PRESIDENTIAL ADDRESS IN MEDICOLEGAL MEDICINE AND INSANITY. By the Hon. W. R.
(jrENTLEMEN
OF
KYNSEY,
THE
c.m.g., p.r.c.p.i.
SECTION
OF
MEDICO-
LEGAL Medicine and Insanity,?My first duty is to thank the members of this Congress? which I have no doubt will mark an epoch in the medical history of the East, and confer real benefit on present and future questions ?for the honour they have conferred upon me by electing me to the post I occupy to-day. I feel it, I can assure you, both an honour and a pleasure to be allowed to preside over a Section wherein the sister-sciences of Law and Medicine are united for the discussion of such subjects of interest to all classes of this great Indian Empire as those enumerated in the invitation to the Congress. My second duty is to thank the members here to-day for their presence and co-operation. The title of the Section sufficiently indicates its scope and object, and all here will agree with me that there is no branch of our profession more neglected than Medical Jurisprudence. Its history in Europe and the East, while full of great triumphs, is also full of cases where most serious consequences resulted from inexperience and ignorance, due to the fact that few make the scientific questions involved the subject of definite and intelligent study. To no science
Jan.
INDIAN MEDICAL CONGRESS.
1895.]
the remarks of lluskin more applicable: The greatest thing a human soul ever does in this world is to see something and tell what he saw in a plain way. Hundreds of people can talk for one that can think, but thousands can think for one who can see." In the relations which exist between Medicine and Law, the testimony of experts is necessary for the purpose of arriving at truth, which is the ultimate object of the Medical and the Legal professions, a trial being merely a means for obtaining it. The interests of good government, the sacredness of human life, and the welfare of man, demand that no one should be accepted as a Medical witness who has not made a special study of the many sciences upon which Medical Jurisprudence is founded. Medical evidence is important in all countries, but in the East it is often the only evidence at all to be relied upon, and on it alone often hangs the liberty or life of a human beino\ O It would be presumptuous on my part to express here opinions on many of the questions which will engage your attention. I shall therefore confine what I have to say to a fewremarks on a couple of the subjects with which I ain most familiar; and first on?
are "
determine the
probability
29
ot'
a
prisoner's
refor-
mation, and the best methods by which this
can
be effected; but it cannot of course be used to discover the author of a crime, although by means of measurements prisoners can be easily identified accurately. Criminals have been classified by Professor Benedikt on a pathological basis into homo crimnormal characteristics), homo inalis (with criminalis neurasthenicus (the professional criminal), homo criminalis degeneratus, and homo criminalis e movbo aut intoxications; and 011 a clinical basis by Professor Enrico Ferri into (1) the political criminal, who may be, as Lombroso calls him, " the true precursor of the progressive movement of humanity," and may be the hero, martyr, or even saint of another land or age ; (2) the criminal by passion; usually distinguished by a previous honest life and genuine remorse, he never becomes a recidivist?his crime is usually a solitary event in his life; careful examination, as a rule, fails to show any striking evidence of abnormality, degeneration, or hereditary taint in the political criminal or criminal by passion; (3) the occasional criminal, who has an element of innate criminality which leads him to commit crime when an opportunity offers?bad heredity is common in this class; (4) the habitual Criminal Anthropology, Criminals, and their or professional criminal, who deliberately adopts a Treatment. career of crime, and commits it either helplessly, From an early period of human history, the degenerate class, or with great intelligence, criminal by, and bhe proper treatment of criminals, the aristocracy of criminality; (5) instinctive or who are a burden in every country, has of all congenital criminals, (crimiuel-ne of the French, sociological problems been considered the most delinguente-nato of the Italian). Lombroso difficult to deal with effectuall}7'. Recent writers identifies the instinctive criminal with the moral in Italy, Germany, France, America, and Eng- insane. Criminals of this class form only a land have brought prominently to the notice of small percentage of the prison population, but the medical profession, jurists, and publicists the}' are the most serious proportion. They the necessity of considering, not so much our frequently present well-marked physical and penal statutes, as the criminal himself, and the psychical signs of abnormality, degeneration, best methods to be pursued by society for his or disease. They reveal criminality in its most management and reformation. The writings of pronounced shape, and they are related on one Lombroso, the distinguished Professor of Medico- side to the occasional criminal, and on the other Legal Medicine at Turin, of Ferri of Rome, pass gradually into (6) the insane criminal, withGarofalo of Naples, with others of the Italian out any clear line of demarcation between the school, of Ellis in England (whose book on The two. Criminal" I can strongly recommend), the work The Italian school, and those who think with of the International Congresses of Rome, Brus- them, consider criminality from a scientific point sels, Switzerland, and Paris, have excited an of view, and assert that it is a neurosis originatenormous amount of interest throughout the ing either in an inherited or an acquired conIt has occurred to me that a dition of the brain, which may be actual disease scientific world. few remarks on this subject would not be out of resulting in degeneration, or the non-developplace here, considering its magnitude and im- ment of certain faculties, the existence of which would preclude the possibility of crime. Crimportance in the East. The term Criminal Anthropology was first inality is a sign of physical degeneration of the given by Lombroso to that branch of morbid nerve centres, crime its outward expression. psychology which is concerned with the study Crime is not then the result of personal sponof the physical and psychical peculiarities found taneity, but springs from the secret forces of in criminals, and it deals with all the problems organization, and is a symptom of moral alienaconnected with the criminal as he is in himself, tion due to inherited vice of character over and as he becomes in contact with society. He which the criminal has no more control than the maintains that by its means it is possible to lunatic. They answer the question. Why is a "
"
"
INDIAN MEDICAL GAZETTE.
30
criminal? by replying: For the same reason that another man is a moralist or an honest, law-abiding citizen. A criminal inherits a brain incapable of generating moral faculties, or through the influence of his environment his mind does not evolve sufficient moral strength It is no to control his appetites and passions. more difficult to believe that brain development in the evolution of mind may stop short of completely unfolding the moral faculties than it is to believe that it may, as it certainly does in many cases, stop before high intellectuality is attained. Whether a man will commit crime at all will depend to a great degree on his constitutional characteristics and education, and the nature of his crime on his environment, inherited tendencies, or both. It is difficult to say how much can be attributed to heredity, how much to environment, as the fall from virtue to vice in the number of healthy, any one is possible, but carefully brought up children who adopt a career of crime is very small, and such cases are generally curable. The habitual and instinctive criminal, on the other hand, conies from a family in which inebriety, insanity and criminality are hereditary, and whose members are surrounded by physical and social defilement. As there are anomalies, monstrosities, infirmities, and natural imperfections in the physical and intellectual world, there are the same in the moral, and the criminal differs physical^, mentally and morally, from the honest member of society as much as the imbecile from the genius. Maudsley, who has written wisely and well " on the subject of criminality, says : The criminal class constitutes a degenerate or morbid variety of mankind: they are, it has been said, as distinctly marked off from the honest and well-bred operatives as black-faced sheep are from other breeds, so that an experienced detective officer, or prison official could pick them out from any promiscuous assembly at church or market. They herd together in our cities in a thieves' quarter, giving themselves up to intemperance, rioting, and debauchery, without regard to marriage ties or the bars of consanguinity, and propagating a criminal population of degenerate beings." The physical and mental peculiarities of the criminal which bias his character and irresistibly impel him to crime have been carefully studied. Their heads differ little from the average. Thieves usually have small heads, and murderers large ones; the cephalic indices are not infrequently an exaggeration of those of the race to which the criminal belongs; abnormality or irregularity in shape is frequent; the orbital capacity is great, frontal crest prominent, and the mediam occipital fossa is often present; signs of old meningitis, pigmentation, cysts, and degenerating capillaries are frequently observed on postmortem examination. The weight of the lower man
a
[Jan.
1895.
is considerably above the average, and the zygoma is usually prominent; the ears are large and outstanding and often abnormal; wrinkles are precocious and well marked; the beard is scanty, and the hair on the head abundant. Muscular and sexual anomalies, pigeon breasts, imperfectly developed chests, and stooping shoulders abound; heart disease, left-handedness, absence or exaggeration of the tendon reflexes of the knee, anaesthesia, analgesia and disvulnerability, or rapid recovery from wounds, are common. The sensibility is much less than that of normal persons ; the eyesight is inferior, and hearing obtuse, with great proneness to disease of the ear; the sense of taste is less developed than in the normal man; sexual precocit}r, showing itself both in natural and unnatural forms, is excessive. Marro has found that the proportion of criminals whose parents were very young or very old at conception is decidedly greater than of ordinary persons. " Despine, in his great work, Ps3'chologie Naturalle," considers that the great psychical conditions for crime are moral insensibility, absence of real remorse, perversity, with imprudence, vanity, and lack of forethought. Of 400 murderers, Dr. Bruce Thompson of Perth only knew three to express remorse; of the 4,550 prisoners who passed through Elmira 34 per cent, showed on admission no susceptibility to moral impressions, 23 per cent, were ordinarily susceptible. Salsotto studied 130 women condemned for premeditated assassination, or complicity in such assassinations. He could only recognize genuine penitence in six. He concluded from his observations that penitence is seldom real, and that real penitence is not obtrusive. The criminal is not necessarily diseased, but there generally exists a latent neurotic bias, if not actual neurotic disease, such as epilepsy, inebriety, or insanity; and he is frequently scrofulous or tuberculous, all indicating nervous and bodily degeneration. Mentallj he can reason about the crimes committed, but he cannot comprehend any moral wrong, and, conscious of punishment for past offences and almost certain of it for future ones, rushes wildly, heedlessly, remorselessly, into the vortex of criminality, and never pauses until the arm of the law interferes to protect society. Despine, in his exhaustive study of the criminal's mental nature, " There must be something abnormal in says: the disposition of criminals when they yield with the utmost facility to desires which would excite the strongest repugnance and horror in a truly moral man. Does not this abnormal state reveal itself in the clearest manner when, contrary to what poets and moralists have represented, we see the wretch who has committed a crime exhibiting no symptoms of remorse, but rather a disposition to repeat the same criminal
jaw
Jan.
INDIAN MEDICAL CONGRESS.
1895.]
act." He drew from this the conclusion that the criminal is morally insane, usually incurable, and that he should be treated in the same way as the intellectually insane person. The heredity of specific characters is a well established fact, and the transmission of individual form or external physical characters, and even peculiarities, is universally acknowledged. The child resembles either the father or the mother, or both, or some member of the ancestral line, in general form, features, and even in colour of hair and eyes, tint of skin, and general expression. Even deviations from the normal type are handed down through several generations, and ma)r possibly establish new species. The functions of the organism, instincts natural and acquired, the perceptive faculties through which impressions of the outer world reach the brain and are there converted into conscious sensations, memory, emotions, reason, will, the appetites, passions, and moral impulses, normal and abnormal, and the pathological conditions to which physical and mental life are liable, are all capable of transmission under the laws of Like begets heredity from parent to offspring. like." The hereditary character of crime was recognized in remote antiquity. Aristotle tells the story of the man who, when his son dragged him to the door by the hair of ltis head, exclaimed, Enough, my son ; I did not drag my father beyond this." Inebrietj^, insanity, crime, are 01086137" related : each is the result of a pathological condition of the brain, each is a stage in the progressive degeneration of a family, all are hereditary, and undergo mutual metamorphosis during the stages of transmission. Of 4,550 inmates of the Elmira Reformatory 12 8 per cent, were of insane or epileptic heredity. Of 233 prisoners at Auburn, New York, 23 per cent, were clearly of neurotic origin. Virgilio found 195 out of 266 criminals were afflicted with hereditary diseases. Rossi found to 71 prisoners 5 insane parents, 6 insane brothers and sisters, and 14 cases of insanity among more distant relations. Marro found the proportion of prisoners with bad heredity was 90 per cent. Penta found among the parents of 184 criminals only 4 or 5 per cent, were quite healthy. Alcoholism in either parent is frequently associated with criminality in the child. Of the 4,450 criminals of Elmira, drunkenness clearly existed in the parents in over 38 per cent. In Rossi's 71 criminals, whose ancestry he was able to trace, in 20 the father was a drunkard and in 11 the mother. Thirty years ago Dr. Bruce Thompson, Physician to the Prison at Perth, Scotland, proved the existence and self-perpetuation of a criminal class. He states that of 5,432 prisoners he found 673 whose mental state appeared to be unsound, "
"
were
not, according
though they opinion, proper subjects
for
an
to
asylum.
31
In a house 904 convicts 440 were recommitted. of detention 109 criminals came from 50 families, In America one family having furnished eight. the Jukes family in seven generations furnished
709 criminals. I have endeavoured to show that' many eminent
writers look on crime as the result of disease of the brain, and in consequence advise the treatment instead of the punishment of this morally diseased class, and urge that the problem of prison administration is how to treat prisoners with the least burden to the community, and at the same time secure ultimately the best advantages to the criminal. "The prison is the battle field between vice and virtue, with the advantage of position and numbers on the side of vice." The modern school on this vexed question have no faith in punishment as such, but believe in correctional treatment, their motto being that every prisoner carries with him the possibility of good citizenship. Prison treatment should be no doubt both punitive and deterrent, but should also have for its object the permanent improvement rather than the deterioration of the prisoner's character; and unless jails are properly managed on these principles the State practically undertakes the criminal education of the dangerous classes. Crime can never be diminished through fear of punishment,; and the benefits to be derived from the conviction and imprisonment of criminals increase in proportion as penal and retributive methods give place to more enlightened reformatory methods. In America 60 to 70 per cent, of juvenile prisoners are reformed. The causes of crime have been most carefully classified under cosmic, such as climate and diet biological, such as personal peculiarities, anatomical, physiological, psychical; and social, which includes economic perturbations, alcohol, pauperism, &c.; but the chief factors have always been and ever will be heredity, a vicious life, alcohol, a woman, a knife, caste, race, and religious pre-
judices.
If it is admitted, as it must be I think, that every truly criminal act proceeds from a person who is temporarily or permanently diseased, the older views on punishment will have to be considerably modified. As it has hitherto been directed at the offence, and it was not considered necessary to take the offender into account at all the result has been most unsatisfactory, as statistics on the phenomena of recidivism prove, and the main cause of recidivism is the failure of prisons to act as reformatories. Laloue, the Inspector-General of Prisons in France, says: "With our existing system twenty-four hours' imprisonment suffices under certain circumstances to ruin a man." As to the reformation of the criminal," general remarks Dr. Paul Aubrey, that is a myth ; the Out of prison is still the best school of crime which we "
"
INDIAN MEDICAL GAZETTE.
32
possess;" and a young Italian thief said: "The houses of correction are much more houses of corruption !" In this place, for obvious reasons, I can only very briefly allude to the main proposals of prison reformers. They are :? (1) To remove the belief that the criminal is an average human being, but to look upon him as an abnormal member of and to make society, " the prison a moral hospital for his treatment and cure. Sir Thomas Moore long ago said that is nothing else but the the end of punishment destruction of vices and the saving of men." (2) To abolish the definite and pre-determined sentence, and to substitute for it an indefinite This removes from the judge, who must one. be ignorant of the nature of the individual before him, the power of definitely fixing the period of confinement in prison, and transfers it to the managers of the reformatoiy, who have the power, if they see fit, to let prisoners out on parole (ticket-of-leave) at any time after a probationary period. Since the introduction of this system into the Elmira prison at New York several thousand prisoners have passed through lit, and only a small percentage prove recidivists; lit was first suggested by1 two Englishmen, the brothers Frederick and Mathew Hill, and independently by Garofalo of Naples. (3) To improve the prison staff, under the belief that the prison warder of to-day is as well fitted for the treatment of criminality as the hospital nurse of half a century ago was .fitted for the treatment of disease. No one should be appointed to the care of criminals who has not been specially trained for the purpose. (4) To educate the criminal physicallj', mentally, and industrially, by means of skilled teachers, so as to win him back from the antisocial to the social world, and to give him when he leaves the prison a trade or means by which he can earn an honest livelihood. (5) To introduce a sound sj'stem for the identification and registration of criminals. The recognition of the habitual criminal is one of the most delicate and difficult functions of the police: they are blamed if they fail in identifying, and doubly blamed if they mistake an innocent person for the real offender. Both identification and registration can be accurately -and uniinpeachably carried out by the anthropometric system of Bertillon, which consists in "'the measurement of parts of the bod}'' which do not alter with age, accident, thinness, or corpulence of the individual, combined with a record of marks, profile and three-fourth face photographs. The measurements are the machinery of identification; the personal marks are the "
"
'proofs.
It is worthy of note that the Japanese have had for ages a system of prison treatment very similar to that which our most advanced thinkers now recommend, in which every prisoner is
[Jan.
1895.
taught to do that at which the limit of' his natural faculties is reached, and where the only method of punishment is one dark cell seldom used, and flogging is unknown. (6) To deal with the occasional criminal by substituting "liability to punishment" for actual detention in jail. This Section is not the one to deal with the question of prison mortality, as its consideration would involve a history of the diseases of prisoners and many other points; but as it is a subject of the deepest interest to all engaged in Jail Administration in the East, I may be permitted to make a few remarks. Writers at home are very fond of contrasting the deathrates of British and Indian jails, to the detriment of the latter, from want of knowledge. I am certain every one who has had the management of prisoners in the East will allow that mortality in prisons depends largely upon (1) the class of prisoner admitted, whether he is selected, the nature of his occupation in the free state, and whether he comes from a malarious or healthy district. The enormous influence of malaria in augmenting Eastern prison death-rates has not been taken sufficiently into account, and it is a curious fact that the removal of prisoners from malarious districts to healthy ones is often disastrous. (2) The discipline and nature of his labour in jail. The stricter the discipline and the more continuously prisoners are made to work, even irrespective of its amount, especially if never accustomed to work before, or if they are employed at work to which they were previously unaccustomed, the higher the death-rate. (3) Diet, whether there is change to unaccustomed food, and whether it is too much or too little. (4) The early detection and treatment of disease. My experience is, that as well as malingering, there is a good deal of concealment of disease and actual indifference about health. If Eastern prisoners could be treated as the following extract shows they are pampered in England, I have no doubt their sick and death-rates would be as low :? The Commissioners of Prisons in their report for 1887-88 attribute the low rates of sickness and mortality to the improved dietary, which gave the prisoners a sufficient amount of food composed of proper ingredients, and they claim for it the great merit of simplicity aud economy. The yearly average death-rate for the 16i years ending March 1878, was 116 per mille, while for the ten years ending March 1888, it was 8'1. The Commissioners state that imprisonment as now generally conducted in England is a condition more or less akin to physiological rest. The struggle for survival is suspended, and the prisoner appears to feel that the prayer for daily bread is rendered unnecessary by the solicitude of his custodians. Tranquillity of mind and freedom from anxiety are leading characteristics -
Jan.
INDIAN MEDICAL CONGRESS.
1895.]
of bis life. From the moment the prison gates close behind him the tendency in most cases is to lessened waste of tissue : he lives in fact less than before. rapidly " He is insensibly subdued to settled quiet," and finds in many instances a peace and repose to which as a law-abiding citizen he was perThe work exacted of him chance a stranger. is never excessive, that, as a rule, lie is free from worry, that he is well clothed and housed and surrounded even in the depths of winter b}r a warm atmosphere, that he spends nine hours out of every twenty-four in bed, does nothing on Sunday, and is exempt from distracting emotions and desires. Finally, he is scrupulously protected from all preventible bodily suffering, and may be said to be an inmate of a l^gienic hospital for the promotion of the physical and mental health. The second subject I wish to say a few words about is?
Insanity. There never was a period of human history when insanity did not exist, and it would be strange if this were not so, with the brain, the organ of mind, liable to have its development arrested, its functions disordered, or its action suspended, and the type of mental and nervous disease which exists in different races and ages is exactly that form which is in accord with their respective mental development?the most common in the savage is imbecility, in children idiocy. There can be no moral insanity where there is 110 moral sense, and no ideational in infants because they have no ideas. The period of the world in which we live is characterized by an enormous increase in frequency of neurotic affections, due to the unparalleled activity and progress, rush and worry of modern life, a life of anxiety and high tension. The rapid cultural development of our time, gratification of ambition, change in the whole style of existence, strife of competition, and the desire to grow rapidly rich, have made nations and individuals discontented. As Horace said two thousand years ago? "
Qui fit, Maecenas, lit nemo, quam sibi sortem Seu ratio dederit, seu fors objecerifc, ilia contentus vivate; laudet diversa sequentes."
In other words, the rapid advancement of our civilization with the conditions of the new age,
and the
which it raises in intellectual, and social existence, has not been effected without mental strain and large expenditure of nerve force, because the change has unfortunately brought with it bad habits not known before, and displaced many old restraining influences which it would have been wise to preserve until something better in their place had been established. Insanity, like criminality, is waits on civilization, which Cartyle says underneath which a the savage merely covering nature of man burns with an infernal fire," and
political,
problems
"
33
the reason for this is not difficult to explain, as there can be no doubt that there is an increasing complexity of the brain, the result of this higher civilization, march of education, and struggle for existence, and, like all machinery, the more delicate its mechanism becomes the more liable it is to get out of order, and the more difficult it is to re-adjust it again. One melancholy evidence of the increase of insanity is the increase in number and size of the asylums which Christian benevolence and statesmanship have established for the custody and treatment of persons mentally afflicted. In Ceylon the admission rate continues to increase, the percentage of recoveries on this rate being about 52 per cent., and the cases are of the usual mental types. The uneducated brain of the native is not usually roused to excessive fabrication of ideas even by insanity, his mental symptoms being more a monotony of noise, bad language, and filthy conduct. In all delusional cases, the patients are persons of education?an example of its effect in enlarging the capacity of mankind for misery. The causes are even more difficult to ascertain than in Western countries, but all experience is against the influence of opium as an important factor in its causation; but there is no doubt about bhang being morally and mentally injurious. In an inquiry which I made some months ago into the opium and bhang question with the Inspector-General of Prisons, we found that the average importation of opium for each year of the decade 1871?80 amounted to 9,622 lb., while for each year of the decade 1881?90 it amounted to 9,957 lb., an increase of 385 lb., or 35 percent. on the annual importation; but taking into account the increase of population, there was an actual decrease per head. In the first period 1 lb. of opium was consumed by, or at least imported for, every 208 persons; in the second period 1 lb. was consumed by, or at least imported for, 302 persons: in other words, it now takes 302 persons to consume what was formerly used by 208. As regards race, Malays are most addicted to this drug, Moors probably come next, the Sinhalese next, then the Tamils, and lastly Burghers and Europeans. We found no satisfactory evidence that the abuse of opium as distinguished from its use was on the increase, nor was there any evidence to show that the abuse of the drug has extended bej^ond a very small section of the community, and the admission to hospitals and asylums has not been influenced to any appreciable extent thereby. We were convinced of the enormous benefits which resulted from its judicious use, and we had reason to believe that a not inconsiderable portion of the drug imported was used in the treatment of animals; further that any considerable diminution in its importation would
INDIAN MEDICAL GAZETTE.
34
involve a considerable increase in human and animal suffering. We were strongly of opinion that the use, even the abuse, of opium had not tended in any to increase crime or insanity, though in way certain cases it may have exercised an enfeebling influence over mind and body. As regards bhang, we found many cases on record in which it had been the immediate cause of crimes of violence, and we advised that its use should be restricted as far as possible by means of a heavy import duty, and the prevention of its cultivation in the Island. My belief is that natives who use opium have selected the least harmful form of stimulant, one which rarely acts as a cause of crime, insanity, or disease, and that any unwise interference will practically substitute alcohol, with all its dreadful immediate and remote effects, for opium. The agitation against it seems to be the result of ignorance. \ have seen a few cases of that curious and dangerous condition known as running amuck, or amok, among Malays, due to bhang and perhaps to opium. It is no doubt a transitory form of madness closely related to epilepsia cnrsiva of Bootius, in which the person commences running and then falls down in a fit. Wallace suggests " that it is a resort to what appears to a savage to be a kind of honourable suicide on the part of a man who for some reason is plunged in sorrow and dejection, thinks himself wronged by society, or to whom on account of misfortune life has become a burden." Trusting that my remarks have not been too long, and thanking you for your attention, I now give place to those who have prepared papers which we have all come here to hear read. o
o
[Jan.
IS95.
(jrENTLEMEN
OF
KYNSEY,
THE
c.m.g., p.r.c.p.i.
SECTION
OF
MEDICO-
LEGAL Medicine and Insanity,?My first duty is to thank the members of this Congress? which I have no doubt will mark an epoch in the medical history of the East, and confer real benefit on present and future questions ?for the honour they have conferred upon me by electing me to the post I occupy to-day. I feel it, I can assure you, both an honour and a pleasure to be allowed to preside over a Section wherein the sister-sciences of Law and Medicine are united for the discussion of such subjects of interest to all classes of this great Indian Empire as those enumerated in the invitation to the Congress. My second duty is to thank the members here to-day for their presence and co-operation. The title of the Section sufficiently indicates its scope and object, and all here will agree with me that there is no branch of our profession more neglected than Medical Jurisprudence. Its history in Europe and the East, while full of great triumphs, is also full of cases where most serious consequences resulted from inexperience and ignorance, due to the fact that few make the scientific questions involved the subject of definite and intelligent study. To no science
Jan.
INDIAN MEDICAL CONGRESS.
1895.]
the remarks of lluskin more applicable: The greatest thing a human soul ever does in this world is to see something and tell what he saw in a plain way. Hundreds of people can talk for one that can think, but thousands can think for one who can see." In the relations which exist between Medicine and Law, the testimony of experts is necessary for the purpose of arriving at truth, which is the ultimate object of the Medical and the Legal professions, a trial being merely a means for obtaining it. The interests of good government, the sacredness of human life, and the welfare of man, demand that no one should be accepted as a Medical witness who has not made a special study of the many sciences upon which Medical Jurisprudence is founded. Medical evidence is important in all countries, but in the East it is often the only evidence at all to be relied upon, and on it alone often hangs the liberty or life of a human beino\ O It would be presumptuous on my part to express here opinions on many of the questions which will engage your attention. I shall therefore confine what I have to say to a fewremarks on a couple of the subjects with which I ain most familiar; and first on?
are "
determine the
probability
29
ot'
a
prisoner's
refor-
mation, and the best methods by which this
can
be effected; but it cannot of course be used to discover the author of a crime, although by means of measurements prisoners can be easily identified accurately. Criminals have been classified by Professor Benedikt on a pathological basis into homo crimnormal characteristics), homo inalis (with criminalis neurasthenicus (the professional criminal), homo criminalis degeneratus, and homo criminalis e movbo aut intoxications; and 011 a clinical basis by Professor Enrico Ferri into (1) the political criminal, who may be, as Lombroso calls him, " the true precursor of the progressive movement of humanity," and may be the hero, martyr, or even saint of another land or age ; (2) the criminal by passion; usually distinguished by a previous honest life and genuine remorse, he never becomes a recidivist?his crime is usually a solitary event in his life; careful examination, as a rule, fails to show any striking evidence of abnormality, degeneration, or hereditary taint in the political criminal or criminal by passion; (3) the occasional criminal, who has an element of innate criminality which leads him to commit crime when an opportunity offers?bad heredity is common in this class; (4) the habitual Criminal Anthropology, Criminals, and their or professional criminal, who deliberately adopts a Treatment. career of crime, and commits it either helplessly, From an early period of human history, the degenerate class, or with great intelligence, criminal by, and bhe proper treatment of criminals, the aristocracy of criminality; (5) instinctive or who are a burden in every country, has of all congenital criminals, (crimiuel-ne of the French, sociological problems been considered the most delinguente-nato of the Italian). Lombroso difficult to deal with effectuall}7'. Recent writers identifies the instinctive criminal with the moral in Italy, Germany, France, America, and Eng- insane. Criminals of this class form only a land have brought prominently to the notice of small percentage of the prison population, but the medical profession, jurists, and publicists the}' are the most serious proportion. They the necessity of considering, not so much our frequently present well-marked physical and penal statutes, as the criminal himself, and the psychical signs of abnormality, degeneration, best methods to be pursued by society for his or disease. They reveal criminality in its most management and reformation. The writings of pronounced shape, and they are related on one Lombroso, the distinguished Professor of Medico- side to the occasional criminal, and on the other Legal Medicine at Turin, of Ferri of Rome, pass gradually into (6) the insane criminal, withGarofalo of Naples, with others of the Italian out any clear line of demarcation between the school, of Ellis in England (whose book on The two. Criminal" I can strongly recommend), the work The Italian school, and those who think with of the International Congresses of Rome, Brus- them, consider criminality from a scientific point sels, Switzerland, and Paris, have excited an of view, and assert that it is a neurosis originatenormous amount of interest throughout the ing either in an inherited or an acquired conIt has occurred to me that a dition of the brain, which may be actual disease scientific world. few remarks on this subject would not be out of resulting in degeneration, or the non-developplace here, considering its magnitude and im- ment of certain faculties, the existence of which would preclude the possibility of crime. Crimportance in the East. The term Criminal Anthropology was first inality is a sign of physical degeneration of the given by Lombroso to that branch of morbid nerve centres, crime its outward expression. psychology which is concerned with the study Crime is not then the result of personal sponof the physical and psychical peculiarities found taneity, but springs from the secret forces of in criminals, and it deals with all the problems organization, and is a symptom of moral alienaconnected with the criminal as he is in himself, tion due to inherited vice of character over and as he becomes in contact with society. He which the criminal has no more control than the maintains that by its means it is possible to lunatic. They answer the question. Why is a "
"
"
INDIAN MEDICAL GAZETTE.
30
criminal? by replying: For the same reason that another man is a moralist or an honest, law-abiding citizen. A criminal inherits a brain incapable of generating moral faculties, or through the influence of his environment his mind does not evolve sufficient moral strength It is no to control his appetites and passions. more difficult to believe that brain development in the evolution of mind may stop short of completely unfolding the moral faculties than it is to believe that it may, as it certainly does in many cases, stop before high intellectuality is attained. Whether a man will commit crime at all will depend to a great degree on his constitutional characteristics and education, and the nature of his crime on his environment, inherited tendencies, or both. It is difficult to say how much can be attributed to heredity, how much to environment, as the fall from virtue to vice in the number of healthy, any one is possible, but carefully brought up children who adopt a career of crime is very small, and such cases are generally curable. The habitual and instinctive criminal, on the other hand, conies from a family in which inebriety, insanity and criminality are hereditary, and whose members are surrounded by physical and social defilement. As there are anomalies, monstrosities, infirmities, and natural imperfections in the physical and intellectual world, there are the same in the moral, and the criminal differs physical^, mentally and morally, from the honest member of society as much as the imbecile from the genius. Maudsley, who has written wisely and well " on the subject of criminality, says : The criminal class constitutes a degenerate or morbid variety of mankind: they are, it has been said, as distinctly marked off from the honest and well-bred operatives as black-faced sheep are from other breeds, so that an experienced detective officer, or prison official could pick them out from any promiscuous assembly at church or market. They herd together in our cities in a thieves' quarter, giving themselves up to intemperance, rioting, and debauchery, without regard to marriage ties or the bars of consanguinity, and propagating a criminal population of degenerate beings." The physical and mental peculiarities of the criminal which bias his character and irresistibly impel him to crime have been carefully studied. Their heads differ little from the average. Thieves usually have small heads, and murderers large ones; the cephalic indices are not infrequently an exaggeration of those of the race to which the criminal belongs; abnormality or irregularity in shape is frequent; the orbital capacity is great, frontal crest prominent, and the mediam occipital fossa is often present; signs of old meningitis, pigmentation, cysts, and degenerating capillaries are frequently observed on postmortem examination. The weight of the lower man
a
[Jan.
1895.
is considerably above the average, and the zygoma is usually prominent; the ears are large and outstanding and often abnormal; wrinkles are precocious and well marked; the beard is scanty, and the hair on the head abundant. Muscular and sexual anomalies, pigeon breasts, imperfectly developed chests, and stooping shoulders abound; heart disease, left-handedness, absence or exaggeration of the tendon reflexes of the knee, anaesthesia, analgesia and disvulnerability, or rapid recovery from wounds, are common. The sensibility is much less than that of normal persons ; the eyesight is inferior, and hearing obtuse, with great proneness to disease of the ear; the sense of taste is less developed than in the normal man; sexual precocit}r, showing itself both in natural and unnatural forms, is excessive. Marro has found that the proportion of criminals whose parents were very young or very old at conception is decidedly greater than of ordinary persons. " Despine, in his great work, Ps3'chologie Naturalle," considers that the great psychical conditions for crime are moral insensibility, absence of real remorse, perversity, with imprudence, vanity, and lack of forethought. Of 400 murderers, Dr. Bruce Thompson of Perth only knew three to express remorse; of the 4,550 prisoners who passed through Elmira 34 per cent, showed on admission no susceptibility to moral impressions, 23 per cent, were ordinarily susceptible. Salsotto studied 130 women condemned for premeditated assassination, or complicity in such assassinations. He could only recognize genuine penitence in six. He concluded from his observations that penitence is seldom real, and that real penitence is not obtrusive. The criminal is not necessarily diseased, but there generally exists a latent neurotic bias, if not actual neurotic disease, such as epilepsy, inebriety, or insanity; and he is frequently scrofulous or tuberculous, all indicating nervous and bodily degeneration. Mentallj he can reason about the crimes committed, but he cannot comprehend any moral wrong, and, conscious of punishment for past offences and almost certain of it for future ones, rushes wildly, heedlessly, remorselessly, into the vortex of criminality, and never pauses until the arm of the law interferes to protect society. Despine, in his exhaustive study of the criminal's mental nature, " There must be something abnormal in says: the disposition of criminals when they yield with the utmost facility to desires which would excite the strongest repugnance and horror in a truly moral man. Does not this abnormal state reveal itself in the clearest manner when, contrary to what poets and moralists have represented, we see the wretch who has committed a crime exhibiting no symptoms of remorse, but rather a disposition to repeat the same criminal
jaw
Jan.
INDIAN MEDICAL CONGRESS.
1895.]
act." He drew from this the conclusion that the criminal is morally insane, usually incurable, and that he should be treated in the same way as the intellectually insane person. The heredity of specific characters is a well established fact, and the transmission of individual form or external physical characters, and even peculiarities, is universally acknowledged. The child resembles either the father or the mother, or both, or some member of the ancestral line, in general form, features, and even in colour of hair and eyes, tint of skin, and general expression. Even deviations from the normal type are handed down through several generations, and ma)r possibly establish new species. The functions of the organism, instincts natural and acquired, the perceptive faculties through which impressions of the outer world reach the brain and are there converted into conscious sensations, memory, emotions, reason, will, the appetites, passions, and moral impulses, normal and abnormal, and the pathological conditions to which physical and mental life are liable, are all capable of transmission under the laws of Like begets heredity from parent to offspring. like." The hereditary character of crime was recognized in remote antiquity. Aristotle tells the story of the man who, when his son dragged him to the door by the hair of ltis head, exclaimed, Enough, my son ; I did not drag my father beyond this." Inebrietj^, insanity, crime, are 01086137" related : each is the result of a pathological condition of the brain, each is a stage in the progressive degeneration of a family, all are hereditary, and undergo mutual metamorphosis during the stages of transmission. Of 4,550 inmates of the Elmira Reformatory 12 8 per cent, were of insane or epileptic heredity. Of 233 prisoners at Auburn, New York, 23 per cent, were clearly of neurotic origin. Virgilio found 195 out of 266 criminals were afflicted with hereditary diseases. Rossi found to 71 prisoners 5 insane parents, 6 insane brothers and sisters, and 14 cases of insanity among more distant relations. Marro found the proportion of prisoners with bad heredity was 90 per cent. Penta found among the parents of 184 criminals only 4 or 5 per cent, were quite healthy. Alcoholism in either parent is frequently associated with criminality in the child. Of the 4,450 criminals of Elmira, drunkenness clearly existed in the parents in over 38 per cent. In Rossi's 71 criminals, whose ancestry he was able to trace, in 20 the father was a drunkard and in 11 the mother. Thirty years ago Dr. Bruce Thompson, Physician to the Prison at Perth, Scotland, proved the existence and self-perpetuation of a criminal class. He states that of 5,432 prisoners he found 673 whose mental state appeared to be unsound, "
"
were
not, according
though they opinion, proper subjects
for
an
to
asylum.
31
In a house 904 convicts 440 were recommitted. of detention 109 criminals came from 50 families, In America one family having furnished eight. the Jukes family in seven generations furnished
709 criminals. I have endeavoured to show that' many eminent
writers look on crime as the result of disease of the brain, and in consequence advise the treatment instead of the punishment of this morally diseased class, and urge that the problem of prison administration is how to treat prisoners with the least burden to the community, and at the same time secure ultimately the best advantages to the criminal. "The prison is the battle field between vice and virtue, with the advantage of position and numbers on the side of vice." The modern school on this vexed question have no faith in punishment as such, but believe in correctional treatment, their motto being that every prisoner carries with him the possibility of good citizenship. Prison treatment should be no doubt both punitive and deterrent, but should also have for its object the permanent improvement rather than the deterioration of the prisoner's character; and unless jails are properly managed on these principles the State practically undertakes the criminal education of the dangerous classes. Crime can never be diminished through fear of punishment,; and the benefits to be derived from the conviction and imprisonment of criminals increase in proportion as penal and retributive methods give place to more enlightened reformatory methods. In America 60 to 70 per cent, of juvenile prisoners are reformed. The causes of crime have been most carefully classified under cosmic, such as climate and diet biological, such as personal peculiarities, anatomical, physiological, psychical; and social, which includes economic perturbations, alcohol, pauperism, &c.; but the chief factors have always been and ever will be heredity, a vicious life, alcohol, a woman, a knife, caste, race, and religious pre-
judices.
If it is admitted, as it must be I think, that every truly criminal act proceeds from a person who is temporarily or permanently diseased, the older views on punishment will have to be considerably modified. As it has hitherto been directed at the offence, and it was not considered necessary to take the offender into account at all the result has been most unsatisfactory, as statistics on the phenomena of recidivism prove, and the main cause of recidivism is the failure of prisons to act as reformatories. Laloue, the Inspector-General of Prisons in France, says: "With our existing system twenty-four hours' imprisonment suffices under certain circumstances to ruin a man." As to the reformation of the criminal," general remarks Dr. Paul Aubrey, that is a myth ; the Out of prison is still the best school of crime which we "
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INDIAN MEDICAL GAZETTE.
32
possess;" and a young Italian thief said: "The houses of correction are much more houses of corruption !" In this place, for obvious reasons, I can only very briefly allude to the main proposals of prison reformers. They are :? (1) To remove the belief that the criminal is an average human being, but to look upon him as an abnormal member of and to make society, " the prison a moral hospital for his treatment and cure. Sir Thomas Moore long ago said that is nothing else but the the end of punishment destruction of vices and the saving of men." (2) To abolish the definite and pre-determined sentence, and to substitute for it an indefinite This removes from the judge, who must one. be ignorant of the nature of the individual before him, the power of definitely fixing the period of confinement in prison, and transfers it to the managers of the reformatoiy, who have the power, if they see fit, to let prisoners out on parole (ticket-of-leave) at any time after a probationary period. Since the introduction of this system into the Elmira prison at New York several thousand prisoners have passed through lit, and only a small percentage prove recidivists; lit was first suggested by1 two Englishmen, the brothers Frederick and Mathew Hill, and independently by Garofalo of Naples. (3) To improve the prison staff, under the belief that the prison warder of to-day is as well fitted for the treatment of criminality as the hospital nurse of half a century ago was .fitted for the treatment of disease. No one should be appointed to the care of criminals who has not been specially trained for the purpose. (4) To educate the criminal physicallj', mentally, and industrially, by means of skilled teachers, so as to win him back from the antisocial to the social world, and to give him when he leaves the prison a trade or means by which he can earn an honest livelihood. (5) To introduce a sound sj'stem for the identification and registration of criminals. The recognition of the habitual criminal is one of the most delicate and difficult functions of the police: they are blamed if they fail in identifying, and doubly blamed if they mistake an innocent person for the real offender. Both identification and registration can be accurately -and uniinpeachably carried out by the anthropometric system of Bertillon, which consists in "'the measurement of parts of the bod}'' which do not alter with age, accident, thinness, or corpulence of the individual, combined with a record of marks, profile and three-fourth face photographs. The measurements are the machinery of identification; the personal marks are the "
"
'proofs.
It is worthy of note that the Japanese have had for ages a system of prison treatment very similar to that which our most advanced thinkers now recommend, in which every prisoner is
[Jan.
1895.
taught to do that at which the limit of' his natural faculties is reached, and where the only method of punishment is one dark cell seldom used, and flogging is unknown. (6) To deal with the occasional criminal by substituting "liability to punishment" for actual detention in jail. This Section is not the one to deal with the question of prison mortality, as its consideration would involve a history of the diseases of prisoners and many other points; but as it is a subject of the deepest interest to all engaged in Jail Administration in the East, I may be permitted to make a few remarks. Writers at home are very fond of contrasting the deathrates of British and Indian jails, to the detriment of the latter, from want of knowledge. I am certain every one who has had the management of prisoners in the East will allow that mortality in prisons depends largely upon (1) the class of prisoner admitted, whether he is selected, the nature of his occupation in the free state, and whether he comes from a malarious or healthy district. The enormous influence of malaria in augmenting Eastern prison death-rates has not been taken sufficiently into account, and it is a curious fact that the removal of prisoners from malarious districts to healthy ones is often disastrous. (2) The discipline and nature of his labour in jail. The stricter the discipline and the more continuously prisoners are made to work, even irrespective of its amount, especially if never accustomed to work before, or if they are employed at work to which they were previously unaccustomed, the higher the death-rate. (3) Diet, whether there is change to unaccustomed food, and whether it is too much or too little. (4) The early detection and treatment of disease. My experience is, that as well as malingering, there is a good deal of concealment of disease and actual indifference about health. If Eastern prisoners could be treated as the following extract shows they are pampered in England, I have no doubt their sick and death-rates would be as low :? The Commissioners of Prisons in their report for 1887-88 attribute the low rates of sickness and mortality to the improved dietary, which gave the prisoners a sufficient amount of food composed of proper ingredients, and they claim for it the great merit of simplicity aud economy. The yearly average death-rate for the 16i years ending March 1878, was 116 per mille, while for the ten years ending March 1888, it was 8'1. The Commissioners state that imprisonment as now generally conducted in England is a condition more or less akin to physiological rest. The struggle for survival is suspended, and the prisoner appears to feel that the prayer for daily bread is rendered unnecessary by the solicitude of his custodians. Tranquillity of mind and freedom from anxiety are leading characteristics -
Jan.
INDIAN MEDICAL CONGRESS.
1895.]
of bis life. From the moment the prison gates close behind him the tendency in most cases is to lessened waste of tissue : he lives in fact less than before. rapidly " He is insensibly subdued to settled quiet," and finds in many instances a peace and repose to which as a law-abiding citizen he was perThe work exacted of him chance a stranger. is never excessive, that, as a rule, lie is free from worry, that he is well clothed and housed and surrounded even in the depths of winter b}r a warm atmosphere, that he spends nine hours out of every twenty-four in bed, does nothing on Sunday, and is exempt from distracting emotions and desires. Finally, he is scrupulously protected from all preventible bodily suffering, and may be said to be an inmate of a l^gienic hospital for the promotion of the physical and mental health. The second subject I wish to say a few words about is?
Insanity. There never was a period of human history when insanity did not exist, and it would be strange if this were not so, with the brain, the organ of mind, liable to have its development arrested, its functions disordered, or its action suspended, and the type of mental and nervous disease which exists in different races and ages is exactly that form which is in accord with their respective mental development?the most common in the savage is imbecility, in children idiocy. There can be no moral insanity where there is 110 moral sense, and no ideational in infants because they have no ideas. The period of the world in which we live is characterized by an enormous increase in frequency of neurotic affections, due to the unparalleled activity and progress, rush and worry of modern life, a life of anxiety and high tension. The rapid cultural development of our time, gratification of ambition, change in the whole style of existence, strife of competition, and the desire to grow rapidly rich, have made nations and individuals discontented. As Horace said two thousand years ago? "
Qui fit, Maecenas, lit nemo, quam sibi sortem Seu ratio dederit, seu fors objecerifc, ilia contentus vivate; laudet diversa sequentes."
In other words, the rapid advancement of our civilization with the conditions of the new age,
and the
which it raises in intellectual, and social existence, has not been effected without mental strain and large expenditure of nerve force, because the change has unfortunately brought with it bad habits not known before, and displaced many old restraining influences which it would have been wise to preserve until something better in their place had been established. Insanity, like criminality, is waits on civilization, which Cartyle says underneath which a the savage merely covering nature of man burns with an infernal fire," and
political,
problems
"
33
the reason for this is not difficult to explain, as there can be no doubt that there is an increasing complexity of the brain, the result of this higher civilization, march of education, and struggle for existence, and, like all machinery, the more delicate its mechanism becomes the more liable it is to get out of order, and the more difficult it is to re-adjust it again. One melancholy evidence of the increase of insanity is the increase in number and size of the asylums which Christian benevolence and statesmanship have established for the custody and treatment of persons mentally afflicted. In Ceylon the admission rate continues to increase, the percentage of recoveries on this rate being about 52 per cent., and the cases are of the usual mental types. The uneducated brain of the native is not usually roused to excessive fabrication of ideas even by insanity, his mental symptoms being more a monotony of noise, bad language, and filthy conduct. In all delusional cases, the patients are persons of education?an example of its effect in enlarging the capacity of mankind for misery. The causes are even more difficult to ascertain than in Western countries, but all experience is against the influence of opium as an important factor in its causation; but there is no doubt about bhang being morally and mentally injurious. In an inquiry which I made some months ago into the opium and bhang question with the Inspector-General of Prisons, we found that the average importation of opium for each year of the decade 1871?80 amounted to 9,622 lb., while for each year of the decade 1881?90 it amounted to 9,957 lb., an increase of 385 lb., or 35 percent. on the annual importation; but taking into account the increase of population, there was an actual decrease per head. In the first period 1 lb. of opium was consumed by, or at least imported for, every 208 persons; in the second period 1 lb. was consumed by, or at least imported for, 302 persons: in other words, it now takes 302 persons to consume what was formerly used by 208. As regards race, Malays are most addicted to this drug, Moors probably come next, the Sinhalese next, then the Tamils, and lastly Burghers and Europeans. We found no satisfactory evidence that the abuse of opium as distinguished from its use was on the increase, nor was there any evidence to show that the abuse of the drug has extended bej^ond a very small section of the community, and the admission to hospitals and asylums has not been influenced to any appreciable extent thereby. We were convinced of the enormous benefits which resulted from its judicious use, and we had reason to believe that a not inconsiderable portion of the drug imported was used in the treatment of animals; further that any considerable diminution in its importation would
INDIAN MEDICAL GAZETTE.
34
involve a considerable increase in human and animal suffering. We were strongly of opinion that the use, even the abuse, of opium had not tended in any to increase crime or insanity, though in way certain cases it may have exercised an enfeebling influence over mind and body. As regards bhang, we found many cases on record in which it had been the immediate cause of crimes of violence, and we advised that its use should be restricted as far as possible by means of a heavy import duty, and the prevention of its cultivation in the Island. My belief is that natives who use opium have selected the least harmful form of stimulant, one which rarely acts as a cause of crime, insanity, or disease, and that any unwise interference will practically substitute alcohol, with all its dreadful immediate and remote effects, for opium. The agitation against it seems to be the result of ignorance. \ have seen a few cases of that curious and dangerous condition known as running amuck, or amok, among Malays, due to bhang and perhaps to opium. It is no doubt a transitory form of madness closely related to epilepsia cnrsiva of Bootius, in which the person commences running and then falls down in a fit. Wallace suggests " that it is a resort to what appears to a savage to be a kind of honourable suicide on the part of a man who for some reason is plunged in sorrow and dejection, thinks himself wronged by society, or to whom on account of misfortune life has become a burden." Trusting that my remarks have not been too long, and thanking you for your attention, I now give place to those who have prepared papers which we have all come here to hear read. o
o
[Jan.
IS95.
