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the mind is morbidly affected in its natural manifestation, by which the insane person is made incapable of conducting his cause as a sane person would, or as he would in his rational mental estate. It is on the basis of disease that the insane should have rights before the law different from those accorded the sane. Their rights are not all secured to them when they are tried exclusively in the same manner as the sane are. Disease of the mind, if it exists, must be established in the same manner as any other fact.
Now, a just regard for the rights of the insane as mentally diseased persons, and consequently more or less crippled and perverted in their mental operations, demands that we should accord to them a medical examination after medical methods, into the question of disease; and that courts should aid in the inquiry by every means known to them or suggested by medical science, as calculated to elicit the “ truth, the whole truth, and nothing but the truth,” respecting the existence or nonexistence of disease.
It is obvious, therefore, that the hypothetical case, without ample personal examination by medical men, is not full justice to the really insane, while it may, and often does, answer the purpose of casting doubt on the jury's mind respecting the sanity of really sane persons, thus aiding the unworthy to escape the consequences of crime, while it does not give the best chance to the innocent, by reason of mental disease, to fully establish the existence of disease, or, rather, to have their disease established for them. The really insane should not have their chances of vindication imperiled by possible medical deficiencies of counsel. Defending counsel may fail, through ignorance of essential symptoms, to so present them as to convince medical experts, and yet the prisoner may be insane, and his insanity may be susceptible of proof if sought out by medical men by medical methods.
As the determination of the question of disease in general by an ordinary jury trial must obviously be very unsatisfactory and unjust to the afflicted, so must such an inquiry in special cases of mental disease sometimes jeopardize the interests of the really insane, as in times of great public excitement, and in localities where prejudice has grown up against the plea by reason of previous escapes of the guilty upon it, through misuse and misapplication of the hypothetical case. At such times and occasions it would seem only just to the insane for the court to order medical expert commissions, selected from remote distances, to deliberate upon and determine the question of the prisoner's mental status from personal examination and all obtainable evidence.
Finally, a proper regard for the rights of the insane before the law, should secure for them rulings by courts in accordance with the nature of their malady, as shown by clinical experience, rather than in accordance with those theoretical conceptions of courts which are often judicial misconceptions of insanity. Such judicial rulings as declare that evidence of the existence of the knowledge of right and wrong in the mind is evidence of responsibility, regardless of the overmastering influences of those resistless morbid impulsions which are common to and characteristic of certain forms and phases of mental aberration, do violence to the sacred rights of the insane, to that just protection due to the helplessness of disease, from the rational and powerful to protect or crush them. Insanity is a law unto itself, and is no respecter of the theoretical boundaries with which jurists have sought to circumscribe it. We know from observation of this malady that an abstract knowledge of right and wrong may exist in a mind rendered powerless, by reason of overmastering disease, to resist the wrong and morbid impulsion, as may be demonstrated in many cases in asylums for the insane. A really insane person is entitled to judicial rulings in accordance with the facts and truth of his malady, whether it conflict or conform with non-medical conceptions of what the nature of insanity ought to be.
A subsidiary right of the insane is to have the State provide criminal lunatic asylums, in order that the rights of the insane may not be put in jeopardy by the just fear in the public mind of having insane murderers and others go free. insane murderer should be under the State's surveillance for life, and law should secure to the lunatic and the community this protection against the possible consequences of disease. Such security to society incidentally guards the insane man in his rights, and makes the chances for equal and exact justice when insanity is pleaded in excuse for crime much more secure.
The last right of the insane, but not the least, that I would here mention, is the right to medical inquiry, in lieu of the ordinary trial by jury, into the question of their insanity, before
committing them to asylum care and custody,—such an inquiry and so conducted as might not aggravate the siek man's malady, by undue causes of irritation or needless publicity, or jeopard his chances of timely hospital treatment by a verdict of “not insane enough for hospital treatment, because not yet dangerous to self or others, or a disturber of the public peace;" such a thorough unimpassioned medical inquiry as would certainly reach the true nature and needs of his malady,—and such an inquiry is best secured by men competent from experience to investigate the nature of mental disease.
No reasonable construction of the “due process of law" guaranteed to any one deprived of liberty ought to be made, that can deprive a mentally diseased man of a thorough medical inquiry, conducted in accordance with the nature and demands of his disease, in preference to the ordinary “jury of” the insane “ man's peers."
IN THE CITY AND COUNTY OF PHILADELPILIA, DURING A DECADE,
1872 to 1881 INCLUSIVE.
BY JOHN G. LEE, M. D., CORONER'S PHYSICIAN,
Among the many forms of mortality which annually exact tribute from the human race, few have been the subject of more profound study and deep thought than suicide, or self-murder.
This form of death has, within the last century, attracted the attention of many of our scientific brethren in foreign countries, and has been treated of by such eminent men as Esquirol, Quetelet, Marc, Winslow, Casper, Bourdin, Boismont, Morselli, Legoyt, and Massaryk, together with a host of others, who, investigating the subject in all its bearings, and carefully studying it in all its different relations to the communities where it occurs, have attempted to discover the causes and define the laws governing a phenomenon apparently so contradictory to the habits and instincts of mankind; and, by conclusions skillfully deducted from generalizations more or less vast, these investigators have built up ably-conceived theories, which they have submitted to the profession for consideration, approval and acceptance.
In this country, however, if we except a paper by Brigham,* published in 1844, one by Adams,t in 1861, and the recent work of O'Dea, but little attention seems to have been accorded so interesting a form of death; not so much, possibly, from any difficulties which the study of the subject may present, as owing to the almost insurmountable obstacles which stand in the way
* "Statistics of Suicide in the United States."--- American Journal of Insanity, 1844-45.
† J. G Adams, M. D.—"Statistics of Suicide in New York City, for 1859 and 1860."-- American Journal of Med. Sciences, October, 1861.
of obtaining data sufficiently reliable and numerous enough for the rearing of a synthetical structure, the generalizations of which shall be sufficiently widespreading to permit of analytical observations from which conclusions of interest and value may be deducted.
This work it has been my ambition to do,—or, rather, to commence,-occupying an official position offering exceptional advantages for the study of self-destruction, in its different aspects, phases, and relations to and among the population of a great industrial and commercial centre. I have endeavored to repeat some of the work which our European confrères have already accomplished abroad, with the hope that other gentlemen occupying positions similar to my own, in all our large cities, will follow my example, and some day give the results of their observations to the profession; thus contributing America's share to the total quota of work required for the ascertaining of what laws, if any, govern the self-destruction of individuals of the human species.
I therefore have the honor of presenting for your consideration a study of suicide among the population of the city of Philadelphia during the past ten years,—1872 to 1881 inclusive. Examining self-murder as regards its ratio to the population; its relative frequency of recurrence at different seasons of the year, the ages, sexes, and conditions in life of the victims, and the various means selected by the unfortunates for the termination of their existence. I also vouch for the accuracy of the different figures herein advanced, the statistics having been compiled by myself from the Cordner's dockets, as the returns of suicides contained in the annually published reports of the Health Office are frequently inexact, owing to the careless manner in which death certificates issued by the Coroner's office have been made out. The other figures are derived from the reports of the Health Office, the efficient Registrar of which, Mr. George E. Chambers, I will here take the opportunity to thank for his many kindnesses and valuable suggestions.
From the thirty-first day of December, 1871, until the first day of January, 1882, out of 12,936 cases of death requiring a Coroner's investigation, 636 individuals were ascertained to have ended their existence by their own hands, or a ratio of about 53 suicides to every 1,000 inquests. And there is every reason to suspect that during such a lengthy term of years some