Proceedings Medical Jurisprudence Society of Philadelphia THE LEGAL RESPONSIBILITY OF INEBRIATES BY JOSEPHJARRISH MD Read December iith 1888 Go 1 * A A THE UNALTERABILITY OF STRYCHNINE IN THE BODY AFTER DEATH BY ALFRED H ALLEN FIC FCS , Read October gin 1888 THE LEGAL RESPONSIBILITY OF INEBRIATES. By JOSEPH PARRISH, M. D., OF BURLINGTON, N. J. Read before the Medical Jurisprudence Society of Philadelphia, December nth, 1888. [Reprinted from The Polyclinic, January, 1889.] What is it ? is the question of the hour. To find the answer, let it first be determined what, or who are inebriates. That there are thousands of persons who consume intoxi- cants habitually and constantly, who are never visibly intoxicated, is a very obvious truth. It is nevertheless true, that there are many, who, by nature and constitutional bias, are inebriates, who have never taken an inebriating draught, but who, knowing themselves, and their morbid tendency, avoid the danger of excess by absolute and perpetual abstinence. Not a few such persons may be found among intelligent and careful people, with whom each day is a day of conflict-of con- flict with themselves and their environment. They are a multitude of heroes, whose battles with self will never be known, and the record of whose conquests will never be made. Such cases have their analogues in various forms of morbid inheritance, only two of which need now be.mentioned-in- sanity and pulmonary consumption. The natural history of insanity and ine- briety is so similar that it is sometimes diffi- cult to draw the line of separation. Indeed, they are so near to each other, as to admit in some cases of an equal place in nosology, as, for example, in the use of the terms, "insane drunkenness " and " drunken in- sanity," both representing kindred patho- logical conditions. The relationship is so patent even to the unprofessional observer, that I need dwell no longer on this point than to allude to a striking inconsistency in the law, as viewed from a medical stand- point. If I understand its meaning, the law discriminates between common drunk- enness and dipsomania, but fails to recog- nize the likeness between dipsomania and insanity, or in other words, it does not see a similarity between insanity from drink and insanity from other causes, though the mani- festations may be similar. It assumes that the dipsomaniac is a voluntary demon or drunkard, and if he will, he may avoid the paroxysms that characterize the disease. Science, however, declares a dipsomaniac, or an inebriate in the medical sense, to be what he is, from an impaired or defective will, that is unable-to resist the " nerve storm," which assails him at intervals, that he cannot always anticipate, as is the case in hysteria, epilepsy, etc. In consequence of this error, the law provides in the same statute, for habitual drunkenness and in- sanity, making a criminal act committed by an insane person so far different in its results from the same act committed by an inebri- ate, as to warrant the commitment of the former to an asylum, while the penalty in- flicted upon the latter, may be imprisonment for life in a penitentiary, or it may be hang- ing by the neck till he is dead. The analogy presented by pulmonary consumption may not, in the view of some, be so decided, and hence I invite attention to the early symptomatology and hereditary signs of the two disorders. Thousands are being born with a decided and well-marked consumptive diathesis, but who, knowing themselves and their family history, adapt themselves to such hygienic and climatic methods of living as tend to counteract the progress of the disease, and thus avoid its fatal ravages. Such persons, however, are consumptives by natural descent*.who 2 would go steadily on to a consumptive's lingering death, but for the knowledge of their tendency to it, and their ability to avail themselves of means to resist its ap- proaches. While it is interesting to observe these analogues, and while the very fact of likeness serves as confirmatory evidence of disease, there is ample testimony from dis- tinguished sources to fix the fact of disease independent of any likeness to other morbid conditions. Dr. Quain, editor of the recent "Dictionary of Medicine," defines disease to be " any deviation from the standard of health, in any of the functions or compo- nent materials of the body." Dr. Norman Kerr, a distinguished medical practitioner of London, an expert and author on inebriety,and on medico-legal topics, says, in his recent work on inebriety, ''In drunken- ness of all degrees, and every variety, the Church, sees only sin; the world, only vice; the state, only crime. On the other hand, whatever else any intelligent medical practi- tioner beholds in such cases, he generally discovers a condition of disease. ' ' In our own country, the current medical opinion favors the same view, and I am convinced that it is gaining a firmer hold on the public mind in all departments of our social and civil life. It remains for the legal and the judicial sentiment of the land so to classify alcoholic intoxication as to remove it from the domain of morals, not even regarding it as a species of moral mania, but to accord to it its legitimate place as a physical disease. For our present purpose, at least, it is assumed that we are agreed as to the abstract question of disease as applied to inebriety, but it becomes us to extend our enquiries a little further, that we may ascer- tain to what class of disorders it belongs. By common consent it is assigned to the realm of neurotic disorders. It affects most immediately and seriously the nervous sys- tem. Here, again, we may pause a moment to notice a fact concerning the complicated nervous system, which I think is not fully appreciated outside the medical profession. I refer to the sympathetic system of nerves as distinct, and largely independent of the motor system. In order to apprehend the ravages of alcohol upon the sensitive nature of man, it is essential that we understand the functions of the vital, as distinct from the mechanical or automatic forces and movements of the body. I take it to be an admitted principle of law that to con- stitute a criminal act, the will must consent to the performance of the act, and in the study in which we are now engaged it is highly important that we discriminate as I have suggested ; that we appreciate the difference between the nervous system which has to do with vital forces and functions, and the other nervous system which does not control or influence vital forces or functions. The inhibitory, restraining power resides in the series of nerves which is specifically assailed by alcohol when taken into the body, and this is the prime fact in the whole matter of responsibility, to which the law of the land does not seem to attach importance. I read in my Blackstone that " all the several pleas and excuses which protect the committer of a forbidden act from the punishment which is otherwise annexed thereto may be reduced to this single consideration-the want or defect of will. Indeed, to make a complete crime cog- nizable by human law, there must be both a will and an act. In the time when this wholesome doctrine was proclaimed, the dogma of disease as applied to inebriety was not considered. Intoxication was taken to be a voluntary act, and hence it was said of an inebriate that " what hurt or ill soever he doeth, his drunkenness doth aggravate it." This doctrine may be to-day orthodox in law, but in medicine it is not, and herein lies the difference between law and medicine. Occasions or opportunities like the present are meant to reconcile the two professions to the acceptance of this wiser doctrine and more humane practice. But the question arises here, and is sub- 3 mitted from the legal side, if inebriety is not to be punished, how will society be pro- tected from the assaults of the drunkard ? Judge Noah Davis says : 11 No disease excuses any man for the commission of crime. A man in the last stages of consumption is to be hanged for a murder as surely as though he was in perfect health, and no disease, by reason of its own existence can, under any circumstances, excuse any man for the commission of crime. Hence, to establish that it is a disease is only to put it on the exact footing on which all other diseases stand in respect of violation of law and their punishment."* If, then, insanity being considered a disease, and inebriety be taken by law to be also a disease as well defined and understood, we should gain all that we ask for. Then I should hail this utterance from such a distinguished source as the keynote of a new doctrine, which should be taken up by the courts of law and sounded with accumulating force and rhythm till the jurisprudence of the whole range of disease and crime in their joint relation shall be infused by its healthy tone. While it proposes that society shall be protected from the voluntary and deliberate criminal by punishment, be it hanging or what else, it will protect society from the involuntary and unconscious criminal, by isolation in a hospital or asylum pro- vided by the State for its unfortunate citi- zens who have come into this world with an organization that is out of harmony with the ethical and civil relations which the law sanctions and provides for. When the philosophy of law, and the science of medi- cine shall join hands together to create a jurisprudence founded on such, a basis, it will be a step toward a state of society that is much to be desired, and will be doing more in the direction of relief from the blight of intoxication, than can, in the very nature of things, be done by the methods so ineffectually put forth at this time. There is, however, one very important' point in this discussion which must not be overlooked. It is the pathological differ- ence between common drunkenness and the disease of inebriety. The late distinguished British Alienist, Dr. Forbes Winslow, testi- fied before the House of Commons Com- mittee that " there is a normal drunkenness and an abnormal drunkenness." By this is meant that there is an occasional or acci- dental intoxication in a person who is not an habitual drinker, that is not to be counted as a disease, but that there is a state of intoxication which is the result either of a long continued habit of indulgence by which the tissues have become diseased, and an alcoholic diathesis thus formed, or a state of intoxication which is the result of an inherited tendency to which the victim yields, till self-control is lost, and he be- comes an abandonded slave to debauchery. When alcohol enters into the human body in excess, its affinity for nerve structure is manifest in its grasp upon the inhibitory forces as among its very early influences. The will is the citadel of the soul, by which life and conduct are guarded and guided, but when it is seized and made captive, to obey only the behests of this destructive force, the victim is lost to himself, and acknowledges that he is enslaved. The relation of the human will to the nervous system is sadly misjudged. The wonderful network of nerves known as the sympa- thetic system acts independently of the will. It presides over vital functions. It has to do with th& forces of life with which the will has nothing to do. The heart beats, the stomach digests, all the vital organs fulfill their respective offices without any reference to the will. It works while we sleep, and the vital functions are in action during our unconscious rest. By its side the will is powerless. If it presides over appetite, its behests are absolute. The inebriate, with inherited or acquired passion for stimu- lants, or for their hypnotic effect, cannot control his longing when it asserts itself. * Remarks in closing the discussion of this subject before the New York Medico-Legal Society, in December, 1888. 4 The hungry man who is starving for bread cannot, at his will, bid his hunger depart. The true inebriate, when his restless nerves, and sinking spirits, and burning desire, demand repose and satis- faction, must obey the call. He obeys, though his will, his conscience, his judg- ment, his past experiences, his moral sense, etc., join in earnest protest. Is it depravity of his nature or infirmity of his will? A very wide distinction exists between depravity and pravity of will. Depravity signifies, a state of natural de- basement, without any cause. The idea of a cause is precluded. It is natural. Pravity signifies a departure from a right purpose, for which a cause is implied, which is generally subjective. Indeed, an impaired, feeble will is frequently the first symptom of an approaching debauch. In concluding this paper, I offer the views it inculcates in the form of the following. i. Alcoholic inebriety is a disease which chiefly affects the nervous system, and may be transmitted from one generation to another, or it may be created by long contin- ued indulgence, and render its victims as much slaves to its power as if inherited. 2. In either case the symptoms are the same, and the person is debauched at inter- vals of varying duration, being controlled by an impulse which is beyond the reach of human will. 3. When committing a criminal act, it is usually done in a state of unconsciousness and irresponsibility. 4. If convicted of crime, he should be isolated from the community, in a hospital or asylum provided by the State. 5. The dangerous element of the disease is in the fact that when alcohol enters into the human body in excess, it assails the in- hibitory power, controls the will, and en- slaves its victim beyond his power of choice. Summary. THE UNALTERABILITY OF STRYCHNINE IN THE BODY AFTER DEATH. By ALFRED H. ALLEN, F.I.C., F.C.S. President of the Society of Public ^Analysts of Great Britain. Read before the Medical Jurisprudence Society of Philadelphia. Early in the year 1881, a Coroner's inquest was held near Ashbourne, Derbyshire, Eng- land, on the body of a young man who had evidently died from poisoning. It appeared that an hour or two previously he had sucked an egg (the shell of which was partly broken) which, it was presumed, had been intended as a bait for jackdaws, and which the deceased had picked up during a country walk. On analysis of the stomach and its contents, I found abundant evidence of the presence of strychnine, and the symptoms exhibited by the deceased pointed strongly to poisoning by strychnine as the cause of death. A portion of the stomach and its contents were preserved by the addition of alcohol, and a few weeks since the bottle was opened and strychnine sought for in the ordinary way. The poison was detected without difficulty. The bitter taste and oxidation color test were very marked, and the characteristic chromate and ferrocyanide of strychnine were pre- pared. Another portion of the stomach had been placed in a beaker, which was tied over with bladder and immersed in a jar, the mouth of which was choked with a bag con- taining animal charcoal. When this was 5 opened a few weeks since, the contents of the beaker had entirely disappeared, with the exception of some fine dust at the bottom. This gave abundant evidence of the presence of strychnine. It appears, therefore, that while the ordinary tissues underwent com- plete eremacausis, with reduction literally to dust, the strychnine remained unchanged during more than seven years. I place this result on record, as I am not aware that any attempt has been made to detect strychnine under similar conditions, and the experience suggests that interesting experiments might be made in a similar manner with other definite organic prin- ciples, poisonous and otherwise, which admit of ready and positive chemical recogni- tion. [Subsequent to the reading of this note, it was stated by Dr. Henry Leffmann that in the case of a man under sentence of death, who had committed suicide, in 1879, by taking strychnine, the washings of the stomach were examined and the strychnine detected, and that a portion of the liquid has been kept until the present time, and still shows readily the oxidation color test.]