise to either pleasure or pain, may be neutralized and the impulse to action suppressed. The ability to control the emotions and to suppress them is an essential element of true greatness — for with this power developed to a high degree only can full exercise of reason and judgment be obtained. The weak Will yields to the demands of appetite, to the appeal of passion, to the example and influence of emotion in others. The power of the Will in controlling the passions, and the emotions of joy and grief, pleasure and pain, is illustrated with the old philosophers and in savage life better than elsewhere. They show a strange contrast between the mastery of the passions and the weak-willed, emotional class of more civilized life. Uphavi thus pictures it in the savage : " Let the reader go with us a moment to yonder dark and boundless forest. Behold beneath the light of the uncertain and shuddering moon the fire kindled which is destined to consume the victim taken in war. View him fastened to the stake, his flesh slowly consumed, and, as it is burning torn piece-meal from his blackened bones. What inexpressible suffering ! And yet this dark son of the forest, this poor, ignorant child of nature betrays no weakness of purpose, sheds no tears, utters no exclamation of impatience. His enemies Ohio State Medical Society, 29 can take from liim his distant wigwam, his wife and chil- dren, his burning body, his expiring life ; but the sudden death-song rising loudly and triumphantly is a proof that they have not taken, nor are they able to take from him, the firm resolve — the unconquerable luill." Bain says, "A second outlet for desire is ideal or imagin- ary action.'" The desire in question arising from some want or deficiency of the system, and having been once sup- pressed only by strong drink, the condition thereby ob- tained remains in memory, and the condition recurring, is a motive to repeat the excesses that desire may be unfelt. The vision of strong drink appears — the imagination pic- tures it constantly to the mind in pleasing colors, and the victim of dipsomania endeavors to drown his sensations in the intoxicating draught. In man /our main classes of desires may be said to exist, arising from the wants of his natural organization, or to supply material for the growth of body and mind: 1. The intellectual. 2. The moral. 3. Vegetative functions: Hunger, thirst, respiration, &c. 4. Reproductive functions. These seem to be allied closely in the manner of exhib- iting their demands. Either a motive to action is afforded through the desire, or an emotional condition results, re- quiring the exercise of will-power to restrain it. In a state of sanity the will is directed by the motive, subject to the sanction of conscience, reason, and judgment. In criminal procedure, a man alleged to be insane, and consequently irresponsible, must be beyond the infiu- ence ot motives, otherwise there is no immunity from pun- ishment. Motives must cease to have power over him. With great criminals, or hardened and incorrigible, there is 4 30 Dipsofnania and Drunkenness. a debatable, middle ground between sanity and insanity, in which motives have not lost their power, if the attention is directed to the consequences of an act. The individual is ajp'parently beyond the reach of motives, the censure or ap- proval of society no longer influences him, yet he can if he sees proper govern his actions. There is a blind, instinct- ive impulse directing his actions, yet not beyond his power to thwart if self-interest prompts otherwise, or some end to be achieved can thereby be gained. In the vortex of the whirlpool of passion no ear is open to the voice of con- science. In this state of moral weakness deliberation and judgment fail to produce mature fruit. On the one hand there is an appetite, a desire, — a lust, — on the other, in the dim distance, looms up faintly to the unheeded, or unedu- cated conscience, with its imperfect ideal of good and evil, the path of duty. Emotion, the offspring of sensation, antagonizes will. The desire becomes imperative, and the will unaccustomed to exercise its executive power untram- meled, yields. The individual, if motives do influence himy flies to the society and scenes that past experience has taught him will absorb his attention, and drown all prompt- ings of his better nature. He throws himself a loiUing vic- tim into the current that will bear him irresistibly on, until he sinks beneath its turbulent surface to rise no more. The prayer of conscience is drowned amid the uproar of de- bauchery, attention forbids to exercise its office, and all that can operate for good is enjoined by this cultivated moral apathy to inactivity. Again, where conscience is not suc- cessfully stifled but 7vill be heard, the individual pursues his way much as did the man who would not rise till noon. He delays reformatory action to hear the pleading of desire, until procrastination steals the opportunity for any other action. The attention divided between good and evil ren- Ohio State Medical Society. 31 ders man powerless to pursue the path of duty. The truth can only be found by undiverted, undissipated, unwavermg attention in the course of proper pursuit. A French author {31alebranche, Traite de Morale,) beau- tifully ilhistrates the fact that good actions can spriug only from attention^ and this full exercise of attention only from a cultivated, regenerated Will. " The discovery of truth can only be made by the labor of attention; because it is only the labor ot attention which has light for its reward; the attention of the intellect is a natural prayer by which we obtain the enlightenment ot reason. But since the fall, the intellect frequently experi- ences appalling droughts; it can not pray; the labor of at- tention fatigues and afflicts it. In fact, this labor is at first great, and the recompense scanty; while at the same time we are unceasingly solicited, pressed, and agitated by the imagination and the passions, whose inspiration and im- pulses it is always agreeable to obey. ^Nevertheless, it is a matter of necessity; we must invoke reason to be enlight- ened; there is no other way of obtaining light and intelli- gence but by the labor of attention. Faith is a gift of God which we earn not by our own merits; but intelligence is a gift usually conceded to desert. Faith is a pure gift in every sense; but the understanding of a truth is a grace of such a character that it must be merited by labor or the co-operation of grace. Those, then, who are capable of this labor, and who are always attentive to the truth which ought to guide them, have a disposition which would un- doubtedly deserve a name more magnificent than those bestowed on the most splendid virtues. But although this habit or this virtue be inseparable from the love of order, it is so little known among us that I do not know if we have done it the honor of a particular name. May I^ there- 32 Dipsoma7iia mid Dt'mikenness. fore, be pardoned in calling it by the equivocal name of force of intellect. To acquire this true force by which the intellect supports the labor of attention, it is necessary to begin betimes to labor; for in the course of nature, we can only acquire habits by acts, and can only strengthen them by exercise. But perhaps the only difficulty is to begin. We recollect that we began, and that we were obliged to leave off. Hence we get discouraged; we think ourselves unfit for meditation; we renounce reason. If this be the case, whatever we may allege to justify our sloth and neg- ligence, we renounce virtue, at least in part. For without the labor of attention we shall never comprehend the grandeur of religion, the sanctity of morals, the littleness of all that is not God, the absurdity of the passions, and of all our internal miseries. Without this labor, the soul will live in blindness and disorder, because there is naturally no other way to obtain the light that should conduct us; we shall be eternally under disquietude and in strange embarrass- ment, for we fear everything when we walk in darkness and are surrounded by precipices. It is true faith that guides and supports, but it does so only as it produces some light by the attention which it excites in us; for light alone is what can assure minds like ours which have so many enemies to fear." Man's moral power, moral principle, is then dependent upon the exercise of an intellectual faculty: attention, and attention upon the supreme executive faculty of the mind: the Will. Without attention there can be no exercise of the other mental faculties. The weakened will has been regarded by some as a spe- cies of insanity. It is in reality an imbecility dependent upon an enfeebled cerebrum. How many criminals have their career of crime determined by an inherited feebleness Ohio State Medical Society. 33 of the will. The Coleridges illustrate well this principle of imbecility. The elder was an opium eater — the younger inherited the condition his parent had by habit acquired. Rash, impulsive, his life was a series of failures and bitter self-reproaches. In one ot his books he w^rote: "Oh! -woful impotence of weak resolve, Recorded rashly to the writer's shame, Days pass av^ay, and time's large orbs revolve, And every day beholds me still the same. Till oft-neglected purpose loses aim, And hope becomes a flat unheeded lie." This is ever the condition of those who inherit a thirst for alcoholic liquor. Elam declares that 'Hhe habit of the parent, when inherited, does not appear in the child as a habit merely, but in most cases as an irresistible impulse, — a disease." A writer in the Psychological Journal of Winslow, re- marks in this language concerning the nature of so strange a disease : "An impulsive desire for stimulant- drinks, uncontrol- lable by any motives that can be addressed to the under- standing or conscience, in which, self-interest, self-esteem, friendship, love, and religion are appealed to in vain; in which the passion for drink is the master passion, and sub- dues to itself every other desire and faculty of the soul. ^ * >K ^\^Q victims of it are often the offspring of per- sons who have indulged in stimulants, or who have weak- ened the cerebrum by vicious habits or undue mental labor." 3forel presents a clear statement of those who inherit de- praved tendencies, and sets forth a correct statement of those who inherit dipsomania: 34 Dipsomafiia a?td Drunkenness. ^^ Such cases present themselves to our view with the predominance of a phenomena of a mental order, which I have had occasion to mention — that is, a complete abolition of all the moral sentiments. One might say that no distinc- tion between good and evil remains in the minds of these degraded beings." That dipsomania is the result of derangement of nerve- element, may be inferred from its tendency to transmission by the same laws that govern the various forms of hered- itary nervous disorders. It must be allied to gluttony, lib- ertinism, nymphomania, and a variety of conditions that may be transmitted from parent to child — in their own form or one into which that has been metamorphosed. It finds its analogue in many diseases of a hereditary char- acter. As the scrofulous child will devour lime, plastering from the walls, or mud from the boots of any one within its reach, so the methomaniac craves, and drowns his desires in strong drink. It is a physical condition, displaying its main features through derangement of the digestive or- gans, and consecutively through intellectual disturbance. In diseases in which there has been a great drain from the system analogous desires exist. Thus, during the war, I have observed hundreds of men who had an ungovernable appetite for food and drink, who were the victims of chronic diarrhea. Digestion, absorption, and assimilation, all seemed to be arrested. The body melted down and flowed away in the frequent liquid discharges. Here the unsat- isfied wants of the vegetative system gave rise often to a mental condition — to an apathy or torpor of the intellect- Ohio State Medical Society. 35 ual faculties, in which the patient thought only of food and the demands of nature. The brain did not, in many cases, sympathize with the local disturbance in the digest- ive organs. With those suffering from dipsomania there is, on the contrary, a condition of the nervous system similar to that of hysteria. The nerve-centers are weak, irritable, un- stable. This condition of the nervous system is encount- ered with the libertine-. In fact, writers use very similar language in speaking of the influence of the sexual passion over the mind that they do of drunkenness. Most writers regard dipsomania as a sequel to intemperate indulgence rather than as a spontaneous condition, or as an idiopathic disease. Bourgeois says of libertinism: "It is to the abuse of voluptuous sensations rather than to virtuous abstinence that it is necessary to attribute the maladies we have named (erotomania, &c); such is the mature opinion of thought- ful men, such as Max Simon, Duffieux, Diday, Mayer, Briquet, and Fredault, who have furnished indisputable proofs." Writers have attributed erotomania to continence. Bour- geois, p. 118, Les Passions, says, " Seek not to excuse then the relaxation of morals, under the pretext of continence — that continence is impossible, that it is hurtful. ISTo, this is not the physiological demand, it is the desire unrestrain- ed, it is the abuse which has forced to bad habits and which corrupts the health. The brain has a powerful influence upon the, functional activity of the genital organs. The s^alacite comes most often from the excitations of a depraved imagination." 36 Dipsommiia and Drunkenness. Again, he says of the power of habit in producing the condition: ''In these impure connections soon is destroyed all mental vigor, soon is thrown to the wind all moral sen- timents. % i^ ^ ^^ lensrth the inveterate habit of the debauchee can not be broken and you see many who remain unmarried that they may continue more at their ease their dissolute life." Is it not true of the dipsomaniac? He at first experi- ences only an increased desire for drink, but yielding to it he establishes a habit which eventually becomes so deeply rooted that mind alone can not uproot it. 111. The Mental State. As may be inferred from the preceding pages, we regard the disease, dipsomania, as a pnrely physical condition, not entitled to the rank of an insanity until continued and oft-repeated returns of the drinking fits have degenerated the nerve-centers to such an extent that the will can no longer repress the desire. The intellectual disturbance will, as in fevers, dyspepsia, and all diseases giving rise to local abdominal irritation, be ob- served to keep pace with the condition of the nerve-centers, in relation to their stability or excitability. These persons previous to drinking, when the fit comes on, appear to be able to fully comprehend their condition, to know right from wrong, that their excesses are disgrace- ful, yet, as do thieves, murderers, and scoundrels of all grades, they persist in their course, deaf to all entreaty, self- interest, reputation, or their own safety. There is no want of ability to comprehend what is their duty, but a persist- ent, absolute determination to drink at all cost — at all haz- ard — regardless of all consequences — Will seems subservient Ohio State Medical Society. 37 to the animal. The mental state, during the 'period of so- briety, differs in no way from that of other individuals who are not habituated to the use of alcoholic liquors — ivhen drunk the mental state is similar to that of other drunkards. In my opinion the disease is acquired, and even in those cases in which the hereditary thirst for drink seems irre- sistible, the condition is not developed fully until there has been previous indulgence. These repeated indulgences produce degenerations. There is in all forms of nervous disorders more or less periodic tendency exhibited. In common drunkenness there are few individuals who drink to any extent, that do not show more or less periodical de- sire. As degeneration of nerve-structure of the brain is developed, meningeal, gastric, and other irritations induced, the disease partaking more and more of the nature of de- lirium tremens so is responsibility lessened. While we do not dispute that in all countries where drunkenness has prevailed through several generations that a physical con- dition is acquired, described by writers, and which may be transmitted, becoming a desire, an instinctive impulse with the child, we do not believe that drunkenness, previous to excesses, is wholly involuntary, constituting a psychial entity, a special or distinct form of insanity. That is, loe admit the existence of a dipsomania, but regard it as a physical con- dition. We admit more: that true insanity may be attended in its development, among other symptoms, with a nervous prostration — exhaustion — that impels the person to use immoderately of strong drink. It is theyi a symptom, not the disease more than a hot skin or a coated tongue is a bilious fever. It should be considered at its true value, as any 38 Dipsomania and Drunkenness. other symptom, indicating a physical state. There are not the well marked pathological conditions of delirium tremens^ illusions, hallucinations, tremors, and sleeplessness, de- pendent on degeneration of nerve-element. If these are an element of the case, forming an essential part of the ag- gregate of symptoms, we should be inclined to consider the case one of pure delirium tremens, and call it by that name. If previous excesses determined the condition we should then, if the above symptoms were present, have no doubt of the true character of the disease. For legal purposes, as a defense, it would be well to try to establish this in evidence. IV. What "tests" shall we apply to determine the degree of responsibility f "Knowledge of right and wrongV The individual when not too drunk, has as clear a perception of duty as do the men who recruit the general class of evil doers. They declare positively the right and as positively enter upon the contrary. Shall the " irresistible impulse," that indefinable something, be the test ? If we admit this principle into the Code of Criminal Procedure, making it the guide in determining responsibility, where shall we place the limit that shall cut it off from vice — from sensu- ality — immorality and complete indifference to the rights of others. The same tests must be applied to all the monomanies — the same investigation of causes, conditions, and conse- quences that govern the acknowledged or accepted forms of insanity. If the condition is one of insanity it does not follow as a natural consequence that it relieves from all legal responsibility. To determine the existence of insanity is to establish one fact — the degree of responsibility is another. Ohio State Medical Society. 39 With delirium tremens there is no room for difference of opinion — the law relieves from all responsibility, as we shall show. The only test of insanity here required is, that the condition be proved to exist. The Legal Relations of Drunkenness must be made to conform in their application to the more general relations of insanity. If voluntarily induced it bears about the same relations to crime that do the passions, and in no way excuses crime, yet as we shall see by the general course of cases, intoxication may be pleaded to show that passion, and not premeditation, intent, and malice, ingredients of the crime of murder, which if absent reduce the grade of the offense, was the motive-power in inducing the crime com- mitted. The plea of intoxication is admitted more by way of ex- planation than of excuse or mitigation. Thus to constitute a case of murder at common law the aforementioned in- gredients must be proved to exist. The fact to be proved then is not whether the party was in a state of intoxi- cation, but the state of mind with reference to these ingre- dients. It matters not in the final issue whether the party be drunk or sober; the question of fact is, whether any of the ingredients of the crime are absent. If intoxicated the law still presames, in the absence of contrary evidence, that the act of killing is willful, deliberate, malicious, and premeditated, and the evidence of drunkenness is only ad- mitted to explain whether there existed the ingredients of murder — premeditation, malice, intent, — at the time the al- leged act was committed. If intoxicated, the law still re- gards the party to be of sound mind. 40 Dipsomania and Drunkenness. Guy says of drunkenness : " This lias no legal effect on any offense to which it leads. It neither increases nor mitigates the penalties that attach to it. It has even been deemed an aggravation. A drunkard's acts are therefore valid, unless it can be shown that the drunkenness was pro- cured by another person with a view to an unfair advantage." Those whose interest or curiostiy leads them to a further examination of the legal relations, will find in the follow- ing authorities what they may desire. Their views are those accepted by the courts, or the ruling of the Court itself. " Long-continued inebriety, although resulting in occa- sional insanity, does not require proof of a lucid interval to give validity to the acts of the drunkard, as is required when general insanity is proved. When the indulgence has produced general derangement of mind, it would be otherwise." — [Gardiner v. Gardiner, 22 Wend. 526. " Though voluntary drunkenness can not excuse for the commission of crime, yet where, as upon a charge of mur- der, the question is, whether an act was premeditated, or done only from sudden heat and impulse, the fact of the party being intoxicated has been held to be a circumstance proper to be taken into consideration." — [So * ruled by Holroyd, J., Eex v. Grindley, 1 Russ on Cr., by Grea, 8. Repeated in Penn. v. McFall, Addis, 257. Delirium Tremens excuses crime. In the case of Dreio (U. S. V. Drew), for the murder of Clark, the relations of delirium tremens to responsibility are well set forth. The evidence before the court, U. S. Circuit Court, May term, 1828, showed that Drew was of fair character, but addicted ^' Overruled by Parks and Littledale in Rex v. Carroll, 7, C. & P., 145. Ohio State Medical Sodety. 41 to the excessive use of ardent spirits; After recoverinoj from a drunken spree, in August, 1827, he threw all the liquor overboard from his ship. In two or three days after, he began to exhibit symptoms of an approaching mania a 'potii — suffered loss of appetite, sleeplessness, hallucinations and delusions. One of these was, that an Indian belong- ing to the ship was about to kill him, and calling him by name he promised to drink no more if he would not kill him. In the night of the 31st of August he attempted to throw himself overboard, but was prevented. The next morning while Drew and Clark were at breakfast, Drew left the table suddenly and was observed to conceal some- thing under his jacket which was on the transom in another part of the cabin. He then turned round and re- quested Clark to go upon deck. The latter replied that he would as soon as he had finished his breakfast. Drew then exclaimed, " Go upon deck or I will help you;" took the knife he had covered with his jacket, and saying no more, plunged it into the right side of Clark's breast. Clark fell but rose again and went upon deck. Drew cocked a pistol, pointed it at witness and snapped it; it missed fire. Drew followed them on deck, and said to his mate: "Mr. Cofiin, in twenty- four hours the ship shall go ashore." He was then seized and confined. For some weeks his actions were those of one insane. When restored he was told that Clark was dead, and he replied that he knew nothing about it ; that it appeared to him like a dream; that when he awoke he found himself handcuffed, but knew no more."^ '^ "It is not competent for the prisoner to give in evidence his own account of the transaction, related immediately after it happened, even though no 42 Dipsoma7tia and Drunkenness. After the above evidence, Justice Story gave as an opin- ion that the indictment could not be maintained, because the prisoner was beyond doubt insane when the offense was committed. He added : "The question made at the bar is, whether insanity, whose remote cause is habitual drunkenness, is or is not an excuse in a court of law, for a honiicide committed by the party while so insane, but not at the time intoxicated or under the influence of liquor. We are clearly of opinion that insanity is a competent excuse in such a case. In gen- eral, insanity is an excuse for any crime, because the party has not the possession of his reason, which includes respon- sibility. An exception is, when the crime is committed while the party is in a fit of intoxication, and while it lasts; and not, as in this case, a remote consequence, superinduced by the antecedent exhaustion of the party arising from gross and habitual drunkenness. "However criminal, in a moral point of view, such an in- dulgence is, and however justly a party may be responsible for his acts arising from it to Almighty God, human tribu- nals are generally restricted from punishing them, since they are not the acts of a reasonable being. Had the crime been committed when Drew was in a fit of intoxication, he would have been liable to be convicted of murder. As he was not then intoxicated but merely insane from an absti- nence from liquor, he can not be pronounced guilty of the offense. The law looks to the immediate and not the re- mote cause, to the actual state of the party, and not to the cause which remotely produced it. Many species of insan- person was present at the occurrence; for his account of it was no part of the res gestae.^' Greanleaf Ev., Sect, 149, and also State v. Tilly, 3 Ired. 424. Ohio State Medical Society, 43 ity arise remotely from what in a moral point of view is a criminal neglect or fault of the party — as from religious melancholy, undue exposure, extravagant pride, ambition, &c; yet such insanity has always been deemed a sufficient excuse for any crime done under its iniluence." — [5 Mason, 28.] The man was acquitted. Concerning intent, premeditation, and malice as ingre- dients of the crime of murder, as to whether they are re- moved by intoxication, the following opinions and rulings in leading cases by the presiding judges may be presented. It was held that " intoxication, when existing to a suf- ficient extent to prevent deliberation, lowers the oflense to the second degree." — [Com. v. Jones, 1 Leigh, 612; Com. v. Haggerty, Lewis, C. L., 403; Pirtle v. State, 9 Humph, 664. Competent authority declares the opinions in these cases not law; some are overruled. Judge Lewis, C. L., 405, says, " Except in the case of murder, which happens in consequence of actual or at- tempted arson, rape, robbery, or burglary, a deliberate in- tention to kill is the essential feature of murder in the first degree. When this ingredient is absent, where the mind, from intoxication or any other cause, is deprived of its power to form a design with deliberation and premedita- tion, the ofiense is stripped of the malignant features re- quired by the statute to place it on the list of capital crimes; and neither courts nor juries can lawfully dispense with what the act of the assembly requires." (Penn. Statutes governed the opinion.) In a case in Tennessee, Green, judge, said: "Voluntary intoxication is no excuse for the commission of crime ; on 44 Dipsomania a7id Drunkenness. the contrary, it is considered by our law as an aggravation of it *; yet if the defendant was so deeply intoxicated by spirituous liquors at the time of the killing, as to be in- capable of forming in his mind a design deliberately and premeditatedly to do the act, the killing under such a state of intoxication would only be murder in the second degree." Judge Reese, who delivered the opinion of the court in the case of Swan v. the State, 4 Hump. K. 136, said : "But although drunkenness in point of law constitutes no excuse or justification for crime, still, when the nature and essence of a crime is made to depend by law upon the peculiar state and condition of the criminal's mind at the time, and with reference to the act done, drunkenness, as a matter of fact, affecting such state and condition of the mind, is a proper subject for consideration and inquiry by the jury. The question in such case is. What is the mental status ? Is it one of self-possession, favorable to a fixed purpose, by de- liberation and premeditation, or did the act spring from ex- isting passion, excited b^ inadequate provocation, acting, it may be, on a peculiar temperament, or upon one already ex- cited by ardent spirits .^ In such case it matters not that the provocation was inadequate, or the spirits voluntarily drank; the question is. Did the act proceed from sudden passion, or from deliberation or premeditation ^ What was the mental status at the time of the act, and with reference to the act? To regard the fact of intoxication as meriting consideration in such a case, it is not to hold that drunk- enness will excuse crime, but to inquire whether the very crime which the law defines and punishes has been in point of fact committed." *Held to be an error by the supreme court, and decision reversed ; Halile V. State, 11 Humph., 154. [See further in this paper the case noticed.] Ohio State Medical Society. 45 In this, the design of the court was not to indicate to the jury the fact that a party under the influence of liquor to such a degree that he could form no purpose of mind would be absolutely incapable of exercising deliberation and pre- meditation, but that if deliberation and premeditation were established, as an element of the case, drunkenness would not affect the issue. Judge Turley, who gave the opinion of the court in the caseof Pirtle v. the State, said: "It will frequently happen necessarily, when the killing is of such a character as the common law designates as murder, and it has not been per- petrated by means of poison, or by laying in wait, that it will be a vexed question whether the killing has been the result of sudden passion, produced by a cause inadequate to mitigate it to manslaughter, but still sufficient to mitigate it to murder in the second degree, if it be really the true cause of the excitement, or whether it has been the result of premeditation and deliberation; and in all such cases whatever fact is able to cast light upon the mental status of the offender is legitimate proof: and among others, the fact that he was at the time drunk; not that this will ex- cuse or mitigate the offense, if it were done willfully, delib- erately, maliciously, and premeditately; (which it might well be, though the perpetrator was drunk at the time,) but to show that the killing did not spring from a premeditated purpose, but to sudden passion, excited by inadequate prov- ocation, such as might be reasonably expected to arouse sudden passion and heat, to the point of taking life, with- out premeditation and deliberation." " Mere intoxication is no excuse for crime. Evidence of it may be admissible to the question of malice." — [Kelly v. the State, 3 Smedes & Marshal, 518. Further upon intent and malice-. The State v. Cross, 27 5 46 Dipsomania and Dnmkenness. , Missouri, 332; Golden v. the State, 22 Georgia, 527; the same, Jones v. the State, 29, 594; Moonej v. the State, 33 Alabama, 419; O'Herrin v. flie State, 14 Indiana, 420; Dawson v. the State, 16 Indiana, 428. In Eex V. Day, 3 Paris & Fonbl. Med. J. 140., it was held, "intoxication is no excuse for crime," and the defend- ant, who in a paroxysm of drunkenness rose in the middle of the night and cut the throats of his father and mother, ravished the servant-maid in her sleep and aferwards mur- dered her, was executed for these crimes. "If a person while sane and responsible makes himself intoxicated, and while in that condition commits murder by reason of insanity, which was one of the consequences of intoxication and one of the attendants on that state, he is responsible." — [United States v. McGrue, 1 Curtis C. C. I; also the People v. Robinson, 2 Parker C. R., 235; the People V. Hamill, same Rep. 223; the State v. Harlowe, 21 Missouri, 446; Com. v. Hawkins, 3 Gray, 463; Mercer v. the State, 17 Georgia, 146; Carter v. the State, 12 Texas, 500; the People v. WiUey, 2 Parker C. R., 19. As to delirium tremens, " State v. Sewall, 3 Jones' Law, 245; the People v. McCann, 3 Parker C. R., 272; Mac- conehey v. the State, 5 Ohio, 77. From all these cases, what are we to conclude ? With Roscoe, Criminal Evidence page 909, Wharton, Cr. Law, 3d Ed., 92, and the multitude of other authorities, shall we say, "Intoxication is no defense as to the fact of guilt?" Shall we say with the old English writer, " A drunkard who is voluntarius demo, hath no privilege thereby, whatever ill or hurt he doth, his drunkenness doth aggravate it." (Coke's Littleton, 46). We believe the views of Guy are sustained in the most recent American cases. They have been allowed to pursue their way, the question of drunkenness having no bearing upon the final issue, — and upon just grounds. Ohio State Medical Society. 47 In the case, Cornwall v. the State of Tennessee, Mar. & Ser., 147, 1849, the point is well set forth : "A contrary doctrine ought to be forced out of circu- lation, if it has obtained it, by every friend to virtue, peace, quietness, and good government. All civilized govern- ments must punish the culprit who relies on so untenable a defense; and in doing so, they preach a louder lesson of morality to all those who are addicted to intoxication, and to parents and guardians, and to youth and to society, than comes with cold abstract from pulpits. To the justice and correctness of these remarks, all who have had experience in the annals of crime can bear testimony. It is only at the present term of the court that we have seen it proved that an oifender, a short time before the perpetration of a horrid murder, inquired of a grocery keeper what kind of liquor w^ould make him drunk soonest, and swallowed thereon a bumper of brandy. We have had three cases of murder, and one of an assault with intent to murder, before us at this term of court, in every one of which there are convictions in the circuit court and affirmances in this; every one of which is of aggravated character, and in every one of which the perpetrator, at the time of the commis- sion of the oflense, was laboring under dementia affedata, drunkenness; an awful illustration of the necessity of hold- ing to the law as it has been adjudged upon this subject. There is, in our judgment, no conflict of authority upon this point of law; every case which may have such appear- ance, being a case of exception on the application of the rule, or a case of no authoritj^ upon the subject." The same is held in Kelly v. State, 8 Smedes & Marshal, 518, in which case the question was of intent. The Court of Error and Appeals (Miss.) laid down the law, as being well established, that drunkenness is no excuse for crime, 48 Dipsomania and Drunkenness. although sometimes held proper for consideration, where the sole question is whether the act done was premeditated or done only w^ith sudden heat or impulse, which might be as truly said of anger or any other excitement arising from sudden provocation or peculiar cirumstances ; but not much importance was attached to it, as might be conceived from the presumption which was equally great, that the design might have previously existed, and intoxication have been employed to nerve the criminal to the commission of the crime; that the law discriminates between the delusion of intoxication and the insanity which it may ultimately pro- duce. If drunkenness, they said, was to be considered an excuse for crime, there would be established a complete emancipa- tion from criminal justice. — [Wharton in W. & S., Sect. 93. We may conclude then that the difference of opinion be- tween jurists is rather upon the rule of law governing the evidence than upon the legal relation of the crime. Thus, if alleged that premeditation, intent, and malice existed, and a doubt arose as to whether the act done was the result of a deliberate purpose, the best authorities do not admit that proof is admissable of drunkenness, that, taken in connec- tion with all the other facts and circumstances, the jury can determine whether the case is one of murder in the first or second degree.* If all the ingredients of murder in the first degree exist previous to the killing, except the act itself, as intent, premeditation, malice, then drunkenness, however great, will not be admitted as a plea that the defendant was too drunk to entertain them. These ingredients are ques- tions oifact, and as any other fact, are subjects of legitimate *An article I have written for the Lancet and Observer (published by E. B. Stevens, M. D., 319, Elm Street, Cincinnati, Ohio,) contains a clear statement of this question, with authorities upon it. Ohio State Medical Society. 49 inquiry; the circumstances, manner of killing, and evidence from other sources, must all go to the jury together, leav- ing them to determine the degree of guilt, after having de- termined these facts. In Ilalile v. State, 11 Humph., 154, it is said: ^' Any. fact that will shed light upon this subject ma\^ be looked to by them (the jury), and ma}^ constitute legitimate proof for their consideration. And among other facts, any state of drunkenness being proved, it is a legitimate subject of in- quiry, as to what influence such intoxication might have had upon the mind of the offender in the perpetration of the deed. We know that an intoxicated man will often, upon a slight provocation, have his passions excited and rashly perpetrate a criminal act. ISTow, it is unphilo&oph- ical for us to assume that such a man would in the given case be chargeable with the same degree of premeditation and deliberation, that we would ascribe to a sober man, perpetrating the same act upon a like provocation. It is in this view of the question, that this court held, in Swan's case, and in Pirtle's case, that the drunkenness of a party might be looked to by the jury, w^ith the other facts in the case, to enable them to decide whether the killing was done deliberately and premeditatedly. But his Honor, the circuit judge, told the jury that drunkenness was an ag- gravation of the offense, unless the defendent w^as so deep- ly intoxicated as to be incapable of forming in his mind a design deliberately and premeditatedly to do the act. In this charge there is error, for which the judgment must be reversed. Reverse the judgment and remand the case for another trial." We ought not to close this paper without a direct state- ment of the relations of dipsomania to common drunken- ness, before the law. Of the works upon criminal law 50 Dipsomania and Drunkenness. Alison* presents the clearest views upon the subject. They are, that the law makes no distinction between dipsomania and the various states of ordinary drunkenness. Juries do sometimes make such distinctions in their verdicts. He reports cases. ToyloT adds to this, that if drunkenness were admitted as an excuse for crime three fourths of the crimes committed would go unpunished. The general tenor of cases is that dipsomania does not exculpate more than common drunkenness ; that it is the result of habitual indulgence, and that the greatest differ- ence between dipsomaniacs and common drunkards is, that they are impelled to drink from different degrees of strength of the desire. Both have a thirst for drink, and both when it is encouraged attain to a point beyond which retreat is impossible. The dipsomaniac, if relieved from all legal obligation and restraint, would open the door to all grades of offenders who stand upon the middle ground between insanity and crime. The fact that true dipsomaniacs in their sober mo- ments take measures, as the fit approaches, to seclude themselves and otherwise protect others from annoyance and injury, in a great majority of cases, shows that they abandon themselves to their passion, when it is established as the libertine, the gambler, and other victims of " moral mania^^ (?) do to their impulses. With this we close our article. We regret that we al- lowed ourself to delay the preparation of it until three or four days before the meeting of the society. Much of this time was occupied with our practice, leaving too little time to digest and put in a desirable shape the matter we desired ^Criminal Law of Scotland. Ohio State Medical Society. 51 to present. Our object has been to give an outline of tbe literature of the subject, rather than a discussion of the true principles involved — or the ground of our own opin- ions. In our paper upon monoraania we shall aim to dis- cuss the grounds for the views, pro and co?i, of the subject, rather than the literature of the subject, but will present briefly the views of authors, that our paper may represent the subject clearly, and not seem based wholly upon our own opinions. In this paper, lengthy as it may be, and to those versed in the subject, we hope, without being prolix, we have es- tablished: 1st. That there is a dipsomania. 2d. That the condition is sl physical one, 3d. That the symptoms are so unvarying that all authors agree in their description of them; and that authors use nearly the identical language in describing the condition, that was used from 1817, to 1825, when the disease was first pointed out. 4th. That the law makes no distinction between the re- lation of the dipsomaniac and the common drunkard, to full legal responsibility. We hope those whose interests prompt them to study the subject will find fully represented the classic writers extant. Of the German: Hofibauer, Casper, Bruhl-Cramer, Griesinger, Salvatori, Erdman, Fuchs, &c. Of the French : Falret, Dagonet, Morel, Marc, Marce, Tardieu, Esquirol, &c. Of the English and American: Winslow, Tuke, Hutch- inson, Ray, Wharton, Story, Taylor, &c. We have not had 52 Dipsomania and Drunkenness. time to consult the various works upon evidence and crim- inal practice, with the view of presenting their opinions upon the points of evidence, as the taking into consideration the state of intoxication^ but preferred to take from our notes made from state Reports, the opinions given in leading cases in which this view was presented by the court. We have given these "pro and con. It will be seen by the foot- notes, that the opinions of the first were overruled, not be- ing regarded as law. In our work upon Medico-Legal Criminal Procedure we will give a reference to all cases contained in the State Reports, for and against the con- sideration of the evidence in question, so that those hav- ing occasion to refer to them can readily do so, if they have access to the Reports. In all cases tried in 1873, we have noticed the court has ruled with Alderson, in Rex. v. Meakin, 7 C. & P., 297: "drunkenness can have no effect on the consideration of the WMlicious intent of the party; and in the same case, " If a man chooses to get drunk it is his own voluntary act. ^ >i< >i^ That voluntary species of mad- ness which it is in a party's power to abstain from, he must answer for." And also in Rex v. Carrol, 7 C. & P., 145, in which Parks overruled the precedent established in Rex v. Grinley, by Holroyd's ruling. UNITED BRETHREN PUBLISHING HOUSE, DAYTON, OHIO. THE Course of Lectures i^^^-s By D. a. morse, M.D., :R U=r&^" LEGAL MEDICINE AND INSANITY. J FCTTTRFl [Candidates for the Degree of Doctor of Medicine will he examined upon this Course.) SUBJECT. No, 1. The Medical Expert,— D&f^n\i\on of Medical Juris- PRTJDEXCE ; its application. Who are exper^ts, or skilled witnesses ? "Opinions" distinguished from "Evidence." Duties, privileges, secrets, fees. 2. JIalpf'actice. — Who are Physicians or Surgeons? Their legal responsibilities. Contract — Express or implied. When no express contract is made "must render with due diligence and attention ordinary sJcill.^' What constitutes " ordinary skill ? " Implied Contract : cannot be held as having warranted a cure, or in surgery perfect results. Amputations, fractures, dislocations — usual results. Negligence. 3. The Passions. — Kelation to Insanity — metaphysical and physiological elements. Exaggerated passions — ambition, pride, envy, jealousy, anger, revenge, grief, shame, remorse, &c. 4. General observations upon the nature and pathology of the so- called Functional Nervous Disorders — Chorea, Hysteria, Epilepsy, &c. Legal relations. 5. JMEental Derangements, — The proper " method " — meta- physical versus physiological — of studying the mind. 6. Definition, classification, diagnosis of insanity. Thorough knowledge of the Sources of Evidence of insanity as important to the general practitioner as to the alienist or expert. Difficulty arises and apparent contradiction of experts, in point of diagnosis, from considering irresponsibility, a consequence of insanity, as identical with the question of insanity. Sources of evidence of insanity: Heredite; education; habits; religious influences; previous disease; physical organization : form, hands, feet, features ; state of nervous system: anaesthesia, hyperesthesia; sensorial functions — illusions. hallucinations ; pupil of the eye ; taste ; digestion ; metaphysical considerations : desires, affections and passions ; perversion of moral nature; will, attention, memory, judgment ; periodicity: is there irritability, excitement, depression or stupor, alternating with other conditions; temperature of body; pulse; skin, 7. Same subject continued. 8. JPathology of l7isanify, — Must be studied before its legal consequences can be comprehended. 9. Varieties of Insanity, — 1. Congenital defects. 2. Ac- quired. 10. Legal JRelations of Insanity. — Relation of organiza- tion to responsibility ; moral liberty dependant on development and integrity of nerve-centres. Is there a monomania ? Instinctive, im- pulsive, reasoning mania? Can there be idiocy of man's moral as of his intellectual faculties ? 11. Crime versus Insanity. — Depravity vs. moral insanity. What degree of mental development — what condition or ideal standard of mental organization, constitutes mental soundness with full responsibility for acts performed ? When this ideal, or given standard of mental capacity determines full legal responsibility, what must be wanting, what less than this assumed standard of capacity can incapacitate for criminal acts ? 12. Insanity, — Wills, contracts, management of estates, ability to testify as witnesses, &c. 13. Persons Found Dead, — What to observe; signs of death.; post-mortem examination. 14. TFounds, — Definition. What to observe. 15. Death from drowning, hanging, strangulation, suffocation, cold, and starvation. 16. Suicide, — Evidence of suicide; is it a species of insanity? Legal relations. 17. JSomicide, — Proof of corpus delicti, that a crime was com- mitted. What constitutes a crime? Ingredients: malice, intent, premeditation. Whsit may he presmned ? Burden of proof ; in- sanity must be proved beyond a reasonable doubt ; if not so proved prisoner must have benefit of such doubt ; opinions to the contrary. 18. Rape. — What constitutes rape ; sources of evidence. 19. Pregnancy, — Signs, duration, delivery. 20. Infanticide; Criminal Abortion; Concealment of Birth. Poisons : definition, classification, sources of evidence in alleged poisoning, and the more common forms discussed at such length to complete the course as circumstances justify and the wants of the class require. LIST OF PRINCIPAL AUTHORS CONSULTED IN THE PREPARATION OF THE PRECEDING LECTURES. All of the Foreign Works mentioned have been furnished^ with but few exceptions^ by the house of LINDSAY & BLAKISTON, Publishers, Booksellers, and Importers of Foreign Medical Books, 25 SOUTH SIXTH ST., PHILADELPHIA, PA. Devergie, Medecine Legale, . Briande et Chaude, Med. Legale Taylor, Med. Jurisprudence, . Guy's Forensic Medicine, Dean, Med. Jurisprudence, , Beck, " " Orfila, Medecine Legale Mahon, " " Fodere, " " Bayard, " " Wharton and Still e, Med. Jurisprudence, Casper, Medecine Legale — Gerichtl. Med., Bocker, Lehrbuch der Gerichtliclien Med., ♦* Memoranda, " " *' Bergman, Lehrbucli et Med. Forensis, . Friedricli, Handbuch — Gerichtl. Pyschol., &c Henke, Handbuch der Gerichtl. Med., . Krahmer, " " " " Meckel, Mende, Nicolai, Schurmayer, works, Siebold, Lehrbuch der Gerichtl. Med., . Wald, Gerichtl. Med., .... Ordronaux, Jurisprudence of Medicine, . Chitty, Medical Jurisprudence, Trebuchet, Juris, de la Med., . ^o\i Paris and Fonblanque, Med. Jurisprudence, Taylor on Poisons, . Christison, " Otto, " Duriau, Strychnia, . Orfila, Tra^ite de Toxicologic, '' Elements de Chemie, " Lecons de Toxicologic, Galtier, Toxicologic Generalc and Spec, Hillairet, I'Empoisonnement par 1 'arsenic, Imbert, par I'Arsenic, .... Hardy, Effets Toxicologique, . Keveil, Progres de la Toxicologie, . "Wormley, Poisons, Micro-chemistry, Tardieu, Etude ^^' sur I'empoisonnement, Barse, Toxicologie Man. de la Cour d'Assizes, Poilroux, de Med. Legale criminelle, Alibert, Physiol, ces Passions, Descuret, Medecine des Passions, Bourgeois, Les Passions, . Letourneau, Physiol, des Passions, . Lucas, Traite **Heredite, Yoisin, Etudes sur la nature de I'homme, " Causes of Insanity, Collineau, Analyse de I'entenderment, Luys, Maladies Hereditaire, Beaussire, Liberte dans le ordre, &c., Morel, Medecine Legale des Alienes, Eegnault, Competence des Me.decins, Etoc-Demazy, Suicide, Lisle, Du Suicide, .... Cazauvieilh, Du Suicide, . Bertrand, Du Suicide, Brierre de Boismont, Du Suicide, " " Hallucinations, " " Perversion des Faculties Thulie, Folic Avant la Loi, Ferrand, Etudes sur la Mort, Bichat, Sur la Vie et la Mort, Josat, De la Mort, . Bouchut, Signes de la Mort, Yigne, Mort apparante, . Julia de Fontenelle, Signes de Mort Goubert, I'Art des Autopsies, . Macario, Du Sommeil, Lemoine, Du Sommeil, . Hammond, Sleep, Bergeret, Abus des Boissons, Eacle, Alcoolisme, . Fregier, Classes dangereuses, Voisin, Etat mentale dans I'Alcoolisme, Audhoui, Pathol, gen. de I'Empoisonnementpar I'Alcool Godfrin, De I'Alcool, Magnan, Sur I'Alcool, Issartier, De I'Alcoolisme, Yerneuil, Les Alcooliques, Hebert, Des Alcools, Pennetier, De la Gastrite dans I'Alcoolisme Voisin, Etat mentale dans I'Alcoolisme, . Jolly, L'Alcool, Contesse, Etudes sur I'Alcoolisme, Morel, Degeneracies, Key, " . . Esquirol, Maladies mentales, . Dagonet, " " Marc, " " Marce " " Ealret, '* " Morel, " " Pine], " " Guislain, " " Calmeil, " " Greisinger, " " Georget, " '■ different work's, Foville, Monomania, Pinel, " Ealret, De la Eolie raisonnante, " Hypochondrie, " Etat des Epileptiques, . " Alienes dangereuse, " Eesponsibility des Alienes " Eolie paralytique, Mandon, Histoire de la Folie, . Bonnet, Sur la Monomanie, Ollivier, Moral Pathologic, Eay, Jurisprudence of Insanity, Mayo, Medical Evidence in Insanity, Prichard, Insanity, .... vol. 6 Wigan, Insanity, ... j, .... 1 vol. Haslam, " ........ 1 <« Maudsley, Mental Pathology, . Bucknill, Responsibility of Insane, Bucknill and Tuke, Insanity, , Winslow, Medico-Legal Evidence, TJpliam, Disordered Mental Action, Herpin, Epilepsie, .... Hoffbauer, Medicine Legale des Alienes, A number of works upon the effects of Alcohol, Drunken- ness, &c., as Magnus Huss, Carpenter, Miller, &c. Tardieu, L'Affair Armand, " Etude I'Avortement, . " Manuel de Pathologic, *' Infanticide, " Attentat aux Moeurs, Michea, Hallucinations, . Baillarger, " . . Calnieil, Maladies Inflam. du Cerveau, " De la Paralysie, Yingtrenier, Alienes des Prisonniers ; Lauvergne, Les Forcats, On Metaphysics: Locke, Brown, Reid, Steward, Mills, Bain, Porter, Spencer, Laycock, Hamilton, Edwards on the Will, Tappan, "Whedon, &c., &c., &c. Ferrus, Des Prisonniers ; {IN PREPARATION.) MOESE'S MEDIOO-LEGAL CEIMINAL PROCEDURE: THE LAW, EVIDENCE, AND PKACTICE. MEDICAL JURISPRUDENCE REDUCED TO PRACTICE. Entered according to Act of Congress, in the year 1872, by D. A. Moese, M.D., in the office of the Librarian of Congress, at "Washington, D. C. The Author has found a great demand existing, in both the legal and medical world, for a work that will contain, in one volume, the Law relating to Experts, the Rules of Law governing the Production of Evidence, the Inception of Criminal Cases, Eorms, &c. This he aims to present in his work upon Medico-Legal Criminal Procedure. Everything relating to the subject of Medical Juris- prudence, as usually taught in books, will be considered ; but more especially will be the objiCct of the work to give a full consideration of all subjects that may become questions of legal importance in criminal investigations. The work is designed to meet, as a text- book, the wants of the medical student, as well as of the practi- tioner, the lawyer, coroner, justice of the peace, grandjuryman, &c. The Author has observed in many coroners' investigations, or preliminary examinations before justices, where death from violence is suspected or alleged, that the true cause of death is not deter- mined. This is generally due to one of two causes : the incompetency of those who conduct the post-inortem examination ; or the inability of those conducting the examination of witnesses so to frame ques- tions that the truth will be elicited. To meet the wants of all who require, the art of conducting post-mortem examinations — appearances after death — post-mortem changes — and the changes wrought by disease, in organs, to be dis- tinguished from those resulting from violence, will be considered at considerable length — showing what should be observed in 8 any given case. One chapter will be devoted to questions^ these serving a double purpose — aiding in the study of the work, as well as facilitating the examination of witnesses by furnishing sugges- tions. In the preparation of this work many legal gentlemen of ability and acknowledged authority have been consulted, their views have been desired, and the author has aimed to square every mooted point by direct comparison with them, as well as by standard written authorities. The aim of the book is, as its title expresses, to render everything practical, to present on all points the law, the EVIDENCE, and practice relating thereto. In addition to the works previously cited. State Eeports, Files of Journals, Annales d'Hygiene Publique et de Medecine Legale, the various "Dictionnaires," Archiv fiir Psychiatric und Nerven- krankheiten, and many Monographs, Dissertationes, works found in the State Libraries at Indianapolis, Columbus, &c., &c., the "Work announced above will also be based upon the following Authors : Roscoe's Criminal Evidence, . Burrill's Circumstantial Evidence, . Wills' " " Appleton on Evidence, Wharton's American Law of Homicide, Wharton's Criminal Law, Allison's " " of Scotland, Burnett's " " " Hume's " " " Archibold's Crim, Pract. and Evidence, Bennett and Heard's Leading Crim. Cases, Thacker's '' " " Wheeler's " - " " Chandler's " " " Howell's State Trials, " " Hale's Crown Pleas, " " Davis' Crim. Justice, .... Bicknell's Crim. Procedure in Indiana, . Wharton's Precedents of Indictments, . Train and Heard's Precedents of Indictments Beccaria on Crimes, Russell on Crimes, . . , . . Bishop's Crim. Law, .... Bishop's Crim. Procedure, Colby's New York Crim. Procedure, Dearsley's Crim. Process, Chitty's Crim. Law, .... Bassett's Crim. Pract. and Pleading, Warren, Swann, Crocker, Edwards, Bell, &c., on Forms, &c., &c. Halstead, Powell, Phillips, Phillips and Amos, Starkie, Bentham, Greenleaf, &c., on Evidence. 1 vol 2 2 2 34 2 1 1 2 1 1 2 2 2 2 1 (CL(c c O C C cr d Ci C c^*:/' C- CC. 'OCCCT ct cGc: • ^ cc ^ ^ c c ^ ' V c c c <- C ft ' c r C c c ( ( c <_cc ^ C . C cc C «^ C.CC V CC C?/c O C xcv