# Popular Science Monthly/Volume 51/August 1897/New Questions in Medical Jurisprudence

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* NEW QUESTIONS IN MEDICAL JURISPRUDENCE.
By T. D. CROTHERS, M. D.
THE startling revelations in the scientific world are repeated in some degree in the sudden opening up of a new territory of medico-legal science, the jurisprudence of inebriety. Within five years the question of the mental soundness of the inebriate and his capacity to act or reason normally has been raised with increasing frequency in a great variety of criminal and civil cases. The rapid advances in psychological studies fully sustain the wisdom and necessity of scientific inquiry in this field. The medical profession has been suddenly called to determine facts and their meaning, and give advice along this new line of inquiry, without precedent, and opposed by public opinion and deep-rooted prejudice, and hence are often plunged into great doubt and confusion. As a result, the strangest theories prevail as to what inebriety is and is not, theories of moral and legal accountability and responsibility, that presuppose a degree of psychological knowledge that can only be obtained after centuries of further study.
To-day there are hundreds of persons awaiting trial or sentence for crime committed when poisoned by alcohol. There are hundreds of business contracts disputed and contested by law, made when the parties were intoxicated. There are hundreds of wills whose validity is questioned for the same reason. There are hundreds of divorce suits where the inebriety of the parties is the vital question on which the issue of the case turns.
Although these topics have so recently come into medico-legal notice, and are so complicated with theories and superstitions, yet they have already divided into three distinct theories or points of view:
First, the ethical and moral view, which seeks an explanation of inebriety from the teaching of Scripture and the opinions of theologians and metaphysicians. This view asserts that inebriety is only a phase of moral depravity innate in every life, and one that is susceptible of great growth and development, by willful neglect and gratification of all the animal instincts. Medico-legally the remedy is severe punishment, increased responsibility, prayer, conversion, and the application of moral suasion.
The second is the legal view, which is practically an outcome or result of the moral theory. It assumes that inebriety is a phase of savagery or the inborn tendency to lawlessness and giving up of all control and restraint; or the indulgence of the lower passions regardless of society, law, and order. The legal remedy is severe punishment, increased penalties, and suffering.
​The theory is to develop the higher nature of man by causing pain and suffering in the lower nature; in this way to rouse up the brain and will power to regain control of the animal part. Three hundred years ago Lord Coke, of England, held that inebriety always aggravated the offense, and the punishment should rather be increased. This has been the corner-stone of the legal view of inebriety up to very recent times.
The third theory is the scientific and medical view. This affirms inebriety to be a physical condition, the tendency of which is often inherited and also acquired; that this physical condition is always a disease, a modified or pronounced form of insanity. In other cases it is a positive symptom of insanity; also, it is a form of brain degeneration that, like other diseases, has distinct causes, development, progress, and decline. It is also urged that the continuous use of alcohol always causes disturbances of brain circulation, and is followed by brain congestion, brain paralysis, and impaired senses; the result of which is incapacity to realize the nature and character of acts, the judgment is defective, and the control is lessened and is not normal. Medico-legally this theory regards the inebriate as diseased and incapacitated to act sanely, to be treated as a sick man and placed under medical and legal care and control, until recovery or for life.
The first two theories assume perfect sanity in all cases of inebriety, and assert that the remedy is to be more severe punishment, and accountability to law and society. The third theory recognizes a physical condition, and demands a scientific study of each case before the remedy or treatment can be determined. Another theory has been asserted, that in some cases inebriety was a vice at first, then later a disease; that in some cases punishment is the remedy, and in others medical care and treatment. Such are some of the theories and standpoints from which the subject of inebriety is approached medico-legally.
The confusion and doubt of the exact nature of inebriety is due in a large part to the failure to study these cases independently. The dictum of judges, the teachings of theologians, newspaper views, and public opinion, are too often the sources from which medical men derive their views. This was very apparent in a contested will case, where five medical men testified to the mental capacity of a chronic inebriate who willed his property to a mistress. The judge declared he should act on his own judgment, and decide the man unsound and incapable. A man set fire to a church without apparent motive. Three physicians swore to his sanity, although he had delirium tremens repeatedly and was a chronic inebriate, and intoxicated at the time. The jury decided otherwise.
​Questions involving the capacity or incapacity of inebriates can never be determined by any metaphysical theory of mind or morals.
One of the very obscure questions which have recently come into legal prominence has been called the alcoholic trance state. The frequent statement of prisoners in court, that they did not remember anything about the crime they are accused of, appears from scientific study to be a psychological fact.
It is well known to students of mental science that in certain unknown brain states memory is palsied, and fails to note the events of life and surroundings. Like the somnambulist, the person may seem to realize his surroundings and be conscious of his acts, and later be unable to recall anything which has happened. These blanks of memory occur in many disordered states of the brain and body, but are usually of such short duration as not to attract attention. Sometimes events that occur in this state may be recalled afterward, but usually they are total blanks. The most marked blanks of memory have been noticed in cases of epilepsy and inebriety. When they occur in the latter they are called alcoholic trances, and are always associated with excessive use of spirits. Such cases are noted in persons who use spirits continuously, and who go about acting and talking sanely although giving some evidence of brain failure, yet seem to realize their condition and surroundings. Some time after, they wake up and deny all recollection of acts or events for a certain period in the past. This period to them begins at a certain point and ends hours or days after, the interval of which is a total blank, like that of unconscious sleep. Memory and certain brain functions are suspended at this time, while the other brain activities go on as usual.
Probably the largest number of criminal inebriates who claim loss of memory as a defense for their acts are the alcoholic dements. These are chronic inebriates who have used spirits to excess for years. This, with bad training in early life, bad surroundings, and bad nutrition, have made them of necessity unsound, suffering from many and complex brain defects. Such persons are always more or less without consciousness or realization of their acts. They act automatically, only governed by the lowest and most transient impulses. Crimes of all kinds are generally accidents growing out of the surroundings, without premeditation or plan. They are incapable of sane reasoning or appreciation of the results of their conduct. The crime is unreasoning, and general indifference marks all their acts afterward. The crime is along lines of previous conduct, and seldom strange or unusual. The claim of no memory in such cases has always a reasonable basis of truth in the physical conditions of the person.
​The second group of criminals who claim no memory are those where the crime is unusual, extraordinary, and unforeseen. In such cases the trance condition may have been present for some time before and escaped any special notice, except the mere statement of the person that he could not recollect his acts. The unusual nature of the crime, committed by persons who never before by act or thought gave any indication of it, is always a factor sustaining the claim of no memory. The explosive, unreasoning character of crime always points to mental unsoundness and incapacity of control.
A third group of criminals urge this statement of no memory. They are positive inebriates, drinking to excess, but not to stupor, who suddenly commit crime with the most idiotic coolness and indifference, never manifesting the slightest appreciation of the act as wrong, or likely to be followed by punishment. Crime committed is never concealed, and the criminal's after conduct and appearance give no intimation that he is aware of what he has done. These cases have been termed moral paralytics, and the claim of the trance state may be true.
A fourth group of cases where memory is claimed to be absent occurs in dipsomaniacs and periodical inebriates, who have distinct free intervals of sobriety. This class begin to drink to great excess at once, then drink less for a day or more, and begin as violently as ever again. In this short interval of moderate drinking some crime is committed of which they claim not to have any recollection.
Other cases have been noted where a condition of mental irritation or depression preceded the drink explosion, and the crime was committed during this premonitory period and before they drank to excess. The strong probability of trance at this period is sustained by the epileptic character of such conduct afterward. The trance state may be justly termed a species of aura, or brain paralysis, which precedes the explosion.
In some instances, before the drink storm comes on, the person's mind would be filled with the most intense suspicions, fears, delusions, and exhibit a degree of irritation and perturbation unusual and unaccountable. Intense excitement or depression, from no apparent cause, prevails, and during this period some crime may be committed; then comes the drink paroxysm, and later all the past is a blank. In these groups the crime is generally automatic, or committed in a manner different from other similar crimes. Some governing center has suspended, and all sorts of impulses may merge into acts at any moment. The consciousness of such acts and their consequences is practically destroyed.
One of the questions which has become prominent recently in ​many cases is as follows: How far can the testimony of inebriates or persons under the influence of spirits be trusted concerning matters observed in this condition?
This question called for an answer in the following cases:
1. An. inebriate physician, partially intoxicated, witnessed an assault, and swore to the identity and exact part which the accused was supposed to have taken in the crime.
2. A barkeeper, partially intoxicated at the time, swore to the particular man who shot another in a crowd, where several shots were fired by different persons.
3. A man under the influence of spirits testified that he saw the person accused put fire to a building which was burned down.
4. A man on his way home from a saloon, where he had spent the evening drinking, identified a man in the courtroom whom he asserted he had seen breaking into a house.
In these cases the medical witness was asked, What, in your opinion, as an expert, based on the statements of the witness, and the circumstances of the case, was the condition of the witness's mind as to the power of clearly observing and remembering the facts and incidents to which he has testified? Also, do you believe in these cases that the witness was competent to observe and clearly remember the incidents to which he has sworn?
If the medical expert has formed no higher opinion of inebriety than that it is a vice in the moral sense, and alcohol produces a state of exhilaration, his answer will be unsatisfactory; but if he is a scientific student he will form a general conclusion which will at least approximate very near to the real facts. In arriving at the facts the medical witness must start from some general principles which are recognized as established beyond question.
First, the action of alcohol is always that of an anæsthetic, benumbing and paralyzing (1) the nerve function and the consciousness of nerve impression; (2) the power of co-ordinating and regulating these impressions; (3) the reasoning or capacity of comparing acts and events is disturbed. Thus both the sense impressions and the power of analyzing and correctly estimating them are impaired. This takes place in all cases, depending on the amount and quality of spirits taken: where intoxication follows, these effects are very clear; but where a smaller amount of spirits is taken, and only partial intoxication is present, they are not so prominent. It is present in those who use alcohol continuously, and is noted as a general diminution of brain and sense acuteness. In active life, brain workers, trained experts, and all persons whose work requires delicate nerve adjustment and accuracy of brain and muscle work, soon find the use of alcohol ​impairing their powers, and abandon its use, especially when they are called to do any particular work. The musician, the actor, the scientist, and the professional and business man very quickly discover the impairments which follow from the use of alcohol, not only over the senses, the volition, the nerve and muscle co-ordination, but the power of clearly realizing the relation of events. The increased action of the heart from alcohol is of short duration, and is surely followed by diminished sensibility and anæsthesia.
The vigor and strength supposed to come from alcohol quickly merge into weakness and debility. Hence, the man who is visibly poisoned by alcohol, however slight the degree, has defective senses, defective nerve impressions, defective co-ordination, and defective reasoning. He is literally suffering from the first stages of paralysis, which begins with the senses. He can neither see nor discriminate accurately; he is always open to the possibility of false impressions and false conclusions, and is unable to correct them. His senses may be but little impaired, but his power of comparison, of analyzing events and their meaning, is faulty. He has anæsthesia of the higher brain centers, which does not appear except from close observation.
From these general facts the study of the individual case resolves itself into a question of how far the person used spirits, and how much he had drank at or about a certain specified time; also the circumstances, conditions, and surroundings of the act in question, and the statement of the man; from this a medical witness can draw accurate conclusions.
In the two murder cases referred to, other testimony made the statement of the drinking witness doubtful. In the third case a clear alibi was established by the accused. In the other cases, although the evidence of the witness was accepted, there was a strong probability of mistake. The conclusion, which appears to be sustained by all the facts and scientific study of these cases, is as follows:
The testimony of persons while under the influence of spirits, concerning matters observed by them, and their judgment as to events and their meaning, are never accurate, but always open to sources of error and unconsious self-deception which they are unable to correct.
The medical expert should have no hesitation in denying the value and truthfulness of all such testimony.
A second question which has come up recently along this same line of research is more difficult and requires more accurate psychological and physiological study.
It is this: How far are the statements or confessions of persons partially intoxicated, or under the influence of spirits, concerning their personal acts to be accepted as true and veritable?
​An answer to this question was sought in the following cases:
First. An inebriate shot and killed his partner while under the influence of spirits. At the station house, soon after, he made a confession, which reflected very severely on him. On the trial the statement of the crime was not sustained, but contradicted in many ways.
Second. A man was found drowned, and a drinking friend confessed to have pushed him into the water while in a state of intoxication. This confession was clear in its details, and he seemed very earnest and contrite. It was accepted as true, and he was sentenced to prison for life. Subsequently it was found that the drowning was accidental, and the confessed murderer was miles away sleeping at this time, suffering from alcoholic stupor. A few hours later he came to the scene of the drowning, and at once came to the conclusion that he had committed the crime.
A third case was that of a man who, after drinking all the evening in a saloon, saw on his way home after midnight a deadly encounter with a burglar in the hall of a house he was passing. He was taken to the station house and, after a series of questioning, identified the burglar, and swore to many details of the crime. This was found to be untrue, although he adhered very closely to the details and urged their truthfulness. In reality he had been told what he saw by the officer, whose suggestive questions made up the entire statement.
The medical questions in these cases were answered from the assumption that the use of alcohol, unless to stupor, does not impair the senses and reason on matters that concern the personal acts and conduct. It was assumed that any statements or confessions of crime that did not peril the freedom and safety of the man could have no other motive except that of the promptings of a wounded consciousness to repair the injury. It was assumed that no man under the influence of spirits, not stupidly intoxicated, would ever confess to acts not committed, or ever delude himself with such impressions, especially as at this time the brain was in a state of increased activity. All these assumptions were wrong, and contradicted by the facts. The man under the influence of spirits is always semiparalyzed; his brain is in a confused state, and never guided or controlled by natural, healthy motives; his senses and judgment are weakened, and the repetition of any statement which may impress him may soon seem a reality which he is never able to correct. His mind is open to all sorts of morbid impressions which quickly appear like realities.
In the lower courts these special phases of brain palsies are seen in the confessions and sworn statements of acts and events observed that are often found to be absolutely false. The ​conclusion is evident that no testimony, statement, or confession of a person under the influence of spirits concerning his acts, conduct, or motives has any value or can be trusted unless sustained by collateral and other evidence.
A third question along this line of inquiry has also become prominent during the year: How far shall an inebriate, or man under the influence of spirits, be held liable for any acts or contracts, such as wills, marriages, or bargains?
The questions the medical man is asked are these: How far is the person in this state capable of appreciating the nature and consequences of his acts? Was his mind in any way impaired to that extent as to be unable to clearly realize his duty and obligations to himself and others? Was the act sane in its execution and reasonable consequences? These questions came up for an answer in the following cases: An inebriate who had drank at intervals for twenty years had made a will disposing of a large property, and had repeatedly mentioned its terms with pleasure and satisfaction. At his death it was found that he had made another will giving most of his property to the Freedman's Bureau for the education of colored children. He had been a very miserly man all his life, and this was an unusual act. The will was made after a drink period, and he seemed to the lawyer and witnesses sober and fully conscious of what he was doing. The medical men held that the use of spirits had not weakened his mind or rendered him incompetent to dispose of his property.
In a second case, a man who drank to excess at intervals bought a large interest in a traveling circus while under the influence of spirits. He seemed perfectly sane at the time, yet the act was unusual, and he sought to annul the contract, claiming that he was subject to undue influence.
The testimony of medical men as to the probable state of the mind when these acts were performed is the central evidence upon which the issue of each case must turn. The necessity of thorough scientific study of the mental condition of men who use spirits at intervals or continuously, and the application of all the facts that enter into the history of the cases in question, is imperative.
The question of premeditation in the drink paroxysms is a subject of much confusion in many cases.
The frequent instances where inebriates, in apparent possession of good judgment, go away and drink to great excess, displaying a degree of forethought and premeditation fully characteristic of all the ordinary events of life, are often very confusing to the ordinary observer. When the drink paroxysm comes all unexpectedly upon the victim, in some unforeseen state and circumstance, and he falls, it is apparent that he is suffering from ​some unstable or diseased brain state, which has burst out from the application of some exciting cause. But when the paroxysm is anticipated and prepared for, and all the surroundings are made subservient to this end, when every facility to procure spirits is increased, when money is secured and business arrangements are made in view of this coming paroxysm, the conclusion most commonly reached by all non-expert observers is that it is deliberate vice and wickedness. When the history of a number of these cases is studied and compared, they are found to be well-marked cases of reasoning insanity, with drink paroxysms. These paroxysms are the acute attacks—the deliriums which expend themselves like storms that gather and burst—and are preceded by long periods of rest.
Several very noted cases of capital crime by inebriates have brought out this fact of premeditation, with conviction, on the theory that disease and insanity were incompatible with power of conceiving and coolly executing crime. This theory is opposed by the facts in the history of the following case: A business man, who had drank at intervals to excess for ten years, had a preliminary period of moderate drinking before the stupor or the delirium of the paroxysm of drink. During this time he continued his business as usual, but to his confidential friends he explained various schemes of revenge, in which he wished to punish persons who had injured him in business. These plans were skillfully and shrewdly arranged, and indicated a clear, unusual conception of causes and effects. The reasons for these acts were delusional, and based on strained inferences. His friends advised delay, and after the drink paroxysm his recollections of these plans became indistinct, and his interest passed away. He treated them as crazy notions, and was ashamed to consider or talk about them. These delusions only appeared when he began to use spirits, and were concealed and only mentioned to his most intimate friends. This scheme of revenge comprised arson and murder, and the execution required a combination of studied acts that would mislead and mystify others. With but little encouragement he would have committed this crime, and premeditation and malice could have been clearly brought out in the trial.
In a second case a periodical inebriate, whose preliminary period lasted from two to three weeks, planned a bank swindle. At about the time of its consummation he drank to great excess, having the usual paroxysm, then recovered and denied all knowledge of this event. While the act was very unusual and opposed to all his previous conduct and character, yet during the time it was planned he appeared to be very clear and fully conscious of the nature and character of the act. The probability is that all acute reasoning and display of full consciousness of the act ​and its consequences are based on delusions, either concealed or openly confessed. The action of alcohol seems to suspend some governing center, and capacity to discriminate the folly of the act. The mind appears to be eclipsed, and previous standards of truth and honor are overshadowed. All the former vigor remains, or appears to be intact; judgment and reason display vigor and clearness in criminal acts and conduct. Motives and purposes of life have changed, although the form and semblance of the past conduct remain.
Innumerable illustrations are seen among petty criminals, so called, where the acts have preceded the drink craze, and always been executed while the victim was using spirits in small quantities. Premeditation, acute reasoning, and apparent consciousness of acts and their consequences, preceding a drink excess, either associated with a moderate use of spirits or immediately before spirits are used in excess, should always be regarded as symptoms of mental derangement.
The use of spirits for the purpose of committing crime is another disputed question in courts.
Crimes which are supposed to have been committed by persons who deliberately used spirits for this special purpose are commonly found to have been stimulated and provoked by other causes. To give spirits to a person and encourage him to commit crime may not be an unusual occurrence, but its consummation is an accident and exceedingly uncertain. On general principles the natural tendency of an inebriate's mind is to ignore all restraint and obligation, legal, social, and moral. The higher governing centers are depressed and more or less paralyzed. The senses are deranged, and false impressions are constantly received, and the power of analysis and reason is diminished and broken up. All higher relations of duty are obscured, and only the lowest, most transient impulses control the mind. At this time temptations to acts that are criminal, urged on the bewildered mind, may be acted upon, from simple incapacity to reason and understand the consequences. This blurred mental state is of short duration, and merges quickly into anæsthetic physical and mental states, or delusional conceptions, of which fear and suspicion are prominent. The use of spirits to give courage to commit crime very often produces the opposite effect, particularly where an interval occurs between the use of spirits and the performance of the act.
The courage or stimulation of the first stage from the action of alcohol on the brain is of short, uncertain duration, and liable any moment to change to abject fear or other states.
There are two conditions in which crime is committed by persons who drink spirits for this purpose: one, where they become ​the agents of others, and accept and carry out the plans arranged for them, either tacitly as by power of compulsion of an idea, or desire to please another; secondly, the act is the materialization of a delusion which has existed before and has been stimulated into activity by the use of spirits. In the first case some hypnotic state, in which an idea becomes dominant, exists. But this is very unstable, and while it may be increased by alcohol, is uncertain in duration, and liable to change any moment. Thus in a case where a man who, after using spirits, developed delusions of suspicion that his partner was robbing him, this was increased by giving him more spirits and reiterating the idea, and suggesting criminal revenge. It was noticed that there was a certain brief period when he might execute a criminal act, but before and after it was very doubtful. The brain could not be depended upon: it might act in an entirely different way and from a different motive apparently. Alcohol clearly predisposes to criminality by lowering and paralyzing the higher brain centers which preside over consciousness of right and wrong. The immediate effect of spirits is to cause impulsive, petty acts. For the present moment such acts might materialize into serious crime, but it would depend upon favorable conditions and surroundings. The unstable condition of the brain made so by alcohol, is more or less incapable of sustaining a preconceived idea and carrying it out, especially if time and continuous drinking follow. This is the rule to which there are exceptions, but these exceptions clearly follow certain circumstances which are easily traced. Often it is claimed that spirits are given for the purpose of obtaining undue influence in the making of a will or signing a contract. This is confirmed by a clinical study of cases, and facts indicate the impulsiveness of the act, with absence of deliberation or forethought. Delusions and misconceptions of acts and motives are very common in all inebriates. Faulty reasoning, childish credulity, and general failure of capacity to discriminate and adjust himself to the conditions and surroundings, must of necessity result in wrongdoing; although in many cases this condition is covered up, and only when the person acts along unusual lines is it apparent.
All contracts and wills written by inebriates should be subjected to careful scrutiny. Not infrequently such acts display sound judgment, and it is found that they are the culmination of previous conceptions. Where they manifest imbecility and strange motives, it is clearly the workings of an anæsthetic brain, acting from suggestions from without or deranged impulses formed within. While a very large number of inebriates act rationally in ordinary affairs of society and business, and do not commit overt acts that come under legal recognition, it is a question if ​this is not the result of accident and conditions. There are strong reasons for believing that a slight change of surroundings both mental and physical would explode the degeneration which exists and bring to light insanity, criminality, or idiocy. Instances are not infrequent of acts of lawlessness and crime in inebriates previously law-abiding and honest citizens. It was not the last use of spirits which provoked the act; this only exploded a condition which had been gathering like a storm long before. The direction and form which this disturbance would take could not always be foreseen.
The designing man who gives spirits and suggests crime and wrongdoing is in peril of being the victim himself. He is practically exploding a state of insanity, and trusting that he may be able to control it.
The inebriate or moderate drinker who uses spirits to give courage to commit some act makes the same blunder of supposing that he can paralyze the higher governing centers and still direct and control the lower faculties. Where imperative ideas and delusions already possess the brain, alcohol may intensify them for a time, but confusion and uncertainty of thought and act are inevitable.
The claim that alcohol is used for the purpose of committing crime should be a question open for evidence, and one to be considered doubtful until proved by facts that can have no other meaning. Crime committed when under the influence of spirits will be found as a rule to follow uniform lines and be very much alike in methods of execution. If spirits have been used for the special purpose of facilitating the commission of crime, very wide differences will appear. No two cases will be alike, and doubt and uncertainty will complicate the factors in every case.
These are some of the many new questions coming into prominence in the courtroom with increasing frequency every year. The present obscurity and confusion of law rulings and medical theories will be cleared away in the near future, when the subject is studied from the scientific point of view.