The practical conclusions to which we arrive are these, viz:1st. Insanity is a mental phenomenon, symptomatic of a physical disease, having its seat in the brain, and hence, can neither be intellectual nor moral, exclusively, but necessarily involves both thought and feeling, for the reason that the mind is the source, and the brain is the organ of both. 2d. No alleged insanity, which is not preceded or accompanied by positive disease in the brain, of which the physical signs are cog. nizable and demonstrable, should be regarded by our courts of civil or criminal jurisdiction, as justifying the judgment, either of incapacity or irresponsibility. 3d. When any disease of the brain is proved to exist, and a perversion or alienation of the moral or intellectual functions of the mind is present, while the subject is unconscious of any change in his mental or moral status; in all such cases, insanity exists to an extent demanding impunity from the penalty of any law; and the protection of society, as well as the safety of the insane subject, requires that he be committed to the custody and remedial influences of an asylum, or hospital, until his restoration to health and a sound mind is satisfactorily established by competent and adequate proof. 4th. All alleged "moral insanity," if unaccompanied by the preceding and simultaneous proofs of disease of the brain, by charac teristic symptoms, should be regarded as moral depravity, for which, as well as for its consequences, the party should be held accountable to the law. 5th. No metaphysical or psychological theory of "irresistibility," or the loss of "moral freedom," should receive the countenance of our profession, in the absence of unequivocal evidence of physical disease, involving the brain. 6th. Neither "delusion," "illusion," "hallucination," "systematic design," "knowledge of good from evil, or right from wrong, or that the act was lawful, or unlawful, or contrary to the laws of God and nature," or "impassivity," or "hereditary taint," can be safely relied on, in deciding upon responsibility, or irresponsibility; the presence or absence of disease in the brain, being the only true criterion of sanity or insanity. 7th. In all cases of acquittal from crime, on proof of insanity, perpetual restraint upon liberty during life, by committal to an asylum; or until full proof of entire recovery; should be secured by statute law. The confinement of insane convicts should be in a separate and distinct institution, nor should they ever be admitted to the asylums or hospitals for other insane patients. 8th. Medical psychology, especially in its relations to juridical inquiries on the subject of insanity, should be made an integral part of medical education; and clinical teaching should be introduced into every asylum for the insane, as a measure of public policy, the duty to devolve upon the superintendent of each. 9th. Until a general provision is secured for the education of all students in medical psychology, no physician who has not special qualifications, both by study and practice in this department, should consent to give testimony in cases of alleged insanity, unless after consultation and concurrence with an acknowledged expert. The reputation of the profession will else be jeoparded, if not compromised and destroyed, by indiscreet opinions, which the courts are obliged to overrule, or which are often notoriously disproved. Meanwhile, let all the arbitrary distinctions into kinds and degrees of insanity, whether phrenological, metaphysical, or psychological, be ignored, when medical men are testifying in civil or criminal courts, and let their evidence be restricted to the relevant and single inquiry, whether the party is sane or insane. As to insanity on one subject only, with sanity on every other, it is a myth,` as all practical men now admit, and hence the term monomania must soon become obsolete. So, also, moral insanity, co-existing with intellectual sanity, is a fable, unless moral depravity and intellectual purity can govern in the same mind at the same time, which is a mental and moral absurdity. As a man thinketh, so is he. The appointed office of the intellect in man, is to govern and control the moral feelings and conduct. If the intellect is sound, to prate of moral or legal irresponsibility is a farce; while, practically, it is to "throw the loosened rein upon the neck of headlong appetite;" to abolish all distinction between vice and virtue, and overthrow all the standards of both morals and law. Let physicians, then, keep within their province, the presence or absence of physical disease, and they will then be invulnerable to the cross questioning of legal counsel. Leave the phrenology, psychology, and metaphysics of insanity to the gentlemen of the long robe, but claim familiarity with the signs of diseased braina physical entity; and having hence pronounced our professional judgment on the sanity or insanity of the party, let us leave the VOL. XI.-48 law and its ministers to deal with abstractions, such as responsibility and punishability, which are questions foreign from our vocation, after we have acquitted ourselves of our own responsibilities in the premises. Our law will punish nobody who is proved to be insane. It is our province and duty to testify, authoritatively, and when we shall have agreed what insanity is, our evidence will never be set aside, either by an intelligent jury, or an honest judge, when we deal with facts, and not with metaphysical distinctions. |